AUGUST 2008: SADIE

Sadie is a 2 year old, 36 pound, black and red, Shetland Sheepdog Mix.  She was seen for a routine physical exam after the owner had adopted this dog from a rescue.  Upon physical exam, it was noted that the left upper first molar and the left lower first molar were suffering severe, end-stage, periodontal disease.  The rest of the mouth had little calculus and no gingival nor periodontal pathology. The remainder of the physical examination was normal.  Blood work was drawn and all results were within normal limits.

Sadie was admitted on July 18th, 2008 for a comprehensive oral health assessment and treatment under general anesthesia.  A pre-anesthetic examination revealed minimal anesthetic risk.  The anesthetist administered 1mg/kg Morphine Sulphate + 0.01mg/kg Metomidine hydrochloride IM 20 minutes prior to induction.  Sadie was pre-oxygenated then induction was accomplished by the slow administration of Propofol IV.  She was intubated with a size 8.5mm clear tube.  Anesthetic maintenance was provided at 1.5% Isoflurane and O2.

All teeth were cleaned and the mouth was charted.  The only areas of concern were the left upper and lower first molars.  There was greater than 3mm gingival recession with the upper molar and a 6mm periodontal pocket.  The lower molar had 3-5mm gingival recession, root and bone exposure.  It was also noted that both of these teeth are dilacerated, an abnormal angulation or curve in the root or crown of a formed tooth.  This abnormality has predisposed these teeth to early periodontal disease.

Maxillary and inferior alveolar nerve blocks of Lidocaine and Bupivicaine were administered prior to intra-oral radiography. Radiographs were taken.  The X-ray of the lower molar revealed very involved vertical and periapical bone loss.  There was a periapical lucency associated with the upper first molar.

A size 15 blade was used to perform two vertical releasing incisions and a molt elevator was used to elevate the mucosal tissue from the bone.  When the area was properly flapped, tooth 309 was sectioned using a #557 surgical bur on a water cooled high speed handpiece.  A size #3 Wiggs wigged elevator was employed to elevate the roots from the extraction site.  A size #2 round burr was used to smooth the boney edges and the granulation tissue was curetted out.  There was sufficient 4 walled infra-boney pockets to support the implantation of Consil™ (a bioglass osseoinductive agent).  This was all accomplished without complication and the site was closed without any tension with 4-0 Monocryl® on a FS-2 needle.

The left upper first molar was very dilacerated as well.  The tooth was basically anchored between the left upper fourth premolar and the second molar.  This tooth epilated out completely intact and the palatal lesion was already healing and almost completely granulated in.  We flushed the site and did not attempt to close.

Sadie received 0.25mg/kg Morphine IV intra-operatively and we repeated that dose post operatively along with 0.003mg/kg Metomidine IM.  Since the Mean blood pressure had held at a range of 69-106, a subcutaneous injection of carprophen was administered post-op as well. Recovery was uneventful.