Vital Pulpotomy in the Dog and Cat~ No.34


DrDonDeForge
Advanced Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com

DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
[Practice Limited to Dentistry]

Treatment of the Recent Fracture
Vital Pulpotomy

Image result for Picture of a dog with an open pulp canal


Vital Pulpotomy-Saving Teeth!
The vital pulpotomy is a  procedure used most often in immature teeth in young dogs with a  recent fracture. It can be used in older dogs, with recent crown fractures, if dental x-rays show no radicular [root] pathology. 
The client must be told that all dogs undergoing Vital Pulpotomy treatment must have a post-treatment endodontic x-ray in 12  months post-care. 
If the apex of the tooth is abnormal, the patient will need a conventional root canal at that time.  The pulpotomy, in young patients, is recommended because it keeps the tooth vital allowing for tooth maturation.
If there is radicular [root] pathology, then the patient must undergo conventional root canal therapy. 
Besides vital pulpotomy and or root canal therapy the only other option for a tooth with an open pulp canal is extraction.  A patient should never be left with an open pulp canal.  It is painful and can lead to a very poor quality of life.
 For the large canine teeth in dogs and cats, and the large chewing (carnassial) teeth in dogs, the extraction procedure can be traumatic and painful due to the size of the roots in our animal patients. The root of the canine tooth is longer and wider than the crown (the part of the tooth you can see above the gums). Extraction of these teeth involves major oral surgery, comparable to removing impacted wisdom teeth in human patients. The patient also loses the function of the tooth, which can be very important in working dogs.
Dr. DeForge tries to avoid extraction of fractured but otherwise healthy teeth.
After any endodontic procedure a restoration is utilized to close the treatment site.
There are exceptionally strong enamel shaded restoratives available to animal dentists from human dentistry. Amalgam is another very safe alternative in restorative dentistry.  No restoration is permanent in the dog.
Dog's can dislodge restorations quite easily if chew behavior is not modified.
The restoration that has the least chance of being dislodged by our animal patients is a full jacket crown.

Comments from Dr. DeForge:
The most important single aspect of successful vital pulp treatment is a correct diagnosis.  The clinician must ascertain the tooth to be vital! This determination is made through a thorough workup  including the clinical examination and radiographic appearance of the tooth.--all performed under general inhalation anesthesia. 

Vital Pulpotomry is only performed on recently fractured teeth.
It is commonly performed in young patients.  It can be used in any age patient as long as the clinician is sure that the tooth in question was recently traumatized and endodontic x-rays are within normal limits.

Subjective and objective pain determination is quite difficult to determine in the dog an cat. Clinically, the tooth must be free of soft-tissue symptoms of gingival swelling and pathologic mobility. Radiographs should not show any periapical radiolucency. There should be no radiographically demonstrable external or internal resorption.

 

Pulpotomy:

Following the induction and maintenance of the patient with gas inhalation anesthesia the technique of pulpotomy, regardless of agent used, is exactly the same up to the application of the pulpal medicaments.  

MTA and Calcium Hydroxide are the most common medicants for the pulpotomy in the dog. Either is applied as a paste that remains over the pulp. Dr. DeForge uses the most up-to-date materials to assure a successful pain-free outcome.

The second most important aspect of pulpotomy assuring a successful outcome is the placement of a start of the art  base; primer-resin adhesive and a composite restoration. 

There is no guarantee that Vital Pulpotomy will be successful. If bacteria have reached a point below the treatment site, infection can continue into the pulp necessitating a root canal.  

The Vital Pulpotomy is an important first step in care that may need no further treatment. It decreases anesthesia time; removes pain; and allows maturation of the tooth.  

The root canal is reserved as a last resort.  Once a root canal is performed the tooth is now non-vital.  The advantage of the root canal is that it is also non-invasive and the patient has a remarkable return to normalcy without pain.

Extraction is invasive and requires surgical cutting of mucosa and bone and is never recommended by Dr. DeForge as first choice of care in recently traumatized teeth.

Post treatment x-rays in 12 months is the key! If these x-rays show an abnormal apex after Vital Pulpotomy, root canal therapy is then advised.

Follow-up oral radiology in 6-12 months is imperative.




Questions?
E-Mail DonDeForge100@gmail.com

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