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Contents Focus on Dentistry September 18-20, 2011 Albuquerque, New Mexico Contents Focus on Dentistry September 18-20, 2011 Albuquerque, New Mexico Thanks to sponsors Boehringer Ingelheim Vetmedica, Equine Specialties, Pfizer Animal Health, and Capps Manufacturing, Inc. for supporting the 2011 Focus on Dentistry Meeting. Sunday, September 18 Peridental Anatomy: Sinuses and Mastication Muscles ............................................... 1 Victor S. Cox, DVM, PhD Dental Anatomy .................................................................................................................8 P. M. Dixon, MVB, PhD, MRCVS Equine Periodontal Anatomy..........................................................................................25 Carsten Staszyk, Apl. Prof., Dr. med. vet. Oral and Dental Examination .........................................................................................28 Jack Easley, DVM, MS, Diplomate ABVP (Equine) How to Document a Dental Examination and Procedure Using a Dental Chart .......35 Stephen S. Galloway, DVM, FAVD Equine Dental Radiography............................................................................................50 Robert M. Baratt, DVM, MS, FAVD Beyond Radiographs: Advanced Imaging of Equine Dental Pathology .....................70 Jennifer E. Rawlinson, DVM, Diplomate American Veterinary Dental College Addressing Pain: Regional Nerve Blocks ......................................................................74 Jennifer E. Rawlinson, DVM, Diplomate American Veterinary Dental College Infraorbital Nerve Block Within the Pterygopalatine Fossa - EFBI-Technique .......82 Carsten Staszyk, Apl. Prof., Dr. med. vet. Monday, September 19 Developmental Craniofacial Abnormalities and Disorders of Development and Eruption of the Teeth ...............................................................................................85 P. M. Dixon, MVB, PhD, MRCVS Acquired Disorders of Equine Teeth ..............................................................................93 P. M. Dixon, MVB, PhD, MRCVS EOTRH: Macroscopical and Pathohistological Investigations .................................105 Carsten Staszyk, Apl. Prof., Dr. med. vet. Etiology of the Syndrome Involving Equine Odontoclastic Tooth Resorption and Hypercementosis: An In-Depth Evaluation of 15 Cases to Determine Any Possible Causes or Associations ............................................................................109 Edward T. Earley, DVM, FAVD/Eq Clinical Management of Equine Odontoclastic Tooth Resorption and Hypercementosis .....................................................................................................112 Robert M. Baratt, DVM, MS, FAVD Equine Odontoclastic Tooth Resorption and Hypercementosis Syndrome in the United States ...................................................................................................................... 117 Rebecca C. Smedley, DVM, MS, Diplomate ACVP How to Recognize and Clinically Manage Class 1 Malocclusions in the Horse .......120 Robert M. Baratt, DVM, MS, FAVD Skeletal Abnormalities in the Equine Skull .................................................................131 Edward T. Earley, DVM, FAVD/Eq Pulp Happens – How to Perform Vital Pulp Therapy ...............................................134 Jennifer E. Rawlinson, DVM, Diplomate American Veterinary Dental College Deciduous Tooth Management .....................................................................................141 Jack Easley, DVM, MS, Diplomate ABVP (Equine) Equine Oral Extractions................................................................................................147 Jack Easley, DVM, MS, Diplomate ABVP (Equine) Tuesday, Tuesday, September 20 Periodontal Disease Research and Treatment – UK Experiences .............................153 P. M. Dixon, MVB, PhD, MRCVS Surgical Extraction of Canine Teeth ............................................................................160 Jennifer E. Rawlinson, DVM, Diplomate American Veterinary Dental College Review of Anatomy and Surgery of the Paranasal Sinuses of Horses ......................... 