Complications Compared for Cheek Teeth Extractions

Oral extraction of cheek teeth had the lowest risk of complications compared with other extraction techniques, according to a recent study.

In a retrospective study, veterinarians at the University of Edinburgh Veterinary School in the United Kingdom looked at the complications of equine cheek tooth exodontia techniques. They reviewed the clinical records of all cheek teeth extractions performed at the university between February 2004 and September 2018.

Afterward, owners were asked to complete a followup questionnaire regarding complications.

In all cases, oral extraction was initially attempted prior to Steinman pin repulsion or minimally invasive transbuccal extraction (MTE). A total of 428 cheek teeth extractions were performed over the study period, 58 (13.6%) of which had complications post-extraction.

The most frequent complication was the forma tion of intra-alveolar bony sequestra (32/58). The most severe post-extraction complications were seen in 4 horses that had swollen mandibles pre-extraction due to apical infections, which went on to develop severe mandibular osteomyelitis post-extraction. Two horses developed sinusitis following maxillary cheek teeth exodontia.

Overall, the complication rate was 10.8% for oral extraction, 24.4% for Steinmann pin repulsion, 20% for standard repulsion and 25.6% for MTE.

Post-extraction complications caused a longerterm clinical problem in 34/428 (7.9%) of horses and were asymptomatic or quickly self-resolving in the other 24 (5.6%) cases.

The risk of developing a post-extraction alveolar disorder was increased following extraction of the mandibular 06s, 07s or 08s compared with all other cheek teeth combined (P=0.001); for cheek teeth with apical infections (P=0.002) compared with those without; and following repulsion or minimally invasive transbuccal extraction (MTE) than following oral extraction (P=0.01 and P=0.02 respectively).

Improved knowledge of the prevalence, types and risk of development of post extraction complications may help reduce these complications, the researchers said.

Figure S4: (Left) Oral endoscopy of the alveolus that has now developed mandibular osteomyelitis with sequestration 10 weeks post extraction. The left image shows the non-healing alveolus containing debris andfibrin with exposed white-colored, alveolar bone on its buccal aspect(arrow). (Right) At 16 weeks post extraction, the alveolus has healedexcept for a midline cleft that is draining purulent material. Used with permission.

Source: Courtesy of the Equine Veterinary Journal

For more information: Kennedy R, Reardon RJR, James O, et al. A long-term study of equine cheek teeth post-extraction complications: 428 cheek teeth (2004- 2018). Equine Vet J. 2020 March 6 (Epub ahead of print). https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13255