Patient
Bengal tiger, female, born in a private zoo on June 5, 2017. Weight: 130 kg. Currently housed in the same zoo, which specializes in the breeding of felines.

Medical history
Tooth 204 fracture approximately 6 weeks old; the mechanism of injury is unknown. Detailed examination without anaesthesia is not feasible due to the species. Diagnosis: complicated fracture of tooth 204, subgingivally (T/FX/CCRF).

Case description
Anaesthesia was administered by an attending veterinarian responsible for routine veterinary care in the facility. Induction to anaesthesia was performed in the breeding facility. The patient was anaesthetized with ketamine 1.5 mg/kg (Narkamon 100 mg/ml, Bioveta, Ivanovice na Hané, Czech Republic) in combination with xylazine 0.6 mg/kg (Xylased 100 mg/ml, Bioveta, Ivanovice na Hané, Czech Republic). After the onset of action, the same combination of anaesthetics was reapplied intramuscularly with ketamine at 0.4 mg/kg and xylazine at 0.12 mg/kg. Afterwards, an intravenous cannula was inserted into the v. saphena lat. sin. Propofol was then administered as a bolus at 0.4 mg/kg (Propofol 1%, Fresenius). The patient was subsequently transported to the local veterinary clinic, the duration of transport was 5 min. As the clinic is not a specialized dental clinic, local conditions had to be adapted to the requirements for dental treatment. The patient was positioned on a stationary X-ray table, directly under the X-ray source (AJEX 2000H). This setup allowed for continuous extra oral radiographs to be taken without the need to manipulate the patient. The patient was then connected to inhalation anaesthesia. O2 + Isofluorane (initial 1.2% isoflurane for 30 minutes, 1% for an additional 60 minutes, and 0.8% until the end of the procedure). During anaesthesia, two additional boluses of 5 ml propofol were administered. Local anaesthesia with 2% lidocaine was applied in f. infraorbitale sin. An intravenous infusion of 1000 ml PL was initiated, along with meloxicam at 0.06 mg/kg (Loxicom 20 mg/ml inj., Norbrook).

Dental Examination
204 T/FX/CCRF. Pulp still vital, bleeding on probe examination. The fracture area extends 8 mm subgingivally mesially. The tooth root, periodontal space, and bone tissue show no pathological changes. 104 AB. Vertical abrasion of the distal side of the crown, known as “cage biting”.

Therapy
Dental hygiene (PRO) performed, plaque removed. Cavity prepared, access to the pulp cavity widened. Pulp extraction of vital pulp performed. Rinsing with NaOCl 3% disinfectant solution (Parcan N, Septodont), application of EDTA 15% paste (Endo Prep cream, Cerkamed, Poland). Gradual mechanical preparation of the pulp cavity with H-file hand instruments, length 100 mm, size ISO = 40 - 100. Alternating application of NaOCl and EDTA throughout the treatment. Stop bleeding with a paper plug with adrenaline (Adrenaline Medication injection 1ml/1mg). Endomethasone N (Septodont) and gutta-percha points were used to obturate the canal. Gutapercha inserted into the endodontic cavity gradually, with lateral condensation. Mechanical cleaning of the pulp chamber using a spoon excavator, Ultra-blend plus glass ionomer cement was used and the base on top of the GP and Endomethazone (Ultradent Products Inc.). Subsequent treatment of the access cavity and removal of excess cement using a round a diamond bur at 50000 rpm. Etching of dentin with phosphoric acid 37% (Etching gel, Spofa Dental) for 15 sec. After rinsing and drying, bonding material (Prime&Bond NT, Dentsply) was applied. Air was used to dissipate the volatile fraction and thereafter it was light cured to effectpolymerization. The composite (Valux plus, 3M ESPE) was added in layers and subsequently cured. After the endodontic treatment, the gingival margin on the mesial side of the crown was reduced - gingivectomy (GV). Intra- and post-op extraoraly radiographs were being performed trough the whole procedure. The patient was transported under anaesthesia immediately after the procedure back to the breeder, where she woke up from anaesthesia under the supervision of the vet.