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ePaper created 2016-06-01, 09:58:05 | version 1.38.0
10 I I clinical article_ treatment planning implants 1_2016 larycuspidwasluxatedwithaslightmesialdeviation, 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 twoorthreemonths;extractionofthecanineandno replacement; or extraction with immediate implant placement, providing the alveolar process and vault wereintactandprimarystabilityoftheimplantcould 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 ex- tracted and implant placed. The authors believe all three options have their own inherent complications. The owner did not de- sire 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 sta- bilization 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 compositehasnotbeenapositiveexperienceforcats withluxatedcanines.Theytypicallydon’ttoleratethe 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 maintain- ing proper occlusion. Even with the best intentions, possibleperiodontalligamentdevitalizationanden- dodontic treatment being attempted in two to three months, a very good possibility of root resorption complicationexists.1 Additionally,extractionandim- mediateimplantplacementcanalsobeproblematic. But it’s less problematic than attempting to stabilize the luxated canine with subsequent endodontic treatment. At the time surgery was performed, all past im- mediate implants in cats have integrated, and no integrationfailureshavebeenobservedduringlong- term follow-up on these patients. If the implants are not restored (put to sleep), the buccal osseous morphology is well-maintained, preventing a trau- matic 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 secre- tions orally and has the added benefit of regulat- ing 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. General anesthesia was induced by mask with Sevoflurane (vaporizer #7, O2 @ 4L per minute; Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 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. 7_Radiograph at 26-months post-insertion demonstrating maintenance of bone at the same level as at insertion with no evidence of periimplantitis.