Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-04-13, 10:04:12 | version 1.38.0
Editor - Online Haseeb Uddin CLINICAL PRACTICE Feline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning elines (cats) are by nature carnivores and, as such, their diet reflects that. It is accepted that diet affects health, and ability to eat (or lack thereof) can have negative effects on the diet, and thus, general health. Implants have become an option for replacement of lost canines in these animals. This allows the animal to maintain the level of mastication found in those felines who have normal oral health and permit better nutrient uptake as well as psychological maintenance of the animal. We will discuss two cases of lost maxillary canines and implant treatment to replace the lost teeth. Case report 1 A 4.5-year-old male neutered Russian Blue cat weighing 11.5 pounds was referred for multiple bite wound evaluation and a luxated R maxillary canine tooth (#104) of three-day duration. On initial examination, there were multiple bite wounds with deep penrose drains in place, bruising and abrasions in the inguinal areas. The sites were stable. Also, the R maxillary cuspid was luxated with a slight mesial deviation, mobility and painful. All treatment options were considered with the owner of the pet. These included: stabilization of the luxated tooth followed by endodontic treatment in two or three months; extraction of the canine and no replacement; or extraction with immediate implant placement, providing the alveolar process and vault were intact and primary stability of the implant could be attained. After discussion with the feline's owner reviewing the pros/cons of the different treatment options, the owner chose to have the canine extracted and implant placed. The authors believe all three options have their own inherent complications. The owner did not desire having a cat without prominent anterior teeth. The owner, a well-educated engineer, analyzed all of the options and made an informed decision. The lead author has performed numerous stabilization and endodontic treatment cases with luxated canines in dogs with relatively good results. In his experience a Figure 8 wire around the canines and use of acrylic or spot cure with some flowable composite has not been a positive experience for cats with luxated canines. They typically don't tolerate the procedure very well. With a fracture as it presented in this case, the maxillary right cuspid (tooth #104) is not very stable and can be a challenge maintaining proper occlusion. Even with the best intentions, possible periodontal ligament devitalization and endodontic treatment being attempted in two to three months, a very good possibility of root resorption complication exists.[1] Additionally, extraction and immediate implant placement can also be problematic. But it's less problematic than attempting to stabilize the luxated canine with subsequent endodontic treatment. At the time surgery was performed, all past immediate implants in cats have integrated, and no integration failures have been observed during long-term follow-up on these patients. If the implants are not restored (put to sleep), the buccal osseous morphology is well-maintained, preventing a traumatic episode with the ipsilateral canine. Implant placement in these situations are becoming more predictable with happy owners and patients.[2] Surgical phase The patient was pre-medicated with Atropine Sulphate (1/120 grain; 1 ml/20#; subcutaneously: VetOne; Boise, Idaho) and Acepromazine (10 mg/ml; .02-.05/#; subcutaneously; VetOne). Atropine is given before anesthesia to decrease mucus secretions orally and has the added benefit of regulating heartbeat during sedation. Acepromazine is a common tranquilizer and central nervous system depressant given to pets. It is also used to prevent anxiety associated with thunder, fireworks and vet or groomer visits. Continued on page 12 By Rocco E. Mele, DVM, Anthony Caiafa, BVSc BDSc, & Gregori M. Kurtzman, DDS, MAGD, DICOI F Fig. 2: Implant placed into osteotomy at immediate extraction site at the right maxillary canine with buccal flap (left and middle) and primary closure of the site (right). Fig. 3: Closed tray impression coping placed into the implant (left), radiograph to verify part mating (center) and healing abutment placed (right). Fig. 4: Soft-tissue model with analog and completed cast abutment-crown ready for cementation into the implant intraorally. Fig. 5: Completed and luted abutment- crown intraorally. Fig. 6: Case 26-months post-insertion of the abutment-crown demonstrating good gingival health with a lack of inflammation. Fig. 1: Radiograph demonstrating alveolar fracture adjacent to mobile maxillary right canine. Fig. 7: Radiograph at 26-months post- insertion demonstrating maintenance of bone at the same level as at insertion with no evidence of periimplantitis. Fig. 8: RClinical examination with endodontic file in the right maxillary canine (left) and radiograph demonstrating apical pathology at the mobile tooth (right). Fig. 9: Diamond being used on the residual root (a) to atraumatically extract the root, implant being inserted into the osteotomy (b), implant placed subcrestally (c) and site closed by primary intention (d). Fig. 10: Patient at initiation of restorative phase showing lack of inflammation at previously placed implant (a), tissue punch being used to expose the implant (b) and uncovery of the cover screw (c). Fig. 11: Radiograph of the implant at initiation of the restorative phase (top and bottom right) and after placement of healing abutment (bottom left). 10 DENTAL TRIBUNE Pakistan Edition March 2016 DT International USA