Introduction
The extraction of equine cheek teeth has historically been performed with often prolonged, highly invasive techniques and with high reported complication rates, including the risks associated with these procedures being performed under general anaesthesia (Prichard et al. 1992, Lane; 1997, Caramello et al., 2020). In more recent times, complication rates have been reduced by the re-introduction of oral extraction techniques, and more recently minimally invasive techniques, with a large percentage of procedures being performed under standing sedation (Langeneckert et al., 2015, Coomer et al., 2011). For successful outcomes, proper diagnostics and planning of dental procedures is crucial. Dental procedures should preferably be performed under clinical settings in a quiet environment with veterinary surgeons and staff experienced in equine dentistry, to reduce the sedation time for the horse and the overall procedure time. It is not uncommon to hear anecdotal reports of dental extraction procedures being very prolonged, extending to multiple hours or even days, which is likely to lead to higher complication rates, and compromise welfare. Prolonged sedation with detomidine, butorphanol and morphine; common drugs for dental procedures; have been shown to slow down gastrointestinal transit and intestinal mobility (Elfenbein et al., 2014, Gaddini et al. 2022). The overall mortality for standing sedation was shown to be 0,2 % in a study by Gozalo- Morzilla et al. 2021). Hence, short procedures are beneficial for the horse to reduce the risk of postoperative colic. With modern equipment, techniques and training, this should no longer be acceptable. To our knowledge, there are no studies to date demonstrating the average time spent performing oral and surgical extractions in horses.

Materials and Methods
Four veterinary surgeons participated in this study: two EVDC Diplomates and two EVDC Residents. Extraction timings are recorded from June to December 2024. All procedures were performed in clinical settings. Each procedure was timed from start to finish in addition to recording the time spent for the following steps of the procedure: Oral examination and decision making, radiographic examination, nerve block, local anaesthesia, gingival elevation, spreading, pre-extraction procedures (restorations, coronectomy, sectioning), oral extraction attempt, surgical procedure (minimally invasive trans-buccal extraction, minimally invasive repulsion), placing a plug, miscellaneous (scrubbing, setting up equipment, waiting for nerveblock/sedation etc). Both oral and surgical extraction procedures were included in this study. Simple oral extractions of very loose geriatric or deciduous cheek teeth were not included in this study. The age of the horses was recorded, oroscopic findings, tooth number, type of procedure and pathology seen pre- and post-extraction was noted.

Results
The average age of the horses in our study population was 13,9 (5-22) years old. Triadan position 109 and 209 were the most frequently extracted teeth. 77,6% were oral extractions, 20,4% transbuccal extractions and 2% minimally invasive pin repulsions. The average overall total procedure time was 76 minutes (range 35-185 minutes). The average total time spent for oral extractions was 62 minutes and for performing transbuccal extractions 98 minutes. The time average time spent extracting a tooth following completion of local and regional anaesthesia was 13,9 minutes for oral extractions and 36 minutes for minimally invasive surgical procedures. No general anaesthetics were performed for any of the extractions performed in this study and all procedures were completed in one sitting on the same day.

Discussion
There are several aspects that are crucial for a successful outcome of equine cheek tooth extractions. Keeping the procedure time to a minimum, thereby reducing the sedative dosage, is likely to reduce the risk of post procedural complications. Prior preparation and planning, quality diagnostic imaging, the skill, experience and training of the veterinary surgeon, proper equipment, a suitable clinical setting including stocks, are all factors that are likely to be linked to the shortest procedure time and reduced complication rates. The premise followed by the surgeons in this study is that for any time the tooth cannot be loosened and elevated within 30-40 minutes, an alternative technique was employed. The decision on which procedure to switch to (partial coronectomy, dental sectioning, alternate oral elevation or minimally invasive surgical procedure) is not always clear but the procedure likely to complete the extraction in the shortest time and with the lowest complication rates is something learnt with time and in the author’s view one best learnt with specialist led guided clinical training. This study shows that with this approach, dental extraction procedures extending over multiple hours or days should be consigned to history and not a continuing norm.

References
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