Right, case-based radiographs, so if it, if it, is that coming through alright there, Paul? Yeah, yeah, absolutely fine. Right, good.

OK, well, look, this again is supposed to be a bit quick, and a a a sort of a, a, a fast ride deliberately to kind of keep energy up and just to kind of bombard you with images and some of that hopefully will stick with you. But yeah, we're gonna, we're gonna look at some case-based radiographs. It it it's, it's really difficult when you're picking.

Your favourite radiographs, which ones to include, which ones not to include, which ones might teach more than others, and, and then blah blah blah blah blah. So I've just, there's various reasons why I've included these cases. One of them is included just because he's a monkey.

But there we go. Enjoy. So just a, a, a, a brief, a note at the start, and there's, there's been so much reference to, I'm really pleased there has been, but there's already been so much references to, even from the first, the, the first talk this morning about radiography, about correct positioning.

I've, I've just said there, look, it, it does get easier with experience. If it feels like a pain in the backside when you start and you're thinking, look, this is taking forever, I don't want to do this. You only get quick with stuff if you, if you do it lots.

And, and you only get that I to just how to kind of get these, get these images, as, as though they're second nature, if, if you do it lots. So don't shy away from it, just, just persevere and it, it does get easier with experience. I've said there about getting the whole tooth through the, the periaapical zone, I know that was mentioned earlier also, just about that sort of 3 mils around the periapical zone.

Multiple views might be required if you, if you're like me and you're yet to sort of, splash out on a, on, on a, on a, SER system where you've got the different, plates and a sponsor plug there. Check out our sponsors, I'm sure they'll be able to help you out with some very, very nice, dental radiography equipment. But yeah, I, I'm currently working with a size to direct system, and, and so, I, I just might need to use multiple views with larger teeth, but that's not a problem, that's what I do.

Now, best to be disciplined, just as we are taught to be disciplined at university when interpreting standard radiographs, the same applies with intraoral radiographs. So I'm just saying there, don't get too, too tunnel visions. Look at, look at all the information you're you're getting on your radiograph.

And I've said, look, it's amazing how many times you uncover pathology that you necessarily hadn't anticipated. So a, a classic might be, you, you, you are . Taking a radiograph from a, a, a, a tooth with a small, small superficial fracture, maybe just an enamel fracture, and you're taking a radiograph and you, you see that that everything is OK with that tooth actually, you're happy with that tooth.

But one a premolar that's just snuck onto the plate might have a a a or an incisor actually, it's more, more common with incisors, you might suddenly find you've got a great big sort of pulp and and and and you've just uncovered pulp necrosis without without really anticipating it. So, . For for that very reason, and, and, and again this was said earlier, you're not wrong to think about whole mouth radiographs of every single case, right, but .

There we go. Don't get two tunnel visions, look at everything on your plate, and I've just said that the next thing, let's just talk about a few easy mistakes to make and I'm the the, I haven't got time to, to teach all of radiography here, but let's just consider, some nuances or or things that might make you question, is that normal? Well, a good rule, when we, and I'll, I'll teach you about tube shift in a in a moment.

But yeah, move that, change your angle, take a slightly different radiograph and, and something that might have looked like a a periaical lucency might move off the tooth, with, with tu tube shift. And then check out the, check out the other side, you know, play spot the difference. You do need to be good at, getting the same image, on both sides.

So, what I mean by that is, things could look very different if you perhaps had a, a, a, a foreshortened image and you were comparing it to a stretched image, elongated image. So that, that's when sort of getting your correct views comes, comes in. But yeah, couple of, couple of basic rules there.

So I mean this is, this is a just a a stock radiograph I've got where we're we're seeing the dental tissues first of all, because of tangentital effects, a bit like when you X-ray eggs, you know, you, you, you only really become aware of enamel when you sort of see it, . Sort of tangential effect like this, . Yeah, I mean it's everywhere, but it's not gonna be visible everywhere.

It's, it's only certain areas where cos of summation you, you see this very bright white line. Then we've got the dentin as our as our next sort of tissue and and then the pulp. We're also looking at the the jaw bone, the periodonti periodontal space.

You probably remember somewhere, if you've ever looked at dental radiograph before, white line, black line. So this is the sort of . This is the cribiform plate where we've got a a a denser sort of alveola bone, which sort of if you like lines the alveolas, and that shows up a bit brighter, that's our white line, and then a more lucent line here which is the periodontal ligament here.

We'll come on to down here in a moment, right, when deliberately not gonna mention that just now. Alright, but we're just looking at everything. We're, we're we're checking out all the way back here.

Yeah. OK. And, and, the canal, the mandibular canal and, and the cortex of the mandible.

I think this looks OK, this, this, this radiograph. We're gonna be fussy and say I'd have to take it again for this particular tooth if this is my tooth of interest because I haven't got my 3 mils here, so we're just gonna shift that plate down a bit, OK. But let's just start without looking at specific cases just at this moment in time, just, just, just interesting things that sort of caught my eye as I was putting this one together.

