Changes

Crown fractures are usually obvious visually.

Crown fractures are usually obvious visually.

<u>Enamel fracture</u>: if only the enamel is fractured, this will appear as chips in the enamel surface.

<u>Enamel fracture</u>: if only the [[Enamel Organ#Enamel|enamel]] is fractured, this will appear as chips in the enamel surface.

The treatment of choice is to smoothe any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.  

The treatment of choice is to smooth any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.  

'''Radiography''' should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

'''Radiography''' should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

<u>Enamel and dentin fracture</u>: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. Pulp exposure should be evaluated for by probing with an explorer tip with the animal under general anaesthesia. Radiographs should be taken to evaluate the root.

<u>Enamel and [[Enamel Organ#Dentine|dentin]] fracture</u>: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. [[Enamel Organ#Pulp|Pulp]] exposure should be evaluated for by probing with an explorer tip with the animal under general anaesthesia. Radiographs should be taken to evaluate the root.

*'''Indirect pulp capping''': covers exposed dentin with glass ionomer cement followed by crown restoration. Follow-up radiographs are taken at 6-monthly intervals.

*'''Indirect pulp capping''': covers exposed dentin with glass ionomer cement followed by crown restoration. Follow-up radiographs are taken at 6-monthly intervals.

*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or glass ionomer cement, followed by crown restoration.  

*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or glass ionomer cement, followed by crown restoration.  

<u>Enamel and dentin fracture with pulp exposure</u>: if the pulp is exposed '''endodontic treatment''' must be performed or the tooth must be '''extracted'''. An untreated exposed pulp leads to necrosis of tissue in the direction of the root apex.

<u>Enamel and dentin fracture with pulp exposure</u>: if the pulp is exposed '''endodontic treatment''' must be performed or the tooth must be '''extracted'''. An untreated exposed pulp leads to necrosis of tissue in the direction of the [[Enamel Organ#Root|root]] apex.

==Crown-root fracture==

==Crown-Root Fracture==

A crown-root fracture involves the enamel, dentine and cementum. It can be further classified into complicated or uncomplicated.

A crown-root fracture involves the enamel, dentine and [[Enamel Organ#Cementum|cementum]]. It can be further classified into complicated or uncomplicated.

==Root fracture==

==Root Fracture==

A root fracture involves dentin, cementum and pulp and is generally complicated.

A root fracture involves dentin, cementum and pulp and is generally complicated.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The alveolus acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The [[Enamle Organ#Alveolar Bone|alveolus]] acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

==Endodontic treatment==

==Endodontic Treatment==

Treatment and prognosis of fractures depends on:

Treatment and prognosis of fractures depends on:

:The degree of displacement and mobility of the fracture segments

:The degree of displacement and mobility of the fracture segments

#Restoring the surface

#Restoring the surface

==Crown restoration==

==Crown Restoration==

Fractures with pulp exposure require endodontic treatment but the '''prosthodontic build-up of the crown''' is optional.  

Fractures with pulp exposure require endodontic treatment but the '''prosthodontic build-up of the crown''' is optional.  

It may be sufficient to simply close the fracture sites with composite resin.

It may be sufficient to simply close the fracture sites with composite resin.

'''Full crown restoration''' may be important for working dogs who rely on normally functioning teeth. It may also be of aethetic advantage in show dogs.

'''Full crown restoration''' may be important for working dogs who rely on normally functioning teeth. It may also be of aesthetic advantage in show dogs.

It may also be indicated to protect the tooth against '''further trauma'''. It will reduce the risk of further breakdown of the remaining tooth structure.

It may also be indicated to protect the tooth against '''further trauma'''. It will reduce the risk of further breakdown of the remaining tooth structure.

Restoration of the tooth structure may help prevent '''periodontal disease''' by preventing food entrapment in the gingiva.

Restoration of the tooth structure may help prevent [[Periodontal Disease|'''periodontal disease''']] by preventing food entrapment in the [[gingiva]].

'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.

'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

[[Category:To Do - Helen]]

 

[[Category:To Do - Review]]

[[Category:Teeth - Pathology]]

[[Category:Dental Diseases - Dog]]

[[Category:Expert Review]]