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Minimally Invasive Oral Surgical Technique in Horses.
- Nick Moore DVM
- 2d
- 3 min read
At our veterinary dental workshop this week, we had the pleasure of working with Dr. Mauricio Bittar, a longtime friend and colleague from Brazil. Mauricio joined us to co-teach a course for veterinarians, and we took the opportunity to share a particularly insightful case that exemplifies the value of both collaboration and thoughtful clinical decision-making.
Learning Beyond Conferences
While conferences are great for networking and catching up on the latest research, there’s something incredibly valuable about spending real, focused time with colleagues. In our case, having Mauricio here in person allows for the kind of nuanced, experience-based exchange that can't happen in a lecture hall. We learn from each other constantly—through case discussions, procedures, and observing the subtle techniques that each of us has developed over time. It’s a reminder that the best learning is often collaborative.
The Case: A Tricky Tooth Extraction
Before our course officially kicked off, we handled a challenging case involving a diseased upper premolar (#208) in a horse. Several previous extraction attempts had failed, with the tooth fracturing and the roots left behind. This is a fairly common issue in equine dentistry. When a tooth breaks, especially with no crown left to grip, the challenge becomes: what’s the safest and most effective way to proceed?
We discussed the options:
Doing Nothing – Always an option, but never a good one for the horse’s wellbeing.
Repulsion – An outdated and invasive technique where the tooth is driven out from above with a hammer and punch. This method creates a high risk of complications, including communication between the sinus and oral cavity.
Transbuccal Extraction – A reasonable option using a screw inserted from the cheek side. While effective, it still involves a small amount of trauma.
Segmented Extraction – Our preferred approach, which involves cutting the tooth into sections and removing each piece carefully. It's the least invasive and results in the best outcomes for the horse.
The Procedure in Action
We chose segmented extraction for this case. After numbing the area with a combination of maxillary, perineural, and infiltrative blocks (ensuring maximum comfort for the horse), we used a water-cooled burr to divide the tooth.
From the moment the horse was blocked to the final extraction, the procedure took just 16 minutes. That’s not to say speed is the goal—it's not a race—but time is a reflection of efficiency. Longer surgeries often mean more trauma and higher complication risks. Efficient, skilled procedures minimize stress and physical impact on the animal.
The Importance of Thorough Examination
After the extraction, we conducted a nasal endoscopy due to the horse's history of nasal discharge. This revealed an oral-nasal fistula—a small but significant tract where food and pus were entering the nasal cavity. It’s a detail that X-rays alone wouldn’t reveal.
Thanks to the minimally invasive nature of the extraction, the fistula was small enough to avoid surgery. We were able to clean it using long, thin cardiac forceps, removing food debris and avoiding more aggressive intervention. Had a repulsion technique been used, the damage would likely have made healing impossible.
Why This Matters
This case is a perfect example of why foundational skills, detailed examination, and collaborative discussion matter so much. As Mauricio put it, “Dentistry is complex. If you understand the basics well, you can piece the puzzle together effectively.” It’s also a testament to the power of continuous learning and international collaboration. By sharing experiences and techniques, we grow—and ultimately, provide better care for our patients.
If you’re interested in these kinds of cases and want to keep learning with us!
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