Equine veterinary journal2026; doi: 10.1002/evj.70179

Anatomical assessment of endodontic debridement challenges in severely diseased equine cheek teeth.

Korsós, SA
·
Josipovic, I
·
Vlaminck, L

Abstract: There is a lack of knowledge on orthograde endodontic techniques in horses and endodontic case selection is mostly empirical currently. Objective: To explore the efficacy of endodontic debridement in severely diseased cheek teeth that are currently deemed unsuitable for endodontic treatment, find where debris is left behind, compare intercanal communications with those described in healthy cheek teeth, explore the effects of endodontic repair mechanisms on endodontic debridement and to investigate the presence of accessory canals and apical deltas in infected parts of the pulp system. Methods: Ex vivo experimental study. Methods: Nine severely infected, extracted, equine cheek teeth underwent a single stage, ex vivo orthograde endodontic treatment by one clinician. Micro computed tomography scans (μCT) were taken both before and after treatment and all samples were sectioned at 6 levels following treatment. All sections were evaluated through a stereo microscope for the presence of residual debris. Intercanal communications were evaluated based on μCT imaging. Results: Varying amounts of residual contamination were present in eight of nine teeth in both physiological complexities of the root canal as well as inside altered canal morphology created by reparative dentine. No apical deltas were found in any of the infected canals of the samples. Intercanal communications differed in seven of nine samples from those described in healthy cheek teeth. Conclusions: Limited sample size, ex vivo debridement, the use of severely diseased cheek teeth currently deemed unsuitable for endodontic treatment. Conclusions: A single stage endodontic protocol was unable to completely debride the endodontic cavity of severely infected equine cheek teeth. Literature on the anatomy of healthy cheek teeth was not accurate in predicting communications between pulp canals in infected cheek teeth. Apical deltas are likely not a cause of concern during equine endodontic procedures. Unassigned: Für orthograde endodontische Techniken beim Pferd besteht ein Mangel an Wissen über deren spezifische Debridement‐Herausforderungen. Die Auswahl endodontischer Fälle erfolgt derzeit überwiegend epirisch. Unassigned: Untersuchung der Wirksamkeit des endodontischen Debridements bei schwer erkrankten Backenzähnen, die derzeit als ungeeignet für eine endodontische Behandlung gelten; Identifikation von Bereichen mit verbliebenen Debris; Vergleich interkanalärer Verbindungen mit denen gesunder Backenzähne; Analyse der Auswirkungen endodontischer Reparaturmechanismen auf das Debridement; sowie Untersuchung des Vorkommens von akzessorischen Kanälen und apikalen Deltas in infizierten Bereichen des Pulpasystems. Methods: Ex‐vivo‐Experimentalstudie. Methods: Neun stark infizierte, extrahierte Backenzähne von Pferden wurden einer einstufigen ex‐vivo orthograden endodontischen Behandlung durch einen einzelnen Kliniker unterzogen. Vor und nach der Behandlung wurden Mikro‐Computertomographie‐Aufnahmen (μCT) angefertigt, und alle Proben wurden nach der Behandlung in sechs Schnittebenen präpariert. Sämtliche Schnitte wuden mittels Stereomikroskop auf das Vorhandensein von Restdebris untersucht. Interkanaläre Verbindungen wurden anhand der μCT‐Bilder beurteilt. Unassigned: In acht von neun Zähnen wurden unterschiedliche Mengen an Restkontamination festgestellt, sowohl bei beiden physiologischen Komplexitätsgraden des Wurzelkanals als auch innerhalb der durch Reparaturen veränderten Kanalmorphologie. In keinem der infizierten Kanäle der Proben wurden apikale Deltas festgestellt. Die interkanalären Verbindungen wichen in sieben von neun Proben von denen ab, die bei gesunden Backenzähnen beschrieben wurden. HAUPTEINSCHRÄNKUNGEN: Begrenzte Stichprobengröße, ex‐vivo‐Debridement, Verwendung stark erkrankter Backenzähne, die gegenwärtig als für eine endodontische Behandlung ungeeignet gelten. Unassigned: Mit einem einstufigen endodontischen Protokoll war es nicht möglich, die endodontische Kavität stark infizierter Backenzähne von Pferden vollständig zu debridieren. Die Literatur zur Anatomie gesunder Backenzähne lieferte keine genauen Vorhersagen hinsichtlich der Verbindungen zwischen den Pulpakanälen in infizierten Backenzähnen. Apikale Deltas stellen bei endodontischen Eingriffen an Pferden wahrscheinlich kein Problem dar.

Get Full Text

Publication Date: 2026-04-24 PubMed ID: 42029171DOI: 10.1002/evj.70179Google Scholar: Lookup

The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.

