Episode 176 - Avoiding Jaw Fractures & Other Extraction Pitfalls in Vet Dentistry

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Host: Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM

Welcome Back to The Vet Dental Show!
Each Wednesday, we dive deep into veterinary dentistry to help veterinarians, technicians, and dental teams excel in their practices. This episode is packed with expert advice and case-based insights you can immediately apply.

On This Episode:
Dr. Brett Beckman answers real questions from veterinary professionals on topics that often create confusion or uncertainty in daily practice. From avoiding iatrogenic jaw fractures to understanding the clinical relevance of Chevron effects and root fractures, this episode is a must-watch for dental practitioners in general veterinary practice.

What You’ll Learn in This Episode:
✅ How to assess the risk of iatrogenic jaw fracture during canine tooth extraction
✅ Key anatomical differences in small vs. medium-sized dogs impacting fracture risk
✅ Proper technique considerations to avoid mandibular fractures
✅ How and when to use the dental explorer and periodontal probe
✅ Identifying true Chevron effects vs. radiographic artifacts
✅ Longevity and application of dental composites and bonding agents
✅ The clinical significance of root fractures and criteria for extraction
✅ Evaluating if learning restorations is financially justifiable in general practice

Key Veterinary Dentistry Takeaways:
✅ Proper extraction techniques dramatically reduce jaw fracture risk
✅ Chevron signs can be misleading—use radiographic comparison wisely
✅ Bonding dentin can be long-lasting when done correctly
✅ Not all root fractures necessitate extraction; radiographic and clinical context is key
✅ Mastering restorative techniques can be beneficial and profitable in general practice

Ready to Advance Your Skills?
Register for Veterinary Dentistry Courses at veterinarydentistry.net. Explore online CE options, including radiographic interpretation courses!

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Questions or insights? Drop them in the comments!

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veterinary dentistry extraction technique, iatrogenic jaw fracture dog, dental explorer anesthesia use, Chevron effect dental radiograph, veterinary root fracture management, canine tooth extraction risks, bonding agents veterinary use, periodontal disease small dogs, learning vet dental restorations, Dr. Brett Beckman dental tips

Episode Transcript

(00:00):
Welcome to the Vet Dental Show.
I'm Brett Beckman, board certifiedveterinary dentist, and we bring
this podcast to you every Wednesdayas a veterinarian, as a technician,
as a dentistry team to help you beeven better if veterinary dentistry
in your practice where sponsored.

(00:22):
And partnered today with theVeterinary Dental Practitioner Program.
If you're interested in beingamong the best anywhere in general
practice as a team in veterinarydentistry, I invite you to request
an invitation is go to i vdi.org/.

(00:51):
INV, like invitation first, threeletters, INV, so IVDI, international
Veterinary Dentistry Institutei vdi.org/i nv and we'll get you
the information that you need.
I. Kristen ha has a question, what isthe risk of iatrogenic jaw fracture

(01:16):
during extraction in the canine patient?
And that it, that's a greatquestion and let me go.
To the keynote, and I'll show youwhat we're talking about and I'll
describe it for our podcast listeners.
So when we have a lucencyadjacent to the apex of the tooth,

(01:44):
then off oftentimes thatlucency is like you see.
In this image where describing this,the roots of the canine tooth are not
really that close at all to the ventralcortex of the mandle, and it would take

(02:08):
a tremendous lucency to extend to thatpoint with the roots that far away from.
The ventral cortex, and even thensometimes there's enough bone stability
there that it's not gonna be a problem.
In this case, let's say itdoes extend to the cortex.

(02:30):
You've got a lucencyaround the mesial root.
It's not that big, but it's.
Pretty dense.
It extends to the cortex and breaksthrough the cortex somewhere, but
there's no bone loss down to that.
And the reason why that toothhas the lucency is because it was
compromised endodontically or.

(02:52):
Either through open fracture orthrough trauma and chronic pulpitis.
And with that lucency and with thosetwo throats being that far away and
no bone loss, there's almost no chanceof fracture that mandible if you
know how to do the correct technique.
So that's the answer to thatquestion from that standpoint.

(03:13):
But if there's bone loss.
That surrounds that entire two rootstructure there from the standpoint
of all the way to the apex.
And those root apices are closer tothe ventral cortex of the mandible,
which happens in small dogs.

