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Challenging Cheek Teeth Extractions - Case Discussions
Micaël Klopfenstein Bregger
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In the majority of cases, cheek teeth are successfully extracted with a trans-oral approach in the standing, sedated horse1. Equine practitioners and specialized equine dentists, however, are frequently challenged with technically difficult exodontia. Reasons that complicate exodontia include pre-existing or iatrogenic cheek tooth fracture that deform or de-stabilize the clinical crown (erupted part of the tooth) and reduce the efficacy of the extraction forceps, diverging tooth roots, restricted surgical access to the clinical crown, and more. In these situations, adaptations in technique and/or specialized instrumentation are often necessary to complete exodontia and to limit collateral damage. Here, a selection of challenging cheek teeth extraction cases and the special techniques and equipment used for successful exodontia will be presented. Restoring the clinical crown prior to cheek tooth loosening and extraction attempts can be a valuable technique when extracting cheek teeth with a sagittal fracture. To restore a fractured clinical cheek tooth crown, the fracture gap can be filled with polymethyl methacrylate (PMMA). Partially reducing the fracture gap prior to filling the cleaned gap with PMMA allows for a more efficient use of molar spreaders, thus in- creasing the efficacy of the oral extraction forceps and fulcrum.
This has proven to be a valuable technique in facilitating successful oral extraction in a many cases of molars/premolars with a sagittal fracture2. If all attempts fail to extract a cheek tooth with a strictly trans-oral approach, a minimally invasive transbuccal screw extraction (MITSE) technique has been described3. Although specialized equipment is necessary for this technique, it represents a valuable, minimally invasive alternative for the extraction of cheek teeth with absent or fractured clinical crowns that is usually performed in standing, sedated horses. Furthermore, the same specialized equipment can be used effectively for the loosening and retrieval of residual tooth fragments within the alveolus. […]
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Affiliation of the authors at the time of publication
ISME Equine Clinic and Vetsuisse Faculty, University of Bern
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