Jane's Endo Money! Flashcards by Jane Pegg

Kortegaard HE, Anthony Knudsen T, Dahl S, Agger JFG, Eriksen T. Consequences of crown shortening canine teeth in Greenland sled dogs. Journal of Small Animal Practice. 2015;56(4):264-269.

What is the increase in risk from having crowns shortened on the tooth level and on the dog level?

12 x on the tooth level

4 x on the dog level

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Kortegaard HE, Anthony Knudsen T, Dahl S, Agger JFG, Eriksen T. Consequences of crown shortening canine teeth in Greenland sled dogs. Journal of Small Animal Practice. 2015;56(4):264-269.

What does the author state as another common cause of pulp exposure?

•Dogs are living in a rocky environment, chained up and fed semi-thawed food, so incidental fractures are also common

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Kortegaard HE, Anthony Knudsen T, Dahl S, Agger JFG, Eriksen T. Consequences of crown shortening canine teeth in Greenland sled dogs. Journal of Small Animal Practice. 2015;56(4):264-269.

by what factor does having pulp exposed increase risk of periapical pathology?

109x

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Riehl J, Hetzel SJ, Snyder CJ, Soukup JW. Detection of Pulpal Blood Flow In Vivo with Pulse Oximetry in Dogs. Frontiers in Veterinary Science. 2016;3(MAY).

How often were readings obtained compared to the control region?

25% of the time

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Riehl J, Hetzel SJ, Snyder CJ, Soukup JW. Detection of Pulpal Blood Flow In Vivo with Pulse Oximetry in Dogs. Frontiers in Veterinary Science. 2016;3(MAY).

Did the pulse rate match? How much was the SPO2 different by?

Nope,

usually about 10 points lower

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

In what proportion of teeth were there signs of total or partial pulp necrosis?

92%

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

What proportion of teeth had radiographc changes consistent with endodontic disease?

57%

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

What was the calculated risk of unnecessary endodontic treatment?

<10%

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

What are 3 requirements for tissue engineering?

3 requirements for tissue regeneration:
1. Appropriate source of stem cell/progenitor cells
1. Growth factors that are capable of promoting stem cell differentiation
1. Appropriate scaffold for the regulation of cell differentiation

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

What are 3 goals of treatment?

Primary: Elimination of infection and bony healing
Secondary: Increased root wall thickness/length
Tertiary: Positive response to vitality testing

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

for what age of patient is this suggested in vet med?

pets of 5 months – 2 years

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

What would be te expected timeframe for radiographic changes with success?

•Radiolucency should resolve over 6-12 months, Increase width of root wall after 12-24 months

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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.

What is apexification?

•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

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Clarke DE. Vital pulp therapy for complicated crown fracture of permanent canine teeth in dogs: A three-year retrospective study. Clarke DE. Journal of Veterinary Dentistry. 2001;18(3):117-121

What proportion of teeth were vital in each group at 3 months?

All teeth, all groups

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Clarke DE. Vital pulp therapy for complicated crown fracture of permanent canine teeth in dogs: A three-year retrospective study. Clarke DE. Journal of Veterinary Dentistry. 2001;18(3):117-121

What proportion of teeth were vital in each group at 1 year?

<48 hours - 95%

2d-1 week - 50%

3 weeks - 25%

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Clarke DE. Vital pulp therapy for complicated crown fracture of permanent canine teeth in dogs: A three-year retrospective study. Clarke DE. Journal of Veterinary Dentistry. 2001;18(3):117-121

What proportion of teeth were vital in each group at 3 years?

<48h - 88%

2d-1 week - 41%

3 weeks - 23%

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Luotonen N, Kuntsi-Vaattovaara H, Sarkiala-Kessel E, Junnila JJT, Laitinen-Vapaavuori O, Verstraete FJM. Vital pulp therapy in dogs: 190 cases (2001–2011). Journal of the American Veterinary Medical Association. 2014;244(4):449-459.

What was the failure rate?

15%

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What was the success rate and the no evidence of failure rate?

success - 73%

NEF - 12%

overall 85% success

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what was the success rate for MTA?

92%

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What was the success rate for CaOH?

