Case courtesy of Dr. Jan Bellows, DVM, AVDC, ABVP of All Pets Dental in Weston, FL.
Furcation defects are areas of bone loss, usually resulting from periodontal disease, in which the areas between a tooth’s roots are either exposed or inadequately protected. These defects are often treated through surgical extraction of the affected tooth. However, with the help of VTS’ graft products, surgical extractions aren’t the only option for veterinarians and pet owners.
Guided bone regeneration is a procedure that directs growth of bone to a site. In the case of a furcation defect, these procedures can help to strengthen the bone surrounding the defect. This was the case for a Golden Retriever who was referred to Dr. Jan Bellows. This pet’s owners wanted to do anything they could to save a tooth that another veterinarian wanted to extract. Dr. Bellows recommended she undergo a guided bone regeneration procedure. This patient had similar defects bilaterally. One side, unfortunately, had to be extracted. For the side pictured, Dr. Bellows used VTS’ Synergy and a cancellous mini block.
At the patient’s initial consult, the gingival tissue surrounding the tooth is visibly swollen and inflamed. Plaque and blood can be seen surrounding the defect. This tooth is also affected with an uncomplicated crown fracture.
At the time of referral, the defect had progressed to a stage 3 furcation defect.The soft tissue has recessed to the point that the defect is fully exposed; and a probe can be inserted in one side of the defect and come out the other.
Bone loss is apparent in this pre-operative radiograph. Note the difference between the area of the defect, and the same area on another tooth on the left-hand side of the film.
Following the surgical extraction of the other tooth, the guided tissue and bone regeneration process begins on the tooth to be saved.
First, incisions are made on either side of the defect using a scalpel. The soft tissue is then separated from the tooth to fully expose the defect.
The defect is fully irrigated and cleaned to prepare for graft placement. With periodontal disease like this, it is common for food and bits of plaque to become lodged in the defect, causing further infection, irritation, and bone loss. Fully irrigating and debriding the defect removes the debris and prepares the root for regeneration of the periodontal ligament, which is expected with good root planing and bone grafting.
VTS’ cancellous mini blocks measure approximately 0.5 cm x 0.5 cm x 0.8 cm and are ideal for use in dentistry. Cancellous blocks are made from dense cancellous bone typically found in the condyles and plateaus of femur and tibia.
VTS’ cancellous mini blocks are shipped freeze-dried and must be rehydrated prior to use. Ideally, whole blood taken peripherally or from a bleeding surgical site can be used to rehydrate the graft. If the surgeon is unable to obtain whole blood, sterile saline may be used.
Once the graft has been rehydrated, it can be cut, shaved, or burred to the size and shape the surgeon prefers or works best for the patient. For this case, Dr. Bellows cut the block into a small slice that fit directly into the defect, and then smaller pieces to be packed on top.
The cut and shaped mini block “slice” is placed into the defect site using surgical forceps.
The remaining block pieces packed over the defect.
Dr. Bellows then packed VTS’ synthetic bone graft, Synergy, rehydrated with blood, over the defect site, and into any void left by the soft tissue flap.
The flap is then closed over the surgical site.
Extraction isn’t always the only option for pets with furcation defects. Bone graft is the best substrate for remodeling and reformation of a patient’s lost bone stock. As advances in veterinary dentistry continue, VTS wants to help veterinarians save teeth!