Odontologia Felinos 2017

31/8/17
AFECCIONES DE LA
CAVIDAD ORAL DEL
GATO DOMÉSTICO
ALEJANDRA SEPÚLVEDA VIVAR
M.V. Emap Universidad de chile
2017
Estructura
del Diente
1
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ESMALTE: CEMENTO
• tejido mineralizado que cubre la • capa de tejido óseo que cubre la raíz
corona. del diente y se adhiere al hueso
• Tejido mas duro y mineralizado del alveolar a través del ligamento
organismo periodontal.
• Sin vascularización ni innervación
• Menos calcificado
• s/ capacidad reparativa o
• Procesos de reabsorción y reparación
regeneradora.
PULPA
DENTINA • Fo x tej. Conectivo
• >parte del diente • Delimitado por odontoblastos
• sensible al frío y calor • Tejido blando del diente: nervios, fibras
• continua desarrollándose en un diente sensitivas y vasos sanguíneos
sano x los odontoblastos. Cámara pulpar à espacio en la corona
• Canal radicular à espacio en la raíz
• Ápice
Gorrel,2010.
Tejido periodontal
• Función: inserción y sujeción del diente a la
mandíbula o maxila.
ENCIA
• Surco gingival CEMENTO
• 1-3 mm PERRO
• 0,5 – 1mm GATO
HUESO ALVEOLAR
LIGAMENTO •Rebordes de la mandíbula y maxila
PERIODONTAL que alojan los dientes.
•Fo x: periostio, hueso compacto,
• Tej. Conect. Ancla hueso esponjoso, lámina cribiforme
diente al hueso o lámina dura (líneas de los alveolos
dentarios)
2
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Feline Dentistry, Jan

bellows, 2010
Feline Dentistry, Jan

bellows, 2010
3
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Dentición
DECIDUOS • 2x(I3/I3,C1/C1,P3/P2) =26
PERMANENTES • 2x( I3/I3, C1/C1, P3/P2, M1/M1) = 30
Feline Dentistry, Jan bellows, 2010
Tiempos aproximados de erupción en gatitos
Dientes deciduos permanentes
incisivos 3-4 11-16
caninos 3-4 12-20
premolares 5-6 16-20
molares No presentes 20-24
completa a los 2 meses completa a los 7 meses
4
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Maduración del diente
Gorrel,2010.
Figure 1.33 Directions in the oral cavity. 5

26
Figure 1.33 Directions in the oral cavity.

31/8/17
Figure 1.33 Directions in the oral cavity.
26
SISTEMA TRIADAN MODIFICADO
6
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• El primer incisivo es 01,luego se nombran desde

mesial a distal a lo largo del arco dental, los dientes
faltantes evolutivamente se saltan en la secuencia.
Superior Superior
derecho izquierdo
Figure 1.21 Modified Triadan system

incisor tooth numbering.
Inferior Inferior
derecho izquierdo
Figure 1.23 Mandibular canine vertical groove.
Figure 1.22 Extracted canine tooth.

20
GATOS
7
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Examen Clínico Cavidad oral

• Historia clínica:
• Cuidados dentales previos, dieta, juguetes, hábitos, proced. Dentales
previos, alergias, problemas conductuales.
• Resumen de enfermedades orales concurrentes
sintomas tratamientos cuando notaron
segunda opinion?
nuevos/antiguos previos el problema
dificultad en
cambios en la cambios en
hay dolor? aprehender
conducta alimentación alimento
tocarse la cara, otras

baja de peso? traumas /peleas
babeo enfermedades
acicalamiento?
EXAMEN
CLÍNICO:
Examen clínico Examen extraoral

Examen intraoral
general y e intraoral
(conciente)
extraoral. (anestesiado)
8
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Animal conciente
• Permite entregar un plan diagnóstico

preliminar
• Inspección visual limitada, palpación digital.
• Estructuras evaluables
• Simetríaà cara, arco cigomatico, mejillas
• Palpar globos oculares
• ATM, oclusión
• Músculos masticatorios à inflamación /atrofia
• Glándulas salivares ( mandibular)
• Linfonodos (mandibular y cadena cervical)
Animal conciente
• 1 º Boca cerrada: elevando los labios à
tej blandos y aspecto de los dientes,
• Oler cavidad oral à halitosis
Alejandra Sepúlveda
9
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2 º boca abierta
• Al menos 1 vez
• Evaluación integridad mucosas:
• Color, textura
• Sangrado (petequias, púrpura,
equimosis)
• Sx traumatismo
• Vesículas, ulceraciones.
• Dientes, periodonto:
• Nº dientes
• Fractura dientes
• Retracción gingival
• Exposición furca Alejandra Sepúlveda
Examen bajo anestesia general

• Antes de intubar:
• Oclusión
• Orofaringe
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OCLUSIÓN: Relación de dientes en misma arcada como la relación

con la arcada opuesta.
MORDIDA DE TIJERA INERDIGITACION DE Premolar más rostral

DE INCISIVOS CANINOS es el 2º PM maxilar
INTERDIGITACIÓN DE
• Incisivos superiores rostral a • Caninos mandibulares en PREMOLARES • Gato no tiene 1º PM maxilar
los inferiores diastema entre 3º incisivo y ni 1º y 2º PM mandibulares
canino maxilar sin tocarse.
Figure 1.21 Modified Triadan system

incisor tooth numbering.
*Determinada por : forma de cabeza, largo de mandibula, ancho y posición de

dientes.
40 Feline Dentistry
• Ideal tube positioning is greatly facilitated by tube example, a 4-inch cone requires one-fourth of the expo-
support, arms of various lengths that allow vertical, sure of an 8-inch cone. Generally, short-cone technique,
horizontal, and rotational movement, resulting in which produces less magnification, is preferable because
less patient repositioning. it uses a quarter of the exposure and is easier to position.
• Radiographs can be obtained on the dental opera- The long-cone technique, however, produces films with
tory table rather than moving the patient to a dedi- less divergence and scatter.
cated radiography area (figs. 3.1 and 3.2 a, b, c ). The arm connects the radiograph tube and the control
panel. The control panel contains the timer, kilovoltage
Most dental units are economically priced between
(kV), and/or milliamperage (mA) regulators. Most
US$3,000 and US$5,000, requiring a small cash outlay,
machines have a fixed kV (50–120) and mA (7–15). The
Figure 1.23 Mandibular canine vertical groove. and a long arm can reach two closely located operatory
only variable parameter is duration of the exposure in
areas.
Figure 1.22 Extracted canine tooth. fractions of seconds or pulses (figs. 3.3 a, b).
The position indicating device (PID) is an extension
20 The exposure timer regulates the time an exposure
Equipamiento dental
placed on the tube head at the collimator attachment. To
lasts. The timer is engaged only while the switch is
minimize the amount of radiation exposure, the PID is
depressed and automatically stops at the end of the
lead lined. (Note: older units may not be lead lined.) The
preset exposure. The timer resets after each exposure.
shape of the PID may be circular or rectangular.
Most dental units use 110V, 60Hz AC electricity. A
Dental lead-lined cones are available in a variety of
separate dedicated electrical circuit is recommended.
lengths from 4 to 16 inches. The end of a 4-inch cone may
The kilovoltage peak (kVp) determines the penetrat-
be 8 inches from the radiograph generator. An 8-inch
ing power or quality of radiation produced. Kilovoltage
extension (using a 4-inch cone) is referred to as short-
affects the contrast (shades of gray). The higher the kVp
cone technique; longer extensions result in a long-cone
setting, the higher is the photon energy that strikes an
technique. Exposure adjustments to accommodate dif-
area. To penetrate larger teeth, a higher kilovoltage is
ferent cone lengths employ the inverse square rule. For
required to produce a diagnostic film. When using ultra-
speed D film, the kVp setting varies from 40 to 70,
depending on the tooth and animal size or on the gen-
• UNIDAD RADIOGRÁFICA DENTAL

erator used.
Digital Imaging
• Estáticos / móvil Digital imaging is a major technical advancement in
companion animal dental radiography. Instead of film,
an electronic sensor pad is placed against the teeth; the
pad senses radiation and transfers the pattern as an
image to a computer screen where it can be enhanced,
enlarged, e-mailed, printed, or archived.
A dental radiographic unit is still needed to expose
the sensor. Approximately 1/10 to 1/2 of the nondigital
exposure is commonly needed to obtain a diagnostic
image; however, some systems need the same amount
of radiation as F-speed film. Because of low time expo-
sure settings, older dental radiographic machines may
not have fast enough timers to produce digital images.
The direct-to-digital sensors used in the patient’s
mouth are available in two sizes, similar to film numbers
1 and 2. Phosphor transfer sensors are available in four
sizes, similar to film numbers 0, 1, 2, and 4. Parallel and
bisecting angle techniques are used to position the
sensor and PID properly. The operator selects the tooth
or quadrant to be exposed from computer software. In
a direct systems, images will appear on the screen within
Figure 3.1 Ceiling-mounted radiographic generator and monitor. a matter of seconds (figs. 3.4 a, b).
11
b
Figure 3.4 a. Wired direct radiography (DR) sensor (EVA AFP Imaging).
b. Computed radiography (CR) film plate (Scan X).
b
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Radiografía dental digital
placas convencionales
22 Topics in Companion Animal Medicine
Radiovisiógrafos
•Tamaño máximo 2 22 Topics in Companion Animal Medicine
•Obtención inmediata de la imagen

Placas de fósforo fotoestimulables
Figure 2. Bioray digital sensor.
Figure 4. Scan-X phosphor plate digital system.

Regardless of the type of digital system used, image quality
depends a great deal on the software used to process the
image. For an unbiased comparison of the image quality vice). For future integration with a central image server, read-
•Tamaños 0-4
ers may want to give consideration to systems that have Dig-
produced by different digital systems, you can order a free
“sensor shootout” CD online at www.vetdentalrad.com. ital Imaging and Communications in Medicine (DICOM) 3.0
Most available software systems allow for the manipulationcompatibility. The DICOM standards maintain patient in-
and enhancement of the image after the exposure, which formation for the images and also define a standard image
•Se ingresa placa a sistema de scanner

format so that anyone else with a DICOM-compliant image
decreases the need for additional exposures. As digital com-
munication becomes more common, digital image will be- viewer may see the film in its original form. The reader is
come the norm in clinical practice. A major advantage of cautioned that the DICOM standards for digital dental ra-
diographs in veterinary medicine are not standardized at this
digital systems is the ability to e-mail images for consultation
and review (www.vetdentalrad.com dental teleradiology ser-time and systems vary widely in their ability to integrate into
central DICOM image (PACS) servers. Any claims by ven-
dors with regards to DICOM capabilities should be carefully
Figure 2. Bioray digital sensor. investigated and guaranteed in writing. All digital systems
require some computer literacy. Some digital systems (Bio-
Figure 4. Scan-X phosphorRay, Dentalaire)
plate digitalcan be integrated with practice management
system.
software programs to provide an imaging module which can
Regardless of the type of digital system used, image quality then be used to store and review not only digital dental films,
depends a great deal on the software used to process the but also ultrasound images, endoscopic studies, electrocar-
image. For an unbiased comparison of the image quality vice). For future integrationdiograms,
with a central
computed image server, scans,
tomography read- full-size radio-
produced by different digital systems, you can order a free ers may want to give consideration to systems
graphs, magnetic that
resonance haveorDig-
images, any other images that
are digital in
ital Imaging and Communications in Medicine origin or that(DICOM)
can be scanned.
3.0Some savings that
“sensor shootout” CD online at www.vetdentalrad.com. a digital system provides include elimination of film and
Most available software systems allow for the manipulation compatibility. The DICOM standards
chemistry costs, maintain
no chemicalpatient
disposal in-
fees, no regulatory
and enhancement of the image after the exposure, which formation for the images and also
costs of define
tracking a standard
chemicals and theirimage
disposal, decreased film
decreases the need for additional exposures. As digital com- format so that anyone else storage
with acosts,
DICOM-compliant
and decreased employee image
time to develop and
file radiographs. A typical 1-doctor practice performing 5
munication becomes more common, digital image will be- viewer may see the film indentalits original form. The reader is
cases per week can recoup the additional cost of a
come the norm in clinical practice. A major advantage of cautioned that the DICOM standards
digital system in for
12-18 digital
months.dental ra- of the 2 cur-
Some features
digital systems is the ability to e-mail images for consultation diographs in veterinary medicine
rent typesareofnot standardized
digital at thissystems are pre-
dental radiographic
time and systems vary widely sented in Table
in their 3.
ability to integrate into
and review (www.vetdentalrad.com dental teleradiology ser-
central DICOM image (PACS) servers. Any claims by ven-
Tips for Using Digital Sensors for Dental Radiographs Mod-
dors with regards to DICOM ern capabilities shoulddiagnostic
digital systems provide be carefully
image detail, with DR
investigated and guaranteed in writing.
systems Alldecreasing
also markedly digital exposure
systemstimes when com-
require some computer literacy. Some
pared with digital
dental film orsystems (Bio-
CR systems. Digital systems do
Figure 3. Scan-X phosphor plates. have some unique characteristics that must be recognized to
Ray, Dentalaire) can be integrated with practice management
software programs to provide an imaging module which can
then be used to store and review not only digital dental films,
but also ultrasound images, endoscopic studies, electrocar-
diograms, computed tomography scans, full-size radio-
graphs, magnetic resonance images, or any other images that
are digital in origin or that can be scanned. Some savings that
a digital system provides include elimination of film and
chemistry costs, no chemical disposal fees, no regulatory
costs of tracking chemicals and their disposal, decreased film
storage costs, and decreased employee time to develop and
file radiographs. A typical 1-doctor practice performing 5
dental cases per week can recoup the additional cost of a
digital system in 12-18 months. Some features of the 2 cur-
rent types of digital dental radiographic systems are pre-
sented in Table 3.
Tips for Using Digital Sensors for Dental Radiographs Mod-

