Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilisation (2011–2016)

Abstract

Summary Displaced sagittal cheek tooth fractures are a cause of oral pain, quidding and apical infection. Intraoral extraction is the preferred technique to remove affected teeth, but can be difficult due to displaced and friable fracture fragments. Stabilising fracture fragments via filling of the fracture space with polymethymethacrylate (PMMA) prior to removal may be a useful method to facilitate intraoral extraction. Case details were examined retrospectively. A total of 22 cheek teeth required extraction in 20 horses because of displaced sagittal fractures. Clinical diagnoses were made using oral examination, oral endoscopy, skull radiography and computed tomography. All procedures were performed in standing, sedated horses in stocks. Fracture spaces were cleaned and packed with PMMA and teeth removed using a routine intraoral extraction technique. Digital photographs of extracted teeth were taken and tooth measurements calibrated using digital image software. Intraoperative difficulties, as well as post‐operative complications were recorded. A total of 21 maxillary and one mandibular cheek teeth were extracted. All maxillary teeth had advanced infundibular caries. Intraoral extraction was successful in 16 cases; six were unsuccessful and required repulsion due to tooth fragmentation or abnormal dental anatomy. In 11 cases, maxillary or conchofrontal sinus trephination was performed to either treat sinusitis, repulse the tooth, or both. Two horses developed short‐term complications following local anaesthesia of the maxillary nerve. The mean ratio of fracture depth to tooth length was 0.59 and mean ratio of fracture width to tooth width 0.53. The limitations of the study are its small sample size, retrospective nature and lack of control group to compare extraction success in PMMA and non‐PMMA groups. It was concluded that using PMMA to stabilise displaced sagittal fractures in equine cheek teeth is a simple, effective method of facilitating intraoral extraction and may reduce the need for more invasive procedures.

Malocclusions and Dental Diseases in Privately Owned Horses in the Mazovia Region of Poland

“…Consequently, the opposing mandibular tooth tends to protrude excessively [ 47 ]. Advanced infundibular caries of the maxillary cheek teeth often predisposes to midline sagittal fractures and apical infection [ 52 , 53 ].…”

Comparison of post‐operative inflammatory response in horses undergoing elective castration treated preoperatively with ceftiofur crystalline free acid or procaine penicillin G

“…The use of a single dose of CCFA as a preoperative antimicrobial is attractive to many equine practitioners due to its availability in a long‐acting formulation, broad‐spectrum antimicrobial activity and relatively high margin of safety. Documentation of CCFA being used as a preoperative antibiotic for other surgical procedures such as dental extraction exists in equine medicine (Pearce and Brown 2019). The extra‐label use of antimicrobials in equine medicine should be performed in a cautious manner in situations with an obvious benefit.…”

“…2015; Kaspar et al . 2019; Pearce and Brown 2019). This concern with antimicrobial resistance brings into question the use of preoperative antibiotics in elective surgeries.…”