Tooth extraction chapter
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Upper Canine

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Images courtesy of Simon Guiton MA VetMB MRCVS

The maxillary canines of dogs are large teeth. Approximately 60-70% of the total tooth length is root and the apex is usually located above the premolar 2. The root juga is palpable for the whole of its length.

Is this tooth mobile? If so - extract as for a single rooted tooth. Take care not to rotate the root apex into the nasal cavity.

If the tooth is well attached, follow the steps below.

  1. Palpate the apex of the root by following the root juga (lateral canine eminence) from the gingival margin. The apex is usually located above the mesial (rostral) root of premolar 2. Consider regional local anaesthesia at this time.

  2. Incise from the apex of the tooth (above upper premolar 2) to the caudal line angle of the corner incisor some 2mm rostral to rostral border of the canine. This will avoid having to suture the flap over a void. Incise round the circumference of the canine to sever the epithelial attachments and continue this sulcar incision back caudally as far as UPM2. The incision should look like a reversed 'L' shape.

    Incision from root apex to line angle of 203 & caudally in sulcus to 206
    Incision from root apex to line angle of 203 & caudally in sulcus to 206


  3. Starting at the pointed angle of the two incisions, use a periosteal elevator to lift a large full thickness muco-gingival flap caudally to expose the entire lateral canine eminence.

    Full thickness mucogingival flap lifted from rostral to caudal to expose root juga of 204
    Full thickness mucogingival flap lifted from rostral to caudal to expose root juga of 204


  4. Cut around the outline of the tooth using a Taper Fissure bur (701L or similar), to a depth of at least 50% of the root.

    Cut around outline of root with high speed round or cross cut fissure bur
    Cut around outline of root with high speed round or cross cut fissure bur


  5. Place the blade of a large luxator along the long axis of the root from the gingival margin area pointing towards the apex. Start gently, at first at the rostral angle and then alternate with the caudal angle and lift the tooth out of the alveolus at the midpoint. Do not elevate from the coronal palatal aspect (i.e. from lateral to medial), as this will tip the root apex into the turbinates.

    Luxator blade in channel. Use apical & rotational force
    Luxator blade in channel. Use apical & rotational force


  6. Lift the root out bodily without rotation. Remove any bone spicules with a bone rasp or bur.

    Root should lift bodily from alveolus without any tendency for apex to move medially and enter nasal cavity
    Root should lift bodily from alveolus without any tendency for apex to move medially and enter nasal cavity


  7. 7. Flush the alveolus and check for any pre-existing ONF by flushing the alveolus with saline and checking for liquid flow from the ipsilateral nostril. If there is good integrity of the alveolus floor, pack with alloplastic material (e.g. Boneglass™).

    Note: it is common to find an ONF at this stage. If an ONF is present do not fill with boneglass.



    Bone edges need to be smoothed with a bone rasp or a medium oval diamond bur
    Bone edges need to be smoothed with a bone rasp or a medium oval diamond bur

  8. Suture the flap back into position, starting with the leading edge. Use single interrupted sutures, 1.5mm apart, using absorbable monofilament suture material.

    Suturing flap back into position
    Suturing flap back into position


  9. Use an antibiotic for 5-8 days and an analgesic as required.

  10. If an ONF is suspected; recheck the site at 4-6 weeks. If an ONF exists, assess its suitability for further flap surgery at that time.

    Good healing - 1 week post op
    Good healing - 1 week post op

 

 
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