Goal of presentation
Transcript of Goal of presentation
Slab Fractures Maxillary P4 29.09.2019
1G. Morgenegg
Slab Fractures of the Maxillary
Fourth Premolar
Gottfried Morgenegg
DVM, NST
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Goal of presentation:
• Sensitization
• Understanding
• Examination
• Treatment
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Fracture force:
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Fracture force:
Protected
Pic front
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Fracture force:
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Anatomy:
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Biting force:
•Size of dog
•Further back in the mouth
•Biting enthusiasm
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Tooth fracture:
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Tooth fracture:
Muzzarelli
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Tooth fracture:
Muzzarelli
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Tooth fracture:
Muzzarelli
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Tooth fracture:
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Tooth fracture:
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Tooth fracture:
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Tooth fracture:
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Tooth fracture:
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Tooth fracture:
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WSAVA Dental Guidelines:
1. Good Veterinary Practice (GVP)
• Inspection of oral cavity is an essential
part of clinical examination
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WSAVA Dental Guidelines:
2. Anesthesia
• Full examination and treatment only
under general anaesthesia and intubation
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WSAVA Dental Guidelines:
3. Pain control
• Adequate, preferably multimodal pain
control
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WSAVA Dental Guidelines:
4. No maltreatment
• Cause no damage
• Apply only well trained techniques
• Or refer
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WSAVA Dental Guidelines:
5. Removing calculus
• Is only the begin of a treatment
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WSAVA Dental Guidelines:
6. Extraction
• Extractions are surgical procedures and
should be performed by veterinarians
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WSAVA Dental Guidelines:
7. Professional Ethics
• Animals may not be left in pain
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WSAVA Dental Guidelines:
8. Animal Welfare
• Animal protection laws
• Social media
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Tooth fracture:
Muzzarelli
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Tooth fracture:
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Tooth fracture:
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Slab fracture:
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Slab fracture:
Clinical presentation
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Slab fracture:
Complicated crown fracture
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Slab fracture:
Uncomplicated crown fracture
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Slab fracture:
Crown root fracture
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Slab fracture:
Chip present
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Tooth fracture:
Copyright Mars Inc.
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Tooth fracture:
Soltero-Rivera et al., 2019Gottfried
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24 probes in vitro
CCF 12
CCRF 5
UCF 6
UCRF 1
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Tooth fracture:
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24 probes in vitro
CCF 12
CCRF 5
UCF 6
UCRF 1
GM: mostly UCF in vivo
Soltero-Rivera et al., 2019
Tooth fracture:
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24 probes (summary)
<14 kg 1152 N (9)
15-24 kg 1178 N (6)
25-34 kg 1313 N (4)
>34 kg 1674 N (1)
Soltero-Rivera et al., 2019
Slab fracture:
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Copyright Mars Inc.
Causes:
− Tubular bones
− Hooves
− Antlers
− Anything resisting more than
1200 N
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Examination:1. Cleaning
2. Dental probe
3. Periodontal probe
4. Dental x-ray
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Examination:1. Cleaning
2. Dental probe
3. Periodontal probe
4. Dental x-ray
Cannot be performed on an
awake patient
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Scaling: exposed dentine
Handinstruments or
subgingival scaler
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Dental probe:
Fracture: rough surface
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Periodontal probe:
Pocket depth
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Pocket depth
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Periodontal probe:
Dental x-ray:
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Why an x-ray?
Because I want to know wht’s
going on
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Dental x-ray:
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Dental x-ray:
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Dental x-ray:
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Dental x-ray:
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X-ray:
Conventional x-ray
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X-ray:
Conventional x-ray
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Dental x-ray:
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Dental x-ray:
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Dental x-ray:
Sensor
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Dental x-ray:
Phosphor plates
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Dental x-ray:
Phosphor plates
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Dental x-ray:
Phosphor plates
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Pulp not exposed
Looks so harmless
Uncomplicated crown fracture:
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Uncomplicated crown fracture:
− Enamel dog: 0.3-0.7 mm
− Dentine exposed
− Pain
− Infection
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Why do we talk about all this
so extensively?
