Alveolar Bone Expansion and Arterial Bleeding During Cat Canine Extraction

追加: 2026-05-18

[00:00:00]Hello, this video is going to cover a common problem with cats and that is alvola bone expansion. So how to deal with this type of extraction? So let's look at case I brought up here. This is a cat and what you see in this video is that you have a very loose tooth. So this is uh affected by combination of um elo bone expansion, periodontitis and uh extrusion of the tooth. So the cat is trying to get rid of it. So basically you can just pull that tooth out of the socket. The issue with leaving the socket open is that you will have a delayed healing. So you see here it comes out quite easily.

[00:00:47]So if you decide just to leave it open like that, it could take weeks to months before it finally closes and heals properly. So in this video, I want to teach you how to release that flap and how to close without any tension.

[00:01:06]So let's have a look at how you can do that. So basically you need first a scalpel and you make that releasing incision measial to that elva bone and you make sure that you push firmly all the way down to the bone and you continue the incision distally like this.

[00:01:35]And the next step is to take your pio elevator to pry off that attached ginger of the bone. And here I'm using a type per pio elevator from Dentonomic. This is a flat ended and it is very sharp.

[00:01:56]So it can easily slide under that edge of this very firmly attached ginger. So this ginger is very fragile. So you have to be careful when you pry it off. And I always start at the corner and then try to move sideways because if you start at the bottom and then push up up up like this, then you may penetrate the flap.

[00:02:24]So here you can see I'm kind of moving sideways and taking small increments, millimeters at a time. Again, starting here, going under that edge, small increments, pushing it up. And once you get into that loose mucosa, now it becomes much easier. So, you see it went fairly easy. Some of these can be very tricky, but this was uh a little bit easier. So, I decided to extend that incision just a little bit to give me just a slightly larger flap.

[00:03:14]Again, just lifting here off of that tooth to expose more of the envelope bone.

[00:03:25]And now what you want to do is you want to take away all of this diseased bone.

[00:03:30]You can see all this granulation tissue that is present inside the elbows and that see it's quite loose in here. All this nasty tissue.

[00:03:43]So you can use a Lucas caret to scrape it out just like this. You can see just how much infected tissue is inside this elbow.

[00:04:00]So the goal of the surgery is to remove all of this granulation tissue as well as the overlying elvela bone so you can close without any tension.

[00:04:13]So now I'm using a medium grit diamond football burr on this hand piece and to remove this alvola bone. So you just smooth it down with that burr like so.

[00:04:35]And I'm just continuing here to smooth everything down.

[00:04:43]So you can see I'm just removing that bone with the burr and you may encounter some vessels doing this. See, in this this case, there was a vessel right here that was bleeding moderately.

[00:05:12]So, don't stress out too much about this.

[00:05:16]It's not going to usually be a severe bleeding. Unless you see pulsation, then you need to you need to deal with it. Like here you see now it's starting to pulsate a little bit from this vessel. This means that it's probably not going to stop by its own. So you're going to have to apply some pressure. And I just kept going a little bit with the drilling until I decided to do something about this. So you can see it's now this is pulsating. So in this case you cannot just leave it. You got to apply some pressure. So there's a few things that you can do. The most simple is just applying pure pressure with some gauze and keep it there for about 5 minutes.

[00:06:07]In nine out of 10 cases, this is enough and the bleeding will stop. Okay, so this is about 3 minutes later. I decided to let go of the pressure and see see what we got.

[00:06:22]Let's see.

[00:06:24]Okay, very nicely the bleeding stopped.

