Computed tomographic features of apical infection of equine maxillary cheek teeth: a retrospective study of 49 horses.
Authors: Bühler M, Fürst A, Lewis F I, Kummer M, Ohlerth S
Journal: Equine veterinary journal
Summary
# Editorial Summary: CT Features of Equine Maxillary Cheek Tooth Apical Infection Apical infections of maxillary cheek teeth represent a significant clinical challenge in equine dentistry, yet the diagnostic reliability of individual computed tomographic (CT) findings had not been systematically evaluated. Bühler and colleagues retrospectively analysed multislice CT scans from 49 horses (28 with clinical signs of apical infection, 21 without), documenting changes to the infundibulum, pulp, root, lamina dura, periodontal space and alveolar bone. Whilst individual CT abnormalities were substantially more prevalent in clinically affected horses, the findings revealed important nuances: a nondetectable lamina dura appeared frequently in both groups and commonly as an isolated feature in otherwise normal teeth, whereas clusters of three or more changes (affecting pulp, root, periapical bone, periodontal space and/or involving tooth fracture) reliably identified apical infection and were only observed in clinically symptomatic horses, with one exception. For practitioners relying on CT diagnosis, this work suggests that definitive apical infection requires multiple concurrent radiographic signs rather than isolated lamina dura changes, which may reflect normal anatomical variation or imaging resolution limits rather than pathology, particularly in the rostral maxillary cheek teeth (109/209, 110/210).
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Practical Takeaways
- •Use multiple combined CT findings rather than single abnormalities to diagnose apical infection; a nondetectable lamina dura alone is not sufficient for diagnosis
- •When CT shows pulp, root, periapical bone or periodontal space changes along with tooth fracture, apical infection is likely even if clinical signs are subtle
- •Be aware that infundibular changes on CT do not reliably indicate apical infection and may represent normal variation or incidental findings
Key Findings
- •Combined CT changes involving pulp, root, lamina dura, periapical bone, periodontal space and tooth fractures are reliable diagnostic features for apical infection in maxillary cheek teeth
- •Nondetectable lamina dura was the most frequent CT finding but was often a solitary feature in otherwise normal teeth and should be interpreted cautiously
- •Apical infections (defined as ≥3 CT changes) occurred mainly in teeth 108/208, 109/209 and 110/210 and were found almost exclusively in horses with clinical signs (107/108 affected teeth)
- •Infundibular changes alone were not associated with other CT signs of apical infection and were common even in horses without clinical evidence of disease