I thought, well look, let's let's now look at a a cat's mandible. Here again, we, we can see this is gonna be the mandibular canal here. I think this is a lucency that we probably would call a periaapical lucency here.

And this tooth is, is, is, fractured here. I think this is also a periapical lucency. Not always easy to be entirely confident with this, which is again where we, where we might start just looking at the other the other side.

But it kind of fits, doesn't it? You know, here we've got such severe tooth resorption up here. We we'll, we'll finish talking quite a bit about tooth absorption, but of course we can, we can see how endodontic disease would happen when the tooth has been blown wide open like this with tooth absorption.

So it, it figures that that would be a. To through abscess, sorry, periaical lucency because of the endodontic disease. And just look more more tooth absorption here, a different type of tooth absorption, but let's not get bogged down with that at the moment.

So back to that initial radiograph. What about the shadows? Yeah.

You might find yourself thinking, well, what about these nuisances, are they normal or not? . Well, look, this is, I, I think this is particular radiograph is one I kept because I, I had to wrestle the high speed, and, and the scalpel blade out of a colleague's hand who, who was about to extract this tooth just based on, based on this.

So we did have a look at the, the contraactual tooth and, and very, very sort of similar picture, . And there was no good reason also, you know, just using other sort of clinical experience just to kind of why these, why this tooth would perhaps have endodontic disease. you know, there were no fractures, it wasn't discoloured.

I, I couldn't see any deep caries, so look, we put these down as, as normal. By comparison, And this is something a slide we'll have a look at in, in, in much more depth later on. This is, this is what I'm building up to, this is, this is the this is the crescendo.

But yeah, look, this is, I'm happy to call these er er pathology, endodontic lesions, er periacal lesions. And what, what I think we were seeing in the the radiograph which I sort of said was gonna be what what I considered to be a, a normal lucency is something called a chevron lucency. Now.

This is a lovely chevron lose since you here. Chevron like around the racetrack, OK, it's, it's, if, if we follow the line of the periodontal ligament. It's just seamless seamlessly turns into this lovely shape, this this continuity of of of of that line.

Same down here. And it's neat. And we will get.

Similar things happening on other teeth, these normal lucencies. But if you've perhaps got some dilaceration, which is a sort of, you know, a flick shaped, hook shaped root, it could be that your, your chevron lucency just does look a touch distorted, because of that, that slight abnormality at the the the tip of the roots. OK, so this is this sort of.

Broad comments I just thought were important to mention, before we get specifically case based. Let's just go back to where we were. This, on the other hand, and I said to you earlier about how nice it is when these on this particular cluesal view, because you have got the contralateral tooth right there for direct comparison.

Yeah, look, you can see that by comparison to our nice Chevron lucency, we've got these much rounder, they, they kind of bulge out. And when you look at it like this, you, you can play spot the difference. You, you can see that this is not a nice niche Chevron lucency.

And so we, we, we've got, periapical lucencies here because of, because of, cos of the disease pathology. Other luencies that can sort of, confuse people, particularly, if, if we perhaps had ourselves a, the, the, the, oh crikey, off the top of my head, the, the third, pre-molar in, in, in a cap. .

If, if it, it could be a very confusing lucency indeed this, but this is where we, we're gonna see our framen, mental framing, and so these can confuse also. Another lovely example of tooth resorption, but we'll, we'll get to that. And again, I, I, yeah I might be drawn to this, but, although it's it it's quite cordal, I, I think this is probably a caudal mental foraming.

This on the other hand, we don't like this at all. Not at all. But then again, You know, there are other things that maybe help you along, there are other clues, so to speak, .

That's the, the, the case associated with that radiograph. So it's not like that lucency. I don't think would just kind of catch you by surprise and, and, and, and, and you're not gonna wonder necessarily what's going on there.

It just supports this idea that this is gonna be a a a a malignant neoplasm with a a a nasty sort of bony invasion there. OK, but yeah, just this is also an example of something that perhaps isn't, isn't gonna be pathological. Now case zero, this this this little Elvis's X-rays were, were just in the warm up if you like, but I definitely decided that he, he merits his own case number and to stop me having to change all the other case numbers, Elvis becomes case zero.

So, hence the last minute change, yes, there was a discharging wound below Elvis's, left eye there. So, I mean, most of us when we're we're dealing with these exotics, I'm I'm sure I'm not the only one to see kind of cool little things every now and then. We, we just extrapolate perhaps what we know from, from species we're more, more familiar with.

So all day long with that particular womb there, or or or or or or discharging sinus there, we're, we're gonna be thinking perhaps a, a dental disease, . We've also got a missing a canine here. These looks OK along here.

To my mind anyway, this is a fractured canine. But yeah, fairly business with these tiny little er tiny little monkeys, but good fun. And I get to go to the zoo with my daughter and pretend I am not that I'm a huge fan of zoos, but I I I can pretend I know the monkeys quite well and she likes that.

So, The here's some radiographs from Elvis and I, I just thought these are a nice example of when we might just change the position of of our our tube and and see things perhaps a bit more clearly. For example, although I've got a a a a fractured a canine and I'm anticipating some endodontic disease, I couldn't confidently say this is definitely . A a a lesion there or a lucency there.