ern digital systems provide diagnostic image detail, with DR
systems also markedly decreasing exposure times when com-
ORAL ANATOMY
Figure 3. Scan-X phosphor plates.
pared with dental film or CR systems. Digital systems do
have some unique characteristics that must be recognized to 777
Fig. 9. Intraoral radiograph of the lower first molar region of the dog.
Gorrel,2010.
rostral part of the lower jaw. It is the main continuation of the alveolar
artery of the mandible. The rostral mental artery is the smallest of the three
mental arteries, running to the incisive-mandibular canal [1].
The pterygoid portion has no branches. The pterygopalatine portion has
important rami, including the pterygoid (supplies part of the medial
pterygoid), buccal (large wings are distributed to masseter, temporal, and 12
buccinator muscles terminating in the region of the soft palate and the
31/8/17
56 Feline Dentistry
a b
Figure 3.16 a and b. Left mandibular premolars and first molar. a. Patient, tube head, and sensor position. b. Left mandibular premolars and first molar image.
c and d. Right mandibular premolars and first molar. c. Patient, tube head, and sensor position. d. Right mandibular premolars and first molar image.
Temporomandibular Joint dibular fossa that partially envelops and prevents caudal
luxation of the mandibular condyle. At the rostral
The temporomandibular joint (TMJ), also called the cra- margin of the mandibular fossa there is a small, unnamed
niomandibular joint, is a transversely elongated, syno- protuberance.
vial joint formed by the condylar process of the mandible The joint may be affected by congenital defects (most
and the mandibular fossa of the temporal bone. The commonly dysplasia), trauma (luxation, fracture), infec-
reticular process is a caudoventral extension of the man- tion (septic arthritis, non-infected degenerative joint
13
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• Guía para los odontólogos veterinarios

de animales de compañía
• Cuidados orales preventivos
• Comunicación clientes
• Evaluación dental, limpieza dental y
tratamiento.
Afecciones por edad
0 a 9m 5m a 2a >2 a
Dientes deciduos Progresión de
Enfermedades del enfermedad periodontal
Ausencia o dientes extra desarrollo
Daño de estructuras
Inflamación
dentales
Enfermedades juveniles Dentición permanente,

acumulo de placa o
calculo. Masas orales
Oclusión
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31/8/17
Educación del cliente
Salud oral
preventiva
• Cepillos dentales, cerdas suaves
• 1 -2 veces / día
Higiene oral
• Pasta dental de perros/ gatos
• Dietas dentales
• Juguetes
• Demostrar como se realizan los
procedimientos.
15
31/8/17
Evaluación dental bajo Uso anestesia a gases

anestesia • Traqueotubos con balón
• 1º año de edadà gatos y perros
razas pequeñas – medianas
• 2ª año de edadà perros razas
grandes
Condiciones orales comunes en el

gato
KITTEN <1a ADULTO (1-7a) SENIOR (<7a)

• viral (FELV,FIV, • enfermedad periodontal • enfermedad periodontal
coronavirus, herpes) • FORL • FORL
• gingivitis juvenil • FIV • tumores orales
• periodontitis juvenil • gingivostomatitis • ERC /D. Mellitus
• FORL • complejo granuloma
• maloclusion eosinofilico
• IRA • IRA
16
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INFLAMACIÓN DE LA
CAVIDAD ORAL
ANTECEDENTES
ANAMNÉSICOS
dejar caer
agresión comida
rechazar comida
mufar al comer dura
correr de la
comida
17
31/8/17
SIGNOS
CLÍNICOS
trismos anorexia
agitar la cabeza disfagia
movimiento
excesivo de la halitosis
lengua
pérdida de peso
ptialismo
disconfort deshidratación
Inflamación Oral
tiempo lesiones márgenes ubicación
aguda localizadas bien

definidos diente
crónica multifocales
mal zonas
aguda à definidos edentadas
crónica generalizadas
18
31/8/17
gingivitis
quemaduras periodontitis
enfermedades inflamación gingivostomatitis
oral
metabólicas
reacción a granuloma
cuerpo extraño eosinofílico
enfermedades
inmunomediadas
/autoinmunes
Ubicación Término Definición
GINGIVA GINGIVITIS Inflamación de la gingiva
• La inflamación se limita a la
encía sin destrucción del
tejido periodontal.
• reversible
• gingivitis àperiodontitis.
19
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Ligamento periodontal, hueso PERIODONTITIS Inflamación de los tejidos
alveolar, cemento periodontales
Periodontal disease
a b
Dra Alejandra Sepúlveda

Perdida de soporte
Irreversible
Consecuencia: pérdida pieza dental.
Figure 22 Alveolar bone

c loss is evidenced by d
radiolucency in the
coronal area of the bone.
Horizontal bone loss (a,b)
appears as generalized
bone loss of a similar level
across all or part of an
arcade (red arrows).
Vertical (angular) bone
Dra. Sonia Madrid loss (c,d) has the
radiographic appearance
of one area of recession
below the surrounding
bone (white arrows).
Note also in (d) the
fractured third incisor
(103; blue arrow) and
retained root tip of the
Pérdida de hueso vertical second incisor (102;
red arrow)
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ORAL EXAMINATION IN TH
A systematic approach
20
David E Clarke and Anthony Caiafa

change from a predominantly aerobic and possibly endocarditis, glomeru-
bacterial population to a motile Gram- lonephritis and meningitis, all of which
negative anaerobic bacterial population have been reported in the human
induces destruction and apical migration literature.
of the epithelial attachment. This results In time the cementum will be infiltrated
in loss of the periodontal ligament and with bacteria, endotoxins, plaque and
alveolar bone. At this stage disease calculus. Bacteria may penetrate the
becomes progressive. In reality, dentinal tubules, resulting in cementum
periodontitis does not progress in a
Figure 13 Formation of a periodontal pocket.
necrosis, pulpitis and pulp necrosis 31/8/17
constant regular fashion, as the advancing Note the plaque and calculus accumulation on with internal and external tooth
disease is halted by the immune system the tooth root and loss of attachment including resorption.
periodontal ligament and alveolar bone
Determination of gingival sulcus *. #-,-' )(-. %"$!"%. *'. *!-,. #-,&. ,&-
or periodontal pocket depth MULTIMEDIA -')*#*(,+$. '*-. )%. $+!-#. +'+$$-$. ,*. ,&-
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DOI: 10.1177/1098612X14552364
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a b
Chapter 8
Treatment of Periodontal Disease
Periodontal probe
Gingival sulcus
Dra Alejandra Sepúlveda

Goals of periodontal therapy include removing irritants • Stage 4 advanced periodontitis occurs where there
and debris from the tooth surfaces and periodontalFigure 15 (a)isHolding greater than
and using 50% loss
a periodontal ofnote
probe; periodontal support.
the tip of the probe is at the gingival
pockets, and minimizing pocket depth and attachmentmargin. To measure the periodontal sulcus/pocket, the probe is advanced subgingivally to the
Extraction
epithelial attachment. is generally
(b) Placement the treatment
of a periodontal probe into theof choice.pocket on the
periodontal
loss whileFigure
maintaining at leastprobing
14 Diagram of periodontal two millimeters ofmesiopalatal surface of the maxillary canine tooth (204)
Sondaje periodontal normal
881
attached gingiva.
gatos: 0,5 – 1 mm
Periodontal therapy ranges from removing plaque
Plaque and Calculus Removal
JFMS CLINICAL PRACTICE
and calculus in cases of gingivitis, to mucogingival
Plaque and calculus can be removed by hand using fine
surgery, to extracting affected teeth. Periodontal therapy
curettes or with the help of ultrasonic scalers equipped
decisions should be made by evaluating clinical and
with periodontal tips.
radiographic examination results together with client
Ultrasonic sound waves are composed of alternate
input concerning expectation, finances, and ability to
compressions and rarefactions. During the low-pressure
provide essential after care.
rarefaction cycle, microscopic bubbles are formed.
Stage of disease at the time of the oral assessment
Through the high-pressure compression cycle, the
dictates the recommended therapy (table 8.1). Gingivitis
bubbles collapse or implode. These implosions produce
is confined to gingival soft tissue inflammatory changes.
Estadificación Enfermedad
Periodontitis is diagnosed when there is loss of tooth
support from the peridontium.
• periodontal
Stage 1 disease is characterized by gingival inflam-
Table 8.1. Summary of periodontal therapy.
mation without loss of periodontal support. Radio- Stage Disease Description Therapy
graphs are developed and examined to give more
information about additional pathology present. Stage 1 Gingivitis Inflammation without Supragingival scaling,
Gingivitis is treated with plaque and calculus periodontal support loss irrigation, and
removal, polishing, and irrigation of the crown and polishing
the gingival sulcus. Once the irritating plaque and Stage 2 Early Inflammation, swelling, Supragingival and
calculus areÍndice de Gingivitis (0-3)
removed, the gingiva returns to normal periodontitis gingival bleeding upon subgingival scaling,
as long as home care is instituted. probing, with up to 25% irrigation, and
Índice de Calculo (0-3)
• Stage 2 early periodontitis is present when there is periodontal support loss polishing
less than 25% loss of periodontal support. Stage 2
Índice de Movilidad (0-3) Stage 3 Established Inflammation, edema, Supragingival and
disease is treated as above, plus removal of plaque periodontitis gingival bleeding upon subgingival scaling,
Exposición Furca (1-3)
and calculus from the exposed root surface (subgin- probing, pustular irrigation, and
gival scalingMovilidad Dental (1-3)
root planing) and gingival curettage. discharge, moderate bone polishing; extraction
loss, between 25% and of affected teeth if
• Stage 3 established periodontitis exists when 25%
50% periodontal support owner cannot provide
to 50% of the periodontal support is lost. The prog-
loss home care
nosis is better when there are nonpocket defects
compared to pocket defects, which readily accumu- Stage 4 Advanced Inflammation, edema, Extraction of affected
late oral debris after the oral assessment, treatment, periodontitis gingival bleeding upon teeth
probing, pustular
and prevention (Oral ATP) visit. Efforts of plaque
discharge, tooth mobility,
and calculus removal versus extraction must be
marked (>50%)
weighed against the ability to provide daily home periodontal support loss
care.
181
21
31/8/17
TRATAMIENTO
Objetivo:
controlar la Higiene oral Terapia
causa de la periódica: periodontal
inflamación dueño profesional.
(placa )
TERAPIA PERIODONTAL PROFESIONAL
Destartraje supra y subgingival
Alisado radicular
Pulido corona
Cirugía periodontal
22
31/8/17
TERAPIA PERIODONTAL PROFESIONAL

• Anestesia general (gases)
• Manejo antibiotico
• Manejo del dolor
• Instrumental
• Ultrasonido /scaler
• Sonda periodontal
• Rx dental
• Pieza de mano de baja velocidad
• Turbina ( alta velocidad)
• Bisturí
• Suturas: vicryl 3/0 P; 4/0 G
Destartraje
• SUPRAGINGIVAL
• Remoción de placa y cálculo
sobre el margen gingival.
• ultrasonido.
• 15 seg x diente.
• SUBGINGIVAL
• PULIDO
• PASTA PROFILÁCTICA
• Pieza de mano baja velocidad
• 15 seg x diente
• EXODONCIA
23
31/8/17
Enfermedad resorptiva felina (FORL)
• Son defectos progresivos de la sustancia

