Repulsion of maxillary and mandibular cheek teeth in standing horses

Objective: To report the technique and results of cheek teeth repulsion in standing, sedated horses. Study Design: Case series. Animals: Horses (n=12), ponies (6). Methods: Medical records (2006–2009) of horses that had cheek tooth repulsion while standing were reviewed. Inclusion criteria included: maxillary or mandibular cheek tooth disease diagnosed by clinical and radiographic examination where attempted oral extraction failed necessitating repulsion. Horses were sedated and a local nerve block performed. Intraoperative radiographs facilitated instrument positioning and ensured repulsion of all dental remnants. Alveolar cavities were packed postoperatively and secondary dental sinusitis treated with lavage. Results: Median horse age was 7 years (range, 1–30 years). Maxillary (n=15) and mandibular (5) cheek teeth were removed successfully. One horse was euthanatized 1 week after tooth removal because of concurrent liver disease and 10 horses (59%) had resolution of discharge after the 1st treatment; 41% of extractions required follow‐up medical or surgical treatment to resolve signs [6/12 maxillary sinusitis and 1/5 persistent mandibular drainage]. Conclusions: Standing repulsion of diseased and fractured cheek teeth is an effective means of resolving clinical signs of dental disease when oral extraction fails. Chronic sinus involvement increased the risk of postextraction surgical treatment for sinusitis.     

Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilisation (2011–2016)

Displaced sagittal cheek tooth fractures are a cause of oral pain, quidding and apical infection. Intraoral extraction is the preferred technique to remove affected teeth, but can be difficult due to displaced and friable fracture fragments. Stabilising fracture fragments via filling of the fracture space with polymethymethacrylate (PMMA) prior to removal may be a useful method to facilitate intraoral extraction. Case details were examined retrospectively. A total of 22 cheek teeth required extraction in 20 horses because of displaced sagittal fractures. Clinical diagnoses were made using oral examination, oral endoscopy, skull radiography and computed tomography. All procedures were performed in standing, sedated horses in stocks. Fracture spaces were cleaned and packed with PMMA and teeth removed using a routine intraoral extraction technique. Digital photographs of extracted teeth were taken and tooth measurements calibrated using digital image software. Intraoperative difficulties, as well as post-operative complications were recorded. A total of 21 maxillary and one mandibular cheek teeth were extracted. All maxillary teeth had advanced infundibular caries. Intraoral extraction was successful in 16 cases; six were unsuccessful and required repulsion due to tooth fragmentation or abnormal dental anatomy. In 11 cases, maxillary or conchofrontal sinus trephination was performed to either treat sinusitis, repulse the tooth, or both. Two horses developed short-term complications following local anaesthesia of the maxillary nerve. The mean ratio of fracture depth to tooth length was 0.59 and mean ratio of fracture width to tooth width 0.53. The limitations of the study are its small sample size, retrospective nature and lack of control group to compare extraction success in PMMA and non-PMMA groups. It was concluded that using PMMA to stabilise displaced sagittal fractures in equine cheek teeth is a simple, effective method of facilitating intraoral extraction and may reduce the need for more invasive procedures.     

Transmaxillary anchored silicon embedded gauze plug in the post-operative treatment of a large oromaxillary fistula caused by a supernumerary cheek tooth

A 9-year-old Hungarian sport horse gelding was presented to the clinic in poor condition displaying malodorous bilateral purulent nasal discharge. Oral examination revealed the presence of supernumerary 111 and 211. Bilateral diastema formation between the third maxillary molars and the supernumerary teeth with deep periodontal pockets and massive food impactions were diagnosed endoscopically. Radiography revealed inhomogenous sinus opacities in the left and right paranasal sinuses. Following bilateral oral extractions of the supernumerary cheek teeth and third maxillary molars, bilateral oromaxillary fistula formations were diagnosed (about 17 mm diameter on the right side). Bilateral frontal and right-sided maxillary trephinations and resection of the right bulla of the maxillary septum were performed. Massive food impactions of the left and right paranasal sinuses were removed under endoscopic control. Repeated trans-endoscopic sinus lavage was performed post-operatively. After 2.5 months, the large right-sided oromaxillary communication was temporarily closed with a transmaxillary anchored, gauze-cored silicon plug on an outpatient basis. Follow-up examination after 187 days revealed complete closure of the oromaxillary fistula and absence of sinusitis. In a 1.5-year follow-up control, no pathological conditions were found.     

