Clinical lesions and radiographic evidence of root resorption and ankylosis
A crown amputation procedure has been described to extract certain teeth exhibiting FORLs.6 In this procedure, you remove the crown of the tooth affected with an FORL while intentionally leaving the resorbing roots
behind. Before performing this procedure, make sure there is no evidence of concurrent periodontal disease. Cats with associated
periodontitis or stomatitis are not candidates for crown amputation. Dental radiography is essential for accurate diagnosis
and treatment planning (Figures 5A-5C).
Figures 5A & 5B. The maxillary right third premolar (#107) shows evidence of an FORL on oral examination (5A). The dental
radiograph (5B) shows #107 (white arrow) with extensive root resorption. This tooth is a good candidate for crown amputation.
5C. The tooth in Figures 5A & 5B before crown amputation. A mucogingival flap has been raised exposing the buccal cortical
bone (1) overlying the resorbing roots. The crown (2) will be amputated along the black dotted line, intentionally leaving
what’s left of the roots behind. The flap is then reapposed with fine, absorbable suture.
In multirooted teeth, if only one root is affected with resorption, the root exhibiting the resorption should be crown-amputated,
and the healthy root should be elevated and routinely extracted.
If you perform dental extraction or crown amputation, manage the patient's pain with a combination of preoperative and postoperative
analgesia, intraoral regional nerve blocks, and analgesics for a few days after the procedure. A common protocol would include
premedication with hydromorphone, appropriate intraoral regional nerve blocks with bupivacaine hydrochloride, postoperative
hydromorphone, and a fentanyl patch. Of course, many other options are available, and the individual pain management plan
should be based on the expected degree of pain and the patient's general health status.
Postoperative antibiotics are often given prophylactically for five to seven days. Antibiotics effective against gram-negative
anaerobic bacteria are good choices. Other postoperative oral hygiene measures such as oral rinsing with chlorhexidine can
be used, but they are often poorly tolerated by cats.
Reevaluate patients two or three weeks after the procedure to verify that healing has occurred. At that time, a dental home
care program can be reinstituted. This may include a combination of tooth brushing, dental diets, appropriate chew treats,
and a scheduled six-month recheck. Keep in mind that although a home care program is an important tool in preventing periodontal
disease and other oral problems, nothing can be done at home to prevent FORLs. This fact has assuaged many clients' guilt.
1. Gorrel C, Larsson A. Feline odontoclastic resorptive lesions: Unveiling the early lesion. J Small Anim Pract 2002;43:482-488.
2. Harvey CE, Orsini P, McLahan C, et al. Mapping of the radiographic central point of feline dental resorptive lesions. J Vet Dent 2004;21:15-21.
3. Gorrell C. A practical approach to managing feline odontoclastic resorptive lesions, in Proceedings. 18th Annu Vet Dent Forum 2004.
4. Bellows J. Oral surgical equipment, materials, and techniques. In: Small animal dental equipment, materials and techniques—A primer. Ames, Iowa: Blackwell Publishing, 2004;297-328.
5. Holmstrom SE, Frost P, Eisner ER. Exodontics. In: Veterinary dental techniques for the small animal practitioner. 2nd ed. Philadelphia, Pa: WB Saunders Co, 1998;216-244.
6. DuPont G. Crown amputation and intentional root retention for advanced feline resorptive lesions—A clinical study. J Vet Dent 1995;12:9-13.
"Dental Corner" was contributed by Daniel T. Carmichael, DVM, DAVDC, The Center For Specialized Veterinary Care, 609-5 Cantiague
Rock Road, Westbury, NY 11590.