TREATING UNCOMPLICATED FRACTURES IN VITAL TEETH
With uncomplicated crown fractures, exposed dentin can result in painful pulp stimulation and bacterial infection leading
to pulp necrosis, especially immediately after the fracture when the dentinal tubules have been freshly exposed. Treatment
should include composite restoration of the defect and possibly preparing for and placing a full- or partial-coverage crown.
Recent information has shown that canine dentin has less intertubular dentin (dentin between tubules) than human dentin does,
possibly decreasing the bond strength of modern composites compared with those placed on human teeth.10 The decreased intertubular dentin could lead to weaker shearing forces and increased failure of composite restorations.
Thus, placing a metal crown to protect the remaining tooth from further damage and bacterial ingress may be desired. However,
the choice depends on the amount of remaining dental hard tissue, the thickness of the tooth axial walls surrounding the pulp,
and client expectations.
Frequent (every six to 12 months) radiographic monitoring is necessary. If radiographic evidence of endodontic disease is
observed, root canal therapy or, though less desirable, extraction is indicated.
TREATING COMPLICATED FRACTURES IN NONVITAL TEETH
Vital pulp therapy is a treatment option for acutely fractured teeth in patients less than 18 months old.16 Treatment success is related to the time between the injury that exposed the pulp and treatment. Marked bacterial contamination
and histologic signs of inflammation in the coronal pulp occur just 48 hours after experimentally induced crown fracture.17 In a separate study, the success of vital pulp therapy decreased to 0% when it was performed more than seven days after
the injury.18 If the therapy is unsuccessful or performed on a nonvital tooth, further pain and tissue loss from continued necrosis of
the infected pulp may occur. Thus, vital pulp therapy is an excellent treatment option for intentional crown reduction procedures,
but it should only be used for treating fractures that result from trauma in young (< 18 months) patients. Even then, the
prognosis is guarded, and frequent radiographic follow-up is necessary.
In adult animals or animals with fractures that are more than 48 hours old, root canal therapy is a good treatment option.
The reported failure rate for root canal therapy in dogs was only 5%.19 Root canal treatment allows a patient to maintain tooth function and is often less invasive than extraction. After root
canal treatment, the tooth is restored with either a composite or metal crown, as mentioned above.
If salvaging the teeth is impossible, the only other recommendation for teeth with pulp necrosis or imminent pulp necrosis
is extraction. However, teeth with severe endodontic disease may still have healthy periodontal attachment, and extracting
these teeth can be challenging.
Matthew Lemmons, DVM, DAVDC
Circle City Veterinary Specialty and Emergency Hospital
9650 Mayflower Park Drive
Carmel, IN 46032
Daniel T. Carmichael, DVM, DAVDC
Veterinary Medical Center
75 Sunrise Highway
West Islip, NY 11795
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Got a question about a difficult dental fracture case or other dental problem?
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Subject line: Dental Question