Jane's 5 point Endodontics articles

Question 1

Hale FA. Localized intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs. Journal of Veterinary Dentistry. 2001;18(1):14-20.

Answer 1

• Study of intrinsically stained teeth, entire tooth discoloured tan, purple or gray, 71 dogs 84 teeth total
• Gross signs of total or partial pulp necrosis in 92% of these teeth (based on no bleeding at all, or no bleeding in coronal pulp, but bleeding in radicular pulp)
• 57% of teeth had radiographic sign of endodontic disease
• N.B. Only examined pulp on 64 teeth, and had rads on 84, so % numbers based on different denominators
• Concluded risk of unnecessary endodontic therapy is <10% in discoloured teeth even without radiographic changes indicative of endodontic disease.

Question 2

Feigin K, Shope B. Regenerative Endodontics. J Vet Dent. 2017;34(3):161-178.

Answer 2

• 3 requirements for tissue regeneration:
• 1. Appropriate source of stem cell/progenitor cells
• 2. Growth factors that are capable of promoting stem cell differentiation
• 3. Appropriate scaffold for the regulation of cell differentiation
• 3 goals:
• Primary: Elimination of infection and bony healing
• Secondary: Increased root wall thickness/length
• Tertiary: Positive response to vitality testing
• Factors which affect results:
• Effective disinfection and sealing of the coronal access
• Diameter of the open apex: Have been successful with as small as 0.5 mm but much more successful if >1mm
• Patient’s age: People 8-16 years of age
• Suggest age in pets of 5 months – 2 years
• Radiolucency should resolve over 6-12 months, Increase width of root wall after 12-24 months

Question 3

Hennet P, Girard N. Surgical endodontics in dogs: A review. Journal of Veterinary Dentistry. 2005;22(3):148-156.

Answer 3

•While nifty to read, this is an old-school rehash of Cohens later chapters… skipperoo

Question 4

Juriga S, Marretta SM, Niederberger V. Mineral trioxide aggregate (MTA) for apexification of non-vital immature permanent teeth. J Vet Dent. 2007;24(4):274-277.

Answer 4

• Step by step to accompany the article where they did this in a cat.
• Apexification is a method of inducing the formation of a calcified barrier in a root with an open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulp
• Involves cleaning and debriding the root canal, then putting 2-3mm of MTA at the level of the apical foramen within the canal to induce cementogenesis at the apex
• Usually 2 stages – placec MTA and then fill with CaOH or other medicament, then finish obturation at another time
• Can do a 1 visit technique by adding a barrier of self curing GI over the top of the MTA and then obturating immediately

Question 5

Niemiec BA. Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats. Journal of Veterinary Dentistry. 2001;18(3):122-125.

Answer 5

• Retrospective analysis of success/failure of VPT therapy for crown reductions and crown fractures, used CaOH as medicament for all of them.
• Paper is a bit wacky, numbers aren’t totally consistent, vary from one place to another… – they did owner surveys to ask if teeth were still vital (90% thought they were), and rechecked 32 of them.
• Of the teeth that actually got rechecked, 100% of the crown reductions were vital, and 100% of the CCF >7days before VPT teeth were non vital
• In the 4 immature teeth with CCF’s, even though they became non vital, 3/4 teeth had additional radicular development to permit root canal treatment.