Analysis and Assessment of Pulp Vitality of 102 Intrinsically Stained Teeth in Dogs.

Our prospective study analyzed clinical, radiographic, and histological characteristics of 102 intrinsically stained teeth. Sixty-nine dogs ranging from one to fifteen years of age were included in this study. Little more than half of the intrinsically stained teeth had no evidence of coronal injury (53.9%, 55/102). We found that most intrinsically stained teeth were histologically nonvital (87.6%, 85/97) and approximately 2/3 of these (57.7%, 56/97) had no histological endodontic or periodontal inflammation at the time of evaluation. Radiographic evidence of endodontic disease was present in 57% (58/102) of the intrinsically stained teeth. Radiographic evidence of periodontal disease was present in 48% (49/102) of intrinsically stained teeth and 28% (29/102) had radiographic evidence of tooth resorption. 18.6% (19/102) of intrinsically stained teeth were radiographically normal. Evidence of pulp necrosis was common in these intrinsically stained teeth, while only occasional teeth (12.4%, 12/97) had histologically confirmed pulpitis. All teeth with radiographic evidence of periapical lucency had pulp necrosis. Based on our histological findings, the majority of intrinsically stained teeth 87.6% are truly nonvital.

Crown Reduction and Vital Pulp Therapy in a Dog With Malocclusion.

Crown reduction and vital pulp therapy is an accepted treatment for abnormal occlusion resulting in palatal trauma caused by malpositioned mandibular canine teeth in dogs and cats. This article describes use of mineral trioxide aggregate for vital pulp therapy after crown reduction. A list of materials and commonly used equipment is provided.

Radiographic outcome of root canal treatment of canine teeth in cats: 32 cases (1998-2016).

OBJECTIVE To describe the radiographic outcome of root canal treatment (RCT) of canine teeth of cats. DESIGN Retrospective case series. ANIMALS 32 cats with 37 canine teeth with complicated crown fractures that underwent RCT. PROCEDURES Medical record databases of 5 referral veterinary hospitals were searched to identify cats that underwent RCT between 1998 and 2016. Only cats that had at least 1 follow-up examination during which radiographs were obtained of the treated canine tooth or teeth were included in the study. Dental radiographs obtained before and immediately after RCT and during all follow-up examinations were reviewed. Treatment was considered successful if the periodontal ligament space was within reference limits and preoperative external inflammatory root resorption (EIRR), if present, had stabilized. Treatment was considered to have no evidence of failure if preoperative EIRR had stabilized and preexisting periapical lucency was stable or decreased in size but had not resolved. Treatment was considered to have failed if periapical lucency or EIRR developed subsequent to RCT or preexisting periapical lucency increased in size or preoperative EIRR progressed following RCT. RESULTS Follow-up time after RCT ranged from 3 to 72 months. The RCT was successful for 18 (49%) of the 37 treated teeth, had no evidence of failure for 12 (32%), and failed for 7 (19%). Preexisting EIRR and patient age ≥ 5 years significantly increased the rate of RCT failure. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that RCT was a viable treatment option to salvage endodontically diseased canine teeth in cats.

Vital pulp therapy in dogs: 190 cases (2001-2011).

