Trephining for maxillary tooth removal

[Kyrabee]

My dear 21yo mare has had a tooth that began fragmenting with slabs breaking off about 3-4 years go and as of December ‘22, the final remaining piece fell out leaving nothing below the gum. So far, she hasn’t had any infections. I took her in for x-rays today and some small pockets are starting to appear adjacent to the root and of course, that tooth root is only mm from the sinus but no signs for any infection. The vet felt it should come out before it does get infected and that trephining through her sinus to get it out would probably be easier on her since there is nothing to grasp intraorally and the tooth has fractured vertically and he would be trying to dig out many pieces. It would be done standing and with packing so I won’t even have to adjust her diet to mashes.

Since she currently has no infection and I am going to start using a drench gun to irrigate the hole and try and keep food packing to a minimum, I decided to put off any action until after I go on vacation in mid-May.

Has any one had to do this and what was your horse’s recovery like?
TIA
Susan

[cayuse]

Kyrabee, my mini is going thru this procedure this morning! I’m waiting for an update any minute. He has an infected sinus and a bad root and the tooth is going to be removed as you described barring any last minute complications. I will let you know how his recovery goes.

[LCDR]

Here is a reference for you. My non-expert opinion is that I would hesitate to electively create an oroantral opening when there is no sinus infection present. The situation presented by @cayuse with a pre-existing sinus infection is different from yours.

I have posted about this before, but there are many veterinarians who do dental procedures as part of their general practices, and there are also a much smaller number of academically trained and qualified equine dental specialists. They are also veterinarians, but have additional years of training and specialize in the limited area of equine dental surgery and pathology.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiNrqf_oYH-AhUnnWoFHVQICD0QFnoECCQQAQ&url=https%3A%2F%2Fwww.research.ed.ac.uk%2Ffiles%2F85926329%2FTreatment_of_equine_oro_nasal_and_oro_maxillary_fistulae.docx&usg=AOvVaw1vmvpJSit1qfvSQtPIRAjz

[Kyrabee]

Yes. That is why I am not jumping on it…with no current issues except a space that packs food.
That article really just talks about the sequelae (fistula) of an extraction. It does not address her problem of having no tooth below the gum line to grasp and vertical breakage that would probably not allow any kind of tool to be drilled into the stump without breaking it into a lot of pieces.
This vet practice is a fairly large regional hospital that does a lot of services and surgery but yes, I want to speak to the surgeon before hand. We have some non-DVM dentists that I am not familiar with. It may be worth a second opinion if I can find a decent one. I have had some long ago experience with some that weren’t very good.

Cayuse…big jingles for your little man.

Susan

[hut-ho78]

I had a trainer about 30 years ago whose horse had this done. It healed well. It seemed a bit daunting in theory and visually, but if memory serves, the horse had no issues and was competed nationally soon after. I can’t remember the follow up now. I think there was some irrigation of the hole by the vet a couple of times but not sure at all. It was in a large barn and that vet practice had associates stopping by often so they could easily check it.

She was out of town for several days and I had to check (as a barn buddy, not a veterinarian) it for a portion of that. There was nothing for me to do except look at it to make sure it didn’t look infected.

[cayuse]

My mini is doing well so far, saw him today at the clinic. Yesterday they did the procedure and he sailed through it just fine. He has a small incision and about 2 stitches where they made the hole, and they told me the tooth popped out easily. He does have a tiny tube inserted into his forehead to flush his sinus, but that is only because he had an infection. There is some packing where the tooth was that needs to be removed at a later date. He is eating hay already. I’ll post another update in a few days. I was going to take a couple of pics to post but got gabbing and forgot!

[Kyrabee]

Thank you Cayuse. I am glad he is doing well.

I am still going to wait until I get back from vacation but will probably get it done. That fact that the molars on either side are pinching in on the space where the crown of that tooth is missing could it get to the point where it would be hard to get the root out by any method or make it a much harder procedure. The crown fractured off in several vertical slabs and I can’t believe that at some point, gunk isn’t going to make its way up into the root and get infected. I am rather surprised that it hasn’t happened yet.

Do let me know how he is doing.
Thank you,
Susan