Tooth resorption in cats: pathophysiology and treatment options.

PRACTICAL RELEVANCE: Tooth resorption is common in the domestic cat and the incidence has been reported to increase with increasing age. Cats with clinically missing teeth have also been found to be more likely to have tooth resorption. All types of teeth in the feline dentition may be affected, but lesions seem to be more common in certain teeth. CLINICAL CHALLENGES: Tooth resorption can be difficult to detect, with cats often masking signs of oral discomfort or pain. Routine radiography is required for timely diagnosis, as clinical (visual and tactile) methods only detect late-stage lesions - that is, when they become evident in the crown. The aetiology of many tooth resorptions is not clear. A large number of lesions appear to be idiopathic and, to date, there is no known treatment that prevents the development and/or progression of this category of tooth resorption. Tooth extraction is the gold standard treatment but teeth with resorptive lesions are notoriously difficult to extract and coronal amputation is often indicated. Determining the best treatment option in an individual case again relies on radiography. AUDIENCE: This review is aimed at feline and general practitioners, as well as veterinarians with expertise in dentistry. EVIDENCE BASE: The author draws on the published literature and her clinical experience and own research to review current thinking about the epidemiology, aetiology and pathogenesis of tooth resorptions, and to offer advice on diagnosis and treatment options.

Evaluation of extraction sites for evidence of retained tooth roots and periapical pathology.

The objective of this retrospective clinical study was to determine the frequency and pathogenicity of unintentional retained tooth root fragments after extraction of the maxillary fourth premolar (108 and 208) and mandibular first molar teeth (309 and 409) in 74 canine and 42 feline client-owned patients. Radiographs of client-owned animals with historical evidence of extraction of teeth 309 and 409 were reviewed. All patients had dental extraction(s) for clinical reasons, and all extractions were deemed successful by the practitioners. Extraction sites were radiographed to identify tooth root fragments and pathology. Twenty-five canine and 25 feline patients that had extractions utilizing preoperative and postoperative radiography were also included. Sixty-one of 74 canine patients (82.4%; P < 0.0001) and 39 of 42 feline patients (92.8%; P < 0.0001) had evidence of retained tooth root fragments. In total, 100 of 116 cases (86.4%; P < 0.0001) had retained tooth root fragments, and periapical pathology was found in 66 of 116 (56.8%; P = 0.000000743) radiographs, including 39 of 74 canine cases (52.7%; P = 0.00002765) and 27 of 42 feline cases (64.3%; P = 0.01589). The control group had no evidence of retained root fragments. Further veterinary dental training and routine use of pre- and postoperative dental radiology are recommended.

Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth.

REASONS FOR PERFORMING STUDY: Radiography is commonly used for the diagnosis of equine cheek teeth (CT) infection but, to our knowledge, no study to date has evaluated the relative values of individual specific radiographic signs when making a diagnosis. OBJECTIVES: To investigate the sensitivity and specificity of individual radiographic signs identified from the literature for the diagnosis of CT apical infection using a retrospective case-control study. METHODS: Cropped radiographs taken using computed radiography of 41 apically infected CT and 41 control CT were independently blindly evaluated by 3 clinicians for the presence of 12 predetermined radiographic signs associated with CT apical infection. A final diagnosis of either noninfected or infected was made. Sensitivity and specificity were calculated for the presence or absence of each radiographic sign for each clinician. Uni- and multivariable conditional logistic regression were used to determine strength of association of the 12 radiographic signs with apical infection. RESULTS: Median sensitivity and specificity for the diagnosis of CT apical infection were 76 and 90%, respectively. Periapical sclerosis, clubbing of one or 2 roots, degree of clubbing and periapical halo formation had the highest sensitivities (73-90%), with moderate specificity (61-63%). Multivariable conditional logistic regression revealed that severity of periapical sclerosis and extensive periapical halo were strongly associated with CT apical infection. CONCLUSIONS: The presence of periapical sclerosis and formation of a periapical halo were strongly associated with CT apical infection. Computed radiography appears to have a higher sensitivity but similar specificity to previously published results using film radiography to detect CT apical infection. POTENTIAL RELEVANCE: These findings may aid practitioners when interpreting radiographs of equine CT as to the relative significance of their findings.

Surgical endodontics in dogs: a review.

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.

Prevalence of odontoclastic resorption lesions and periapical radiographic lucencies in cats: 265 cases (1995-1998).

OBJECTIVE: To determine whether odontoclastic resorption lesions were associated with radiographic evidence of periapical lucencies in cats. DESIGN: Retrospective study. ANIMALS: 265 feline dental patients. PROCEDURE: Full-mouth radiographs were examined for evidence of odontoclastic resorption lesions, periapical lucencies, periodontitis, and fractured teeth. RESULTS: Odontoclastic resorption lesions affecting 567 teeth were identified in 161 (60.8%) cats. Periapical lucencies were identified in 53 teeth in 35 cats. Periapical lucencies were most commonly associated with fractured teeth (25 teeth with periapical lucencies) and severe periodontitis (21 teeth). None of the periapical lucencies appeared to be specifically associated with resorption lesions. Prevalence of periapical lucencies in cats with resorption lesions was not significantly different from prevalence in cats without. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that although odontoclastic resorption lesions are common in cats, pulpal involvement associated with these lesions does not appear to be associated with development of radiographically detectable periapical lucencies. Crown amputation with intentional root retention may, therefore, be a suitable alternative to extraction in selected cats with odontoclastic resorption lesions.

[Veterinary dentistry (14). Periapical diseases]. / Veterinaire Tandheelkunde (14). Periapicale aandoeningen.

In this article periapical disease is discussed. A differentiation is made in infections, abscesses, granuloma and cysts.

[Veterinary dentistry (15). Apex resection in the horse]. / Veterinaire Tandheelkunde (15). Apexresectie bij het paard.

Periapical disorders in horses can be treated by resection of the apex. The indications, contraindications, diagnosis, treatment and complications of the intervention are discussed. Four case reports of horses in which apicoectomy with retrograde endodontic treatment was performed are reviewed.