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This case courtesy of Dr. Rocco Mele, DVM assisted by Emily Schmidt, CVT, BS of Eastpoint Pet Clinic in Tucson, Arizona, photography by Cathy Mele

Dental specialists and general practice veterinarians alike are familiar with the difficult task of treating periodontal disease in canines and felines – whether it be through extractions, guided tissue regeneration, or a basic oral hygiene regimen. When full-mouth or multiple extractions are a surgeon’s only option, Veterinary Transplant Services’ injectable bone putty, Fusion Xpress, can assist with bone and soft tissue regrowth and help your patients heal stronger!

Sophie, a 13-year-old terrier mix, presented to Dr. Rocco Mele with grade 4 periodontal disease that necessitated extraction of several teeth.

Bone loss surrounding the roots of Sophie’s molars can be seen on radiography taken at her initial consultation. Her mandibular bone height is decreased, leaving these teeth unstable and her mandible prone to fracture.

 
Dr. Mele’s recommendation for Sophie, to prevent pathologic fracture of her mandible and further bone loss in her surrounding teeth was the surgical extraction of the diseased molar and premolar (which was also suffering bone loss, with both interior and exterior resoprtion taking place).

This photograph, taken intra-operatively following surgical extraction, shows the extent of the bone loss in Sophie’s mandible. Prior to the placement of Fusion Xpress, the site is fully debrided and irrigated to reduce potential for bacterial growth.

 
Fusion Xpress is the perfect solution for these hard-to-reach surgical sites. Made of a combination of equine bone and our synthetic bone substitute, Synergy, and packaged in individual doses in regular luer-tip syringes, Fusion Xpress can be expressed directly into a surgical site. Fusion Xpress‘ putty carrier makes it possible for the graft to stay in place while irrigating and regardless of the shape or size of the defect.

Fusion Xpress in place. This image, of another patient receiving periodontal surgery, illustrates the utility of the putty to mold to unique defects and stay in place even in bloody or irrigated sites.

Following graft placement, flaps can be opposed and the site surgically closed. Closure can happen immediately after graft placement – no drying or setting time is required.

Both the particles of the equine bone and the synthetic are visible on the radiograph of the mandible immediately post-operative.

 
Sophie was seen for a recheck appointment 18 months following surgery.

On physical exam, a probe held over the mandibular ridge shows a width of nearly 12mm. The robust bone growth is further illustrated when the surgeon grasps the mandible to isolate the mandibular ridge from the surrounding soft tissue.

Two-view radiographs of the mandible reveal strong, radiopaque bone growth in the areas previously marred with bone loss secondary to Sophie’s periodontal disease. Both images were taken at the same visit.

 
Help your patients fight bone loss with Fusion Xpress – it’s easy to apply, offered in a variety of sizes and at a price that can fit any practice. Packaged in single-use doses, our putty is stored at room temperature and has a two-year shelf-life. Let VTS help you help your patients beat periodontal disease!

This case courtesy of Dr. Rocco Mele, DVM of Eastpoint Pet Clinic in Tucson, Arizona

Oronasal fistulas (ONFs), a communication between the oral cavity and the nasal passages, are a common malady seen by both veterinary dental specialists and general practice veterinarians. Oronasal fistulas can be caused by trauma (such as a bite wound), or sometimes by extraction of large teeth; or by bone loss secondary to periodontal disease.

Riley was referred to Eastpoint Pet Clinic with an ONF (palatal and apical to tooth #104). This fistula occurred secondary to the surgical extraction of her maxillary canine tooth by a referring veterinarian several weeks earlier.

Oronasal fistulas can be painful and uncomfortable to pets. Bits of food can become lodged in the defect or enter the nasal passages, causing infection and discomfort. Riley was likely dealing with an infection when this photograph was taken; purulent discharge can be seen in and around the defect.

 
Large tooth extractions with oronasal fistulas like this one can result in significant bone defects in the maxilla, providing a passageway for food (and infection) to enter the nasal cavity, and poor Riley was no exception.

Riley’s oronasal fistula, with soft tissues fully retracted. Here, the mouth’s communication with the caudal nasal passages can be fully appreciated. With a bony void of this size, failure to fill the site with bone graft can result in soft tissue collapse, surgery site dehiscence, and necessitate further surgery.

 
The repair of oronasal fistulas is perfect for use of VTS’ Ossiflex, a thin, flexible bone membrane. Riley’s defect was repaired using an Ossiflex on the right side, which was trimmed to fit the defect after it was rehydrated with sterile saline.

The rehydrated membrane is placed over the defect and sutured in place. The membrane provides a rigid barrier that allows for bone growth to happen in a protected environment. The membrane closes the abnormal opening between the oral and nasal cavities. It will slowly ossify, providing support for Riley’s soft and hard tissue to regenerate.

The trimmed Ossiflex is sutured in place using absorbable suture. Stabilization ensures the membrane will remain in place following flap apposition, as the surrounding tissue heals.

After the Ossiflex is secured and the defect is covered completely, the surrounding soft tissues can be replaced and sutured closed with a tension-free flap.

 
At seven months post-operative, Riley has healed beautifully. The soft tissue covering the defect site, per Dr. Mele, is solid and firm to the touch. Riley is able to eat, drink, and play as she did prior to developing the fistula with no risk of food entering her nasal passages.

Riley has been anesthetized for recheck radiographs at 7 months post-operative. The area where the defect was has completely healed, and the soft tissue appears healthy and strong, and maintains gingival margins similar to that of her surrounding teeth, preventing traumatic injury from her lower canines.

 
Radiographically, ONFs can be difficult to visualize. Below, Riley’s pre-operative and 7 month post-operative films illustrate tremendous bone growth. A “bridge” of new bone can be seen across the space previously occupied by her maxillary canine. As Riley continues to heal, that bridge will likely continue to grow, strengthening her maxillary bone structure.

Radiographs of pre-operative and 7 months post-operative. The circle highlights the bridge of new bone that has grown over the void left by the fistula and maxillary canine extraction.

 
Ossiflex is ready to cover your largest bony defects! Available in five sizes; thin enough to cut and suture, yet strong enough to resist food pressure and provide an immobile substrate for bone regeneration. Our flexible bone membrane is the answer for any patient with an ONF!