6 month old dog with overshot jaw

RE: 6 month old dog with overshot jaw

Peter Southerden — Sun, 06 Mar 2016 23:18:52 GMT

I just mix as much as I need at the time. I would certainly not use two separate pouches.

RE: 6 month old dog with overshot jaw

Evelyn Barbour-Hill — Sat, 05 Mar 2016 15:38:54 GMT

[quote user="Rob Davis"]Would you not expect ball therapy to tilt the teeth mesially as well as buccally, which would be undesirable in this case.[/quote]

Well, maybe, I don't think it's really that precise. And I don't think. looking at the photos, that they could tilt mesially because they'd be blocked by the upper canines. Ball therapy is such an imprecise thing, I think it can only tilt teeth in a direction they are going to be directed by occlusion anyway – the direction they are just waiting to go in anyway, if you see what I mean.

[quote user="Rob Davis"]92% success rate with MTA, 58% success with Ca(OH)2.... I've so far not used MTA as it's so expensive, but perhaps I should rethink![/quote]

Look into BioDentine. Early results suggest it might be the bees' knees.

RE: 6 month old dog with overshot jaw

Rob Davis — Sat, 05 Mar 2016 10:23:42 GMT

[quote user="Evelyn Barbour-Hill"]You could start "ball therapy" right now: you never know, with a bit of luck it might be all that's necessary[/quote]

Would you not expect ball therapy to tilt the teeth mesially as well as buccally, which would be undesirable in this case.

RE: 6 month old dog with overshot jaw

Rob Davis — Sat, 05 Mar 2016 10:21:20 GMT

[quote user="Peter Southerden"]Vital pulp therapy in dogs:190 cases (2001-2011) JAVAMA 2014 Feb 15, 244 (4): 449-59[/quote]

92% success rate with MTA, 58% success with Ca(OH)2.... I've so far not used MTA as it's so expensive, but perhaps I should rethink!

On this sort of case, where you are doing direct pulp capping on two teeth in one procedure, do you have to use 2 pouches of MTA, or do you only mix half of it initially? Using 2 pouches would seem to be extravagant!

RE: 6 month old dog with overshot jaw

Evelyn Barbour-Hill — Fri, 04 Mar 2016 21:02:11 GMT

[quote user="Nicola M"]Any recommended dental specialists in the cambridgeshire area (or within travelling distance of cambs if not)?[/quote]

Go to www.bvda.co.uk and go to "Members offering advanced dental services"

RE: 6 month old dog with overshot jaw

Nicola Cole — Fri, 04 Mar 2016 20:21:39 GMT

Brilliant, thanks so much for the replies. It's the worst one I've see and referral is an option for the owners so I'll let them know. Any recommended dental specialists in the cambridgeshire area (or within travelling distance of cambs if not)?

RE: 6 month old dog with overshot jaw

Peter Southerden — Fri, 04 Mar 2016 20:12:37 GMT

Vital pulp therapy in dogs:190 cases (2001-2011) JAVAMA 2014 Feb 15, 244 (4): 449-59

RE: 6 month old dog with overshot jaw

Evelyn Barbour-Hill — Fri, 04 Mar 2016 20:05:21 GMT

Well. It's not going to be possible to restore anything like a normal occlusion and all we are concerned with is removing a traumatic occlusion.

You could start "ball therapy" right now: you never know, with a bit of luck it might be all that's necessary. If that fails, I would guess from the pictures that an orthodontic appliance of the inclined plane type would tilt the lower canines buccally quite nicely. The end result would look a bit odd, lower canines caudal to the upper, but then the dog's overshot so it's going to look odd anyway. The point is, the occlusion would no longer be traumatic.

Or, the teeth can be shortened by just enough so that they are fractionally clear of the opposing gum on full closure. Which implies pulp capping of course.

I've been criticised for this before, but in my opinion in such a case my preference would be for tooth shortening. It gets the job done immediately and spares the dog six weeks or more of an appliance stuck in its mouth... during which time all sorts of things can, and sometimes do, go wrong. Pulp capping in such cases may not be 100% successful (is anything ever 100% successful?) but it must be close, because the pulp exposure is small, clean, and brief. Yes, you need to have the patient back for a radiograph – but with orthodontics you have to have the patient back at least once, for device removal, and that's assuming everything goes well.