But I am up here Particularly where perhaps when I compare it to the the the the the contralateral contralateral tooth perapical area there. This, this for me is, is, is now quite an obvious lucency, but less so here. So it's a nice example of how things, it, it's always a nice idea to be taking an occlusal view and and and a lateral view of our canines for sure, if, if you can, .

So, again, I, what I was saying to to people earlier about being disciplined though, this is one of those occasions where I, I hadn't anticipated finding what we found. It's this shadow caught my eye, this lucency caught my eye here. And when I went back and revisited that tooth in my periodontal probe, perhaps I hadn't perhaps been as, as, as disciplined as, as Hannah was saying we need to be, earlier, because I hadn't necessarily appreciated any extra probing.

But on the 2nd, 2nd sweep, sure enough, actually, I did just get a little bit of increased probing, and, and, and even a slight bit of mobility with this tooth. But this is why you keep your eyes open, . This is, this is clearly an endedontic a periacal endodontic disease causing a periaical lesion here, and, and we're comparing it to our other side there.

It's quite obvious. And I'd say it's, do we know which one of those is perhaps giving rise to the, the, the discharge and wounds? No, not really, but, both get dealt with and, job, job well done really.

Here we go. Just to say, not as clear there is is there for me anyway. OK, case one.

Now this was gonna be case one, and we've already touched on Bruno, a six year old Labrador with a a fractured tooth. This was the case which was sent my way for this fracture. And the referring vet, to be fair, acknowledged that it wasn't necessarily gonna be lending itself to a root canal treatment because of the nature of the fracture, but it's just a mandibular canine, and, that vet didn't want to, extract it.

Yeah, they, they, they're not fun, are they? . Well, I like him, but a lot of people don't like them anyway.

And this is also the case where we, spotted this. And I don't think I mentioned before, but we also spotted this, a discoloured tooth, quite a worn tooth. And Something's going on just here, for sure.

We've, we've also got a, pretty unusual fracture, of, of the, maxillary second premolar. So radiographs, now this is the one we used as an example about the, the pulp width er er discrepancy also. When Look, let's, let's just touch on the theory quickly.

There are cells that line your, your pulp called adontoblasts, and they will produce, new dentin throughout the life of a tooth. They cannot regulate that production if they need to, and, and that's what we kind of get with, with, wear and tear and dogs that carry balls around and, and, and they make tertiary dentin. But this, this, this secondary dentin is, is produced all the way through, a dog's life.

Now, if the Aodontoblasts are dead, the development of the tooth ends and the tooth is frozen in time, and this is why we have ourselves a great big baggy root canal compared to on this side. Now, kind of disappointing for me, I, I, I, I was hoping that this might give me the mother of all, with regards to kind of forming some presentations, given how long this, this, this tooth has been dead, and, and the tooth was full of just, oh, it was, it was such a, a long standing fracture with a great big sort of orifice at the top. It was full of soil and all sorts.

It wasn't nice. But for me this is. Not the most convincing sort of periaical lucency.

But over here, I just, I wasn't happy that this, this didn't look too clever either. Now I perhaps wouldn't expect any periapical changes if it was a a recently a recent fracture. That the referring vet had suggested it was.

But actually, this is actually what it looked like and once we took that that fragment of tooth away. So this is actually also a fairly long standing fracture that just no one had really noticed. The pulp has had long enough to turn itself into a black slime, and, and, and, and not, not nice pink jelly.

So yeah, this is probably some. Some periapical changes. Again, not the most classic textbook example, but there we go, there's there's these radiographs.

This is the this is a a a a a lateral view where I actually think on the wider longer standing fractured tooth we've got ourselves just something a little bit more convincing of, of a per colucency. This isn't, this isn't the X-ray I used for the, the second premolar, if you remember that, that discoloured pre-molar on, on the mandible. But the X-rays for that were were were actually again, fairly disappointing, not, not hugely remarkable.

But I, I, it, it definitely was extracted, because it was a dull brown colour and, and there's no way I would want to leave a tooth that colour in, in a, in a dog's mouth, regardless of, of, of whether, we had. A convincing radiographic change. Up the top We did have a convincing radiographic change.

I mean the these yellow arrows are supposed to sort of show where we've got a . Perpical lucency and the pink arrow here is is is showing that we've we've also got ourselves some . Root resorption, some external resorption there.

And a nice fracture through the. Just back to this, a bit more theory for you. And, and, and, and this was this was something that came to light on one of these, one of the Facebook forums, which just a nice bit of interesting uma conversation.

So I, I went away and I, I got hold of a a a a young dog's canine that I just had in a pot somewhere and . I just wanted to see the difference in pulp width, if we, if we took the same tooth and we had a lateral view and, and what would be more of an occlusal view and you can see there on the right hand side, we, we've got a big difference. Now where where that is significant is if, if this view here on the left hand side is not a true or cluesal view and, and the, the dog's on a wonk, excuse my technical language, you could start seeing discrepancies in canal width just because your orientation's not right.