Head and neck abscessation and thrombophlebitis following cheek tooth extraction in a pony

Due to their long hypsodont reserve crowns, extraction of equid cheek teeth can be difficult and result in more complications than the extraction of their shorter brachydont counterparts although the more recent resumption of oral extraction has greatly reduced such complications. The more common post-extraction sequelae in equids include non-healing alveoli due to retained dental or alveolar sequestrae which may lead to oromaxillary or oronasal fistula formation, chronic external sinus tract formation or osteomyelitis of the supporting bones. Collateral damage to adjacent teeth has also occasionally been reported during dental repulsion. Systemic complications following equine cheek tooth extraction have been infrequently described, including a small number of cases of exodontia-related bacterial meningioencephalitis. This is surprising, as dental manipulation can lead to bacteraemia in many species, including horses. Infections at distant sites related to the spread of dental pathogens have been well described in humans and in small animals. This report describes deep abscessation of the masseter muscles followed by extensive thrombophlebitis of the jugular, facial and rostral cervical veins following oral cheek tooth extraction in a pony affected by pituitary pars intermedia dysfunction (PPID) that was successfully treated by abscess drainage and thrombectomy of the affected veins.     

Chronology and sequence of emergence of permanent premolar teeth in the horse: Study of deciduous premolar ‘cap’ removal in Thoroughbred racehorses

Reasons for performing study: There are few published data to support the ages of emergence of permanent dentition widely reported in horses. Objectives: To clarify the chronology and sequence of permanent premolar (PM) tooth emergence in Thoroughbred racehorses. Methods: A prospective study was undertaken in which records were kept of deciduous PM ‘cap’ extractions performed during routine dental examinations in Thoroughbred racehorses. Mixed effects multiple regression analysis was used to relate the observed ages, measured in days, for PM ‘cap’ extractions simultaneously with different predictive variables. Care was taken to account for clustering of multiple observed outcomes within individual horses. Results: A total of 508 deciduous premolar ‘caps’ were removed from 207 horses, mean ages at removal from PM2, PM3 and PM4 were 35.1, 37.7 and 45.1 months, respectively. Age at which deciduous ‘cap’ removal occurred was associated significantly with tooth row, upper or lower jaw and gender of the horse concerned. There was a significant trend for later ‘cap’ extraction age with more caudal teeth, teeth in the upper jaw and female gender. Conclusions: Age at removal of deciduous premolar ‘caps’ in this population differed considerably from the ages of emergence of permanent dentition reported widely in equine publications. The results provide the first evidence of sexual dimorphism in the eruption of the permanent premolar dentition in horses. These findings strongly support a model of cheek tooth eruption in the horse in which chronology and sequence of emergence are more complex than previously thought, but which is consistent with understanding of tooth eruption in species that have been studied in greater detail. Potential relevance: Abnormalities of cheek tooth eruption are thought to be a factor in the pathogenesis of a variety of dental conditions, and a thorough understanding of the process of eruption is fundamental to the development of rational strategies for prevention and treatment.     

Acute normovolaemic haemodilution in a Clydesdale gelding prior to partial resection of the left ventral concha under general anaesthesia

A 16‐year‐old Clydesdale gelding underwent oral extraction of tooth 210 under standing sedation with partial resection of the left ventral concha under general anaesthesia 4 days later. Due to the highly vascular nature of the surgical site, significant intraoperative haemorrhage was anticipated. A lack of compatible donor horses confirmed by crossmatching prompted an autologous donation of 6 l of blood and acute normovolaemic haemodilution using a gelatine solution immediately prior to surgery. Intraoperative haemorrhage was estimated at 5% circulating volume and autologous transfusion was commenced once haemostasis was confirmed. The horse recovered uneventfully from general anaesthesia and surgery. To our knowledge this is the first report of acute normovolaemic haemodilution used in a clinical equine case.     

