Surgical Repair (Partial Pulpotomy) of Bilaterally Fractured Tusks in an African Elephant (Loxodonta africana)
A 3-year-old, 1,030 kg, male African elephant (Loxodonta africana) was anesthetized with etorphine (Wildlife Pharmaceuticals, Inc., Fort Collins, CO, USA; 3 mg, IM) and azaperone (Stresnil, Merial Canada, Inc., Baie-D’Urfe, QC, Canada; 20 mg, IM) on two separate occasions, 27 days apart, for the repair of bilaterally fractured tusk tips with pulpal exposure (class III fractures). Due to positioning, a separate procedure was necessary for each tusk repair. The anesthetic protocols following induction included orotracheal intubation after administration of propofol (Hospira, Inc., Lake Forest, IL, USA; 500 mg bolus, IV), and the maintenance of anesthesia utilizing isoflurane (AErrane, Baxter Pharmaceutical Products, Inc., Deerfield, IL, USA; 0.5–2.0%) in oxygen, intravenous propofol (150–500 mg boluses), or intravenous etorphine (0.2 mg). Positive pressure ventilation was provided as needed during the procedures. Recovery was uneventful after intravenous administration of naltrexone (Wildlife Pharmaceuticals, Inc.; 150 mg).
After determination of the depth of the contaminated pulp tissue insult utilizing a handheld portable X-ray unit (Nomad 75, Aribex, Inc., Orem, UT, USA) and a digital radiology screen (EDR3, Eklin Medical systems, Inc., Sunnyvale, CA, USA), the tip of each fractured tusk was repaired utilizing a modified partial pulpotomy technique. The tip of each tusk was transected at the appropriate level utilizing a water-cooled rotary cut-off tool after which the pulp canal was enlarged with an industrial carbide burr in an air driven die grinder. The coronal tip of the exposed pulp horn tissue was amputated with a surgical curette and hemorrhage was controlled by direct pressure. The pulp canal was then decontaminated by simultaneous lavage with 3% hydrogen peroxide and 5.25% sodium hypochlorite followed by 3 minutes of laser decontamination therapy utilizing a YSGG laser (Waterlase MD, Biolase Technology, Inc., Irvine, CA, USA) in the sterilization mode. The canal was then filled with a layer of synthetic particulate bone graft material (Consil, Nutramax Laboratories, Inc., Edgewood, MD, USA) followed by a layer of light cured flowable composite resin (Premise Flowable, Kerr Corporation, Orange, CA, USA). Finally, the coronal portion of the tusk was restored with a hybrid dental resin composite material (Herculite XRV, Kerr Corporation) polymerized with a plasma arc curing unit (Demetron Curing Light, Kerr Corporation). The irregular fractured tip of each tusk was then recontoured into a rounded profile with an abrasive sanding disk on a handheld electric grinder. After modification of the elephant’s enclosures (securing loose chains, etc.), no further tusk damage has occurred.