Chapter 12 Exodontics (Extractions) PP

Exodontics: A branch of veterinary dentistry focusing on the extraction of teeth.
Objective: The primary aim of veterinary dentistry is to save teeth, but extractions may be necessary under certain circumstances.
Training: This chapter outlines indications, equipment, and techniques for extractions but emphasizes the necessity of hands-on training from qualified experts for those legally authorized to perform the procedures.

When Teeth Cannot be Salvaged: Extraction may be necessary when a tooth is irreparable.
Client's Role: The veterinarian should consult with the client prior to performing extractions, emphasizing that extractions are final.
Factors for Extraction:
- Client's inability or unwillingness to perform required dental home care.

State Laws: Legislation varies by state regarding who may perform extractions.
- In some states, non-veterinarians may perform extractions under the supervision of a veterinarian.
Veterinary Technicians and Extractions:
  - Credentialed veterinary technicians may be allowed to perform extractions, but surgical procedures are typically prohibited.
  - Many extractions are surgical in nature (involving techniques such as flaps, split root extraction, and bone removal).
  - Insurance may not cover procedures conducted by unauthorized persons, emphasizing a safe stance: only non-surgical (mobile) teeth should be extracted unless otherwise permitted.

A complete list of instruments is critical to effective exodontics (Refer to Box 12.2).

Luxator:
  - Function: Used to cut the periodontal ligament and expand the alveolus (tooth socket).
  - Design: Features a thin, flat blade that may be curved.
  - Usage: Not intended for elevation or leverage.
Elevators:
  - Function: Used to elevate canine and feline teeth.
  - Design: Comprises curved blades that wrap around tooth roots.
  - Variety: Available in many sizes suited to different teeth.
Root Tip Picks:
- Function: Designed for elevating and extracting retained root tips.
- Design: Features a thin and pointed tip.
Periosteal Elevators:
- Function: Used to elevate gingival tissue and periosteum from bone during periodontal surgery.
VetTome Powertome:
  - Function: A power-driven periotome operated by foot pedal, cuts the periodontal ligament like a luxator.
  - Benefits: Reduces trauma and minimal or no alveolar bone loss, ensuring protections against hard tissue damage.
  - Limitations: Does not replace proper extraction techniques.

Magnification and Lighting:
- Essential for improving visibility during procedures.

Sharpening Elevators:
- Recommended sharpening method includes using a flat stone or Rx Honing Machine.
- The bevel side should be positioned on the stone and sharpened in a rotational back-and-forth motion.

All instruments must be sterilized prior to exodontic procedures to prevent infection and complications.
  - Unsterilized instruments may introduce bacteria to unsterile tissues.
  - Chemical disinfectants can be effective but require appropriate contact time to work and can dull sharp instruments.
  - Gas sterilization is non-damaging to instruments; however, it may present health risks.
  - Autoclaving (using pressure and steam) is the recommended sterilization method.

Single-Rooted Extraction:
  - Step 1: Sever gingival attachment all the way around the tooth (See Fig. 12.14).
  - Step 2: Employ vertical and horizontal rotational techniques for gentle extraction (See Figs. 12.15 & 12.16) with an emphasis on time and technique (5 to 15 seconds per side).
  - Step 3: Use extraction forceps once the periodontal ligament has been sufficiently compromised for tooth mobility (See Fig. 12.17).
Multirooted Teeth Extraction:
  - Recommended to split the teeth before extraction for effective results (See Figs. 12.19 & 12.20).
  - Utilize a high-speed bur for precision cuts between the furcation and the crown tip.
  - Example: Splitting the maxillary fourth PM involves addressing the mesiobuccal and distal roots first, followed by the palatal roots (See Figs. 12.21 A & B).
  - Technique for Dogs: A T-shaped cut can be utilized for efficient extraction from molars by separating root structures as needed.

Trauma at Extraction Site: Monitoring for any excessive trauma during extraction is essential.
Hemorrhage: Control bleeding by applying gauze and consistent pressure.
- Products such as Hemablock, Gelfoam, Vetigel, and Vetspon can assist in managing blood loss.
Instrument Slippage:
- Minimize slippage by maintaining a grip close to the tip with a "Shortstop Grip" for better control.
Loss Function of Extracted Tooth: Patients may experience lip or tongue biting or trauma inflicted by maxillary canines (See Fig. 12.22).
Root Tips in Mandibular Canal: If this occurs, a surgical flap may be required to access and extract the root from the canal.

Incisions:
- Create releasing incisions on the mesiobuccal and distobuccal line angles of adjacent teeth.
- Follow with an intrasulcular incision along the gingival margin.
Elevating the Gingiva: Utilize a periosteal elevator to elevate the gingiva from the bone, then remove buccal bone using a high-speed handpiece and irrigation.
Closing the Flap: Once extraction is complete, ensure proper closure of the flap is achieved, noting that if one knot fails the entire line may dehisce.

Suture Material: Recommended sizes are 3-0 or 4-0 synthetic materials, with Monocryl being preferred due to its absorbability.
Common Patterns:
  - Simple Interrupted: Most frequently used due to its reliability.
  - Cross Pattern Mattress: Offers a quicker application but creates a larger suture mass.
  - Continuous Interlocking: Fast method but results in less suture mass.

Emphasize the importance of hands-on training, proper equipment, and a solid understanding of veterinary anatomy.
Techniques include the use of regional anesthesia (nerve blocks) and intraoral dental radiology.
Follow Halsted’s Tenants of Surgery:
  - Make incisions as conservative as possible – remove as little bone as needed.
  - Visibility is critical: "If you can’t see it, you can’t do it!"
  - Use appropriate-sized flaps and treat all tissues with respect.
  - Keep a calm demeanor and practice patience during the procedure.
Post-Procedure Care: Proper medications should be provided, with antibiotics only for severe infection and always ensure pain management medication is administered!