Advances in the Treatment of Diseased Equine Incisor and Canine Teeth

Temporomandibular joint biomechanics and equine incisor occlusal plane maintenance

In equine dentistry, the physiological incisor occlusal surface is visually perceived as a plane with a distinct inclination to the head's coronal plane, extending rostro-ventrally to caudo-dorsally. To better understand the formation of this inclined plane and its connection to dental wear, we investigated the hypothesis that it arises from masticatory movements and the considerable distance between mandibular articular heads and the incisor occlusal surfaces, acting as the three points of support for the mandibles. Leveraging data from a large-scale clinical study involving static and dynamic orthodontic measurements in horses, we approximated the mandibular movement range where incisor occlusion and dental wear occur. By introducing and testing a segment coordinate system, we explored possible angular deviations from the occlusal plane caused by mandibular roll and pitch rotations during two lateral mandibular movement patterns, protrusion and retrusion. Theoretical biomechanical calculations and simulations confirmed the visual perception of the incisor occlusal surface as a plane. To further examine our assumptions, we employed a simple mechanical simulator to assess incisor normal occlusion and provoked malocclusions (diagonal, smile, and frown bite) by modifying temporomandibular joint (TMJ) movement patterns. The results from clinical investigations were corroborated by both the theoretical analysis and mechanical simulations, strengthening our understanding of the biomechanical basis behind the physiological incisor occlusal plane maintenance in horses. These findings have significant implications for equine dental health and contribute to a thorough understanding of TMJ dynamics.

An application of the density standard and scaled-pixel-counting protocol to assess the radiodensity of equine incisor teeth affected by resorption and hypercementosis: preliminary advancement in dental radiography

BACKGROUND

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome is a dental disease where the radiographic signs may be quantified using radiographic texture features. This study aimed to implement the scaled-pixel-counting protocol to quantify and compare the image structure of teeth and the density standard in order to improve the identification of the radiographic signs of tooth resorption and hypercementosis using the EOTRH syndrome model.

METHODS AND RESULTS

A detailed examination of the oral cavity was performed in 80 horses and maxillary incisor teeth were evaluated radiographically, including an assessment of the density standard. On each of the radiographs, pixel brightness (PB) was extracted for each of the ten steps of the density standard (S1-S10). Then, each evaluated incisor tooth was assigned to one of 0-3 EOTRH grade-related groups and annotated using region of interest (ROI). For each ROI, the number of pixels (NP) from each range was calculated. The linear relation between an original X-ray beam attenuation and PB was confirmed for the density standard. The NP values increased with the number of steps of the density standard as well as with EOTRH degrees. Similar accuracy of the EOTRH grade differentiation was noted for data pairs EOTRH 0-3 and EOTRH 0-1, allowing for the differentiation of both late and early radiographic signs of EOTRH.

CONCLUSION

The scaled-pixel-counting protocol based on the use of density standard has been successfully implemented for the differentiation of radiographic signs of EOTRH degrees.

Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a recently described painful and progressive condition of unknown etiology that occurs in middle-aged and geriatric equines. It predominantly affects the permanent incisor and canine teeth and, less commonly, the premolar and molar dentition. EOTRH was first reported in peer-reviewed literature in 2008, with subsequent publications of case reports, histological studies and retrospective case series. There have been few significant research developments related to this disease. The existing studies have primarily involved single case studies or small sample sizes, without control groups. This review aimed to report current information about EOTRH in terms of clinical, histopathological, diagnostic, radiological, and therapeutic aspects, by searching the available peer-reviewed scientific literature.

Intra- and Interexaminer Measurement Variability Analysis of an Orthodontic Gauge Device to Determine Incisor Occlusal Surface Angles in the Horse

Simple Summary

Annual tooth rasping is integral to prophylaxis work in equine dentistry. The procedure begins with a thorough examination of the oral cavity, including assessment of incisor occlusal surface angles. Any dental misalignment should be corrected or reduced to prevent abnormal forces from acting on teeth and supporting tissues and to maximize functionality of the masticatory apparatus. Thus far, clinical methods for dental angle assessment are scarce and not validated in terms of data reproducibility and comparability. These parameters are vital to objectively assess treatment needs and outcome, obtain population data, and establish data comparability among studies. However, this is the first study systematically validating a commercial dental angle measuring device. The data indicate high device performance and its applicability in practice.

