Fractured tooth, periapical abscess, and retained root fragments in a Pomeranian
Dental radiographs revealed a periapical lesion and retained root fragments that were not visible on routine examination.
The owners of a 5-year-old Pomeranian presented due to bad breath and a significant amount of dental calculus.
During the initial examination, a fractured tooth was found on the maxilla. A dental procedure following the COHAT protocol with full-mouth dental radiography was scheduled for a complete assessment of the oral cavity.
Dental radiographs showed that the visible fractured tooth was only part of the problem: periapical changes consistent with an abscess were found at its root, and retained root fragments were found in other areas.
- Pomeranian, 5 years old
- Fractured tooth
- Periapical lesion
- Retained roots
- Dental radiography
- Piezosurgical extraction
- Day 5 recheck
- Patient
- Pomeranian, 5 years old.
- Presenting complaint
- Bad breath and dental calculus.
- Examination finding
- Fractured tooth on the maxilla.
- Dental radiograph findings
- Periapical lesion near the fractured tooth and retained root fragments.
- Treatment
- Extraction of the fractured tooth and root fragments using a piezosurgical unit.
- Follow-up
- Recheck examination on day 5 after surgery.
This video contains footage from a dental surgical procedure. The content may be sensitive for some viewers.
Presenting complaint
The owners of a 5-year-old Pomeranian presented due to bad breath and a significant amount of dental calculus.
Bad breath and visible dental deposits can accompany periodontal disease, but external examination alone is not enough to assess the condition of the tooth roots and surrounding bone.
What we found on initial examination
A fractured tooth was found on the maxilla during examination.
The damaged crown could be seen visually, but the condition of the root, the surrounding bone, and other areas of the oral cavity could not be determined without dental radiography.
A dental procedure following the COHAT protocol was scheduled for comprehensive diagnostics and treatment.
Diagnostics during the COHAT
As part of the procedure, a complete oral examination under anesthesia, periodontal probing, assessment of every tooth, professional dental cleaning, full-mouth dental radiography, and the formation of an individualized treatment plan based on the diagnostic findings were performed.
- Complete oral examination under anesthesia
- Periodontal probing
- Assessment of every tooth
- Professional dental cleaning
- Full-mouth dental radiography
- Individualized treatment plan based on diagnostic findings
What the dental radiographs showed
The dental radiographs showed periapical changes at the root of the fractured tooth, consistent with a periapical abscess.
This meant that the pathological process was not limited to the visible part of the tooth but extended into the area around its root and the adjacent bone.
In addition, retained root fragments that were not visible on routine examination were identified on the dental radiographs.
Dental radiography was what made it possible to determine the full extent of the pathology and formulate a justified treatment plan.
Why it matters to identify retained root fragments
Root fragments can remain completely hidden beneath the gingiva.
In some cases they do not cause obvious external changes right away, but they can be associated with:
- Chronic inflammation
- Dental pain
- Changes in the surrounding bone
- Risk of further complications
That is why, after a complex extraction, it is important to assess the area with dental radiographs and confirm that the roots have been completely removed.
Why extraction was the decision
Based on the combined clinical and radiographic findings, retaining the fractured tooth in this case was not clinically justified.
The decision was made to extract the fractured tooth associated with the periapical pathology, along with the identified retained root fragments.
The treatment approach was formulated after a complete assessment of the oral cavity and dental radiographs.
Piezosurgical extraction
A piezosurgical unit was used for controlled work on the bone.
A piezotome allows precise work on mineralized tissue and controlled access to the roots.
It does not make the surgery completely atraumatic and does not eliminate all surgical risks. However, in this case piezosurgery helped to more precisely control the extraction and reduce excessive mechanical stress on the surrounding tissues.
After extracting the fractured tooth and root fragments, the surgical sites were managed and sutured.
Postoperative treatment
After the procedure, the dog was prescribed an individualized pain management plan, antibacterial therapy as clinically indicated for this case, oral and suture site care, an appropriate postoperative feeding regimen, and a recheck examination.
Recheck examination
The recheck examination was performed on day 5 after surgery.
The mucosa was healing well, and no significant facial swelling was observed.
According to the owners, by the very next day the dog was very active, felt well, and was asking for toys again.
By the time of the recheck examination, the postoperative period had proceeded without complications.
Key takeaway
On initial examination, a fractured tooth and dental calculus were visible.
However, only dental radiography revealed the full clinical picture:
- A periapical lesion at the root of the fractured tooth
- Changes in the surrounding bone
- Retained root fragments
- The true extent of treatment needed
This case shows why a dental procedure should not be limited to removing visible calculus or working only on the part of a tooth above the gumline.
Full-mouth dental radiographs help identify pathology that cannot be assessed on routine visual examination.
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During a consultation, we can assess visible changes, discuss symptoms, and determine the next diagnostic steps. The condition of the tooth roots and surrounding bone is assessed using dental radiographs during a complete dental procedure.
Every clinical case is individual. Diagnostic and treatment approaches are determined after examining the specific patient and reviewing dental radiographs.