A crown height reduction and vital pulpotomy is a procedure we commonly perform on teeth that are malpositioned and causing trauma to the soft tissues within the mouth. This procedure is most often applied to young dogs with a Class 2 Malocclusion (overbite), where the mandibular canine teeth contact and traumatise the roof of the mouth and in dogs with a Class 1 Malocclusion (Linguoverted mandibular canines).
For these patients, orthodontic movement of the teeth may not be practical or possible and leaving them with no treatment results in chronic pain and potential oronasal fistula formation (a hole between the mouth and nose) from constant trauma.
A crown height reduction and vital pulpotomy procedure involves reducing the height of the mandibular canine(s). Cutting these teeth will expose the sensitive living part of the tooth – the pulp. This delicate pulp must be covered to protect it from the external environment.
To do this, we first drill down into the tooth to amputate a small amount of the pulp to make way for a filling. Following this a layered filling is placed with the layer in contact with the pulp tissue having multiple functions. It acts as both a physical barrier to bacterial penetration but also stimulates formation of new dental material below it.
Most teeth treated in this manner do well and continue to remain vital and go on to mature, with an overall success rate of 90% when performed correctly. To determine that a tooth has survived the procedure and is healthy, we must examine the treated teeth periodically over the patient’s lifetime. The first of these checks is 3 months after the vital pulpotomy procedure. This examination involves assessing that the fillings placed remain intact and no evidence of pathology can be detected on dental radiographs. We want to see evidence of continued maturation of the tooth over time. If this is not present or signs of infections are detected, further treatment such as root canal therapy or extraction may be required.
This procedure may be advantageous compared to extraction of teeth as it can aid in retention of jaw structure and maintenance of function.
Patients who have a crown height reduction and vital pulpotomy procedure should avoid play with abrasive toys such as tennis balls. Being mindful of play behaviour and not throwing hard objects to catch is also advised to minimise the chance of damage to the fillings. There is no need to alter diet or chewing behaviours.
Crown height reduction and vital pulpotomy can be an excellent treatment choice for the right patient. Determining if this treatment is right for you and your pet is something that we can do following a thorough assessment and discussion of all available treatment options.