So you, you do need to be quite fussy about your views, OK? And, and, and, and keeping an eye on other teeth like your premolars here and comparing what they look like, would, would be good guides is to tell you whether or not you you're looking at something which is pretty much clues or or or whether you you are on a, on a wonk. OK.

And, and I've said that the same is true for other contra contralateral. Have I spelled that right? Oh well, you know what I mean.

Comparisons. So if, if, if we're comparing maxillary canines, for example, and we, we've got, different, X-ray plates, you've got to work hard to achieve the same view for you to be able to comparison, compare them. Right.

Case 1 B, I've just added this one as well. Annoyingly, I only thought to get my clinical photograph, just after I picked up the scalpel blade, so apologies for that. And I also should have cleaned off this little bit of polish here, .

Or strawberry jam. But I was, I, I just got disappointed on your behalf that this tooth didn't give us a more exciting radiograph, so I wanted to show you where a, a subtle, . Colour, colour change can give you a dramatic radiographic change.

Some I might have skipped over by the way, this for me is, is a tooth which has lost its lustre, if we compare this lovely little pearly white. Nice pearly white with a splodge of strawberry jam, and then this, this was dull, and it just almost had that kind of, you know, nicotine stained appearance to it, so it it it was it was it was radiographed, . And there's the radiograph here.

Yeah. Nice, nice discovery though. Because I thought to myself how how easy it might be to miss something like that, because the colour, the colour change was, was fairly subtle.

Or the discoloration was subtle, I should say. Now, case two, this is a 7 year old boxer dog that had a fractured carnational and wear facets on the mandibular canines cause it loved to chew cola bottles. The owner would kind of kick him around a warehouse and this dog would run around chasing him and picking them up and what have you.

And this is why the dog came to us. But on a, on an oral exam. Oh, Backtrack slightly.

Hold, hold that thought. But this is where I was going to teach you about tube shift also with separating out tooth roots or superimposed structures. Now this works for lucencies like I was talking about earlier, but it also perhaps helps you see where you are with the the, particularly the medial roots of, of your, your, your 4th maxillary pre-molar.

If you put your two fingers out in front of you, so that you cannot see the, the, the rear finger, and if you just hold up your hand in front of your head now and do it. What we're talking about doing is if you move your head, but keep your hands still, you will bring that second finger visible. And that's what we're doing by moving our our X-ray head.

The, the slob, it's called the slob rule because . If, if the structure in this case, perhaps if the tooth root moves in the same direction, S for same. As you, as the X-ray tube, then the, the, the structure.

Is lingual. If it moves in the opposite direction to the X-ray head, it's buckle. So that's kind of the slob is, is the rule, really.

But if you can't remember slob or don't want to remember slob, I often just hold my fingers out in front of my head and tilt my head and, and just remind myself, just what should be moving in what direction. OK. This is a different patient.

But I couldn't find the clinical photograph of this boxer dog I was telling you about. It had, this boxer dog, playing with its cola bottles was, had flatterclusal surfaces to its canine teeth, and they were actually, not black or dark brown. There was just, there was still pretty white, maybe with just a slight kind of creamy pink discoloration, a bit like in this photograph, even though this is a different patient.

But my sharp Explorer just caught right in the centre of one of these flattened occlusal surfaces. Just, just caught, all right, now. That is a concern, and it definitely is enough to prompt a a a radiograph.

And you know, thank, thank goodness we did. Because this was not an obvious one. And this, again, a bit like the, the one I showed you before, this could have been so easily missed.

Not if you're in the you know, disciplined and, and, and taking full mouth radiographs, no matter what. This is, this is another great selling point for why you should perhaps be doing that each and every time. But, yeah, you could have definitely missed this.

Easily miss this. And I'm so glad I didn't. This is kind of what, would keep me awake at night.

The idea of perhaps performing a dental procedure on a, on a, on a dog or a cat, and actually having them leave your dental room still suffering like this. So, this was a good find. And this was the one where I said, I wouldn't really touch this with indontic treatment, because there's so much going on at, at the apex there.

Right, let's rattle through them. This old, this old chestnut, this, this slide again, you must be sick of umlungoverted, sorry, lingoverted mandibular canines. This is just the the radiographs to sort of show.

What's, what's lurking? Why we need to be so careful, and, and, and use really good disciplined, techniques when we are extracting these teeth. Because If you just kind of go in there and and and work all the way round the tooth root, maybe maybe a closed approach with a, with a luxator and, and you just start putting that luxator down, particularly on on the the lingual aspect of of of this tooth here, you're gonna whack this.

OK. Not a good area to be working. So this is why I wanted to include the include these radiographs because this.

Particularly if people keep breeding cockapoos. Is that a slightly inflammatory comment? Apologies if it is.

. We we're gonna have to get well used to doing these extractions. And and you don't wanna be. You want to be very aware of where everything is.

