TECHNIQUE

Extraction of Cheek Teeth in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords Extraction of molars
Description

Extraction of cheek teeth is usually undertaken as part of treatment of periodontal or endodontic disease with associated facial abscessation. It is not suitable to prevent regrowth of cheek tooth spurs. 

Note: 

  • Extraction of cheek teeth where there is not already a degree of tooth loosening due to periodontal disease is difficult. (B601.18.w18)
  • Extraction is not advisable as a treatment for molar spurs. (B600.7.w7)
  • Access is "problematic". (B601.18.w18)
Intraoral approach

Useful only if there is already considerable mobility of the tooth (B601.18.w18); access is not easy. (B600.7.w7)

  • Anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restraint
  • Sever the gingival attachment with a scalpel blade or similar sharp instrument. (B601.18.w18)
  • Insert a rabbit molar luxator into the periodontal space on one side of the tooth (buccal or lingual/palatal) and hold in with gentle apical pressure for 10-20 seconds. (B601.18.w18)
  • Repeat on the other side of the tooth. (B601.18.w18)
  • Alternate between the two sides. (B601.18.w18)
  • Once the tooth is mobile, grip the tooth, preferably with rabbit molar forceps (specially designed). (B601.18.w18)
    • Small haemostats may be used. (J513.6.w4)
  • Push the tooth into the alveolus and move it to destroy the germinal tissues of the apex, preventing regrowth. (B601.18.w18)
  • Withdraw the tooth from the alveolus. (B601.18.w18)
    • If it is too long to be taken out in one piece, section the tooth and remove in pieces. (B601.18.w18)
  • If the alveolus is infected:
    • Remove purulent material by debridement. (J513.6.w4)
    • Flush the socket. (B601.18.w18, J513.6.w4)
  • If several adjacent teeth are removed, suture the gingiva or glue it with tissue adhesive. (B601.18.w18)
    • This prevents impaction of food in the socket. (B601.18.w18)
Extraoral approach
  • Anaesthetise the rabbit. (J513.6.w4)
  • For mandibular teeth, place the rabbit in dorsal recumbency. (J513.6.w4)
  • Incise over the apex of the tooth. (B601.18.w18)
    • A 1 cm incision may be adequate. (J513.6.w4)
      • A larger incision may be required. (V.w125)
    • Dissect through subcutaneous and muscle layers down to bone. (J513.6.w4)
    • For teeth associated with a facial abscess, the approach may be through the abscess, dissecting down after removing all pus. (B600.7.w7, B601.18.w18)
  • If buccal bone plate is still present over the tooth root, use a slow-speed burr to remove this. (B601.18.w18)
    • Irrigate copiously during burring to prevent overheating. (B601.18.w18, J513.6.w4)
    • Take great care to avoid iatrogenic mandibular fracture. (J513.6.w4)
  • Use luxators, in a retrograde direction (from the apex) or both retrograde and orthograde (from the crown) to sever the periodontal ligament around the tooth. (B601.18.w18)
    • A 22-gauge or 25-gauge needle can be used to loosen the tooth from its socket. (J513.6.w4)
  • Once the tooth is mobile (all periodontal attachments broken down), remove it through the original incision or repulse it into the oral cavity for removal. (B600.7.w7, B601.18.w18, J513.6.w4)
  • Close the surgical site only if no infection is present and aseptic technique has been used. (J513.6.w4)
    • Close the muscle and subcutaneous layers using 4-0 (1.5 metric) absorbable suture material. (J513.6.w4)
    • Close the skin using 3-0 (2 metric) non-absorbable suture material. (J513.6.w4)
  • To allow abscess healing, suture the abscess open (marsupialisation) or debride aggressively and implant an antibiotic source from slow release. (B601.18.w18)
  • Monitor the growth of the opposing teeth, remembering that each rabbit cheek tooth opposes two of the teeth of the opposite arcade. (B601.18.w18)
Appropriate Use (?)
  • In treatment of periapical abscesses. (B600.7.w7, B601.18.w18)
  • The intraoral approach is useful only if there is already significant loss of attachment between the tooth and its socket, such that the tooth is relatively mobile. (B601.18.w18)
  • The extraoral approach is used when the intraoral approach is problematic due to e.g.
    • Tooth-bone attachment in cases or periapical infection or osteomyelitis. (J513.6.w4)
    • Tooth fracture below the gum. (J513.6.w4)
    • Tooth is not already mobile (mobility, i.e. reduced attachment of the tooth, occurs due to periodontal disease). (B601.18.w18)
  • The extraoral approach is particularly useful for the mandibular cheek teeth. (J513.6.w4)
Notes
  • Extraction of the opposing tooth is not necessary. (B600.7.w7)
  • If a tooth crown is found, during examination under anaesthesia, to be loose from the underlying tooth, the loose crown can be pulled off and out through the oral cavity. (B600.7.w7)
Complications/ Limitations / Risk
  • Extraction of cheek teeth is difficult. (B600.7.w7)
  • Extraction of cheek teeth where there is not already a degree of tooth loosening due to periodontal disease is difficult. (B601.18.w18)
  • Extraction of cheek teeth by the intraoral approach is difficult unless periodontal disease has caused reduced attachment, (B600.7.w7, B601.18.w18) and is "virtually impossible" if ankylosis of the tooth has occurred. (B601.18.w18)
    • The narrow oral cavity and the position of the tooth in the arcade can make extraction difficult. (J513.6.w4)
    • Adhesion between the tooth and alveolar bone may occur with periapical infection or osteomyelitis. (J513.6.w4)
  • Access to the teeth is difficult. (B601.18.w18)
  • Extraction is not advisable to prevent regrowth of cheek tooth spurs which require repeated trimming. (B600.7.w7)
  • Buccotomy (extraoral approach) necessitates surgical damage to the muscles of mastication and is painful postoperatively. (B600.7.w7)
  • There is a risk of fracture of the thin bone over the cheek teeth. (B600.7.w7)
Equipment / Chemicals required and Suppliers
  • Scalpel blade or other sharp instrument for severing the gingival attachment.

  • Luxator e.g. Crossley molar luxator. (B601.18.w18)

  • Forceps e.g. Crossley rabbit molar extraction forceps.

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, J15.30.w1, J513.6.w4

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