In small animal practice tooth extraction is commonly indicated. There are often alternative treatments other than extraction. Alternative treatment is recommended for strategic teeth, i.e., the permanent canine and large posterior teeth, if they are periodontally sound. Treatment by extraction, however, is always preferable to leaving pathology untreated.
Some indications for extraction are:
1. Persistent primary teeth
2. Advanced periodontitis
3. Fractured teeth
4. Teeth with advanced enamel/ dentine destruction
6. Teeth involved with neoplasia or developmental cysts
7. Overcrowding/Supernumerary teeth
8. Teeth involved in a fracture line
There are probably no absolute contra-indications for extraction, but bleeding disorders or clotting defects should be identified since a life threatening haemorrhage can follow extraction in these patients.
There are two basic extraction techniques, namely:
1. Closed - This can be defined as extraction using simple elevation, without the need to remove alveolar bone. The extraction socket is either left open to heal by granulation or it may be closed by suturing the gingiva over the defect to achieve primary healing.
2. Open - This technique is where a mucoperiosteal flap is raised in order to access the alveolar bone. The alveolar bone overlying the buccal surface of the tooth root is usually removed in order to facilitate tooth removal. The mucoperiosteal flap is replaced to close the extraction socket thus allowing primary healing.
The choice of either a closed or open technique will depend on several factors. The most important are:
1. tooth morphology
2. existing pathology
3. operator preference
Irrespective of the type of extraction, it should be performed in a clean mouth, i.e., the teeth should be scaled and polished and the mouth rinsed with a a chlorhexidine solution before starting the extraction procedure.
Extraction should be performed under radiographic control. Pre-operative radiograph to check tooth morphology and assess the extent of the pathology necessitating the extraction are mandatory. The preoperative radiographs will allow determination of the type of extraction procedure indicated. Intra-operative radiographs should be taken if the procedure is not proceeding as planned. Post-operative radiographs are also mandatory, to allow assessment of adequacy of procedure.
Common complications to tooth extraction include:
1. Tooth fracture
2. Jaw fracture
The technical details of tooth extraction (closed and open techniques) will be demonstrated during the presentation.