OBJECTIVE: To evaluate factors associated with the outcome of vital pulp therapy (VPT) in dogs. DESIGN: Retrospective study. SAMPLE: 190 teeth in 138 dogs. PROCEDURES: Medical records were reviewed; radiographs obtained before, immediately after, and during the last available follow-up examination for VPT were evaluated. Treatment was categorized as successful (with radiographic evidence of continued secondary dentin production, continued root formation in immature teeth, and absence of clinical and radiographic signs of apical periodontitis and internal or external inflammatory root resorption), having no evidence of failure (with signs for success fulfilled except the width of the apical periodontal ligament space, which could be wider than but no more than double the width of the periodontal ligament space in other areas), or failed (with radiographic evidence of pulp necrosis, apical periodontitis, or inflammatory root resorption). Associations between diagnostic or treatment-related variables and outcome were assessed with multinomial logistic regression. RESULTS: Overall, treatment was classified as successful for 162 of 190 (85%) teeth, including 23 (12%) teeth with no evidence of failure, and as having failed for 28 (15%) teeth. The overall success rate was 137 of 149 (92%) for teeth treated with mineral trioxide aggregate alone and 21 of 36 (58%) for teeth treated with Ca(OH)2 alone. Use of Ca(OH)2 and deep penetration of dressing material into the vital pulp were each significantly associated with increased odds of treatment failure. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that VPT with mineral trioxide aggregate was an effective option for use in crown reduction to treat malocclusion and for treatment of recent crown fractures in immature or mature permanent teeth.

Outcome of surgical endodontic treatment in dogs: 15 cases (1995-2011).

OBJECTIVE: To document the short- and long-term outcomes of surgical endodontic treatment in dogs in a clinical setting. DESIGN: Retrospective case series. ANIMALS: 15 dogs that underwent surgical endodontic treatment. PROCEDURES: Medical records of dogs that underwent surgical endodontic treatment at 3 institutions from January 1995 to December 2011 were reviewed. Information extracted included signalment, history, initial clinical signs, physical and radiographic examination findings, treatment, and outcome. Outcome was determined through evaluation of the pre- and postoperative radiographs as well as clinical and radiographic findings at follow-up evaluations. On the basis of radiographic findings, treatment was considered successful if the periapical lesion and bone defect created by surgery had completely healed and no new root resorption was detected; a treatment was considered to have no evidence of failure if the periapical lesion remained the same or had not completely resolved and root resorption was static. RESULTS: 15 dogs were treated by means of apicoectomy and retrograde filling following a failed or complicated orthograde root canal treatment. The mean long-term follow-up time was 15.2 months (range, 3 to 50 months). On radiographic evaluation, 10 of 15 dogs had successful resolution of the periapical disease; 5 dogs had no radiographic evidence of failure of endodontic treatment. All dogs were considered to have a successful clinical outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical endodontic treatment was an effective option for salvaging endodontically diseased but periodontally healthy teeth of dogs in which orthograde treatment was unsuccessful and nonsurgical retreatment was unlikely to succeed.

Pathological studies of cheek teeth apical infections in the horse: 5. Aetiopathological findings in 57 apically infected maxillary cheek teeth and histological and ultrastructural findings.

Examination of 57 apically infected maxillary cheek teeth (CT) showed one or more viable pulps and minimal apical calcified tissue changes present in recently infected CT. With chronic infections, pulps were necrotic or absent, pulp horns were filled with food if occlusal pulpar exposure was present, and gross caries of dentine was occasionally present. With chronic infections, the apical changes varied from gross destructive changes in some teeth, to extensive proliferative calcified apical changes in others. Infundibular caries was believed to cause apical infection in just 16% of infected (maxillary) CT, anachoretic infection in 51%, periodontal spread in 12%, fractures and fissures in 9%, dysplasia in 5% and miscellaneous or undiagnosed causes in 7%. Histology showed viable pulp and absence of circumpulpar dentinal changes in some recently infected CT, but chronically infected teeth had loss of predentine and progressive destruction of the circumpulpar secondary, and even primary dentine, with bacteria identified within the dentinal tubules surrounding infected pulps. Tertiary dentine deposition was rarely detected. Scanning and transmission electron microscopy confirmed these histological findings and showed extensive destructive changes, especially to the dentinal architecture surrounding the pulp chambers of some infected teeth.

Veterinary endodontics: an online study guide.

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will cover veterinary endodontics.

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Surgical endodontics in dogs: a review.

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.

Fundamentals of endodontics.

