Comparison of therapeutic techniques for the treatment of cheek teeth diseases in the horse: Extraction versus repulsion

Diseased cheek teeth are rarely worth preserving. Besides the seldom used buccotomy, the expulsion and the repulsion are established therapeutic techniques. The aim of the present study was to compare data about clinical outcome and complications after the extraction and the repulsion of cheek teeth. The patients' records of 20 horses undergoing expulsion or repulsion were analysed retrospectively. Additionally, the owners and referral veterinarians of the patients were interviewed in order to assess the outcome of the cases after the horses were discharged from the clinic. Only horses of the some age range and with similar teeth being affected were included in the study in order to allow comparison between groups. The repulsion via bone flap or trephination which was performed under general anaesthesia allowed removal of the affected tooth in all cases (success rate of 100%). One patient fractured a leg during recovery phase and was euthanized. The extraction was performed in twelve out of 20 horses in the standing, sedated and, if required, locally anaesthetised horse. This technique was unsuccessful in three out of 20 horses (success rate of 85%). In these horses, the diseased tooth had to be removed using a Steinmann pin or a dental punch. The procedure was performed in the standing, sedated horse in one case and under general anaesthesia in two horses. After repulsion, the short term complication rate (< six weeks) was 52.6% (10 out of 19 horses) and included fractured mandibles, persistent nasal discharge, delayed wound healing and complications associated with anaesthesia. After extraction, the short term complication rate was 17.7% (three out of 17 horses). Residual parts of bones and teeth and damage to neighbouring teeth resulted in long term complication rate of 21.1% (four out of 19 horses) in the expulsion group. Such complications were not observed in the repulsion group. Due to the necessity of general anaesthesia and the higher rate of postoperative complications, the total costs were significantly higher in the repulsion group than in the extraction group. Furthermore, the horses of the repulsion group stayed significantly longer in the clinic. In accordance with the results of the present study, the extraction is the recommended first therapeutic choice for removing diseased cheek teeth. An appropriate local anaesthesia, sedation and analgesia have a great impact on the success rate. If repulsion needs to be performed, the bone flap is the preferred surgical approach compared to the trephination. The sinus can be inspected in more detail and it can be closed completely after repulsion of the tooth and sinus flushing resulting in a less time consuming after care.