Disease management in horses encompasses the strategies and practices employed to prevent, control, and treat diseases affecting equine populations. This field involves understanding the etiology, transmission, and clinical presentation of various equine diseases, as well as implementing biosecurity measures and therapeutic interventions. Common diseases in horses include equine influenza, strangles, and equine herpesvirus. Effective disease management relies on accurate diagnosis, vaccination protocols, and the use of antimicrobials and other treatments. This page compiles peer-reviewed research studies and scholarly articles that explore the methodologies, challenges, and advancements in managing diseases in equine health.
Dürrwald R, Kolodziejek J, Weissenböck H, Nowotny N.Borna disease (BD) is a sporadic neurologic disease of horses and sheep caused by mammalian Borna disease virus (BDV). Its unique epidemiological features include: limited occurrence in certain endemic regions of central Europe, yearly varying disease peaks, and a seasonal pattern with higher disease frequencies in spring and a disease nadir in autumn. It is most probably not directly transmitted between horses and sheep. All these features led to the assumption that an indigenous virus reservoir of BDV other than horses and sheep may exist. The search for such a reservoir had been unsuccessfu...
Pinna A, Martins G, Hamond C, Medeiros MA, de Souza GN, Lilenbaum W.The objective was to investigate potential differences between two Leptospira serovars, host-adapted (Bratislava) and incidental (Copenhageni), in causing reproductive disorders in mares. From August 2009 to March 2011, 608 adult recipient mares from eight studs located in the state of Rio de Janeiro, Brazil, were screened for leptospirosis. These mares were 3-8 years of age, of various breeds, and were managed in a semiextensive system (embryo transfer centres). According to the reproductive history of these mares, the studs were categorised as Group A (357 mares: high prevalence of reprodu...
Schemann K, Toribio JA, Taylor MR, Ward MP, Dhand NK.To evaluate the level of biosecurity training among Australian equine veterinarians and to assess their perceptions of biosecurity and infectious disease risk and their opinions about the management of the 2007 equine influenza (EI) outbreak. Methods: Cross-sectional study. Methods: A survey was conducted among equine veterinarians attending the 2010 annual conference of the Equine Veterinarians Australia (EVA) in New South Wales, Australia. Data were collected using a self-completed questionnaire and analysed using Fisher's exact tests to assess veterinarians' levels of biosecurity training, ...
Nielsen MK, Pfister K, von Samson-Himmelstjerna G.Since the 1960s equine parasite control has relied heavily on frequent anthelmintic treatments often applied with frequent intervals year-round. However, increasing levels of anthelmintic resistance in cyathostomins and Parascaris equorum are now forcing the equine industry to change to a more surveillance-based treatment approach to facilitate a reduction in treatment intensity. The principle of selective therapy has been implemented with success in small ruminant parasite control, and has also found use in horse populations. Typically, egg counts are performed from all individuals in the pop...
Stull CL, Holcomb KE.Every state in the United States has regulations prohibiting acts of neglect and cruelty against animals. Local law enforcement and animal control agencies are responsible in many communities to enforce these statutes. As society's perception of horses has changed from their origin as livestock to companion animals in modern times, owners have transitioned their care and management. The goal of this study was to identify the role and capacities of local animal control services in the United States that investigate equine neglect, cruelty, and abandonment investigations and to identify challeng...
Pérez DS, Tapia MO, Soraci AL.Fosfomycin (FOS) is a natural bactericidal broad-spectrum antibiotic which acts on proliferating bacteria by inhibiting cell wall and early murein/peptidoglycan synthesis. Bactericidal activity is evident against Gram positive and Gram negative bacteria and can also act synergistically with other antibiotics. Bacterial resistance to FOS may be natural or acquired. Other properties of this drug include inhibition of bacterial adhesion to epithelial cells, exopolysaccharide biofilm penetration, immunomodulatory effect, phagocytosis promotion and protection against the nephrotoxicity caused by ot...
Reef VB, Bonagura J, Buhl R, McGurrin MK, Schwarzwald CC, van Loon G, Young LE.Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a ...
