TECHNIQUE

Extraction of the Incisors in Rabbits (Disease Investigation & Management - Treatment and Care)

Incisor removal - loosening incisor. Click here for full page view with caption Incisor removal - first incisor removed. Click here for full page view with caption Incisor removal - loosening incisor. Click here for full page view with caption Incisor removal - loosening incisor. Click here for full page view with caption Incisor removal - removing incisor. Click here for full page view with caption Incisor removal - destroying germinal tissue. Click here for full page view with caption Incisors removed. Click here for full page view with caption Post incisor removal, eating hay. Click here for full page view with caption

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description
Anaesthesia and analgesia
  • General anaesthesia is required. (J15.19.w3)
  • Provide pre-operative analgesia:
    • e.g. Carprofen, 2 mg/kg by subcutaneous injection. (J60.6.w3)
Pre-operative preparation
  • Take at minimum a lateral radiograph to show the degree of curvature of the upper incisors and to assess any other dental disease. (J60.6.w3)
    • Four views: lateral, ventro-dorsal and left and right obliques will give much more information. (V.w125)
  • Place the rabbit in dorsal or dorsolateral recumbency. (J513.6.w3)
Extracting the tooth - closed extraction
  • Use sterile technique to reduce the risk of infection and abscess formation. (B600.7.w7)
  • Gently scrub the gingiva with dilute povidone iodine or chlorhexidine. (J513.6.w3)
  • Break down the periodontal ligament. (J15.19.w3)
    • A small elevator or an 18 or 18 gauge gauge needle can be used. (J15.19.w3, J60.6.w3)
      • There is a specialist elevator available (Crossley elevator). (J60.6.w3, J513.6.w3)
        • The Crossley molar luxator may be used in extraction of incisors (and is preferred to the Crossley incisor luxator by some veterinary surgeons). (V.w125)
      • An 18 gauge needle, bent to fit the tooth contours, is very useful for breaking down the attachments on the rostral and caudal aspects of the tooth. (J513.6.w3)
        • Flattening the needle by using e.g. artery forceps may be helpful. (V.w125)
      • A 22-gauge needle is appropriate for loosening the pen teeth. (J513.6.w3)
    • Use a no. 11 scalpel blade used to sever the gingival attachment down to the level of alveolar bone. (B601.18.w18)
      • To incise the rostral edge of the periodontal ligaments. (J513.6.w3)
    • Gently insert an appropriate elevator (luxator) on the mesial aspect of the tooth and apply gentle apical pressure for 10-20 seconds. (B601.18.w18, J513.6.w3)
    • Move the luxator to the lateral aspect of the tooth and repeat. (B601.18.w18, J513.6.w3)
    • Alternate the pressure on the mesial and distal aspects of the tooth, gradually inserting the luxator further into the periodontal ligament. (B601.18.w18)
      • Due to the curvature of the root and the weaker periodontal ligament on the buccal and lingual aspects, normally the luxator is not used on these surfaces. (B601.18.w18)
    • Note: Support the mandible or head whenever pressure is being applied, to reduce the chance of iatrogenic jaw fracture. (B601.18.w18)
  • Extract the tooth
    • Check that the tooth is free of the periodontal ligament, particularly on the medial aspect of the tooth. (J513.6.w3)
    • Once the tooth is very obviously mobile, grasp it with extraction forceps and use steady longitudinal pressure to withdraw the tooth from the alveolus. (B601.18.w18)
      • Grasp on the lateral and medial sides of the tooth. (J513.6.w3)
      • Use steady, gradually increasing extraction force, without applying pressure to the tooth. (J513.6.w3)
      • Excessive force should not be needed, so long as the periodontal attachment has been broken down and the tooth is not severely deformed. (J513.6.w3)
    • Follow the curvature of the tooth. (J60.6.w3, J513.6.w3)
      • This is particularly important for the upper incisors. (J513.6.w3)
      • Also rotate the tooth laterally during extraction
    • Note: Extract the tooth without twisting, as fracture of the tooth is likely under twisting forces. (J15.19.w3)
    • Control bleeding, if necessary, using sterile cotton-tipped applicators. (J513.6.w3)
      • A cotton bud dampened with adrenaline may be used. (V.w125)
  • Disrupt any remaining germinal tissue in the alveolus
    • Press the tooth back into the socket. Or
    • Debride the apical end of the alveolus using a small curette (repeatedly insert a needle into the alveolus). 