58%

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What were factors in the univariate analysis?

dressing material

distinct intraop hemmorhage

penetration of dressing into pulp

use of ab’s (inc failure)

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What were factors in the multivariate analysis and odd ratio?

use of CaOH - 6x risk of failure

deep penetration of the dressing material into the pulp - 5 x risk of failure

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were time from fracture or formation of a dentin bridge significant?

nope

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Results of root canal treatment in dogs: 127 cases (1995–2000)
Helena Kuntsi-Vaattovaara, DVM; Frank J. M. Verstraete, DrMedVet, DAVDC; Philip H. Kass, DVM, PhD, DACVPM

JAVMA, Vol 220, No. 6, March 15, 2002

What were the percentages of success, failure and NEF?

success 69% (my favourite number)

NEF 26%

failed 6%

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Results of root canal treatment in dogs: 127 cases (1995–2000) Helena Kuntsi-Vaattovaara, DVM; Frank J. M. Verstraete, DrMedVet, DAVDC; Philip H. Kass, DVM, PhD, DACVPM JAVMA, Vol 220, No. 6, March 15, 2002 What factors were associated with increased risk of failure?

Pulp necrosis Pre-existing periapical lucency pre-operative external inflammatory root resorption

canines, mandibular fourth premolars and mandibular first molars compared to maxillary P4's

Fulton AJ, Fiani N, Arzi B, Lommer MJ, Kuntsi-Vaattovaara H, Verstraete FJM. Outcome of surgical endodontic treatment in dogs: 15 cases (1995-2011). Journal of the American Veterinary Medical Association. 2012;241(12):1633. What were the proportions of success, failure and NEF?

success - 66% NEF - 33% no failures

instrument separation (5) failure despite appropriate fill (4) stenotic canals (3)

haemorrhage, perforation of palatal bone plate, maxillary swelling

Radiographic outcome of root canal treatment of canine teeth in cats: 32 cases (1998–2016). Strøm PC, Arzi B, Lommer MJ, et al. Journal of the American Veterinary Medical Association. 2018;252(5):572-580. What were the proportions of success, NEF and failure?

success - 49% NEF - 32 % Fail - 19%

vertical compaction with thermoplastic GP

* Pre-existing EIRR (10x increase - sig) * Age at time of RCT (older worse - sig) * obturation voids in the apical third (5x worse, but not significant - small numbers) * Time since procedure (Treatment success declined steadily past 2 years post treatment)

Stein KE, Marretta SM, Siegel A, Vitoux J. Comparison of hand-instrumented, heated gutta-percha and engine-driven, cold gutta-percha endodontic techniques. Journal of Veterinary Dentistry. 2004;21(3):136-145. What was the difference in time between the two techniques?

rotary 50% faster

No apical dye leakage associated with rotary instruments/simplifill/GP technique compared to 44% apical leakage in K-file hand instruments and Succesfil technique.

Apical Microleakage in Root Canals Obturated With 2 Different Endodontic Sealer Systems in Canine Teeth of Dogs. J Vet Dent. Lothamer CW, Anderson A, Hetzel SJ, et al. 2017;34(2):86-91. what differences were ther ebetween AH plus and gutta flow for leakage?

no difference in prevalence (21% in AH+, 23% in GF)

AH+ 6.7mm GF 2.8mm NSD

* Epoxy amide sealer, 2 tubes, mix equal parts * Temperature dependent polymerization, working time of 4 hours, setting time of 8 hours * Low solubility 0.3%, shrinkage of 1.7% * Older AH 26 released formaldehyde, AH plus releases 3.9ppm * Cytotoxic for 4 hours (working time)

* Guttaflow 2 * Silicone based sealer addition polymerization reaction with platinum salt as a catalyst * Working time is 10 15 minutes, cure time 25 30 minutes * Expands on polymerization by 0.2% * Solubility of 0% * Non toxic in tissue, but will be encased in fibrous tissue

Hernandez SZ, Negro VB, Maresca BM. Morphologic features of the root canal system of the maxillary fourth premolar and the mandibular first molar in dogs. Journal of Veterinary Dentistry. 2001;18(1):9-13. how common are non apical ramifications overall?

