TECHNIQUE

Pulpotomy in Bears  (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords
  • Vital pulpectomy
  • Partial coronal pulpectomy (the most precise term). 
Description 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 open.
  • 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 burr.
  • 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 tooth).
  • 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 sterilisation.
  • 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 cavity.
  • Re-drill the cavity to a depth of 3 mm, making sure there is an undercut.
  • 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.

(P64.26.w6, B10.34.w41)

Appropriate Use (?)
  • Pulpotomy can be used if the pulp is healthy and time, skill and specialised equipment required for root canal procedures are not available. (P64.26.w6, B10.34.w41)
  • 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)
Notes --
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

  • Antibiotics

Expertise level / Ease of Use
  • This procedure should be carried out by personnel with experience and training in dental surgery in animals.
Cost/ Availability
  • 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 equipment.
  • 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).).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Suzanne I. Boardman BVMS MRCVS (V.w6)
References B10.34.w41, B336.51.w51, P1.1979.w4, P3.2006a.w1, P64.26.w6

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