Dental fracture

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• Fracture of tooth may expose pulp that will become infected and eventual periapical abscessation.
   Pulp exposure is painful.
• Cause: traumatic and iatrogenic.
• Treatment: endodontics to attempt to save tooth, extraction.
• Signs: visible damage, signs of pain not always obvious.
• Prognosis: requires treatment of other problems.

• Pain. (rare presentation).
• Periodontal disease as well as:
  • Visible tooth damage.
  • History of trauma.

• Trauma - road traffic accident, fights (rare cause).

• Exposure of pulp due to fracture inflammation and infection of pulp necrosis of pulp periapical abscessation.
• If dentin intact, breakdown products of pulp necrosis cause discoloration of tooth.
• Sharp edges of fracture injure oral soft tissues (very common to find tongue injury due to contact with tooth).

• Instantaneous, effects immediate.

• Pain.
• Infraorbital swelling when maxilliary fourth premolar appelted.

• Recent injury.
• Pain.

• Obvious tooth fracture.

• Black spot on fractured tip of crown (exposed pulp cavity).

• To check for root fracture, longitudinal fractures, other possible complications.
• To check for periapical pathology (difficult to diagnose periapical abscess by radiography).

• Signs.
• Radiology.

Either Endodontics - pulp is exposed or killed provided no extension of periodontal disease or extensive absorption of alveolar bone.
 Do not use for long axis tooth fracture, root fracture in coronal 2/3rds of root - instability likely.
Or Pulpotomy if recent fracture, ie fresh and possibly still bleeding in young animal.
 Success greatest if least delay after incident (2-36 hours at most)
Or Long-standing fractures require root canal therapy (pulpectomy).
Or Extraction : - if - long axis root fracture, root fracture in coronal 2/3rds if root, teeth with crown fracture and no endodontic treatment authorized.

• Antibiotics: 8 day course of clindamycin .

• Radiography: comparative films at time of surgery and 6 months post-operatively. Show thickening of dentinal wall and dentinal bridge over the pulp.

• Reasonable: if pulpotomy performed while fracture fresh.
• Good: if root canal therapy (pulpectomy).

• Pulpotomy: presence of dentinal bridge over pulp demonstrated on radiograph 6 months after procedure and absence of apical rarefaction with root canal therapy, absence of clinical signs (discomfort).

• Pulpotomy performed when pulp contaminated.
• Poor surgical technique.

• Recent references from PubMed.
• Bennett J W et al (1994) Dental composite for the fixation of mandibular fractures and luxations in 11 cats and 6 dogs. Vet Surg 23 (3), 190-194 PubMed.
• Davidson J R & Bauer M S (1992) Fractures of the mandible and maxilla. Vet Clin North Am Small Anim Pract 22 (1), 109-119 PubMed.

• K A Crossley BVet Med FAVD, Animal Medical Centre, 511 Wilbraham Road, Charlton, Manchester M21 0UB, UK. Tel: 0161 881 3329 Fax: 0161 861 8553.

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