Removing a canine from a dog

RE: Removing a canine from a dog

Luke Bam — Wed, 06 Oct 2021 21:33:36 GMT

Definitely feel your pain. Had a similar case with a Labrador last week where a supposedly straight forward 104 extraction took an exceptionally long time. Can I ask though, did you radiograph the tooth first? In my case, this particular canine radiographically had a much less well defined PDL than normal which was the case for a number of other teeth too. On questioning the owner, the dog had some facial trauma a few years ago which resulted in the (sub)luxation of multiple teeth so i guess this could have contributed to the ankylosis of the remaining teeth?

Knowing this didn’t help extract the tooth, but made me feel less of a failure for finding it so challenging!

RE: Removing a canine from a dog

Rachel Perry — Wed, 06 Oct 2021 16:05:18 GMT

I remove bone buccally a day as Rob says look for change in appearance as you approach root cementum. Then I follow the curvature of root round- which will lead you directly to periodontal ligament space - you can often see it as a thin black line. Then make sure thus gutter is about half depth of root . I use a taper fissure for bone removal (701L in dogs, 699 in cats) and the tips are just the right width to delineate the ligament space

RE: Removing a canine from a dog

Rob Davis — Wed, 06 Oct 2021 16:02:37 GMT

Yes, this is sometimes difficult.

Look at the radiograph to identify the shape of the root you are attempting to outline with the gutters.

Use the bur in light strokes and look for the meshwork of blood vessels which can often be seen when you reach the periodontal ligament. If in doubt, amputating the crown generally makes it easier to identify the precise position of the ligament and enables you to orientate the shank of the bur parallel to the root rather than perpendicular which helps to ensure the tip of the bur remains in the correct position.

If you're not sure if your gutter is in tooth or bone, repeat the radiograph (use a small needle as a marker).

RE: Removing a canine from a dog

Neil Wheadon — Wed, 06 Oct 2021 15:31:31 GMT

[quote userid="2161" url="~/001/veterinary-clinical/small-animal/dentistry/f/discussions/30018/removing-a-canine-from-a-dog/233464#233464"]As long as your gutter is in exactly the right place[/quote]

Does anyone else have trouble defining what's tooth and what's bone, that's the other tricky bit, getting a gutter in the right place

Neil

RE: Removing a canine from a dog

Rachel Perry — Wed, 06 Oct 2021 12:42:52 GMT

Hi Neal-

agree with what Rob and Evelyn have suggested. But also: this is the one instance where winged elevators can really help. Place it mesially or distally in the periodontal ligament gutter than you’ve created at the level of alveolar bone. Keep it in line with long axis of tooth. Then wrap one wing under (ie palatally) the tooth. Then rotate. It should lift nicely and be quite quick from there. As long as your gutter is in exactly the right place- with no wings of buccal bone holding onto the tooth. Bone removal only needs to be about 33-50% length of the root.

RE: Removing a canine from a dog

Evelyn Barbour-Hill — Wed, 06 Oct 2021 12:34:36 GMT

Use a sharp thin quality luxator, quite a wide one, on the palatal side. Move it bodily side to side, don't angulate it or twist it. In other words, pure cutting and no levering. Obviously the instrument has a certain thickness, so as you go down there's an element of wedging.

If you are skilled and experienced with forceps, once there's a little movement you can use forceps to either wiggle (equine experence shows that wiggling does work) or sensitively twist-and-hold (always twisting the apex labially, not palatally) .

The risk to the bone on the palatal side is not from easing a sharp instrument (luxator) down through the periodontal ligament, it's from forcing a coarse instrument (e.g. elevator) down and smashing through the bone.

RE: Removing a canine from a dog

Rob Davis — Wed, 06 Oct 2021 10:00:11 GMT

Sometimes these can be a little tricky...

Once you have created your gutters a sharp luxator can be used to extend the gutter around the curve of the tooth on the mesial and distal aspects towards the palatal side. This should enable your elevator to be placed slightly further round the root which can help. Sometimes amputating the crown will enable you to visualise the periodontal ligament better on the palatal aspect, though I don't often do this for canine teeth.

I don't think you need to be terrified of using instruments on the palatal aspect, though I would be luxating rather than elevating as far as possible (ie cutting the periodontal ligament rather than tearing by applying sustained force). You are right that the bone plate is thin, and oronasal communication is a significant possibility, but it is not a particularly significant problem as long as you have created a suitable flap which you can close with no tension (periosteal releasing incisions are key here). Permanent oronasal fistulation will not occur unless the flap breaks down.

If I have understood correctly, you managed to shift the tooth by applying lateral force at the tip of the tooth. I would suggest that this carries a significant risk of pushing the apex through the bone plate and causing oro-nasal communication, although as above, this isn't necessarily a disaster.