calcificada de los dientes permanentes
producto de la actividad destructiva de los
ODONTOCLASTOS sobre el cemento radicular.
• Prevalencia: 29-67%
• Aumenta la incidencia con la edad.
24
31/8/17
Etiología
Pérdida de
matriz Liberación de
microfracturas citoquinas
inflamación de la orgánica que
Dieta que estimulan
placa inducida superficie del protege
la actividad
cemento tejidos duros
clástica
en raíz.
Diagnóstico
• Inspección visual
• Tejido gingival hiperplásico sobre la lesión
Dra. Sonia Madrid
• Calculo dental evita ver lesiones
• Examinación bajo anestesia con explorador dental
• Rx dental intraoral
Dra. Sonia Madrid
Dra. Sonia Madrid
25
tooth root is being replaced by new bone.
In type 2 tooth resorption, the periodontal ligament is thin to absent in areas and the
With all types of tooth resorption, radiolucent foci may be seen on or within the
alveolar bone contacts the cementum and begins replacing the dental hard tissue with
crown of the tooth. These foci are often congruous with grossly visible defects in
osteoid, and ankylosis of the tooth root to the alveolar bone (dentoalveolar ankylosis)
the crown.
occurs. When type 2 tooth resorption is present, the periodontal ligament space and
When dura
lamina type are1 tooth resorptionon
not identifiable is the
present, there The
radiograph. is noradiographic
evidence that the of
border dental hard
the root
tissue is being replaced
is indistinguishable frombythe bone. The periodontal
radiographic border of ligament spacebone.
the alveolar is visible and the
An artist’s
lamina dura is seen at
rendering is shown in Fig. 9. the periphery of the periodontal ligament space. The roots
are easily distinguished
The radiodensity from
of the rootthe surrounding
is not homogenous bone. An artist’s
when rendering isispresent.
type 2 resorption shown in
Fig.
With8. type 1 resorption, the root is uniformly radiodense compared with the
Often what bone.
surrounding
ontothe
thatcrown
is observed
of theofsurrounding
on radiographs
With type 2 resorption, is
the tooth. Typically
bone. However,
thea overall
focal orradiodensity
this corresponds
there may be
multifocal radiolucency
withradiodense
a defect that
present
of the root is similar
is visible
threads visibleon 31/8/17
examination.
(Fig. 10). In this defect, the enamel of the crown is missing and the dentin is
exposed.
With typeIn later stages, the
2 resorption, pulp
part of ofthethe
roottooth
mayisbe exposed and often with
easily detectable appears inflamed.
radiographs
A but
proliferation
the originalofborders
soft tissue
of thefrom
rootthe havegingiva that covers
been replaced or fillsThere
by bone. the crown
is still adefect
radio- is
often
lucentobserved. This soft the
margin between tissue is not root
existing typically
and observed
bone, andon radiographs.
root may have a conical
appearance. In these cases
A focal radiolucency on theit isroot advisable
may nottonecessarily
extract the visible and radiographically
show external resorption. It
evident
may portion
indicate of theresorption
internal root while or leaving the portion
resorption withinreplaced
the rootby bone.If the radiograph
canal.
tubeType 2 resorption
is shifted may beoblique,
to slightly radiographically present without
the radiograph externalgross evidence
lesions of toothto
will appear
resorption.
move away fromIt is generally
the pulp thought
and internal that iflesions
there iswill
noremain
resorption coronal to
contiguous thethe
with alveolar
pulp.
bone and no evidence of internal resorption, there is no associated pain. However it
is impossible to predict how quickly this lesion will progress. It may be prudent to treat
these teeth proactively.
Clasificación según aspecto rx raíz y ligamento When type 1 resorption is present, the roots may still display external resorption,
which is seen as a focal radiolucency on the root or a scalloped appearance of the
periodontal: root. It is common to find that the associated alveolar bone is reduced in height or
infrabony pockets are present. There is evidence that type I resorption is more
common than type 2 resorption in the presence of concurrent periodontitis.5 Peri-
odontal bone loss is not a common finding in teeth with type 2 resorption. The alveolar
Tipo 1 bone height is often normal.
The periodontal ligament space is not always obvious in normal teeth. Inability to
identify it on a radiograph does not necessarily indicate that the tooth is undergoing
•Radiolucencia normal type 2 resorption. If the density of the root is uniformly more radiodense than the
surrounding bone but the periodontal ligament space is not easily seen, it is possible
•Espacio del ligamento periodontal that the periodontal ligament is too thin or the resolution of the radiograph not high
visible.
•Raices se distinguen fácilmente
Fig. 8. Artist’s rendering of type 1 tooth resorption.
Tipo 2
•Ligamento periodontal delgado o

ausente en áreas
•Anquilosis dentoalveolar
•Ligamento periodontal y lámina dura Clinical Feline Dental Radiography 541
no diferenciables
Tipo 3
• Tipo 1 y 2 en el mismo
diente
indicate that only enamel is missing. However, for enamel to be lost, underlying
dentin must first be resorbed.
Stage 2 indicates that there is some dentin loss; however, the lesion has not
extended into the pulp. These lesions appear radiographically as focal or
multifocal lucency on the crown and/or root.
Stage 3 resorption involves the pulp of the tooth. This may be seen grossly as a pink/
red soft tissue bleb present within a defect in the crown. On radiographs, the
lucency is contiguous with the root canal or pulp chamber.
Stage 4 indicates that a significant portion of the root is missing.
In teeth with stage 5 tooth resorption, the crown of the tooth is absent, but a spur of
Clasificación según progresión bone may be seen rising from the occlusal ridge of the jaw. These structures
occasionally contain spicules of bone or osteoid that may protrude through
the gingiva.
Again, it is only appropriate to perform crown amputation with intentional root
resorption on roots undergoing type 2 resorption. Roots undergoing type 1 root
resorption may not resorb and can remain as a nidus for inflammation (Fig. 13).
ESTADIO 1
cemento
ESTADIO 2
cemento - dentina
Fig. 13. Teeth with type 1 tooth resorption should not be treated with crown amputation.
ESTADIO 3 The roots do not resorb and may be a nidus for infection and inflammation, as shown by
cemento- dentina -pulpa

the periapical lucency and extrusion of the mesial root of the right molar. Note the U-shaped
defect in the root, which may indicate that a previous clinician attempted to drill out the root.
ESTADIO 4 (a,b,c)
daño extensivo, anquilosis
ESTADIO 5
remanentes radiculares Copyright© AVDC®, used with permission
26
31/8/17
ESTADIO 1 ESTADIO 2 ESTADIO 3
ESTADIO ESTADIO ESTADIO

ESTADIO 5
4a 4b 4c
r
q
Figure 5.25 Continued
125
27
31/8/17
Tratamiento
• Objetivo: aliviar el dolor, prevenir la progresión y

restaurar la función.
• Manejo conservador à monitorear lesiones rx
• Extracción dental
• amputación de corona
Management Tree / DENTISTRY Peer Reviewed
Oral Inflammation in Cats Judy Rochette, DVM, FAVD, DAVDC

West Coast Veterinary Dental Services
Vancouver, British Columbia
Juvenile CBC, serum biochemistry Adult

profile, viral testing
Infected Eruption TR, perio- Systemic

dental sac gingivitis Stomatitis dontal disease disease
Operculectomy, Treat
antibiotics COHAT COHAT underlying
disease
Plaque control, Extractions

gingivectomy (as needed),
plaque control
Resolution Persistence Interval

professional
care
Annual
professional
care
Unable to perform home Able to perform home

care/plaque control care/plaque control
Extraction of Extraction of all teeth Extraction of

all teeth caudal to canines compromised teeth
Resolution Incomplete resolution Interval

professional care
28
Plaque control Extraction of any
and annual remaining teeth
professional care
(if any teeth
remain)
31/8/17
INFLAMACIÓN CAVIDAD ORAL
MUCOSA ALVEOLAR MUCOSITIS ALVEOLAR Inflamación de la mucosa

alveolar
Mucosa de la cavidad oral MUCOSITIS CAUDAL Inflamación de la mucosa

caudal caudal de la cav oral
29
31/8/17
Mucosa labial MUCOSITIS LABIAL Inflamación de la

O BUCAL mucosa labial o
mejilla.
Mucosa sublingual MUCOSITIS Inflamación de la

SUBLINGUAL mucosa del piso de
la boca.
boca ESTOMATITIS inflamación de la mucosa que cubre cualquier estructura de la boca. el

termino se reserva para describir la inflamacion oral generalizada
30
inflammation in FCGS, by definition, extends Many
beyond the mucogingival junction to encom-
pass the alveolar mucosa and other soft of ju
tissues including the lingual mucosa, glos- gingiv
sopalatine folds, caudal oral mucosa and occa-
be mis
31/8/17
sionally the fauces (Figure 22). If inflammation
is confined to gingival tissues, by definition a
diagnosis of FCGS cannot be made. The
FC
administration of antiviral and immunomod- If infla
ulatory treatments to young cats suffering
from intense gingivitis has no scientific basis. is co
to g
Figure 22 Correct
terminology for inflammation tissu
seen in feline chronic
gingivostomatis (FCGS).
The caudal area of the
defin
mouth (commonly and
incorrectly referred to as diagn
the fauces) does not have
a specific anatomical term;
inflammation here should
FCGS
be referred to as caudal
stomatitis or mucositis. be m
The fauces are actually
the lateral walls of the
oropharynx, housing the
tonsils. Inflammation here
is termed faucitis but would
usually only be identified
under anaesthesia.
Inflammation may extend
beyond the mucogingival
junction to involve the
alveolar mucosa (alveolar
mucositis) and eventually
cheek mucosa (buccal
mucositis). The palatoglossal
folds may also be affected
in this frustrating condition.
Caudal stomatitis must be
identified in order to
diagnose FCGS
52 JFMS CLINICAL PRACTICE
Gingivostomatitis crónica
felina
31
31/8/17
Gingivostomatitis Crónica Felina (GCF)
Inflamación oral severa en gatos, la cual es

vista comúnmente en la práctica veterinaria a
menudo refractaria al tratamiento.
• 0,7- 10% de gatos que acuden a consulta veterinaria
• 3% practica odontológica
• edad promedio : 7 años
Table 1.1: Nomenclature for feline chronic gingivostomatitis
Described location of lesions Name given to syndrome Reference
Premolar/molar gingiva with or without palatoglossal arches, pharynx, hard Gingivitis stomatitis Frost and Williams (1986)
palate, tongue, periodontal disease
Gingiva with or without palatoglossal folds, pharynx, hard palate, tongue Plasma cell gingivitis-pharyngitis Sims et al. (1990)
Gingiva or palatoglossal folds, pharyngeal walls, tongue, palate, lips, buccal Plasma cell stomatitis pharyngitis White et al. (1992)
mucosa
Gingiva or adjacent mucosa or palatoglossal folds with or without cheeks, Feline gingivitis stomatitis pharyngitis complex Diehl and Rosychuk (1993)
tongue, lips
Fauces with or without gingiva and tongue Gingivostomatitis Hawkins (1999)
Isolated or a combination of gingivitis, stomatitis, periontal disease, glossitis, Gingivitis-stomatitis-oropharyngitis (GSO) Mihaljevic (2003)
palatitis, buccostomatitis, faucitis, ostitis, osteomyelitis
Gingivitis-stomatitis: premolar/molar gingiva/bucca with or without FCGS Gorrel (2004)
palatoglossal folds and lingual area
Stomatitis-gingivitis: Palatoglossal folds and gingival/buccal mucosa with or
without hard palate, tongue
Gingiva, caudal parts, lips, ventral tongue Lymphoplasmacytic gingivitis Baird (2005)
Caudal parts extending to buccal and gingival mucosa with or without pharynx, FCGS Healey et al. (2007)
palate, tongue
Palatoglossal folds or gums or palate or buccal mucosa or tongue FCGS Bellei et al. (2008)
Palatoglossal folds, premolar/molar gingival and buccal mucosa FCGS Southerden and Gorrel (2007)
Southerden (2010)
Arzi et al. (2010b)
Hennet et al. (2011)
A selection of names for FCGS taken from the literature and the described location of the lesions
Dolieslager, 2012
32
31/8/17
• inflamación proliferativa y ulcerativa de la

cavidad oral que afecta una variedad de sitios
• lesiones orales inflamatorias mucosa gingival y
no gingival
dolor severo disminución de

Halitosis (75%) ptialismo (71%) (34%) peso (62,5%) disfagia (15%)
pérdida de la manipular la
inapetencia Anorexia conducta de cavidad con las Sangramiento
acicalamiento manos (pawing)
•calicivirus
•Herpesvirus
•FIV
•VILEF
•Bartonella henselae
•Pasteurella multocida
Etiología Desconocida, agentes

predisposición infecciosos
por raza, estrés (factor de
ambiental riesgo)
Causa 2º a causas
inmunomediada variadas
•neoplasias
•toxinas
•enfermedades metabólicas
33
31/8/17
Calicivirus
• Los gatos con GCF tienen infecciones
por calicivirus persistentes R E V I E W / ABCD guidelines on feline calicivirus infection
• Diseminación persistente en todos los

gatos con GCF a diferencia del 20% en
gatos normales
• 87-93% de positividad a calicuvirus
felino en gatos afectados por GC (Harvey
et al, 2010).
• Ulceración paladar, filtrum y lengua
• inducción de una respuesta inmune
citotóxica subyacente la cual puede ser
asociada con una etiología viral. FIG 1 Tongue ulcer in a cat with feline calicivirus infection. FIG 2 Sloughing oral ulcer and rh
Courtesy of Albert Lloret feline calicivirus. Courtesy of Meria
occur, most clinical courses show a typical

syndrome of lingual ulceration and mild acute
respiratory disease (Figs 1 and 2). More severe
signs can resemble the respiratory disease
caused by FHV.
Acute oral and upper respiratory disease is
seen mainly in kittens. After an incubation
period of 2–10 days, oral ulceration, sneezing
and serous nasal discharge are the main signs.14
Fever is also observed. Anorexia is sometimes
accompanied by hypersalivation due to the
erosions, which are located mainly on the tongue
and are usually more prominent than rhinitis.
The erosions usually resolve after several days.
In some severe cases, pneumonia, manifesting as
dyspnoea, coughing, fever and depression, can
occur, particularly in young kittens. Virulent systemic FCV d
Outbreaks of highly viru
Chronic stomatitis FCV infection have rece
Feline calicivirus can be isolated from nearly all in the United States an
cats presenting with the chronic lympho- disease has been named ‘
plasmacytic gingivitis/stomatitis complex. It calicivirus disease’
is characterised by a proliferative/ulcerative ‘hemorrhagic-like fever’.
PLACA BACTERIANA faucitis (Fig 3), which is possibly an immune- are most commonly ref
mediated reaction to FCV (and to other oral systemic feline caliciviru
antigens). However, the disease has not been The incubation period
• factor contribuyente reproduced experimentally, and the exact role systemic FCV infection in
of FCV remains unclear. but in the home environm
• > prevalencia de P. multocida en gatos con GCF to 12 days.28 The disea
que en gatos sanos * implicancia etiológica. Limping syndrome adults than in kittens. In
An acute transient lameness with fever can did not protect again
follow FCV infection and vaccination. In although, experimentally
natural infection, it occurs a few days or weeks been achieved.16,28,29 It is u
Aberración en la respuesta inmune: after the acute oral or respiratory signs.27 is due to inherent cha
hypervirulent strains o
strains are unlikely to c
vaccination is so widely p
• linfocitos T CD8+ (linfocitos T citotóxicos) While subclinical infections occur, most clinical Virulent systemic
characterised by a sys
superaron notoriamente a las celulas T CD4+ (T courses show a typical syndrome of lingual response syndrome,
helper), sugiriendo que los patógenos ulceration and mild acute respiratory disease.
vascular coagulation, m
death, with mortality rat
intracelulares, como los virus, juegan un rol en
la patogénesis de GCF.
558 JFMS CLINICAL PRACTICE Downloaded from jfm.sagepub.com at UNIVERSIDAD DE CHILE on March 23, 2015
34
31/8/17
Exámenes Complementarios
• Bioquímica sanguínea:
• se limitan a altas concentraciones de globulinas à hipergammaglobulinemia
policlonal
• igG, igM, e igA.
• Saliva : GCF la cual tiene mucha mas igG, moderada igM y menor igA.
242 R. Harley et al.
Table 2
• Radiografía cavidad oral completa. permite diferenciar entre enfermedad

