Surgical Extraction of the Mandibular First Molar Tooth in the Dog

Abstract

Common indications for tooth extraction include crown fracture and periodontal disease. Extractions performed for crown fracture are challenging since the periodontium is usually unaffected. Even in cases of extraction for severe periodontal disease, roots may be more firmly attached than anticipated. Large, multi-rooted teeth such as the mandibular first molar (M1) are candidates for surgical extraction which is described step-by-step (Figs. 1-9). Extraction of multi-rooted teeth may be particularly challenging since the roots are usually divergent providing resistance to delivery of the intact tooth (Fig. 10). Another anatomical consideration is the proximity of the mandibular canal and the neurovascular structures within the canal. Slippage of the periodontal elevator should be avoided and displaced root tips should be handled carefully to avoid trauma to the mandibular artery, vein, and nerve. The oral surgical methods described here including development of a mucoperiosteal flap, buccal alveolar bone removal, and crown sectioning facilitate uncomplicated extraction of the mandibular Ml tooth. The primary complication associated with surgical extraction of this tooth is iatrogenic fracture of the mandible, especially in cases of alveolar bone loss associated with endodontic and/or periodontal disease. Preoperative radiographs aid the clinician in documenting the degree of pathologic bone destruction before the extraction procedure in order to properly advise the client and develop an appropriate treatment plan. In cases of moderate to severe alveolar bone loss, additional bone removal should be judicious in order to avoid iatrogenic fracture and maintain mandibular integrity postoperatively. Repair of mandibular fracture associated with M1 extraction may be challenging since loss of bone and tooth structure limit surgical techniques to provide fracture stabilization (see the Veterinary Dentist at Work feature on page 22). Osseoconductive materials applied in the alveoli may be indicated to augment and expedite bony healing at the extraction site.