July 2010
Dr Gerhard Steenkamp

An 8 month - old puppy is brought to you for swollen gingiva, in the area where the right maxillary 3 incisors (101, 102, 103) is. The owners explain that the pup was bitten by the bitch when they were still suckling. The deciduous 3 incisors were lost due this traumatic event. Furthermore the owner confirms that no permanent teeth have erupted in this area

a Describe the lesions present in this right pre-maxilla
b What will your next diagnostic step be?
c What treatment is indicated?

Memorandum

a There is a marked swelling and congestion of the gingiva (gingivitis) in the area where you would expect the 3 incisors of this pre-maxilla to be. The gingiva is perforated by white hard structures resembling tooth fragments.

b Dental radiography is essential in any lesion where there are teeth absent. In this radiograph radiodense structures are present in the areas of the absent incisor teeth. These possibly represent deformed incisors of which the normal development was hampered secondary to acute trauma to the developing tooth buds. As a result, dental hard tissue was formed haphazardly and therefore no normal tooth structure is evident.

c Removal of the tooth-like material and treatment of the infection is indicated. To enable you to do this a full length flap of the pre-maxilla on the right is created and the tooth-like structures removed. In this case they were very easy to remove as there was no significant periodontal ligament attachment. Due to the fact that these tooth-like structures were only partially erupted they were still covered by gingival mucosa which resulted in a small opening for bacterial infection into the underlying soft tissue surrounding the structures.

After removal and curettage the flap was closed with simple interrupted sutures, using a 5/0 monofilament absorbable material. Only peri-operative antibiotics (amoxycyllin) was administered. Healing was uneventful with no post-operative complications.

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