RESEARCH
Treatment of Turtle Shell Ulcerations Using Photopolymerizable Nano-Hybrid Dental Composite

https://doi.org/10.1053/j.jepm.2016.06.013Get rights and content

Abstract

Shell ulcerations are commonly observed lesions in chelonians, with treatment typically required for disease resolution. In this study, photopolymerizable nano-hybrid dental composite was used as a closure material for ulcerative lesions affecting chelonian shells. Shell ulcerative lesions were diagnosed in 33 different species of turtles: 14 red-eared sliders (Trachemys scripta elegans), 5 yellow bellied sliders (Trachemys scripta scripta), 11 Sicilian pond turtles (Emys trinacris), 2 Florida red bellied cooters (Pseudemys nelsoni), and 1 Mississippi map turtle (Graptemys pseudogeographica kohnii). Turtles were premedicated with tramadol and meloxicam administered intramuscularly; anesthesia was induced using a combination of ketamine and diazepam administered intramuscularly, and maintained on a surgical plane of anesthesia using isoflurane. The patient’s shells were washed with a povidone iodine solution before being placed on a heating pad to maintain a normothermic condition. After the initial lesion debridement, surgical curettage was performed with a tungsten carbide burr. The surgical curettage was necessary to generate an appropriate cavity and suitable surface for applying the photopolymerizable dental composite (PDC). During the curettage procedure, sterile saline solution, containing 3 mL/L of 2% lidocaine, was continuously applied onto the lesions. After the curettage procedure, an EDTA solution, followed by a dehydrating potassium-based solution, was applied on the prepared shell sites. An etching gel was painted on the areas where the PDC was to be placed and maintained for approximately 1 minute. After the etching gel dried, a bonding agent was applied, and it was polymerized with single cycle of curing light. Cavities were filled using a light-curing nano-hybrid composite, which was polymerized using a light-emitting diode curing light. On average, 10 minutes was required to fill the cavities with the PDC. After the shell repair procedure, the turtles were placed in dry hospital holding units for 24 hours, after which they were moved to several hospitalization water tanks. Antibiotic treatment and postsurgical analgesia were performed for 6 days. After 7 days of hospitalization, treated turtles were discharged to their owners. On the follow-up examinations, 30 days posttreatment lesions had healed in 48.4% of treated turtles; 60 days posttreatment lesions had healed in 78.7% of treated turtles; and 90 days posttreatment lesions had healed in 100% of treated turtles. Treatment of shell ulcers with photopolymerizable nano-hybrid dental composite appears to eliminate shell ulceration relapses, long and expensive antimicrobial treatment, and dry docking hospitalization, while promoting rapid healing of the shell along with fast and excellent recovery of the turtle patients.

Section snippets

Animals

Multiple shell ulcerations were diagnosed in 33 different species of turtles (Table 1): 14 red-eared sliders (Trachemys scripta elegans), 5 yellow bellied sliders (Trachemys scripta scripta), 11 Sicilian pond turtles (Emys trinacris), 2 Florida red bellied cooters (Pseudemys nelsoni), and 1 Mississippi map turtles (Graptemys pseudogeographica kohnii). All turtles were presented to the Veterinary Teaching Hospital by their owners. The turtles, of various ages, were determined to be 19 females

Results

On average, 10 minutes of work was necessary to completely fill the cavities with the PDC. Some examples of the treatment results are shown in Figure 3. Follow-up examinations, divided by turtle species treated with composite, are described in Table 2. At 30 days posttreatment, 48.4% (16/33) of the treated turtles had the fillings separate from the lesions. At 60 days posttreatment, fillings had separated from the lesions in 78.7% (26/33) of the subject turtles. At 60 days posttreatment,

Discussion

To treat shell ulcerations, an aggressive surgical debridement of the necrotic tissue is recommended to stimulate the neovascularization of the tissues.20 In addition, local antimicrobial ointments could be applied to the lesions, however, this therapy must be combined with systemic antibiotic administration for 20 to 30 days to avoid reoccurrence of the disease condition. It is also recommended to provide supportive care to the chelonians that present with ulcerative shell lesions in the form

Conclusion

The treatment of shell ulcers with PDC provides an impermeable barrier on the shell lesion. The PDC appears to eliminate relapses of the shell disease condition, long and expensive antimicrobial treatment, and dry docking hospitalization, while promoting rapid healing of the shell lesions and a timely recovery of chelonian patients.

Acknowledgments

The authors would like to thank the nursing staff and the students for assistance and photos. The authors would also like to thank Dr. William Grech for his kind and accurate assistance in the English language review of this article. The study was performed in compliance with directive 2010/63/EU of the European parliament and of the Council of the European Union.

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