Equine exodontia: techniques, complications and current outcomes

The traditional technique of exodontia used for most of the 20 =^th century was repulsion, initially in cast horses and later under general anaesthesia^1,2 . Many cheek teeth apical infections (most caused by blood-borne infections, i.e. anachoresis) develop in younger horses that can have 7 to 8 cm of attached reserve crown with just localised pathological changes around the apex of the tooth with the remaining periodontal membranes being healthy and strong. Consequently, great mechanical force is required to repulse such teeth into the oral cavity. The repulsion procedure invariably fractures the apical aspect of the tooth, allowing parts of the tooth to be retained in the alveolus. Trauma from the repulsion technique can also cause fractures of the alveolus, including by incorrect angulation of the punch. Additionally, many cases developed delayed alveolar bone sequestration, likely due to traumatic damage to its blood supply during the repulsion procedure. Consequently, the chronically infected alveoli can cause external sinus tracts in the mandible or the rostral maxilla, persistent paranasal sinusitis, or oro-maxillary or oro-nasal fistula formation. Other complications include dehiscence of the repulsion site wounds and fracture of adjacent healthy teeth^1,2,3,4 . Many cheek tooth repulsion cases required a second general anaesthesia to treat the above sequelae that increased the chances of general anaesthetic related morbidity or mortality as well as increasing costs. [...]