& Management / Disease
Investigation & Management / Techniques:
NOTE: Although the procedures are described
below as accurately as possible, these descriptions are NOT a substitute for learning the
procedures by watching and assisting a veterinarian who is already
experienced in the technique.
- Induce anaesthesia in the bear. Various options are possible see Treatment and Care
- Bear Anaesthesia
- One the bear is fully immobilised, intubate and maintain with
isoflurane on a circle system.
- Give appropriate perioperative analgesia,
e.g. carprofen 4 mg/kg
butorphanol 0.07 mg/kg
immediately post-induction. (P3.2006a.w1)
- Provide local analgesia: bupivacaine
provides 3-10, usually 6-8, hours
of analgesia; lidocaine
(lignocaine) could be used to provide a shorter period of
local anaesthesia: (P3.2006a.w1)
- For maxillary
canine extraction, use an infraorbital nerve
- For mandibular canine extraction, a maxillary nerve block can be
combined with a mental nerve block (to improve analgesia if the
maxillary nerve block fails). (P3.2006a.w1)
- Monitor during anaesthesia (e.g. visual monitoring, pulse oximetry,
- Give intravenous fluids during surgery. (P3.2006a.w1)
Open Extraction Procedure 1 (standard approach to removal of
canine teeth in carnivores)
Open Extraction Procedure 2 (alternative, non-standard)
- Make an incision from the gum down over the root of the canine along
the whole length of the root.
- Elevate the gingiva
(gum) with a periosteal elevator to expose the bone;
reflect the gum to either side.
- Using an osteotome (1 cm wide), remove the lateral alveolar wall
over the root of the canine tooth.
- Using the osteotome and dental
elevators, gently elevate the rostral,
medial and caudal aspects of the root from their
attachments (i.e. break down the attachments of the tooth root to its
only the proximal 2/3 of the root appears to be attached to the socket
by the peridontal ligament.
- Elevate and remove the tooth from the socket.
- Scrape the inner alveolar surface to remove any debris from the
- Use bone rongeurs to remove any splinters of bone from the alveolar
crest (the edge of bone around the tooth socket).
- Lower the alveolar crest using bone
- This will allow the edges of the gum to be placed together and
sutured over the empty socket without tension.
- Flush the extraction site with dilute chlorhexidine
- Insert a calcium/sodium alginate dressing (Kaltostat, Conva Tec
Ltd.) into the alveolar socket to fill the defect, provide a matrix
for clot formation and provide a support for the gingiva.
- The dressing also provides a barrier to help prevent food
impaction in the socket if any dehiscence of the gingiva
- Replace the gingiva and debride the margins to aid healing by
- Suture the gingival margins with tension-relieving sutures:
polydioxanone (PDS, Ethicon) in a cruciate pattern is suggested.
- Post-operative analgesia orally for 3-5 days as required (depending
on clinical evaluation).
- Antibiotics orally (these can be given in a treat such as a
- Monitor wound healing daily, when the oral medications are given
|Appropriate Use (?)
- When canines have been damaged resulting in pulp exposure, and
neither pulpotomy [Pulpotomy in Bears]
nor root filling [Root Canal Procedures in Bears]
is appropriate: e.g. vertical
fractures extending under the gum or affecting the root; infected
teeth with an open root apex, or with associated peridontal disease;
or if materials and equipment for pulpotomy or root canal treatment are
not available. (B214.3.4.w16,
- It has also been suggested for situations in which canines have been damaged resulting in pulp exposure, and filling the tooth is not appropriate
check-ups/follow up will not be possible. (P3.2006a.w1)
However, it should be noted that bears maintain root-fillings well if the fillings are properly
- The technique described as "Procedure 2" above, involving a gingival incision directly over the tooth
root, is "contrary to all principles of oral
surgery" (B452.10.w10), with the suture line overlying the
bony defect, but more than 150 canine tooth extractions have been
carried out on rescued Ursus
thibetanus - Asiatic black bears using this method, without any
- Continuous irrigation with water is important while bone is being
removed: to cool the alveolar bone, preventing overheating and necrosis; to cool the burr, which will have its efficiency lost if it
overheats; to wash away bone chips, so they do not clog the burr; and
to keep good visibility of the surgical site. (B452.10.w10)
- Surgical aspiration (suction) is required to take away irrigation water and
blood and maintain good visibility. (B452.10.w10)
|Complications/ Limitations / Risk
- Risk of breakdown of the gingival sutures and food packing into the
- With bupivacaine
as a local anaesthetic there is a risk that the
bear might self-traumatise after waking from the general anaesthesia.
However, this has not been a problem in the series of more than 150 operations carried
out on Ursus
thibetanus - Asiatic black bear. (P3.2006a.w1)
- According to the principles of dental surgery, healing of the
gingival incision over an osseous defect [as created in the first
procedure described] is unpredictable; there is increased risk of
dehiscence of the flap. (B452.10.w10)
- Possible sequelae to removal of large canine teeth in carnivores
include "post-operative infection, malocclusion, bone
resorption, jaw fracture and damage to adjacent teeth." (B470.19.w19)
|Equipment / Chemicals required and Suppliers
General anaesthetic agents and appropriate equipment
for anaesthetic administration and monitoring
Local anaesthetic agent
Anaesthetic monitoring equipment
Needles and syringes for injection
Suture materials and instruments
|Expertise level / Ease of Use
- This procedure should be carried out by personnel with experience
and training in dental surgery in animals.
- The costs of this procedure include the costs of the personnel
required (minimum one suitably qualified person to carry out the
dental work and one to monitor the anaesthetic), and costs of
|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).).
||Debra Bourne MA VetMB PhD
||Suzanne I Boardman BVMS MRCVS