Dr. John Scheels - Exotic Animal Dentistry
Dr. John Scheels - Exotic Animal Dentistry
 
Dr. John Scheels - Exotic Animal Dentistry Dr. John Scheels - Exotic Animal Dentistry
 

Recent Cases

Recent cases that are instructional and illustrative
of typical zoo dentistry cases

Siberian tiger mandibular canine endodontic procedure
October 16, 2014
Milwaukee County Zoo.

Dr. John Scheels - Exotic Animal Dentistry

Transporting Tula
(Click image to enlarge)
photo by Mike Nepper

"Tula" is a 2 1/2 year old Siberian tiger, weighing 242 pounds. She fractured her mandibular canine when playing with her littermate, sister, on an elevated structure. An observant zookeeper spotted the canine tip piece, approximately 1 1/2 cm. long, shortly after the incident and confirmed by observing the tigress, that the canine was short, fractured.

Tula did not seem to be in pain or distress and her behavior was normal according zookeepers. However, I am aware of fresh fractures of this type, exposing the pulp and nerve caused some captive carnivores to be in so much pain and distress that they attacked and killed a cage mate. ("Bubba", Brookfield zoo, year?)

Approximately ten days later, on October 16, 2014 the zoo veterinarians, primarily Drs. Jennifer Haussmann and Vickie Clyde, sedated Tula, and transported her to the Milwaukee County Zoo Animal Health Center. Following the vets and techs establishing an intravenous line, attaching a pulse-oximeter and intubation establishing general anesthesia, we were given permission to start the dental procedure.

Dr. John Scheels - Exotic Animal Dentistry

Figure 1
(Click image to enlarge)
photo by Mike Nepper

A brief oral exam revealed no other oral or dental pathology warranting treatment other than the mandibular right canine. The pulp was exposed with pulp tissue at the surface of the opening. The fractured canine segment and observation of the tooth had already established the pulp exposure (Figure 1).

The pulp was vital. The preoperative radiograph (Figure 2) revealed the pulp on this young animal widened a short distance beyond the fracture.

After explaining to the veterinarians, I used the high speed dental hand piece to cut another approximate cm off of the tooth to permit optimal pulp access for the endodontic procedure (Figures 3 and 4).

Dr. John Scheels - Exotic Animal Dentistry

Figure 2
(Click image to enlarge)
photo by Mike Nepper
Dr. John Scheels - Exotic Animal Dentistry

Figure 3
(Click image to enlarge)
photo by Mike Nepper
Dr. John Scheels - Exotic Animal Dentistry

Figure 4
(Click image to enlarge)
photo by Mike Nepper

I extirpated the pulp and nervous tissue with a 100 mm endo file. Working length was established at 72 mm. This correlated with my measurement and estimation from the preoperative radiograph. Using successively larger diameter files, and copious irrigation with NaOCl and RC prep the canal was shaped and dissenfected (Figures 5, 6 and 7).

Dr. John Scheels - Exotic Animal Dentistry

Figure 5
(Click image to enlarge)
photo by Mike Nepper
Dr. John Scheels - Exotic Animal Dentistry

Figure 6
(Click image to enlarge)
photo by Mike Nepper
Dr. John Scheels - Exotic Animal Dentistry

Figure 7
(Click image to enlarge)
photo by Mike Nepper

Hemostasis was established and the pulp was dried with sterile pipe cleaners. They must be actual pipe cleaners comprised of absorbent cotton. Not colorful craft items. Bag and sterilize (Figure 8).

Dr. John Scheels - Exotic Animal Dentistry

Figure 8
(Click image to enlarge)
photo by Mike Nepper

After fitting the master gutta percha cone at the established working length, the canal was then obturated with PCA endo filler paste (a ZOE based paste) by placing the Large Volume Veterinary Endodontic Syringe needle at the apex and backfilling as it is withdrawn. The paste was deposited with a 20 gauge, 2 1/2 inch spinal needle (Figure 9). Additional gutta percha points were then placed and condensed in the canal.

A zinc phosphate cement base was placed over the endo fill. The access opening was briefly prepared and a composite resin restoration placed. I rounded and smoothed off the fractured canine edges when polishing the composite resin (Figure 10).