Endodontic disease is a highly prevalent (>10% of all dogs) and insidiously painful process that can have significant local and systemic effects. The root canal system is a delicate organ and is prone to inflammation, infection, and partial and complete necrosis. Vital pulp therapy must be performed quickly, gently, and meticulously if it is to be effective. The relatively high rate of failure in direct pulp capping makes regular follow-up radiographs of critical importance to ensure patient health. Once a tooth is dead, there are often no obvious clinical signs; therefore, clinicians must be educated in the diagnosis of the disease processes. Once properly educated, the practitioner must remain vigilant for subtle signs of the disease process. Standard root canal therapy is an effective method of removing the inflammation, infection, and associated discomfort of the endodontically diseased tooth while maintaining its function. Endodontic failure most likely remains hidden unless dental radiology is used. Follow-up radiographs at regular intervals throughout the patient's life are critical for ensuring the long-term success of any endodontic therapy.

Results of root canal treatment in dogs: 127 cases (1995-2000).

OBJECTIVE: To evaluate results of root canal treatment in dogs. DESIGN: Retrospective study. SAMPLE POPULATION: 127 tooth roots in 64 dogs. PROCEDURE: Radiographs obtained before surgery, immediately after surgery, and during follow-up examinations after surgery were evaluated by 2 individuals. Treatment was considered successful if the periodontal ligament space was normal and possible preoperative root resorption, if present, had ceased. Treatment was considered to show no evidence of failure if possible preoperative root resorption had ceased but a preexisting periapical lesion had remained the same or only decreased in size and not complete resolved. Treatment was considered to have failed if a periapical lesion or root resorption developed subsequent to endodontic treatment, if a preexisting periapical lesion had increased in size, or if possible preoperative root resorption appeared to continue after endodontic treatment. RESULTS: Follow-up time ranged from 1 to 60 months (mean, 13 months). Treatment was classified as successful for 87 (69%) roots, as showing no evidence of failure for 33 (26%) roots, and as having failed for 7 (6%) roots. The success rate was lower for canine teeth than for maxillary fourth premolar teeth. Roots with a preexisting periapical lucency or preexisting root resorption had lower success rates. The use of intracanal medication and the method and quality of obturation were not associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that root canal treatment offers a viable option for salvage of periodontally sound but endodontically diseased teeth in dogs.

Endodontic decisions based on clinical appearance.

Too often, endodontically compromised teeth are ignored because they are not accurately identified, nor their significance realized. By systematically evaluating each potentially affected tooth, a practitioner can correctly diagnose endodontic cases and plan therapy accordingly. Endodontic pathology, with non-vital pulps and subsequent abscessation, can affect not only the tooth but also the rest of the patient. Physical examination, both external and oral, can be combined with tactile and transillumination assessment. Radiographic appraisal is essential in determining periapical health, both to determine the vitality of the tooth and to ascertain if endodontic therapy is appropriate, of if extraction is the best choice. This report aims to provide the reader with a clearer understanding of diagnosing endodontic cases to facilitate selection of the appropriate treatment.

Endodontic instruments for root canal therapy.

This article on endodontic instrumentation includes endodontic instruments and techniques of root-canal preparation of teeth in veterinary patients. Familiarity with instruments covered in this article and with advances in veterinary endodontics has become necessary for the veterinary dental practitioner who wishes to practice dentistry using current techniques. Veterinary endodontic techniques that help to retain the teeth longer are increasing in demand as an option to extracting damaged teeth. Endodontic treatment involves removal of the irreversibly damaged pulp, followed by cleaning and shaping of the root canal space using endodontic instruments and subsequent filling, or obturation, with a semisolid material and a sealer.

Restorative procedures after root canal therapy.

One of the most common indications for veterinary dental restoration involves replacing tooth structure after a root canal procedure. Special considerations are necessary due to the interaction of the restorative material with materials used to obturate the root canal. The restoration must provide a hermetic seal of the pulp chamber, as well as restore function. Combining several different restorative materials provides the best overall performance. In certain instances, full crown coverage is required to restore functional length or cervical anatomy.