Radical surgical resection of locally invasive oro-cutaneous tumors in the buccal region of 2 horses

OBJECTIVE: To report treatment and wound healing after radical surgical mass excision in the equine buccal region. STUDY DESIGN: Clinical case reports. ANIMALS: An 11-year-old Warmblood gelding and a 9-year-old Norwegian Trotter gelding. METHODS: Large tumoral masses were removed from the buccal region by radical electrosurgery, creating large defects into the oral cavity. Wound ultimately healed by second intention. RESULTS: Buccal defects in both horses healed well by second intention without tumor recurrence. CONCLUSIONS: Locally invasive tumors involving the cheek region of the horse can be successfully treated by radical electroexcision alone, creating transmural defects up to 14 cm length x 8 cm height. CLINICAL RELEVANCE: Large transmural defects in the cheek region of the horse, formed by radical surgery can heal satisfactorily by second intention healing without undue discomfort to the patient or major complications.     

Endodontic treatment of a mandibular premolar abscess in a horse: A case study

A pulpar abscess of cheek tooth 307 (according to the Triadan numerical system) was diagnosed in a 7‐year‐old female Quarter Horse. History included a painful response to palpation in the mandibular region for approximately 4 weeks. Symptoms included swelling of the mandibular bone with subsequent fistulisation. A complete intraoral examination was performed and no lesions or abnormalities were found. Digital radiographs of the mandibular arcade demonstrated a periapical lesion of cheek tooth 307. Various therapeutic options were considered, including standing oral extraction, retrograde repulsion and endodontic therapy. Together with the client, a decision was made to perform endodontic therapy, with the double aim of preserving the tooth and maintaining normal molar occlusion. This was done under general anaesthesia without apicectomy, and using materials commonly used in the field of human endodontics. Following surgery, radiographs were taken and confirmed the complete sealing of the pulp canals. Recovery was uneventful and no post operative complications were observed. A complete intraoral follow‐up examination was performed one year after surgery, and revealed normal eruption and occlusion of the tooth involved. Radiographic examination confirmed the correct position and integrity of the sealant material, as well as normal perialveolar bone structure. This case report indicates that endodontic therapy, following the above protocol, involving pulpectomy and sealing of the pulp cavity, represents a valid alternative to the more commonly used technique of tooth extraction.     

The relationship between cheek tooth occlusal morphology, apparent digestibility, and ingesta particle size reduction in horses

OBJECTIVE: To investigate potential relationships between cheek tooth occlusal morphology, apparent feed digestibility, and the reduction in feed particle size that occurs during digestion in horses. DESIGN: Cross-sectional study. ANIMALS: 17 horses of various ages and breeds and either sex. PROCEDURES: Horses were fed 1 of 3 hay-based diets ad libitum for 14 days prior to euthanasia; nutrient analysis was performed on samples of each of the 3 diets. At the time of postmortem examination, the head was disarticulated, photographs were taken of the occlusal surfaces of the maxillary and mandibular cheek tooth arcades, and samples of stomach and small colon or rectum contents were collected for determination of apparent feed digestibility and particle size determination. An overall oral pathology score was assigned, and morphologic features of the occlusal surfaces of the cheek tooth arcades were determined. RESULTS: Results of nutrient analyses did not differ among the 3 hay diets, and there was no significant difference in apparent feed digestibility among diets. Feed particle size differed significantly among the 3 diets, but stomach content and fecal particle sizes did not differ among diet groups. No significant correlations were identified between cheek tooth morphologic variables and feed digestibility, and fecal particle size was not significantly associated with oral pathology score. CONCLUSIONS AND CLINICAL RELEVANCE: Results did not provide any evidence of associations between cheek tooth morphologic variables, fecal particle size, and apparent digestibility in horses.     

