Evaluationof the ClinicalPerformanceand Effectiveness

of Adhesively-Bonded MetalGrownson
DamagedCanineTeethof WorkingPogs
Overa Two-to S2-MonthPeriod-

Andries van Foreest.DVM

Joost Roeters,DMD, PhD

Summary: In this clinical study, 41 metal full crown restorations of canine teeth were
placed in 18 working dogs. Twenty-six canine teeth had severe attrition with no involve-
ment of the pulp cavities; 15 fractured canine teeth were endodontically treqted. With the
exception of one tooth, at least one-third of the coronal part of each canine tooth was
available for a supragingivally performed, minimal tooth crown preparation. A dental
resin luting cement technique was used to bond the electrolytically etched crown (made
from an alloy of cobalt-chrome-molybdenum)to the tooth. The metal crowns were slight-
ly shorter and with a more rounded tip than the original tooth. Posts or post-and-core
techniques were not used. Median follow-up period was 30 months (range 2 to 6I
months), at which tinte 36 crowns were found to be intact and functional. Five crowns
were lost; three as aresult of subsequentinjury andfracture of the toothbelow the crown;
one as a result of use of less than one-third of the coronal portion of the tooth for reten-
tion of the crown; and one as a result of an obliquefracture of the root. J Vet Dent 15(1),
13-20,1998.
IntfOduCtiOn strength of the cement is relatively unimportant (in
Direct trauma is a frequent cause of tooth fractures dogs the loads are normally in an axial direction). In
in dogs, which commonly involve the maxillary fourth human dentistry,- zinc phosphate and carboxylate
premolartoothandthecanineteeth.Thepeicentage cements have sufficient stren_gth.According to,the
-of
fractured teeth in the literature before f9gO vari6a literature, these cements are frequendy used in dogs
between 3.42o/o utd 10.7o/o.r-5In t'*vo more recent and are not very technique sensitive,4'rl-25 however
surveysofdogsanesthetizedatveterinaryhospitalsfor there have been no reports on their long-term
reasons other than dental disease.the percentaee of evaluation.
dogs with fractured teeth was 27%oisandb%o.z " In working dggs, the canine teeth are subjected to a
Dogs used for police or security work need their combination of co-mpression, shear, and tensile forces.
teethlespecial$ tfie canine teeth) to catch and hold If the resistance of tle prep_arationis less 4ran ideal, a
persoru,jrpr.y.During the trainihg activities of these high tensile_strength bf the cement will be more
-dogs
there-are many potential traumatic causes for x important. Conventional cements have a low tensile
tooth fracture, such as retrieval of stones and metal strength, wtrich diminishes their suitability for use in
objects caught in the air or an overly aggressiveattack working dogs. The resin,composite cements combine
ona training pad.a If the dog does not-tike a fi.rll bite, a high tensile strength with good compressive
but only biiei wlth its canine and incisor teettr, the strength.26 These materials have the advantage that
forces perpendicular to the long axis of these teeth can they can be combined with an adhesivetechnique.
be sufficient to cause a fracnrre] if there is a fracture of Techniques such as sand blasting, tin platirig, and
one canine tooth, the biting grip can be out of balance, electroftic etching create a retentive surface on metal
causing a fracture of the-otcluding - or contralaterai crowns. On such a surface, composite cement
-will
canine tooth.s provide micro-mechanical retention, and, in fact,
Developme.nts m3de in dental treatments during the retention can be so. high. that the . bond strength
last two decadesafford the veterinarian techniques"that su4)assesthe strength of the remaining tooth.zT Js
can be used successfirlly for restorative treatinent of achieve this, the tooth itself (enamel and dentin) aiso
fracnued teeth. Owners'of working dogs may be more has to be acid-etched to provide a retentive surface.
-than -extraction
receptive to treatrnent options odrer The purpose of this_study was to evaluate the clinical
for fi:acnrred teeth, considering the time and money performance and effectiveness of adhesively-bonded
they have invested in triining ttreir animals. metal crowns on damaged canine teeth of working
Due to "ltthe"dy
enormous biting force generated by dogs.