Scoring system for severity of microscopical inflammatory change
Histopathological grade and microsco

periodontal, FORL y gingivostomatitis crónica. Grade 0: Normal
Stratified squamous epithelium with s
lymphocytes. The lamina propria/subm
scattered mast cells and lymphocytes. The
small subepithelial aggre
HE. Bar, 100 mm

Grade 1: Minimal to mild infl
Variable, mild epithelial hyperplasia and
slightly increased numbers of intraepithelia
exocytosing neutroph
The lamina propria/submucosa contains a sp
to interstitial population of plasma cells, lym
rare macrophages
HE. Bar, 100 mm
Grade 2: Moderate inflam

Epithelial hyperplasia variably with regi
Diagnóstico: HISTOPATOLOGÍA
ulceration. Mild to moderate numbers of in
variably mixed with macrophages
The lamina propria/submucosa contains a
cell infiltration of lymphocytes and plasma
numbers of macrophages and neutrophils.
Mucosa y submucosa: infiltrado de células plasmáticas con menos número de linfocitos, may form a distinct ‘lichenoid’ band with
neutrófilos y macrófagos à asociado cualquier inflamación en la boca de un gato. propria. In the submucosa the infiltrating
242
Utilidad: descartar neoplasia. R. Harley et al. skeletal muscle fibre
Table 2
Scoring system for severity of microscopical inflammatory change
HE. Bar, 200 mm
Histopathological grade and microscopical features
Grade 0: Normal Grade 3: Severe inflamm
Often extensive regions of epithelial degen
Stratified squamous epithelium with sparse intraepithelial
lymphocytes. The lamina propria/submucosa contains ulceration
sparse and superficial exudation wit
scattered mast cells and lymphocytes. The lymphocytes may form neutrophils and lympho
small subepithelial aggregates. The lamina propria/submucosa contains
infiltrate with variable proportions of lym
macrophages and neutrophils. In some sect
expanded or replaced by immature gr
fibrinonecrotic debr
HE. Bar, 100 mm HE. Bar, 200 mm
Grade 1: Minimal to mild inflammation

Variable, mild epithelial hyperplasia and parakeratosis. May have
slightly increased numbers of intraepithelial lymphocytes and sparse
exocytosing neutrophils.
The lamina propria/submucosa contains a sparse to light, perivascular
to interstitial population of plasma cells, lymphocytes, mast cells and
rare macrophages.
HE. Bar, 100 mm
Grade 2: Moderate inflammation

Epithelial hyperplasia variably with regions of degeneration or
35
ulceration. Mild to moderate numbers of intraepithelial lymphocytes
variably mixed with macrophages and neutrophils.
The lamina propria/submucosa contains a moderate inflammatory
cell infiltration of lymphocytes and plasma cells mixed with variable
numbers of macrophages and neutrophils. The inflammatory cells
may form a distinct ‘lichenoid’ band within the superficial lamina
propria. In the submucosa the infiltrating cells often extend around
skeletal muscle fibres.
31/8/17
Tratamiento
• Profilaxis dental. Cepillado dentalà

difícil por dolor en cavidad oral
• Antibióticos. control la placa bacteriana
Management Tree /
pero esta ampliamente aceptado que
DENTISTRY Peer Reviewed
como droga única no sirve para tratar la

Oral Inflammation in Cats Judy Rochette, DVM, FAVD, DAVDC
West Coast Veterinary Dental Services
GCF.( Addie et al, 2003) Vancouver, British Columbia
• Antiinflamatorios no esteroidales.
Juvenile CBC, serum biochemistry Adult
Eficacia dudosa a largo plazo.

profile, viral testing
Infected Eruption TR, perio- Systemic

dental sac gingivitis Stomatitis dontal disease disease
Operculectomy, Treat
antibiotics COHAT COHAT underlying
disease
Plaque control, Extractions

gingivectomy (as needed),
plaque control
Resolution Persistence Interval

professional
care
Annual
professional Estomatitis
care
Unable to perform home Able to perform home

care/plaque control care/plaque control
Extraction of Extraction of all teeth Extraction of

all teeth caudal to canines compromised teeth
Resolution Incomplete resolution Interval

professional care
Plaque control Extraction of any

and annual remaining teeth
professional care
(if any teeth
remain)
Incomplete resolution
Diagnosis
Investigate
Feline ω- Supportive COHAT = comprehensive Treatment

interferon Cyclosporine care/adjunct oral health assessment
therapy and treatment, TR = Results
tooth resorption
Management Tree / NAVC Clinician’s Brief / June 2012 ......................................................................................................................................................................101
36
31/8/17
Tratamiento
El tratamiento
quirúrgico es
Extracción dental. el tratamiento
de elección en
gatos con GCF.
60 a 80% de los gatos

vía más efectiva para conGCF mejoran 20% presentan mejoría
minimizar la placa y pero necesitan
significativamente luego
reducir la inflamación de la extracción de todos medicamentos para
oral. los premolares y molares. controlar estomatitis.
13% mejoría pero

necesitan de tto 7% sin mejoría luego de
tto medico y quirurgico.
antiinflamatorio continuo.
R E V I E W / Oral anatomy and tooth extraction
IDGHAJ A=/HGFCBJ @H6IJ B@HC;4J :AHG2GE;;I?

8AH?IBJ :FCJ ;IDIGCHGED9J HD?J >=GGED9J G@IJ ;ICEFJ2
?FDGHAJAE9H<IDGJ8IG3IIDJG@IJGFFG@JHD?JHA6IF2
AHCJ 8FDI7J IDGHAJ IAI6HGFCBJ @H6IJ AIBBJ B@HC;4
<FCIJ>=C6I?J8AH?IBJ'E9=CIJ)4J:EGGED9JG@IJ>EC2
>=<:ICID>IJ F:J G@IJ GFFG@J GFJ I/ICGJ HJ CFGHGEFDHA
:FC>I4J G@=BJ GIHCED9J G@IJ ;ICEF?FDGHAJ AE9H<IDG
:E8CIB7J.@IBIJEDBGC=<IDGBJHCIJ9CHB;I?J3EG@JG@I
8=GGJF:JG@IJ@HD?AIJBIHGI?JEDJG@IJ;HA<4JHD?JG@I
ED?I/J:ED9ICJI/GID?I?JHAFD9JG@IJ8AH?IJGFJH>GJHB
HJBGF;JEDJ>HBIJG@IJEDBGC=<IDGJBAE;B7$ &<HAAJCFFG
Figure 6 Assortment of friction-grip burs for use in a high-speed dental handpiece; GE;J A=/HGFCB4J IAI6HGFCBJ HD?J :FC>I;BJ HCIJ H6HEA2
round carbide burs (left), cross-cut fissure burs (middle) and round medium-coarse diamond H8AIJ :FCJ CI<F6HAJ F:J CFFGJ CI<DHDGBJ 'E9=CIJ $)7
burs (right). S = surgical (ie, the shank is longer than normal); L = long (ie, the working end is
longer than normal) .@IJ 8IH+BJ F:J I/GCH>GEFDJ :FC>I;BJ B@F=A?J DFG
Principles of exodontics Chapter | 11 |
Figure 8 Winged dental elevators (sizes 1–4, from left to

