Alaskan Malamut with crown fracture

We performed a X-ray using 2 projections: parallel and bisecting angle. After developing of the size 4 occlusal films we could see 3 distinct areas of translucency of the mesial, palatal and distal root apex of the tooth, please see Fig. 1.

The forth premolars together with the lower first molars represent the most important teeth for mastication and slicing of food in dogs (carnasial teeth). 
 

We decided to perform a classical root canal treatment. Since the distal root had quite a large apical lucency we could not guarantee the success and the outcome of the procedure and if at the control X-rays that will be performed in 4 weeks we notice no improvement, than we will have to perform an apicectomy (apical root resection).

The access openings were executed using a diamond reverse cone burr and high speed turbine in the vestibular mesial and distal part of the crown, centered towards the middle of the cusps, a ultrasonic endodontic handpiece and specially adapted sonic Haedstrom files were used, see Fig. 2.
 

After the necrotic pulp was extirpated with the nerve broaches (tire-nerves) we performed the mechanical cleaning and enlargement of the root canal by a combination of manual filing (using Kerr and Haedstrom files) and ultrasound filing (using an adapted file for the regular descaler unit).  A thorough flushing with sodium hypochlorite and peroxide alternately followed this procedure.

Drying of the canal was performed using veterinary size paper cones and air spray, see Fig. 3.

We used a 2 component endodontic cement applicable with a special syringe (RSA RoekoSeal Automix) and gutta-percha cones.

The intermediate filling consisted of a light curing glass-ionomer cement (GC Fuji II LC), after which a non-gamma amalgam for the final restoration of the crown, Fig. 4.

A control X-ray showed a very good quality closure of the tooth pulp and root canal,  Fig. 5, in comparison with the X-ray performed before root canal, see Fig. 4.

Barli’s owner was recommended not to feed him only with soft food for 2 days, an antibiotherapy was administered (Clindamycin for 7 days) to prevent possible bacterial infections. The patient should return for control in 4 weeks.

At that time, an X-ray should be performed to control the status of the premolar.

DDr. Camil Stoian PhD, Mag. Helene Widmann