[quote user="Rob Davis"]PS You may find that once the canines have been sorted, the mouth closes more fully and the lower incisors start to impinge on the palate....[/quote]

Yes, of course, this is inevitable with an overshot. It doesn't matter. Those incisors will probably make permanent indentations in the palate soft tissue. But they won't go any deeper or do any harm. Because, although in such a case incisors-to-palate will be the first contact that's made on closure, once the mouth is fully closed, with the more distal molars intercuspating, it's fully closed.

RE: 6 month old dog with overshot jaw

Rob Davis — Fri, 04 Mar 2016 19:59:04 GMT

[quote user="Peter Southerden"]Crown amputation at the height of the mandibular third incisors, vital pulpectomy, direct pulp capping with MTA and restoration. A recent study by Helena Kuntsi Vaattovaara showed that this technique using MTA had around the same success as conventional root filling. [/quote]

That's interesting, do you know where I can find that paper?

[quote user="Peter Southerden"]Again I agree with Rob[/quote]

Wow, you've agreed with me twice in one day

RE: 6 month old dog with overshot jaw

Peter Southerden — Fri, 04 Mar 2016 19:54:10 GMT

Again I agree with Rob that this isnt a case that should be left. Because of the indentation that the right mandibular canine is sitting in, the right mandible is fixed in relation to the maxilla. The left may already be occluding caudal to the left maxillary canine (mesial and distal relate to tooth surfaces - if you are describing the position of a structure in relation to another then rostral/caudal) though I can't see this on the photo. The lower jaw consequently will be deviated to the left.

The options are:

1. Extraction of the mandibular canine teeth - suboptimal and not recommended.

2. Orthodontic movement of both mandibular canines so that they are occluding caudal to the maxillary canines and the lower jaw is positioned centrally. This should work but it is possible that the crown height of the mandibular canine teeth may not give adequate retention once the appliance has been removed.

3. Crown amputation at the height of the mandibular third incisors, vital pulpectomy, direct pulp capping with MTA and restoration. A recent study by Helena Kuntsi Vaattovaara showed that this technique using MTA had around the same success as conventional root filling.

Given the the sleepless nights that orthodontic procedures can cause and the consistent results achieved with crown amputation, No 3 would be my preferred option though either 2 or 3 would be acceptable. This is definitely a case for referral unless you have the relevant experience.

Yours Pete

RE: 6 month old dog with overshot jaw

Rob Davis — Fri, 04 Mar 2016 18:54:42 GMT

It's slightly difficult to see well from the photos... but I would suggest that a wait and see approach is not going to work. I would advocate intervention sooner rather than later, and if you don't have any experience with orthodontics then I would advise referral.

If there is room for the lower canines to occlude distal to the upper canines, then an acrylic plane may work, or possibly acrylic crown extensions, but it's very difficult to assess properly without seeing the dog. Crown shortening with pulp capping would be an option, but it would be preferable to keep the teeth intact if possible, and pulp capping has a higher failure rate than conventional root canal treatment which would not be possible at this age as the root apices will not have closed.

I'm sure Evelyn and Pete will appear with more expert advice shortly!

PS You may find that once the canines have been sorted, the mouth closes more fully and the lower incisors start to impinge on the palate....

RE: 6 month old dog with overshot jaw

Nicola Cole — Fri, 04 Mar 2016 17:27:17 GMT

Brilliant-thanks Gillian!

RE: 6 month old dog with overshot jaw

Gillian Mostyn — Thu, 03 Mar 2016 21:56:44 GMT

Yes - you can't copy and paste directly. You need to go to the 'insert media' icon in the 'write post' box (the one below the left align formatting symbol) and then insert the files from there.

RE: 6 month old dog with overshot jaw

Nicola Cole — Thu, 03 Mar 2016 20:16:56 GMT

Oh no, I included three photos and they seem to have disappeared. whats the best way to upload them (on an iPad)? I just did copy and paste and it doesn't seem to have appreciated it!