EQUINE VETERINARY EDUCATION / AE / AUGUST 2019
423
0 1 2 3 4 5 6 7 8
108 109 110 207 209 210 211 407 Triadan tooth number
Fig 3: Number of cheek teeth listed by Triadan position.
Fig 2: A successfully extracted 109 tooth with PMMA packing the fracture space. Note the fermented feed material that remains lodged at the apex of the fracture.
a primary objective of the study. All statistical analysis was performed using Microsoft Excel13 (2010).
Results
The median age of horses in the study was 15 years with a range of 9–32 years. There were seven Warmbloods, four ponies, two draught crossbreds, two Quarter Horses, two Arabians and three other breeds. Fourteen were geldings, six were mares. Six did not have symptoms reported by the owner on presentation. Of the 14 horses with symptoms, nine had purulent nasal discharge, three halitosis, two quidding, one with facial swelling and one displayed signs of oral discomfort. Three animals had multiple clinical signs. A total of 21 maxillary and one mandibular cheek teeth
were extracted. In animals with multiple tooth extractions, teeth were extracted in independent procedures separated by one month. The most commonly affected teeth were the Triadan 109 and 209s, forming 50% of all cases (Fig 3). This was followed by 110 and 210s, which formed 32%. All maxillary cheek teeth had grade 4 infundibular caries, defined as having the integrity of the tooth affected (Honma et al. 1962). Preoperative radiographs were taken for 17/22 cases. All
had a fracture space on dorsoventral projection and seven cases had sinus opacity consistent with sinusitis. In 10 cases, widening of the periodontal ligament space and periapical lucency was present, 10 affected teeth showed periapical sclerosis and in two, a small, apical, circular radiopacity consistent with reactive hypercementosis was present. Standing computed tomography became available and was used for the last case, a 32-year-old Welsh pony. Preoperative standing computed tomography of the skull revealed a complete sagittal fracture with displaced palatal and buccal fragments (Fig 4). Loss of alveolar bone and trabecular architecture of the maxilla immediately surrounding the root apices at the fracture space was evident.
Fig 4: A transverse computed tomography image through a sagittal fractured 209 tooth, showing the fractured, displaced tooth.
Intraoral extraction was successful in 16 cases (73%).
Individual case details are listed in Supplementary Item 1.Of the six failures, three were due to root fractures, two failed because of fragmentation of the clinical crown and in one case, abnormality in size and shape of the tooth would not allow oral extraction. Eight of the nine cases with preoperative sinusitis had paranasal sinus lavage via a conchofrontal (n = 4), rostral maxillary (n = 2), or caudal maxillary (n = 2) sinus trephine. One case had a significant oroantral fistula used to lavage the rostral maxillary sinus retrograde following successful intraoral extraction. Three cases that did not have preoperative sinusitis required trephination to facilitate repulsion of the tooth via transcortical bone (n = 1), rostral maxillary (n = 1), or caudal maxillary (n = 1) trephines. Two cases with preoperative sinusitis also had persistent post-operative sinusitis, one of which had the tooth repulsed (resolved after 29 days) and one which did not require repulsion (resolved after 50 days). Overall, of nine cases with preoperative sinusitis, seven resolved immediately after sinus lavage and tooth extraction. Two horses that did not have preoperative sinusitis developed post-operative sinusitis which resolved after 28 and 109 days. For all cases, repeat examinations and dental plug changes were scheduled for 14 days post-operatively, then as
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Number of teeth removed
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