FORT SILL, Okla. (Dec. 14, 2017) -- Most people probably don't look forward to root canals, and canine patients would likely agree. However, late last month a very special dog got a successful and less painful root canal and porcelain crown at the Veterinarian Treatment Facility (VTF) on post. Dentists from the Cowan Dental Clinic here performed the procedures.
Zeus, 8, a Belgian Malinois, is a special dog because he's a military working dog and he needs his teeth to work. If his teeth don't work the mission fails, and he needs his teeth to protect his handler and to practice his mission.
The process for doing a root canal on a dog differs slightly from that of a human, explained dental staff. They require more anesthesia because they are less agreeable and tolerant to the process than humans. With the latest technology, the root canal and crown can be finished and installed on the dog (or human) in three to four hours. After dental staff rouses the dog from anesthesia and observes him for up to an hour for any complications, he and the handler are free to leave the clinic.
Capt. Janet Myung, a general dentist who works at Cowan Dental Clinic on post, took much of the lead doing the root canal as part of her advanced dentistry residency.
Capt. Nicholas Stroeters, licensed dentist also in advanced training assisted. Experienced dentists Drs. (Majs.) Jarom Burbank, an endodontist (root canal specialist among other areas) and Michael Kroll, general dentist, also of Cowan, oversaw, assisted and performed the more intricate tasks.
Dr. (Capt.) Joseph Thomas, officer in charge of the VTF oversaw anesthesia and presided over the event.
Kroll also serves as the assistant director of the Advanced Education in General Dentistry program. Part of his job is to teach and mentor dentists in training.
Kroll explained the process of root canals and crowns for canines. "Typically what we do (for human patients) is you come in for a root canal. We'll see you first, do the root canal and immediately send you to my chair."
In human patients, dentists do the root canal first, then the crown; in dogs it's opposite.
Kroll elaborated in a paper he wrote last year: The Computer Aided Design-Computer Aided Manufacturing machine (CAD CAM) allows a specialist to make a crown while the patient is being treated. It is low cost, highly durable and esthetically appealing. It eliminates several hours and follow up appointments.
"We have to prepare the crown first because it takes about 45 minutes to an hour for me to process from start to finish, so that gives Dr. Burbank time to work. That way we can get the dog done in a matter of about two hours. The longer that dog is under anesthesia, the more complications can happen."
Thomas described the pre-operative procedures. Among them: In order to keep Zeus as calm as possible, he and his handler wait at least a half hour in a private medical room at the VTF before Zeus is introduced to his team of dentists. Thomas explained the pre operative local and general anesthesia in detail:
"Zeus won't fall asleep under local sedation. He'll just be disorientated and loopy," he said. "He'll tolerate the root canal and crown better. A few minutes after local sedation the medical staff will put an IV catheter in and will induce another drug that actually causes Zeus to lose consciousness.
"When you induce (sleep) they fall asleep right away and will get a ventilator and will generally stop breathing," Thomas said. "You want to get a (breathing) tube in right away; then we maintain them on (sedatives) for the procedure. All of those drugs together won't over sedate him. The good thing is you target the kinds of drugs you use. You try to get your pain management done with your pre meds. That's That way they're under general anesthesia for less and safer time."
While the dog undergoes a root canal, Kroll simultaneously tends to creating the crown.
"On a human when we do this we put (the tooth) into what's called a virtual articulator," Kroll said. "It's kind of like the bite analysis you were talking about. We used to take stone models and put them on a physical virtual articulator, and I would sit in the lab for hours taking the jaw through different movements, different movements especially if you have bruxism and grind.
"The problem with dogs, dogs don't grind. They're jaws are much different than ours," he elaborated. "It's a pure hinge jaw. It's up and down. The problem with dogs is their jaws go side to side and they're teeth are so long that they create a lot of sheer forces. That's what we're kind of looking out for here. She (technician Amber Washington) is putting the crown in this (model) jaw so we can get a basic idea of where we want to put the tooth in the dog's mouth."
Kroll assisted Washington with the CAD CAM machine, a device that assists dentistry staff in the artistry portion of crown work. CAD CAMs have been used in some form or fashion in dentistry since the 1980s, though they were cumbersome then. CAD CAMs are used in many other industries. "It works somewhat like Photoshop," Kroll said. Photoshop is an editing software frequently used by photographers.
"We always say that digital dentistry doesn't make the dentist better. It doesn't make a bad dentist fast. It just speeds up processes that are maybe more inefficient," Kroll said. "If I were to take this crown and make it by hand, I'd have to take an impression on the dog, which is a goopy impression. I'd have to pour it up in a laboratory in stone, then actually make the crown in wax, I'd have to melt the wax after I've put it in a stone model, and then inject molten porcelain into that mold.
"I can do that, but for me to do that process, it would probably take me a good eight hours just to sit down if no one is interrupting me," he said. "The nice thing is (with CAD CAM) we do all the same preparation. We do everything the exact same way, but everything is done digitally. I can do that process in about 15 to 20 minutes. So it just speeds up that process. All the bite analysis you're talking about, all the preplanning, all the work ahead of time, we still have to do that, absolutely. It just speeds up the process, that's all."
After Kroll and Washington draw and finely design the crown, Kroll assembles a wax mold in a milling machine. He further evens out any imperfections before casting the crown into porcelain and fitting it onto the dog.
Zeus' handler, Staff Sgt. Corey Stoudemayer of the 97th Security Forces Squadron at Altus Air Force Base, roughly 60 miles due west of Fort Sill, explained the incident that happened over Thanksgiving in which the dog suddenly needed an emergency crown.
They were training and playing. The dog was biting but not letting go, Stoudemayer said. He wouldn't let go. My supervisor actually noticed the blood coming from his mouth. He broke most of the tooth, which was embedded into the cloth cord wrap. Since it was Thanksgiving holiday and much on post was closed, Zeus had to wait until after the holiday to get treatment.
Zeus and his handler spent about four hours at the Fort Sill VTF getting the root canal and crown. The mission ended successfully.
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