Facebook X LinkedIn Email Copy

Summary
Cite This
Publication
Affiliations
Grants
References
Citations

Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

This study investigated the challenges of cleaning (debridement) severely infected horse cheek teeth using orthograde endodontic techniques, which are poorly understood and currently selected mostly by empirical judgment.
The researchers examined how effective a single-stage endodontic procedure was, where debris remained, anatomical differences in infected teeth compared to healthy ones, and the presence of anatomical features like accessory canals and apical deltas.

Background and Objectives

Orthograde endodontic treatment involves cleaning and sealing the inside of a tooth’s root canals through the natural tooth opening.
In equine dentistry, there is limited knowledge about how to properly perform and select cases for this treatment, especially for severely diseased cheek teeth.
This study aimed to:
- Evaluate how well orthograde endodontic cleaning works in severely infected horse cheek teeth, which are normally considered unsuitable for treatment.
- Identify locations where debris and contamination remain after cleaning.
- Compare the anatomical connections between root canals in diseased teeth to what is known about healthy teeth.
- Investigate the impact of the tooth’s own repair mechanisms (like formation of reparative dentine) on the cleaning process.
- Check for accessory canals and apical deltas (complex root endings) in infected pulp tissue.

Methods

The study was conducted ex vivo, meaning outside the living horse, using nine extracted equine cheek teeth that were severely infected.
A single experienced clinician performed a one-stage orthograde endodontic cleaning and treatment on each tooth.
Micro-computed tomography (μCT) scans were taken before and after treatment to visualize internal tooth anatomy and debris.
After treatment, the teeth were sectioned at six different levels inside the tooth to physically examine under a stereo microscope where residual debris remained.
Intercanal communications (connections between root canals) were assessed via the μCT images.

Results

In eight out of nine teeth, varying amounts of residual debris and contamination remained after treatment.
Debris was found both in naturally complex root canal areas and in regions where the tooth structure had changed due to reparative dentine formation.
No apical deltas were detected in any infected canals, suggesting these complex root endings do not play a significant role in infection or cleaning difficulty in these cases.
Seven of the nine teeth showed intercanal communication patterns that differed from what has been described for healthy equine cheek teeth, indicating that infection alters anatomy unpredictably.

Conclusions and Implications

A single-stage orthograde endodontic cleaning protocol was not able to fully clear debris from severely infected equine cheek teeth.
Anatomical data from healthy teeth are not reliable predictors of canal anatomy or connections in severely infected teeth, complicating treatment planning.
Apical deltas, often considered a concern in endodontic treatment of other species, were not found here and are unlikely to pose difficulties during equine endodontic procedures.
The study’s limitations include a small sample size, ex vivo conditions (which may differ from in vivo), and use of teeth currently deemed unsuitable for treatment—meaning results may not generalize to less severely affected cases.
These findings suggest the need for revised approaches and further research to improve endodontic outcomes in severe equine dental disease, potentially including multi-stage treatment protocols or alternative techniques tailored to the altered anatomy seen in infected teeth.

Cite This Article

APA

Korsós SA, Josipovic I, Vlaminck L. (2026). Anatomical assessment of endodontic debridement challenges in severely diseased equine cheek teeth. Equine Vet J. https://doi.org/10.1002/evj.70179

Publication

Equine veterinary journal

ISSN: 2042-3306

NlmUniqueID: 0173320

Country: United States

Language: English

Researcher Affiliations

Korsós, Szabolcs Atád

Department of Large Animal Surgery, Anesthesia and Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.

Josipovic, Iván

Department of Physics and Astronomy, Radiation Physics, Faculty of Science, Radiation Physics Research Group-Centre for X-ray Tomography of the UGent, Ghent University, Ghent, Belgium.

Vlaminck, Lieven

Department of Large Animal Surgery, Anesthesia and Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.

