Abnormally developed tooth

Montecor is a 10 month old Bernese Mountain Dog, male, not neutered, that came to our dental service with a swelling on the right side of the oral cavity, that was very painful, bled easily and spontaneously. The owner was really worried that this might be a tumor.

At the clinical inspection we noticed an unerrupted canine tooth (104) on the right side of the oral cavity, and instead of the canine a swelling that was easily bleeding (Fig.1).

We decided to go ahead with the surgery. After a complete pre-operative profile blood analysis (complete kidney and liver parameters, blood chemistry) and a full assessment of the anesthesia risks, we began the surgery. The anesthesia was performed by our special department according to the patient tailored protocol. The first move was to take a series of intra-oral X-rays with the special dental unit. At the film interpretation (size 4 type 2, occlusal film) we noticed an abnormally developed tooth, with a very thin dentinal wall and a huge dental pulp with the tooth crown missing, the communication of the pulp towards the crown was not closed, just covered with a thin mucosal wall (Fig.2), the very reason why the pulp bled so easily.

The surgical approach consisted of a figure L muco-periosteal flap which offers a very good view but also has better vascularisation than a figure U flap. We could see that the dentinal wall was very thin and friable, in fact we removed it with a periosteal elevator and than we could see the giant pulp, congested and bleeding (Fig.3).

The possible differential diagnosis were with a dentigerous cyst, dismissed soon since it was lacking the specific round shape, a cementoma and/or odontoma would have been possible, but confirmed only after a proper pathological evaluation. The removal of the tooth did not pose any special difficulties, and the alveolus was left clean after a quite long haemostasys (Fig.4).

The post-extractional X-rays revealed a clean, well delimited alveolus without any leftovers, detrituses or other formations (Fig.5). We finished by suturing the flap in a simple interrupted pattern with a 3.0 Vycril resorbable suture material (Fig.6).

The proper pain control medication and antibiotherapy was established as well as complete post-operative instructions to the owner. Montecor returned for control in one week, much happier than before surgery, he has no more pain, feeds freely and has no more mouth bleeding, the photos show a good healing with the suture material almost resorbed (Fig.7).

The pathological findings were not characteristic to any tumoral formation, thus dismissing any suspicion of malignancy. This was actually a very rare case of a malformed canine tooth, probably caused by a local trauma that prevented the normal development of the permanent canine tooth.

DDr. Camil Stoian PhD, Mag. Helene Widmann