Endodontic disease of the mandibular first molar tooth secondary to caudal crossbite in a young Shetland sheepdog

A six month-old intact female Shetland sheepdog was referred to the University of Illinois Veterinary Dental Clinic with a left-sided mandibular deviation and a thickened left ventral mandible in the region of the first molar tooth. On oral examination, left caudal crossbite was diagnosed. Dental radiographs revealed endodontic disease of the mandibular first molar tooth involved in the crossbite. Because of the difficulty of treating caudal crossbite and the potential of a pathological mandibular fracture, the endodontically affected tooth was extracted. Ten months following the extraction, mandibular deviation and alveolar bone lysis were resolved, but alveolar ridge resorption was present. The abnormal occlusal relationship caused by the caudal crossbite may have led to movement of the tooth, resorption of the tooth alveolus, and irreversible pulpal damage. Although not employed in this case, use of alveolar ridge preservation techniques can prevent mandibular bone loss after extractions.     

Survival of an adult Quarter Horse gelding following bacterial meningitis caused by Escherichia coli

Bacterial meningitis in the mature horse is a rare and typically fatal condition. This report describes a 7‐year‐old Quarter Horse gelding that initially presented following suspected trauma to the left eye but subsequently developed bacterial meningitis, and a nasal and palpebral abscess, all of which cultured the same isolate of Escherichia coli. The entry site of infection in bacterial meningitis is often related to a breach in the calvarium and extension of bacteria residing in the paranasal sinuses. This case is unique as there were multiple pathways through which bacteria may have entered the central nervous system including haematogenous spread from a nasal abscess, local extension of periocular infection or an undetected skull fracture. Aside from persistent blindness in the left eye, the horse made a full recovery.     

Actinomyces endogenous endophthalmitis in a cat following multiple dental extractions

An 8‐year‐old, brachycephalic, mixed breed cat underwent full mouth tooth extractions for the treatment of tooth root abscessation. Subsequently, the cat developed anterior uveitis refractory to topical therapy that eventually necessitated enucleation. Actinomyces species were isolated from both the tooth root abscesses and the anterior chamber after enucleation. Histopathology of the enucleated eye revealed panophthalmitis with abundant intralesional bacteria morphologically consistent with Actinomyces. Between the time of tooth root extraction and enucleation (20 weeks), the cat was diagnosed with hyperthyroidism and treated with oral steroids for inflammatory bowel syndrome. We believe this report represents a rare case of endogenous endophthalmitis secondary to dental disease, possibly precipitated by concurrent immunosuppression.     

Oral endoscopy as an aid to diagnosis of equine cheek tooth infections in the absence of gross oral pathological changes: 17 cases

Reasons for performing study: Removal of cheek teeth in all but the aged horse or pony is a serious undertaking with potentially deleterious sequellae. Rigid endoscopy permits detailed examination of the oral cavity and erupted dental tissues and has the potential to assist in the correct identification of the diseased tooth. Objectives: To document oral endoscopic findings associated with infected equine cheek teeth in cases without gross oral pathological changes and thereby determine the usefulness of rigid oral endoscopy as an aid to diagnosis of such infections. Methods: Records of all cases of equine cheek tooth removal attempted under standing sedation over a 38 month period were examined. Cases were excluded from the study if apical infection was associated with gross dental fracture, malalignment, diastema/periodontal pocketing or supernumerary teeth. Endoscopic and radiographic findings were analysed and correlated to diseased tooth location. Results: Seventeen cases of apical dental infection fitting the inclusion criteria (nonresponsive to antibiotics and with no gross oral abnormality of the affected arcade) were identified in which oral endoscopy was used as an aid to diagnosis. In 15 (88%) of the 17 cases, oral endoscopy revealed abnormalities specific to the infected tooth. Focal gingival recession (10/17 cases) was the most common visible abnormality associated with infected teeth. Conclusions: In the majority of cases of apical infection of equine cheek teeth there is visible intraoral evidence implicating the affected tooth. Potential relevance: Oral endoscopy facilitates detailed examination of the mouth and should be considered along with radiography as an important aid to diagnosis in cases of equine dental infection.     