So it's a, it's an open extraction and and we're looking to avoid luxators coming down on on on this lingual aspect there. And if you are still doing kind of prep room wiggle outs with luxators, just, just stop, because it's only a, you'll you'll be causing hyperplasia and and developmental defects on the adult teeth. Right, case 4, an 8 month old Jack Russell terrier for routine neutering.

And We find, this, now all what all these different colours mean, they, they made sense to me last night when I was doing this, but the blue arrows show open. Immature adult teeth with an open apex. Cause another thing I've noted on these dental forums on Facebook, a lot of people are saying well how can I tell the difference between a a perhaps a retained deciduous tooth and a a a a young .

Adult tooth. The pup teeth have, formed, apices. The adult teeth don't.

Now the Pink arrow here, bright pink, is just to show that where we've had some pressure, we we've had some tooth resorption here because of the close proximity of the erupting adult tooth. And this pink line here is just to say. Look at the size of this.

Roots, which still has a very definite periodontal space and needs extracting properly. Again, don't do a prep room wiggle out with a with a luxator. You'll, you'll snap these, you'll, you'll leave roots behind and and it's not good practise, right?

So we need to be, we need to be extracting these properly with an with an open technique. Now I like this slide also, cause I also say to people, well what do we do about this retains. The city was too.

And, and I can't ask you cause I'm, I'm talking, talking to myself in a room at the moment, but the answer is, is you can leave these. Retained deciduous teeth are only necessarily a problem if you've got an adult tooth trying to trying to share that same spot in the arcade. So given that we haven't got ourselves, the, the pre-mo as we would anticipate erupting there, the adult teeth, that that pup tooth can stay there.

Yeah, no worries. Not the same dog, but just carrying on from that one. This is an example of teeth trying to occupy the same area.

And these are these sort of little shark mouth chihuahuas that you get. Again, I've seen loads of those on Facebook just lately on these dental forums. And they do provide a challenge, you know, trying to extract this without damaging this is, is, is can be, can be very tricky.

And, and, I don't mind admitting that there has been an occasion where I've actually ended up getting to a point where I, I've, I've, I've had to extract this tooth because I've just decided that I may well have actually. Caused enough sort of trauma to that area that that, that pre-molar, the adult premolar might not be viable anymore. And so it's, it's come out, it's, it's been extracted, which I, I, I don't like having to do, but it's, it's better that than, leave behind a a tooth which is gonna cause problems.

And it's not, if you like, a, it's not one of the big fours. It's, it's not a carnational, it's not a, a canine, and I felt comfortable doing that. But we've, we've got ourselves again, if we look carefully, open apex, closed apex.

This, this one is the yellow arrows are just to show that you can get odd and and tricky things happening with these teeth. This, this, distal root of this deciduous tooth is present still. But the, the medial one has resolved.

And that's not uncommon. So, so that's why you, you, you, I keep saying it, I mean I'm, I'm probably preaching to the converted now, but radiographs are absolutely essential. You're not gonna get these treatments right without them.

Case 5, an 18 month old crossbreed, a chronic oral wound since a dog attack as a young puppy. 104 was extracted at 7 months of age, that's when the dog attack happened because it was fractured. The dog has been depressed and painful since, and there's also this non-healing wound.

So, 12345 in sizesors should be 6. You can actually see something there that looks either like necrotic bone or or possibly a a a fragment of dental tissue. And, and, and this, this catches the eye, but don't get tunnel visions.

Look at the whole mouth, chart thoroughly, like Hannah was saying before, and, and, and you won't, you won't get caught out. It also had a cleft lip from the dog attack, which everyone, previously that this lady had seen had said the dog just had to live with, which seemed a bit of a shame. So this was a lovely case to be involved in, .

Because once we went looking. We found we had a retained route here. I actually think that might, might will have happened at a later date, that that's not been caused, by a dog attack at sort of 7 months of age.

But look, this is, . What I, I, I think we, what we're looking at here is the apical portion of the deciduous canines route. So the, the, the, the previous vets had extracted the adult fractured canine but without radiographs, they hadn't appreciated, they were leaving behind some of the deciduous roots.

And that's just been sat in there for over a year, or around a year. These, these, this blue zone there is a, is a, is a outlines a reactive area of, of, of where I think we've got lytic, sorry, more loose lucent appearance to the bone here, . And yeah, look, this, this was extracted.

. And just to be nice, we, we, we sold that up as well. And this was a lovely case where the, the lady thanked us for giving her a happy dog, because it had just been a very sorry for itself puppy all that time, hadn't really been playing, it had just been sleeping, no energy. And .

Going back to these, these, you know, the, the kind of pro dental talk I did earlier, it's kind of rare I think that you're doing, any other work where you you you you get feedback quite as powerful as that, that you, you've just given some, a dog a new, a new lease of life, or rejuvenated them or, or, or, you know, made them that much happier, and just with a pretty simple surgery. Right, K 6, a 4 month old Labradoodle, dog fight, jaw fracture. We've looked at this one before.

Now, I'm not gonna just bore you with fixation techniques and and and and the challenging the the the challenges we face with this particular case. I say I'm not gonna bore you with it. I'm, I'm I I I I might not want to go into it, because what we ended up doing, I would probably split opinion.

