Observations of the periodontal ligament and cementum in cats with dental resorptive lesions

The etiology of feline dental resorptive lesions is unknown, but some evidence suggests that interactions between components of the periodontium may be initiating factors in the development of these lesions. In the present study, 22 clinically normal teeth were harvested from 7 cats. The teeth and periodontium were radiographed and examined histologically. In addition, 14 of the 22 teeth were examined histometrically. Two teeth were histologically normal with an open apical foramen and two were normal with a closed apical foramen. Histological evidence of periodontal ligament degeneration without cementum resorption was observed in 8 teeth, and varying degrees of cementum resorption were observed in 10 teeth. Mandibular molar and premolar teeth had distal drift, and mandibular canine teeth had mesial drift. Alterations in the periodontal ligament may represent a preclinical stage of dental resorption.     

Prevalence of odontoclastic resorption lesions and periapical radiographic lucencies in cats: 265 cases (1995-1998)

OBJECTIVE: To determine whether odontoclastic resorption lesions were associated with radiographic evidence of periapical lucencies in cats. DESIGN: Retrospective study. ANIMALS: 265 feline dental patients. PROCEDURE: Full-mouth radiographs were examined for evidence of odontoclastic resorption lesions, periapical lucencies, periodontitis, and fractured teeth. RESULTS: Odontoclastic resorption lesions affecting 567 teeth were identified in 161 (60.8%) cats. Periapical lucencies were identified in 53 teeth in 35 cats. Periapical lucencies were most commonly associated with fractured teeth (25 teeth with periapical lucencies) and severe periodontitis (21 teeth). None of the periapical lucencies appeared to be specifically associated with resorption lesions. Prevalence of periapical lucencies in cats with resorption lesions was not significantly different from prevalence in cats without. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that although odontoclastic resorption lesions are common in cats, pulpal involvement associated with these lesions does not appear to be associated with development of radiographically detectable periapical lucencies. Crown amputation with intentional root retention may, therefore, be a suitable alternative to extraction in selected cats with odontoclastic resorption lesions.     

Comparison of periodontitis and root replacement in cat teeth with resorptive lesions

Cat teeth with resorptive lesions and periodontitis may have a distinctly different clinical and radiographic appearance compared with teeth that have focal, lesion-associated gingivitis. A retrospective, case-controlled study was performed to determine the occurrence of root replacement in cats with resorptive lesions and associated periodontitis. Of 543 teeth evaluated with resorptive lesions, radiographic and/or clinical signs of periodontitis were identified in 236 (43.5%) teeth. Periodontitis was present in 43 of 275 (15.6%) teeth with root replacement and 193 of 268 (72.0%) teeth that had normal radiodensity and maintenance of the periodontal ligament. There was a significantly lower occurrence of root replacement in cat teeth with resorptive lesions and periodontitis.     

Bilateral maxillary periodontal ligament hamartoma in a dog

A 12.5-year-old dog was presented for severe periodontal disease and bilateral maxillary enlargement. Radiographs of the maxilla showedgeneralized root resorption, ankylosis, and rarefaction of bone with focal radiodense areas. Surgical tooth extraction of multiple maxillary teeth and bilateral incisional biopsies of the periodontal tissue and maxilla in the region of the maxillary fourth premolars were performed. Histopathologic examination showed features typical of fully differentiated periodontal ligament with abundant cementum/alveolar lining bone and sparce odontogenic epithelial cell rests. Histopathology in conjunction with radiographic and clinical signs suggested a diagnosis of bilateral periodontal ligament hamartoma. Examination 3-months postoperatively indicated uncomplicated healing of the extraction and biopsy sites with no resolution of the maxillary enlargement.     

Efficacy of enamel matrix proteins on apical periodontal regeneration after experimental apicoectomy in dogs

Adult dogs have a complex apical delta structure in all root apexes of teeth. This complex structure may affect the formation of apical lesions in the teeth such as apical abscesses. The purpose of this study was to evaluate the efficacy of enamel matrix protein (EMP) which was used for periodontal regeneration therapy after an experimental apicoectomy for an assumed apical lesions of the teeth in dogs. The maxillar canine roots and maxillar fourth premolar buccal mesial roots in five beagles were experimentally apicoectomized under general inhalation anesthesia. After the root apex was exposed and excised, EMP was applied on the surface of the exposed dentin. After 12 weeks, dogs were euthanized. and the experimental teeth together with the surrounding soft and hard periodontal tissues were collected for histological evaluation under a light microscope. In the EMP group, the size of the defect where the root apex was removed was smaller than that of the control group. New cementum was dominantly achieved in the EMP group compared to the control group. Furthermore, new collagen fibers that bridged area between the new cementum and new alveolar bone were detected only in the EMP group. The present results demonstrated marked apical periodontal regeneration after apicoectomy in the EMP group. These results, therefore, suggest that the application of EMP can effectively induce the regeneration of periodontal strUctures in apicoectomized dogs.     

