Case Study: Arrow His bite was worse than his bark

BACKGROUND Arrow is a 3.5-year-old male neutered German Shepherd / Belgian Malinois dual-purpose police dog. During bite work practice, his handler observed moderate bleeding from Arrow’s mouth; however, the only sign of oral discomfort was a slight reduction in bite strength. Although Arrow continued to eat and drink normally, his primary care veterinarian at Family Pet Clinic of Southampton, PA, referred Arrow to Veterinary Dentistry Specialists ​(VDS) in Mt. Laurel, NJ, for evaluation.  Arrow was found to have sustained a complicated crown fracture of tooth 104 (right maxillary canine). He had root canal therapy and a full metal titanium jacket crown placement on tooth 104. He re-presented in August 2022 after sustaining traumatic ​crown fractures of the left mandibular canine tooth (304) and right maxillary third incisor tooth (103)​.  EXAM AND DIAGNOSTICS  Anesthetized oral examination confirmed complicated crown fractures (pulp exposure) of ​both 103 and 304. Arrow had severe abrasion on the distal aspect of ​teeth 204 (left maxillary canine) and 404 (right mandibular canine). The previously placed full​ metal​ titanium jacket crown on ​tooth 104 was still in place, and the tooth had no radiographic evidence of failure. Radiographs of teeth 304 and 103 did not reveal any apical pathology (i.e., periapical lucencies).  Pre-operative blood work (complete blood count and serum chemistry) was unremarkable.

Radiograph of completed root canal therapy of 304.

DIAGNOSIS AND TREATMENT Given Arrow’s profession, protecting his strategic canine teeth from further trauma was essential. Arrow underwent staged procedures: First, he underwent standard root canal treatment of ​the complicated crown fractures of teeth 103 and 304, and crown preparation ​of ​teeth 204, 304, and 404 ​to receive full cast metal crowns. Dental impressions of the three teeth were taken in preparation for permanent full metal jacket crowns. Temporary crowns were made with dental composite material to help protect the teeth in the interim. Arrow was not permitted to engage in bite work while he awaited permanent placement of ​the custom metal crowns.  OUTCOME Three weeks later, Arrow underwent his second procedure for cementation of ​the permanent metal crowns. Arrow’s metal crowns had an excellent fit, and he was cleared to return to work without restrictions two days later. Following his treatment, Arrow has regained his original bite strength.

The temporary composite crowns are in place (orange arrows). Note that the coronal aspect of the temporary crown on 404 has been damaged, despite the handler’s best efforts to control Arrow’s chewing (green arrow).

The temporary composite crowns have been removed from the teeth.

The teeth are prepared and cleaned with pumice and water to remove remaining plaque and debris.

Note the 1 mm rim on 204 and 304 that was created for the titanium metal crown (orange arrows). This is called a chamfer margin.

The titanium metal crown is filled with cement material.

The metal crown is pressed firmly into place.

Excess cement is removed from the margin.

The junction of the metal crown and tooth has Oxyguard applied for oxygen inhibition to allow the cement to cure.

The outcome with full jacket titanium metal crowns on all four canine teeth.

Coming in 2023, VDS will offer Lunch N Learn Continuing Education Programs. Stay tuned for more details.

AAHA-Accredited Referral Practice 2061 Briggs Rd, Suite 403 | Mt. Laurel, NJ 08054 856.242.9253 | info@vdsvets.com | vdsvets.com Additional Locations: Chadds Ford, PA and Katy, TX Please visit our website and follow us on Facebook and Instagram.

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