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Imported Study Blue Equine > export_chapter 20 exodontia > Flashcards

export_chapter 20 exodontia Flashcards

1
Q

When is an intraoral approach for equine cheek tooth extraction not possible?

A
  • when crown of tooth can’t be grasped such as: Reserve crown fractured, clinical crown brittle dt caries, when reserve crown so large from cemental hyperplasia or dental tumor cant traverse the alveolua
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2
Q

What are two extraoral approaches to equine tooth extraction?

A
  • repulsing into oral cavity with mallet and punch

- buccotomy after removing lateral plate of alveolar bone

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3
Q

Are retained deciduous incisors in a horse a problem?

Where are they usually located?

A
  • cosmetic only

- rostral to adult

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4
Q

Are supernumerary incisor teeth usually a problem in horses?

What happens to gap in teeth when incisor tooth extracted?

A
  • cosmetic only

- teeth realign and gap dissapears

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5
Q

Are supernumerary incisors difficult or easy to extract in horse?
Why?

A
  • difficult

- long reserve crown and close proximity to other teeth.

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6
Q

What should be done for an avulsed equine incisor?

Avulsed equine incisor with some gingival attachments?

A
  • extraction

- debridement and reduction of fracture w/ immobilization

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7
Q

What are 4 indications for extracting equine canine teeth?

A
  • severe periostitis from bit injuries
  • fractured tooth or fracture alveolus
  • resorptive lesions
  • hypercementosis syndrome
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8
Q

Why is extracting equine canine teeth not recommended unless absolutely necessary?

A
  • tongue will spill out which can affect performance if show horse
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9
Q

Why are equine canine teeth extractions difficult?

What nerve can be damaged?

A
  • long curved alveolus

- mandibular alveolar nerve

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10
Q

What tooth is the equine wolf tooth?

Are they more common in mandible or maxilla?

A
  • first premolar

- maxilla (rare in mandible)

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11
Q

What percentage of horses have maxillary wolf teeth?
Are they always bilateral?
When do they erupt?

A
  • 40-80%
  • often only one
  • 6 and 18 months
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12
Q

Where are wolf teeth usually located?

A
  • variable: rostral to second PM, buccal, palatal or close to canine
  • subgingival
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13
Q

What is problem with subgingival wolf tooth?

A
  • occasionally associated with gingival ulceration, discomfort when contacted by bit
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14
Q

Why have wolf teeth traditionally been extracted?

Is this necessary?

A
  • large, molarized, aberrantly placed
  • entrapment of buccal mucosal fold of commisure of lips–> bitting problems
  • difficulty in floating second PM
  • not sure about 2 and 3
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15
Q

What has traditionally been used to extract wolf teeth?

What works better?

A
  • burgess elevator

- small curved periodontal elevator (more precise and effective)

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16
Q

Should mandibular wolf teeth be extracted?

A
  • probably-cause bit discomfort
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17
Q

When should deciduous teeth be removed?

When should they not be removed? Why not?

A
  • periodontitis from entrapped food
  • painful remnant in interproximal space
  • if gingival attachments intact b/c underlying permanent tooth may not be doen forming
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18
Q

What are complications associated with repulsion of equine cheek teeth?
What are complications of extraction through buccotomy?
What is preferred technique? Why?

A
  • dental or osseous sequesta
  • oro-antral fistula
  • Damage to branches of the dorsal buccal nerve or the parotid salivary duct.
  • per os. cheaper, probably easier
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19
Q

Why is extraction per os often cheaper than repulsion or buccotomy?

A
  • usually can be done with standing sedation
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20
Q

Which teeth are the most difficult to extract in the horse?

A
  • caudal (10s and 11s)

- young horses with long reserve crowns and little period dz

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21
Q

Do all fractured teeth need to be extracted?

A
  • no if no evidence of apical infection
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22
Q

Which tooth is the most commonly fractured tooth in the horse?
What is typical configuration of fractured tooth in the horse?

A
  • maxillary 09
  • parasagital lateral slab that is easily removed
  • larger non displaced parent fragment that doesn’t need to be extracted if exposed pulps not sealed off and no apical infection present
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23
Q

What is possible problem with a diseased maxillary tooth?

How is this treated?

A
  • inspisated exudate in sinus

- osteoplastic flap to remove exudate

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24
Q

Who first described per os extraction in horse?

A

O’Connor 1942, Guard 1951

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25
Q

Between which teeth should spreaders be used gently?

A
  • 06 and 07 when extracting 07

- 10 and 11 when extracting 10

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26
Q

How long do you keep a molar separator in place?

A
  • 5 minutes each side
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27
Q

Which equine cheek teeth are are narrowest?

A
  • mandibular
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28
Q

How are equine molar extractors used?