Abstract

Incisor malocclusions are common in horses. As yet, an evidence-based understanding of incisor occlusal surface angle dynamics and normocclusal range is missing. Orthodontic measuring devices could help unravel this information objectively but imply measurement validation. We evaluated intra- and interexaminer variability of repeated sagittal and transversal incisor occlusal surface angle measures using a commercial orthodontic gauge device (MaPHorse1). Five examiners (two experienced, three inexperienced) measured six cadaver heads on 2 consecutive days in a blinded block-randomization design, resulting in 16 measures per examiner*head. Sagittal and transversal angle measures revealed low intraexaminer variability at scale-level independent mean SDs of α 0.58° and α 0.69°, respectively. Sagittal angle measures associate with low interexaminer variability, showing small mean angle differences (max. α 0.51° ± 0.35°), small scatter, and more consistent data reproducibility. Despite comparable mean interexaminer differences, the spread of transversal angle measures was relevantly higher using the proposed landmarks (average 2.2-fold higher interquartile range). The measurement performance of experienced and inexperienced examiners did not systematically differ. The time required for individual measurements was already comparable after 24/96 repetitions. This instrument may help deciphering sagittal angle normocclusal range and orthognathic dynamics and, with a proposed procedural amendment, transversal angle as well.

Equine Incisor Lesions: Histologic Confirmation of Radiographic, Macroscopic, and Micro-Computed Tomographic Findings

Simple Summary

Incisor diseases are a common problem in equine medicine. However, Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other lesions are often only diagnosed in advanced stages. In this study, the incisors of 20 horses were examined. The findings of X-rays, macroscopical inspection, and micro-computed tomography (µCT) were compared. Five categories from healthy to severely affected teeth were formed and selected teeth from each category were additionally examined by means of histology. Odontoclastic resorption of dental hard substances, infiltration of inflammatory cells, areas of irregular dental cementum, and formation of granulation tissue were observed. Resorptive lesions previously detected by µCT were confirmed by microscopical imaging, however, not all resorptive lesions were regarded as a pathological condition like EOTRH. Detailed microscopical inspection revealed the presence of so-called surface resorptions which represent repaired resorptive lesions without any pathological consequence for the horse. Nevertheless, some incisors which appeared healthy on the X-rays featured histological findings related to EOTRH. Therefore, the detection of early incisor lesions in equine medicine remains challenging.

Abstract

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other incisor lesions are often diagnosed only in advanced stages. The incisors of 20 horses were examined radiographically, macroscopically, and via micro-computed tomography (µCT) to discriminate EORTH-affected teeth. Five categories from healthy to severely affected teeth were formed and teeth from each category were examined histologically to evaluate the opportunity of earlier radiographic diagnosis. Histologically, odontoclastic resorptive lesions, leukocytic infiltrations, and areas of irregular cementum and granulation tissue were observed. The extent and severity of histological findings were correlated to the µCT data. Micro-CT imaging was suitable to detect subtle irregularities in the dental substances which were referred to as resorptive lesions. Although histological examinations confirmed the presence of resorptive lesions, not all of them were classified as pathological conditions. Instead, repaired surface lesions were documented which were regarded as a physiological condition. Nevertheless, incisors which were radiographically regarded as healthy can also feature histological signs of EOTRH. Therefore, due to the possibility of misinterpreting radiographic findings combined with superimpositions on intraoral radiographs, the detection of early resorptive lesions remains challenging.

EOTRH Syndrome in Polish Half-Bred Horses - Two Clinical Cases

The aim of this paper is to thoroughly describe the etiology, diagnostic processes and recommended treatment of equine odontoclastic tooth resorption and hypercementosis (EOTRH). It is a relatively recently described disease. Most recent reports show that it is a common problem involving older equine patients. The most common and significant symptom of EOTRH is oral pain. The main clinical signs include periodontitis and gingivitis with a gingival recession, alveolar bone protrusion, periodontic fistulas and soreness of the incisors. When establishing the final diagnosis, it is necessary to compare the results of the clinical and radiological examination, because in the early stage, the disease may not show any symptoms. Authors used two clinical cases of Polish Half-Bred horses to present some aspects of diagnostic and surgical techniques. The knowledge presented in the paper may be valuable for equine practitioners working in the field to achieve more beneficial outcomes and provide a higher level of welfare for their equine patients. Nevertheless, further research and observations are necessary, since the etiology of the disease remains unclear.