right), the curved blades of which are designed to fit the
circumference of a tooth
Fig. fragment
Figure 7 Feline tooth extraction kit. Root 11.8 Use of a ‘pool
elevators noodle’luxating
(A), winged for positioning of the patient’s neck
elevators (B),
extraction forceps (C), root tip forcepswhile
(D), needle holder
in dorsal (E), suture scissors (F), curved
recumbency.
Metzenbaum scissors (G), Adson thumb forceps (H), scalpel handle (I), surgical curette (J)
and periosteal elevators (K)
Principles of exodontics Chapter | 11 |
:EBB=CIJ 'GFJ BI>GEFDJ <=AGE2CFFGI?J GIIG@)J HD? Section | 3 | Exodontics
Luxators and CF=D?J ?EH<FD?J 8=CBJ 'GFJ B<FFG@J HA6IFAHC
a pharyngeal pack, cuffed endotracheal tube and suction are also
8FDI)JB@F=A?J8IJH6HEAH8AIJ'E9=CIJ#)7
elevators are recommended when working with a patient in dorsal recumbency.10
=<8ICBJ,J'3EG@J<IGCE>JC=AICJ<HC+ED9B)JHD?
The use of a pharyngeal gauze pack is recommended regardless of
grasped with the "JB>HA;IAJ@HD?AIBJH>>I;GJD=<8ICBJ1-4J114J1"JHD?
patient positioning to prevent teeth or fragments of teeth from enter-
1"J ing8AH?IB7
1-
*?BFDJ 1Jwhere
the oropharynx, x 0J :FC>I;BJ
they could;CF6E?IJ H
be aspirated or swallowed
butt of the handle :EDIJCHGJGFFG@J9CE;4J>H=BED9J<EDE<HAJGCH=<HJGF
during recovery.56
Fig. 11.9 A sterilizable bur block containing (left to right) a cross-cut
fissure carbide bur, tapered diamond bur, 12 -round carbide bur, and
?IAE>HGIJ FCHAJ GEBB=IB7J GJ prior
EBJ B=99IBGI?J G@HGJwill
FCHAallow more accurate
seated in the palm, :AH;BJRemoval of calculus
HCIJ 9CHB;I?J FDJ G@IECJ
to extractions
>FDDI>GE6IJ GEBB=I
small, medium and large round diamond burs.
assessment of the tooth structure and provides a cleaner environment
and the index finger BE?IJ forCHG@ICJ
surgery.G@HDJ HGJ G@IECJ
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the blade to act as GFJ extractions.
CHEBIJ FCHAJ :AH;BJ HD?J
Instruments shouldB@F=A?J HA3H5BJ
be sterilized prior to use, and the use
Once a mucoperiosteal flap is elevated and bone is exposed, the flap
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)7J.@IJ:AHGJFCJ>FD>H6IJBE?IJF:JG@IJ8AH?IJEBJ=BI?
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it during osseous surgery or sectioning of a tooth. The same periosteal
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G@IJBF:GJGEBB=I4JCI?=>ED9JG@IJCEB+JF:JGIHCED9JFC
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retractors, such as the Cawood–Minnesota retractor (see Fig. 6.8B),
Fig. 11.12 Proper grasp of a;=D>G=CED9JG@IJIAI6HGI?JBF:GJGEBB=I7
occasionally
luxator. The index a fragment
finger is extended or a$fractured
of tooth along Fig. dental
Fig.11.14 bur
11.10 will
Figure
Proper become
9 grasp
High-speed
Small dental
root
of handpiece
tip luxators
extraction
are heldThe
and root
forceps.
specifically
tipinelevators
aindex
made modified
finger
for pen grip.
is placed
keeping tongue, lips and cheeks away from
(‘teasers’) for removal of root remnants
the shaft towards the tip of the airborne,
blade in order
hardtoplastic
minimize traumaare
goggles to the between instead
recommended the handles to prevent generation of excessive force, which can
of simple
the surgical site.
904
patient should the instrument slip during extraction.
splash-proof face shields, which may notleadprotect
to crushing of the
against tooth.
ocular
injury.10 Long hair should be tied back or preferably covered with a
surgical cap.56 extraction forceps. The elevator Instruments
is used as a lever, fortransmitting
sectioning rota- teeth and
tional force from the handleremoving to the blade, toalveolartear Sharpey’sbone fibers and
to lift the tooth from its alveolus.
consist of three Air-driven dental handpieces are commonand a in veterinary practice, and
EQUIPAMIENTO DENTAL
Elevators
INSTRUMENTS AND MATERIALS components: a handle, a shank,
blade (Fig. 11.11A). The handle use of is high-speed
typically made handpieces
of steel withand either
is of acarbide or diamond burs has
substantial size, so it may be comfortablylargely replaced held other
in the methods
palm of the forhand
sectioning teeth and removing
Instruments for creating mucogingival and used to apply flapscontrolled bone. Cross-cut
force. fissure
The steel carbide
shank or tapered
connects the diamond burs are useful for
handle to the blade, and must sectioning
be strongmultirooted
enough to transmitteeth, while the round
force diamond burs are ideal for
A # 15 blade is typically used to incise the gingiva and mucosa. The removal of alveolar
from
Fig. 11.15 theFX-49
handle to the(Courtesy
forceps. blade. The
of blade
Hu-Friedy, is the bone
Chicago, working
IL)
(Fig.end 11.9).
of theDental handpieces should be
round scalpel handle no. 5 (see Fig. 6.1B) is easier to hold in a modi- held with
elevator, which is used to transmit forcea to
modified
the tooth pen or grasp
alveolar (Fig. 11.10).
bone.
fied pen grip (see Fig. 6.2) than is a flat scalpel handle. The round
Its width may vary from 2 to 4 mm. The blade is made of strong steel
handle allows it to be rotated, which facilitates following the contour
Fig. 11.13 (A) Apexo # 301 apical elevator. (B) Root tip teaser. (Courtesy and has a concave surface onDental its working elevators
side, so that it may be used
of the tooth when making a sulcular incision. A periosteal elevator 62
of Hu-Friedy, Chicago, IL) 11.14)
in thetosameavoidmanner
generatingas a excessive
shoehorn.pressure, which might crush the
such as a # 24G (see Figs 6.7B & 6.8) or Molt # 9 (see Fig. 6.7A) is One of the most commonly used instruments in C dental extractions is
tooth.Some elevator blades have sharp tips, which may be used in a
employed to reflect the gingiva or mucosa from the bone as a single the elevator (e.g., Seldin # 304W (Hu-Friedy Mfg. Co., Chicago, IL
In human
similar dentistry,
manner specific extraction
as luxators, to cut theforceps have been
periodontal ligamentdesigned rather
layer with the underlying periosteum. 60618)), which is used to loosen teeth prior Fig.to11.11
application of #the
(A) Seldin 304W elevator. (B) Luxator. (C) Close-up of blades
forthan
eachfatigue
kind ofit.tooth.
WhenMany usingofelevators
these forcepsin this arefashion,
unsuitable the for
blade use is
as a lever to engage a root fragment and lift it from the alveolus. After inplaced
the dogparallel
and cat.toSharply
the long axis of
curved the root
forceps, suchand as advanced
the so-called apically.
‘lower of elevator (top) and luxator (bottom). The flat blade of the luxator is
drilling a 2–3-mm hole in the root with a bur, the tip of the pick is molar Elevators
forceps,’are
and available
forceps with
withasharp straight shank and
triangular tipsblade,
are most or with
likelythe designed to enter the periodontal space in order to cut the periodontal
ligament fibers, while103the semicircular shape of the elevator blade is
inserted into the hole and, using the buccal bone as a fulcrum, the toblade
cause offset at an angle
root fractures. from the
Extraction shank.
forceps The angled
designed elevators
for veterinary useare
better for leveraging against the tooth to fatigue and tear the
root is elevated from the alveolus.62 These root tip picks can also be aredesigned
available, tobut
facilitate
severalaccess to theforceps
extraction caudal designed
areas of the formouth but must
use in human periodontal ligament fibers. (A, Courtesy of Hu-Friedy, Chicago, IL)
used as elevators on very small teeth, such as incisors in the cat. The be usedcan
patients withbecare, as the forces
successfully usedapplied to the practice.
in veterinary handle do Forchange
example, direc-
root tip teaser has a long narrow handle between two angled working tion with
so-called the angle
‘upper anterior of forceps’
the blade. (such as the pedodontic Cryer # 150S
ends which are mirror images of one another. It is a thin, delicate Triangular-shaped
(Hu-Friedy elevators,
Mfg. Co., Chicago, ILsuch
60618))as Cryer
haveelevators
been found (Hu-Friedy
to be suit- Mfg.
instrument that is used to tease small root tips from their alveoli (see Co.,
able forChicago,
use in theIL dog 60618),
and cat.come65,66
in pairs
These forceps(left
haveand right),conical
a slightly and are
Ch. 16).62 In contrast to an apical elevator, wheel-and-axle or leverage designed
grip and fit formost useteeth,
withina ‘wheel-and-axle’
spite of the greatmotion. variationThe thattipexists
of the in eleva-
the the tooth, and the tip of the luxator is pushed into the alveolar socket.
forces applied to a root tip teaser will damage the instrument. torand
size is placed
shapeinto the alveolus,
of teeth in dogs with the shank
and cats. on the buccal
Root forceps, such as alveolar
the Because the luxator is not used as a first-class or wheel-and-axle lever,
boneforceps
# X49 perpendicular
(Hu-Friedy to the
Mfg. root.
Co.,The sharp tip
Chicago, of the elevator
IL 60618) is used
(Fig. 11.15), the handle does not need to transmit rotational forces, and is usually
to engage
differ from the cementumextraction
conventional of the rootforceps surface,inthethathandletheyishaveturned,long, and made of plastic rather than steel. The shank and blade are made
Extraction forceps the root
narrow is thus
beaks which elevated from the alveolus.
close completely,
62
making them particularly useful of softer steel than that of an elevator. The thin blade is designed
Extraction forceps are used after elevation or luxation to grasp the
loosened tooth and remove it from the alveolus.62 The three compo-
nents of extraction forceps are the handle, hinge and beak. The handles
Winged small
for grasping elevatorsroothave recently become popular in veterinary den-
fragments.
tistry. These elevators have a short shaft and large-diameter handles
for improved control and more comfortable use by clinicians with
Instruments 63 for suturing flaps
smaller hands. The winged blades, available in 1.5-, 2.5-, 3.5- and
to be resharpened frequently.64 Luxators (e.g., Ericsson luxators (JS
Dental Manufacturing, Inc., Ridgefield, CT 06877)) are available in
widths of 1–5 mm, and with a straight or angled blade. The gouge
(e.g., Coupland gouge) is related to the luxator. It has sharp straight-
37
should be of sufficient size to grasp comfortably; they are usually ser-
rated to prevent slippage, and may be straight or curved. The hinge 4.5-mm
Fine suturewidths,
material conform to roots
with small of various
swaged-on circumferences,
needles is generally achieving
used edged blades and is semitubular in shape. Luxators should be held in
transfers the force applied to the handles to the beak. The beak is inbetter purchase(see
oral surgery on theCh. tooth
7). The surface.
needleHowever,
holdersif indicated
too much in torque
oral is the palm with the index finger extended towards the tip of the blade
designed to adapt to the tooth root at the cemento-enamel junction, placedare
surgery ontherefore
small teeth, roottofracture
delicate match the maysize occur,
of the so needles.
care must Thebe (Fig. 11.12). This will minimize trauma to the patient in the event of
and should be placed parallel to the long axis of the tooth. It is not employed.
Halsey needle holder (see Fig. 6.11A) is a very versatile needle holder instrument slippage.
designed to grasp the crown of the tooth. Narrow beaks should be well suited for most intraoral procedures. Similarly, the delicate Adson
used for smaller teeth, wider beaks for larger teeth. The more closely 1X2 tissue forceps (see Fig. 6.5A) is used most commonly in oral
Luxators Root tip picks
the forceps’ beaks adapt to the tooth roots, the more efficient will be surgery for gentle tissue handling. Choice of suture scissors is based
There are two types of root tip picks: the apical elevator (Fig. 11.13A)
the extraction.62 The chance for root fracture increases if the beaks are onThe luxator is a sharp instrument with a less concave blade than an
operator preference. Some surgeons working without assistants
elevator (Fig. 11.11B, C). It is used to cut or sever Sharpey’s fibers and the root tip ‘teaser’ (Fig. 11.13B). The apical elevator has a handle,
not properly adapted to the root surface. Extraction forceps should be prefer a needle holder with built-in scissors such as the Olson-Hegar
within the periodontal ligament and loosen the tooth prior to extrac- shank and blade similar to a standard dental elevator, but with a
grasped in the palm, with the index finger between the handles (Fig. needle holder (see Fig. 6.11D).
tion. The shank and blade are placed parallel to the root surface of smaller-diameter handle and a sharper, narrower blade. It may be used
Figure 3.36 Elevators31/8/17
should be
sharpened on their convex surface at
the correct angle to maintain the tip
shape. Using a wrist action the tip is
wiped back and forth.
Figure 3.37 Luxators and elevators

must be held in such a manner that
the index finger is extended along the
shaft of the instrument, to prevent
inadvertent injury should the
instrument slide off the alveolar bone /
tooth surface. Intra-cranial and intra /
retro-bulbar injuries are serious
consequences of such accidents.
81
Infraorbital Foramen
Mental Block
a Middle Mental Foramen
b c
Figure 7.8 a–c. Infraorbital nerve block.
38
31/8/17
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Journal of Feline Medicine and Surgery (2015) 17, 66–72