(03:33):
This this case that we're describingis probably a medium sized dog, so
the roots aren't all the way downto the ventral cortex, but in small
dogs, the tooth roots and the.
A crown are too big, hence theproblem with crowding of the crowns
and periodontal disease with smallerdogs and the fact that those teeth
are too big for their mouths.

(03:55):
So with that, we often get boneloss at significant, starting at.
The marginal bone level where theperiodontal disease is working its
way down, killing the tooth, thenproducing perial lucencies and or
migrating down that bone or thattooth root bone interface, destroying

(04:17):
the bone so that tooth might evenbe a little bit mobile then that.
Becomes an issue sometimes with fractureif the proper techniques not used.
So many of our students that even cometo our wet labs are apprehensive and
rightfully so about extracting that tooth.

(04:38):
In particular, if there's a lot ofbone loss and possibly that tooth
in particular, even if there'sno bone loss as it's perceived
as a difficult extraction.
In reality, it's not that difficult.
And if you have the proper training,and we provide that with our wet labs,
we've got those coming up in June, youcan find [e-mail].

(05:02):
Just look at my name downthere and you'll see the link.
You can register for the course in Atlantaat our new teaching center, brand new.
We've only used it twice andit's incredible in in north
of Atlanta and Sandy Springs.
So I love to see you guys there.
But anyway, again, that's oneof those tangents I get off on.
But with that being said, that toothand the mandibular canine are the ones

(05:25):
that fracture jaw structure most oftenduring extractions with situations
where the practitioner may not bethat comfortable with the extractions.
And so those are often referred.
And if you're not comfortable with that,I would recommend that you refer as well.
But if you're comfortable, aperfectly good technique that
you've taught you've been taught,then certainly fine to do that.

(05:48):
That hopefully that answers your question.
That's a long answer Christian Kristen.
But that's the answerto that that question.
Sue Bowman is the Denton Trailmentioned made with the Explorer
and Yes, it indeed it is The DentalExplorer, which is on the other side
usually of your periodontal probe.

(06:12):
That's, that is what's the term?
Scored in millimeters generally tolet you measure periodontal pockets
and attachment loss with gingivalrecession and bo or both combined.
And is it done in the awake patient?
No, it's done in thepatient under anesthesia.

(06:32):
You could possibly do it in the awakepatient if you have a super good awake
patient, but if that patient's headmoves, that's a super sharp point.
Therein lies the problem, so Iwould suggest that in all cases.
With few exceptions that youdo it under general anesthesia,
it's gotta be evaluated anyway.
And your radiographs are super important.

(06:53):
If there is something that is associatedwith an abrasion of a tooth, and so that
determination, you need radiographs anywaybecause that tooth been traumatized.
So do it under anesthesia, Sue wouldbe the best way to, to answer that.
Hailey.
Ola.
Hailey, thanks for your questions.
Chevron affects something thataffects more breeds than others.

(07:17):
Is it common to see more on themaxillary or the mandibular teeth?
And we generally seethat in several places.
One is the four centralmaxillary incisors real common.
The canine teeth, especially themaxillary canine has a Chevron effect.
Or it may have an effect from superimposition of the nasal cavity over

(07:37):
the apex, which may look like a hugechevron effect or a huge lucency.
So you have to be reallydiscerning in order to make that
call on the maxillary canines.
Mandibular canines may havesome of that, but usually not.
Those, if you see lucency, you want tolook at the other side on those, for sure,

(07:58):
on the apex of the mandibular canines.
And then the other placethat you'll see those is the
mandibular first and second molar.
More common in the mandibular, firstmolar, I think, than most teeth.
You always want to compare that to theother side as well and make sure that.
Your views are both parallel, which is alittle easier to do if you're comparing

(08:19):
canine to canine in the maxilla, alittle bit more difficult because you
have to have the same, pretty muchthe same angle of the tube head in
order to compare really accurately.
But you'll get a general idea, and ifthere's any question, then you either
have a somebody consult with you on thatradiograph after the patient wakes up.
You don't want to assume thatit's an extraction unless you know

(08:40):
for sure, certainly training and.
Radiographic interpretation will help.
We've got an online course for thatat that URL that I mentioned before.
Five hours of justradiographic interpretation.
So those things and theexperience will help you make
those determinations on that.
So thanks Haley for that question.

