LESSONS LEARNED    DENTAL TREATMENT  OF RESCUED DANCING SLOTH BEARS  (Melursus ursinus)  AND TIGERS www.wildlifesos.org Dr...
“ Dancing Bears of India” Preliminary Study  1995-1997 <ul><li>Practice prevalent for the past 300-400 years. </li></ul><u...
<ul><li>STATUS OF TEETH IN DANCING BEARS </li></ul><ul><ul><li>Canines  (fractured) </li></ul></ul><ul><ul><li>Incisors  (...
SLOTH BEAR DENTAL FORMULA I 2/3 C 1/1 PM 4/4 M 2/3
DENTAL  RECORD
ANAESTHESIA XYLAZINE AND KETAMINE, HALOTHANE GAS VIA 18MM ET TUBE
ANAESTHESIA <ul><li>Intra-operative fluids given to all bears </li></ul><ul><li>Vital Parameters are continuously monitore...
ET-INTUBATION
AFTER ET-INTUBATION
EXAMINATION
DENTAL EQUIPMENTS
PROBLEMS IN  CANINE TEETH
PROBLEMS IN CANINE TEETH
MALOCCLUSIONS
Draining sinus tracts PROBLEMS IN CANINE TEETH
INCISORS <ul><li>Many incisors had pulp exposure </li></ul><ul><li>Some were fractured </li></ul><ul><li>Most probably due...
MOLARS  &   PREMOLARS <ul><li>Fractured premolars </li></ul><ul><li>Caries lesions </li></ul>
<ul><li>Histopathological analysis showed gingival recession and calculus showed enamel dysplasia </li></ul>
DENTAL RADIOGRAPHY
DIAGNOSIS <ul><li>Decision to perform </li></ul><ul><li>  *  Extraction or </li></ul><ul><ul><li>*  Root Canal treatment b...
Surgical Extraction of Upper Canine: <ul><ul><li>A muco-periosteal flap was raised from the medial aspect of 104 to distal...
* EXTRACTIONS
* EXTRACTIONS <ul><li>Dilacerated roots </li></ul><ul><li>Resorbing roots </li></ul>
* EXTRACTIONS <ul><li>Debrided the sockets well </li></ul><ul><li>Did not pack </li></ul><ul><li>Sutured with monocryl 4/0...
POST-EXTRACTION HEALED TISSUE
* ROOT CANAL TREATMENT <ul><li>Most teeth had necrotic pulps  </li></ul><ul><li>All teeth with vital pulps had been fractu...
* ROOT CANAL TREATMENT <ul><li>All except 3 teeth were less than 60 mm WL so standard veterinary length hedstrom files wer...
* ROOT CANAL TREATMENT <ul><li>Flushed with 5.25% NaOCl </li></ul><ul><li>Dried with pipe-cleaners and paper points </li><...
* ROOT CANAL TREATMENT <ul><li>Filled with sealopex using a veterinary length lentulo. </li></ul><ul><li>Paste syringed in...
* ROOT CANAL   TREATMENT <ul><li>Restored with glassionomer (chemical cure) </li></ul><ul><li>Final restoration - amalgam ...
MULTIPLE ENDO AND TIME CONSIDERATION
RECOVERY  <ul><li>The bears were carried back to the dens.  </li></ul><ul><li>Most bears were up within 30 minutes </li></ul>
* A 14 year old male bear weighing 115 kgs was found having a  large mass on the left upper jaw. CASE STUDY 1 <ul><li>Diag...
Extraction of Lower Canine <ul><li>An incision was made from the medial aspect of the mass in a distal direction along the...
<ul><li>Dimensions of Incised bony mass </li></ul><ul><ul><li>= 4 x 3 x 2.5 cm. </li></ul></ul><ul><li>On slicing a part o...
<ul><li>Chronic inflammation of hyperplastic squamous lining epithelial cells. </li></ul>HISTOPATHOLOGY FINDINGS
HISTOPATHOLOGY FINDINGS <ul><li>Fibrocollagenous tissue showed: </li></ul><ul><ul><ul><li>Islands of irregular cementum fo...
DISCUSSION FOR CASE STUDY 1 <ul><li>The lesion: </li></ul><ul><ul><li>may be solitary or  </li></ul></ul><ul><ul><li>occur...
<ul><li>An abscess is an abnormal cavity containing pus.  </li></ul><ul><li>The cavity is formed in tissues, due to local ...
Ventral aspect of the lower jaw of    Tikku Bear (Left) and Chotu Bear (Right) The opening of Periapical abscess fistula f...
DENTAL RADIOGRAPHY Radiograph showing Periapical Abscess of the infected lower right canine of Tikku bear (left) and Chotu...
<ul><li>Infected Root Canal of Lower Right Canine(s) (Red Arrow) of   </li></ul><ul><ul><li>Tikku Bear (Left) and  </li></...
