ENDO Dental bulge restoration and gingival collar expansion after endodontic treatment of a complicated maxillary fourth premolar crown-root fracture in a dog Reiter, Lewis COPY

Question 1

What does the chase report describe?

Answer 1

endodontic, restorative, and periodontal treatment of a complicated crown-root fracture of the right maxillary fourth premolar tooth in a dog.

Question 2

What two factors are considered integral to success in restoring crown/root fractures?

Answer 2

Biologic width maintenance in periodontal surgery and need for owner compliance with home oral hygiene

Question 3

What type of flap can be used to help restore a crown/root fracture of this type?

Answer 3

Apically positioned flaps can be utilized for salvage of canine teeth with oblique crown-root fractures

Question 4

What are the steps involved in performing an apically repositioned flap?

Answer 4

1. reflection of a mucoperiosteal flap with bilateral releasing incisions 2. removal of a rather significant amount of tooth-supporting alveolar bone (alveolectomy). 3. Recontouring of the alveolar margin (alveoloplasty), 4. Restoration if indicated, 5. Root planing 6. Debridement of granulation tissue, and apical positioning and suturing of the flap

Question 5

What are apically positioned flaps largely unsuitable for multirooted teeth?

Answer 5

Due to inherent furcation exposure once the flap is sutured in an apical position

Question 6

What features demonstrated that the fracture was not recent?

Answer 6

The amount of calculus accumulation, lack of pulpal bleeding upon exploration of the fracture site, excess gingival granulation tissue filling the gap between the tooth and the slab, and small periapical lucencies on dental radiography indicated that the tooth had not been injured recently

Question 7

To what level was the alveolectomy performed and why?

Answer 7

Alveolectomy was performed to a level approximately 2-mm apical to the most apical extent of the tooth fracture. This is done to maintain biological width.

Question 8

What does the following picture depict being performed

Answer 8

There is an external bevel of the alveolar margin and enamel (arrows) allowing a smooth anatomical fit with the ginival margin and the slight undercut retentions into dentin at the coronal, apical, mesial and distal walls (arrowheads). To manage the biological width.

Question 9

What does this picture illustrate and what do the different markers represent

Answer 9

Illustration of the periodontal biologic width. A: the free ginigval margin

B:The space requirement for gingival connective tissue attachment (approximately 1-mm)

c: The junctional epithelial attachment (approximately 1-mm),

The sum of these structures necessitates gingival tissue maintenance approximately 2-mm from the alveolar margin to the base of the gingival sulcus in a tooth with healthy periodontal tissues

Question 10

What are four indications for restoration of a tooth at the cervical margin?

Answer 10

Indications for restorations at the cervical portion of the tooth include crown-root fracture, caries, tooth wear, and resorption.

Question 11

What is the consequence of not restoring the buccal bulge on a damaged tooth?

Answer 11

This convex overhang of the buccal bulge may function in deflection of food and debris away from the tooth crown and the gingival tissues. If not restored anatomically food and debris may remain in or traumatize the gingival margin, entering the gingival sulcus and cause focal gingivitis, periodontitis, and periodontal pocket formation.

Question 12

What features can be used in restorative design to improve retention beyond acid etching and appropraite preparation of the bonding surface?

Answer 12

Additional retention can be given to a restorative by using pins, potholes or channels, and

undercuts.

Question 13

What principles relating to periodontal attachment are imperative for understanding the concept of restoration of a defect at the cervical portion of a tooth?

Answer 13

1. Gingiva attaches to enamel, cementum and dentin, but there is very little or no attachment to restorative materials.
2. A distance of 2-mm between the most coronal aspect of alveolar bone and the most apical extent of the restoration must be maintained to allow for gingival attachment
3. Removal of granulation tissue and appropriate thinning of the flap are imperative to prevent inflammation and root resorption, and to allow for tight adherence of the sutured soft tissues to the tooth
4. The longterm prognosis is good only if pet owners are committed to daily home oral hygiene and frequent postoperative examinations including professional dental cleanings and periodontal therapy

Question 14

What preparation of the root was performed after root planing and why?

Answer 14

Root conditioning was performed using dilute chlorhexidine gluconate (0.12 %),

:citric acid, tetracycline, EDTA and fibronectin have been advocated for conditioning of the root surface. This is done in order to promote improved attachment of gingival connective tissue fibers