Introduction of a case of malposition of (pre)molars in a young horse

This case report describes the management of a complex dental malformation in Q., a 2-year and 4-month-old BWP horse. The horse was referred to Equide, a veterinary equine dental clinic, for pronounced swelling in the area of the head/right maxilla. Diagnosis revealed the need for surgical intervention to prevent severe complications such as large oronasal fistulas. The dental extractions were performed at Equide by Dr. Wouter Demey, veterinarian and equine dentist, and his team.

Second Report (4 September 2024)

The horse was hospitalized for the extraction of abnormally positioned molars under sedation and local anesthesia.

Treatment on 4 September 2024:

• Sedation: Detomidine (D), Midazolam (Mid), Torbugesic (T), administered intramuscularly and/or intravenously.
• Antibiotics: Penicillin.
• Extraction procedure for the first malpositioned tooth:
  • Extraction of the cap of tooth 206 and wolf tooth 205 under local anesthesia.
  • An incision was made in the rostral gum of 206, and the bone covering the tooth was milled to allow access to the root.
  • Tooth 206 was horizontally segmented into multiple pieces, with each segment carefully removed using specialized instruments.
  • The alveolus was curetted to remove any pathological tissue and stimulate healing.
  • A Coepak dressing containing bio-inductive bone granules was applied to encourage bone regeneration in the alveolus.
  • The incision was closed with sutures (2/0).

Third Report (18 September 2024)

During the postoperative check-up, the horse was in good general condition, although the BCS was at 3, indicating a slight loss of physical condition compared to the desired average of 4-5.

The oral examination revealed that the Coepaks placed in the alveoli of 106 and 206 were still in place. The presence of pus and small sequestra in the alveoli was noted, but the granulation tissue was in good condition, indicating proper healing.

Treatment on 18 September 2024:

• Sedation.
• Sequestra were removed, followed by curettage of the alveoli to stimulate tissue regeneration.
• Intraoral sutures were removed, and a new Coepak was applied to protect the alveoli and promote healing.

Postoperative Follow-Up of a Case of Malposition of (Pre)Molars in a Young Horse

A follow-up check is recommended in 6 to 9 weeks unless complications arise. Monitoring is particularly important to ensure bone healing and avoid any risk of infection. The bone swellings should gradually disappear over the coming months.

Discussion of a Case of Malposition of (Pre)Molars in a Young Horse 

In such extreme cases of malposition, there are few alternative treatment options.
Complex dental extractions, such as those performed on Q., illustrate the importance of proactive management of dental malformations in young horses. Rotated molars represent a significant long-term health risk, and their extraction is necessary before complications such as oronasal fistulas occur. The extraction procedure, though difficult, was successfully carried out using advanced techniques such as segmentation and screw extraction, followed by the application of Coepak to promote healing.

Conclusion of this Case of Malposition of (Pre)Molars in a Young Horse 

This case demonstrates the importance of early intervention to correct dental malformations in young horses, particularly when such malformations can lead to serious complications. The techniques used, combined with rigorous follow-up, ensured effective management and encouraging results in the healing process.

FAQ

1. What is malposition of permanent premolars in a young horse?
Malposition refers to improper alignment or orientation of premolars. In this case, teeth 106 and 206 were rotated—one root pushed laterally and the other extending horizontally. If untreated, this may lead to complications like oronasal fistulas.

2. What treatment was performed for this malposition?
The treatment included surgical extraction under sedation and local anesthesia. The affected teeth were segmented and removed, alveoli curetted, and Coepak dressing with bone granules used to promote bone healing.

3. What is the recommended follow-up after such a surgery?
A postoperative check is advised 6 to 9 weeks later, monitoring bone healing, ensuring no infection, and observing that swellings gradually reduce.