Page 773 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

748 CHAPTER 4

VetBooks.ir involve dentine or pulp chambers. Cheek tooth com- treatment. First aid of exposed pulps can involve
application of calcium hydroxide paste (within 48 h
pound fractures usually occur in a plane coalescing
two pulp horns or two infundibula with subsequent
pulpitis. Pathological dental fractures occur com- of the fracture). Fractured teeth can be extracted or
restoration attempted. Restoration is performed in
monly in the maxillary cheek teeth and the 4 (109, the standing horse after a vital pulpotomy or pulpec-
th
209) is most commonly involved (Fig. 4.57). tomy followed by cavity preparation and obturation.
This is followed by a laminated restoration using
Clinical presentation dental composites (Fig. 4.59). Dental salvage has
Compound fractures are painful initially. Incisor advantages over extraction as the subsequent occlu-
fractures will often present with bleeding from the sion is superior and the sensitivity of the incisor is
lips. In chronic cheek tooth fracture, displacement of greatly improved after restoration.
fragments leading to mucosal trauma is often painful
and associated with mucosal ulceration. Many latent Cheek teeth fractures
dental fractures will be detected on routine examina- Fractures of the cheek teeth are almost invariably
tions where clinical signs may have been overlooked. pathological fractures of teeth with pulpitis, caries
or excessive overgrowths. Treatment depends on the
Diagnosis fracture plane and the consequences of the fracture.
Oral examination, oroscopic examination, radiogra- Simple buccal slab fractures that occur in mandibu-
phy, CT. lar and maxillary teeth can be treated by removal of
the fragment and leaving the remainder of the tooth
Differential diagnosis in situ but reducing it from occlusion. Provided pulp
Supernumerary teeth. exposure has not occurred, such horses can remain
asymptomatic for many years. Complex fractures are
Treatment more common in maxillary teeth and are the con-
Incisor fractures sequence of advanced caries when fracture occurs
These are often the result of external trauma, such as coalescing infundibula, or after pulpitis when frac-
kicks and avulsion forces, and are usually transverse ture planes coalesce pulp canals. Such fractured teeth
and expose the pulp cavity (Fig. 4.58). Clinical and are brittle, often associated with paranasal sinus
radiographic appraisal is indicated prior to planning disease and can be problematic to remove as they

4.57 4.58

Fig. 4.57 Fractured teeth can be challenging to Fig. 4.58 Incisor fractures often expose the pulp and
remove and are not always identified early. can be very sensitive.