Extraction chapter
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Multi-rooted Dog Teeth

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Multi-root teeth are more complex to remove due to the strength imparted by two diverging roots.

Begin by taking a pre-extraction radiograph and making a gingival incision as with a single rooted tooth. The general technique is to then reduce the tooth to multiple single roots and then proceed as for single rooted tooth.

 

Flap Creation

Flaps are required to visualise the alveolar bone and root furcation for splitting. Flaps can be of an envelope design, where no releasing incision is made. Envelope flaps stand less chance of severing important blood supply to the flap area. Conversely, they require that we disrupt the gingiva of several adjacent teeth.

An alternative is a mucogingival flap with vertical releasing incisions. Make the releasing incisions on the line angle of the roots of the teeth immediately caudal and rostral to the target. Having the incisions slightly divergent will provide a broader vascular base and, also, allow them to be coronally positioned from the original site.

If releasing incisions are needed, they must be placed off the target tooth or the suture lines may be placed over the void once the tooth is out. This leads to dehiscence.


  Sulcar incision (18 seconds)
     
  Releasing incisions (17 seconds)
     
  Lift full thickness flap (34 seconds)

 

Furcation Exposure

This step is not required if furcation is already exposed.

Remove a semi-circle of bone from the buccal alveolar crest with a small round bur (½ or 1). Once the furcation angle is visible, split the tooth into two (or three) single roots with a Taper Fissure bur (e.g. 701, 669,701L or 700L) working from the furcation towards the crown and not vice versa. This is to ensure that the tooth splits equally.

Remove 1-2mm labial alveolar bony crest circumferentially around the two main roots. Make a small horizontal cut into the tooth roots caudally and rostrally, at the alveolar crest.

  Exposure of furcation (43 seconds)
     
  Explanation of sectioning (18 seconds)
     
  Sectioning caudal and mesiobuccal roots (1 min, 7 seconds, no audio)
     
  Sectioning mesiobuccal and mesiopalatal roots (22 seconds)

 

Luxation

Three main movements are used to fatigue the periodontal ligaments. One, two or all three may be required in any given tooth.

  1. Wedge the two main roots apart with an elevator blade until the periodontal ligament fibres are felt under tension. Hold pressure for 10 seconds. Reverse the angle of the blade and repeat the process. Do this several times until the roots begin to loosen. Take care not to apply excessive pressures and fracture the root tip.

  2. Apply the elevator to the caudal or rostral horizontal cut and, by using the sound neighbouring tooth as a fulcrum (if available), wedge rostrally (or caudally) and upwards. Alternate this process with the opposite root.

  3. Select an appropriate size of luxator or elevator. Apply the luxator blade down the long axis of the root, in an apical direction, until resistance is felt, then rotate blade axially around the root. Also, rotate the blade axially around the root severing the periodontal ligament. Allow haemorrhage to occur. The hydraulic pressure will help push the tooth out of the alveolus.

  Explanation of luxation (15 seconds)
     
  Stressing periodontal ligament using one root as a fulcrum against the other (23 seconds)
     
  Using adjacent teeth as a fulcrum (52 seconds)

 

Removal of Root

Remove the tooth with small forceps using rotational and extrusive force. This force should not be excessive but it is best if it is continuous.

 

Management of Alveolus

Clear sockets of debris by flushing with saline. An alveoloplasty (smoothing the bone crest) is necessary to allow the soft tissues to be sutured over the site without tension. Perform an alveoloplasty to remove bone spicules with a round bur (with water irrigation) or a bone file.

  Alveoloplasty (49 seconds)

A recent trend is to pack large sockets with osseopromotive material (Consil™: Vetoquinol UK) before suturing the soft tissues. This has considerable advantages in maintaining the blood clot and encouraging new bone growth to maintain the alveolar bony ridge. Rapid loss of bone height, once a root or tooth is removed, is prevented. Under optimum conditions, the alveolus will fill with new bone within six weeks. Without the graft, the socket is colonised by a blood clot, followed by fibroblasts.

 

Suture

The gingival tissues should be sutured. The sutured edges should be brought together without tension. Use absorbable single interrupted sutures spaced no more than 1.5mm apart. This is a coronally repositioned flap and should cover the site without tension and should provide the teeth rostral and caudal to the extracted tooth with a gingival collar.

Ensure the flap does not have any tension when sutured. Tension will cause rapid dehiscence. If necessary, under-run the flap until it is loose enough to be placed over the extraction site without any tendency to move back to its original position.

  Irrigation of root alveoli and placement of flap (7 seconds, no audio)
     
  Suturing flap (43 seconds)

 

Post Extraction Radiograph

This confirms that all tooth tissue has been removed and that no collateral damage has been created to adjacent teeth or other structures.

 

 
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