Evaluation of calciotropic hormones in cats with odontoclastic resorptive lesions

OBJECTIVE: To assess associations between epidemiologic and laboratory variables and calciotropic hormones in cats with odontoclastic resorptive lesions (ORLs). ANIMALS: 182 client-owned cats older than 1 year of age with oral disease. PROCEDURE: Information on medical history, behavior, living environment, and feeding management was assessed by use of a questionnaire. After induction of general anesthesia, oral examination was performed following standardized protocols and included dental probing and full-mouth radiography. Laboratory analyses included evaluation of FeLV-FIV status, serum biochemical analyses, CBC, urinalysis, and serum concentrations of intact parathyroid hormone (iPTH), parathyroid hormone-related peptide (PTHrP), 25-hydroxyvitamin D (25-OHD), free thyroxine (fT4), and ionized calcium (iCa). RESULTS: ORLs were identified in 72.5% of cats. Mandibular third premolars were the most commonly affected teeth. Cats with ORLs were significantly older (mean, 9.2 years) than cats without ORLs (mean, 6.6 years). Multivariate logistic regression analysis revealed that 25-OHD, urine specific gravity, jaw-opening reflex on probing, and missing teeth were significant variables, even after accounting for age. Cats with ORLs had significantly higher mean serum concentration of 25-OHD (112.4 nmol/L) and significantly lower mean urine specific gravity (1.0263), compared with cats without ORLs (89.8 nmol/L and 1.0366, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: Results did not indicate associations between iPTH, PTHrP, or fT4 and development of ORLs. In affected cats, the importance of high serum 25-OHD and low urine specific gravity has not been determined.     

Prevalence of odontoclastic resorptive lesions in a population of clinically healthy cats

The prevalence of odontoclastic resorptive lesions (ORLs) was determined in a clinically healthy cat population (228 cats) using both clinical (oral examination) and radiographic (full-mouth series with intraorally positioned dental film) methods. The overall prevalence rate was 29 per cent (mean age of the cat population 4.9 years). The mandibular third premolars (307, 407) were the most commonly affected tooth and the pattern of ORL development was symmetrical in most cats. The risk of having ORLs was found to increase with increasing age and cats with clinically and radiographically missing teeth were more likely to have the condition. Neutering, gender, age at neutering or mean whole mouth gingivitis index did not affect the prevalence of ORLs.     

Subgingival odontoclastic resorptive lesions. Classification, treatment, and results in 58 cats.

A commonly recognized dental problem in cats is the resorption of tooth structure and subsequent loss of the tooth. These tooth defects are often very painful, because the sensitive dentin layer is exposed. The destruction of the tooth through odontoclastic resorption is considered a consequence of inflammatory resorption, probably secondary to periodontal inflammation. Because these resorptive lesions are progressive in nature, it is best to stage this progression of resorption in order to address treatment planning. The purpose of this study was to evaluate a group of 58 cats with resorptive lesions to determine the outcome of treatment 6 months or longer after restoration. In 81% of the cats, there was loss of the tooth, evidence of further resorption, or loss of the restoration at one or more resorption sites. Of the 154 teeth restored, only 33% showed no further evidence of loss of tooth structure.     

Feline odontoclastic resorptive lesions an unsolved enigma in veterinary dentistry.

This article presents a comprehensive review of the literature on feline odontoclastic resorptive lesions (FORLs), including etiopathogenesis, prevalence and predisposition, classification, histopathologic appearance, diagnosis, and treatment. Approximately one-third of all domestic cats may develop FORLs during their life span, and the risk of developing FORLs increases with age. Sophisticated dental treatments promise neither cure nor permanent improvement of affected teeth. Extraction is the current treatment of choice. Research on the etiology of FORLs has not been rewarding in recent years, and the causative factors contributing to the development of FORLs are still unknown.     