Kilcoyne I, Dechant JE.To report the clinical findings, incidence of complications, and outcome associated with perineal urethrotomy in equids. Methods: Retrospective case series. Methods: Equids (n = 27). Methods: Medical records (January 2000 to December 2010) of equids that had a perineal urethrotomy were reviewed. Data retrieved and evaluated were breed, age, surgical technique, use of general anesthesia, complications, time from surgery to development of complications and their management, and outcome. Results: Perineal urethrotomy was performed for urolithiasis (n = 22), for treatment of urethral rents...
Cramp PA, Prange T, Nickels FA.The purpose of this article is to review the literature and personal experiences of equine surgeons so as to describe procedures that can be performed in the standing sedated horse to alleviate conditions that result in upper respiratory tract obstruction. Upper respiratory tract surgery requires attention to detail, meticulous planning, and careful dissection and execution with little room for error. This article describes a selection of standing upper airway procedures, the indications for and possible complications of these surgeries, and advantages and disadvantages of a particular method....
Bundgaard L, Jacobsen S, Sørensen MA, Sun Z, Deutsch EW, Moritz RL, Bendixen E.Progress in MS-based methods for veterinary research and diagnostics is lagging behind compared to the human research, and proteome data of domestic animals is still not well represented in open source data repositories. This is particularly true for the equine species. Here we present a first Equine PeptideAtlas encompassing high-resolution tandem MS analyses of 51 samples representing a selection of equine tissues and body fluids from healthy and diseased animals. The raw data were processed through the Trans-Proteomic Pipeline to yield high quality identification of proteins and peptides. T...
Rapoport A, Aharonson-Raz K, Berlin D, Tal S, Gottlieb Y, Klement E, Steinman A.Equine piroplasmosis imposes great concerns for the equine industry regarding international horse movement, and therefore requires reliable diagnostic tools. Recent studies from South Africa and Jordan, including a preliminary study in Israel, reported extremely low seroprevalence to Babesia caballi (B. caballi) (0-1%) using the acceptable rhoptry-associated protein-1 (RAP-1) cELISA. In accordance with the study from South Africa demonstrating a significant heterogeneity in the rap-1 gene sequence of South African B. caballi isolates, the objectives of this study were to phylogenetically chara...
Lassaline-Utter M, Cutler TJ, Michau TM, Nunnery CM.To review the signalment, clinical characteristics, and outcome of horses with nonhealing corneal ulcers treated with diamond burr debridement (DBD); and to evaluate the role of ulcer duration, size and location, and bandage contact lens (BCL) placement on healing. Methods: From January 2012-April 2013, 60 horses were diagnosed with ulcers classified as nonhealing based on the presence of raised epithelial margins and duration of at least 7 days. Methods: Retrospective record review. Results: Average age of included horses was 14.68 years, SD 8.17 years. There were three times as many males (4...
Robin M, Archer D, Garros C, Gardès L, Baylis M.There are concerns that outbreaks of exotic or novel vector-borne viral diseases will increasingly occur within northern Europe and the UK in the future. African horse sickness (AHS) is a viral disease of equids that is transmitted by Culicoides and is associated with up to 95 per cent mortality. AHS has never occurred in the UK; however, it has been suggested that appropriate Culicoides species and climatic conditions are present in northern Europe to support an outbreak. No data are currently available regarding the Culicoides species present on UK equine properties. This study demonstrates ...
Hertzberg H, Schwarzwald CC, Grimm F, Frey CF, Gottstein B, Gerber V.The epidemiological situation of strongyle infections in adult horses in Switzerland is characterized by a strong dominance of small strongyles (Cyathostominae) and an overall low level of egg shedding in the faeces. The prevailing attitude towards anthelmintic therapy considers neither husbandry conditions nor pasture hygiene measures. Instead, calendar-based routine medication, comprising usually 3 to 4 annual treatments, is the typical strategy. Such an approach, however, often results in an excessive administration of anthelmintics. With respect to the continuous spread of drug resistant c...
Corbett CJ, Love S, Moore A, Burden FA, Matthews JB, Denwood MJ.The level of anthelmintic resistance within some cyathostomin parasite populations has increased to the level where sole reliance on anthelmintic-based control protocols is not possible. Management-based nematode control methods, including removal of faeces from pasture, are widely recommended for use in association with a reduction in anthelmintic use to reduce selection pressure for drug resistance; however, very little work has been performed to quantitatively assess the effectiveness of such methods. Methods: We analysed data obtained from 345 donkeys at The Donkey Sanctuary (Devon, UK), m...
