Introduction Oral endoscopy, dental radiography and computed tomography are necessary imaging modalities for diagnosis, management and follow-up of a chronically infected tusk. Apicoectomy may be an option for surgical management of chronically infected tusk.

Dental imaging - oral endoscopy
The porcine oral examination is best accomplished with a hoist system and soft strap placed just behind the maxillary canines/tusks. Oral endoscopy gives excellent visualization of individual tooth structure and soft tissue attachment. The porcine molars have a double row of “rounded” cusps while the premolars have a “sharper” single row of cusps. The difference in the cusp anatomy suggests that the function of the porcine premolars is more for tearing/shredding of food material while the molars appear to have more of a grinding function. Premolars and molars may be affected by a chronic infected tusk due to extension of the disease into the mandible. Oral cutaneous fistulas may also develop due to severe chronic infection.

Dental imaging – radiographic technique
Maxillary arcade: Extra-oral radiographic technique of the maxillary premolars and molars is achieved by placing the screen/sensor next to the arcade to be imaged and placing the generator along the opposite side at ~45 degrees. Positioning for the left maxillary arcade is achieved by placing the sensor vertically along the left side and the generator on the right side at ~45 degrees (above horizontal). The mouth may be held open with a strap and hoist. The “opened mouth” will reduce the amount of dental arcade superimposition. Mandibular arcade: Extra-oral radiographic technique of the mandibular premolars and molars is achieved using a bisecting angle technique. The screen/sensor is placed along the ventral aspect of the mandible(s) and the generator is placed on the side to be imaged at ~60 degrees (above horizontal). Positioning for the left mandibular arcade is achieved by placing the sensor flat along the ventral aspect of the mandible and the generator is directed from the left side with a slightly steep angle of ~ 60 degrees. The mouth is may also be held in an open position with a small “rolled” towel to help minimize dental arcade overlap.

Rostral maxillae and mandible(s): Intra-oral radiographic technique of the rostral maxilla and mandible(s). The screen/sensor is placed within the mouth facing up (maxilla) or down (mandible) and the generator is directed dorsal to ventral for the maxilla and ventral to dorsal for the mandible(s). For the best placement of the sensor, a corner of the screen is placed centrally into the oral cavity to allow more caudal placement between the commissures of the lips. This technique will allow intra-oral imaging of the incisors and canines/tusks.

Dental imaging – computed tomography
With radiographic superimposition of dental, sinus, maxilla and mandible anatomy; three-dimensional evaluation of the skull is often indicated for an accurate diagnosis of dental pathology. The clinical crown of the mandibular tusk is present in the rostral mouth just behind the third incisor. The reserve crown courses through the mandible below the premolars and molars and then at the second or third molar the reserve crown diverges in a buccal direction to the radicular root. The radicular root is encapsulated with bone that is prominent just rostral to the masseter muscle. Using CT imaging, the anatomical features of the mandibular tusk will be discussed.

Surgical management – apicoectomy
If an apical infection of a tusk is isolated to the radicular aspect of the tooth, an apicoectomy may be considered. A case discussion will be presented showing an apical infection of the left mandibular tusk in a male castrate 10-year-old mixed breed pig. With CT imaging of the coronal reserve crown of the same tooth, there is good periodontal attachment. Additionally, there is no endodontic disease (or pulp horn) evident. In the same CT image, a supernumerary tusk on the right side is noted.

The radicular root is developing along the medial aspect of the mandible. A surgical approach to the apical aspect of the mandibular tusk is a rostral curvilinear “C” flap. Once the flap is elevated, buccal bone is removed with a high-speed surgical drill to expose the apical aspect of the tusk. Heavy purulent discharge from the abscess is noted as the buccal bone is removed. The apical portion of the tusk is sectioned in a coronal direction until normal reserve crown and attachment are noted. No pulp horn is evident at the level of final resection of the reserve crown. A Penrose drain is placed, and the flap is closed in three layers; periosteum/deep submucosa, submucosa, subcuticular/skin.