EXTRACTION PROCEDURE
DENTAL ELEVATION
<ul><li>The alveolar bone overlying the buccal surface of the tooth root was removed by using dental drill with the help o...
AFTER EXTRACTION
<ul><li>Systemic administration of a broad-spectrum antibiotic injection Benzathine penicillin and non-steroidal anti-infl...
<ul><li>When the canines teeth first erupt, many gypsies deliberately smash the teeth to disarm the bear and make them loo...
DENTAL SURGERY ON TIGERS Karnataka, India
DENTAL SURGERY -TIGERS
Next day…
MOHAN POST-OP
MANEKA POST-OP
www.wildlifesos.org Wildlife S.O.S  Thank You International Animal Rescue and
Open for Discussion
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INCIDENCE AND MANAGEMENT OF PERIEPICAL ABSCESS DUE TO CHRONIC ...

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  • The alveolar bone overlying the buccal surface of the tooth root was removed by using dental drill in order to facilitate the tooth removal; with the help of dental luxators and elevators the attachment between tooth and periodontal ligament was detached by the way of gently working around the circumference of the canine, then the canine was extracted out using extraction forceps by gentle pulling towards the direction of tooth curvature. The mucoperiosteal flap was replaced to close the extraction socket by simple interrupted sutures with absorbable polyglycemic acid mersuture, thus allowing primary healing. The alveolar bone overlying the buccal surface of the tooth root was removed by using dental drill in order to facilitate the tooth removal; with the help of dental luxators and elevators the attachment between tooth and periodontal ligament was detached by the way of gently working around the circumference of the canine, then the canine was extracted out using extraction forceps by gentle pulling towards the direction of tooth curvature. The mucoperiosteal flap was replaced to close the extraction socket by simple interrupted sutures with absorbable polyglycemic acid mersuture, thus allowing primary healing. The alveolar bone overlying the buccal surface of the tooth root was removed by using dental drill in order to facilitate the tooth removal; with the help of dental luxators and elevators the attachment between tooth and periodontal ligament was detached by the way of gently working around the circumference of the canine, then the canine was extracted out using extraction forceps by gentle pulling towards the direction of tooth curvature. The mucoperiosteal flap was replaced to close the extraction socket by simple interrupted sutures with absorbable polyglycemic acid mersuture, thus allowing primary healing
  • INCIDENCE AND MANAGEMENT OF PERIEPICAL ABSCESS DUE TO CHRONIC ...

    1. 1. LESSONS LEARNED DENTAL TREATMENT OF RESCUED DANCING SLOTH BEARS (Melursus ursinus) AND TIGERS www.wildlifesos.org Dr.Arun A Sha, MVSc Lisa Milella, Paul Cassar, Jonathan Cracknell, Alan Knight
    2. 2. “ Dancing Bears of India” Preliminary Study 1995-1997 <ul><li>Practice prevalent for the past 300-400 years. </li></ul><ul><li>1200 Sloth Bears were being made to “dance” on the street by nomadic Kalandar Tribe. </li></ul><ul><li>Sloth Bear cubs poached from the wild, mother bears killed. </li></ul><ul><ul><li>Protected under Schedule I of Indian Wildlife (Protection) Act, 1972 </li></ul></ul><ul><ul><li>IUCN Status- Vulnerable </li></ul></ul><ul><ul><li>CITES-Listed in Appendix 1 . </li></ul></ul>
    3. 3. <ul><li>STATUS OF TEETH IN DANCING BEARS </li></ul><ul><ul><li>Canines (fractured) </li></ul></ul><ul><ul><li>Incisors (abrasion and fractured) </li></ul></ul><ul><ul><li>Premolars (fractured, caries lesions) </li></ul></ul><ul><ul><li>Molars (caries) </li></ul></ul><ul><li>ROOT CANAL PROBLEM OF CANINES </li></ul><ul><li>GIGANTIFORM CEMENTOMA </li></ul><ul><li>A benign fibro-cemento-osseous lesion around the apices of vital teeth causes severe disfigurement of the jaws. </li></ul><ul><li>OSTEOBLASTOMA – Giant osteoid osteoma </li></ul><ul><li>DEVELOPMENTAL DENTAL DISORDERS </li></ul>COMMON DENTAL DISEASES OF RESCUED DANCING BEARS
    4. 4. SLOTH BEAR DENTAL FORMULA I 2/3 C 1/1 PM 4/4 M 2/3
    5. 5. DENTAL RECORD
    6. 6. ANAESTHESIA XYLAZINE AND KETAMINE, HALOTHANE GAS VIA 18MM ET TUBE
