Mucoperiosteal flap extraction
(16.02.2005) Dicker is a large size, white coated Kuvasz, 11 years old, castrated male dog, which arrived at the dental station with pain and moderate swelling in the right upper maxilla.
Fig. 1
A closer look was possible even without sedation and unveiled an old fracture with an unusual large crown pulp opening just corresponding to the swelling site.
It was the carnasial tooth or the 4th upper premolar. Curiously enough the dog had also a supernumerary first premolar, also visible in Fig1.
Fig. 2
The X-rays were performed in using the bisecting angle and parallel techniques and size 4 occlusal films.
We used 2 separate values 0.35 and respectively 0.45 seconds exposure times and a Explor-X dental machine. The X-rays showed a large bone resorption and translucency area in the furcation area as well as the fracture line in the distal part of the crown and root.
Fig. 3
After appropriate sedation, inhalation anesthesia we tried to perform the extraction by the classical approach, separating the tooth crown and roots in 3, mesial, distal and one palatal part using the elevator and forceps.
The tooth did not move even after assiduous mobilization with the forceps. We than decided to perform a U shaped muco-periosteal flap to expose the premolar and than we burred away the vestibular wall of the alveolar bone, exposing the root fragments that were separated.
We luxated the roots towards buccal releasing all 3 fragments of tooth as in Fig3.
Fig. 4
The alveolar socket was cleaned and afterwards had all sharp edges and irregularities of the alveolar bone and septum smoothened using a round turbine burr and the high-speed handpiece.
We placed Racestyptine to control the bleeding and performed the suture using size 3.0 Vicryl resorbable cutting needle suture material and simple interrupted sutures as per Fig4.
Fig. 5
After we were ready we controlled our extraction with another post-op X-ray using the same exposure times as before.
The site was clean without any root remnants or alveolar bone fragments that might be sequestred and irritate locally the post-extractional site, as in Fig5.
We controlled pain by using Rimadyl injectable solution administered i.v. in the first day and 50 mg tablets per os in the following 2 days.
We also prescribed a systemic antibiotic, Antirobe (Clindamycin) 300 mg capsules for 7 days.
DDr. Camil Stoian PhD, Mag. Helene Widmann