Osseous Surgery to Augment Treatment of Chronic Periodontitis of Canine Teeth in a Cat

J VET DENT Vol. 24 No. 1 March 2007 A 10-year-old neutered/male Manx cat was referred to the dentistry/oral surgery service for periodontal evaluation and treatment. The cat did not receive regular home dental care. The patient’s diet was a balanced, high fiber, dry cat food recommended by the referring veterinarian for weight control and promotion of gastrointestinal function. A professional teeth cleaning procedure with scaling and polishing had been performed by the referring veterinarian 2-months prior to presentation based on clinical signs of oral discomfort. At that time, oral examination showed periodontal pocketing and root exposure of the left maxillary canine tooth (204) and the left mandibular canine tooth (304). An additional tooth, distal to the right mandibular molar tooth (409), was also noted. The referring veterinarian had extracted the right mandibular canine tooth (404) for periodontal abscessation 2-months before presentation. The cat's owners desired periodontal treatment in order to avoid extraction of 204 and 304. The cat appeared bright and alert with no obvious indication of oral discomfort. Conscious oral examination was limited due to the cat’s fractious nature. The extraction site at 404 appeared to be healing without complication. The 204 appeared slightly extruded. A firm buccal alveolar enlargement was noted at both 204 and 304. The tentative diagnosis was periodontitis with chronic alveolar osteitis. The diagnostic plan included preanesthetic laboratory tests, general anesthesia, appropriate analgesia, oral charting, maxillofacial examination, and radiographic evaluation. Treatment options included extraction, root planing, osseous resection, osteoplasty, bone replacement, or a combination of these treatments. Pre-anesthetic laboratory tests, including serum chemistries, electrolytes, complete blood count, and urinalysis were within normal limits. The cat was premedicated with buprenorphine (0.01mg/kg IM) to aid pre-emptive and postoperative analgesia. In order to minimize risk to staff and decrease risk to the patient (stress, incidental injury), induction was accomplished through chamber administration of an inhalant anesthetic. Sevoflurane. was administered to achieve profound sedation and a 4.0-cuffed endotracheal tube was placed with the patient maintained on oxygen and sevoflurane. A 24-gauge intravenous cephalic catheter was placed and an isotonic balanced electrolyte solution was administered at 10ml/kg/hr. The following parameters were monitored: indirect arterial blood pressure, heart rate, respiratory rate, pulse quality, jaw tone, mucous membrane color, capillary refill time, eye position and reflexes. Body temperature was maintained with a warm water circulating heating pad and a warm air-blown body covering. Clindamycin (5.0 mg/kg IV) was administered. Carprofen (1.1mg/kg SQ) was given to provide additional pain control. The mouth was lavaged with a 0.12% chlorhexidine solution to decrease the amount of aerosolized bacteria and the degree of bacteremia induced by the periodontal treatment procedures. Intraoral regional nerve blocks were administered to provide pre-emptive analgesia, reduce the general anesthesia requirement, and to provide post-operative pain relief. Bupivacaine (0.5 mg each) was injected at the right Osseous Surgery to Augment Treatment of Chronic Periodontitis of Canine Teeth in a Cat VETERINARY DENTIST AT WORK