    7. 7. ANAESTHESIA <ul><li>Intra-operative fluids given to all bears </li></ul><ul><li>Vital Parameters are continuously monitored throughout the procedure </li></ul><ul><ul><li>Heart Rate </li></ul></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Respiratory Rate </li></ul></ul><ul><ul><li>Oxygen Saturation </li></ul></ul>
    8. 8. ET-INTUBATION
    9. 9. AFTER ET-INTUBATION
    10. 10. EXAMINATION
    11. 11. DENTAL EQUIPMENTS
    12. 12. PROBLEMS IN CANINE TEETH
    13. 13. PROBLEMS IN CANINE TEETH
    14. 14. MALOCCLUSIONS
    15. 15. Draining sinus tracts PROBLEMS IN CANINE TEETH
    16. 16. INCISORS <ul><li>Many incisors had pulp exposure </li></ul><ul><li>Some were fractured </li></ul><ul><li>Most probably due to abrasion </li></ul><ul><li>Therefore extracted </li></ul>
    17. 17. MOLARS & PREMOLARS <ul><li>Fractured premolars </li></ul><ul><li>Caries lesions </li></ul>
    18. 18. <ul><li>Histopathological analysis showed gingival recession and calculus showed enamel dysplasia </li></ul>
    19. 19. DENTAL RADIOGRAPHY
    20. 20. DIAGNOSIS <ul><li>Decision to perform </li></ul><ul><li> * Extraction or </li></ul><ul><ul><li>* Root Canal treatment based on clinical examination and radiographs </li></ul></ul>
    21. 21. Surgical Extraction of Upper Canine: <ul><ul><li>A muco-periosteal flap was raised from the medial aspect of 104 to distal 106. </li></ul></ul><ul><ul><li>Buccal bone was removed using a no.8 high-speed round bur with sterile water for cooling. </li></ul></ul><ul><ul><li>The tooth was luxated and then elevated using an 8mm winged luxator and couplands no.3 elevator. </li></ul></ul><ul><ul><li>The socket was debrided and then the flap sutured using monofilament absorbable 4/0 suture material. </li></ul></ul>* EXTRACTIONS
    22. 22. * EXTRACTIONS
    23. 23. * EXTRACTIONS <ul><li>Dilacerated roots </li></ul><ul><li>Resorbing roots </li></ul>
    24. 24. * EXTRACTIONS <ul><li>Debrided the sockets well </li></ul><ul><li>Did not pack </li></ul><ul><li>Sutured with monocryl 4/0 </li></ul><ul><li>Absolutely tension free due to suction force </li></ul>
    25. 25. POST-EXTRACTION HEALED TISSUE
    26. 26. * ROOT CANAL TREATMENT <ul><li>Most teeth had necrotic pulps </li></ul><ul><li>All teeth with vital pulps had been fractured for a minimum of 3 yrs </li></ul>
    27. 27. * ROOT CANAL TREATMENT <ul><li>All except 3 teeth were less than 60 mm WL so standard veterinary length hedstrom files were used. </li></ul><ul><li>Access was directly through fracture site </li></ul>
    28. 28. * ROOT CANAL TREATMENT <ul><li>Flushed with 5.25% NaOCl </li></ul><ul><li>Dried with pipe-cleaners and paper points </li></ul>
    29. 29. * ROOT CANAL TREATMENT <ul><li>Filled with sealopex using a veterinary length lentulo. </li></ul><ul><li>Paste syringed in initially due to volume </li></ul>
    30. 30. * ROOT CANAL TREATMENT <ul><li>Restored with glassionomer (chemical cure) </li></ul><ul><li>Final restoration - amalgam </li></ul>
    31. 31. MULTIPLE ENDO AND TIME CONSIDERATION
    32. 32. RECOVERY <ul><li>The bears were carried back to the dens. </li></ul><ul><li>Most bears were up within 30 minutes </li></ul>
    33. 33. * A 14 year old male bear weighing 115 kgs was found having a large mass on the left upper jaw. CASE STUDY 1 <ul><li>Diagnostic imaging done. </li></ul><ul><li>Extraction performed. </li></ul><ul><li>Excised tissue subjected to histological examination and found to be a cementifying fibroma. </li></ul><ul><li>Post-operative monitoring of bear done. </li></ul>
    34. 34. Extraction of Lower Canine <ul><li>An incision was made from the medial aspect of the mass in a distal direction along the muco-gingival junction to the lower canine. </li></ul><ul><li>The mass on the lower right rostral mandible was excised. </li></ul><ul><li>Another incision was made on the lingual aspect of the mass. </li></ul><ul><li>An osteotome and chisel was used to remove the calcified mass together with the lower incisors </li></ul><ul><li>The flap was then extended to the distal canine. </li></ul><ul><li>The lower canine was then extracted. </li></ul><ul><li>The flap was sutured with monofilament absorbable 4/0 suture material using a simple interrupted pattern. </li></ul>
    35. 35. <ul><li>Dimensions of Incised bony mass </li></ul><ul><ul><li>= 4 x 3 x 2.5 cm. </li></ul></ul><ul><li>On slicing a part of the canine teeth </li></ul><ul><li>was also seen. </li></ul>REMOVED FIBROUS MASS AFTER HEALING