Signer-Hasler H, Neuditschko M, Koch C, Froidevaux S, Flury C, Burger D, Leeb T, Rieder S.Hereditary variations in head morphology and head malformations are known in many species. The most common variation encountered in horses is maxillary prognathism. Prognathism and brachygnathism are syndromes of the upper and lower jaw, respectively. The resulting malocclusion can negatively affect teeth wear, and is considered a non-desirable trait in breeding programs. We performed a case-control analysis for maxillary prognathism in horses using 96 cases and 763 controls. All horses had been previously genotyped with a commercially available 50 k SNP array. We analyzed the data with a mixe...
Turner JW, Rutberg AT.There are only two nonlethal approaches with which to manage wildlife populations: remove excess individuals or decrease reproductive rates. In the case of wild horse management, the latter has already been shown to be a more humane and less costly approach. Contraception has been known for many years to be effective in wild horses with regard to both fertility and population alteration. Field testing under real-world management situations is a critical aspect of wildlife contraception assessment. Field testing also requires documentation to justify eventual large-scale use of fertility contro...
Peregrine AS, Molento MB, Kaplan RM, Nielsen MK.Parascaris equorum and cyathostomins are currently considered the most important parasites of horses and have traditionally been controlled with anthelmintics belonging to three drug classes: benzimidazoles, the tetrahydropyrimidine pyrantel, and macrocyclic lactones. Unfortunately, resistance to benzimidazoles, and to a lesser extent pyrantel, is widespread in cyathostomins around the world. Furthermore, resistance to macrocyclic lactones appears to be in the early stages of development in cyathostomins in multiple locations. In contrast, P. equorum populations have remained susceptible to th...
Hilderbran AC, Breuhaus BA, Refsal KR.This study was performed to determine whether sick horses have thyroid hormone (TH) alterations similar to those observed in nonthyroidal illness syndrome in other species. Objective: Horses suffering from systemic diseases have decreased THs and inappropriately low thyroid-stimulating hormone (TSH). Methods: Seventy-one clinically normal horses; 380 hospitalized horses. Methods: Total thyroxine (TT4), free thyroxine by equilibrium dialysis (fT4D), total triiodothyronine (TT3), free triiodothyronine (fT3), and TSH were measured in normal and hospitalized horses. Disease severity was categorize...
Freeman DE, Schaeffer DJ, Cleary OB.Although many studies have described results after small intestinal resection and anastomosis in horses, few have described the outcome in horses with strangulating lesions managed without resection. Objective: To examine short- and long-term recoveries in horses with strangulated small intestine that was judged to be viable during surgery and not resected. Methods: Retrospective analysis of case records. Methods: Data were reviewed from all cases (35 horses) with colic caused by small intestinal strangulation that underwent surgery between 1996 and 2011 at 2 university hospitals and that were...
Mendez-Angulo JL, Tatarniuk DM, Ruiz I, Ernst N.To report long-term outcome in a mare that had extensive rostral mandibulectomy to remove an ameloblastoma. Methods: Clinical report. Methods: A 21-year-old mare. Methods: An ameloblastoma, located in the rostral aspect of the mandible, was removed by complete en-bloc resection of the tumor, removing most of the mandibular symphysis. Results: The day after surgery, the remaining mandibular symphysis (<5 mm) fractured causing marked instability of the hemi-mandibles. Partial wound dehiscence occurred 5 days after surgery; however, the mare was able to eat well and the incision healed within 2...
Guthrie AJ, Coetzee P, Martin DP, Lourens CW, Venter EH, Weyer CT, Joone C, le Grange M, Harper CK, Howell PG, MacLachlan NJ.This is a report of the complete genome sequences of plaque-selected isolates of each of the four virus strains included in a South African commercial tetravalent African horse sickness attenuated live virus vaccine.
Wescott RB.Equine anthelmintics and the resistance of nematode parasites to anthelmintics are reviewed. Recommendations are made for effective treatment of these parasites and for procedures that can be performed to minimize the problem in the future.