n";st#"9::fy,I, :?Tffil'ffi"'tr* Mareriar

Tt,'H:tf; andMerhods
In this dinical study metal crowns were placed on
demands. A crown is an extracoronal restoration that
covers all or most of the coronal portion of a toorh, the, canine leeth of 18 working {ogp. TIe .preed, age,
restores the function and structure of a damaeed and sex of these patiens and the indication for
tooth, and protects the portion of the tooth ffrat treatmentforeachtootharesummarizedinTable I.A
remains. C?own retentibn is dependent uDon total of 4l canine teeth were restored, including all
preparation desrgn and choice of cement. four canine te.etf i1 six dogs. Prior to crown
^ preparation, endodontically compromised teeth were
{etention in ionventional crowning procedures is
largely dependent on the design of tle preparation.
*This article is an amended and augmented ver-
Th-esbace^betweenthe tooth srirfaceand ihe crown is
filled'with cement that provides some mechanical sion .of an^ article gfigll"lf _published it]. Jtt:
interlocking. In dogs, as iir humans, the compressive Ve.terinary.Q,torterly, L9:23-28, 1997. Republished
^ with permission.

J.VET.DENTVoI.15No. 1 March1998 .l
3
 Thble 1. Resultsof Placementof Metal Crowns in 18 Dogs
No. Name Breed Sex Age in years Indication Total crowns Treatment Date Follow.Up Months Lost crowns

I Dourak MH M 5.5 AT 5 8/90 52 0

AT(2o4) I 8/90 4 I

2 Foster MH M 6.5 FR(304) I ta90 49 0

3 Bas CR M 1.5 FR(3M) I 2t92 JJ 0

2/91 N/A

4E vkDPM3 .5AT4 8t92 61 0

5 Erwin DH M 8.0 AT 4 l/93 57 0

6 AIros MH M 7.O AT I t/93 57 0

FR 2 U93 JI 0
FR(204) I U93 ^n
I

7 Franky DH M 1.75 FR(204) I U93 1l I

8 How DH M 4.O FR(404) I 9/94 36 0

9 Bella DH F 3.5 FR(304) 3t95 0 I

FR(404) 3t95 30 0

10 Oscar MH M 7.0 FR(104) 2 3t95 30 0

FR(204) 7t95 26 0

11 Joeri DH M 5.0 AT(304) 2 3/95 30 0

AT(404)

12 Esther DH F 6.0 AT(304) 2 5t95 28 0

Ar(404)

13 Roy MH M 2.s FR(204) I llt95 2 I

t4 Donald BX M 5.0 FR(104) I 8/95 25 0

AT J 8t95 25 0

l5 Charley CR M 5.0 FR(204) 1 2/96 t9 0

16 Barry MH M 4.0 AT 4 5t96 t4 0

17 Rik cR M 3.0 FR(204) I t2t96 10 0

18 Bryan DH M 5.0 Ar(304) (404) 2 9t96 l3 0

MH = Mechelse herder/lVlalinois shepherd; DH = Duitse herdershond/German Shepherd; CR = cross breed; DP = Doberman

Pinscher; BX = Boxer; FR = Fracfured canine tooth with pulp exposure; endodontically treated; AI = attrition with no pulp expo-
sure; Months = number of months between date of treatment and date of lost crown or date of last evaluation interview (9/97);
N/A = not available. The teeth are identifred using the modified Triadan system: 104 = maxillary right canine tooth:204 = m€x-
illarv left canine tooth: 304 = mandibular left canine tooth; 404 = mandibular rieht canine tooth.

ueated and radiographic evaluation was performed.
Follow-up consiste? 6f interviewing the o#ners of the
dogs by telephone at regular intervals. For dogs #1-7,
the first treatment took place in August 1990, the last
one in fanuary 1993, and the evaluation took place
two years later (1995).28 For dogs #8-18, the first
treatment took place in September 1994, the last one
in September 1996, and the evaluation was completed
in September of 1997.
Procedures
The dogs were sedatedwith medetomidine(1000
mcg IM per square meter of body surface) or
anesthetized with a combination of medetomidine and
ketamine (2-3 mg/kg body weight).zr
Dental treatrnent Twenty-six canine teeth had
extensive attrition, with no involvement of the pulp
cavities. The 15 remaining teeth were fractured, with
exposed pr'lF; these canine teeth were treated
endodontically. In all canine teeth (except for dog #9)
at least one-third of the coron.l p"rt of the tooth was
still present. The crown preparation was performed
supragingivally. In this study, crown lengthening by
osteoplasty to add length available for retention was not
necessary.Gingivoplasty was performed ifnecessary. No
posts, pins, or post-and-core techniques were applied.