Dr. John Scheels - Exotic Animal Dentistry

Figure 9
(Click image to enlarge)
photo by Mike Nepper
Dr. John Scheels - Exotic Animal Dentistry

Figure 10
(Click image to enlarge)
photo by Mike Nepper

The entire dental procedure was completed in 53 minutes. Tula recovered from her anesthesia uneventfully. A successful procedure facillitared by excellent general anesthesia by the veterinarians. See the fill radiograph (Figure 11).

Dr. John Scheels - Exotic Animal Dentistry

Figure 11
(Click image to enlarge)
photo by Mike Nepper

This conventional endo approach also called coronal or orthograde is certainly the technique of choice for a fresh, vital pulp, endodontic procedure. Considering the delta apex on mature carnivore teeth, if this tooth was abscessed and or a significant amount of lysis of the apex or a large lytic area in the adjacent alveolar bone was observed, a surgical retrograde approach would have been necessary to treat properly. Also, again considering the delta apex of the tooth, periodic examination including radiography of the tooth root is necessary to monitor the success of the conventional endodontic procedure. The necessity of such follow up should be indicated in the patient's chart so that if she must be sedated for some other reason, the dental exam and radiographs will be done also.

Zookeepers are reminded to be particularly observant of behavior or signs that may indicate pain or abscessation of the tooth.


Bonobo Makanza
February, 2015
Milwaukee County Zoo.

Photos by Mark Scheuber, Zoo Keeper/Photographer

Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Bonobo Makanza, sedated, being prepared for dental treatment. L to R, zookeeper Stacy Whitaker, hospital keeper Celi Jeske and Veterinarian Dr. Jennifer Hausmann.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Maxillary left central incisor and lateral incisor residual roots. Region was inflamed, edematous prior to two weeks of antibiotic therapy.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Conventional dental film in position. Digital Phos Phor plates were also exposed.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Dr. Hausmann and Dr. Scheels positioning Nomad radiography unit.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Digital image reveals periapical lesion on central incisor residual root.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Incision on crest of ridge.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

556 surgical bur used to remove approximately 2mm. of alveolar bone surrounding each root ("ditching".)
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Luxator technique utilized to remove residual roots.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Extracted roots.
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Roots
Dr. John Scheels - Exotic Animal Dentistry

(Click image to enlarge)

Simple interrupted sutures placed with knots inside the wound so that Makanza will find it difficult to disturb them with his fingers and tongue.

This page:
Siberian Tiger Mandibular Canine Endodontic Procedure
Bonobo Makanza

THE WEDGE®

Radiolucent Mouth Prop for Dogs and Cats

Dr. John Scheels - Exotic Animal Dentistry 
(click image to enlarge)
 

The WEDGE® is a one-piece, radiolucent mouth prop. The patented, anatomic design holds the carnivore mouth open during anesthesia by securely engaging the premolars and molars.

Dr. John Scheels - Exotic Animal Dentistry
PATENTED
 

The WEDGE®:

Dr. John Scheels - Exotic Animal Dentistry 
(click image to enlarge)
 

Developed and patented by Dr. John L. Scheels, dental consultant to the Milwaukee County Zoo, Adjunct Assistant Professor, University of Wisconsin-Madison School of Veterinary Medicine.

"The (Scheels) Veterinary mouth prop's biggest asset is its simplicity - open the mouth and stick it in!...it does not interfere with radiographic detail, can be ultrasounded, and autoclaved...can be used for dental and oral surgery procedures...is positioned within the mouth, unlike the spring loaded (extra-oral) devices which can be in the way of the operator and interfere with positioning the patient..."

~ Paul E. Howard, D.V.M.,

Vermont Veterinary Surgical Center, Burlington, Vermont.

Order The WEDGE® from any of these veterinary equipment suppliers:


L.V.V.E.S

Large Volume Veterinary Endodontic Syringe™

Click here for more details
Dr. John Scheels - Exotic Animal Dentistry 
(click image to enlarge)
Dr. John Scheels - Exotic Animal Dentistry 
(click image to enlarge)

An endodontic syringe developed by Dr. John Scheels specifically for veterinary use in all species for complete and consistent obturation of root canals over 30mm long or with large pulp chambers. It permits the positive deposition of endodontic sealer and filler pastes at the apex of these long teeth. NO SPECIAL NEEDLES are required as it may be used with any standard size hub. Plastic, metal, threaded or non-threaded needle hubs will seal well on the tapered syringe nipple.

Purchase from Shipp's