Kirschvink N, Di Silvestro F, Sbaï I, Vandenput S, Art T, Roberts C, Lekeux P.This study aimed to test whether shredded cardboard is an appropriate minimum-dust bedding material for heaves-affected horses. Results of standardized in vitro measurement of airborne dust and aeroallergen concentrations of cardboard bedding were significantly lower than those of common bedding materials. Six heaves-affected horses in clinical remission after pasturing were stabled for two months on cardboard bedding and fed grass silage. Pulmonary function tests (PFT: ventilatory mechanics, arterial blood gases, airway inflammation scoring, bronchoalveolar cytology) were performed before, du...
Geor RJ.Acute renal failure (ARF) in horses is usually prerenal or renal in origin and is most often caused by hemodynamic or nephrotoxic insults. The clinical management of patients that have ARF is largely supportive, including correction of fluid deficits and electrolyte and acid-base disturbances and treatment and reversal of the underlying cause. Use of dopamine and mannitol to promote renal blood flow and urine output is no longer recommended.
Valcek A, Sismova P, Nesporova K, Overballe-Petersen S, Bitar I, Jamborova I, Kant A, Hrabak J, Wagenaar JA, Madec JY, Damborg P, van Duijkeren E....The relatedness of the equine-associated ST1250 and its single- and double-locus variants (ST1250-SLV/DLV), obtained from horses in Europe, was studied by comparative genome analysis. A total of 54 isolates of ST1250 and ST1250-SLV/DLV from healthy and hospitalized horses across Europe [Czech Republic (n=23), the Netherlands (n=18), Germany (n=9), Denmark (n=3) and France (n=1)] from 2008-2017 were subjected to whole-genome sequencing. An additional 25 draft genome assemblies of ST1250 and ST1250-SLV/DLV were obtained from the public databases. The isolates were compared for genomic feature...
Kelly JD, Hall CA.This chapter discusses the resistance of animal helminths to anthelmintics. Resistance is defined as a significant increase in the ability of individuals within a strain to tolerate doses of a compound, which would prove lethal to the majority of individuals in a normal population of the same species. The introduction of phenothiazine and the benzimidazole broad-spectrum anthelmintics, has unfortunately led to the selection of drug-resistant strains of important parasitic helminths. The emergence of an increasing number of resistant helminths is associated with the widespread use and misuse of...
Sallé G, Cabaret J.In-depth knowledge of the use of anthelminthics in the field, especially by veterinarians, is required to design more sustainable parasite control strategies. Methods: An online survey was sent by e-mail to 940 equine veterinary practitioners to describe their equine practice, their awareness about parasites and the management strategies they apply. Results: Gastrointestinal parasites were generally considered (68%) as an issue of moderate importance. Drug efficacy failure was a minor or moderate issue for 47% and 48% of responders, respectively. Parasite management mostly relied on the use of...
Clarke AF.This paper reviews the environmental and host factors which interact to affect the incidence and severity of episodes of respiratory disease in stabled horses. The folly of accepting housing criteria and management practices for the horse, based on direct extrapolations from intensive housing of meat producing animals, is discussed. The factors which affect air hygiene and physical environment of stables are considered in terms of short-term athletic performance and long-term welfare.
Schemann K, Toribio JA, Taylor MR, Ward MP, Dhand NK.To evaluate the level of biosecurity training among Australian equine veterinarians and to assess their perceptions of biosecurity and infectious disease risk and their opinions about the management of the 2007 equine influenza (EI) outbreak. Methods: Cross-sectional study. Methods: A survey was conducted among equine veterinarians attending the 2010 annual conference of the Equine Veterinarians Australia (EVA) in New South Wales, Australia. Data were collected using a self-completed questionnaire and analysed using Fisher's exact tests to assess veterinarians' levels of biosecurity training, ...
Schein FB, Maia MO, Witter R, Marcili A, Camargo LM, Dutra V, Nakazato L, Candido SL, Almeida EM, Oliveira ACS, Pacheco RC.We evaluated the distribution of piroplasmids in equids from the Mato Grosso state in Midwestern Brazil using molecular methods and the interspecific genetic diversity. For this, 1,624 blood samples of equids from 973 farms were examined by PCR, using primer pairs that amplify a fragment of the genes rap-1 and ema-1 of Babesia caballi and Theileria equi, respectively. For molecular characterization and phylogenetic studies, 13 and 60 sequences of the rap-1 and ema-1 genes, respectively, were used to build a dendogram using maximum parsimony. B. caballi and T. equi were detected in 4.11% and 28...
