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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Morgenegg

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

Gottfried

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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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2. Anesthesia

• Full examination and treatment only

under general anaesthesia and intubation

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3. Pain control

• Adequate, preferably multimodal pain

control

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4. No maltreatment

• Cause no damage

• Apply only well trained techniques

• Or refer

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5. Removing calculus

• Is only the begin of a treatment

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6. Extraction

• Extractions are surgical procedures and

should be performed by veterinarians

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7. Professional Ethics

• Animals may not be left in pain

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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.

Gottfried

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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:

Gottfried

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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”

24.9%Gottfried

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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


− 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


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Treatment:

− No signs of endodontic disease

− No signs of periapical disease


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Treatment:

− Sealing

− Restoration


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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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Biomimetic Approach:

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− Anti-Hypersensity

− Anti-Periodontitis

− Caries repair


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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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