Elemental composition of teeth with and without odontoclastic resorption lesions in cats

OBJECTIVE: To determine elemental composition of teeth with and without odontoclastic resorption lesions (ORL) in cats. SAMPLE POPULATION: Normal teeth from 22 cadaver cats and ORLaffected teeth from 21 cats admitted to the veterinary hospital for dental treatment. PROCEDURE: An electron microprobe was used to analyze weight percentages of calcium, phosphorus, fluorine, sodium, magnesium, sulfur, potassium, and iron in enamel, dentin, and cementum. RESULTS: Calcium and phosphorus were the most abundant elements. Fluorine, sodium, and magnesium combined were < 5% and sulfur, potassium, and iron combined were < 0.1% of total elemental composition. In enamel of normal teeth, a significant sex-by-jaw location interaction was seen in mean (+/- SD) phosphorus content, which was higher in mandibular teeth of females (1764+/-0.41%) but lower in mandibular teeth of males (16.71+/-0.83%). Mean iron content in dentin of normal teeth was significantly lower in mandibular teeth than maxillary teeth (0.014+/-0.005% vs 0.023+/-0.019%). Mean enamel sodium content was significantly higher (0.77+/-0.046% vs 0.74+/-0.025) and mean enamel iron content was significantly lower (0.017+/-0.008% vs 0.021+/-0.005%) in ORLaffected teeth, compared with normal teeth. In cementum, mean fluorine content was significantly lower (2.98%+/-0.27 vs 2.99+/-0.20%) and mean magnesium content was significantly lower (0.54+/-0.13% vs 0.60+/-0.13%) in ORL affected teeth, compared with normal teeth. CONCLUSIONS AND CLINICAL RELEVANCE: Results of our study establish baseline mineral content of enamel, dentin, and cementum for normal teeth in cats. Minimal differences in mineral content of enamel and cementum of normal and ORL-affected teeth were detected.     

Significant association between tooth extrusion and tooth resorption in domestic cats

Abnormal extrusion of canine teeth is often noted in middle-aged and geriatric domestic cats. The same age group of cats also is commonly affected by tooth resorption (TR). This study explored the relationship between these two phenomena of unknown etiology. Using digital radiography, the distance between the alveolar margin (AM) and cementoenamel junction (CEJ), referred to as the AM-CEJ distance, was measured in clinically and radiographically healthy maxillary canine teeth of 24 TR-affected and 29 TR-free cats. The mean AM-CEJ distance of maxillary canine teeth of cats with and cats without TR was 2.68-mm and 2.22-mm, respectively. An analysis of covariance adjusting for age revealed a significant correlation (p = 0.02) between tooth extrusion and TR. Extrusion of the maxillary canine teeth became clinically apparent when an AM-CEJ distance of 2.5-mm or greater was evident in the absence of horizontal or vertical alveolar bone loss. Based on this criterion, 15 of 24 cats with TR (63.0 %) exhibited extrusion of maxillary canine teeth, compared to 9 of 29 cats without TR (31.0 %). Four extruded and five non-extruded maxillary canine teeth were evaluated histologically. Cementum of extruded teeth was significantly thicker compared to that of non-extruded teeth. Four of 4 canine teeth with extrusion (100 %) showed histological evidence of resorption, compared to 1 of 5 canine teeth without extrusion (20.0 %). These results suggest that tooth extrusion is linked to or may be caused by similar factors responsible for the development of TR.     

Results of root canal treatment in dogs: 127 cases (1995-2000)

OBJECTIVE: To evaluate results of root canal treatment in dogs. DESIGN: Retrospective study. SAMPLE POPULATION: 127 tooth roots in 64 dogs. PROCEDURE: Radiographs obtained before surgery, immediately after surgery, and during follow-up examinations after surgery were evaluated by 2 individuals. Treatment was considered successful if the periodontal ligament space was normal and possible preoperative root resorption, if present, had ceased. Treatment was considered to show no evidence of failure if possible preoperative root resorption had ceased but a preexisting periapical lesion had remained the same or only decreased in size and not complete resolved. Treatment was considered to have failed if a periapical lesion or root resorption developed subsequent to endodontic treatment, if a preexisting periapical lesion had increased in size, or if possible preoperative root resorption appeared to continue after endodontic treatment. RESULTS: Follow-up time ranged from 1 to 60 months (mean, 13 months). Treatment was classified as successful for 87 (69%) roots, as showing no evidence of failure for 33 (26%) roots, and as having failed for 7 (6%) roots. The success rate was lower for canine teeth than for maxillary fourth premolar teeth. Roots with a preexisting periapical lucency or preexisting root resorption had lower success rates. The use of intracanal medication and the method and quality of obturation were not associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that root canal treatment offers a viable option for salvage of periodontally sound but endodontically diseased teeth in dogs.     