Extraction techniques

Dental extractions are a very common veterinary procedure. As common as they are, they are not a simple undertaking and should be approached with the same depth of preparation as any other surgical procedure. Regardless of size of the tooth, all extractions start with the 9 steps used for simple single-root extractions. These are: obtain consent, expose a dental radiograph, obtain proper lighting and visualization, administer proper pain management, cut the gingival attachment, elevate carefully, remove the tooth, perform alveoplasty, and close. Multi-root teeth require sectioning into single-rooted pieces, which are then treated as single-root extractions. Finally, some extractions (especially canine and carnassial teeth) are better performed after the creation of gingival flaps and removal of bone to ease the extraction process.     

Histologic and micro-computed tomographic evaluation of the osseointegration of a nonresorbable bone substitute in alveoli of ponies after tooth extraction

OBJECTIVE: To evaluate the biological behavior of a nonresorbable bone substitute (NRBS) in the alveoli of ponies, compared with tissue quality in naturally healing alveoli, after cheek tooth extraction. ANIMALS: 5 clinically normal ponies. PROCEDURES: In each pony, both maxillary fourth premolars (Triadan 108/208) were repulsed bilaterally during anesthesia. One randomly chosen alveolus was filled with NRBS and isolated from the oral cavity by use of dental impression material and a spring-wire retention device. The other alveolus was occluded in its occlusal third portion with dental impression material. One year after surgery, cylindrical lateromedial biopsy specimens were collected from the apical, middle, and occlusal level of each alveolus. Biopsy samples were evaluated for bone mineral density and bone volume via micro-computed tomography; qualitative histologic characteristics were evaluated via light microscopy. RESULTS: Bone mineral density and bone volume were greater in control alveoli, compared with NRBS-treated alveoli. Control alveoli were characterized by the presence of few mature bone trabeculae and wide spaces containing fat tissue and mesenchymal stroma. In treated alveoli, biocompatibility and osteoconductive properties of the NRBS were excellent; continuous bone formation and bone remodeling were also evident. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the NRBS was integrated well in calcified alveolar tissues in ponies 1 year after maxillary cheek tooth extraction. Further research is necessary to establish the benefits of this NRBS in the development of a dental implant surgical technique in equids.     

True cementomas (cementoblastomas) associated with a nonvital left maxillary second premolar in an 11‐year‐old miniature horse

An 11‐year‐old miniature horse gelding presented for a left maxillary facial swelling and surgical removal of 2 ovoid mineralised masses located near the tooth roots of the left maxillary second and third premolars. Preoperative radiographs were performed to triangulate the location of the calcified masses for removal, and an oral examination revealed that the left maxillary second premolar was nonvital with multiple feed‐packed pulp exposures. Both the radiographs and oral examination indicated that the mineralised masses were associated with the nonvital second premolar. Therefore, the tooth was extracted intraorally, and the masses were removed via a maxillary trephine dorsal to the extracted tooth. Both masses were submitted for histopathology, which diagnosed the masses as true cementomas (cementoblastomas) with adenomatous hyperplasia of the surrounding nasal glandular tissue.     

