Intermediate/advanced

The presentation will focus on the advantages of piezoelectric instrumentation in oral and maxillofacial surgery, emphasizing its precision, selective cutting properties, reduced trauma to surrounding soft tissues, and potential benefits in promoting improved healing and postoperative outcomes.
It will also focus on the role of (targeted) neoadjuvant therapies in the management of oral tumors, highlighting their potential to reduce tumor burden prior to surgery, improve resectability, and contribute to more favorable oncologic and functional results.

Objective: To describe a naso-facial reconstruction technique following bilateral rostral maxillectomy and its functional and cosmetic outcomes.
Animals: Three dogs.
Study design: Clinical case series.
Methods: Three dogs were presented with a right rostral maxillary mass. Preoperative biopsy and staging revealed a biologically high-grade and histologically low-grade fibrosarcoma (Hi-Lo FSA) in two dogs and a papillary squamous cell carcinoma in one dog. A combined nasal planectomy and radical bilateral rostral maxillectomy was performed, sparing the labial/buccal mucocutaneous flaps bilaterally. Surgery resulted in asymmetry of the width of the flaps; the narrower flap was rotated medially to reconstruct the lip and create an oral vestibule. The wider flap was rotated medially to cover the remaining dorsolateral opening of the nasal conchae. The flaps overlapped in a parallel manner, discretely concealing the nasal passages and separating them from the oral cavity. Haemorrhage occurred in all dogs, with one dog requiring a blood transfusion postoperatively.
Results: Oral Hi-Lo FSA with tumour-free margins was confirmed in two dogs, and a papillary squamous cell carcinoma with tumour-free margins in the last dog. All dogs recovered uneventfully within 4 weeks. Owners reported being very satisfied with the functional (return to normal exercise/activities and uncompromised respiration) and cosmetic outcomes. Based on the owners' telephone follow-up, no tumour recurrence was noted at 36 (Dog 1), 24 (Dog 2), and 6 (Dog 3) months postoperatively.
Conclusion: The full-thickness bilateral labial/buccal rotational flaps were used successfully to reconstruct the rostral maxilla, external nose and facial defects involving the nasal cavity. The technique resulted in acceptable functional and cosmetic outcomes and can be considered for naso-facial reconstruction in selected cases.

This lecture will be a case discussion of a young dog with a diagnosis of papillary squamous cell carcinoma on the left caudal maxilla. The process of the surgical planning and treatment will be discussed in detail. Post operative recovery and two year follow up including computed tomographic evaluation will also be presented.

Single-Access Endodontic Treatment of the Maxillary Carnassial Tooth in Dogs: A Conservative Technique Based on Clinical Experience and Modern Materials
Author:
Dr. Philippe ROUX, Dipl. EVDC
Dentovet Sàrl, Lausanne, Switzerland

Abstract:
Introduction:
Endodontic treatment of the maxillary fourth premolar (P4) in dogs remains a technical challenge due to the complex and irregular anatomy of its three roots. Traditional approaches often require multiple access points, leading to excessive removal of healthy dental tissue and increasing the risk of weakening the tooth structure, particularly the crown.
Objective:
To present a conservative, single-access endodontic technique developed through clinical experience and anatomical observation. This approach aims to minimize hard tissue loss while ensuring effective canal debridement and shaping.
Technique Overview:
The technique is based on a strategic vestibular access through the natural fracture line commonly found at the tip of the main cusp. This allows direct entry to all three root canals from a single point, reducing the need for invasive secondary accesses. The method leverages the use of highly flexible nickel-titanium (NiTi) files, which adapt well to sharp curvatures and angulated canal entries. In addition, modern adaptive file systems are employed to respect the individual morphology of each canal, removing only the dentin necessary for effective cleaning and shaping. This approach prioritizes preservation of the coronal and radicular structure, reducing the risk of post-treatment fracture.
Clinical Rationale:
The combination of anatomical understanding, minimally invasive access, and modern instrumentation provides a technique that is both conservative and practical. It allows for effective endodontic treatment while maintaining the structural integrity of the tooth, especially in cases where the crown is already compromised.
Conclusion:
This single-access conservative technique offers a valuable alternative to conventional multi-access methods in veterinary endodontics. Rooted in clinical experience and supported by recent advancements in endodontic materials, it emphasizes structural preservation, functional restoration, and long-term success. Further sharing and refinement of this approach across clinical settings are encouraged.

