The complete removal of dental fragments during or after tooth extraction in horses is often the aim in clinical practice but is not strictly necessary in all cases. The aim of this article is to formulate an evidence-based and practice-oriented basis for decision-making regarding the indication for or against the removal of dental fragments, based on current literature and personal experience. Retained tooth fragments, particularly apical root remnants, represent a significant risk factor for postoperative complications. Gergeleit and Bienert-Zeit (2020) demonstrated that alveolar sequestrations can result from this and usually require surgical intervention. Pathophysiologically, fragments act as foreign bodies and bacterial reservoirs, which promotes chronic inflammation, fistula formation and delayed wound healing. The clinical relevance is supported by the case report from Clarysse et al.. (2025), in which persistent sinusitis and an oronasal fistula could only be resolved following the complete removal of remaining fragments.

Modern extraction techniques therefore explicitly aim for complete removal in order to minimise complications (Leps et al.. 2024). At the same time, Biermann et al.. (2025) point out that, particularly in geriatric horses, the increased fragility of the teeth raises the risk of intraoperative fractures and necessitates a careful risk-benefit assessment regarding their removal. Not all tooth fragments necessarily require removal. Small, “sterile and inactive” fragments may, under certain circumstances, be left in the alveolus provided there are no clinical symptoms or progressive radiographic changes. In such cases, a controlled, conservative approach is justified, particularly
if the surgical risk would be increased. Regardless of the chosen strategy, comprehensive documentation and the mandatory provision of information to the owner and the referring veterinarian regarding any remaining tooth fragments are essential. Only in this way can adequate follow-up care, including clinical and imaging follow-up checks, be ensured and the risk of delayed complications be identified at an early stage. In summary, the decision to remove fragments should be made on an individual and risk-based basis. Whilst infected or clinically active fragments should be removed consistently, a watch-and-wait approach may be justifiable in asymptomatic cases, provided that transparent communication and close follow-up are ensured.

References
• Gergeleit H, Bienert-Zeit A. Complications Following Mandibular Cheek Tooth Extraction in 20 Horses. Front Vet Sci. 2020 Aug 13;7:504.
• Leps A, Korsos S, Clarysse M, Vlaminck L. Dental sectioning for intraoral equine cheek teeth extractions: 29 cases. Front Vet Sci. 2024 Feb 15;11:1367861.
• Clarysse M, Korsos S, Vlaminck L. Oral Extraction and Nasal Retrieval of a Fragmented Maxillary Fourth Premolar Tooth in a Horse Using Endoscopic Guidance: A Case Report. J Vet Dent. 2025 Sep;42(5):397-406.
• Biermann N, et al.. Extraktion von Backenzähnen bei alten Pferden. Die Praktische Tierärztin 2025 Dec;106.