Intercanine bonding

RE: Intercanine bonding

Rob Davis — Mon, 09 Jan 2017 14:33:47 GMT

It shouldn't be a problem to remove it without damaging the teeth, my fault. I have used this sort of acrylic material for other applications on teeth in the past and have never previously damaged any teeth on removal.

RE: Intercanine bonding

Martin Atkinson — Sat, 07 Jan 2017 10:14:40 GMT

[quote user="Rob Davis"]Iatrogenic. I was probably trying to remove it a little too quickly[/quote]That was the one thing that bothered me about the method of fixation was removal without causing damage.

RE: Intercanine bonding

Rob Davis — Fri, 06 Jan 2017 19:20:22 GMT

Iatrogenic. I was probably trying to remove it a little too quickly as I was worried about the lack of intubation. Luckily there does not appear to be any pulp exposure, but it will need monitoring in due course.

RE: Intercanine bonding

Martin Atkinson — Fri, 06 Jan 2017 18:58:43 GMT

It looks as though the tip of the UR K9 is chipped. Was that iatrogenic or pre-existing?

RE: Intercanine bonding

Rob Davis — Fri, 06 Jan 2017 18:26:24 GMT

[quote user="Martin Atkinson"]How difficult is it to get the material off the teeth?[/quote]

I used a round diamond bur on high-speed handpiece to cut through it, then chipped off in chunks with extraction forceps and ultrasonic scaler. It would be much easier if they made it bright pink as it does look very like tooth material (not surprising as it's designed for making temporary crowns in people and most people prefer not to have bright pink teeth!) and you have to be a bit careful not to damage the crowns.

I did initially try to intubate endoscopically, but as I didn't manage it fairly quickly, I decided not to faff about and got on with removing it asap under incremental propofol, intubating as soon as I had freed up the jaw. I did have a tracheostomy tube to hand just in case, but was relieved not to need it!

RE: Intercanine bonding

Martin Atkinson — Fri, 06 Jan 2017 12:40:18 GMT

Looks good to me. How difficult is it to get the material off the teeth?

RE: Intercanine bonding

Rob Davis — Fri, 06 Jan 2017 12:29:02 GMT

Acrylic bonding removed today (2.5 weeks post application). Cat has coped really well (gained 230g with no tube feeding at all). Occlusion looks pretty good and all feels stable. The jaw is a little stiff to open, but I'm guessing that's to be expected after being immobilised. I'm cautiously optimistic at the moment...

RE: Intercanine bonding

Rob Davis — Wed, 21 Dec 2016 12:57:52 GMT

[quote user="Martin Atkinson"](notwithstanding the fact I initially came to this thread thinking it was going to be a dog behavioural discussion)[/quote]

I see what you mean - should have phrased that better!

[quote user="Martin Atkinson"]Any piccies of the cat post-bonding.[/quote]

[quote user="Peter Southerden"]

I premed as normal and then induce with propofol with enough to continue as an infusion until the bond has been broken.

You could intubate endoscopically with a fine urinary catheter and then pass your ET tube over the top of it.

[/quote]

Thanks, Pete.

RE: Intercanine bonding

Peter Southerden — Wed, 21 Dec 2016 11:33:22 GMT

I premed as normal and then induce with propofol with enough to continue as an infusion until the bond has been broken.

You could intubate endoscopically with a fine urinary catheter and then pass your ET tube over the top of it.

RE: Intercanine bonding

Martin Atkinson — Wed, 21 Dec 2016 11:28:35 GMT

Maybe I'm a bit dim (notwithstanding the fact I initially came to this thread thinking it was going to be a dog behavioural discussion)!, but I am struggling to visualise the technique you employed Rob and how the cat can lap if you've welded its maxillary and mandibular K9's together - or am I getting completely the wrong end of the stick? Any piccies of the cat post-bonding.

As for the question re intubation, given half of this forum doesn't seem to think you should/need to intubate cats for routine surgery, I wouldn't lose too much sleep over it!

RE: Intercanine bonding

Rob Davis — Wed, 21 Dec 2016 10:38:37 GMT

I'm sure this is going to be a daft question, but I have been lying awake last night thinking about it....

When I come to remove the bonding, how do I intubate? I guess I could use dom/ket/torb and use gravity alone to protect the airway, but I would feel happier with a tube in? How do others go about this?

RE: Intercanine bonding

Rob Davis — Tue, 20 Dec 2016 22:52:25 GMT

[quote user="Peter Southerden"]CT would define it more clearly[/quote]

Indeed! We did want to do CT, but the cat is not insured and so the owners decided against this.

Thanks for the input. I will try to remember to post an update in due course.

RE: Intercanine bonding

Evelyn Barbour-Hill — Tue, 20 Dec 2016 22:46:15 GMT

The ankylosis risk is an interesting subject and I don't think there's a simple answer or algorithm for its avoidance. Fixation has to be for long enough to achieve its purpose (and maybe a couple of weeks is enough when you are really just solving a soft tissue problem) yet not so long as to encourage ankylosis. And of course ankylosis may occur when no fixation is employed. It's always a worry, I think, don't you?

RE: Intercanine bonding

Peter Southerden — Tue, 20 Dec 2016 19:22:20 GMT

The left TMJ is abnormal. I suspect there is a fracture affecting the mandibular fossa/ articular eminence. The joint surface of the condyle also looks irregular. CT would define it more clearly.

I agree - MMF for three weeks maximum (possibly less). There is a risk of intra-articular ankylosis.

RE: Intercanine bonding

Rob Davis — Tue, 20 Dec 2016 19:11:55 GMT

Thank you

Can you see anything of significance on the radiographs?

RE: Intercanine bonding

Evelyn Barbour-Hill — Tue, 20 Dec 2016 18:08:07 GMT

Consider doing so after 3 weeks.