14 J.VET. DENT.Vol.15No.1 March 1998


Figure lA. Fractured mandibular canine tooth
(dog #Q). The fracture is oblique, extending sub-
gingr"ally mesially.
Figure lC. Application of acid etchant.
Figure lE. The crown is cemented in place.
A circumferential crown preparation was not made,
and removal of tooth substance was restricted to the
elimination of undercus and contacts with occluding
teeth to create sufficient spacefor the crosm (Fig. lA,
B). In the canine teeth of all dogs except aog+i,A6
margn of the preparation was minima$, l-2 mm
above the gngval margin. In dog #7 the gingiva was
severely traumatized on the buccal side; the crown
preparation in this case \\-as I-2 mm above the
mucogingival line. Preparation \\-as limited to the
enamel laler s,hener-er possible. A minimum of two
longitudirial groo\es s€re made on the buccal and
lingual surfaces of all teeth using diamond-tapered
burs (Fig. lB, D).
J. VEf. DENT.Vol.15 No.1 March 1998
Figure IB.
Following root
canal treatment
and crown prepa-
ration including a
vertical groove,
the tooth is readv
'
for cementation.
Figure lD. The etched enamel appears challcy
white.
Impressio4s were made of the maxillary and
mandibular arches (including incisor, canine, and first
premolar teeth) using impression trays made
specifically for dogs., Fast-setting algrnate material was
used. The algrnate impressions were kept moist and
were poured in stone within a few hours in a dental
laboratory. For detailed reproduction of the
preparation, a sficone impression material was made.3O
A bite registration was obtained with wax sheets.After
the stone models were made, the design of the crown
was discussed with the dental technician. While the
crowns were cast and completed (two days to one
week), the prepared tooth was not protected with a
temporary crown. The owner of the dog was advised
not to work with the dog during this period and was
asked to prevent the dog from playing with hard
objects.
Laboratory procedures: The metal crown was cast
in a cobalt-chrome-molvbdenum allov.b The metal
cro'\^/nwas made slighdy shorter and with a rounder tip
than the original tooth. After the crown was finished,
the internal*surface was etched electrolltically, except
in caseswhen the owner requested a more pointed-tip
crown even though we recommended against this (this
was permitted when considerable crown length was
availablefor cementation).
a. Orthotec Laboratories, The Netherlands.
b. R/Heranium@: Cobalt 63.50/o,Chromium 27 .80/o,
Molybdenum 6.5Yo. Peters Laboratories. The
Netherlands.
15
Figure 24. Mandibular canine teeth (dog #ll) Figure 28. Immediately following cementation
w'ith severe attrition, following preparation. of the crown.

Crown cementin$. To provide adhesion to the

enamel aswell asthe dentin, a resin luting cement with
adhesivepropertiescwas used. Before cementation, the
prepared tooth was polished, cleaned thorougtrly with
water, and air-dried. The inside of the metal crown was
moistened with alcohol to prevent contamination of
the etched surfaceduring checking of the fit. The fit of
the crown was checked to ensure that it would seat
properly and not disturb occlusion. After the crown
and tooth were cleaned, 37o/ophosphoric acid etching
gel was applied for 30 seconds and the tooth was
thoroughly rinsed and air-dried (Fig. tC, D). To
minimize the likelihood of contamination. this
procedure was repeated.
Figure 2C. The crowns are in place l0 months
follorving cementation. They were still in place
30 months following cementation.

Figures 3^4. and 38. Forty months following Figure 38.

cementation of crowns on all four canine teeth.
the crowns are still in place (dog #5).

Figure 4.{'. Metal crown on a mandibular canine Figure 48. 28 months following cementation.
tooth of dog #12, immediately following cementa-
tron. c. Panavia Ex@,Kuraray, lapan.

