Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids.
Authors: Langeneckert Frederik, Witte Thomas, Schellenberger Frank, Czech Christian, Aebischer David, Vidondo Beatriz, Koch Christoph
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Minimally Invasive Transbuccal Screw Extraction for Equine Cheek Teeth Cheek tooth removal in horses frequently becomes complicated when conventional oral extraction fails—a situation the authors encountered in 95% of their 58 extraction cases, most commonly due to crown fracture or insufficient clinical crown height for forceps purchase. The minimally invasive transbuccal screw extraction (MITSE) technique employs intradental screw placement and extraction through the buccal mucosa rather than extensive surgical flaps, and this retrospective review of 54 equids (50 horses, 3 ponies, 1 mule) assessed its safety and efficacy as an alternative to traditional repulsion or buccotomy. Complete removal of the entire tooth structure was achieved in 47 of 58 procedures (81%), with the 11 failed extractions successfully managed by repulsion in 10 cases, and perioperative morbidity remained low: only 7% experienced transient facial nerve paralysis and 7% had bleeding complications, with 98% of owners reporting satisfaction with both functional and cosmetic outcomes at follow-up beyond six months. For the equine practitioner, MITSE represents a valuable middle ground between non-invasive oral extraction and more invasive surgical approaches, particularly when dealing with fractured teeth, limited crown exposure, or cases where conventional methods have already failed. The technique's favourable safety profile and success rate merit consideration in any practice managing complex cheek tooth pathology, though practitioners should be prepared for the possibility of requiring repulsion in approximately one-fifth of cases.
Read the full abstract on PubMed
Practical Takeaways
- •MITSE is a viable minimally invasive alternative when traditional forceps extraction fails or is impossible, particularly for fractured or subgingival cheek teeth
- •Expect an 81% success rate for complete extraction with this technique; plan for possible repulsion in about 1 in 5 cases
- •Complication rates are low (7% bleeding, 7% transient facial nerve paralysis) and compare favorably to more invasive buccotomy or repulsion approaches, with high owner satisfaction
Key Findings
- •MITSE successfully removed entire targeted dental structure in 47/58 (81%) procedures, with 91% of failures resolved by subsequent repulsion
- •Short-term complications were low: bleeding occurred in 7% of procedures and transient facial nerve paralysis in 7% of procedures
- •Previous conventional oral extraction had failed in 95% of cases (55/58), primarily due to cheek tooth fracture (28) or insufficient clinical crown (27)
- •Owner satisfaction with functional and cosmetic outcome was 98% (40/41 animals with follow-up)