McCluskey BJ, Mumford EL.Physical trauma, dietary factors, certain toxins, immune mediated disorders, and vesicular stomatitis virus (VSV) infection are known causes of stomatitis in horses. There is evidence that some outbreaks of equine stomatitis are caused by as yet unidentified infectious agents. It remains to be determined whether stomatitis is an emerging equine infectious disease, or if the increase in reported cases is simply the result of greater public awareness as a consequence of widespread outbreaks of VSV in the southwestern United States in recent years. Focused laboratory and epidemiological studies a...
Hirsch E.Medical diagnosis is typically an iterative process guided by integration and synthesis of data into a model of disease. However, facts are not the only inputs into this process. A case of medical mis-diagnosis is presented, in which systematic cognitive bias is considered to have played a role in generating error. Specific cognitive biases are cited, and measures that can be taken to minimize their negative impact are reviewed.
Nemoto M, Tamura N, Bannai H, Tsujimura K, Kokado H, Ohta M, Yamanaka T.Baloxavir marboxil (BXM), an inhibitor of the cap-dependent endonuclease of the influenza virus polymerase acidic protein (PA), exerts an antiviral effect against influenza A virus. It has been available in Japan since March 2018. This study evaluated the antiviral efficacy of BXM against equine influenza A virus (EIV) by an experimental challenge study using horses. Six horses were experimentally inoculated with EIV, and BXM was administered to the three horses at 2 days post inoculation. Horses treated with BXM showed milder clinical signs than horses without treatment and shed less virus. T...
Lord CC, Woolhouse ME, Mellor PS.A simulation model including two hosts (horses and donkeys) and one vector (Culicoides imicola) for African horse sickness in Spain is extended to consider vaccination strategies. If hosts were protected prior to virus introduction, elimination of simulated epidemics was related nonlinearly to the fraction protected. Protecting donkeys as well as horses increased the effectiveness of vaccination. Prevention of 50% of epidemics required 75% coverage of horses and donkeys or 90% coverage of horses only. Protection after the introduction of the virus was rarely successful in preventing outbreaks....
Awinda PO, Mealey RH, Williams LB, Conrad PA, Packham AE, Reif KE, Grause JF, Pelzel-McCluskey AM, Chung C, Bastos RG, Kappmeyer LS, Howe DK, Ness SL....Tick-borne pathogens that cause persistent infection are of major concern to the livestock industry because of transmission risk from persistently infected animals and the potential economic losses they pose. The recent reemergence of Theileria equi in the United States prompted a widespread national survey resulting in identification of limited distribution of equine piroplasmosis (EP) in the U.S. horse population. This program identified Babesia caballi-seropositive horses using rhoptry-associated protein 1 (RAP-1)-competitive enzyme-linked immunosorbent assay (cELISA), despite B. caballi be...
Burns TA.Endocrine diseases, such as equine metabolic syndrome and pituitary pars intermedia dysfunction, are common in domesticated horse populations, and the frequency with which these diseases are encountered and managed by equine veterinary practitioners is expected to increase as the population ages. As clinicians learn more about the effects of these diseases on equine reproductive physiology and efficiency (including effects on reproductive seasonality, ovulation efficiency, implantation, early pregnancy loss, duration of pregnancy, and lactation), strategies and guidelines for improving fertili...
Humblet MF, Saegerman C.The present paper proposes a tool to follow up the compliance of staff and students with biosecurity rules, as enforced in a veterinary faculty, i.e., animal clinics, teaching laboratories, dissection rooms, and educational pig herd and farm. Unassigned: Starting from a generic list of items gathered into several categories (personal dress and equipment, animal-related items, infrastructures, waste management, management of material/equipment and behavior), a checklist was created for each sector/activity mentioned above, based on the rules and procedures compiled in the Faculty biosecurity st...
Brangsch H, Singha H, Laroucau K, Elschner M.Although glanders has been eradicated in most of the developed world, the disease still persists in various countries such as Brazil, India, Pakistan, Bangladesh, Nepal, Iran, Bahrain, UAE and Turkey. It is one of the notifiable diseases listed by the World Organization for Animal Health. Occurrence of glanders imposes restriction on equestrian events and restricts equine movement, thus causing economic losses to equine industry. The genetic diversity and global distribution of the causing agent, Burkholderia (B.) mallei, have not been assessed in detail and are complicated by the high clonali...
