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Feline Odontoclastic Resorptive Lesions (view source)
Revision as of 15:46, 30 August 2013
, 15:46, 30 August 2013no edit summary
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==Treatment==
Currently, the suggested methods of managing odontoclastic resorptive lesions are:
==Treatment==
# Conservative management'''
# Tooth extraction
# Coronal amputation.
Historically, restoration of the tooth surface has been recommended for the treatment of accessible lesions that extend into the dentine and do not involve pulp tissue. However, several studies have shown that tooth resorption continues and the restorations are lost. Consequently, the use of restoration of odontoclastic lesions as a major treatment technique cannot be recommended.
===Conservative management===
This consists of monitoring the lesions clinically and radiographically. This approach is recommended for lesions that are not evident on clinical examination, i.e. only seen radiographically, and there is no evidence of discomfort or pain. In general practice, most lesions are only diagnosed when pathology is extensive and conservative management is rarely an option.
In most cases, extraction or coronal amputation of an affected tooth is indicated. Preoperative radiographs are mandatory to allow selection of the appropriate treatment option.
===Extraction===
Teeth with resorption are notoriously difficult to extract, as the root is resorbing and being replaced by bone-like tissue. Moreover, there are areas of ankylosis, i.e. fusion of bone and tooth substance, along the root surface.
Teeth affected by resorption can be extracted using a closed technique, but an open technique is usually less traumatic to the tissues and easier to perform. The teeth are often prone to fracture so an open technique allows good access to any root fragments remaining.
===Coronal amputation===
The indications for, and outcome of, coronal amputation have been well documented and the procedure is recommended for selected cases, but needs radiographic monitoring at regular intervals postoperatively to ensure that the root is resorbing and that healing is uneventful. In brief, the technique involves raising a gingival flap to expose the margin of the alveolar bone. The crown of the affected tooth is amputated using a small round bur. A small amount of root tissue is also removed with the bur, just enough to ensure that the intentionally retained root(s) is (are) apical to the alveolar margin. The gingival flap is replaced and sutured in place. This technique is only appropriate for teeth that do not have any radiographic evidence of endodontic disease (ie. periapical inflammation) or [[periodontitis]], and teeth in cats with gingivostomatitis should be removed entirely.
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