Equine Standing Surgical Extraction Techniques

Dental repulsion techniques reported in the past decades have a high incidence of complications. Although the practice of surgical extractions in horses is limited because of the training, instrumentation, and experience required to perform these techniques, veterinarians should be aware these procedures are available, general anesthesia is not required, and when performed by skilled veterinary dentists they have low complication rates. Surgical techniques are often used after failure of other extraction techniques to remove retained tooth root and fragments or to debride chronically contaminated orofacial lesions. However, surgical extractions should be considered during initial treatment planning of all complicated cases.

Update on Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a progressive, painful disease, affecting incisors, canines, and cheek teeth. Examination findings include gingival inflammation, gingival recession and/or hyperplasia, subgingival swelling, bulbous enlargement of teeth, associated periodontal disease, pathologic tooth fracture, and/or tooth mobility and loss. Current hypotheses include biomechanical stresses and secondary bacterial involvement. Early recognition allows case management, but it is a progressive disease. Owner education is crucial; horses with complete or multiple extractions have a favorable prognosis. Human oral and dental health may be affected by bisphosophonate use; long-term effects of these drugs are currently unknown in horses.

Equine Dental Floating (Crown Osontoplasty)

Odontoplasty (floating and occlusal equilibration) is the most commonly performed procedure in equine dentistry. From an anatomic perspective, an irregular occlusal surface, prominent cingula, transverse ridges, and enamel points all contribute to the function, form, and longevity of the equine cheek tooth. With limited reserve crown available and an average functional life range between 18 and 25 years, removal of tooth structure should be conservative. The authors consider a quality oral examination to be the most important dental procedure performed in the horse. Individual tooth evaluation should lead to a specific diagnosis and treatment plan. Tooth odontoplasty should be site-specific.

Maxillary Incisors of the Horse before and at the Beginning of the Teeth Shedding: Radiographic and CT Study

To gain insight into the radiographic appearance of maxillary deciduous incisors and dental germs of maxillary permanent incisors in the period prior to teeth shedding, radiographs and computed tomography (CT) of 25 horse skulls, with an estimated age of between 12 and 42 months, were studied. Data regarding morphology and development were obtained. Dental germs of first maxillary permanent incisors were identified radiographically as rounded radiolucent areas at the level of the apical parts of the first deciduous incisors, in skulls with an estimated age of twelve months. The first sign of crown mineralization of these dental germs appeared in skulls supposedly a few months older. Before teeth shedding, the unerupted, mineralized crowns of the first permanent incisor could be identified radiographically relatively caudal to the corresponding first deciduous incisors. The results of the present study indicate that radiographic intraoral images are suitable to identify the grade of development of the dental germs of maxillary permanent incisors. A detailed description of the radiographic appearance of deciduous incisors and dental germs of permanent incisors will help clinicians to expand their knowledge for diagnostic or treatment purposes.

Terapia fotodinâmica como adjuvante no tratamento da doença periodontal em equinos

RESUMO A doença periodontal é uma afecção comum, relacionada ao aprisionamento de alimentos em diastemas não fisiológicos, em equinos. O tratamento consiste na correção da causa primária, limpeza e desbridamento do sulco gengival, denominado tratamento convencional (TC). Frequentemente antimicrobianos são necessários, pela gravidade ou patogenicidade dos agentes. A terapia fotodinâmica adjuvante (TF) tem sido estudada pelo seu potencial combate bacteriano, sem causar resistência bacteriana. O objetivo deste estudo foi analisar o uso da TF na doença periodontal, experimentalmente induzida, em dentes incisivos de equinos, e compará-la com o TC. O TC não resultou em melhora clínica estatisticamente, tanto em graus como em profundidade, apenas numérica na profundidade aos 30 dias. A TF foi empregada em dentes com profundidade maior da bolsa periodontal que a do grupo TC e, mesmo assim, apresentou melhora clínica já com sete dias, e mais efetiva aos 30, atingindo, em média, o valor considerado normal, três milímetros. A TF apresentou potencial para ser aplicada na rotina, pelo incremento nos resultados, sem causar efeitos colaterais.

