Learn Essentials with the Pros | Learn Cat & Dog Tooth Extraction in 1 Minute (Part 1) – Skills
| August 5, 2020
As the number of pets continue to increase, the need for veterinarians to treat dental diseases also continues to rise, and pet owners are paying all the more attention to the diagnosis and treatment of their pet’s dental diseases. In order to deepen everyone’s understanding of pet dental diseases and to help others quickly learn key points of tooth extraction, RWD has invited Teacher Liu Guangchao, an experienced professional in this industry, to explain how to extract a canine tooth in detail. Detailed points have been made clear and good information is abundant! We recommend you save this article to view again and again.
There is no exaggeration in saying that small animal dental diseases may be the most common to clinicians. Although each doctor may excel in different ways, and might place a different level of attention on dental diseases, it is undeniable that dental diseases will have an adverse affect on an animal’s quality of life and the bond between people and their pets.
Based on the experience of our hospital and many foreign veterinarians, the prospect of using dentistry as a clinical entry point has gradually emerged. There are many ways to treat various dental issues. Concerning periodontal disease, the most common dental disease in dogs and cats, the skill of tooth extraction has stood out as the most effective method, and it is implemented in the clinical front line much more frequently than other advanced dental treatments.
According to my experience, the ratio of dental extraction versus other advanced dental treatment is about 15-20:1. Advanced dental treatment goes hand in hand with vigorous repeated training, over abundant and complicated equipment, high treatment costs, and strict procedures of review. However, tooth extraction is the ultimate solution to many dental problems. If tooth extraction is mastered well, it can increase operation speed and reduce the rate of complications, thereby becoming a great help to clinicians. The ultimate goal of a tooth extraction is to remove the tooth completely and cause as little trauma as possible to the surrounding tissue.
An Introduction to Canine Tooth Extraction
The tooth is able to be stable within the socket you will extract it from by means of the periodontal ligament, providing 85% of retention, and the gingiva surrounding the tooth, providing the remaining 15% of retention. Therefore, the first step of tooth extraction is to use the #11 or #15 blade to cut along the gingival crevasse to the ridge of the alveolar bone. Be careful not to tear the gingiva during this operation.
The white area is the attached gingiva that needs to be cut away, and the purple area is the periodontal ligament
Cutting away the attached gingiva with a #15 blade
Because the roots of the canine teeth are longer, it is necessary to remove 1/3-1/2 of the long buccal bone plate to take them out. Therefore, a full-thickness gingival flap must be made to expose the underlying alveolar bone.
In the picture below, the pink layer is the gingival mucosa and the green layer is the periosteal layer. Between these two is the submucosa, which includes blood vessels and nerve tissue. A gingival flap containing all three of these layers is called a full-thickness gingival flap. A triangular full-thickness gingival flap is the most suitable gingival flap for canine tooth extraction. The main advantages include less stitching, sufficient area exposure, and shorter operation time.
The triangular gingival flap can be made by using the following steps as shown in the picture below. It’s worth noting that:
As step ③ is performed, the blade should be used to cut in the direction indicated by the arrow, the incision should be able to expose the root of the canine tooth, and the depth of the cut should be made directly against the alveolar bone, making sure to cut to the base of the periosteum.
While using a periosteal elevator to elevate the gingival flap, it should be made sure that the junction of ② and ③ is complete, and that the elevated gingival flap should contain the periosteal layer.
To the right is a picture of a lifted full-thickness triangular flap as well as the lower buccal alveolar bone.
Notice that the length of the apical incision enables 1/3-1/2 of the root alveolar bone to be exposed
Use a high-speed handpiece and a round bur or a fissure bur with the aid of sufficient cooling water to remove the alveolar bone to a root length of 1/3-1/2, exposing the root surface of the cementum
Be certain to avoid damaging the gingival flap with the high-speed bur. When bleeding occurs, gauze can be used to stop the bleeding.
Instruments that are correctly inserted into the periodontal ligament can be let go and will remain fixed in the periodontal ligament without being held on to
Use your left hand to hold the head securely and protect the gingiva while you use your right hand to correctly hold the dental elevator and insert it into the space of the periodontal ligament
Next, instruments are needed to destroy the periodontal ligament. The way a tooth is used daily determines that it is good at withstanding the short-term yet high-strength force of biting. However, under long-term low-strength force, the periodontal ligament will wear out and thus easily be torn.
