Complicated Canine Crown and Root Fracture in a chimpanzee

Holophernes, 25 years old, male chimp, 50 kg body weight that had a complicated horizontal and vertical mandibular left caninus fracture (303 Tridan system) as a consequence of a fight with another male.

The fracture comprised the entire crown of tooth to a subgingival level, with an open dental pulp that was spontaneously bleeding, and was very painful (Fig.1 and Fig.2). 

The operating team consisted of the anesthesia team: Drs. Attilio Rocchi and Korbinian Pieper (they actually look much better without the mask on), (Fig.3) that had the difficult task of anesthesia induction, intubation (Fig.4) and maintenance, pre and postoperative pain control  and recovery. 

Dr. Werner Höllriegl was present as well, supervising the operation and offering valuable advice and expertise (Fig.5-right side of photo).

Following an anesthesia premedication with Zoletil (3mg/kg, i.m.) and Fentanyl (1µg/kg, i.v.), induction with Propofol 1,5 mg/Kg, i.v. the maintenance was performed using Isofluran after endotracheal intubation, using a size 8 tube.

The local anesthesia was performed using a mental nerve block with Bupivacaine.

The operation consisted of an open combined vestibular and lingual flap surgical tooth extraction, completed with a circular alveolar bone removal.

After removal of hypertrophic gingival tissue by means of a vestibular and lingual flap (Fig.6) the extent of the fracture could finally be assessed.

We had a horizontal fracture combined with an incomplete vertical fracture involving the entire crown of tooth as well as a small portion of the root.

Since the pulp was opened and was spontaneously bleeding we can realize the amount of pain our chimp Holophernes was going through, explaining his increased irritability, aggressiveness and decrease in appetite.

We decided to apply a circular alveolar bone height reduction, due to the remarkable thickness of the alveolar bone (over 3 mm) housing a huge canine (10 cm long-crown plus root) having to cope with the large occlusal forces of the chimpanzee.

After removal of about 1 cm of alveolar bone using a Mannessman portable electrical drill (30.000 RPM) and a large round steel burr under copious sterile saline irrigation (Fig.7), we could than begin to wiggle our way around the canine using a combination of 3 different size elevators. 

Finally the canine came out, but not without complications(Fig.8). Although particular care, appropriate extraction force and sufficient time where applied, the tip of the root fractured and a portion of about 8 mm was still in the alveolus (Fig.9).

The luck was that we could remove completely the root apex (in several fragments) using a root pick and small root elevators. The large size of the alveolus permitted full visual assessment thus not requiring a post-extractional X-ray.

The caninus root had about 4 cm lenght and 1,5 cm in width(Fig.10). The flaps where sutured after haemostasis (with Tabotamp) using resorbable 3.0 Vicryl suture in a simple interrupted pattern (Fig. 11) closing a challenging full hour of operation.

A forth generation cephalosporin antibiotherapy was advised post-operatively as well as appropriate pain control management.

Our friend Holophernes is doing well 2 days post-operatively and can fight again with other males for supremacy over females, ensuring this way the future of veterinary dentistry and offering interesting post-traumatic cases.

I would like to thank to all my colleagues and to my operating assistant Daria for the active involvement in this operation.

DDr. Stoian Camil, PhD