Pulling Teeth: Dorsal vs Buccal Approaches

This study compared buccal and dorsal approaches for surgical extraction of mandibular canine teeth in cats in regard to extraction time, surgical wound closure time, volume of bone loss, and incidence of complications. It has been suggested that the dorsal approach minimizes iatrogenic damage to the buccal soft tissue and neurovascular structures while allowing access for alveolectomy, extraction, and surgical wound closure. The removal of less alveolar bone associated with the dorsal approach would also decrease the risk for iatrogenic mandibular fracture or symphyseal separation. 

Two surgical approaches were used to extract the mandibular canine—1 approach on each side of 12 feline cadaver specimens. Mean extraction time and bone loss volume were less for the buccal approach, but the difference was not significant. The time required to surgically close the dorsal approach was significantly less than for the buccal approach. The total time (extraction plus closure) was not significantly different between the 2 approaches. Based on postoperative palpation and manipulation of the mandibles, dental radiographs, and computed tomography, no complications were associated with either approach. The authors concluded that both approaches, performed properly, can be recommended to extract feline mandibular canine teeth.

Commentary

This study provided support for use of both dorsal and buccal approaches to extract mandibular canine teeth in cats. The most significant limitation of this study is that pathologic conditions (eg, juvenile teeth morphology, ankyloses, dental or mandibular pathology) were excluded. These conditions are most likely to cause difficulties such as retained roots, iatrogenic fractures, and symphyseal separation. Additionally, because this was a cadaver study, it could not evaluate which approach has greater impact on rate or quality of clinical healing.—Donna Bucciarelli, DVM