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Equine veterinary journal2021; 54(3); 541-548; doi: 10.1111/evj.13475

A computed tomographic study of endodontic and apical changes in 81 equine cheek teeth with sagittal fractures.

Abstract: Sagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination. Objective: This study aimed to document the prevalence of CT changes indicative of apical disease in equine cheek teeth, which have suffered a sagittal fracture involving the clinical ± reserve crown. Methods: This study is a retrospective case series. Methods: CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities. Results: Eighty-seven sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P = .05) of buccal, 55% (6/11, P = .07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) of multiple fractures and 96% (23/24, P = .008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P = .4). There was no significant association between fracture length ratio and apical infection (P = 1.0). Midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures (odds ratio [OR] 5.92, 95% confidence interval [CI] 1.67-20.83, P = .006). Loss of the lamina dura was not significantly associated with apical infection (P = .5). Conclusions: There is a maxillary cheek tooth bias in the data set and the subjective grading system. Conclusions: A large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.
© 2021 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2021-07-06 PubMed ID: 34060137DOI: 10.1111/evj.13475Google Scholar: Lookup
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Summary

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This study examines the prevalence of endodontic and apical diseases in horses’ cheek teeth that have sustained sagittal fractures, using computed tomographic (CT) scans.

Study Objectives and Methodology

  • The authors of the study aim to investigate the how common changes indicative of apical disease are in equine cheek teeth that have suffered a sagittal fracture.
  • The research was conducted as a retrospective case series where CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed. The study evaluated 81 teeth from 49 different horses.
  • Diagnosis was based on CT images, which were analyzed for apical pathology including various symptoms as gas in the endodontic system, widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling.
  • The researchers created a new apical infection grading system and used Hounsfield units to measure the density of the endodontic, apical and periapical regions.

Findings

  • The study recorded 87 sagittal fractures from 81 teeth (74 maxillary and 7 mandibular). Apical infection was diagnosed in a significant portion of the teeth, varying based on the location and type of fractures.
  • The study found no significant relationship between apical infection and clinical signs associated with dental pathology. Also, no association was found between the fracture length ratio and apical infection.
  • However, midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures, suggesting that certain fracture types may have specific complications associated.
  • Loss of the lamina dura was not significantly associated with apical infection.

Conclusions

  • The analysis shows a maxillary cheek tooth bias in the data set and subjective grading system.
  • The study concludes that a large proportion of fractured cheek teeth have evidence of apical infection on CT examination and the instances of these infections are significant enough to warrant treatment.

Cite This Article

APA
Rowley KJ, Townsend NB, Chang YR, Fiske-Jackson AR. (2021). A computed tomographic study of endodontic and apical changes in 81 equine cheek teeth with sagittal fractures. Equine Vet J, 54(3), 541-548. https://doi.org/10.1111/evj.13475

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 54
Issue: 3
Pages: 541-548

Researcher Affiliations

Rowley, Kieran J
  • The Equine Dental Surgery Ltd, Buckinghamshire, UK.
Townsend, Neil B
  • Three Counties Equine Hospital, Gloucestershire, UK.
Chang, Yu-Mei R
  • Royal Veterinary College, Research Support Office, London, UK.
Fiske-Jackson, Andrew R
  • Royal Veterinary College, Equine Referral Hospital, Hatfield, UK.

MeSH Terms

  • Animals
  • Cheek / pathology
  • Fractures, Bone / pathology
  • Fractures, Bone / veterinary
  • Horse Diseases / pathology
  • Horses
  • Retrospective Studies
  • Tomography, X-Ray Computed / veterinary
  • Tooth / pathology

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This article includes 25 references
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Citations

This article has been cited 3 times.
  1. Stieger-Vanegas SM, Hanna AL. The Role of Computed Tomography in Imaging Non-neurologic Disorders of the Head in Equine Patients. Front Vet Sci 2022;9:798216.
    doi: 10.3389/fvets.2022.798216pubmed: 35321060google scholar: lookup
  2. Sidwell AE, Duz M, Hill B, Freeman S, Hole SL. Application of the horse grimace scale in horses with dental disease: Preliminary findings. Vet Rec 2025 Feb 1;196(3):e4800.
    doi: 10.1002/vetr.4800pubmed: 39520383google scholar: lookup
  3. Sidwell AE, Duz M, Khan A, Bodnàr R, Hole SL. Effect of Simple Oral Dental Extraction on Systemic Serum Amyloid A Concentrations in Horses. Vet Med Sci 2024 Nov;10(6):e70104.
    doi: 10.1002/vms3.70104pubmed: 39508719google scholar: lookup
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