Case Study – Jackson (Saving mobile incisal teeth)

by Nicole Graham EqD

July, 2009 Jackson was presented to Performance Equine Dentistry (PED) for a second
Diagnosis opinion regarding mobile incisal teeth, and if there was a possibility of saving
them instead of the prescribed extraction offered.

PED DIAGNOSIS :

 103-Decay on gingival line-disto/labial.

 Sharp enamel points on311

 Gingival recession on 201-203 quadrant

 Gingival recession of molars-moderate

 Build-up of calculus on 304&404

 Remains of severe ETR along molar occlusal surface

 Mobile 201-complete gum recession

 201 abessated

 Incisal teeth dirty & discoloured, oral mucosa light pink in shade & not
very moist.

 Overbite of 200 Quandrant-restricting rostral mandibular excursions

 Enlargement of Temporal muscle Nearside {left}

 Unusual lesion within 103 gingival mucosa-could be mobile root

remnant?
July 09, 2010 PED TREATMENT PLAN:
First
Examination First Examination - Visible pain reaction from horse whilst palpating TMJ.
Protested viewing of Incisors & upset during examination. Horse lacked solid
top line.

July 15, 2010 First Treatment :

First Treatment
 Power reduction of sharp points on molar table.

 Reduction & Grind-in of Incisal teeth to remove locking overbite.

Clean and assess absessation.

 Discussion regarding change of diet to help promote weight gain & keep
oral cavity self- cleaning to stop the constant build-up of tartar
around gingival margins.

 Massage therapy of gums by owner, thrice weekly with herbal ointment

[AloeGel, Fennel & mint] to help stimulate for self-healing of the gums.

Discussion of options with owner:

1. removal of diseased teeth.
2. attempt to treat diseased teeth and save integrity of dental arch.

Option 2 was decided upon.

The gingival tissue has been quite damaged through periodontal disease, and
one first exam very inflamed and sore. Offered two avenues-schematic
treatments or antibiotics.

In the schematic theory, once the premaxilla and premandible are freed and
able to excurd fully, the pressure will be released throughout: incisal,
molar&TMJ.

Next Next appointment - Impression of Incisors.

Appointment
To manufacture special trays, used a skull of the same age as model. Obviously
when designing custom trays, the age inclination of the Pre Max & Mand must
be taken into account.

August 10, 2009 Impressions taken for the brace- not sedated.

The physical change in the horses head is very apparent. Jackson was not “head
sore”, he allowed the head palpations and invasive inspection before accepting
the special tray, loaded full of alginate-twice. Owner said increase in appetite
within days and she felt that he was happier and not in visible pain as he was.
The gum tissue was not as inflamed. The bright red abscess has begun to close
up. {Teeth still mobile}. Horse accepting of all invasive treatment including the
gum massage and TMJ exercises. Left temporal not as defined.

Jackson very obligingly having his impression taken.

The manufacture of the brace.

 Decided on Orthodontic wire gauge 10, this was bent around & along the buccal
& lingual surfaces of the Incisors.

Models where mounted on Adjustable Articulator to ensure no excursions are

impeded.

Advice sought from Dr. Geoff Storey regarding best materials to use to cement
/bond in place. Also regarding the filling of the 103 bm1/3

Advice sought regarding therapies used to help alleviate periodontal disease.

Articulation of models.

September 10, Try in of the brace.

2009

Jackson wore the brace until March 14, 2010. The brace was easily removed by
cutting the wires, then breaking the cement bond with a scalpel blade. The 103
 & 203 had no residual damage from the bracing.

The 301 (opposing tooth) had the incisal edge reduced below the line of
occlusion so as no pressure would be exerted onto the opposing 201.

June 03, 2010 At this appointment, the 201 had to be extracted. The periodontal tissue had
completely resorbed away-the tooth was loose the whole facial/buccal area.
The gum was not inflamed and the periodontal disease had not flared up. The
lingual of the tooth was elevated and the tooth fell out. There was minimal
bleeding from the socket.

June 19, 2010 Check-up to assess the socket and it’s healing.
Check Up
The socket was healed, nice pink in colour. Jackson was happy to have the gum
palpated and showed no pain reaction.

CONCLUSION In the case of Jackson, the brace was successful as it allowed the bone and
tissue to heal, and then expel the problem. The Alveolar bone, when x-rayed,
was dense and calcified in the area of the 201, so only minor lingual tissue
damage from the extraction.

This was a beneficial experiment as it allowed the cross-over of human dental

therapies to equine dentistry. The Professionals that worked on this case, Dr
Geoff Storey, Dr Emma Nichols and Ian Flintoff[advanced dental
prosthesis ]really enjoyed the experience and are happy to work together again
on other projects we developed.

Brace-molar bands on the 3#s hold the wire band (labial arch).
Nic Graham EqD
Phone: 0438 822 704
www.performancedentistry.com.au
info@performancedentistry.com.au