History, clinical findings and outcome of horses with radiographical signs of equine odontoclastic tooth resorption and hypercementosis

The progression of equine odontoclastic tooth resorption and hypercementosis (EOTRH) has not been completely evaluated, and currently, the only effective treatment is extraction of severely affected teeth. We aim to describe how the disease relates to the history and clinical findings and to report on the outcome in individual horses. This case series comprises data collected from 20 horses (age 14–29 years old) with radiographic findings of EOTRH in their incisor and/or canine teeth. Most horses affected with EOTRH in this study were admitted for dental problems, but some for other complaints such as colic. Of the 288 teeth evaluated radiographically, 224 teeth were abnormal. Radiographic findings were most frequently located in the apical aspect and reserve crown of the teeth, and lesions were also commonly found in clinically normal teeth. Histopathology of extracted teeth showed inflammation in the periodontal ligament and revealed that resorption often extended to the dentine. Some owners were unwilling to allow extraction of their horses’ severely affected teeth, even though this treatment has been shown to increase the wellbeing of the horse. As EORTH is a life-long condition, the progression of the disease has to be continuously monitored and the treatments adjusted accordingly.

Treatment of class 2 malocclusion by corrective osteotomy using two short locking compression plates

Objective

To describe a symphyseal osteotomy stabilised with two short locking compression plates (LCPs) for treatment of class 2 malocclusions.

Study design

Case series.

Methods

Five horses (age range 8 months to 5¾ years) with overjets and/or overbites ranging from 6 to 32 mm and from 0 to 60 mm, respectively, were treated by osteotomy through the caudal third of the mandibular symphysis, cranial to the interdental space. After cranial distraction and ventral rotation of the rostral part of the mandible, two short (5/6 hole), bent 3.5 mm LCPs were applied ventro‐laterally and secured with two or three locking screws on each side of the osteotomy. In one case, the osteotomy gap was filled with bone marrow.

Results

Final outcome was good to excellent. Two cases needed a second corrective surgery, one because of non‐occlusion of the cheek teeth and another because of abaxial deviation of the rostral portion of the mandible. In three cases with a persistent fistula, LCPs were removed after bridging; drainage resolved and wounds healed. The time to bridging of the osteotomy gap ranged from 2 to 6.5 months. The procedure is technically challenging. It is important that the incisors are well aligned, which proved to be difficult when there was an abnormal maxillary incisor arcade. Incisors should not make contact when LCPs are fixed. The cheek teeth, however, should have good occlusion after positioning and fixation of the LCPs. Endodontic treatment of open incisor pulp cavities may be helpful.

Main limitations

The study population was small and relatively heterogeneous in severity. A larger population with more severe cases might have allowed for a more definitive assessment of the value of the technique for clinical practice.

Conclusions

This technique can be used to achieve a good correction for class 2 malocclusions. The approach provides adequate stability with smaller implants than other published techniques that require transection of both rami. The technique is less invasive and preserves the roots of the incisors and cheek teeth, as well as the mandibular canal.

Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a painful progressive condition of older horses that involves multiple teeth, including canines and incisors. EOTRH is uncommonly recognized by veterinary pathologists and in some cases may be misdiagnosed as cementoblastoma. The cause is unknown. The goals of this study were to describe the histopathologic features of EOTRH in 17 affected horses from the United States and to increase awareness of this condition. Samples ranged from affected tooth to the entire rostral mandible and maxilla. Affected teeth exhibited cemental hyperplasia and lysis. The marked proliferation of cementum in severe cases caused bulbous enlargement of the intra-alveolar portions of affected teeth. Several teeth contained necrotic debris, bacteria, and plant material in the regions of cemental lysis. All horses exhibited dentinal lysis in at least affected tooth, and several contained necrotic debris in these regions. Endodontic disease was often present with inflammation, lysis, necrotic debris, fibrosis, and/or a thin rim of atubular mineralized tissue in the pulp cavity. Periodontal disease was a common feature that was primarily characterized by moderate lymphoplasmacytic inflammation. Resorption with secondary hypercementosis appears to begin on the external surface of the teeth rather than within the pulp cavity. Distinguishing EOTRH from other diseases requires a complete history that includes the number and location of affected teeth, a gross description of regional hard/soft tissue health, and radiographic findings.