Vetnuus | January 2025 39 Regulars I Dental Column Maxillary and inferior alveolar nerve blocks were performed using a combination of lidocaine and epinephrine (Lignospan). All the deciduous teeth present were extracted (502, 503, 504, 508, 601, 602, 603, 604, 607, 608, 701, 702, 703, 704, 708, 801, 802, 804, 806, 807, 808). Operculectomies were then performed at the 102, 103, 201, 202, 203, 301, 302, 304, 311, 401, 402, 403, 404, 411. Some of the permanent teeth were covered by alveolar bone, hence operculectomies with alveolotomy had to be performed at the following teeth: 108, 109, 110, 208, 209, 210, 307, 308, 309, 310, 407, 408, 409, 410. Absorbable suture material (Monocryl 4/0) was placed to oppose the gingiva in between teeth to maintain a gingival margin.The patient was discharged the same day with meloxicam and paracetamol for 5 days. Discharge instructions included soft food to be given, as well as no access to chew toys. The patient was seen for a follow-up 2 weeks later. On conscious oral examination, it was noted that the operculectomy sites have healed. Most of the permanent teeth started to erupt. Unfortunately, the gingiva at the mandibular incisor teeth closed prematurely, but it was decided to wait two more weeks and to re-evaluate the patient under general anaesthesia with dental radiographs. At the 4-week follow-up examination under general anaesthesia, dental radiographs were made and most of the teeth erupted adequately (Figs 4-8). The mandibular incisor teeth, as well as the left mandibular 3rd molar tooth, were still impacted, and operculectomies were performed, more aggressively this time. The left mandibular 2nd incisor tooth (302) was extracted due to crowding of the teeth. All primary teeth should have erupted by 12 weeks of age (Table 1), and all secondary teeth by 7 months of age. Several factors such as genetics, environmental, infectious and traumatic factors can influence eruption times (Wallis et al., 2023, Bellows, 2011). Should a primary or secondary tooth not be present on oral examination after the expected eruption times, dental radiographs should be performed to investigate whether the tooth is truly absent, or whether the tooth is unerupted. An unerupted tooth can be because of lack of space, improper positioning, or physical Figure 3. Rostral maxilla and mandible show the persistent deciduous teeth as well as unerupted dentition of the rostral mandible and the mandibular canine teeth Figure 4. The 4-week post-operative appearance of the right maxilla together with the dental radiographs Figure 5. The 4-week post-operative appearance of the left maxilla together with the dental radiographs
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