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
The dental formula in the adult cat is: 2 (I 3/3, C1/1, P3/2, M1/1) = 30. The anatomy of the mouth and teeth of the cat has
been previously described.6 Feline teeth are much smaller and narrower than canine teeth. All the incisors and canine teeth have one root. The small
maxillary second premolar usually is a small single-rooted tooth which may have two roots which may be fused together. The
maxillary 3rd premolar has 2 roots with a supernumerary root sometimes present, the maxillary 4th premolar has 3 roots and the maxillary 1st molar is very small with two roots that may be fused. There are 3 mandibular cheek teeth. The 3rd and 4th premolars each have two symmetrical roots and the 1st molar has two asymmetrical roots with a large mesial root and a small distal root.
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 2nd 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.
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.