Structure of peripheral cementum of normal equine cheek teeth

The structure of peripheral cementum of mandibular and maxillary cheek teeth was studied by gross observation, light microscopy, and scanning and transmission electron microscopy. Teeth from four horses aged 4, 8, 17, and 30-years-old were examined. The cementum of the occlusal surface was thicker on the buccal aspect when compared with the lingual aspect of mandibular teeth. The cementum of the occlusal surface was thicker on the palatal aspect when compared with the buccal aspect of maxillary teeth. There was no peripheral cementum on the interdental aspects of either mandibular or maxillary cheek teeth. In the adult tooth, cementum covered the crown and root surfaces. The peripheral cementum of the gingival region showed a dramatic increase in thickness compared with cementum covering the alveolar portion of the embedded tooth. At a microscopic level, three layers (primary, secondary, and tertiary) were identified within cementum. The increase in cementum in the gingival region was of tertiary cementum. All three layers contained vital cementocytes. There was a well-developed vascular system within the cementum. Nerve bundles were also present. Three cementoblast profiles were identified at the junction of the cementum with the periodontal ligament. The results reported in this paper show that cementum is a dynamic vital tissue. These findings should contribute to a greater understanding of the etiology and pathogenesis of cemental caries and periodontal disease in the horse.     

Scanning electron microscopy of root resorption of feline teeth

Scanning electron microscopy was carried out on 10 feline extracted permanent teeth from 3 cases with root resorption. Various-sized resorption lacunae were well defined, showing an etched pattern and configuration as shown in human deciduous teeth. In cats, regardless of the shape and depth of lacunae, the resorption lacunae showed opening dentinal tubules in the wall with or without cement matrix apperring only in the deep and round lacunae of human cases. Some specific process of mineralization for repairing dental root resorption was suggested in cats.     

Radiographic patterns of periodontitis in cats: 147 cases (1998-1999)

OBJECTIVE: To determine patterns of alveolar bone loss (periodontitis) and other lesions evident on full-mouth survey radiographs of cats. DESIGN: Retrospective study. ANIMALS: 147 cats. PROCEDURE: Full-mouth radiographs were evaluated for evidence and severity of alveolar bone loss, odontoclastic resorption lesions (ORL), retained roots, missing teeth, signs of endodontic disease secondary to periodontitis, and apical resorption. RESULTS: 106 (72%) cats had some degree of periodontitis, 100 (68%) were missing teeth, 98 (67%) had ORL, 78 (53%) had expansion of the buccal alveolar bone at 1 or more canine teeth, 75 (51%) had retained roots, 48 (33%) had apical resorption, and 12 (8%) had signs of endodontic disease secondary to periodontitis. Cats < 4 years old were not significantly more likely than the general population to have normal alveolar bone height. Prevalence of ORL increased with age, but cats > or =13 years old were less likely than the general population to have moderate or severe generalized periodontitis. Purebred cats were not significantly more likely to have periodontitis or ORL than mixed-breed cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that periodontitis is common in cats and that horizontal bone loss is the most common radiographic pattern of alveolar bone loss. Purebred cats were not more likely than mixed-breed cats to have ORL or periodontitis, but when they did have periodontitis, it was more likely to be moderate to severe. Cats with ORL were less likely than cats without ORL to have normal alveolar bone height and more likely to have severe focal vertical bone loss.     