165 Jim Schumacher, DVM, MS, MRCVS, Diplomate ACVS Minimally Invasive Transbuccal Surgery and Screw Extraction .............................170 Manfred Stoll, DVM Surgical Extraction of Mandibular Cheek Teeth via Alveolar Bone Removal ........178 Jennifer E. Rawlinson, DVM, Diplomate American Veterinary Dental College Dental Repulsion ............................................................................................................184 Jack Easley, DVM, MS, Diplomate ABVP (Equine) Restorative Dentistry in Horses ....................................................................................196 Stephen S. Galloway, DVM, FAVD Endodontic Treatment of Equine Incisors ..................................................................204 Robert M. Baratt, DVM, MS, FAVD Applied Bitting to Dental Disease .................................................................................209 Jack Easley, DVM, MS, Diplomate ABVP (Equine) Peridental Anatomy: Sinuses and Mastication Muscles Victor S. Cox, DVM, PhD Author’s address: College of Veterinary Medicine, University of Minnesota, 1988 Fitch Ave. (Room 295), St. Paul, MN 55108; e-mail: [email protected]. Take Home Message The paranasal sinuses are closely related to the caudal maxillary cheek teeth and several cranial nerve branches. Dental disease can spread to these sinuses leading to nasal discharge and the possibility of serious neurological complications. Access to the sinuses should avoid damage to the infraorbital canal and nasolacrimal duct. Introduction Peridental entities such as the paranasal sinuses and mastication muscles play important roles in dental disease processes. This presentation is intended to describe the anatomy of these subjects. The paranasal sinuses of the horse are formed by extension of the lining of the nasal cavity between external and internal plates of several skull bones.1 Much of this process occurs after birth.1 The frontal and maxillary bones1-7 are the main ones “excavated”1 to form the paranasal sinuses, but also, the sphenoidal and palatine bones are involved in sinus formation.6 Additionally these sinuses invade the dorsal, ventral and ethmoidal conchae (turbinates). Like the nasal cavity, right and left sinuses don’t communicate.1 The maxillary sinus of the horse is large and divided into rostral and caudal compartments.1-5,7 The facial crest is a landmark for the maxillary sinuses which lie between the boney orbit and the infraorbital foramen and deep to the facial crest. The paranasal sinuses drain into the middle nasal meatus via slit like nasal maxillary apertures8-10 that come from both the rostral and caudal maxillary sinuses. The frontal sinus of other species communicates directly with the nasal cavity, but the equine conchofrontal sinus communicates with the nasal cavity indirectly by way of the caudal maxillary sinus.1 While the nasomaxillary apertures are thin and cryptic, the frontal maxillary opening is a large oval passage that is easily seen. The conchofrontal sinus drains into the dorsal aspect of the caudal maxillary sinus and the small sphenopalatine sinus drains into the ventral part of the caudal maxillary sinus.7 In the horse the main mastication muscles are the masseter and pterygoid muscles while the temporal and digastric muscles are of lesser significance.11,12 The masseter muscle lies lateral to the mandible while the medial and lateral pterygoid muscles attach to the medial side of the mandible. The medial pterygoid muscle is considerably larger than the lateral pterygoid muscle and the mandibular nerve passes between them.12 The latter muscle attaches close to the temporomandibular joint. Grinding movement of the cheek teeth is the result of synergistic action of the masseter and pterygoid muscles acting together to cause lateral/medial movement of the mandible.12 The masseter muscle has superficial and deep parts. The superficial part 1 attaches to the ventral and caudal margins of the mandible while the deeper part has more vertical fibers and attaches to the lateral side of the mandible.12 Materials and Methods In addition to traditional dissection methods, transverse bandsaw sections of cadaver heads were made to correlate with computed tomographic (CT) images from a live horse. Lateral radiographs of hemisected cadaver heads were used to create images free of overlapping structures on right and left sides. Results The frontal sinus of the horse is continuous with the dorsal conchal sinus forming a conchofrontal sinus. This sinus is the most dorsal of the paranasal sinuses; the maxillary sinuses are more ventral and lateral. The conchofrontal sinus communicates with the caudal maxillary sinus via the large oval frontal maxillary opening (Fig. 1) that lies medial and slightly rostral to the boney orbit. Figure 1. CT section of the head of a live 7 year old Warmblood horse at the level of the last cheek tooth (11). CF = conchofrontal sinus, CM = caudal maxillary sinus, VS = vental conchal sinus, asterisk = lumen of endotracheal tube, arrows as follows, yellow = in the frontomaxillary opening, white = nasolacrimal duct, blue = facial crest, red = infraorbital canal, green = groove for great palatine artery which supplies the hard palate. 2 The dorsal concha was clearly attached to the other ethmoidal conchae (Fig. 2). The middle concha contained a space that opened to the caudal maxillary sinus or was not open. The ventral concha was not related to the ethmoidal conchae
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