& Management / Disease
Investigation & Management / Techniques:
- Vital pulpectomy
- Partial coronal pulpectomy (the most precise term).
||NOTE: Although the procedure is described
below as accurately as possible, this is NOT a substitute for learning the
procedure by watching and assisting a veterinarian who is already
experienced in the technique.
This involves removal of
distal, devilatised/infected pulp and filling and capping of the root
canal. Mature canine teeth are usually cut down to the level of the
incisors when this procedure is carried out.
- Anaesthetise the bear. See: Treatment and Care
- Bear Anaesthesia
- Intubate and place on inhalational anaesthesia. See: Treatment and Care
- Bear Anaesthesia - Maintenance and Inhalational Anaesthesia
- Place a wooden block or other suitable instrument to keep the mouth
- Place a rubber dam over the tooth.
- This helps to maintain asepsis.
- The dam also reduces debris and blood reaching the throat and
being aspirated into the lungs during recovery from anaesthesia. (P1.1979.w4)
- Cut the canine tooth down to the level of the incisors (for a mature
tooth) using a suitable instrument e.g. a disk or metal circular saw
mounted on a silicon carbide hand power drill.
- Drill vertically 2-4 mm into the pulp cavity using a No. 35 carbide
- Undermine the canal to create a pocket (with a diameter greater than
the diameter of the distal pulp cavity at the tip of the remaining
- Stop haemorrhage by inserting small cotton pledgets impregnated with
adrenaline (epinephrine) into the cavity.
- Once haemostasis is achieved (bleeding has stopped), remove the cotton pledgets and allow the cavity
to air dry, thoroughly.
- Soak a cotton pledget in formacresol and remove the excess, then
insert the pledget into the pulp cavity and leave it for 2-3 minutes.
- This mummifies the exposed pulp and sterilises the cavity.
- If haemorrhage restarts, repeat the steps for haemostasis and
- Mix 2-3 g zinc oxide powder with one drop liquid eugenol and one
drop foracresol. This produces a dry, shapable putty.
- Pack this firmly into the cavity using a dental condenser.
- Note: the cavity must be dry and haemorrhage must be
stopped; if bleeding starts, remove the zinc oxide and repeat the
steps for control of haemorrhage and sterilisation of the pulp
- Re-drill the cavity to a depth of 3 mm, making sure there is an
- Mix a dental restorative resin as indicated by the manufacturer and
use this to pack the cavity.
- A more durable cap may be produced using silver amalgam rather
than restorative resin.
- Apply firm finger pressure to the restorative for 30 seconds, then
allow to air dry.
|Appropriate Use (?)
- Pulpotomy can be used if the pulp is healthy and time, skill and
specialised equipment required for root canal procedures are not
- Pulpotomy produces a functionally sound tooth. (P64.26.w6)
- Fractured teeth [not vertical fractures] can be treated by vital pulpectomy and filling, even
weeks after the fracture has occurred. (B336.51.w51)
- Vital pulpotomy is the preferred treatment for recent fracture of
the tooth crown in immature teeth, maintaining vital pulp for
continued development of the tooth root. (B470.16.w16)
|Complications/ Limitations / Risk
- Not suitable for teeth with vertical fractures. (V.w6)
- Not suitable if it is not possible to remove all devitalised or
infected tissue before the cavity is closed. (B10.34.w41)
- Not suitable for use in bears which are to be released, or in some
rescue situations, where long-term follow-up will not be possible. (P3.2006a.w1)
- While hobby hand drills such as the Dremel Motor Tool can be used to
cut through bears' teeth, (P64.26.w6)
they work at a low speed (rpm) and tend to heat up excessively, particularly
if the cutting instrument is blunt. (P1.1979.w4)
- If a drill like this must be used, it is important to cool it
e.g. with a flow of air, and to use a new, sharp cutting bit for
each tooth. (P1.1979.w4)
|Equipment / Chemicals required and Suppliers
Dental instruments and compounds, including
appropriate tooth cutting bits and drill.
General anaesthetic agents and appropriate equipment
for anaesthetic administration and monitoring
|Expertise level / Ease of Use
- This procedure should be carried out by personnel with experience
and training in dental surgery in animals.
- The costs of this procedure include the costs of the personnel
required (minimum one suitably qualified person to carry out the
dental work and one to monitor the anaesthetic), and costs of
- Appropriate dental equipment to carry out this procedure properly on
bears may be expensive.
|Legal and Ethical Considerations
- In some countries there may be
legislation restricting the use of this type of technique to licensed veterinarians. For
example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides,
subject to a number of exceptions, that only registered members of the Royal College of
Veterinary Surgeons may practice veterinary surgery." (see: LCofC1
- RCVS Guide to Professional Conduct 2000 - Treatment of
Animals by Non-Veterinary Surgeons).).
||Debra Bourne MA VetMB PhD
||Suzanne I. Boardman BVMS