Another aspect is that the space of the periodontal ligament is very narrow. When a tooth extraction tool is used that is not sharp enough or that does not correctly match the shape of the tooth, it will become difficult to insert the instrument into the space of the periodontal ligament and to directly destroy it, or more force will be required for insertion. This will put pressure on the surrounding alveolar bone or cause the tooth you are extracting to break, and may even cause the instrument to slip out of your hand causing damage to surrounding important tissue.
Based on the above reasons, the selection and maintenance of extraction tools, successful insertion into the periodontal ligament, as well as the correct method of applying force are important prerequisites for successful extraction.
The author’s view of operation points:
◆ Use instruments that are sharp and suitable to the shape of the root of the tooth. Instruments should be sharpened and maintained daily.
◆ Hold instruments correctly and be familiar with the use of dental luxators and elevators. Ensure that your instrument is inserted into the periodontal ligament. When inserted correctly, the dental elevator or blade can be fixed in the periodontal ligament space, the instrument will stay in place even if you let it go. Another indication that you have correctly inserted your instrument, is that the tooth will slightly tilt toward the side of applied force.
◆ Abstain from the method of quickly twisting your wrist back and forth to insert the dental elevator. Instead, incorporate a method of calm and steady force. When the tooth slightly tilts from the pressure, continue to apply force 15-20 seconds. At this time, you will find an increase in the looseness of the tooth.
The most important instruments used in tooth extraction are the dental elevator and luxator, the main difference between these lies in their shape and method of use.
◆ With or without wings
◆ The shape of it’s edge should fit the tooth
◆ After insertion into the periodontal ligament, rotate and hold for 30 seconds
◆ Tears periodontal ligament
◆ Causes greater damage to alveolar bone tissues
◆ Thin and sharp tip
◆ Cuts periodontal ligament with up and down movement
◆ Causes less damage to periodontal tissue
◆ Relatively less postoperative pain
Two methods of operating the dental luxator
It is usually recommended to use the dental luxator to extract teeth. A dental luxator is sharper, causing less damage to the surrounding tissues and resulting in faster operation. The dental elevator and luxator can also be used together. Extraction forceps should only be used after the tooth is clearly loose. If the tooth is not loose enough, you should continue to use the elevator or luxator. Don’t use dental extraction forceps prematurely.
Clamp the dental extraction forceps to the neck of the canine tooth, gently lift and maintain constant tension. Based on the situation, you can consider applying rotational force. The canine teeth are most often pulled out gradually within 5-10 seconds.
Extract the canine tooth and clean the alveolar socket.
Use surgical tweezers to gently hold the gingiva checking the size and tension of the mucosal flap
When the mucosal flap has a lot of tension, the wound is more likely to open during the healing process. Concerning the full-thickness gingival flap mentioned above, the periosteal layer is tougher but has poor elasticity, whereas the mucosal layer has good elasticity. At this time, the periosteal layer can be cut from below the mucosal and gingival junction to release tension, making sure that before suturing there is no tension on the incision line.
Deduction of mucosal flap
Trimming and cleaning the extraction socket and alveolar bone.
·Touch the edges of the alveolar bone and use a round bur or diamond bur to remove sharp bone points and diseased alveolar bone
·Rinse the extraction socket to ensure that there is no tartar or pieces of broken bone
-Dental spoon excavator
-Saline solution or salt water
-Avoid using an air polisher to blow air into the extraction socket
Before suturing, it is recommended to check the edges of the alveolar bone to confirm whether they are smooth or not. Excessively protruding alveolar bone may damage the gingival flap. At the same time, it’s also necessary to remove the epithelial tissue from the edges of the wound. This will ensure fresh bleeding that will promote healing as the wound is closed.
Use 4/0 absorbable single-strand sutures to proceed with figure-of-eight or single interrupted sutures, spaced at 2-3 mm
Appearance after stitching
The extraction of a canine tooth usually comes with certain challenges. It is recommended that beginners should first become proficient in the removal of mandibular incisors and maxillary 1-3 incisors, and then consider canine extraction.
The information shared in this issue ends here. I hope everyone will be able to work hard, put this to use, and master these skills.
We’ll share the article Learn cat & dog tooth extraction in 1 minute (Part 2) soon. Follow us to learn more about it!!!