Apollo: Orthodontic Treatment

Apollo was brought in for evaluation and treatment of linguoversion (teeth deviated towards the tongue) of the lower canines that resulted in a traumatic malocclusion with the hard palate (picture #1) All pictures are obtained in dorsal recumbancy (animal on his back) This malocclusion was also causing disruption to the attachment apparatus (support of the tooth) of the upper canines (picture #2).

The treatment options for Apollo included: 1) orthodontic treatment; 2) crown height reduction of the lower canines; 3) and extraction of the lower canines. If crown height reduction is performed the pulp (the living portion of the tooth) will become exposed and need to be treated. Anytime the pulp is treated inherent risks are involved. Since the lower canines compose a large portion of the canine rostral mandible (front lower jaw) and supporting the tongue within the oral cavity, extraction is only recommended in specific cases. The therapeutic decision-making is based on expense, dental expertise of the veterinarian, and clients ability to provide meticulous homecare (brushing) and follow-up, in order to make the treatment a success.

An inclined plane orthodontic appliance was selected to bucally tip (tip towards the cheek) Apollo's lower canines to prevent them from further damaging the palatal soft tissues and the attachment of the upper canines.

Apollo's teeth were scaled and polished. Dental impressions were obtained and submitted to Gnathodontics (a local dental laboratory) where a white study model was made to guide our orthodontic treatment. An acrylic-composite inclined bite-plate was constructed directly on the upper canines and incisors that provided ramps for the lower canines to contact upon and subsequently tip (picture 3). Apollo was discharged the same day with instructions to eat moist food, not engage in activities that may fracture the appliance (rough play or chewing on hard items). The client was then educated on to the importance of meticulous brushing of the appliance and the contacting gingiva. A water pick can also be used to cleanse the appliance. Chlorhexidine gel was also applied to the margins of the appliance to decrease in bacterial accumulation and provide an occlusive interface at the appliance margins.

The appliance was removed in 6 weeks. Gingivitis was present at all the gingiva that had been in previous contact with appliance (picture 4). The mandibular teeth were tipped in the correct direction at this time (picture 5). We have recommended Dr. Leen Verhart's rubber ball technique to aid in orthodontic retention of the lower canines. We are VERY HAPPY with Apollo's orthodontic success. We thank Apollo's mom and dad for their dedicated compliance in both keeping the appliance clean and not allowing the appliance to break.