Equine Extraction Considerations and Techniques

1. A midline sagittal fracture has occurred on tooth 409 in a 20 year-old Thoroughbred. The fracture extends deep into the reserve crown, but both the mesial and distal roots can be seen on the radiograph. Challenges with this extraction include:

A. Loss of clinical crown to grasp and apply leverage with forceps
B. Strong periodontal ligament attachment along the long, spindly roots
C. Complete intact roots and a weakened crown structure
D. All of the above

2a. The pictures below are of the right maxillary second molar (tooth 110) before and after feed was flushed from a deep periodontal pocket. The patient is an 18 year-old Quarter Horse. What is your next step?

A. Obtain sinus and maxillary dental radiographs.
B. Elevate the gingiva and attempt extract.
C. Aggressively debride the periodontal pocket and pack with impression material to encourage healing.
D. Explain to the owner that this condition is untreatable and should be conservatively managed.

2b. You have obtained paranasal sinus and maxillary dental radiographs. From the radiographs, the following significant findings for treatment planning can be determined.

A. The pathology extends into the caudal maxillary sinus, but appears to be walled off by thick soft tissue.
B. Both the second and third molars (teeth 110 and 111) have severe periodontal disease.
C. At minimum the mesiobuccal and the distobuccal roots remain intact on the fractured tooth 110.
D. All of the above.

2c. Particularly in this challenging case, it is very important to have multiple extraction technique options because there is no guarantee that just one would be successful. Extraction techniques that could be employed to extract tooth 110 include (Check all that apply):

A. Intraoral “simple” extraction
B. Intraoral extraction with coronectomy and/or tooth sectioning
C. Intraoral surgical extraction
D. Minimally invasive transbuccal extraction
E. Extraoral surgical extraction with buccotomy, ostectomy, and alveolectomy
F. Extraoral surgical extraction via radiculectomy +/- light repulsion

2d. Finally, what is the most import message to relay to the owner regarding possible complications and the post-operative period?

A. There is a good chance that a tooth root may be fractured during the extraction, but the site will heal well with time.
B. There is chance that an oroantral (communication between mouth and sinus) fistula may be present and/or created during the procedure, which will negatively impact regional healing.
C. A tumor may be associated with the swelling in the sinus, and a biopsy is needed post-extraction.
D. The loss of 2 maxillary molar teeth will result in an inability to masticate hay; therefore, this horse will require senior pelleted feed for the rest of its life.

Equine Extraction Considerations and Techniques

csuvetce December 17, 2020

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