16 J.VET DENT.Vol.15 No. 1 March 1998

 Results
Forty-one metal crowns were placed on the canine
teeth of 18 working dogs. In all dogs, training activities
were started a few days to one week after the crown
therapy was performed. The first training session was
conducted with caution to give each dog time to
become accustomed to their "new bite."
Follow-up information was obtained by telephone.
The first interview was comoleted one month after
treatment, after the dogs had ilr."dy returned to work.
Additional telephone calls were made at irregular times,
and a final telephone interview was made with the
owners of the treated dogs. All owners were satisfied
that treatrnent had been worthwhile, except for one
owner who was unhappy that his dog fractured the
Figure 5A. Attrition of the canine teeth (dog #I). treated canine tooth trwo months following treatment
(this dog received its working certification and is still
working asawatch dog). Two dogs (#I0 and #16) died
of other reasons n 1997 and two dogs were retired
prior to the final examination. The full biting capacity
and the general suitability ofthe dogs for service had
returned to normal. The six dogs with metal crowns on
all four canine teeth were in firll function and had each
won at least one working dog competition. Two of the
three dogs with only one metal crown were working as
they had-prior to th6 i4ury, and two dogs are now u-sed
as watchdogs (Table l). Two years after dre last of the
4l metal crowns were placed, 36 were still in place and
all 18 dogs were functioning as working dogs2S(Figs.
2,3,4) except for two that had died of other causes.
Three of the metal crowns were lost as a result of
injury. Dog #I lost one metal crown during a training
Figure 5B. Short metal crowns were placed on all sessionfour months after placement. This metal crown
four teeth, leaving much of the natural crown did not cover the whole clinical crown and a fracture
uncovered. line went through the remaining tooth (Fig. 5).
Nevertheless. with three crowned canine teeth and one
endodontically treated fractured canine tooth, the grip
Figure 5C. Four and biting capacities were sufficient and this dog still
months later, a maxil- placed in national working dog competitions. Due to
lary canine tooth frac- repeated traurna, dog #7 lost a treated canine tooth 1l
tured obliquely. The months following treatment because of an oblique
crown remained firm- fracture of the root; this dog had been active as a
ly attached to the working dog prior to the refracture of the tooth, but is
tooth substance. The now used as a watchdog.
other three crowns One metal crown in dog #13 was lost during a
were intact 52 months training sessiontwo months after placement. This dog
following cementa- was not available for further examination. Some pieces
tion. of the tooth were attached to the metal crown.
suggesting that a new fracture of the tooth was the
most likely cause.
Another loss of a metal crown was probably due to
The cementc was mixed following the the length of the crown. In dog #9, o^neof the canine
-applied teeth in the lower iaw had less than one-third of the
manufacturer's instructions. A thin layer was
on the internal surface of the metal crown. which was coronal part of the tooth remaininq. The crown was
seated prope.ly, *d then any excess cement was lost at tlie second training session fdUowittg the initial
removed. As Panavia Ex@ hardens under anaerobic cementation (Fig. 6). The procedure (preparation,
conditions, an oxygen inhibitots n'as applied to the impression and bite registration, laboratory work, and
margin of the metal crown to achieve absolute crown cementing) was repeated. At the first training
isolation from air, enabling the cement to set sessionfollowing re-cementation, the metal crown was
completely. The crown was kept under finger pressrre lost again. This dog, with three canine teeth in function
for approximately six to seven minutes after mixing of (one with a metal crown), was a winner in many
the cement, by which time the cement n'as completely competitions. Ten months after crowning, the dog was
set (Fig. IE). The crorrn margin rr'as finistred Uy examined under sedation (Fig. 6C, D). We concluded
cutting away the re[rnants of cement *ith a hand that the clinical crown length was not sufficient for a
scaler. The occlusion rr'as checked and the crown or successfirlcrowning procedure.
occluding tooth s'as adjusted as necessan'. One crown was lost in dog #6 during a training
sessionat night. The owner reported that the tooth was
fractured; however, no additional follow-up is available.
d. R/Ongard3, Kurarar'. Iapan.