(09:02):
So let's go down to the next question.
Michelle Pang, dental Compositesrecommended to restore.
Defects, seal dal tubules and protectthe underlying tooth structure.
How long does it last?
Assuming normal, everyday mastication.
So if you have composite on there, excuseme, and you have a bonding agent under

(09:25):
there, which is definitely what youwant to do, the dentin bonds to that.
In the connective tissue of the dentin,in the tubules and in the matrix.
And that's pretty much a permanent thing.
The composite could beknocked off, certainly.
And so if you're using composite,which very few people listening

(09:45):
today are there, there are not verymany people who are using composite.
They might be bonding, but weteach that in the advanced course.
So if you're not doing that'swhere you get that information.
But.
If you are looking to how long it lasts,if you're just bonding a minor defect
in the dentin that's gonna last untiltertiary dentin comes in and replaces

(10:08):
that, or it's, it is essentially forever.
You wanna monitor that tooth becauseif you've got that insult into
dentin and you're looking at it, dayone, let's say it comes in Monday,
you don't know when that occurred.
So it might have occurred twomonths ago, and we haven't had
chances for the bacteria to get in.
Of that dentin, kill the pulpand show radiographic changes

(10:30):
as a subsequent result.
So you always wanna check that downthe road a couple months after that
and make sure that you're up to up toactually six months after that or so
to make sure that there's no changes.
If the patient's older, you probablywant to go a year because the
canal is smaller and the changesare much more slowly to develop.

(10:53):
So those are the guidelinesthat you'd use for that.
And mastication is not gonnaalter that for the most part.
Good question there.
Eric Yeager totally a business question.
More than a healthcare question,do you think it's financially
justifiable to learn restorationwork in general practice?

(11:14):
And I think it's super common to find it.
And we get a lot of questions in coursesabout restorations and bonding, and it's
not that super difficult to learn bonding.
You want to know the basic principlesof cavity preparation and the
physiology of bonding to makedeterminations based on that knowledge.

(11:38):
So that's a course in itself.
Great question.
Hope I answered that Eric.
It is indeed justifiable to learnthat, and you just need to invest the
time to, to get that kind of training.
So Monique has a question with a tooththat has only a root fracture, would there
ever be a time where the tooth could stay?

(12:00):
And that's a great, that's a greatquestion and yes, indeed, A lot of
times, and maybe more often than not,that tooth can stay if you've got a
tooth that is undergoing resorption, I.Around a fracture and, but it's under
the bone and there's no periodontalchanges there, then that is, is

(12:25):
probably never gonna be a problem.
So that root fracture under the bonelevel with no perio care or no perio
involvement it does not require extractionas long as there's no lucency there.
If there is.
A lucency present.
Then with that lucency, you wannamake sure that it is indeed a

(12:52):
lucency and not a Chevron sign with.
A case where you have radiographicchanges like the one you're looking at
if you're live, and the one I'll describeif you're watching this on the pod or
listening to this on the podcast, we'vegot an enlarged periodontal ligament space

(13:15):
around the root segment, which means it'sdislodged from the bone and or it has
periodontal disease associated with it,destroying the bone adjacent to it in.
Either case that toothcrown is probably mobile.
And so that would be another indicationalong with what it looks like

(13:40):
radiographically and what it probes aswhen you probe it in order to make a
determination that needs to be extracted.
So radiographically, if youcan see that there's marginal
bone to fracture communication.
So where the tooth root and the bone aresupposed to be and where the fracture

(14:02):
is, there's open space in the radiographand or you have mobility of that crown.
Those are indications where not onlythe crown needs to be taken off.
But that tooth root needs to beextracted, whether it has a lucency
or not because it's probably gonnaestablish a lucency given enough time

(14:26):
if there's periodontal involvement.
If there's a lucency in addition to that,then that means the tooth is already
dead and the bacteria have gotten out,destroyed the bone around the root tip.
And so that's certainly a definiteindication for extraction of that segment.
So I hope that answers your question.

(14:46):
I hope you enjoyed that episode.
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