The Future Is Now In Veterinary Dentistry, Oral Surgery

Veterinary dentistry has come a long way, many improvements in the field and it is only expanding.


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Left side: Mandibular drift after right mandibular gunshot wound. Right side: Correction of drift immediately after mandibular reconstruction with plates and rhBMP-2.

Photos Copyright John Lewis, University of Pennsylvania, 2012

Veterinary dentistry and oral surgery are relatively young specialties, and advances are made each year in how we diagnose and treat patients with oral and craniofacial diseases. This article highlights just a few of the upcoming, and recently unveiled, advances in veterinary dentistry and oral surgery.

Point-of-Care Diagnostics
Diagnostic tests that provide answers, sooner rather than later, are always appealing. One example of a recently released test is the OraStrip QuickCheck Canine, from PDx Bio Tech of Lexington, Ky.

When run across the maxillary gingival margin, this strip measures the concentration of thiols in canine oral fluid of the gingival margin and provides a visual signal related to the thiol concentration. Thiols are produced by anaerobic bacteria and are responsible for halitosis of periodontal origin.

These strips are perhaps most helpful in a general practice setting as an educational tool for pet owners, providing a scale of severity for owners to see. Since much of the disease associated with periodontitis is beneath the gingiva, the strips serve as a semi-quantitative visual gauge.

Other possible point-of-care diagnostics may arise in the future from the field of salivary proteomics, as described in a recent proceedings notes from the 2012 Veterinary Dental Forum.1 Salivary proteomics utilizes a readily accessible bodily fluid (saliva) to assess for evidence of biomarker proteins that may be indicative of local or systemic diseases, such as cancers, viral exposures and systemic steroid levels.

Digital dental radiography has become an indispensible diagnostic tool that provides immediate information for any practitioner performing basic or advanced oral procedures. Options in digital dental radiography continue to improve each year, including sensor quality and software usability.

If you've not upgraded your digital system in 10 years, you will be impressed with the difference these newer sensors and phosphor plate systems can make. The detail generated by these devices is so different than previous devices, the operator needs to be cautious not to over-interpret by falsely diagnosing normal structures as pathological.

Maxillofacial Reconstruction
Wouldn't it be wonderful to re-grow portions of jaws that have been lost due to oncologic surgery or gunshot wounds? It is now possible in some cases!

Various options exist for inducing or conducting new bone growth into a mandibular defect, including allografts, autografts and recombinant bone growth factors. Allografts are cortical or cancellous bone grafts taken from the same species but not the same patient. Autografts are grafts taken from the same patient, either from a local or distant site.

The success of larger autografts often depends on the ability to perform microsurgical reattachment procedures; this may represent the future of maxillofacial reconstruction, as described in the recent proceedings of the 2012 Veterinary Dental Forum.2

Bone Morphogenetic Protein-2 (rhBMP-2) is a human recombinant protein that induces new bone formation in a defect. This technology was first described in a clinical veterinary patient in 2004, and since then, approximately 15 clinical cases have been treated using this technology.3-7

Clinical studies using mandibular reconstruction technology are ongoing at the University of Pennsylvania and University of California, Davis—please contact these schools to see if your patient with a mandibular defect (or mandibular tumor) qualifies for these studies. In September, Pfizer announced the approval and launch of rhBMP-2 for the European veterinary market, called TruScient. Perhaps similar products will be available in the U.S. in the future.

Application of these technologies would not be possible if not for advances in maxillofacial orthopedics, particularly the advent of locking plates. Locking plates allow for bridging of a defect until bone can be formed across the defect. Locking plates act as an internal fixator due to threads on screw heads that lock into matching threads on locking plates.

Locking plates are bendable and are now available in smaller sizes than previously available. Appropriate sizes for our veterinary patients range from 1.5 mm to 2.4 mm screw/locking plate combinations.

These are but a few of the recent and future advances affecting how we practice veterinary dentistry and oral surgery. As we ring in the New Year, the future of diagnostics and therapeutics certainly looks bright. 1

Dr. Lewis, FAVD, Dipl. AVDC, is assistant professor of dentistry and oral surgery at the University of Pennsylvania School of Veterinary Medicine in Philadelphia.

REFERENCES
1. Stepaniuk KS. Salivary Proteomics: Is there a Future in Veterinary Medicine? Proceedings of the Veterinary Dental Forum, 2012, p. 63-65.

2. Reiter AM. Microsurgery-The Future of Maxillofacial Reconstruction. Proceedings of the Veterinary Dental Forum, 2012, p. 73-74.

3. Boudrieau RJ, Mitchell SL, Seeherman H. Mandibular reconstruction of a partial hemimandibulectomy in a dog with severe malocclusion. Vet Surg 2004; 33: 119–130.

4. Spector DI, Keating JH, Boudrieau RJ. Immediate mandibular reconstruction of a 5 cm defect using rhBMP-2 after partial mandibulectomy in a dog. Vet Surg 2007; 36: 752–759.

5. Kirker-Head CA, Boudrieau RJ, Kraus KH. Use of bone morphogenetic proteins for augmentation of bone regeneration. J Am Vet Med Assoc 2007; 231: 1039–1055.

6. Arzi B, Verstraete FJM. Use of rhBMP for Mandibular Reconstruction in Dogs. Proceedings of the Veterinary Dental Forum, 2012, p. 59-61.

7. Lewis JR, Boudrieau RJ, Reiter AM, et al. Mandibular reconstruction after gunshot trauma in a dog by use of recombinant human bone morphogenetic protein-2. JAVMA 2008; 233: 1598-1604.

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