A
  • placed on tooth being careful not to overlap teeth
  • Handles fixed with rubber bandage or locking mechanism
  • moved in slow, low amplitude, horizontal, to and fro oscillation along longitudinal axis of tooth (check after first few to make sure hasn’t slipped)
  • gradually increase amplitude as tooth loosens
  • when squelch heard, apply fulcrum, advance caudally - apply firm steady pressure
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29
Q

What can cause teeth to fracture during extraction?

A
  • torsional movement along axis of extractor handles

- excessive force, or too wide of an arc

30
Q

How long does it take to extract a cheek tooth?

A
  • an hour or more
31
Q

What is done after a cheek tooth is extracted?

A
  • curette any fragments with an angled currette

- pack with polysiloxane putty, dental wax, metronidazole paste (packing extruded as tooth heals)

32
Q

What happens if the tooth breaks during extraction and leaves an apical fragment?

A
  • try to elevate per os using long, right-angled elevators and extracted with long right angled elevators
  • if can’t be extracted per os, repulse using a special root fragment punch or a steinman pin
  • extract via buccotomy
33
Q

How do you extract a root fragment via osteotomy?

A
  • create 4 mm osteotomy over retained fragment with Steinman pin or drill bit
  • repulse fragment with Steinman pin or root fragment punch
  • clean alveolus with spoon currette, then irrigate
  • leave skin incision to heal by second intention
34
Q

How do you extract a root fragment via buccotomy?

What are risks with this method?

A
  • make stab incision at level of alveolus, insert elevator, elevate, extract per os
  • can damage facial nerve or parotid salivary duct or could innoculate subQ tissues with bacteria
35
Q

What should be done if parasinuses are infected?

What if alveolus communicates with parasinuses?

A
  • debride through osteoplastic maxillary or frontonasal flap or trephine hole or lavage through catheter and small trephine hole
  • seal off with polysiloxane putty or PMM bone cement
36
Q

If plug is inserted into alveolus after extraction where should it be?
What is purpose of plug?

A
  • coronal 1/3, flush with gingival margin

- to prevent food impaction

37
Q

What are potential complications of per os extraction?

A
  • fracture of tooth w/ retained fragment
  • damage to healthy adjacent teeth
  • fractured jaw
  • feed impaction
  • oroantral fistula
  • alveolar bone sequestra dt microfracture
38
Q

How are oro-antral or oronasal fistulas treated?

A
  • debride dental or osseus fragments
  • remove food and exudate
  • seal the oral aspect with an acrylic plug, mucoperiosteal flap, transposted muscle belly
39
Q

What are the two surgical extraction techniques in the horse?

A
  • repulsion

- buccal flap and partial alveolar osteotomy

40
Q

Why is repulsion not good way to extract teeth?

A
  • high incidence of complications
41
Q

What should be done before extracting a tooth by repulsions?

A
  • Use forceps per os to disrupt ligament as much as possible
42
Q

How is tooth extracted through repulsion in the horse?

A
  • expose apex through trephination, drill bit, bone saw or chisel/osteotome OR frontonasal or maxillary osteoplastic flap if completely within maxillary sinuses 09-11s
43
Q

How do you find the root apex for repulsion of 2nd or 3rd premolars?
How do you find the root apex for repulsion of 08-11?
What is best way to find root apex?

A
  • center of clinical crown
  • caudal contact of tooth if 9
  • radiographs
44
Q

Is anesthesia or sedation used for repulsion of horse teeth?

A
  • anesthesia
45
Q

When performing osteotomy for repulsion, what teeth may result in damage to infraorbital n or facial artery?
What structures may need to be reflected for 309, 409?

A
  • 06-08

- facial a and v and parotid salivary duct

46
Q

Which teeth require an osteoplastic flap through the paranasal sinuses?

A
  • 09-11
47
Q

What imaginary line is used to find level of osteotomy?
Ventral or dorsal to this line?
If horse is less than 8 years old?
If horse is old where should dorsal aspect of a maxillary osteotomy be?
If horse is young where should ventral aspect of osteotomy be?

A
  • course of the nasolacrimal duct–medial canthus of eye to infraorbital foramen
  • ventral
  • close to the line
  • close to the facial crest
  • at border of mandible
48
Q

After making incision or flap in skin, what are next steps in repulsing and equine tooth?

A
  • remove periosteum
  • create osteotomy 1.5 x 2 cm trephine or 0.95-2.7 cm drill
  • expose apex with bone curette or rongeur
  • transect apical end of tooth
  • seat punch
49
Q

Where should trephine hole be created for Maxillary M1?

- M2?

A
  • paranasal sinus midway between rostral end of facial crest and point on crest at level of medial canthus, 1 cm ventral to line btween io foramen and medial canthus
  • paranasal sinus rostroventral to ventral orbital rim (varies with age)
50
Q

What is the triple trephine technique?

