| Periodontal disease is common in veterinary medicine and often requires surgical intervention. But some cases are more challenging than others—and knowing when to refer is key for good outcomes. Most of the dentistry services we provide our patients in general veterinary practice involve the diagnosis and treatment of periodontal disease. Extractions make up a large portion of the oral surgery performed for this condition. At times we are faced with the unusual or difficult case that, depending upon the skill level and experience of the surgeon, may require referral to a board-certified specialist. This is the first in a series of articles examining these challenging oral surgical cases. Extraction gone bad An 8-year-old neutered male Cavalier King Charles spaniel was presented for oral pain following extraction of a fractured left mandibular fourth premolar (308). Partial anorexia and pawing at the left side of the face were noted by the owner immediately following the procedure and persisted for three weeks up to the time of referral. The referring veterinarian confirmed that the mesial root fractured upon attempted extraction and the apical fragment was forced into the mandibular canal in an attempt to retrieve it with a luxator.
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| Figure 1: View of the healed extraction site of the left mandibular fourth premolar in a Cavalier King Charles spaniel. (All photos courtesy of Dr. Brett Beckman.) | ||||||
| Visual examination of the left mandible indicated normal mucosa at the extraction site (Figure 1). Radiographs confirmed a fractured root tip in the mandibular canal ventral to the alveolus of the mesial root of tooth 308 (Figure 2, white arrow). A diffuse radiodensity was also evident just distal to the root tip (Figure 2, black arrow). The assumption was that this radiodensity consisted of fragments of alveolar bone.
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Figure 2: Radiograph of the left mandible demonstrating an apical root segment (black arrow) and bone fragments (white arrow).
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