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Carnassial tooth extraction in a dog | VETgirl Veterinary Continuing Education Videos

In this VETgirl online veterinary continuing education video, a board-certified veterinary dentist demonstrates how to extract a fractured 4th upper premolar (known as the carnassial tooth) in a dog. First, a pre-extraction dental radiograph should be performed under general anesthesia to confirm the diagnosis, to reveal clinically important pathology and to review the patient’s local anatomy. Based on radiographs, this tooth was confirmed to be fractured with pulp exposure. By the way, aside from extraction of this tooth, another possible treatment option would be root canal therapy with metal crown placement. Next, a caudal maxillary nerve block is performed using a mixture of both bupivacaine and buprenorphine. 0.7 mL of 0.5% bupivacaine is mixed with 0.05 mL of 0.3 mg/mL buprenorphine. Approximately 0.2 mL is delivered at the block site with a 25 gauge needle.

Step 1: A mucoperiosteal flap is created with one or two diverging vertical releasing incisions extending past the mucogingival line to the alveolar mucosa. The flap is elevated with a small periosteal elevator.

Step 2: A round bur in a high speed hand piece is used to remove the buccal alveolar bone.

Step 3: Each tooth root segment is separated with a tapered bur in a high speed hand piece.

Step 4: Each tooth section is elevated and extracted. Use a short finger stop on the dental elevator when applying force to the periodontal ligament space. Count to 15 with each force applied to allow the periodontal ligament to stretch, fatigue and eventually tear. Continue around the tooth segment by inserting the dental elevator and again, counting to 15. When the tooth segment is finger loose, remove each tooth section with extraction forceps. If the root tip is fractured, remove more alveolar bone to increase exposure. In some cases, the root tip can be suctioned out. Be careful not to flush or force the root tip deeper into the alveolus.

Step 5: The alveolus is then curettaged with a small spoon curette, gently flushed and irregular bone edges of the alveolus are smoothed using a round or diamond bur in a high speed hand piece. The alveolus is curettaged and flushed again of any bone debris.

Step 6: A post-extraction dental radiograph is taken to confirm complete extraction of the tooth.

Step 7: Gently debride the flap margins. Suture the flap without tension using 4-0 monocryl in a simple interrupted suture pattern, suturing the corners first.

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