Surgical Extraction of the Maxillary Fourth Premolar Tooth in the Dog

Abstract

Dental extraction is indicated for end-stage periodontal disease, fractured teeth with exposed pulp (when endodontic treatment is not possible), retained deciduous teeth, crowded or malpositioned teeth, and in other select cases. Chewing hard objects is the most common etiology for fracture of the maxillary fourth premolar tooth in dogs.

Extraction of the maxillary fourth premolar tooth is a surgical procedure. The extraction procedure involves: creating a mucoperiosteal flap, removing buccal alveolar bone, and sectioning the tooth to facilitate elevation of its three separate roots. Crown sectioning is generally recommended for multirooted teeth in order to decrease the difficulty of extraction. Sectioning should be performed at the furcation(s) to transform a large multirooted tooth into multiple, single crown-root segments that are more easily extracted. In the method described here, sectioning of the mesial root trunk is preceded by amputation of the mesial cusp to allow for more accurate sectioning at the mesial furcation. Removal of buccal alveolar bone, crown sectioning, and controlled elevation of tooth crown-root segments minimizes operative complications including root fragmentation, infraorbital artery and nerve injury, penetration of the nasal cavity, and ocular trauma.

Other procedural recommendations include alveoloplasty performed with a #4 round bur and a high-speed handpiece to remove any rough or sharp bony projections at the extraction site. Alveoloplasty is complete when digital palpation of the extraction site indicates no sharp projections Finally, the alveolus is irrigated with 0.12 % chlorhexidine solution to decrease bacterial contamination and remove any debris. Primary wound apposition is recommended to reduce postoperative hemorrhage and promote early wound healing. Tension-free wound closure may be facilitated by incising the periosteal attachment in order to mobilize the mucoperiosteal flap. Surgical extraction of the maxillary fourth premolar, including the mesial cusp amputation technique, is described step-by-step.