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Fig.7 Dental radiograph showing a non-mobile mandibular first molar (M1) despite severe periodontal bone loss. Fig.8 Preoperative radiograph showing severe bone loss from periodontal disease resulting in minimal supporting ventral cortical bone. Fig.9 Postoperative radiograph showing the complication of mandibular fracture at the M1 extraction site. Fig.10 Photographs showing extraction of a M1 in a dog with a draining tract (arrow) from periapical abscessation (A). The tooth appears relatively healthy with expected plaque and calculus from peridontal disease (B). A potential difficult extraction is managed using a mucoperiosteal flap, crown sectioning (C), and elevation of individual crown/root segments (D) to decrease the possibility of iatrogenic mandibular fracture.

TooTh ExTracTion: True or False- Mandibular First Molar Extraction is the Most Common Reason for Iatrogenic Mandibular Fracture in Dogs

True! The mandibular first molar tooth (M1) was not meant to leave the mandible! The 2 large tooth roots diverge providing effective anchorage in the mandible. Even when affected by severe periodontal disease, the M1 is often not mobile (Fig. 7). Preoperative intraoral dental radiographs are an invaluable diagnostic aid before extracting any tooth, especially the M1. The radiograph will show how much bone has been lost secondary to periodontal disease and how much mandibular bone remains to support the M1 (Fig.8). Attempting to extract the M1 between office calls can be problematic for both the veterinarian and the dog. It's the crack that can make you shiver (Fig. 9)! The principles for surgical extraction of the M1 includes mucoperiosteal flap elevation, sectioning the tooth into 2 crown-root segments, judicious removal of buccal alveolar bone, elevation of tooth roots with controlled force, application of bone stimulating material, and flap apposition (Fig 10).

Fig. 7 Fig. 8 Fig. 9

Fig. 10a B

C D