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TruTh & ConsequenCes in DenTisTry anD oral surgery
Smith MM. Root morphology: clinical significance in pathogenesis and treatment of periodontal disease. Comp Contin Educ 1995; 17:625-635.
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Drs.
Mar
k M. s
mith
and
Ken
dall
G. ta
ney a
re p
artn
ers i
n th
e Ce
nter
for V
eter
inar
y D
entis
try a
nd O
ral s
urge
ry es
tabl
ished
in
200
6. D
r. sm
ith is
a D
iplo
mat
e of t
he A
mer
ican
Colle
ge
of Ve
terin
ary
surg
eons
and
the
Amer
ican V
eter
inar
y D
enta
l Co
llege
. He w
as P
rofes
sor o
f sur
gery
and
Den
tistry
at t
he VA
-M
D r
egio
nal C
olleg
e of
Vete
rinar
y M
edici
ne a
t Virg
inia
tech
for
16-y
ears
befo
re en
terin
g pr
ivate
pra
ctice
in 2
004.
Dr.
smith
is e
dito
r of t
he Jo
urna
l of
Vete
rinar
y D
entis
try a
nd c
o-au
thor
of A
tlas
of A
ppro
ache
s fo
r Ge
nera
l su
rger
y of
the D
og a
nd C
at.
Dr.
tane
y ha
s pr
actic
ed d
entis
try a
nd o
ral
surg
ery
at t
he
Cent
er a
fter
com
plet
ing
her
resid
ency
in
2007
. sh
e is
a 20
02 g
radu
ate o
f the
VA-M
D r
egio
nal C
olleg
e of V
eter
inar
y M
edici
ne. s
he h
as a
lso p
erfo
rmed
inte
rnsh
ips i
n bo
th ge
nera
l m
edici
ne a
nd su
rger
y, an
d sp
ecia
lized
surg
ery.
Dr.
Dav
id M
. ste
vens
on is
a r
esid
ent i
n de
ntist
ry a
nd o
ral
surg
ery
at th
e Cen
ter.
He i
s a 2
001
grad
uate
of t
he VA
-MD
re
gion
al C
olleg
e of
Vete
rinar
y M
edici
ne.
He
has
6 ye
ars
of e
xper
ience
in
priva
te c
linica
l pr
actic
e in
the
Bal
timor
e ar
ea.
Fig.7 Dental radiograph showing a non-mobile mandibular first molar (M1) despite severe periodontal bone loss. Fig.8 Preoperative radiograph showing severe bone loss from periodontal disease resulting in minimal supporting ventral cortical bone. Fig.9 Postoperative radiograph showing the complication of mandibular fracture at the M1 extraction site. Fig.10 Photographs showing extraction of a M1 in a dog with a draining tract (arrow) from periapical abscessation (A). The tooth appears relatively healthy with expected plaque and calculus from peridontal disease (B). A potential difficult extraction is managed using a mucoperiosteal flap, crown sectioning (C), and elevation of individual crown/root segments (D) to decrease the possibility of iatrogenic mandibular fracture.
TooTh ExTracTion: True or False- Mandibular First Molar Extraction is the Most Common Reason for Iatrogenic Mandibular Fracture in Dogs
True! The mandibular first molar tooth (M1) was not meant to leave the mandible! The 2 large tooth roots diverge providing effective anchorage in the mandible. Even when affected by severe periodontal disease, the M1 is often not mobile (Fig. 7). Preoperative intraoral dental radiographs are an invaluable diagnostic aid before extracting any tooth, especially the M1. The radiograph will show how much bone has been lost secondary to periodontal disease and how much mandibular bone remains to support the M1 (Fig.8). Attempting to extract the M1 between office calls can be problematic for both the veterinarian and the dog. It's the crack that can make you shiver (Fig. 9)! The principles for surgical extraction of the M1 includes mucoperiosteal flap elevation, sectioning the tooth into 2 crown-root segments, judicious removal of buccal alveolar bone, elevation of tooth roots with controlled force, application of bone stimulating material, and flap apposition (Fig 10).
Fig. 7 Fig. 8 Fig. 9
Fig. 10a B
C D