So that, that, I know that would have piqued everyone's interest and I probably get a 100 messages about it now. But the, the case went very well actually, . And, and we just had to kind of use what we had, and I, I, I'm pleased with the result really, I don't, I don't regret what I did, .

It was giving us a this this pup already had a a maleclusion which was a, a class 3 maleclusion, but it also caused some drift there, . And this is how the fracture healed, which I just thought was quite a nice cool thing to show you. .

This is fine. But the, the, the, the first mandibular molar was not able to ride the storm, so to speak, and we ended up with a big developmental defect. This probed, adjusted the gingival margin, you could, put, put a periodontal probe right right into that hole.

It wasn't very nice, and, and it was an indication for extraction, so the, the, the jaw was repaired, but. This is just a nice neat example of what can happen to teeth if they suffer an insult at a key time in their development. So, nice case.

Extracted. Also, just a. This is a, convergent routes.

Just another sort of nice thing to spot. Case 7, a 10 year old bijon freeze with severe periodontitis, so not that uncommon. This is this is that, you know, when you get those Almost white cheese like porulent builds up and it stinks, and, and, and everything is bright red and it's horrible.

This is one of those cases. This is, the, the, the, the yellow arrows are supposed to show our, our bone loss and, and just how significant we had our bone loss, with, with our periodontitis. Our bright pink arrows are just to make you aware, how could we forget that this is where the neurovascular bundle runs, .

And this is to tell us, show, point out to everybody that we've got ourselves a, a dilaceration, and a more subtle one here on, on, on this, on this dog's roots. So another reason why you might take dental radiographs is to get a radiograph like this and then. If you're not confident with your surgery, .

Or if you've just got the common sense to realise that this is just gonna be an absolute pig, you, you've got the opportunity to perhaps even just wake up the dog and, and, and refer it maybe, because this is not going to be a fun extraction. We've got a dilacerated er er root, a narrow periodontal space here. I always find these the hardest dentals, when you've got yourself severe.

pathology and, and, and, and, and bone loss at the sort of more coronal aspect of things, but then apically everything is still very tight and snug. Plus our dilaceration, and because it's a small dog, and we've got almost like a a a relative oversize of, of tooth for the size of the mandible, this is often when you get yourself working right close to the mandibular artery. Now I, I know how close you were to the mandibular artery, cos I, might have made a a a tiny little hole in it, and so.

It, it happens. I'm, I'm not embarrassed to admit that, that's, that's just what can occasionally happen when you are working in such close proximity to these neurovascular bundles. The, the, the dog did very well, it wasn't particularly dramatic.

It was a reasonably small bleed that that that stopped fairly promptly, but yeah, it, it just concentrates the mind, an X-ray like this, and, and you do need to look at it and think, do I, do I actually want to take that on. This is quite a nice example of a. The sort of lucency we were talking about earlier, which I would consider normal.

Case 8, a 9 year old Labrador, severe focal periodontitis, picked up at a routine health exam, so I think the dog was in for a booster, and I said, oh, I don't like that. We'll do this one quickly cos we're gonna run out of time otherwise. This is just a neat example of a Pero.

Endo. Lesion And, and this is when I said I selected some cases because I just thought they were nice, nice teaching cases, and, and, and they get you thinking about teeth in a more in-depth way when you think about the, the journey and the story of how periodontitis can become so severe that it is able to enter the end of thedontic system at the apex here and then almost like a slow fuse, those bacteria come round here and kick off. An abscess here.

I know we've got periodontitis. Here as well, and bone loss here as well, but I'm pretty comfortable saying that this endodontic lesion is, is not, An extension. An extension of this, but it has come through the tooth.

That's my story and I'm sticking to it. Case 9, don't worry, the cats will be coming. 10 year old German Shepherd booked in for scale and polish, aren't they all?

This is an 8 millimetre, pocket. Now look, this is a prehistoric picture. I think if I'd been more .

Comfortable with, with the, where I am now with, with dentistry, I'd I'd be thinking about tissue regeneration, perhaps . The there wasn't the, you know, remembering this, this particular owner there, I don't think there would have been the budget for it though, which might then just leave us with extraction, or we could try a route plane. Now an 8 mil pocket for me was too deep a pocket for to attempt a a route plane.

This, this, this tooth was extracted. But on the other side, it's amazing how symmetrical these things can be. This was a 5 mil pocket.

So, we extracted, the tooth, the noisy neighbour, you know, extract the tiny tooth to save the big tooth. Sometimes you are making those sacrifices in veterinary dentistry. And we did, use a route planning technique here.

And I was really encouraged to follow up radiographs was. But we, we did appear that we, we had some repair and, and some new bony tissue forming where we had a a pathological pocket. And, and that is without a bone graft, that's just with root planing and and home care.

So, I, I said there it this was seen at a follow up. You don't do any of these things without follow up, basically, because there's a, there's a high chance that this could have failed and we would just continue with a really nasty periodontal pocket. So you do, you do need to check these things, you need to follow up.

