Treatment of maxillary cheek teeth apical infection caused by patent infundibula in six horses (2007–2013)

Abstract

Summary Six young horses presented with clinical signs of maxillary cheek teeth apical infection (bilateral in 2 horses) that included the presence of rostral maxillary swellings with discharging sinus tracts and were unexpectedly found to have no evidence of endodontic infection in 7 affected teeth. The apical infection of these teeth was attributed to infundibular dysplasia that allowed inoculation of the periapical tissue with contaminated oral contents. Treatment was by debridement and obturation of affected infundibula from their occlusal aspect using techniques normally used for endodontic therapy. Five out of 6 cases showed resolution of clinical signs over a mean follow‐up period of 19 months (range 6–48 months). These cases demonstrate that patency of the infundibular apex is a potential cause of cheek teeth apical infection in young horses, which can be successfully treated by debridement and subsequent infundibular restoration.

Challenges in developing valid techniques for equine endodontic treatment of apically infected cheek teeth

“…As can be seen in the CT scan in Figure 15 in the article by Pearce () and in the CT scan and CT reconstructions in Windley et al . (,b), there can be marked pathology of the apical aspect of the infundibulum with little or no abnormality of the occlusal portion of the infundibulum.…”

“…Also in this issue, Pearce () reports the staged use of calcium hydroxide and infundibular restoration for treatment of apically infected maxillary cheek teeth in which the underlying aetiology is apical patency of the infundibulum. The infundibula of maxillary cheek teeth have also been recently investigated both in vivo and in extracted teeth with high resolution CT (Windley et al .…”

“…In summary, the clinical cases presented by Lundström and Wattle () and Pearce () should be considered pilot studies. The favourable clinical results reported should justify further laboratory investigation, which may lead to well designed clinical trials to test the efficacy of endodontic treatments in equine cheek teeth.…”

“…One of these newer materials may be a good candidate for laboratory investigation as a combined obturation-restoration material in equine cheek tooth orthograde endodontic therapy. Also in this issue, Pearce (2016) reports the staged use of calcium hydroxide and infundibular restoration for treatment of apically infected maxillary cheek teeth in which the underlying aetiology is apical patency of the infundibulum. The infundibula of maxillary cheek teeth have also been recently investigated both in vivo and in extracted teeth with high resolution CT (Windley et al 2009b;Fitzgibbon et al 2010;Kopke et al 2012).…”

Clinical significance of equine cheek teeth infundibular caries

“…A few studies have reported techniques for the treatment of infundibular caries. 7,14 Despite some of the techniques illustrating the difficulty in effective restoration of the caries, restoration still slows down or ceases the progression of the tooth decay.…”