209 Extraction via Partial Coronectomy

​This mare had an approximately six-week history of left sided, malodorous nasal discharge. She had been treated with SMZs and metronidazole. On oral examination, she was noted to have a left mandibular lymphadenopathy, the above noted nasal discharge, and a complicated crown-root fracture of the 209 through the buccal pulp horns, along with Grade 2 infundibular caries.
 
Radiographs revealed crown lucency and periapical lucency of the 209 as well as periapical sclerosis of the distal buccal root. The left caudal maxillary sinus had fluid lines and soft tissue/fluid opacity. This horse was diagnosed with a left caudal maxillary sinusitis caused by apical disease of the 209.

​Oral extraction of the 209 via partial coronectomy was performed. Partial coronectomy is a minimally invasive technique we have to facilitate tooth extraction. Cheek teeth can be difficult to extract due to dental interlock- the teeth fit so tightly together there isn’t any room to move the tooth in the alveolus (socket). This is especially a problem in young horses with big teeth or with fractured teeth where the adjacent teeth have shifted into the space of the fractured tooth. With partial coronectomy, we use a special burr to remove a sliver of the mesial or distal (front or back) portion of the tooth we are trying to extract. This gives us more room to move the tooth in the alveolus.

​Post-operative radiographs revealed a vacated alveolus. The alveolus was packed with dental impression material which was removed approximately 2 weeks later. This horse continued treatment with SMZs and metronidazole for another 2 weeks to help resolve the sinusitis.