A
  • one hole dorsomedial to the medial canthus of eye to place punch on apex of tooth
  • second hole ventrorostral to medial cnathus to guide punch onto apex and allow post op explore of alveolus
  • third hole at agnle formed by orbit and faical crest to place catheter into sinus for post op lavage.
51
Q

How can maxillary sinus of old horses be accessed?

What is disadvantage?

A
  • maxillary or frontonasal flap

- have to reopen to monitor healing or to currette alveolus (vs. unsutured trephine hole)

52
Q

How is apex of M3 exposed?
What kind of punch must be used?
Why?

A
  • trephine hole in frontal bone or frontonasal osteoplastic flap
  • offset
  • root is below orbit and caudally curved
53
Q

How is mandibular 10 or 11 removed?

A
  • incise ventral aponeurosis of masseter, reflect masseter
54
Q

How should punch be aligned and what is problem if unable to do this?

A
  • along axis of tooth

- if oriented obliquely need more force and more likely to result in sequestra

55
Q

Should a tooth be transversely sectioned as it is repulsed?

A
  • No-should not be necessary
56
Q

How should alveolus be treated after repulsion of a equine tooth?

A
  • coronal 1/3 plugged
  • if left unsutured rolled gauze impregnated with dilute povidine-iodine packed into the apical aspect prior to plugging the coronal apect then gauze gradually remove
57
Q

How do you keep a maxillary PM2 plug or plug of two adjacent teeth in place?

A
  • mesh with wire
58
Q

How do you lavage paranasal sinuses after repulsion of maxillary 10 or 11?
How does fluid exit?
How often should this be done?

A
  • trephine hole into conchofrontal or caudal maxillary sinus. Trephine hole into conchofrontal sinus 2-3 cm medial to madial canthus, trephine hole into caudal maxillary sinus through straight incsion 1.5 cm ventral to ventral lid of eye
  • insert foley catheter, flush with isotonic saline or povidone-iodine
  • through nasal cavity via nasomaxillary aperture
  • 1-7 days
59
Q

What are complications associated with extracting a cheek tooth by repulsion?
What is most common?
What increases risk?

A
  • damage to other teeth, io or mandibular nerve, palatine bone, medial or lateral lamina of mandible or maxilla
  • early loss of plug->contaminated alveolus or paranasal sinus
  • oro antral fistula
  • damage to nasolacrimal duct, parotid salivary duct, IO n, palatine a
  • chronic draining tract from sequestra
  • most common is sequestra
  • more caudal, more complications
60
Q

What tooth cannot be removed by buccotomy?

A
  • 11s
61
Q

Does buccotomy require anesthesia?

What are advantages of buccotomy?

A
  • yes

- more controlled disruption of PDL

62
Q

Which teeth are accessed by vertical buccotomy incision?

Horizontal?

A
  • 09, 10

- 06-08

63
Q

Where is incision for horizontal buccotomy made?

Where is vertical buccotomy incision made?

A
  • curvilinear skin incision centered over the tooth at level of tooth’s gingival reflection in the buccal cleft
  • parallel to the linguofacial artery and vein
64
Q

Why are mandibular first and second molar teeth accessed with vertical incision?

A
  • to avoid the linguofacial artery and vein and the parotid salivary duct
65
Q

What nerves can be damaged when removing maxillary teeth via buccotomy?
mandibular?

A
  • dorsal buccal branch of facial nerve

- ventral buccal branch of facial nerve

66
Q

Where is maxillary buccotomy incision made with respect to parotid papilla?
Where is mandibular buccotomy incision made with respect to parotid papilla?
- what is landmark for the parotid papilla?

A
  • dorsal
  • ventral
  • rostral aspect of 108/208
67
Q

What structures are encountered during deep dissection of tissue for buccotomy?

A
  • ventral buccal glands, buccal venous plexus
68
Q

What vessels make up the buccal venous plexus?

A
  • labialis communis, labialis maxillaris, labialis madinulars vv,
69
Q

What are the steps for a buccotomy once the oral mucousa is incised?

A
  • gingival flap
  • incise periosoteum and reflect
  • incise buccal alveolar bone parallel to long axis of tooth with oscillating saw, surgical fissure burr or sharp chisel, remove plate
  • elevate (split tooth longitudinally or transect transversely first)
  • pack alveolus with gauze and put through adjacent stab incision
  • suture flap or leave open
  • close buccotomy in 3 layers
70
Q

How much lateral wall is removed in buccotomy procedure to expose apical end of tooth?

A
  • 2/3
71
Q

What are complications of horizontal or vertical buccotomy extractions?
How common are complications?

A
  • damage to ventral or dorsal buccal nerve or parotid salivary duct
  • temporary facial nerve paralysis from trauma to dorsal buccal branch of facial nerve
  • partial dehiscense
  • one study only 1 out of 44 needed second surgery

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