C A S E R E P O R T / Globe penetration following maxillary nerve block
C A S E R66_72_Globe
E P O Rpenetration_Case
T report.qxp_FAB 09/12/2014 15:19 Page 66
C A S E R E P O R T / Globe penetration following maxillary nerve block
Journal of Feline Medicine and Surgery (2015) 17, 66–72
Globe penetration in a cat CASE REPORT
followingGlobe
maxillary nerve
penetration block
in a cat
for dentalfollowing
surgery maxillary nerve block
for dental surgery
Figure 1 Focal penetrating injury (circled) in the ventral sclera Figure 2 The sectioned globe. The circle demarcates the site
Clinical summary: Dental treatment wasFigure
carried1 out in penetrating
Focal an 8.5-year-old
injury castrated
(circled) in male domestic
the ventral sclerashorthair Figure 2 The sectioned globe. The circle demarcates the site
of the penetrating scleral injury. Note the associated ventral
Clinical summary: Dental cat found treatment was carried
to have tooth resorption. out in anand
Right mandibular, 8.5-year-old castrated
right and left maxillary malewere
nerve blocks domestic shorthair of the penetrating scleral injury. Note the associated ventral
retinal detachment (arrows) and endophthalmitis
retinal detachment (arrows) and endophthalmitis
administered using a 1 ml syringe attached to a 25 G x 5/8 inch needle and an intraoral technique.
cat found to have tooth resorption. Right mandibular, and right and left maxillary nerve blocks were
The following day the cat displayed blepharospasm of the right eye. The ocular signs progressed and
administered using a 51days ml later
syringe attached to
an ophthalmologist a 25 G
confirmed x 5/8
a blind, inch needle
glaucomatous andIt an
right eye. wasintraoral technique.
suspected that the eye
TheBSc Rachel Perry
following
BVM&S MANZCVS day thehad
catsuffered a penetrating injury during dental
displayed blepharospasm of Thesurgery.
the Enucleation
right
globe was eye.fixedof the
The right eye was
ocular
in neu- signs
Theperformed and
progressed
globe was fixed andin neu- Discussion Discussion
gross and histopathological examination revealed a penetrating wound consistent with a needle tract injury.
MRCVS 1
5 days later an ophthalmologist confirmed a blind, tral buffered
glaucomatous formalin
right and tral
eye.anaesthesia buffered
It was suspected formalin
that the eye and
Practical relevance: Complications arising from veterinary dental regional appear to be rare;
Denise Moore
submitted for pathological submitted for pathological The contemporary approach The contemporary approach
Rachel Perry hadMA VetMB CertVOphthal
however, it may be that they
suffered a penetrating injury during dental surgery. are under-reported. This
examination.
case
Enucleation report
on
highlights
of the
gross
the
exami-
risks involved
right examination. and reviews
eye was performed on gross and
exami- to veterinary practice to veterinary practice
BSc BVM&S MANZCVS the safest and most efficacious regional anaesthesia technique for the feline maxilla.
gross and histopathological examination revealed anation,
MRCVS VN
penetrating
a small wound(0.5–0.7 consistent witha asmall
needle tract injury.
1
mm) nation, (0.5–0.7 mm) demands careful anticipa- demands careful anticipa-
MRCVS1 focal penetrating injury wasanaesthesia tion and prevention of pain
Practical relevance:AnComplications
Emma Scurrell
arising from
elegant and contemporary veterinary
approach to indental
While regional
complications appear
focal penetrating to be rare;
region-injury was tion and prevention of pain
BVSc DipAVCP MRCVS identified the ventral sclera associated
identified
with
in the ventral sclera in patients under our in patients under our
Denise Moore however, it may be that they are under-reported. This
RCVS Specialist Pathology 2
pain management in small animal case1).report
dentistry
(Figure al highlights
anaesthesia
The globe was thenthe(Figure
in dogs risks involved and reviews
and cats are described, care.1–5,17 This includes the
MA VetMB CertVOphthal involves the use of multimodal and pre- these appear to be extrapolated 1). fromThe globe was then
human care.1–5,17 This includes the
theHospital,
safest
Grove Lodgeand most efficacious
Veterinary regional anaesthesia technique for the intofeline
2) maxilla. 14,15
1
sectioned in half (Figure provision of multimodal
MRCVS VN1 Upper Brighton emptive analgesia. 1–5
Peripheral neural block- research systemic sectioned
toxicity. in To halfthe (Figure 2) provision of multimodal
Road, Worthing, to include the
ade describes the use of local anaesthetic authors’ knowledge therescleral lesion, have been no analgesia, whereby different
West Sussex, to include the scleral lesion, analgesia, whereby different
Emma Scurrell BN14 9DL, UK agents to selectively block specificroutinely nerves, processed
reports in the for literature
histo- of local complications
routinely processed for histo -
classes of drugs are used to
classes of drugs are used to
An2CytoPath
elegant and contemporary
Ltd, Ledbury, approach
thus desensitising certain regions of topathology
the body Whileandonly
and embedded
complications
one report inof a severe,
associated
systemic com- with region- block the ultimate conscious
BVSc DipAVCP MRCVS HR8 2YD, UK pathology and embedded in block the ultimate conscious
paraffin. Sections were cut at perception of pain by inter-
CVS Specialist Pathology2 pain managementor inhead (regional anaesthesia or nerve plication arising from a dental nerve block in
small animal dentistry al anaesthesia
4 m and stained
block).3,4 This may form part of a multimodal the cat.with
16 in
haema-
it may
dogs and
be thatparaffin.
complications
cats
Sectionsare described,
arisingwere cut at rupting the pain pathway at perception of pain by inter-
involves
Correspondingtheauthor:use approach
of multimodal and pre-toxylin these
and appear
eosin. to be
while simultaneously contributing from veterinary dental regional anaesthesia 4 m and
extrapolated stained with
from haema-
human different points, to maximise rupting the pain pathway at
1
Grove Lodge Veterinary Rachel Perry,
emptive analgesia.to 1–5pre-emptive analgesia. Easily identifiable
Peripheral neural block- Histo pathological
are genuinely
research examina-
into rare.
systemictoxylin
Alternatively, andit eosin.
Figure 3 toxicity. may 14,15
be examination
To the analgesic provision.1,7,18 The different points, to maximise
Hospital, Upper Brighton oralvet@googlemail.com Histopathological confirms the presence
Road, Worthing, landmarks are often used as a guide tion to direct that they
confirmed theare under-reported.
presence ofHisto pathological
a focal well-delineated examina-
full-thickness penetrating injury (arrow) that rationale of pre-emptive analgesic provision.1,7,18 The
ade describes theneedle use placement.
of localVarious
anaesthetic
blocks ofare ades authors’
-
focal This report
linear knowledge
describes tion
penetrating globe there
involves the sclera,
penetration
confirmed have
choroida and
inthe been
presence no Figure
retina. Reparative
3 Histopathological examination confirms the presence
fibroblastic tissue
analgesia is
of a focal well-delineated full-thickness to prevent
penetrating initial
injury (arrow) that rationale of pre-emptive
West Sussex, Date accepted: partially fills the defect. The retina is pathologically detached.
BN14 9DL, UK agents17 Julyto2014selectively cribed block specific
in the veterinary nerves,
literature for both
wound reports
dogs in
cat following
disrupting the
the literature
maxillaryof
sclera, nerveof local
block complications
during
a focal linear penetrating
Haematoxylin and eosin, x 40
involves the sclera, choroidafferent
and retina.signals
Reparative fibroblastic
reaching
partially fills the defect. The retina is pathologically detached.
the tissue
analgesia is to prevent initial
and cats.3–9 choroid anddental
retina surgery.
(Figure The3);aim is to highlight this risk central nervous system
2
CytoPath Ltd, Ledbury, thus desensitising certain regionsadminister
Human dentists of the body thousands and only
of included
and one
to review report wound
the safestof anda severe, disrupting
systemic
most efficacious
the sclera,com- Haematoxylin and eosin, x 40 afferent signals reaching the
HR8 2YD, UK findings focal patho- choroid and (CNS), and thus reduce the
or head (regional local anaesthesia
anaesthetic injectionsor daily,
nerve this being plication
regionalarising
anaesthesia from a
technique dental
for theretina
feline (Figure
nerve block 3);in central nervous system
logical detachment of the ventral findings retina,included focal patho- risk of altered processing of afferent input that (CNS), and thus reduce the
block).3,4 This maythe most common form of perioperative pain maxilla.
form part of a multimodal the cat.
neutrophilic
control.10 Misjudging the anatomy of the area
and16lymphoplasmacytic
it may be that complications
endoph-
logical detachment ofarising the ventralcould retina, amplify postoperative pain.19risk Local
of altered processing of afferent input that
Corresponding author: approach while simultaneously contributing thalmitis,from mild
Case intraocular
history haemorrhage
veterinary dental and
regional anaesthesia anaesthetics are the only drugs that produce
concerned may not only result in inadequate neutrophilic and lymphoplasmacytic endoph- could amplify postoperative pain.19 Local
Rachel Perry, analgesia, but more serious local or secondary
systemic glaucoma. The discrete linear mor- complete blockade of peripheral nociceptive
oralvet@googlemail.com to pre-emptive analgesia. Easily identifiable
complications. These incidents appear phology are the
to be of An
genuinely rare.
penetratingcastrated
8.5-year-old injury Alternatively,
thalmitis, mild intraocular
was
maleconsis-
domestic
it mayhaemorrhage
short- The discrete linear
be and
input, and therefore offer the most effective
anaesthetics are the only drugs that produce
landmarks are often used as a guide to direct tent that
with they
that are
expected secondary
under-reported.
from a
relatively rare, but even experienced human hair cat was presented to a first opinion prac- needle tract glaucoma. waymor- of preventing central sensitisation.complete 20 blockade of peripheral nociceptive
phology of the penetrating injury was consis- input,theand therefore offer the most effective
needle placement.dental Various blocks
practitioners are urged takeand
areto des -timedidtonot
This support
tice report
for scleral
routine rupture
describes
annual secondary
tent globe
vaccination.
with penetration
during
that
the
expected in aa needlePeripheral
from
neural blockade describes
way of preventing central sensitisation.20
Date accepted: review the anatomy involved.10–12 intohuman blunt trauma.
clinical examination, tooth resorption was use tract
of local anaesthetic agents to desensitise
17 July 2014
cribed in the veterinary medicineliterature for
the research both
tends dogs
to focus on nerve cat observed
following on themaxillary
buccaland didnerve
aspect ofnot block
thesupport
perma- during
scleral rupture secondary
specific nerves using anatomical landmarks Peripheral neural blockade describes the
and cats.3–9 injury associated with regional nerve block, dentalnentsurgery.
right maxillary The aim is totrauma.
topremolar
third blunt highlight
tooth (107). this risk and provide analgesia to a region of the usebodyof local anaesthetic agents to desensitise
but the overall risk associated with regional No other clinical abnormalities were noted on or head, and is the most common form specific of peri- nerves using anatomical landmarks
Human dentistsanaesthesia administer remainsthousands
poorly defined.13 of andoral to orreview the safest
general physical and Amost
examination. recom-efficacious operative pain control used in human and provide analgesia to a region of the body
den-
local anaesthetic injections daily, this beingTheregional discreteanaesthesia
linear morphology technique of the forpenetrating
the feline tistry.10 Veterinary patients may benefit or from
head, and is the most common form of peri-
the most common form of perioperative pain injury was consistent with
maxilla. that expected
The discrete linear morphology from a local anaesthetic techniques under operative
of the penetrating general pain control used in human den-
control.10 Misjudging the anatomy of the area needle tract and did not support scleral rupture anaesthesia as decreased perioperative pain
tistry. 10
Veterinary patients may benefit from
concerned may not only result in inadequate Case history injury was consistent with that expected from a may result in better autonomic stability and
local anaesthetic techniques under general
secondary to blunt trauma. reduced cardiovascular, respiratory or CNS
anaesthesia as decreased perioperative pain
analgesia, but more serious local or systemic needle tract and did not support depression,scleralcontributingrupture
to a safer anaesthetic,
may result in better autonomic stability and
66
complications. These incidents appear to be
relatively rare, but even experienced human
An 8.5-year-old castrated male domestic
doi: 10.1177/1098612X14560101
68hair cat was presented to a first opinion prac-

short-to blunt trauma.
secondary
ü iSFM and AAFP 2015
reduced cardiovascular, respiratory or CNS
depression, contributing to a safer anaesthetic,
dental practitioners are urged to take time to tice for routine annual vaccination. during the
review the anatomy involved.10–12 in human
medicine the research tends to focus on nerve
clinical examination, tooth 68
JFMSresorption
observed on the buccal aspect of the perma-
was
CLINICAL PRACTICE
injury associated with regional nerve block, nent right maxillary third premolar tooth (107).
but the overall risk associated with regional No other clinical abnormalities were noted on
anaesthesia remains poorly defined.13 oral or general physical examination. A recom-
66 JFMS CLINICAL PRACTICE

doi: 10.1177/1098612X14560101
ü iSFM and AAFP 2015
b c
Figure 7.11 a. Extraoral approach to mandibular nerve block. b. and c. Transcutaneous approach to the mandibular nerve block.
39
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.@IJ9ED9E6HAJHGGH>@<IDGJHCF=D?JG@IJGFFG@JEB Figure 11 A 8IJ>CIHGI?JHGJ<IBEHAJHD?J?EBGHAJHB;I>GBJF:JIH>@
coarse diamond
ED>EBI?J 3EG@J HJ D=<8ICJ 1"J B>HA;IAJ 8AH?I7J DI CFFGJGFJHAAF3J:FCJ8IGGICJIAI6HGFCJ;=C>@HBI7
vertical releasing bur (C), and the
Figureincision
15 Theis made alveolar sockets
into gingiva and
mesiopalatal
alveolar mucosa are debrided with
crown-root
Open extraction of left maxillary canine (204) and cheek teeth (206–209) in a cat
segment at the mesial
of the
aspect of the
fourth premolar
a surgical curette
(D) 31/8/17
canine tooth (A).
is still A
intriangular
place (A).oral
The septal
flap isbone
raised with
separating the
a periosteal
already extracted
elevator (B and C);
mesiobuccal
note the position
crown–root
of the infraorbital
segment from
neurovascular
the mesiopalatal
bundle as it exits
Figure 11 A crown–root
the infraorbital
vertical releasing segment is at the
canal
incision is made reduced infraorbital
with a
into gingiva and round foramen
carbide (arrow).
alveolar mucosa bur (B). Alveolectomy
The is
at the mesial performed with a
mesiopalatal
aspect of the round bur (D)
crown–root
canine tooth (A). segment is
A triangular oral elevated and Figure 12 Narrow
flap is raised with removed (C and D) slots are created
a periosteal with a round
elevator (B and C); Figure 16 The
carbide bur at
note the position firstmesial
molar and
tooth distal
of the infraorbital is extracted
aspects of(A).each
neurovascular The root
gingiva
(A). on
Multi-
bundle as it exits the palatal aspect
rooted teeth are
the infraorbital is elevated
sectioned(B).with a
canal at the Sharpcross-cut fissure
bony edges
infraorbital bur (B). Thewith
are smoothed
mesiopalatal
a round medium-
foramen (arrow).
Figure 17 is
Alveolectomy
crown–root
coarse diamond
Irregular wound
performed with a bur segment must be
(C), and the
separated
alveolar sockets from
margins
round bur are
(D) the mesiobuccal
are debrided with
trimmed with crown–root
tissue scissors a surgical curette
(A). The Figure 12 Narrow (D) segment of the
fourth premolar
slots are created
periosteum at tooth (C and D)
with a round
the base of the carbide bur at
flap is incised with mesial and distal
a blade (B) and aspects of each
bluntly dissected root (A). Multi-
with tissue rooted teeth are
scissors (C). sectioned with a
The flap is sutured cross-cut fissure
to the palatal bur (B). The
gingiva in a mesiopalatal Continued on
crown–root
simple interrupted
segment must be
pages 907–910
pattern (D)
separated from
906
the mesiobuccal
908
crown–root
JFMS CLINICAL PRACTICE segment of the
JFMS CLINICAL PRACTICE fourth premolar
tooth (C and D)
Figure 17
Irregular wound
margins are
trimmed with Continued on A.L. Barton-Lamb et al. / The Veterinary Journal 196 (2013) 325–331 329
The Veterinary Journal 196 (2013) 325–331