Use of a synthetic bone substitute to retard molariform tooth drift after maxillary tooth loss in ponies

OBJECTIVE: To evaluate the effect of alveolar bone substitute on post-extraction drift of maxillary cheek teeth in ponies. STUDY DESIGN: In vivo longitudinal experimental study. ANIMALS: Five ponies (5-7 years) with a healthy dentition. METHODS: Both maxillary 4th premolar teeth (Triadan 08) were surgically removed. One alveolus was filled with a biocompatible non-resorbable bone substitute (Bioplant 24), whereas the other healed by second intention. A polyvinylsiloxane plug and spring wire isolated the bone substitute from the oral environment. Pathologic changes to dentition and adjacent soft tissue were recorded. Tooth drift was calculated after 1 and 2 years. RESULTS: At 1 month, bone substitute material was incorporated into healthy tissue. Tooth drift was observed but differed significantly between control and treated sides at 2 years (P<.01). For both techniques, tooth drift differed significantly between years 1 and 2 (P<.001). Total drift in control arcades for year 1 was 10.69+/-2.12 mm and for year 2 was 9.08+/-0.87 mm, whereas for bone substitute arcades it was 9.90+/-1.60 mm for year 1 and 5.60+/-1.78 mm for year 2. CONCLUSIONS: Partial tooth replacement therapy after maxillary P4 extraction provided good healing in the immediate post-surgical phase. Alveolar filling with bone substitute material significantly slowed post-extraction tooth drift but did not stop it completely. Clinical Relevance- Important changes occur in equine dentition after maxillary cheek teeth removal. Further longer term observations are needed to fully validate study findings.     

Evaluation of the long-term oral consequences of equine exodontia in 50 horses

The aims of this study were to objectively evaluate and quantify the process of post-extraction cheek teeth (CT) dental drift in horses, and to report on associated disorders of CT wear and long-term periodontal health. Fifty horses that had CT oral extraction because of apical infection were prospectively re-examined and a full oral examination, including measurements of some dental parameters, was performed.Narrowing of the extraction space was noted in all cases with complete closure occurring in 18% of horses. The rate of dental drift was calculated as 15.7% of extraction space/year (range 4–50%) and was not associated with the age at extraction (P = 0.78) or frequency of dental care since extraction (P = 0.48). There was a significant negative relationship between the rate of dental drift and the duration of time since extraction (P = 0.008). Overgrowths were present on the opposite CT row in 98% of horses, including opposite the extracted CT and on the Triadan 06s and 11s. No significant difference was noted in either the number of diastemata (P = 0.9) or periodontal disease score (P = 0.8) between the extraction and the contralateral cheek tooth rows.     

Evaluation of periodontal changes following intra-alveolar prosthesis for maxillary cheek tooth extraction in ponies

This study investigated the placement of an intra-alveolar prosthesis of bone substitute on gingival/periodontal health in 5 ponies following repulsion of cheek teeth 108 and 208. In each pony, one randomly chosen alveolus was allowed to heal by second intention while the other was filled with a non-resorbable, biocompatible bone substitute. At 6, 12 and 24-months after surgery, both maxillary arches were evaluated for wear abnormalities and for gingival health using a periodontal scoring system. Recorded changes included development of overgrowths on mandibular cheek teeth, widening of maxillary interproximal spaces due to tooth drift with subsequent food accumulation, gingivitis, and subgingival pocket formation. Diastema formation initially occurred between the maxillary 06 and 07s but resolved after 24-months, whereas the diastemata that developed between the maxillary 09 and 10s remained. It was concluded that maxillary cheek teeth extraction induced progressive changes in the position of adjacent teeth that caused periodontitis. The use of a bone substitute prosthesis in the alveolus did not prevent the development of periodontal disease.     

Bone abscess in the mandible of a quarter horse gelding

A 4-year-old Quarter horse gelding presented with a swelling in the soft tissues over the junction of the body and ramus of the left mandible. Radiography showed a well circumscribed lytic area within the mandible surrounded by sclerosis unassociated with any tooth. Aspiration of the lesion yielded pus. The abscess cavity was opened, curetted and lavaged. A Penrose drain was placed in the abscess cavity for 10 days. Bacteriological culture of the exudate and soft tissues from the abscess produced a few colonies of Staphylococcus intermedius. Histopathology showed chronic pyogenic infection. The horse recovered well and was normal 1 year after treatment.