RE: Is it recommended to do a crown amputation in a cat with stomatitis?

Evelyn Barbour-Hill — Tue, 12 May 2020 16:29:47 GMT

[quote userid="2161" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29074/is-it-recommended-to-do-a-crown-amputation-in-a-cat-with-stomatitis/222253"]Sometimes the resorption extends only half way up the root, in which case try to remove as much "normal' root as possible (effectively a low crown amputation).[/quote]

Quite so.

Which is why I slightly dislike the term "crown amputation" What we are doing is removing as much as possible, while "crown amputation" to me suggests just slicing the crown off.

One thing that is certain is that in many extraction situations, a broken root tip can be left in as long as it is well buried, and depending upon the original reason for extraction, if the trauma necessary to remove it outweighs the possible harm from leaving it. However this is not the case in feline chronic gingivostomatitis complex – if a root tip is left, the procedure will fail. I'm not sure that we truly understand why.

RE: dentistry

Rachel Perry — Mon, 04 May 2020 08:27:16 GMT

This is a great question and one of the contraindications for a crown amputation, is in cats with stomatitis.

However, let's break this down and think it through logically. We perform crown amputation in radiographically confirmed cases of type 2 resorption, which is essentially external replacement resorption. This means tooth substance has been resorbed by the odontoclasts, and replaced by bone. i.e. there is no root left, and what we are removing is crown substance just below the level of alveolar bone, and then suturing the gingiva closed. So, if you were to try and perform a full extraction on a tooth undergoing type 2 resorption, you would undoubtedly cause a lot of unnecessary trauma, and potentially fracture the jaw.

Remember radiographically type 2 resorption can be identified not only by the lack of periodontal ligament space, but also because the root radiodensity is reduced to that of bone (compared to more radio dense root). Sometimes the resorption extends only half way up the root, in which case try to remove as much "normal' root as possible (effectively a low crown amputation).

The key thing to remember with stomatitis extractions is that they must be performed under radiographic control by a surgeon competent and confident in feline extractions. Research has shown these cats are likely to have periodontitis and type 1/inflammatory resorption, which means full extractions are therefore required.

Farcas N, Lommer MJ, Kass PH et al. Dental radiographic findings in cats with chronic gingivostomatitis (2002–2012). J Am Vet Med Assoc 2014; 244 (3): 339-345