Relief Cuts/Diastema Widening This specimen has had the 100-arcade reduced to show approximate levels at which pulp is exposed. But my interest is focused on other issues. In my hands, periodontal disease is best treated by proper equilibration and air abrasion with prophy powder. The areas that do not respond to this treatment are often corrected with relief cuts/diastema widening. A minor mitigation at 108-9 may well have been indicated if food was packing but a full medial to lateral procedure was demonstrated at 109-10. This particular attempt was too invasive of the 110, particularly at the buccal extremity but I find this treatment first published by James Carmault, to have almost a 100% success rate in eliminating food packing and continued periodontitis. Others will argue that this is too invasive and less is more. Others will point out that the continuous of enamel in the interproximal space will cause the teeth to be weakened and result in fracture. I have seen the latter in only one case out of several hundred procedures. 3-4 mm of crown can usually be removed on either side of the diastema at the occlusal surface and if tapered to the gingival level, will not expose pulp. April 2016 Another case of what you cannot see without a radiograph The referral of this 10-year-old horse was specifically for the extraction of a shattered 107 to be performed under the supervision of the presiding clinic veterinarian. He requested a post op radiograph to evaluate the presence of any remaining 107 fragments. It became immediately obvious that major pathology existed in the 108 which was not apparent orally. All pulps had been probed and there was no facial swelling or nasal discharge. The extraction was quite difficult due to the bulbous swelling noted in the image. It is likely
Shear Mouth “What constitutes a designation of Shear Mouth” and “How much can you correct in one procedure?” A very recent and thorough search of the literature describes the normal molar table angle to be anywhere between 12 and 45 degrees. Forty-five degrees or greater is generally considered by most authors to be classified as “Shear Mouth”. Many publications consider an angle of 15- 25 degrees as being normal with variations from rostral to caudal. It is also stated that this should not be changed during equilibration but few practitioners have a measuring device to attempt this verification. Dr Kunz does have such a device (refer to Matteo Pellachin IGFP presentation) but its accuracy would certainly be called in question in this case, due to the extreme irregularity of this dentition. The best attempt read 35 degrees but individual teeth appear to approach 45. In any case, the dentition is locked with no lateral excursion and in my experience, reduction should be quite liberal until excursion is reestablished. August 2016 Continuation of Shear Mouth As in last month’s case, a painful condition on the ipsilateral (same side) causes the horse to restrict mastication to the opposite arcades, which were fairly normal but resulting in the very steep molar angle on the affected site and resulting in a total block. The original culprit was the deformed, rotated and abscessed 208 which must have precluded any use of the left side. As the post-surgical photos show, a major reduction of the molar table angle was accomplished in one procedure – from a molar table angle or 45 to 27 degrees. When the pack was changed on the fifth day, it was noted that the patient was already chewing on the left side and at the three month recheck, the chewing pattern was equal on both sides. A similar case
Melanomas It is well documented that ninety percent of gray horses over the age of 15 are diagnosed with melanomas. This tumor may be found at any age and can occur anywhere in the body. Often, they are small and unobtrusive but on other occasions are quite invasive and may affect bowel and urinary function. Another very common site is the lips, where the swelling may interfere with use of a bit. The images shown here depict a case where the lesions were invasive enough that the 6’s had lacerated the cheeks. In this situation, the solution was to perform extreme bit seats or rostral profiling to allow for the expansion of the tumor. If the No.6 pulp was exposed, temporary fillings could have been employed. If this had been a geriatric patient, extraction of the 6’s might have been considered. This area of the lip is not usually amenable to surgical excision but a new vaccine is reported to be successful in many cases. If the Dental Provider advises their clients when the lesions are quite small, appropriate therapy may be instituted to preserve performance as well as comfort. December 2016 THE IMPORTANCE OF PRESURGICAL RADIOGRAPHS BEFORE ATTEMPTING MAJOR EXTRACTIONS. We must admit that we have all attempted major extractions without radiographs and been quite successful and lucky. However, this approach cannot be recommended, as demonstrated by this case. A 3-year-old grey thoroughbred was presented to a clinic with the complaint that a sore on the face would not heal. It was recognized as a fistula and most likely of dental origin. An oral exam revealed obvious 108 pathology and appeared to be an uncomplicated extraction. One and a half hours later, little progress had been made and the procedure was abandoned. The case was referred to another facility for radiographic imaging and this massive lesion was noted. The actual procedure required two and a half hours from an intraoral approach and another one and a half hours under general anesthesia to complete the operation. radiographs would have saved a great deal of time and expense and revealed that this was a case for referral to a facility with highly skilled dental practitioners.