    (B601.18.w18, J60.6.w3, J513.6.w3)

  • Flush the cavity
    • Use dilute povidone iodine or chlorhexidine. (J513.6.w3)
    • If the incisor apex is infected, flushing with antiseptic is particularly important. (J513.6.w3)
  • Suture the alveolus (or leave it open)
    • Leave the alveolus open to granulate, or suture the gingiva closed over the alveolus, using 5/0 (1 metric) absorbable suture material swaged-on a cutting or reverse-cutting needle. (B601.18.w18)
    • Use a purse string suture with at least four points of fixation in the gum. (J513.6.w3)
    • Use 3-0 or 4-0 absorbable suture material. (J513.6.w3)
    • Suturing can prevent food entering the alveolus, and may improve cosmetic appearance. (J513.6.w3)
    • Do not suture if the alveolus is infected. (J513.6.w3)
  • Postoperative care
    • Provide postoperative antibiotics to reduce the risk of infection and abscess development. (B600.7.w7)
      • e.g. enrofloxacin, 10 mg/kg orally once daily for 7 - 10 days. (J60.6.w3)
    • Following extraction, initially offer food shredded or grated. (J60.6.w3)
    • Usually the rabbit will start eating within six to eight hours. (J60.6.w3)
Extracting the tooth - open extraction
  • Use a no. 11 scalpel blade used to sever the gingival attachment down to the level of alveolar bone. (B601.18.w18)
  • Extend the incision mesially and distally. (B601.18.w18)
    • Extend a sufficient distance that the releasing incisions will not be sutured over the void left by the extracted tooth. (B601.18.w18)
  • Make a short releasing incision at both ends of the flap. (B601.18.w18)
  • Use a fine periosteal elevator to elevate the gingiva and periosteum (full-thickness mucoperiosteal flap). (B601.18.w18)
  • Gently retract the flap. (B601.18.w18)
  • Use a small round burr (low speed, with copious irrigation) to remove the alveolar bone plate over the tooth until the tooth is visible.
  • Luxate the tooth:
    • Gently insert an appropriate elevator (luxator) on the mesial aspect of the tooth and apply gentle apical pressure for 10-20 seconds. (B601.18.w18)
    • Move the luxator to the lateral aspect of the tooth and repeat. (B601.18.w18)
    • Alternate the pressure on the mesial and distal aspects of the tooth, gradually inserting the luxator further into the periodontal ligament. (B601.18.w18)
    • Repeat until the tooth is mobile. (B601.18.w18)
  • Use e.g. root fragment forceps to grasp the tooth and pull it out.
  • Debride the apical part of the alveolus. (B601.18.w18)
  • Replace the gingival flap. Suture using simple interrupted sutures about 1.5 mm apart. (B601.18.w18)
    • If necessary, gently undermine the base of the flap to avoid tension. (B601.18.w18)
Post-operative care
Appropriate Use (?)
  • Permanent treatment of incisor malocclusion.
    • Treatment of choice for congenital incisor abnormalities. (B600.7.w7, J15.19.w3)
    • One option for treatment of acquired molar abnormalities. (B600.7.w7, B601.18.w18, J15.19.w3, J60.6.w3)
  • Open extraction is appropriate if the tooth breaks during closed extraction and immediate removal is important due to the presence of infection. (B601.18.w18)
Notes
  • Rabbits are able to eat adequately without their incisors, so long as hard foods (e.g. carrot, apple, broccoli) are chopped or grated. Food will be prehended with the lips. (B600.7.w7, J15.19.w3, J60.6.w3)
    • Rabbit may find cubes easier than grated food. (V.w125)
  • Removing the maloccluded incisors will not prevent development of abnormalities of the cheek teeth. (J15.19.w3)
Complications/ Limitations / Risk
  • Total extraction may be difficult or impossible due to periostial reaction around the teeth. (J15.19.w3)
  • If the tooth breaks, leave to regrow (about four to six weeks) before re-operating. (B601.18.w18, J60.6.w3) or use an open extraction technique. (B601.18.w18)
  • Rabbits are less able to groom without their incisors. (B600.7.w7)
Equipment / Chemicals required and Suppliers
  • Anaesthetic drugs

  • Analgesic drugs.

  • Appropriate dental elevator e.g. Crossley elevators.

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience.
Cost / Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Molly Varga BVetMed DZooMed MRCVS (V.w125)
References B600.7.w7, B601.18.w18, J15.19.w3, J15.30.w1, J60.6.w3, J513.6.w3

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