P. 610

An Urban Experience
the periodontal ligament  bers that hold each root within its alveolus.
Placing too much rotational pressure on the elevator
at this point will simply fracture the roots. Slow, steady, continuous pressure is the key to breaking down the periodontal ligament  bers. Rapid, forceful, and intermit- tent pressure will greatly increase the chances of fractur- ing roots. Once the space at the site of sectioning has widened slightly, the dental elevator can then be inserted along the mesial and distal aspects of the tooth with gentle, apically directed pressure.
The key is to start advancing the cutting edge of the elevator into the periodontal ligament space. If apically directed pressure is placed against the crown of the tooth or against the crestal bone, no progress will be made in elevating the root, and slippage of the elevator may result. Keeping the elevator dry at the sites of hand contact will also help to minimize slippage and undesired patient trauma. As the periodontal ligament  bers start to tear, the roots will start to show small
degrees of movement. Placing the dental elevator on the lingual aspect of each sectioned crown and pushing it apically into the periodontal ligament space will help loos- en the roots further. As the elevator is gently advanced apically, the mobile roots tend to displace coronally, indicating a successful extraction.
The following step is to perform an osteoplasty with a medium grit, medium sized football shaped diamond bur to reduce the sharp alveolar crest and bony ridges to a smooth surface which will safely accommodate the full thickness  ap upon closure. Post extraction radiographs are made prior to suturing the site.
Extracting canine teeth in the cat can be particularly challenging, given the relatively long roots and delicate surrounding jaw structures. This is especially true for mandibular canines, where symphyseal separations and rostral mandibular fractures can be a complication of the extraction process. Creating a full thickness triangular  ap on the buccal aspect of the mandibular canine tooth in combination with a lingual envelope  ap can help with the surgical exposure and process of selective bone removal. Using a high speed carbide bur to remove bone over the buccodistal aspect of the root can be helpful when extracting this tooth. This preserves a mesiobuccal section of bone and can serve as a fulcrum for a dental elevator. Removing bone, in such a fashion as to create a “slot” between the root surface and the remaining alveo- lar bone, provides an available insertion point which can guide the tip if the elevator to the periodontal ligament space. Slow, sustained pressure used to both twist the elevator and drive it apically is what will work to loosen the root of the canine tooth. Sudden forceful movements will increase the risk of root or jaw fractures. Once a canine tooth has been extracted, the alveolus curetted
and  ushed, and osteoplasty completed, it is well worth considering a bone augmentation product to  ll the alve- olus prior to closing the mucoperiosteal  ap.
Wound closure: Tension-free suturing and an appropri- ate shape and size of  ap are of key importance. Flaps planned to cover certain areas have to be larger (approx- imately 50%) than the size of defect due to postoperative shrinkage.
Generally, absorbable mono laments are recommended for oral surgery, size 5/0 for cats. This type of material causes the least irritation and is associated with the least amount of infection. Polyglecapron 25 is the most pop- ular material but in wounds where slow healing may be anticipated, PDS may be a good option.
Suture needles for oral surgery must be the swaged-on type. Needle curvature is either 3/8 or 1/2 with the latter more indicated in the caudal part of the oral cavity. A reverse cutting needle is the best for suturing gingiva and mucosa but for delicate mucosa, a taper point may be optimal.
The needle should be inserted into tissues perpendicu- larly to make the smallest possible entry wound and to avoid tearing of the mucosa.
Double layer suturing in major surgical procedures is better than one layer if possible. A distance of 2-3mm between the wound edge and the suture entry point and a 2-3mm distance between interrupted sutures is rec- ommended. In general a single interrupted suture is best and recommended in most oral procedures, although some authors suggest the use of continuous sutures af- ter total extractions in stomatitis patients reduce the time of closure and decrease surgical time.

   608   609   610   611   612