25% of roots

distal root max P4 - 47%

, 68.0 of maxillary fourth premolar 20.4'% of mandibular first molar teeth significant difference

1-3 mm Mandibular M1's 17% longer than 3mm

secondary 20% of roots Lateral 7% of roots accessory 1.5% of roots

called canals secondary if in the apical 1/3 of the root, called them lateral if they were in the coronal 2/3 of the root. Called them accessory if they branched from a secondary

4-6mm

Negro VB, Hernandez SZ, Maresca BM, Lorenzo CE. Furcation canals of the maxillary fourth premolar and the mandibular first molar teeth in cats. Journal of Veterinary Dentistry. 2004;21(1):10-14. what proportion of cats have a furcation canal in at least 1 tooth?

44.5%

Negro VB, Hernandez SZ, Maresca BM, Lorenzo CE. Furcation canals of the maxillary fourth premolar and the mandibular first molar teeth in cats. Journal of Veterinary Dentistry. 2004;21(1):10-14. What proportion of all teeth examined had a furcation canal?

27%

104 um and range 25-250

Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog Sabás Z. Hernández, DVM, PhD; Viviana B. Negro, DVM, PhD; Georgina de Puch , Paula G. Toriggia , DVM Which teeth had significantly more foramina?

Mandibular M1's

Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog Sabás Z. Hernández, DVM, PhD; Viviana B. Negro, DVM, PhD; Georgina de Puch , Paula G. Toriggia , DVM What was the average diameter of the foramina?

32-35 um

Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog Sabás Z. Hernández, DVM, PhD; Viviana B. Negro, DVM, PhD; Georgina de Puch , Paula G. Toriggia , DVM 85% of foramina were below what diameter?

50 um

Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog Sabás Z. Hernández, DVM, PhD; Viviana B. Negro, DVM, PhD; Georgina de Puch , Paula G. Toriggia , DVM what was the maximum diameter?

234 um

Scanning Electron Microscopic Evaluation of Tooth Root Apices in the Dog Sabás Z. Hernández, DVM, PhD; Viviana B. Negro, DVM, PhD; Georgina de Puch , Paula G. Toriggia , DVM how many foramina did P4's, canines and M1's have on average?

P4 - 36 Canine - 38 M1 - 57

Almansa Ruiz JC, Bosman AM, Steenkamp G. Bacterial Profile of Necrotic Pulps in Cheetah (Acinonyx Jubatus) Canine Teeth. J Zoo Wildl Med. 2016;47(1):98-105. What were the results with culture?

* 55% G+ 45% G- * Facultative anaerobes 63%, aerobes 28%, anaerobes 8.5%

Almansa Ruiz JC, Bosman AM, Steenkamp G. Bacterial Profile of Necrotic Pulps in Cheetah (Acinonyx Jubatus) Canine Teeth. J Zoo Wildl Med. 2016;47(1):98-105. What were the results with PCR?

anaerobes (60.8%), facultative anaerobes (30.2%), aerobes (8.6%).

Almansa Ruiz JC, Bosman AM, Steenkamp G. Bacterial Profile of Necrotic Pulps in Cheetah (Acinonyx Jubatus) Canine Teeth. J Zoo Wildl Med. 2016;47(1):98-105. What were the best antibiotics?

•Amikacin and gentamicin

Almansa Ruiz JC, Bosman AM, Steenkamp G. Bacterial Profile of Necrotic Pulps in Cheetah (Acinonyx Jubatus) Canine Teeth. J Zoo Wildl Med. 2016;47(1):98-105. What were the worst antibiotics?

•Lyncomycin and Lincospectin and orbifloxacin were the worst

Srečnik Š, Zdovc I, Javoršek U, Pirš T, Pavlica Z, Nemec A. Microbiological Aspects of Naturally Occurring Primary Endodontic Infections in Dogs. Journal of Veterinary Dentistry. 2019:0898756419873639. How many bacterial species were cultured?

•61 isolates cultured representing 30 bacteria

•number of isolates cultured decreased

* 54% were Gram-negative bacteria, 46% gram positive * 53% were facultative anaerobic, and 42% were anaerobic bacteria, 5% aerobes.

•naturally occurring primary endodontic infections in dogs are polymicrobial and involve a select number of opportunistic pathogen species, which are part of the normal oral flora of dogs.