[00:06:26]So, in this case, the manual pressure definitely worked. So, going back and drilling, I of course have to be aware that I don't just rip up this uh vessel again cuz then we're going to going to start over. So, I'm using this pio elevator to pry off that palatal side of tissue. And the reason we do this because we need an edge to place our suture in. If we don't have a loose edge, we're just going to place the suture through the soft tissue into the bone. Need to go under the soft tissue and over the bone. So that's why we need to raise it from the bone so we can take a good bite. And you can see how I'm checking the tension with this flap and it lays pretty nicely over that defect. That's how you check it. You want to place it over the defect and see if it stays there or not. So, this edge is quite inflamed. And the nice thing about this diamond football bird is you can actually drill the inside of the flap. So, you can use this use it to deprive the inside of the flap.

[00:07:40]So instead of cutting away part of the flap with a pair of scissors, you can in many cases reduce or remove this epithelial layer that has been developed on the inside simply by running this diamond football bur across the inside of that flap. Don't use a round bur. Don't use a tapered uh crosscut tapered fisher bur because this will destroy the flap. But a diamond bur will just debride it. So this is a very nice tip that you can use.

[00:08:17]And now it's time to suture.

[00:08:21]You want to use this is a monochrome five odd on a reverse cutting needle.

[00:08:28]And see why I released this the edge of the flap so that I can make a good bite here.

[00:08:46]So, grab the flap, insert it at a 90°.

[00:08:50]Make sure you exit at a 90° angle.

[00:08:54]This will reduce tearing.

[00:08:57]Do a double throw here.

[00:09:00]And then one, two, three, and four throws on top of that.

[00:09:15]And try to place the sutures about 3 mm apart and grab about 3 mm byes.

[00:10:02]So, this part can be a little bit tricky. That's why I decided to go in from the other side cuz I get I could get a better bite of that tissue in front of the flap if I went in from this side.

[00:10:18]So sometimes you have to adapt your angle, your insertion point.

[00:10:30]And that's the finished result.

[00:10:33]And it did heal uneventful.

[00:10:40]So something you can do, I don't do this every time, but you may have heard of the concept of lip entrapment. So most of cats, at least 2/3, they will develop some sort of lip entrapment after extraction of the upper canine. So that means the lower canine will catch the lip and it will like push it upwards like this.

[00:11:06]This could result in a small wound of the of the lip. Most cases resolve by themselves. You don't need any treatment at all. But I'm just going to show you how you can do a little odontolasty. So you take a burr. This could be a diamond burr, fine diamond burr. In this case, this is an Arkansas stone burr. And you want to smooth around the tip a little bit. And you want to do this X-ray guided. So I had my X-ray that was taken prior to the surgery and this showed me how close to the surface that the pulp chamber is. So in cats you usually cannot take off more than 1 mm before you um risk getting too close to the pulp. So here I'm just smoothing it making it nice and round so that it will not penetrate the upper lip. It's not something I'm saying you have to do every time, but I'm just showing you how you can do it if you decide to to do it.

[00:12:16]So, by drilling into this, you have now exposed some dentine tubils. And these tubils need to be sealed. And for that, I'm using some self-etching bonding agent here.

[00:12:31]And you rub it on for 20 seconds.

[00:12:35]And this will close those dentine tubils that you may have opened now with your uh burr. So it's going to create a smear layer that is incorporated with this bonding material and plucking those tubles. And now you want to air dry it just a little bit to eva evaporate some of the solvents. Then you light cure for 10 seconds. Follow the instructions. um from the manufacturer. Don't use materials that are too old uh because they won't work as well.

[00:13:15]And that's it.

[00:13:18]So, just make sure that you don't go too deep. Use your X-ray to guide you. And this is a fairly straightforward procedure. If you like this video and you want to have more extractions video at hand. So let's say you have a lower canine extraction coming in tomorrow and you want to review the surgery. You want to see the exact step by step how to perform the surgery to avoid breaking the jaw for example, then I've made a complete extraction video library that you can get access to. So, just click that link in my bio to go to my website.

[00:13:58]Then you can get access to the my video library guiding you through every extraction you need to know and you can have it right in your pocket on your phone and pull it up whenever you need it. So, just click the link in my bio to go and check it out. It's called the video extraction library.