    36. 36. <ul><li>Chronic inflammation of hyperplastic squamous lining epithelial cells. </li></ul>HISTOPATHOLOGY FINDINGS
    37. 37. HISTOPATHOLOGY FINDINGS <ul><li>Fibrocollagenous tissue showed: </li></ul><ul><ul><ul><li>Islands of irregular cementum formation </li></ul></ul></ul><ul><ul><ul><li>Rimming of cells observed </li></ul></ul></ul>
    38. 38. DISCUSSION FOR CASE STUDY 1 <ul><li>The lesion: </li></ul><ul><ul><li>may be solitary or </li></ul></ul><ul><ul><li>occur in multiples. </li></ul></ul><ul><li>The initial lesion is a periapical proliferation of benign fibrous connective tissue in the periodontal ligament. </li></ul><ul><li>There are no symptoms and x-ray shows a periapical radiolucency ordinarily not exceeding a centimeter. </li></ul><ul><li>Cementum is slowly formed in the central area and the entire lesion becomes converted to a mineralized mass that appears radio-opaque on x-ray. </li></ul><ul><li>Often a thin radiolucent halo persists around the circumference of the opaque lesion. </li></ul>
    39. 39. <ul><li>An abscess is an abnormal cavity containing pus. </li></ul><ul><li>The cavity is formed in tissues, due to local suppurative inflammation. Infection around the apex of a tooth leads to periepical abscess; usually its secondary to periodontal or endodontic disease and its characterized by acute, sever painful swelling in the area of the affected tooth. </li></ul>PERIAPICAL ABSCESS CASE STUDY 2
    40. 40. Ventral aspect of the lower jaw of Tikku Bear (Left) and Chotu Bear (Right) The opening of Periapical abscess fistula from the infected canine
    41. 41. DENTAL RADIOGRAPHY Radiograph showing Periapical Abscess of the infected lower right canine of Tikku bear (left) and Chotu Bear (right).
    42. 42. <ul><li>Infected Root Canal of Lower Right Canine(s) (Red Arrow) of </li></ul><ul><ul><li>Tikku Bear (Left) and </li></ul></ul><ul><ul><li>Chotu Bear (Right) </li></ul></ul>
    43. 43. EXTRACTION PROCEDURE
    44. 44. DENTAL ELEVATION
    45. 45. <ul><li>The alveolar bone overlying the buccal surface of the tooth root was removed by using dental drill with the help of dental luxators and elevators. </li></ul><ul><li>The attachment between tooth and periodontal ligament was detached by the way of gently working around the circumference of the canine. </li></ul><ul><li>The canine was extracted out using extraction forceps by gentle pulling towards the direction of tooth curvature. </li></ul><ul><li>The mucoperiosteal flap was replaced to close the extraction socket by simple interrupted sutures with absorbable polyglycemic acid mersuture, thus allowing primary healing. </li></ul>DENTAL DRILLING
    46. 46. AFTER EXTRACTION
    47. 47. <ul><li>Systemic administration of a broad-spectrum antibiotic injection Benzathine penicillin and non-steroidal anti-inflammatory injection Meloxicam given for five days. </li></ul><ul><li>To reduce further complication and pain the bear was feed with only semisolid wheat porridge with boiled milk and multi vitamin supplement after cooling for five days. </li></ul><ul><li>The animal made an uneventful recovery with out any complication and start consuming fruits and solid food after complete recovery. </li></ul>POST OPERATIVE CARE
    48. 48. <ul><li>When the canines teeth first erupt, many gypsies deliberately smash the teeth to disarm the bear and make them look less aggressive for tourists. </li></ul><ul><li>It is not known at what age their teeth had been fractured, but mostly all four canines and most incisors were fractured and had necrotic pulps. </li></ul><ul><li>The sloth bear was fed a combination of soft dietary ingredients that is taken in by a sucking action. </li></ul><ul><li>Traumatic condition caused by the Kalandars by brutally breaking the teeth with iron chisels and stones in order to avoid biting while make them to perform. </li></ul>ETIOLOGY OF DENTAL DISORDERS IN BEARS
    49. 49. DENTAL SURGERY ON TIGERS Karnataka, India
    50. 50. DENTAL SURGERY -TIGERS
    51. 51. Next day…
    52. 52. MOHAN POST-OP
    53. 53. MANEKA POST-OP
    54. 54. www.wildlifesos.org Wildlife S.O.S Thank You International Animal Rescue and
    55. 55. Open for Discussion

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