J. VET.DENT.Vol.15 l,lo. 1 Mardt 1998 17


Fizure 6A Meal crown on a fractured mandibu-
laicanine tooth in dog #9, which left very little
crown length.
Figure 6C. Ten months later, the crov/n is still
present as a sflrmp.
Discussion
Fractured teeth should be restored if they are
important to the health and useof a working dog.tz 1tt
wo-rking dogs, severely reduced crown height often
leads tb difiiirished 6iting ability and a frrnctional
handicap. Working dogs of all breeds need a strong
restoratilon of a fraZturei canine tooth to withstand th;
forces exerted when the doe is "working."9
A canine tooth that is sh6rter than n-ormal will not
always pose a problem for a working dog. If the
r.*iiniirg cororial portion of the tooth-is he-atthy and
long eno"ugh so thit functional interdigitation 6f the
canine-inciior teeth results, and the dog-is functioning
well durine trainine. crowning is not essential. There
will alwayibe a risFof repeat& fracture of this canine
tooth (oi fracture of another canine tooth) becausethe
normail equilibrium and balance of a biting grip with
four canint teeth has been lost. The exposeddentin of
the fractured. uncrowned tooth will wear faster than
enamel and the crown heieht will diminish.
The size of the coronal-part of the tooth necessary
for successfirl crown therapy by cementation needs
more research. No guidelines have been agreed upon
in the recent litera[rrre. "At least one-t[ird of^the
coronal part of the tooth should be available for
successfirlcrown therapy."4 "Crown replacement on
canine teeth requires af least two-thirds 6f the coronal
part of the tooth to be present if retention of the
18
Figure 68. During
the second training
exercise following
crown cementa-
tion, the crown was
lost.
Figure 6D. The opposite side, immediately fol-
lowing cementation. This crown was still in place
30 months later. The fractured maxillary canine
tooth was treated endodontically, with a compos-
ite restoration.
crown is to be maintained bv cementation onlv."3l *ff
less than two-thirds of the cbron"l p".t of theiooth is
left, then a core build-up or a core build-up and a post
should be used to add rs1snti6n."l5,3l.32
In this study, the crowning of one canine tooth (dog
#9) showed that if less thai 6ne-third of the corbnii
part of the tooth is present, crowning is not successfirl.
The crown therapy on the same tooth failed twice.
Subsequently,a thri:e year-old, male German Shepherd
was presented with three fractured teeth. Endodontic
procedures were performed; crowns were not
recommended because insufficient crown length was
available. Three months later the dog was re-presented
and the owner requested metal crown therapy on the
two canine teeth in the lower jaw. The coronal part of
both canine teeth was less than one-third of the
coronal part of the tooth. The crowning procedure
was performed after the owner was warned about
possible failure. Despite prior experience with 24
crowns, both of these crowns were lost during ttre first
training sessionfollowing cementation. This dog is not
included in Table I because we did not recommend
crown Dlacement.Since this experience. resin-bonded
'lower
metal irowns on canine teeth it't the jaw of
working doqs are not placed unless at least one-third of
the fuil crown height of the tooth is present for
retention.
Very little information about the results of crowning
J. VET.DENT. VoL 15 No. 1 March 1998
 teeth in working dogs has been reponed. Clinical
observations of six injured canine teeth (sith no pulp
exposure) in five dogs treated with a metal crown havb
been described, the last follor-up being made after
about 12 months.22 It was not reported ufiether these
dogs were working dogs. Since then there have been
several reports of prosthetic-m€tal crowns, most being
case reports with no follow-up or long-term
evaluation.I9,22,24,33-44 In a young Boxer with enamel
hlpoplasia, four crowns were placed. These cast
crowns remained clinically adequate in this zuard dos
over a period of 12 yexs.as twenty-three-fracnrrei
canine teeth in 14 service doqs were crowned: the
fractures reduced the dogs' bidng ability and general
suitability for service. After treatment, fi.rll bitine ability
retorned for two to three vears.4 with no
follow-up reported. "daitio.tit
Reconstruction of a fractured canine tooth in
combination with the acid-etching technique is
indicated if enough enamel is present. As there is never
too much retention, crown lengthening is sometimes
indicated and can be achieved by gingivoplasty,
osteoplasty, or an endodontic post and core build-up.
The results of the present study indicate that crown
therapy for canine teeth in working dogs that are
fractured or have severe attrition is successful if
sufficient clinical crown length is available. In this
study, all owners of the 18 working dogs, in which 4I
metal crowns were placed, were satisfied with the
