Equine cheek tooth extraction: Comparison of outcomes for five extraction methods.

Authors: Caramello V, Zarucco L, Foster D, Boston R, Stefanovski D, Orsini J A

Journal: Equine veterinary journal

DOI: 10.1111/evj.13150 PubMed: 31260572Log in to save

Summary

# Editorial Summary: Equine Cheek Tooth Extraction Methods When a cheek tooth requires extraction, practitioners must balance the likelihood of success against post-operative morbidity—yet comparative data on extraction methods have been limited until now. This retrospective analysis examined 162 cheek tooth extractions across five techniques (oral extraction, tooth repulsion via maxillary trephination, mandibular trephination, or sinus bone flap, and lateral buccotomy) in 137 horses treated between 1997 and 2013, using logistic regression to quantify complication rates and identify method-specific risks. Oral extraction emerged as significantly superior, succeeding in 71% of attempts with only 20% post-operative complications, whereas repulsion by sinus bone flap carried an alarming 80% complication rate and substantially elevated risks of adjacent tooth damage, sinusitis, orosinus fistulation, and delayed healing. Repulsion by maxillary trephination (42% complications), mandibular trephination (54%) and lateral buccotomy (53%) occupied an intermediate position, though the latter notably increased facial nerve neuropraxia risk, and all repulsion methods showed higher pyrexia rates. For practitioners selecting extraction methods, these findings strongly support standing oral extraction as the first-line approach, with the caveat that some complication rates were based on small sample sizes and that contemporary refinements to oral extraction technique may further improve the already-favourable outcomes reported here.

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Practical Takeaways

•Attempt standing oral extraction first—it has the best safety profile and should remain your first-line choice for cheek tooth removal
•If surgical extraction is necessary, avoid sinus bone flap technique due to high complication rates; maxillary/mandibular trephination or lateral buccotomy are safer alternatives
•Be prepared for post-operative fever in repulsion cases and monitor closely for sinusitis and orosinus fistulation, particularly after sinus bone flap procedures

Key Findings

•Oral extraction was successful in 71% of attempts and had the lowest complication rate at 20%, compared to 42-80% for surgical methods
•Repulsion by sinus bone flap had the highest complication rate (80%) and significantly increased risk of sinusitis, orosinus fistulation, and damage to adjacent teeth
•Lateral buccotomy significantly increased odds of facial nerve neuropraxia; maxillary trephination increased superficial incisional surgical site infections
•Post-operative pyrexia was more common across all repulsion methods compared to oral extraction

Conditions Studied

cheek tooth disease requiring extractionpost-operative complications following tooth extraction

Related References

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