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Why do we talk about all this
so extensively?
Because it often does not look like
it actually is
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Main point:
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Main point:
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Main point:
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Dentinel tubules:
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Dentinel tubules:
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Physiology:
Brännström,1966
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Enamel Dentin Pulp
Pain:
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Brännström,1966
Pain:
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Brännström,1966
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Pain:
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Hyperosmotic
solutions
Heat
Cold
Dehydration
Pain:
Hit and fire
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Infection:
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Infection:
Love, 2002Gottfried
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Infection:
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Infection:
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Periapical lucency:
rarefaction
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Good job:
Early diagnose + proper
treatment: reduces period of
suffering
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Goodman et al., 2019
“The Incidence of Radiographic
Lesions of Endodontic Origin
Associated with Uncomplicated
Crown Fractures of the Maxillary
Fourth Premolars in Canine
Patients”
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Mandible:
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Mandible:
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Mandible:
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Mandible:
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Mandible:
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Complicated crown fracture:
− extraction or root canal treatment
Crown-root fracture:
− Extraction
Uncomplicated crown fracture
− Sealing
− Restoration
− If no endodont. disease
Treatment:
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Good Veterinary Practice
Treatment:
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Perform in a professional way
Treatment:
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Do only what you learned
Treatment:
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Avoid:
Treatment:
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Avoid:
Treatment:
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Treatment:
− Signs of endodontic disease
− Signs of periapical disease:
− Root canal or extraction
Uncomplicated crown fracture
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Treatment:
− No signs of endodontic disease
− No signs of periapical disease
Uncomplicated crown fracture
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Treatment:
− Sealing
− Restoration
Uncomplicated crown fracture
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Smooth out
1. Sealing:
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1. Sealing:
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Smooth out
Prevent calculus
accumulation
1. Sealing:
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1. Sealing:
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Apply sealant• Scale, smooth out and polish (no fluoride!)
• White stone
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1. Sealing:
• Shape
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1. Sealing:
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• Smooth out
1. Sealing:
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• Polish (no fluoride!)
1. Sealing:
• Acid etch 20 sec. 37.5% phosphoric acid
• Rinse min. 30 sec.!!!
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1. Sealing:
• Apply sealant (Prime&Bonding active,
Dentsply)
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1. Sealing:
• Light cure
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1. Sealing:
Keep edge
Anker for restoration
2. Restoration:
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Keep edge
Anker for restoration
2. Restoration:
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2. Restoration:
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Painful
Often bleeding
Sticking chip:
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Sticking chip:
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Sticking chip:
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Sticking chip:
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Extend gingiva
Main point: bleeding, hemostatics
Sticking chip:
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Extend gingiva
Main point: bleeding, hemostatics
Sticking chip:
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Watch out for fissure line
Special situation:
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Special situation:
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Biomimetic Approach:
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• Polyphosphate microparticles
• Morphogenetically active amorphous
calcium polyPhosphate (polyP)
Müller et al., 2017
Toothpaste:
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Müller et al., 2017
Biomimetic Approach:
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− Anti-Hypersensity
− Anti-Periodontitis
− Caries repair
Müller et al., 2017
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Roman sculls:
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• Draw wells
• 100-300 p.c.
Roman sculls:
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Roman sculls:
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Roman sculls:
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Wolves in Croatia:
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Wolves in Croatia:
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Pavlović et al., 2007
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Wolves in Croatia:
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Pavlović et al., 2007
Wolves in Croatia:
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Take home:
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1. GVP: Oral examination
2. Slab fractures are frequent
3. Tooth problems are painful
4. Uncomplicated fractures can cause
severe problems
5. Dental x-rays are imperative
Author:
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− Dr. Gottfried Morgenegg-Wegmüller
− Dorfstrasse 70, CH-8912 Obfelden
− Mail: [email protected]
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