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The complications associated with the PMMA stabilisation


technique reported in this study were minimal. Two cases that developed maxillary nerve block complications resolved with medical management within 4 days. Two cases which did not have preoperative sinusitis developed sinusitis following tooth removal. In one of those, leakage of feed material around the dental alveolar plug following tooth repulsion had occurred, tracking into the sinus and establishing infection. Resolution was obtained with gauze debridement of the orosinus fistula, plug replacement and antibiotic therapy. The second case developed sinusitis following successful oral extraction, and resolved when sequestered right ventral concha bulla bone was removed. The short- and long-term post-operative complications,


following successful intraoral extraction of PMMA stabilised teeth, is in line with the low complication rate reported for oral extraction of diseased cheek teeth and compares favourably with alternative extraction techniques. In a report of standing maxillary and mandibular cheek tooth repulsion, 41% of extractions required follow-up medical or surgical treatment to resolve signs of maxillary sinusitis or persistent mandibular drainage (Coomer et al. 2011). Alternative approaches to intraoral extraction are


associated with higher prevalence of intra- and post- operative complications such as oromaxillary fistula formation, alveolar sequestrae formation and tooth fragments remaining in the alveolus. These complications were described in 15/23 (65.2%) cases following failed intraoral extraction (Reichert et al. 2014), alternative approaches included minimal invasive buccotomy, classical lateral buccotomy and a combination of repulsion and minimal invasive buccotomy. In the case series by Reichert et al. (2014), the most common reason to use an alternative procedure to oral extraction was complete fracture of the clinical crown. A report of lateral buccotomy in 114 horses described complications in 30% of cases, including partial wound dehiscence and infection, temporary and permanent facial nerve paralysis, myositis, sinusitis and establishment of an oroantral fistula (O’Neill et al. 2011). A minimally invasive transbuccal approach and


intradental screw placement for standing cheek teeth extraction has been described (Langeneckert et al. 2015). While good overall success (81%) and minimal post-operative complications were reported, the technique was less successful in teeth that were carious and friable. In 10 cases (45%), the tooth fragmented during molar


spreading or extraction and six of those had fragments that required repulsion. In four cases useful loosening of the tooth was achieved prior to fragmentation, which enabled easy fragment extraction with root forceps. It is also conceivable that loosening, facilitated by PMMA stabilisation and molar spreading, is beneficial even when the tooth is ultimately repulsed. An initial concern in the development of the technique


was whether the PMMA would bond to the adjacent mesial and distal teeth. Clinically, cheek tooth spreaders were able to be placed without difficulty in all cases. The exothermic nature of PMMA hardening did not cause any known long-term pathology to the adjacent mesial and distal teeth. In conclusion, significant fracture displacement was


recorded in this study population. Utilising PMMA to stabilise sagittally fractured cheek teeth for intraoral extraction is a useful technique with minimal complications. It is simple to


implement, although operators are encouraged to have experience with standing oral extraction as well as adequate facilities, equipment and expertise to undertake repulsion or other minimally invasive extraction techniques should it be required.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research


Research ethics committee oversight is currently required by this journal for ‘some retrospective studies’. In this retrospective study of clinical records, informed owner consent was diligently sought and obtained from 17 out of 20 horses in the study; the remaining three owners were unable to be contacted.


Source of funding None.


Authorship


Both authors approved the final version of the manuscript and contributed to study design, data collection and study execution, data analysis and interpretation and preparation of the manuscript.


Manufacturers' addresses


1Jorgensen Laboratories Inc., Loveland, Colorado, USA. 2Epica Medical Innovations, San Clemente, California, USA. 3Orion Corporation, Espoo, Finland. 4Bayer, Shawnee Mission, Kansas, USA. 5Pfizer Inc., New York, New York, USA. 6Bimeta Inc., Le Sueur, Minnesota, USA. 7Henry Schein Animal Health, Dublin, Ohio, USA. 8Zoetis, Kalamazoo, Michigan, USA. 9DenMat Holdings, Lompac, California, USA. 10Unichem pharmaceuticals (USA) Inc., Rochelle Park, New Jersey,


USA. 11Nikon J1, Nikon Corporation, Shinagawa, Tokyo, Japan. 12U.S. National Institutes of Health, Bethesda, Maryland, USA. 13Microsoft Corporation, Redmond, Washington, USA. 14Bausch & Lomb Inc., Tampa, Florida, USA.


References


Barakzai, S.Z. and Dixon, P.M. (2014) Standing equine sinus surgery. Vet. Clin. North Am.: Equine 30, 45-62.


Bartmann, C.P., Peters, M., Amtsberg, G. and Deegen, E. (2002) Dentogenous sinusitis caused by gram-negative anaerobes in horses. Tierarztl. Prax. G. N. 30, 178-183.


Bienert, A. and Bartmann, C.P. (2008) Partial crown fractures of equine cheek teeth. Tierarztl. Prax. G. N. 36, 266-272.


Bienert, A., Bartmann, C.P., Verspohl, J. and Deegen, E. (2003) Bacteriological findings for endodontical and apical molar dental diseases in the horse. Dtsch. Tierarztl. Wochenschr. 110, 358- 361.


Coomer, R.P.C., Fowke, G.S. and McKane, S. (2011) Repulsion of maxillary and mandibular cheek teeth in standing horses. Vet. Surg. 40, 590-595.


Cruz, A.M., Rubio-Martinez, L. and Dowling, T. (2006) New antimicrobials, systemic distribution, and local methods of antimicrobial delivery in horses. Vet. Clin. North Am.: Equine 22, 297-322.


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