A computed tomographic study of endodontic and apical changes in 81 equine cheek teeth with sagittal fractures.
Authors: Rowley Kieran J, Townsend Neil B, Chang Yu-Mei R, Fiske-Jackson Andrew R
Journal: Equine veterinary journal
Summary
# Sagittal Cheek Tooth Fractures: Hidden Apical Pathology on CT Imaging Sagittal fractures of equine cheek teeth are frequently identified during clinical examination, yet their associated endodontic and apical consequences remain poorly characterised. Kieran and colleagues retrospectively reviewed CT scans from 49 horses presenting with 81 teeth bearing sagittal fractures, systematically evaluating 87 individual fracture lines for evidence of apical infection using a novel grading system and quantitative Hounsfield unit measurements of endodontic density. Midline and infundibular-involving fractures showed particularly high rates of apical infection (100% and 96% respectively), with buccal fractures affecting approximately 73% of teeth; concerning, 73% of the entire cohort demonstrated CT evidence of apical pathology despite a notable absence of consistent clinical signs of dental disease. The most significant clinical implication is that sagittal fracture orientation predicts infection risk more reliably than fracture depth or clinical presentation—midline fractures warrant particular scrutiny given their fivefold increased association with sinusitis. For practitioners, these findings suggest that horses with sagittal fractures visible on oral examination should be referred for CT imaging to detect subclinical apical infection, as the majority of these teeth will require endodontic intervention or extraction rather than conservative monitoring based on clinical signs alone.
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Practical Takeaways
- •Sagittal cheek tooth fractures frequently develop apical infections even without clinical signs; CT examination should guide treatment decisions rather than relying on visible symptoms alone
- •Midline sagittal fractures pose particular risk for sinus involvement and warrant careful monitoring and potentially more aggressive intervention
- •Fractures involving the infundibulum have near-universal apical infection and should be treated proactively to prevent complications
Key Findings
- •73% of buccal sagittal fractures, 55% of palatal/lingual fractures, and 100% of midline fractures showed evidence of apical infection on CT
- •Midline sagittal fractures were significantly associated with sinusitis (OR 5.92, P=0.006) compared to other maxillary fractures
- •96% of fractures involving infundibula had apical infection, the highest prevalence among fracture types
- •No significant relationship existed between presence of clinical signs and apical infection (P=0.4), suggesting asymptomatic teeth may harbour disease