tissue scissors
(A). The
pages 907–910
Contents lists available at SciVerse ScienceDirect
periosteum at
906
the base of the
The Veterinary Journal flap is incised with
JFMS CLINICAL PRACTICE a blade (B) and
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / t vbluntly
jl dissected
with tissue
scissors (C).
The flap is sutured
Evaluation of maxillary arterial blood flow in anesthetized to cats
the palatal
with the mouth closed and open gingiva in a
simple interrupted
A.L. Barton-Lamb a, M. Martin-Flores a,⇑,1, P.V. Scrivani a,1, A.J. Bezuidenhoutpattern b b
, E. Loew(D), H.N. Erb c,
a
J.W. Ludders
a
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
908
b
Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
c
Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
326 A.L. Barton-Lamb et al. / The Veterinary Journal 196 (2013) 325–331
a r t i c l e i n f o a b s t r a c t
Article history: The mouth-gag is a common tool used in veterinary medicine during oral and transoral procedures in cats
Accepted 21 December 2012 but its use has recently been associated with the development of blindness. The goal of this study was to
investigate whether maximal opening of the mouth affects maxillary artery blood flow in six anesthe-
tized cats. To assess blood flow, the electroretinogram (ERG), brainstem auditory evoked response (BAER)
Keywords: and magnetic resonance angiography (MRA) were evaluated qualitatively with the mouth closed and
Blindness open. During dynamic computer tomography (CT) examinations, detection of contrast medium in the
Deafness
maxillary artery was quantified by measuring the Hounsfield units (HUs). The peak HU, time to peak
Dynamic CT
Feline
and mean HU were determined. Changes P10% of these parameters were considered indicative of altered
Maxillary artery blood flow.
Magnetic resonance angiography ERG and BAER were normal with the mouth closed in all cats, but was abnormal with the mouth
opened maximally in two cats and one cat, respectively. During MRA, blood flow was undetected in either
maxillary artery in one cat and reduced in the right maxillary artery in two cats, when the mouth was
open. During CT, the peak HU decreased P10% in three cats, the time to peak was P10% longer in two
cats, and the mean HU was P10% lower in one cat when the mouth was open. No cat developed apparent
blindness or deafness. Maximal opening of the mouth caused alterations in several indicators of blood
flow in some individual cats.
! 2013 Published by Elsevier Ltd.
Fig. 5. Three dimensional-TOF MRA of the head and cranial neck of a 2 year old, Fig. 6. Three-dimensional TOF MRA of the head and cranial neck of (A) a 2 year-old,
Introduction association between the use of a spring-loaded mouth gag and
intact male, domestic shorthair cat (Cat 3). (A) Closed mouth. Note the high signal intact female, domestic shorthair cat (Cat 4) and (B) a 3 year-old, neutered male,
the development of blindness and central neurological deficits intensity of the paired maxillary artery (1) and external carotid artery (2) where domestic shorthair cat (Cat 6). In both cats, the mouth was held open using a mouth
Temporary and permanent blindness or deafness has been re- was suggested. Such association is attributed to the feline anatomy
Carótida interna funcionalmente inexistente.
only the right side is marked. (B) Open mouth. Note there is undetectable blood gag adjacent to the right canine teeth. (A) In the right-maxillary artery, note the
ported in cats following general anesthesia (Jurk et al., 2001; Stiles in that the internal carotid artery is functionally nonexistent and flow in the left and right maxillary arteries rostral to the level of the temporo- moderate diffuse reduced signal intensity in the maxillary artery and focal
et al., 2012; Falzone and Lowrie, 2011; Son et al., 2009; Stevens- the maxillary artery, which is the continuation of the external car- mandibular joint. disruption of signal at the level of the angle of the mandible (arrows). In the left-
Sparks and Strain, 2010). Although infrequent, these complications otid artery, is a major supplier of oxygenated blood to the brain, maxillary artery, also note mild focal disruption of signal at the level of the angle of
the mandible (arrow).
can be devastating to feline patients and to cat owners and have re-
sulted in the euthanasia of some cats. The pathogenesis of these
retina, and inner ear (Davies and Story, 1943; Kumar et al., 1976;
Gillilan, 1976). Because the maxillary artery courses around the A. Maxilar : continuación de c. externa à
opened maximally. These findings provide additional evidence to
complications is essentially unknown, but the conventionally pro- caudal aspect of the mandible, it might be partially or completely perfusion to the retina (Wong and Macri, 1964). The ERG findings
posed mechanism is anesthesia-related decreased oxygen supply occluded when the mouth is opened maximally. Occlusion might cerebro, retina oido interno.
support the contention that blindness and deafness can be related
to maximal opening of the mouth, and are not exclusively associ- (Fig. 2) suggest that there was reduced blood flow to the retinas
to the brain through cardiovascular depression, hypotension or be due to bulging of the pterygoid muscles or to compression by ated with the delivery of general anesthesia. Although historically during mouth opening. The ERG resulting from a full-field light
hypoxemia. the angular process of the mandible (Fig. 1). During normal activ- these complications were attributed to reductions in perfusion and flash represents the electrical activity of the outer retina and Mul-
Reports documenting blindness or deafness in cats after anes- ity, this anatomical arrangement is unlikely to cause blindness or oxygenation associated with the administration of anesthetic ler cells. It is known that the appearance of the ERG is altered dur-
thesia often share a common characteristic and the complications deafness because the mouth is rarely opened to the maximum ex- ing anoxia and ultimately disappears completely over a very short
agents, a recent investigation identified the use of a mouth gag
frequently occur after oral or transoral procedures when the mouth tent for a prolonged period of time. However, the application of a
as a risk factor for the development of cerebral ischemia and blind- period of time (Armington, 1974; Braun and Linsenmeier, 1995).
Fig. 1. Illustrations showing the
is held open by a gag (Stiles et al., 2012). In that investigation, an primary arterial blood supply to thegag
spring-loaded brain,
inears, and eyes via the
anesthetized catsrete
canbranches
resultofinthethe
maxillary
mouth arteries. (A) Ventral view of the head and
cranial neck. (B) Left-lateral view of the head with beingthe mouth closed.beyond
(C) Left-lateral view of range
the head ness following anesthesia in cats (Stiles et al., 2012). Our results The same is true for the BAER that ultimately arises from the activ-
opened the typical ofwith the mouth
motion and open.
for a Compare
pro- (B and C). Note the proximity of the
angular process of the mandible and the maxillary artery, and how the relationship varies with mouth positioning. 1 – Common carotid artery, maxillary artery (unlabeled) is provide evidence that blood flow through the maxillary arteries ity of the inner ear hair cells (E. Loew, personal observations of
⇑ Corresponding author. Tel.: +1 607 253 3060.
included
longed period of time. It is therefore possible that maximal open-
in circle as an extension of (2); 2 – external carotid artery; 3 – occipital artery; 4 – ascending pharyngeal artery; 5 – anastomotic branch of the ascending pharyngeal can be altered when the mouth is opened maximally. chickens and dogs).
E-mail address: mm459@cornell.edu (M.with
artery Martin-Flores). ingtemporal
the internal carotid artery; 6 – superficial of the artery;
mouth 7 –is a mirabile
rete contributing factor for8 –altering
arteria maxillaris; maxillary
infraorbital artery; 9 – rostral meningeal artery; 10 – rostral
work. 11 – cerebral vascular circle (circleartery blood In cats, the maxillary arteries are continuations of the external In some cats, dynamic CT findings are consistent with reduced
1
These authors contributed equally to this artery;
cerebral of Willis); 12 –flow.
internal carotid artery; 13 – vertebral artery; 14 – ventral spinal artery.
carotid arteries, at the level of the angle of the jaw. Each maxillary maxillary artery blood flow when the mouth is open. Because ret-
1090-0233/$ - see front matter ! 2013 Published by Elsevier Ltd. artery continues rostrodorsally in an S-shaped curve and immedi- inal perfusion comes mainly from the maxillary artery, the altered
http://dx.doi.org/10.1016/j.tvjl.2012.12.018 ately downstream forms a fine network of vessels (rete). Arising retinal function that we observed with the mouth open could be
The primary objective of this study was to investigate whether IV catheter was inserted into a cephalic vein and after 5 min of preoxygenation
via face mask, general anesthesia was induced with IV propofol (PropoFlo, Abbott
opening the mouth alters blood flow in the maxillary artery in from this rete, the ophthalmic artery further bifurcates into the due to ischemia. This, in turn, might contribute to post-operative
Animal Health) given to effect. Cats were intubated and anesthesia was maintained
anesthetized cats. We hypothesized that maximal opening of the with sevoflurane (SevoFlo, Abbott Laboratories) in oxygen. Spontaneous ventilation long posterior ciliary arteries, which send branches that provide retinal blindness.
mouth would result in changes indicative of altered blood flow was allowed for the duration of the experiment. Lactated Ringer’s solution was in-
through the maxillary arteries. fused IV at a rate of 5 mL/kg/h. Monitoring included electrocardiogram, pulse oxim-
eter, capnography, non-invasive arterial blood pressure (oscillometric, every 2 min)
and rectal temperature. Dopamine (DOPamine, Hospira; 5–10 mcg/kg/min constant
40
Materials and methods rate infusion) or atropine (Atropine, Med-Pharmex; 0.02 mg/kg), was administered
IV if hypotension (mean arterial pressure <70 mmHg) or bradycardia (<120 beats/
Experimental design min) occurred. Body temperature was maintained P37.5 !C.
Cats were evaluated with and without the use of a mouth gag. The dependent
variables were electroretinography (ERG), brain auditory evoked response (BAER),
quantitative computed tomography (CT) scores, and qualitative three-dimensional,
time-of-flight, magnetic resonance angiography (3D-TOF MRA) scores; the indepen-
dent variable was the presence or absence of the mouth gag. This protocol was ap- Electrodiagnostics
proved by the Institutional Animal Care and Use Committee at Cornell University.
The effects of mouth opening on the ERG and BAER were evaluated. Anesthe-
tized cats were placed in right lateral recumbency, and ERG and BAER were per-
Animals formed on the left eye and ear by the same investigator. Both examinations were
performed twice, prior to imaging. First, the mouth was allowed to close naturally
Six healthy adult domestic shorthair cats, with a median age of 1.9 years (1.7– (except for the endotracheal tube), and then it was held open using a spring-loaded
2.7 years) and a median bodyweight of 4.9 kg (4.2–5.4 kg), underwent ERG, BAER, mouth gag placed between the right maxillary and mandibular canine teeth. Qual-
CT, and 3D-TOF MRA examinations twice (with and without the gag in place) during itative ERG and BAER examinations were based on visual interpretation of the
the same anesthetic event; the order of the imaging examinations was randomized waveforms with comparisons before and after mouth opening. The responses were
31/8/17
Tratamiento
• Manejo del dolor postquirúrgico à
intrahospitalario
• Metadona / metamizol / CRI dexmedetomidina
• ALTA:
• tramadol
• Meloxicam
• Colutorios : clorhexidina 0,12% x 14 días
• Dieta blanda
• Antibioticoterapia
• Ttos previos
EVALUACIÓN POST CX
• Según grado de enfermedad periodontal:
• Retiro puntos
• Gram +
• Educación en cepillado dental
• Anaerobios • Continuar con controles
periódicos para evaluar recidiva.
Tratamiento
• Corticoides.
• En gatos que no responden a la extracción de molares, premolares
o de boca completa à desafío terapéutico.
• efecto inmunosupresor
• medicación más prescrita para el manejo de estomatitis refractaria.
• (+):
• reducen la inflamación oral y controla las causas inmunomediadas
generando una mejoría rápida, aumento del apetito y alivio del dolor
oral.
• fácil acceso y económicos
• (-) :
• cambios conductuales, adelgazamiento de la piel, poliuria, polidipsia
• resistencia a la insulina/diabetes mellitus
41
31/8/17
Tratamiento
• Ciclosporina.
• Suspensión /opcion tópica
• estudio retrospectivo en gatos
• 30-50 mg diariamente
• 50% logró remisión de inflamación en 90
días
• el 50% restante mostró leve a buena
evolucion de un 40-70%.
• Testeo previo toxoplasmosis
• SUSPENSIÓN MICROEMULSIFICADA:
• 2,5 mg/kg PO C/12 H
efectos secundarios leves:
vómitos y diarrea
pacientes outdoor toxoplasmosis diseminada.
Tratamiento
• Interferon omega felino.

• Inmunomodulador , infecciones retrovirales felinas.
• Intralesional, PO, transmucosa
• 2,5 MU en mucosa derecha caudal derecha y 2,5 MU
izquierda.
• 0,1 MU /24 hrs PO + scn po antiseptica + AB
• * pacientes en donde los corticoides están

contraindicados
• diabetes mellitus tipo II
42
31/8/17
Tratamiento
• Lactoferrina bovina.
• Lactoferrina es una proteina glicosilada de 80 kDa, 700
aminoácidos
• funciones: antimicrobiana, inmunomoduladora, antiinflamatoria y
anticarcinogénica.
• PO: inhibir la expresión del interferon gamma e interleuquina-2, y
puede reducir la signología asociada al dolor, salivación y anorexia
en gatos con estomatitis intratable sin efectos adversos
significativos ( Hung et al, 2014).
• Presentación en spray
• Sola o combinación con un antiinflamatorio no esteroidal :
• sx clínicos mejoraron en el 77% de los gatos
La combinación de lactoferrina bovina en spray y piroxicam era segura y se

podría utilizar para disminuir los signos clínicos de la estomatitis caudal en
gatos.
Enabling Technologies for Cell-Based Clinical Translation

ENABLING TECHNOLOGIES FOR CELL-BASED CLINICAL
TRANSLATION
Therapeutic Efficacy of Fresh, Autologous

