Extractions are by far the most common oral surgery performed in animals. However, to a veterinary dentist, extraction is often viewed as a defeat. Most teeth are salvageable, but sometimes the degree of disease, health status of the patient, inability of the owner to perform homecare and financial constraints make extraction the best option. Indications include: advanced
periodontal disease, fractured teeth, supranummary (extra) or
crowded teeth, Feline oral resorptive lesions, inflammatory disease, and
orthodontic disease that is causing oral trauma.
For fractured teeth we would generally prefer to perform a root canal procedure and save the tooth. This is especially true of the canines, upper fourth premolars, and lower first molars. These teeth are very important to the patient, and the large size of the roots makes extraction very difficult if the tooth is periodontally healthy. For early oral
resorptive lesions restoration can be an option, but these lesions are progressive. Bases on the severity of the disease, periodontal disease can be treated with surgery, however the owner must be willing to perform home care if this avenue is to be explored.
The first step we perform is to take a dental radiograph of the tooth to ensure that there is no root pathology or aberrant anatomy that would effect the extraction. Extractions are performed by using a dental elevator to fatigue the periodontal ligament enough so that the tooth can be removed easily with extraction forceps. For teeth with more than one root, the tooth is sectioned into single root segments and each root removed as a single root entity. The veterinarian may or may not suture closed the extraction site depending on the size of the hole. Dissolvable suture is typically used so the patient does not need to be sedated for suture removal. I generally recheck my extraction sites two weeks post operatively to ensure that the site is healing well.
Canines that are broken but are periodontally healthy are a very different matter. The roots on these teeth are very large. The root is approximately twice the length of the crown (the area you can see) and larger in diameter. This makes standard extractions very difficult, however not impossible. Generally, I will perform a surgical extraction to save time, effort, and animal discomfort. This procedure entails creating a flap in the gingival tissue on the outside of the tooth to expose the underlying bone. Using a high-speed dental bur, the bone on the outside of the tooth root is removed. Then, the tooth is luxated out of the socket. Finally, the harvested flap of gum tissue is sutured over the extraction site to cover the defect.
X-rays show that the gum had grown over the root tip of a fractured tooth. A flap assisted the extraction of this retained root tip.