Repair of experimental plaque-induced periodontal disease in dogs

Forty mongrel dogs were used in this study for induction of periodontal disease by placing subgingival silk ligatures affecting maxillary and mandibular premolar teeth during a 12-month period. Experimental premolar teeth received monthly clinical, radiographic, and histometric/pathologic assessments. The results demonstrated significant increases in scores and values of periodontal disease parameters associated with variable degrees of alveolar bone loss. The experimental maxillary premolar teeth exhibited more severe and rapid rates of periodontal disease compared with mandibular premolar teeth. Histometric analysis showed significant reduction in free and attached gingiva of the experimental teeth. Histopathological examination of buccolingual sections from experimental premolar teeth showed the presence of rete pegs within the sulcular epithelium with acanthosis and erosive changes, widening of the periodontal ligament, and alveolar bone resorption. Various methods for periodontal repair were studied in 194 experimental premolar teeth exhibiting different degrees of periodontal disease. The treatment plan comprised non-surgical (teeth scaling, root planing, and oral hygiene) and surgical methods (closed gingival curettage, modified Widman flap, and reconstructive surgery using autogenous bone marrow graft and canine amniotic membrane). The initial non-surgical treatment resulted in a periodontal recovery rate of 37.6% and was found effective for treatment of early periodontal disease based on resolution of gingivitis and reduction of periodontal probing depths. Surgical treatment by closed gingival curettage to eliminate the diseased pocket lining resulted in a recovery rate of 48.8% and proved effective in substantially reducing deep periodontal pockets. Open root planing following flap elevation resulted in a recovery rate of 85.4% and was effective for deep and refractory periodontal pockets. Autogenous bone graft implantation combined with canine amniotic membrane as a biodegradable membrane was used in 18 premolar teeth and failed to improve advanced furcation defects in most teeth.     

Tooth resorption in the Swedish Eurasion lynx (Lynx lynx)

The etiology of tooth resorption in the domestic cat remains unknown. The high prevalence and progressive nature of the disease complicates defining healthy control groups. In order to evaluate the possible influence of various life style changes on the prevalence of tooth resorption, healthy control groups are a prerequisite. This paper presents a prevalence study for tooth resorption in a free-ranging wild felidae population. Skulls from 46 free-ranging Eurasian lynx (Lynx lynx) were examined. The age of the animals had previously been estimated based on cementum annuli in the maxillary right canine tooth. The dental examination included both dental probing and radiographic imaging. Complicated fractures of the canine teeth were found in 9/46 (19.5%) skulls. In one fractured canine, apical root resorption and periapical lucency was detected. The root resorption was attributed to inflammatory resorption as a consequence of the initial dental trauma and necrotic pulp. No signs of tooth resorption were found in the remaining teeth. Supernumerary roots were detected in 18/46 skulls (39.1 %). Supernumerary "peg" teeth caudal to the mandibular first molar tooth were detected in 6/46 (13.0%) skulls. Although further studies on dental ultra-structure are needed, the Swedish Eurasian lynx may, in the future, be useful as a healthy comparative model for studies on the etiopathogenesis of tooth resorption in the domestic cat.     

Allogeneic tooth transplantation in the dog

Allogeneic tooth transplantation was evaluated as a functional and aesthetic treatment for dental fracture in the dog. Of 7 dogs that received tooth transplants, 5 were research animals and 2 were clinical patients. Canine teeth were transplanted immediately after extraction in the research dogs. Endodontic therapy had been performed on the affected canine tooth of one clinical patient. The other clinical patient had bilateral maxillary canine fractures 2 months earlier. One of the research dog transplants failed at 3 weeks as a result of improper surgical technique. Four of the research dogs had a solid implant for 18 months, after which time the dogs were euthanatized serially. All transplanted teeth were anchored firmly into the alveoli, but were nonviable. Root resorption, with bone replacement, was first noticed at 24 months. The transplanted tooth in the first clinical patient remained functional for 3 months, after which time the tooth was fractured. The right canine transplant in the second clinical patient failed by 3 months, probably because of preexisting periapical inflammation. The left transplanted tooth remains stable at 38 months. It was concluded that allogeneic tooth transplantation may have merit as a rapid and inexpensive method for replacement of fractured teeth in the dog. Function is compromised gradually as a result of root resorption and ankylosis, with tooth fracture likely to occur after 2 years.     

Mapping of the radiographic central point of feline dental resorptive lesions

Intraoral dental radiographs of 217 cats presented for dental treatment were examined. Radiographic signs of dental resorptive lesions were identified in 107 cats, and the apparent central point of each lesion was mapped on a diagram of the tooth. Mapping was only possible on maxillary and mandibular canine teeth and on mandibular third premolar, fourth premolar, and first molar teeth. Resorptive lesions were most common on the molar teeth (n = 103) and maxillary canine teeth (n = 96), and least common on fourth premolar teeth (n = 56). Resorptive lesions on premolar and molar teeth were widely scattered, noted more commonly in the coronal portions of the root. Resorptive lesions in canine teeth had a tendency to be located more apically on the roots.