Mesenchymal Stem Cells for Severe Refractory
Gingivostomatitis in Cats
BOAZ ARZI,a EMILY MILLS-KO,b FRANK J.M. VERSTRAETE,a AMIR KOL,b NAOMI J. WALKER,b
MEGAN R. BADGLEY,c NASIM FAZEL,d WILLIAM J. MURPHY,d NATALIA VAPNIARSKY,e DORI L. BORJESSONb
Key Words. Adipose-derived stem cells x Fresh x Autologous x Cats x Gingivostomatitis x
Oral mucosa x Immunomodulation
ABSTRACT
Downloaded from http://stemcellstm.alphamedpress.org/ by guest on February 17, 2016
a
Department of Surgical and
OBJETIVO: evaluar los efectos clínicos, inmunológicos e histopatológicos de la
Radiological Sciences, Mesenchymal stem cells (MSCs)cells
administración de ctem are amesenquimales
promising therapy for immune-mediated and inflammatory disor-
en gatos con GCF que no respondieron a
b
Department of Pathology, ders, because of their potent immunomodulatory properties. In this study, we investigated the use of
Microbiology and fresh,terapia convencional.
autologous, adipose-derived MSCs (ASCs) for feline chronic gingivostomatitis (FCGS), a chronic, de-
Immunology, School of bilitating, idiopathic, oral mucosal inflammatory disease. Nine cats with refractory FCGS were enrolled in
Veterinary Medicine, this pilot study. Each cat received 2 intravenous injections of 20 million autologous ASCs, 1 month apart.
c
William R. Pritchard Oral biopsies were taken before and at 6 months after the first ASC injection. Blood immune cell subsets,
serum protein, and cytokine levels were measured at 0, 1, 3, and 6 months after treatment to assess im-
Veterinary Medical Teaching
Hospital, dDepartment of
munomodulatory effects. Seven of the 9 cats completed the study. Five cats responded E
either complete clinical remission (n = 3) or substantial clinical improvement (n = 2). Two cats were non-
T
NABLINGto treatment
ECHNOLOGIES C -B
by FOR ELL ASED LINICAL C
Dermatology, School of responders. Cats that responded to treatment also exhibited systemic immunomodulation demonstrated T
RANSLATION
Medicine, and eDepartment by decreased numbers of circulating CD8+ T cells, a normalization of the CD4/CD8 ratio, decreased neu-
of Biomedical Engineering, trophil counts, and interferon-g and interleukin (IL)-1b concentration, and a temporary increase in serum
University of California, Davis,
Davis, California, USA
Therapeutic Efficacy of Fresh, Allogeneic
IL-6 and tumor necrosis factor-a concentration. No clinical recurrence has occurred following complete
clinical remission (follow-up of 6–24 months). In this study, cats with <15% cytotoxic CD8 T cells with
Correspondence: Boaz Arzi,
Mesenchymal Stem Cells for Severe Refractory Feline
low expression of CD8 (CD8lo) cells were 100% responsive to ASC therapy, whereas cats with >15% CD8lo
cells were nonresponders. The relative absence of CD8lo cells may be a biomarker to predict response to
D.V.M., Department of Surgical
and Radiological Sciences, School
Chronic Gingivostomatitis
ASC therapy, and may shed light on pathogenesis of FCGS and mechanisms by which ASCs decrease oral
inflammation and affect T-cell phenotype. STEM CELLS TRANSLATIONAL MEDICINE 2016;5:75–86
of Veterinary Medicine,
University of California, Davis, BOAZ ARZI ,a KAITLIN C. CLARK ,b AYSWARYA SUNDARAM,b MATHIEU SPRIET,a
One Shield Avenue, Davis, a
Department of Surgical and FRANK J.M. VERSTRAETE,a NAOMI J WALKER,b MEGAN R. LOSCAR,c NASIM FAZEL,d
California 95616, USA. SIGNIFICANCERadiological Sciences, WILLIAM J. MURPHY,d NATALIA VAPNIARSKY,e DORI L. BORJESSONb
Telephone: 530-752-2470; b
E-Mail: barzi@ucdavis.edu This study is theDepartment of Pathology,
first to demonstrate the safety and efficacy of fresh, autologous, adipose-derived stem
Microbiology and Key Words. Adipose-derived stem cells • Fresh • Allogeneic • Cats • Gingivostomatitis •
cell systemic therapy for a naturally occurring, chronic inflammatory disease in cats. The findings dem-
Oral Mucosa • Immunomodulation
Received June 12, 2015; accepted Immunology, School of
onstrate that this therapy resulted in complete clinical and histological resolution or reduction in clinical
for publication September 28, Veterinary Medicine,
disease severity c and immune modulation in most cats. This study also identified a potentially useful
William R. Pritchard
2015; published Online First on ABSTRACT
November 18, 2015. biomarker thatVeterinary
could dictate patient
Medical enrollment
Teaching and shed light on immune modulation mechanism.
As a naturally occurring animal model,
Hospital, dDepartment Mesenchymal
of FCGS also provides a stem cellsplatform
strategic (MSCs) have potent immunomodulatory
for potentially translat- functions and are a promising
©AlphaMed Press
able therapy for the treatment
Dermatology, ofofhuman oraltherapy
School for immune-mediated
inflammatory disease. inflammatory disorders. We previously demonstrated the efficacy
1066-5099/2015/$20.00/0 of fresh, autologous, adipose-derived MSCs (ASCs) to treat feline chronic gingivostomatitis (FCGS),
Medicine, eDepartment of
a chronic oral mucosal inflammatory disease similar to human oral lichen planus. Here, we investi-
http://dx.doi.org/ Biomedical Engineering,
gate the use of fresh allogeneic ASCs for treatment of FCGS in seven cats. Radiolabeled ASCs were
10.5966/sctm.2015-0127 University of California, also tracked systemically. Each cat received
INTRODUCTION
Davis, California, USA Naturally occurring diseasestwo in intravenous
client-owned injections of 20 million ASCs, 1 month
apart. Oral inflammation, blood lymphocyte subsets, anti-fetal bovine serum antibody levels, ASC
Immune-mediated, oral mucosal
Correspondence: Boazinflammatory
Arzi
DVM, DAVDC, DEVDC, Associate
dis-
cats (57%)
animal species serve as useful animal models of hu-
crossmatching and serum proteins and cytokine concentrations were determined. Four of the 7
man disease, to
responded as they reflect[complete
treatment the complex genetic,
clinical remission (n 5 2) or substantial clinical
43
eases are prevalent in the
Professor, human population
Department of andimprovement
in- (n 5 2)]. Three
environmental, andcats were nonresponders.
physiologic Prior to therapy, most cats had increased
variation present
clude oral lichen planus,
Surgical Radiologicalpemphigus,circulating
andstomatitis, and CD81 T cells, decreased CD8lo cells, and a decreased CD4/CD8 ratio, however clinical
in outbred populations. Feline chronic gingivosto-
resolution was not associated with normalization of these parameters. Nonresponders showed
Sciences, School of Veterinary
pemphigoid [1,Medicine,
2]. TheseUniversity
disordersofcause painful more
mu- severe matitis (FCGS)inflammation
systemic is a severe, idiopathic,
(neutrophilia, oralhyperglobulinemia
inflam- and increased interferon
cosal lesions that markedly
California, reduce
Davis, quality of lifegamma
One Garrod and and tumor
matory necrosis
disease of factor alpha
cats that concentration)
is estimated prior to ASC therapy. Clinical remission
to affect
ther- up to
took 20 months and no clinical relapse has occurred. A higher fraction of radiolabeled ASCs
Drive, Davis, California, 95616,
often require long-term immunosuppressive
USA. Telephone: (530) 752-2470; 0.7%–10% of the general cat population [6–10].
were identified in the oral cavity of FCGS affected cats than the control cat. The administration of
apy with significant associated
Fax: (530) 754-5739;risks and side effects.
e-mail: ClinicalASCs
fresh, allogenic signs are moderate
appeared to severe
to have lower clinical oral pain
efficacy with a delayed response as compared
barzi@ucdavis.edu
The pathogenesis of these diseases is complex to the fresh,
and andautologous
discomfort,ASCs. In addition,
including the mechanism(s)
inappetence, reduced of action for autologous and allogenic
The work was performed at ASCs may differ in this model of oral inflammation. STEM CELLS TRANSLATIONAL MEDICINE
heterogeneous, but consistently involves tissue infil- grooming, weight loss, and hypersalivation [7, 8,
31/8/17
Arzi, Mills-Ko, Verstraete et al. 77
Figure 2. Feline adipose-derived mesenchymal stem cells (ASCs) expressed surface markers consistent with an M
CD105+ (A), CD44+ (B), CD90+ (C), CD182 (D), and MHC II2 (E). (F): They also suppressed proliferation of activated
reactions experiments (n = 5; p = .03). Abbreviations: BrdU, 5-bromo-29-deoxyuridine; ConA, concanavalin A; MSC
PBMC, peripheral blood mononuclear cell.
Downloaded from http://stemcellstm.alphamedpress.org/ by guest on February 17, 2016

Figure 1. Images present the study design (A) and timeline (B) as well as signalment and clinical data (C). p, Animals are deceased due to un-
related causes. Abbreviations: DSH, domestic shorthair; ELISA, enzyme-linked immunosorbent assay; FBS, fetal bovine serum; neg, negative;
post, after treatment; pre, before treatment.
Dulbecco’s modified Eagle’s medium (DMEM; Corning Life antibodies, a mouse IgG-phycoerythrin antibody (Jackson
Sciences, Manassas, VA, http://www.cellgro.com), 10% FBS ImmunoResearch Laboratories, West Grove, PA, http://www.
Figure 3. Clinical measure
(HyClone Inc., Logan, UT, http://promo.gelifesciences.com), and of disease severity.
jacksonimmuno.com) was used Allfor
cats had severe
secondary labeling.oral mucosal inflammation at the caudal oral cav
Canine
1% penicillin/streptomycin (Thermosponse amongWaltham,
Fisher Scientific, the responder
CD8a cats was characterized
(CA9.JD3), rat immunoglobulin by complete clinical
G-allophycocyanin remission (A2) in three cats and substantial c
(IgG-
MA, http://www.thermofisher.com) catsin (B 2). No response was observed in two cats (C2). The stomatitis activity disease index (SDAI) was used to score dise
tissue culture flasks APC) (eBR2a; eBioscience), and mouse IgG-APC (MCA928; AbD
(Nunc, Roskilde, Denmark, http://www.thermofisher.com)
completed the study. and (D):Serotec,
Table Kidlington,
showing Oxford,
the SDAI UK,scores
http://www.abdserotec.com)
at entry and at exit of the study with a calculation of perce
incubated at 37°C in 5% carbon dioxide. Cells were passaged once were used as isotype controls. Samples were run on a flow cytom-
responders are
they reached approximately 70% confluence. Fresh, expanded,
in gray and italicized type (cats 4 and 7). (E): Graph of SDAI scores at entry and exit indicating five resp
eter (Cytomics FC500; Beckman Coulter, Brea, CA, http://www.
early-passage cells were used for and two (second
treatment nonresponding
or third cats (open boxes).Flow
beckmancoulter.com). Abbreviations:
cytometry data werePost, afterusing
analyzed treatment; pre, before treatment.
passage) and the remaining cells were cryopreserved. For the FlowJo flow cytometry software (Tree Star, Ashland, OR, http://
subsequent dose (at 4 weeks afterASC Administration
the first dose), an aliquot Modulates
company.flowjo.com) Immune Cell Subsets: Neutrophil counts were generally elevate
of first-passage cells were thawed and cultured expanded for
72 hours to regain cell viability andCats
functionWith
prior FCGS Have High Circulating CD8+ T Cells That
to infusion, terval in responding cats (responders pre
Peripheral Blood Mononuclear Cell Proliferation Assay
Normalize
effectively using second- or third-passage With
cells. Cells Therapy
are pro- 4.8 3 103; reference range: 2.0 3 103–9.
vided in glass vials to avoid plastic adherence while awaiting Peripheral blood mononuclear cell (PBMC) isolation and mixed leu-
administration. Cats with FCGS typicallykocyte havereactions
systemicwereevidence
carried out asof previously [58] withnormal or near-normal levels within 6 mo
inflammation,
described
including blood neutrophilia, modifications this section. Histopaque 1119 (Sigma-tion (6 months: 6.3 3 103 6 3.0 3 103) (
described inhypergammaglobuline-
polyclonal
Aldrich, St. Louis, MO, http://www.sigmaaldrich.com) was mixed
ASC Phenotyping mia, and increased expression of proinflammatory
with Ficoll-Paque (GE Healthcare, serum NJ, http://www.ponding cats showed no change in
cytokines
Piscataway,
Surface protein expression on fetal[9,MSC36]. The cats in this
lines was determined study recapitulated
gelifesciences.com) and diluted withthis
tissue phenotype.
culture water for a finalremained in or near the reference inter
using flow cytometry, as described previously [17]. All anti- specific gravity of 1.066. This diluted Ficoll-Paque was layered over
bodies were purchased from the Leukocyte Antigen Biology the Histopaque. Whole blood was diluted with modified Tyrode’s/
Laboratory, University of California, Davis (UCD), unless other- HEPES buffer containing EDTA (12 mM NaHCO3, 138 mM NaCl,
©AlphaMed Press 2016 S TEM C ELLS T RAN
wise indicated. Antibodies included MHC II (42.3), CD18 2.9 mM KCl, 10 mM HEPES, and 1 M EDTA), and layered on top
(FE3.9F2), CD90 (CA1.4G8), CD44 (IM7; BioLegend, San Diego, of the diluted Ficoll-Paque layer. The blood was centrifuged
CA, http://www.biolegend.com), and CD105 (SN6; eBioscience, and PBMCs were collected and resuspended in activation me-
San Diego, CA, http://www.ebioscience.com). For unconjugated dium (DMEM plus 10% FBS plus 1% penicillin/streptomycin),
www.StemCellsTM.com ©AlphaMed Press 2016
44

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M.V. Emap Universidad de chile

Feline Dentistry, Jan

Feline Dentistry, Jan

DECIDUOS • 2x(I3/I3,C1/C1,P3/P2) =26

PERMANENTES • 2x( I3/I3, C1/C1, P3/P2, M1/M1) = 30

Feline Dentistry, Jan bellows, 2010

Tiempos aproximados de erupción en gatitos

Dientes deciduos permanentes

incisivos 3-4 11-16

caninos 3-4 12-20

premolares 5-6 16-20

molares No presentes 20-24

completa a los 2 meses completa a los 7 meses

Feline Dentistry, Jan bellows, 2010

Maduración del diente

Feline Dentistry, Jan bellows, 2010

Figure 1.33 Directions in the oral cavity. 5

Figure 1.33 Directions in the oral cavity.

Figure 1.33 Directions in the oral cavity.

Feline Dentistry, Jan bellows, 2010

SISTEMA TRIADAN MODIFICADO

• El primer incisivo es 01,luego se nombran desde

Figure 1.21 Modified Triadan system

Figure 1.23 Mandibular canine vertical groove.

Figure 1.22 Extracted canine tooth.

Examen Clínico Cavidad oral

tocarse la cara, otras

Examen clínico Examen extraoral

• Permite entregar un plan diagnóstico

Examen bajo anestesia general

OCLUSIÓN: Relación de dientes en misma arcada como la relación

MORDIDA DE TIJERA INERDIGITACION DE Premolar más rostral

Figure 1.21 Modified Triadan system

*Determinada por : forma de cabeza, largo de mandibula, ancho y posición de

• UNIDAD RADIOGRÁFICA DENTAL

Feline Dentistry, Jan bellows, 2010

Radiografía dental digital

•Obtención inmediata de la imagen

Figure 4. Scan-X phosphor plate digital system.

•Se ingresa placa a sistema de scanner

Tips for Using Digital Sensors for Dental Radiographs Mod-

Feline Dentistry, Jan bellows, 2010

• Guía para los odontólogos veterinarios

Afecciones por edad

Enfermedades juveniles Dentición permanente,

Educación del cliente

Evaluación dental bajo Uso anestesia a gases

Condiciones orales comunes en el

KITTEN <1a ADULTO (1-7a) SENIOR (<7a)

agitar la cabeza disfagia

tiempo lesiones márgenes ubicación

aguda localizadas bien

enfermedades inflamación gingivostomatitis

Ubicación Término Definición

GINGIVA GINGIVITIS Inflamación de la gingiva

Dra Alejandra Sepúlveda

Figure 22 Alveolar bone

Downloaded from jfm.sagepub.com at UNIVERSIDAD DE C

David E Clarke and Anthony Caiafa

Dra Alejandra Sepúlveda

TERAPIA PERIODONTAL PROFESIONAL

Destartraje supra y subgingival

IDGHAJ A=/HGFCBJ @H6IJ B@HC;4J :AHG2GE;;I?