Severe Periodontal Disease and Post-extractional Oro-nasal Fistula

Once again we can see the importance of prophylaxis in the prevention of oral and dental diseases.

One of the most common disease in small animals, in particular in dogs is periodontal disease.

A multifactorial disease where plaque, microflora, calculus, species, breed, genetics, general health, age, home dental care, chewing behavior, saliva , and local irritants are some of the  most common factors that contribute to the apparition, onset and clinical form of periodontal disease.

After our usual anesthesia protocol consisting of  premedication, induction and maintenance with isofluran, we where able to asses the full clinical aspect of the dog’s mouth. I guess that the photos (Fig.1-left side and Fig 2-right side) speak for themselves.

Since all of the teeth with no exception had an increased mobility, a lot of calculus and plaque and as a consequence deep periodontal pockets filled with pus and debris.

Considering his advanced age we were expecting a certain amount of geriatric periodontitis (periodontal ligament involution is normal after a certain age) but this was a real exception to the worse.

We decided to extract all teeth, since not even one could be saved. The extraction did not pose any particular difficulty; however all the multirooted teeth were extracted by separating each root by means of high-speed turbine (300.000 rpm) and a round steel burr with a long shaft.

The reason why we separated the roots was to avoid iatrogenic fracturing of the alveolar wall, and the mandible due to very deep infrabony pockets and alveolar bone resorption. The gruesome image of all teeth and their aspects is shown in Fig.3.

The risk of fracture is not the only complication that might occur due to advanced periodontal disease and deep infrabony pockets.

Oro-nasal communication or fistula is another consequence of post-extractional complications . We had that happening  to us after extracting both upper canini. We could see air bubbles coming in the mouth through the post extractional alveolus and blood coming through the respective nostril.

We closed both oro-nasal communication by occluding the alveolus with a little piece of Tabotamp ® haemostatic material that has not only excellent haemostatic properties and is self resorbable but also offers an good occlusion material that facilitate the execution of the flap and the closure of the communication.

The flap was designed by means of the Ellman radiosurgical unit (Fig.4).  This excellent radiosurgery equipment can be used for many other procedure:

• Removal of hypertrophied tissue or scar tissue (epulis fissuratum, papillomatosis)

• Desensitization of hypersensitive dentin

• Gingivectomies, gingivoplasties

• Frenectomies

• Removal of soft tissues over impacted teeth to achieve tooth eruption

• Biopsies

• Incision and drainage of abscesses

• Periodontal flap surgery

• The unit is operating at 3.8MHz for smooth, bloodless cutting

After preparing the flap by 2 releasing incisions (Fig.5) and having detached the palatal and vestibular mucosa with a periosteal elevator we proceeded in suturing the flap in a simple interrupted pattern with a Vycril 3.0 multifilament resorbable material (Fig.6).

The dog recovered well and although he has no teeth left in the mouth he manages to feed better than before with the deeply diseased teeth that only caused him pain.

DDr. Stoian Camil, PhD