Right, now, a bit like a a firework display, you, you, you build up to a crescendo, and you think, crikey, this is getting good, this must be near the end. I love this case, it tells such a story, I think. A 4 year old miniature poodle, depressed, bad breath, heavy calculus.

This is the, the picture. I haven't got a picture, I'm afraid of the other side, stupidly I forgot to take one, before I actually scaled the teeth. But take my word for it, there was a there was a, a fraction of this calculus on the other side.

And you can kind of see, you can imagine, you can just see it's a much healthier side on the other side, and this is the other side of the calculus taken off. This is significant. It's just this sort of dark line here.

And this is the radiograph. I think I've cropped this just to be in my slideshow, just trust me that I got more tissue down here, OK? Oh.

Now, all these colours, what do they mean? Right, blue. Huge amounts of bone loss.

Severe periodontitis? I think the photos move slightly, but these pink arrows. Is the pulp er oh no that's the green arrows.

The pink arrows are our periaical lesions. Yeah. The green arrows.

The pulp width strikes me as being far too wide. Well they are too wide, we, we, we know the pulp's dead, look, we've we've got lesions down here, so they're they're too wide, we, we've got ourselves in a necrotic pulp. And then we've got this.

Odd structure here. So this is, this is dens and vaginitis or or tooth in a tooth and . Yeah, these are cool when you find these.

Now they leave the tooth open because of a sort of unfolding in in the in the tooth development which gives rise to this structure, and they leave the kind of door open for . An, an infection of the pulp, and. When we looked on the other side, like I say, a lot of things are symmetrical in veterinary dentistry.

Same things going on. Narrower Pulps. Compared to the other side.

But I don't like this, this is when we, this is when that lucency actually is, is, that's getting too big, isn't it? Less convincing here, but that, that's an endodontic lesion. But if we go back right, so this is really wide.

That's less wide. So we've got a bilateral condition. But it It happened on this side first.

And probably the, I wanna say the the the pain of having endodontic lesions, endedontic disease. Probably meant that this side was not used for chewing. And, and, and, and kind of went redundant.

Which is why we've probably got such a huge amount of calculus, form, top and bottom. Don't get me wrong, I mean, being a miniature poodle, it was gonna be predisposed to this sort of thing anyway. But that's why I think I can explain there was such a, a difference in, in, in one side versus the other.

And then, you know, that's, that's why we got such severe periodontitis. And that's where we found the case and both, both teeth were extracted. Plus, plus these teeth affected by the severe periodontitis, and I think if I recall, you know, we, we would have definitely had to extract some of those teeth, in the in the maxillary arcade as well.

Now feline tooth resorption. You'll see tonnes of it. Absolutely tonnes of it.

Now. Just let's just, before we get to case specifics, let's just talk about er different types. This is type one.

It's often can be called like an inflammatory tooth absorption, where we get these lesions where you can imagine a little mouse has sat there and nibbled away at the tooth, but we've still got a. Very definite root structure with a periodontal lucency around there, a clear definition of where we've got the the the mandible and and and and the and the root. Same here.

I mean there's a lot going on here. You shouldn't still need convincing to, to go and get some radiographs if you haven't already, but you don't do feline dentistry, without it. I know that's a mixed message because you shouldn't be doing any, dentistry without it, but especially not feline dentistry.

We, we've got ourselves a, you you you would never know about this about the radiograph. You'd never know that that was actually fractured at this point. So if it just, you, you wouldn't, you'd probably leave that behind without a radiograph as well.

And it's, yeah, more, more, more sort of severe tooth resorption there but again sort of type, type one, with also severe periodontitis, yeah. Type 2 The easiest way I can explain it is can you see definition between where you've got the, the bone and the tooth roots, or does it just all look merged? And I know that's put in a very simple way, but that's probably the easiest way I can explain it.

There's no point trying to extract these roots, because you won't find roots there. They're not, they're they're they're they're no longer defined from the jaw bone around them. And this is back to our nice little mental frame and by the way, if you recognise the slide.

And we've seen this one before, where we've got a tooth, suffering like a type 1 tooth resorption with some per apical lesions. And we've got this tooth over here, which I'd I'd have to retake this X-ray to get all the information about this tooth, but we can see it's suffering a type 2 resorption here. Possibly type 3, we'll come on to type 3 in a moment.

There you go. So here, I can't see where a tooth root is, not convincingly, but here, I think I can. Zoom in.

I think If I ask my Young daughter to try and draw around where she thought her tooth fruit was, she, she would also find that line. So for me that's something which needs to be extracted, we we definitely need to have a very good attempt at a complete extraction of this tooth root, but not, not here. Now a case, OK, a 12 year old cat booked in for dentistry, suspect falls, as the, I think on the other side we had a supra gingival tooth resorption lesion, which is like a classically, you know, the pink spots.

This, I think appeared reasonably normal, just grossly. But we can see this going on. You know, where, where is the tooth root there?

We, we, we can't see a defined tooth root there. The, the pulp canal's been obliterated and, and the definition is lost. So we can definitely talk about an extraction there or perhaps more correctly a crown amputation.