Lejeune JP, Franck T, Gangl M, Schneider N, Michaux C, Deby-Dupont G, Serteyn D.Degenerative osteoarthropathy resulting in a reduced active lifespan was observed in Ardenner horses. In the context of joint biology, insulin-like growth factor I (IGF-I) is a potential candidate to affect the anabolism of cartilage matrix molecules. A group of 30 Ardenner horses reared under standardized conditions from weaning were evaluated periodically from 15 to 28 months of age to detect the early manifestations of the disease. At the end of this period, horses were classified in two pathological groups related to the degree of interphalangeal degenerative osteoarthropathy based on clin...
Murray MJ, Eichorn ES, Jeffrey SC.The objective of the study reported here was to characterise the microscopic appearance of peptic-injured equine gastric squamous epithelium in relation to the duration of peptic injury. Erosions and ulcers were induced in equine gastric squamous epithelium using a feed deprivation protocol that results in prolonged increased gastric acidity. Specimens of normal gastric mucosa and mucosa with lesions created after 48 and 96 h of feed deprivation were compared for characteristics associated with angiogenesis and mucosal proliferation. Fifteen mature horses, 9 geldings and 6 mares, age 3-20 year...
Chapman MR, Klei TR, French DD.A critical trial was performed with five ponies 6-9 months of age and raised on a horse farm with demonstrated benzimidazole-resistant cyathostomes. Eleven species of cyathostomes were recovered, seven of which had resistance to thiabendazole. Degrees of resistance varied among ponies and from species to species. Resistant species were Cyathostomum coronatum, Cyathostomum catinatum, Cylicostephanus minutus, Cylicostephanus calicatus, Cylicostephanus longibursatus, Cylicostephanus goldi and Cylicocylus nassatus. This is the first study identifying resistant cyathostome species in the Gulf Coast...
Christensen BW, Troedsson MH, Murchie TA, Pozor MA, Macpherson ML, Estrada AH, Carrillo NA, Mackay RJ, Roberts GD, Langlois J.A 19-year-old Thoroughbred mare was evaluated at 265 days of gestation with a markedly distended abdomen and edema of the ventral portion of the abdomen. Results: The uterus was distended over the pelvic rim, making transrectal palpation of the fetus impossible. Transabdominal ultrasonography revealed excessive amounts of fetal fluid. Results of analysis of fluid obtained via amnio- and allantocentesis confirmed that the amniotic cavity was large. Results: The mare was monitored for signs of weakness of the prepubic tendon and abdominal wall. The fetus and placenta were monitored for signs of ...
Kinne J, Joseph M, Wernery U, Nogradi N, Hagen F.During the past decades there has been an increase in cryptococcal infections caused by the basidiomycetous yeast species Cryptococcus gattii sensu lato, among humans and animals that live in endemic regions in Australia, Europe and the Americas. Unlike human cryptococcosis, little epidemiological data are available about C. gattii sensu lato infections in horses. Methods: A fatal case of a disseminated C. gattii sensu lato infection in an 11-year-old Arabian gelding imported from South Africa into the United Arab Emitares is reported. Tissue samples were studied by conventional mycology proce...
Robin CA, Lo Iacono G, Gubbins S, Wood JL, Newton JR.The National Equine Database (NED) contains information on the size and distribution of the horse population, but the data quality remains unknown. These data could assist with surveillance, research and contingency planning for equine infectious disease outbreaks. Objective: 1) To assess the extent of obsolete and missing data from NED, 2) evaluate the extent of spatial separation between horse and owner location and 3) identify relationships between spatial separation and land use. Methods: Two questionnaires were used to assess data accuracy in NED utilising local authority passport inspect...
Simhofer H, Stoian C, Zetner K.The aim of this study was to evaluate the long-term results of apicoectomy and retrograde endodontic treatment in 12 horses with apical cheek teeth infections. The affected apices were removed using a diamond bur mounted on a dental drill, and after pulp removal the root canals were filed with Hedstrøm files and then alternately flushed with sodium hypochlorite, hydrogen peroxide and alcohol. The pulp canals were dried and filled with endodontic cement and gutta-percha points. An undercut was made in the apical aspect of the root canals that were then sealed with self-curing glass ionomer cem...
