Proper Equipment and Instrumentation for Feline Extractions

A high-speed handpiece with fiberoptics is extremely helpful when performing surgical extractions in cats. The fiberoptic handpiece provides a light source directly on the surgical site. Burs utilized frequently include small round burs for the removal of buccal bone and tapered fissure burs for sectioning multi-rooted teeth. Essential hand instrumentation for performing feline extractions have been previously described.^1-5 Hand instrumentation specifically designed for feline extractions is available through numerous veterinary supply companies. Instruments for feline extractions may be packaged together in a feline extraction pack and steam sterilized prior to each use. Instrumentation in feline extraction packs include: scalpel handle upon which a #15 blade can be placed prior to surgery, a small feline periosteal elevator, a soft tissue retractor, a variety of dental elevators and luxators, small extraction forceps, small needle holders, Adson tissue forceps, suture scissors and an iris scissors for cutting soft tissue. A small root forceps is also helpful for reaching down into an alveolus and obtaining a firm grasp on a loose root tip. It is imperative to routinely sharpen dental extraction instrumentation to insure optimal functionality.

Anatomic Features of Feline Teeth

Techniques for Performing Feline Extractions

There are several different techniques for performing feline extractions. These techniques include a simple extraction, multi-rooted extraction, single-rooted surgical extraction, partial or full-mouth extractions for the treatment of feline stomatitis, and crown amputation with intentional root retention for the treatment of feline resorptive lesions.

Simple or Closed Extraction

The incisors, the maxillary 2^nd premolar and the maxillary molar teeth are generally small single rooted teeth in the cat and can be removed using simple or closed extraction techniques. Simple or closed extraction techniques have been previously described.^1-5 The procedure is initiated by cutting the gingival attachment around the whole circumference of tooth using a No. 11 scalpel blade in a handle or a sharp luxator. A luxator that matches the curvature of the tooth is selected and is placed into the gingival sulcus at a slight angle to the tooth and pressed into the periodontal ligament space and worked around the entire circumference of the tooth using gentle apical pressure. The operator may now elect to continue the extraction using a dental elevator or continue using a luxator. A dental elevator may be used once adequate space has been created for the thicker tipped instrument. An appropriate sized elevator is selected, placed in the periodontal ligament space and worked around the tooth with a gentle rotational pressure held at each point for 10-15 second to help break down the periodontal ligament. Once the tooth becomes loose it can be removed digitally or gently grasped with a small dental extraction forceps placed as far apically on the tooth as possible and with a gentle rotational movement of the forceps in the long axis of the tooth, the tooth may be gently rotated and removed from the alveolus.

Multirooted Extraction

Extraction of multirooted teeth in cats requires additional consideration because of the tendency for these roots to fracture during extractions. A modified technique for extracting multirooted teeth in the cat has been reported.² This technique involves raising both buccal and lingual flaps and removing adequate alveolar bone to expose the furcation. The furcation is then sectioned using a size 2 round bur making two cuts from the furcation at 45⁰ , one distally and one rostrally thereby removing a significant portion of the crown leaving only a small portion of the crown mesially and distally. A size 2 or 4 round bur is then used to remove the interradicular bone between the mesial and distal roots to the apical region of the roots without invading the nasal cavity or mandibular canal. This results in support of the roots by 3 sides. An appropriately sized luxator or elevator can be eased into the interradicular space created by the bur and into the periodontal ligament of the roots to gently remove the roots independently. Additional buccal bone may be removed as necessary. Sharp edges of bone are removed with a small round bur, the surgical site is flushed and the flap is closed with 4-0 chromic or 4-0/5-0 poliglecaprone on a small reverse cutting needle.