Advances in dental extraction techniques have changed the landscape of veterinary dentistry, offering general practitioners the potential for improved patient outcomes and fewer complications than traditional methods. First, let’s discuss the elephant in the room. One of the most favorable descriptors in both human and veterinary surgery is the term “minimally invasive.” Therefore, the term may be misused. Given the vast surface area of veterinary patients’ teeth, referring to the extraction of a firmly rooted tooth as “minimally invasive” is akin to referring to a grenade as “minimally explosive.” Extraction of firmly rooted teeth requires oral surgery, which is inherently invasive to some extent. However, there are some tools that can make the process easier for both the patient and the operator. Importantly, some of these tools will help to minimize life-altering complications, such as fractures of the jaw. Perhaps a more accurate term than “minimally invasive” in the context of oral surgery would be “less invasive” or “minimally traumatic.” There is a truly “minimally invasive” option for a firmly rooted, endodontically diseased tooth: root canal therapy. Root canal therapy is an elegant option for fractured teeth and teeth with pulpitis to maintain function and, hopefully, prevent future infection. Success rates with root canal therapy in dogs are high. One study, with a mean follow-up of 13 months of 127 tooth roots in 64 dogs, found failure in only six percent of roots treated with root canal therapy.1 Minimally traumatic dental extractions have gained traction in small animal dentistry, driven by shorter recovery times, fewer complications, and preservation of healthy tissue. With new technology and techniques emerging rapidly, general practice veterinarians are increasingly equipped to perform extractions that once required referral. These techniques emphasize preservation of alveolar bone, reduced trauma, and possibly less postoperative pain. Successful application of these tools depends on proper case selection, familiarity with anatomy, and use of appropriate instrumentation. Tools of the trade A variety of new instruments specifically designed for veterinary patients have advanced the field: The Vet-Tome automated periotome (IM3) may be utilized for veterinary dental extractions in cats, dogs, and even zoo animals. Its flexible thin tips (Figure 1) allow gentle, controlled division of the periodontal ligament, minimizing force and alveolar bone loss. Think of this device as a jackhammer for soft tissue periodontal attachments. It is important to know this is not for use on ankylosed teeth, where the normal dark line of the periodontal ligament space is not visible radiographically. Figure 1. Thin tip of the automated periotome can be advanced into the periodontal ligament space to break down periodontal attachments with less trauma. Photo courtesy Dr. John R. Lewis Piezosurgery has been a helpful addition to our armamentarium. Used as a finesse tool for maxillectomies and mandibulectomies, it is also helpful for challenging extractions, such as firmly rooted canine teeth and carnassial teeth. A small, thin piezosurgery tip is advanced into the periodontal ligament space approximately 5-10 mm, allowing a dental elevator or luxator to gain easier purchase. The piezosurgery tip can be used in patients with radiographic evidence of ankylosis. Figure 2. Piezosurgical tip designed for extraction of firmly rooted teeth. Photo courtesy Dr. John R. Lewis Veterinary-specific luxators and elevators are essential. Ideally, your armamentarium should include a variety of elevators and luxators in different shapes and sizes, which can help reduce crown/root fractures and operator fatigue. Dental elevators and luxators are used in different ways. Winged elevators are seated within the periodontal ligament space and then rotated to stretch and tear periodontal ligament fibers with slow, constant tension. Luxators are thinner and flat at their tips, acting like miniature scalpel blades to cut the periodontal ligament attachments (Figure 3). Figure 3. The working ends of a luxator (right) and winged elevator (left). Note the thin, flat surface of the luxator. Photo courtesy Dr. John R. Lewis Reflecting soft tissue Three common oral surgery flaps, in order of least to most exposure of the alveolar bone overlying root structure: envelope, triangle, pedicle. Envelope flaps (freeing up the gingiva circumferentially around a tooth) were historically utilized for incisors, first premolars, and third molars, but with the advent of new tools, even a canine tooth can sometimes be removed with an envelope or triangle flap. However, even if releasing incisions are not needed to extract a tooth, they may be necessary for a tension-free closure. Proper flap planning is essential to avoid unnecessary damage, prevent chronic oronasal communications, and reduce the risk of surgical dehiscence. A recent study in feline patients revealed that simple interrupted sutures with buried knots provide a significant healing advantage in gingival wound closure after extractions, further supporting the value of meticulous soft tissue handling as part of a minimally invasive surgical philosophy.2 Other minimally traumatic “pearls:” Always perform thorough preoperative imaging to rule out ankylosis, root fractures, or periapical pathology that may complicate minimal access procedures. Use a gentle, progressive approach: begin with the least traumatic instrument and escalate only if necessary, reserving bone removal as a last resort. With multi-rooted teeth, plan and section roots precisely. Use a guard to prevent adjacent soft tissue trauma, such as a tongue depressor on the lingual side of the mandible when sectioning mandibular teeth. Always keep your index finger extended along the shaft of a dental luxator or elevator to prevent advancement if the instrument slips. Training Vendors often provide extraction videos, workshops, and live demonstrations. Continuing education wet labs provide the best learning experience for simulating extraction techniques and for learning how to use new tools. Advances in minimally invasive dental extraction enable the general practice veterinarian to offer high-level care, with the potential for improved patient comfort, reduced complication rates, and better preservation of oral structures. John R. Lewis, VMD, FAVD, DAVDC, practices at Veterinary Dentistry Specialists and teaches at Silo Academy Education Center, both in Chadds Ford, Pa. References Kuntsi-Vaattovaara H, Verstraete FJ, Kass PH. Results of root canal treatment in dogs: 127 cases (1995-2000). J Am Vet Med Assoc. 2002;220(6):775-780. Klim EB, Mestrinho LA, Gawor JP. Effect of a buried knot in the healing process of dental extraction sites: a prospective study in cats. J Feline Med Surg. 2025;27(3):1098612X251314701.