Introduction:
Root canal therapy (RCT) has become a standard and conservative alternative to extraction in dogs, allowing preservation of strategic teeth. The success of RCT depends on effective canal disinfection and a dense, three-dimensional obturation. In human dentistry, ultrasonic activation has been shown to improve irrigant penetration and obturation homogeneity, but this technique has not previously been evaluated in veterinary patients.
Objectives:
This study aimed to describe and assess the outcome of a standardized endodontic protocol that combines passive ultrasonic irrigation (PUI) with ultrasonic-assisted thermoplasticised obturation in canine teeth, using cone-beam computed tomography (CBCT) for postoperative evaluation. To our knowledge, this is the first veterinary study to incorporate ultrasonic activation into both cleaning and obturation phases of endodontic treatment.
Materials and Methods:
Medical records and CBCT scans from 47 dogs (53 canine teeth) treated at AzurVet (2012–2024) were reviewed. All teeth had complicated crown fractures diagnosed as irreversible pulpitis or pulp necrosis. Root canal preparation followed standard veterinary endodontic guidelines. Irrigation was performed with 3% NaOCl activated ultrasonically in three 10-second cycles, followed by 17% EDTA. Obturation used ultrasonic spreaders and pluggers for lateral and vertical thermocompaction of gutta-percha cones coated with zinc oxide eugenol sealer. Outcomes were classified on follow-up CBCT (3–24 months) as success, NEF, or failure according to ESE criteria.
Results:
Overall, 87% of treated teeth were classified as successful, 4% NEF, and 9 % as failures. When pulp status was considered, all irreversible pulpitis cases healed completely (100%), while necrotic pulpitis cases achieved 75% success, 6% NEF and 16% Failure. The use of ultrasonic irrigation appeared to improve cleaning of the apical delta, while ultrasonic obturation produced a denser and more homogeneous fill compared to conventional cold lateral condensation. The technique was well tolerated, and no adverse heat effects were recorded.
Conclusion:
Ultrasonic-assisted root canal therapy combining PUI and thermoplasticised ultrasonic obturation provided predictable clinical and radiographic success, particularly in early pulpitis cases. This protocol enhances canal debridement and sealing quality in long, narrow canine roots and may shorten operator time. To our knowledge, this is the first report describing ultrasonic cleaning and obturation as an integrated approach in veterinary endodontics. Further prospective studies are warranted to confirm long-term benefits and to refine clinical application in complex endodontic cases.

This lecture will review the findings of a micro-CT study1 of the pulp cavity anatomy of Maxillary fourth premolar teeth in dogs. Some of the relevant observation for root canal treatment were the variations in the number and shape of pulp horns, the variations in the localization of root canal orifices, and the 150° curve in the palatal canal under the protocone. With regards to those findings, tricks, opinions or further questions will be discussed and will cover coronal access localization and angulation, instrumentation of the pulp chamber and of the pulp canals.

Morin MC, D'Astous J. A micro-CT study of the pulp cavity morphology of maxillary fourth premolar teeth in dogs. Front Vet Sci. 2024 Nov 15;11

There are multiple treatment options for difficult to treat endodontically compromised teeth or for teeth with failed endodontic treatment. Apicoectomy (surgical root canal) is an effective treatment in these cases. The appropriate treatment for some failed endodontic procedures is retreatment. Treatment options for a tooth with a diseased apex may include treatment with MTA, extraction, or apicoectomy. Some compromised teeth with no apical disease may require close monitoring only. Factors in the decision making process include the radiographic appearance of the tooth, health of the apex, and previous treatments. When apicoectomy is the chosen treatment, the procedure requires specific equipment due to the small area of access to the apex. MTA or other bioceramic materials are the preferred apical fill products. Performing a successful apicoectomy procedure requires accurate location of the apex, removal of an adequate amount of the apex, appropriate cleaning, adequate apical fill, and appropriate closure. Case presentations will be provided.

Dentin bonding is the commonly used term for the application of unfilled or partially-filled restorative materials to exposed dentin and enamel surfaces to seal or close exposed enamel and dentin tissue. The use of adhesives has many applications in veterinary dentistry, both as part of composite resin application or a “stand-alone” therapeutic option. In this presentation we will focus on the use of resin adhesives to treat uncomplicated crown fracture or acutely exposed dentin tissue. In order to understand when to use dentin sealants, it is also important to understand when not to use them. This requires a discussion of anatomy and the dentin-pulp complex as well as a discussion of product choices.

The term bonded sealant is used loosely in dentistry and can be confusing if taken literally. Hours can be spent on the discussion of the various types of products available to use for this purpose. These products are micromechanically interlocked into the dentin and enamel with resin tags that interlock into the prepared demineralized dentin collagen fibril mesh, creating a dentin-resin hybrid layer. They can be used alone to seal the tooth surface or to bond or adhere composite resins or other materials to the tooth. The typical products used can be resins, glass ionomers, or pit and fissure sealants. They can be unfilled or filled.

Products used as bonded sealants need to be chosen based on multiple factors and I would posit that one size fits all may not be applicable in our veterinary patients. The majority of our products are designed for human usage, occlusal forces, and oral environment. Our veterinary patients (primarily dogs) have a different oral environment, different occlusal forces, dietary substrates, more densely packed and ovoid dentin tubules, and thinner enamel.

There is no consensus on when to apply a dentin adhesive to “seal” uncomplicated crown fractures and enamel fractures. There are multiple factors that should be considered when making this decision and, in some areas, the research is limited or inconclusive for treatment of uncomplicated crown fractures and defects. As part of the dentin-pulp response to injury, the odontoblasts can create regenerative dentin or the mesenchymal cells in the pulp tissue can differentiate and replace lost odontoblasts to make reparative dentin. If sufficient barrier is created and reversible pulpitis is present, the tooth can survive if the source of irritation or trauma is removed. The preparation for and placement of a bonded sealant may disrupt or destroy the barriers put in place by the tooth.

Intraoral imaging is required and should be considered in conjunction with a complete periodontal examination. If radiographic findings of endodontic disease or terminal periodontal disease are present, alternative therapy (root canal therapy, periodontal surgery, or extraction) should be considered.

A review of application and use principles will be included.

An overview of indications for prosthodontic crown therapy, the feather margin preparation of canine teeth, as well as a review of materials, success rate for this method, and reasons for failure.