result. The reduction in biting and gripping ability that
was present before treaflnent disappeared one or two
training sessionsafter treatment. Full biting ability and
general suitability for service were restored to normal.
The fact that three teeth fractured (resulting in loss of
the metal crown) indicates that dre coronal part of the
treated teeth had been of sfficient length tir keep the
metal crown in place.
Owners of w-orking dogs should reahze that the
crown restoration of icaniie tooth is weakerwhen the
crown replacessound tooth strucrure. Preparation of
sound tobth tissue should be kept to a minimum and
fhe use of poss minimized. In human dentistry, a
circumferential crov*'n preparation is standard. The
crown preparation used in this study is different in that
removal of tooth substance was restricted to the
elimination of undercus and contacts with occluding
teeth to create sufficient spacefor the crown. With the
final crown, the contour of the original crown will not
be restored, but an "over contour" will be present if
there is space available. During preparation an effort
should be made to stay in the enamel layer, as enamel
provides a stronger bond than dentin for the adhesive
technique_. More extensive preparation probably
increasesthe risk for subsequent fracture of the tooth.
The longitudinal grooves guide the metal crown into
position and provide better resistance and retention of
the crown. as thev act as an anti-rotational lock.
Because'estheticconsiderationsare not important in
working dogs, fracture-resistant metal crowns are the
material of choice. The tip of the metal crown is
rounded, as a sha4l point might lead to stress
concentration and loss of the crorvn if it becomes
entangled in leather armshields during raining. The
metal crown is always made slightly shorter than the
lost crown, as this rvill reduce the leverage forces
applied to the tip of dre cro\\n. Occlusal and lateral
stress is minimized nith this shape. The preferable
length of the crorrn is discussedn-ith the on.ner of the
dog. In this studr', electrohtic etching of the internal
surface provided sulicient retention to the resin-based
J.VEf DENT.Uol.15tb 1 Ahtdr 1998
cement.
Gingivoplasty or osteoplasty may be considered to
lengttien dle c'linical ,tol,n!(;iz If the length of the
tooth is inadequate, crown therapy has a poor
prognosis. Crown lengthening by osteoplasty or other
alternatives may be necessary if there is not enough
crown length to complete the therapy used in this
study. Further research on minimal crown height for
succ'essful attachment of metal crowns. aria tne
possibilities for crown lengthening, should be pursued.
The choice of cement used to fix metal crowns on
the canine teeth of working dogs is important. Glass
ionomer and resin composite cements have recendy
been developed; they have gained in popularity
because of their capacity to bond to tooth substance.
These cements have strong resistance to crushing, and
work well for cementing crowns in working
dogs.z02|,3zi8,a9In comparison to other types of
cements) the resin cement Panavia Ex@has the highest
compressive and tensile strength.z6 The use of Panavia
Ex@cement in veterinary dentistry has been reported,
but details of the methods used and results obtained
were not gven.2zt,+v In this study Panavia Ex@was
found effective and provided adequate retention. It is
a composite of low viscosity, and very strong bonding
to sandblasted metals is claimed.so Another advantage
of Panavia Ex' is the absence of microleakase of the
crown.Sl Studies in monkeys showed compaEbfity of
resin composite cements, which are well accepted by
pulpal tissue. Studies to evaluate the pulpal responses
to resin adhesive and composite have shown that there
is no detrimental effect on the pulp.sz's4
Transdental fixation (a pin is placed through the root
canal and apex, and anchored in part in the alveolar
bone) has been described in a dog.5aAttaching a cast
crown to a fractured non-vital canine tooth bv
cementing and transverse bolting has also beei
describediz32,ss.s6 In the case oT failure, such a
technique will probably result in a fracture extending
to (or into) the root of the tooth.
Conclusion
Abraded and fractured canine teeth with sufficient
length can be effectively restored with metal crowns. A
resin cement with adhesive properties, in combination
with a retentive surface on the tooth and crown,
provides a strong bond. When there were failures (five
out of 4l), three were not due to adhesive failure, but
to a new fracture through the tooth.
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Author Information
From the Dental Refenal Service at the Veteinary
Specialist Centrum " de Wagenrenk,"KeijenbergsewegI 8,
NL 6705 BN Wageningen,The Netherlands (van Foreest)
and the Departrnent of Cartobgy and Endodontology,
University of Nijmegen, The Netherlands (Roeters).
J.VET. DENT.Vol.15 No. 1 March 1998