Grant Funding

Ghent University, Faculty of Veterinary Medicine

References

This article includes 21 references

Baker GJ, Kirkland KD. Endodontic therapy in the horse.. Proc Am Assoc Equine Practnrs 1992;38:329–335.
van Foreest AW, Wiemer P. Veterinary dentistry (15). Apex resection in the horse.. Tijdschr Diergeneeskd 1997;122(23):670–679.
Fahrenkrug P. Apicoectomy in horses—technique and results.. 14th Annual Veterinary Dental Forum: VDF Proceedings. Vol 14. Equine Series 2000. Albuquerque: Veterinary Dental Forum; p. 294–295.
Schramme MC, Boswell JC, Robinson J, Butson RJ, Stephen AM, Smith RKW. Endodontic therapy for periapical infection of the cheek teeth: a study of 19 horses.. Proc Am Assoc Equine Practnrs 2000;46:113–116.
Simhofer H, Stoian C, Zetner K. A long‐term study of apicoectomy and endodontic treatment of apically infected cheek teeth in 12 horses.. Vet J 2008;178(3):411–418.
doi: 10.1016/j.tvjl.2008.09.016google scholar: lookup
Facchini C, Bono S, Faughnan M, Iacopetti I. Endodontic treatment of a mandibular premolar abscess in a horse: a case study.. Equine Vet Educ 2014;26(4):194–199.
doi: 10.1111/eve.12137google scholar: lookup
Pearce CJ, Stoll M. Extraoral endodontal treatment and replantation of equine cheek teeth. Part 3: case series.. Proceedings of the 26th European Veterinary Dental Forum. Vol 26. Equine dentistry 2017. Malaga, Spain: European Veterinary Dental Forum; p. 124–125.
Staszyk C, Krähling B, Stoll M, Pearce CJ, Pöschke A. Extraoral endodontic treatment and replantation of equine cheek teeth: anatomical, histological and molecular biological considerations.. Proceedings of the 26th European Veterinary Dental Forum. Vol 26. Equine dentistry 2017. Malaga, Spain: European Veterinary Dental Forum; p. 120.
Stoll M, Pearce CJ. Extraoral endodontal treatment and replantation of equine cheek teeth. Part 2: technique and materials.. Proceedings of the 26th European Veterinary Dental Forum. Vol 26. Equine dentistry 2017. Malaga, Spain: European Veterinary Dental Forum; p. 121–123.
Garcia F, Sanromán F, Llorens MP. Endodontics in horses. An experimental study.. Zentralbl Veterinarmed A 1990;37(3):205–214.
Lundström T. Orthograde endodontic treatment of equine teeth with periapical disease: long term follow‐up.. Proceedings of the 51st British Equine Veterinary Association Congress BEVA. Vol 51 2012. Fordham: British Equine Veterinary Association (BEVA); p. 105–106.
Lundström T, Wattle O. Description of a technique for orthograde endodontic treatment of equine cheek teeth with apical infections.. Equine Vet Educ 2016;28(11):641–652.
doi: 10.1111/eve.12540google scholar: lookup
Du Toit N, Pearce CJ. Long‐term follow‐up of equine incisor endodontic treatments using an orthograde technique.. J Am Vet Med Assoc 2023;261:1–6.
doi: 10.2460/javma.23.07.0398google scholar: lookup
Windley Z, Weller R, Tremaine WH, Perkins JD. Two‐ and three‐dimensional computed tomographic anatomy of the enamel, infundibulae and pulp of 126 equine cheek teeth. Part 1: findings in teeth without macroscopic occlusal or computed tomographic lesions.. Equine Vet J 2009;41(5):433–440.
doi: 10.2746/042516409x390214google scholar: lookup
Korsós SA, Staszyk C, Boone M, Josipovic I, Vogelsberg J, Vlaminck L. Micro‐CT and histological examination of accessory canals in 34 equine cheek teeth.. Front Vet Sci 2024;11:1396871.
doi: 10.3389/fvets.2024.1396871google scholar: lookup
Boutsioukis C, Arias‐Moliz MT. Present status and future directions—irrigants and irrigation methods. Int Endod J 2022;55(S3):588–612.
doi: 10.1111/iej.13739google scholar: lookup
Du Toit N, Kempson SA, Dixon PM. Donkey dental anatomy. Part 1: gross and computed axial tomography examinations. Vet J 2008;176(3):338–344.
doi: 10.1016/j.tvjl.2008.03.003google scholar: lookup
Ricucci D, Siqueira JF. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod 2010;36(1):1–15.
doi: 10.1016/j.joen.2009.09.038google scholar: lookup
Casey MB, Pearson GR, Perkins JD, Tremaine WH. Gross, computed tomographic and histological findings in mandibular cheek teeth extracted from horses with clinical signs of pulpitis due to apical infection. Equine Vet J 2015;47(5):557–567.
doi: 10.1111/evj.12315google scholar: lookup
Kopke S, Angrisani N, Staszyk C. The dental cavities of equine cheek teeth: three‐dimensional reconstructions based on high resolution micro‐computed tomography. BMC Vet Res 2012;8(1):173.
doi: 10.1186/1746-6148-8-173google scholar: lookup
. endodontic treatment of equine cheek teeth. Equine dentistry and maxillofacial surgery Newcastle upon Tyne: Cambridge Scholars Publishing; 2022. p. 731–753.