Standing oral extraction of cheek teeth in 100 horses (1998‐2003)

Abstract

Summary Reasons for performing study: Extraction of cheek teeth (CT) by the conventional repulsion technique requires general anaesthesia and carries a high rate of post operative complications. Consequently, an alternative method of extraction, i.e. orally in standing horses, was evaluated. Hypothesis: The need for and risks of general anaesthesia could be avoided and post extraction sequelae reduced by performing extractions orally in standing horses. Methods: One hundred mainly younger horses (median age 8, range 2‐18 years) with firmly attached CT that required extraction because of apical infections, displacements, diastemata, idiopathic fractures and the presence of supernumerary CT had the affected teeth (n = 111) extracted orally under standing sedation. Follow‐up information was obtained for all cases, a median of 16 months later. Results: Oral extraction was successful in 89 horses and unsuccessful in 11 due to damage to the CT clinical crown (n = 9) during extraction, for behavioural reasons (n = 1) and because the apex of a partly extracted CT fell back into the alveolus following sectioning (n = 1). Predispositions to extraction‐related CT fractures were present in 5 of the 9 cases, i.e. advanced dental caries (n = 2) and pre‐existing ‘idiopathic’ fractures (n = 3). The iatrogenically fractured CT were later repulsed under standing sedation (n = 3) and under general anaesthesia (n = 6). Eighty‐one of the remaining 89 horses had successful oral CT extraction with no or minimal intra‐ or post operative complications occurring. Post operative complications in the other 8 cases included post extraction alveolar sequestration (n = 3), alveolar sequestration and localised osteomyelitis (n = 1), localised osteomyelitis (n = 1), incorporation of alveolar packing material into alveolar granulation tissue (n = 1), and nasal discharge due to continued intranasal presence of purulent food material (n = 1) and to ongoing sinusitis (n = 1). The above sequelae were treated successfully in all cases, with general anaesthesia required in just one case. Following oral extraction, significantly (P<0.001) fewer post operative problems developed in 54 horses with apically infected CT in comparison with 71 previous cases that had repulsion of apically infected CT at our clinic. Conclusions and potential relevance: Oral extraction of cheek teeth is a successful technique in the majority of younger horses with firmly attached CT and greatly reduces the post operative sequelae, compared with CT repulsion. Additionally, the costs and risks of general anaesthesia are avoided. Further experience and refinement in the described protocol could potentially increase the success of this procedure and also reduce the incidence of post operative sequelae.

Approaches to cheek teeth removal after failed oral extraction in 23 horses

“…Boussauw (2003) concluded that the lateral buccotomy technique is limited to maxillary and mandibular CT 6 to 9 and in selected cases maxillary CT 10. Dixon et al (2005) also reported the classical approach to be unsuitable for its use in more caudal CT. Stoll (2011) described a minimally invasive transbuccal surgery and screw extraction technique as an alternative to trephination and repulsion in cases of crown fractures or other cases in which oral extraction is impossible. Nowak et al (2011) reported complications associated with minimal invasive buccotomy to occur only in very few cases.…”

“…It is reported to be associated with a higher incidence of postoperative complications (Prichard et al 1992, Orsini et al 1992, Lane 1994, Dixon et al 2000b, Boussauw 2003, Dixon et al 2005, Bienert 2008) than oral extraction (Bienert 2008). Frequently the tooth to be repulsed is traumatized so that it is often extracted in multiple pieces with the potential for remaining tooth fragments in the alveolus (Dixon et al 2000b, Dixon et al 2005. Dixon et al (2000b) reported continuing purulent discharge from the alveolar surgical site in 6 of 33 cases after mandibular CT repulsion because of sequester formation or development of local mandibular osteomyelitis.…”

“…Fractures can be caused by external, bit-related or iatrogenic trauma. Iatrogenic traumatic fractures can occur during dental manipulation (Dixon et al 2000a) and have a reported incidence of 9 % during attempts of standing oral CT extraction (Dixon et al 2005). A fracture of the clinical crown limits the possibility of oral extraction and may necessitate alternative approaches for completion of tooth removal.…”

“…There are older reports indicating an incidence of equine tooth fractures of 0.71 % (Becker 1945), 8.8 % (Gnädinger et al 1945) and 3.5 % (Geres 1962). CT fractures have been described to be the reason for 21 % of equine CT extractions (Dixon et al 2005). CT fractures have been categorized into traumatic and idiopathic (Dixon et al 2011) whereby traumatic fractures are reported to occur mostly in mandibular and idiopathic fractures in maxillary CT (Dixon et al 2000a).…”

“…Cheek teeth (CT) fractures are one of the main indications for CT extraction in horses (Dixon et al 2005). There are multiple reasons for the development of CT fractures (Dacre et al 2007).…”