Repair of Incisor Avulsion Fractures

Rostral mandibular and maxillary factures are the most common type of fractures sustained to the head of the horse. They are most often seen in younger animals with deciduous or mixed deciduous and permanent dentition. These injuries are frequently seen to arise from falls or kicks, biting behavior with tie-up chains, or involvement with window bars or mangers. Rare cases are iatrogenic from dental procedures or secondary to pathological conditions such as tumors, osteomyelitis, or equine odontoclastic tooth resorption with hypercementosis (EOTRH). Clinical signs can vary from some horses being asymptomatic to those showing excessive salivation, dental misalignment, crepitation or swelling of the head region, bleeding from the mouth and malodor. Careful evaluation via a general physical examination and intraoral examination followed by radiographs will usually lead to a diagnosis. Dental structural integrity and temporomandibular joint function should be evaluated. Since a large number of these injuries occur in young horses it is important to take intraoral radiographs and evaluate the impression of the injury to the support structures of the tooth, the state of reserve crown maturity, and root development or fracture and the relation of the deciduous tooth to its permanent successors. Techniques of reducing and stabilizing rostral incisive fractures with various configurations of wire and acrylic splints have been well described in the literature.Stabilization of rostral mandibular fractures with tension band wires in the mouth supported by an intraoral acrylic splint, provides a high level of stability in an invitro equine model.The literature gives these injuries a favorable prognosis for healing but the long-term health and viability of the hypsodont teeth have only recently been considered in the veterinary literature. Always attempt to salvage the teeth and associated bone. Consider the health and vitality of the teeth for survival. True success is a long-term favorable result for the bone fracture to heal and the tooth to survive with continued functionality. In humans, avulsed teeth have a favorable prognosis for implantation if the tooth is kept moist and reimplanted within 30 minutes. Most equine cases are not seen in that time frame. Root or pulp exposure and subsequent avascular necrosis of the avulsed teeth can lead to periapical (the area around the tooth root) abscessation that will necessitate future endodontic therapy or exodontia (extraction). The owner should be informed of short-term and long-term sequelae of injury and repair. Fractures to the incisive area need to be dealt with as a surgical emergency if the teeth are to be preserved. First aid care by the primary practitioner in the field should consist of gentle cleansing of the areas to remove food and gross debris. A muzzle or moving the horse to a stall with no bedding and restricted access to food, will limit further contamination. The horse should be placed on broad-spectrum antibiotics and non-steroidal anti-inflammatory drugs prior to referral for further diagnostics and/or surgical repair. Once referred for specialty care, these