This line is where you wouldn't do a a a crown amputation. This line is where you would, or actually, now I'm looking at on a big screen, perhaps perhaps I'd come even higher. But the, the key to this is you, you do want to here I can see where we've got a a distinction between where the tooth is and where we've got the alveolar bone.

And and and up here is actually where it merges. So that's as a rule, you need to be coming at least that far sort of apically. When you lose the crown and perform a crown amputation.

And to do that, you do need to raise a, a small flap like you would perhaps for other extractions, and it's it's something that you suture back and place tension free afterwards. So that's the, that's the best way to do a crown amputation to actually still be raised in small flaps and making sure that you do go apical enough. And an eight year old cat.

Not been right since dental. This happened at, . a practise which didn't have, dental radiographs, and.

We had this sort of alveolar bone expansion and a, a, a discharging sinus. And I, I wasn't hugely surprised when we took some radiographs that we found, something that looked a bit like this. Now this structure.

For me, is defined from the rest of the tissue around it, and I think what we're looking at there is this sort of an apical portion of of of of a root. But I, I keep saying it's amazing how symmetrical these things can be. What hadn't been picked up on on on the previous dental procedure is that there was a, a lot of probing and attachment loss on the other side of this cat's mouth.

Just here, look. And I, I've said amazing symmetry, but we've got ourselves a huge amount of resorption going on, probably because of the, the, the periodontitis, but you can see how easy it would be to. For that just a fracture there, and we would have exactly the same thing going on I think with this little apical portion of tooth root up here as as the other side.

I just thought this was a fascinating case to show you that to keep going on about the symmetry things. It's not always this way. But this is a lovely example of, you know, go looking on a hunch for for what else might be going on, and also, definitely, chart properly cos then you're gonna find .

There's probing, definitely, and, and always take your radiographs. Otherwise you're always gonna leave little bits behind. Cat cat's roots are, are swines.

They, they do all these sorts of sort of odd inflammatory sort of resorption which happens a lot, lot less in in dogs. So, yeah, cats keep you on your toes. And finally, here we go, a, a case 12 is a 10 year old domestic shorthair booked in for a fractured canine.

And this again, this could easily go so wrong for you without radiographs. Here, I think we've got an internal. Root absorption due to endodontic disease coming up here from our, our, our, our fractured, tooth and pulp exposure.

But you don't need me to tell you that if you're gonna extract this tooth and, and, and your technique isn't particularly good, and, and particularly if you're gonna try and, and doing a, a sort of closed extraction, that bit will come out, this bit won't. And you'll have a problem. There we go, that was my last slide, and amazingly enough, that's also looks like it's round to time.

Cool. Pretty well, Tom, thank you so much for that. Very brief, really, very quickly, we've just got 3 quick questions here, if you're OK to answer those.

Yeah, go for it, yeah, yeah. Any tips on extracting roots with dilaceration? Yeah, you, you do need to remove a a a lot of the the buckle or the labial bone plates, so you, you just need to get exposure that kind of.

Yeah, I, I, sorry, forgive me because I can't remember who gave you the talk earlier, when we're talking about the alveolectomy and and in in some young dogs you, you can take less, and in older dogs you take more. Dilacerated roots, you take more, because that root is not gonna twist itself round. The corner, particularly the bad ones, you've, you've almost got to bring them out sideways, which means you sometimes are taking bone away completely to the apex, basically.

Right, that leads on to the next question, how is it best to avoid the mandibular artery when removing mandibular molars? Yeah, carefully. .

Not excessive force, a, a, a real gentle, I mean, you, as you know, you're getting into that territory. I, I'm using a diamond bur cos it's just less vicious, rather than a sort of, you know, a, . A fissura, and I, I'm just taking things away ever so slowly, you will, if you're working very, very carefully, which you should be if you, if, if your X-ray tells you you're down in that area, you, you, you will just gently know when you're there, you'll you'll feel it, and you just need the the slightest of touch to be working in that area, cos you certainly don't want to slip with a luxator.

You, you need good visibility, sort of a steady hand, and, and you need to, to just be prepared that you're taking on something which is gonna feel, hairy, if, if I can put it like that. That, that is why there's no shame in, in getting a radiograph like that and saying, do you know what, that's for someone else, that's not for me, really. Yep.

And should a dog's tooth showing signs of root resorption always be extracted? So there was that one particular slide where we had the external root resorption because of kind of chronic grumbling perapical disease. I mean.

I know of, perhaps, well, I don't, I don't, I, I, I know that sometimes people would actually do a surgical approach to the apex of that tooth, and they might be able to resect the the sort of very diseased apical portion of the root and and do something called surgical endodontics, where you, you put a stopper in place after you resect all that diseased tissue. So it, it, there are these very advanced techniques where. You wouldn't absolutely have to extract it, but I probably would, .

OK, thank, thank you. Thank you very much, Tom, for finishing off this essential stream. I'd like to thank everybody for participating, our speakers who've given us so much information, our partners who've made this event possible, and our delegates, without whom it would be a bit of a waste of time.

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