Granulation tissue was debrided and rough bone was smoothed with a curette prior to proceeding with the procedure. Generally
5 mm of root is excised with the aid of a bur on a high-speed handpiece following removal of the bone on the vestibular (lateral)
aspect of the root tip. Special tips placed upon a piezoelectric scaler (Photo 3) aid in removing several millimeters of gutta
percha to make room for the root-end filling material.
Photo 6: The radiographic appearance of the MTA placement and synthetic bioglass within the bone defect. A slight change in
radiodensity at the root end represents the MTA vs. gutta percha.
Although a variety of compounds historically have been used to seal the root tip, mineral trioxide aggregate (MTA) is a compound
that is now widely accepted as a root-end filling material. Special instruments facilitate mixing and placement. In several
hours this biologically friendly cement hardens to seal the root canal (Photo 4).
In this case, a synthetic bone-graft particulate was used to fill the massive void in the bone that was left following
removal of the granulation tissue and root-tip removal (Photos 5 and 6).
Resolution of the lesion was rapid. The clients, although not aware of any activity changes prior to surgery, mentioned positive
activity and attitude changes three days postoperatively. Radiographic follow-up has not been an option in this case due to
owner reluctance in light of continued clinical resolution and other more pressing medical issues.
Root-canal therapy in this case failed to resolve the fistula. It is likely that the degree of bone destruction prior to therapy
was so extensive that root-canal therapy would fail regardless. It could be that the perfect fill was not attained, resulting
Unfortunately, most of our patients with endodontic disease don't show gross changes like this patient. Radiographic evidence
usually is the only way to definitively recognize pulp death with associated root-canal diameter and periapical changes. Keep
this in mind when evaluating the dentition of all of your patients. Proper diagnostics will minimize the potential for severe
disease and fistula formation as seen in this patient.
Brett Beckman DVM, Dipl. ACVD, Dipl. AAPM
Dr. Beckman is acting president of the American Veterinary Dental Society and owns and operates a companion-animal and
referral dentistry and oral surgery practice in Punta Gorda, Fla. He sees referrals at Affiliated Veterinary Specialists in
Orlando and at Georgia Veterinary Specialists in Atlanta, lectures internationally and operates the Veterinary Dental Education
Center in Punta Gorda.
For a complete list of articles by Dr. Beckman,