Content uploaded by Elizabeth M Santschi
Author content
All content in this area was uploaded by Elizabeth M Santschi on Mar 16, 2015
Content may be subject to copyright.
How to Use Antibiotic Impregnated Plaster of
Paris for Alveolar Packing after Tooth Removal
Steven S. Trostle, DVM, MS; James S. Juzwiak, DVM; and
Elizabeth M. Santschi, DVM
Plaster of paris is an excellent material used to pack the alveolus after tooth removal. Advantages
of plaster of paris include that it is cold curing, provides a form of local antimicrobial delivery, is
biodegradable, and is economical. Authors’ addresses: University of Wisconsin, School of Veteri-
nary Medicine, Department of Surgical Sciences, 2015 Linden Dr. West, Madison, WI 53606 (Trostle
and Santschi); Manor Equine Hospital, 2506 Monkton Rd, Monkton, MD 21111 (Juzwiak). © 2000
AAEP.
1. Introduction
The most common reason to remove a tooth is to elim-
inate a tooth that has incurred significant dental dis-
ease in which removal is the last resort. In a
comprehensive retrospective study, complications oc-
curred in 47% of horses with maxillary tooth involve-
ment and in 32% of those with mandibular tooth
invovlment.
1
The most common complications were
draining tracts, sinusitis, sequestrum, and loss of the
temporary seal provided by the dental packing.
1
In addition, if the dental packing is prematurely dis-
lodged, feed materials or debris from the oral cavity
can also be a source of infection.
2,3
The high inci-
dence of complications can often lead to a second
surgical procedure to resolve the complication.
3
Following tooth removal, packing or plugging
the alveolus to provide a temporary seal is thought
to be essential to protect the alveolus.
2
Packing
materials have included roll gauze, acrylic dental
base plate wax, dental acrylics, and polymethyl-
methacrylate (PMMA). Dental wax has the ad-
vantage in that it is cold curing unlike some
PMMA products, which undergo an exothermic
reaction in the curing process. However, PMMA
has an advantage in that it can elute antimicro-
bials if they are added to the PMMA, and den-
tal wax does not. Both dental plate wax and
PMMA are non-biodegradable and may need to
be removed. The purpose of this study was to
report the results of antibiotic-impregnated plas-
ter of paris for dental packing following tooth re-
moval. Plaster of paris has many advantages
over other dental packing materials because it is
cold curing, elutes antimicrobials, is biodegrad-
able, and is economical.
4
2. Materials and Methods
Medical records were reviewed from two surgical
referral hospitals that had horses with teeth re-
moval followed by packing with antibiotic-impreg-
nated plaster of paris. Eight horses were included
in the study. Various breeds and ages were repre-
sented in the study (Table 1) and all horses only had
a single tooth removed. Two horses had teeth
orally extracted and 6 horses had teeth removed by
repulsion either through a sinus trephination or si-
nusotomy. In all horses, after extraction of the
tooth, the alveolar socket was packed with a mixture
of plaster of paris. The plaster of paris dental pack-
ing was prepared by mixing approximately 40 g of
the hemihydrate (dried calcium sulphate hemihy-
drate [CaSO
4
]) and 12 ml of saline. Antibiotics
were added to mixture and varied in volume and
concentrations (Table 1). It takes approximately
10 to 15 minutes for hemihydrate plaster of paris to
reach a “dough ball” or working consistency. At
that time, the plaster of paris is molded to fill to 25
to 50% the depth of the socket and with a slight
flange was over the gingival line to seal the alveolus.
Care was taken to ensure that the plaster of paris
packing did not extend to the occlusal surface of the
tooth to prevent premature removal when the horse
masticates. Plaster of paris did not completely
harden or cure in most cases for approximately 30 to
35 min. All horses were examined the day after
surgery to ensure that the plaster of paris dental
packing was present. Outcome was assessed by
telephone conversation with owner or referring vet-
erinarian.
3. Results
Table 1 presents our results in tabular form.
180 2000 ⲐVol. 46 ⲐAAEP PROCEEDINGS
HOW-TO SESSION
Reprinted in the IVIS website with the permission of AAEP
Close window to return to IVIS
Proceedings of the Annual Convention of the AAEP 2000
4. Discussion
Although advances are being made in endodontic
therapy, tooth removal is still a common procedure
in equine practice. There are many potential com-
plications associated with tooth removal, and pro-
tecting the alveolus with a temporary seal is critical
for preventing oral contamination and subsequent
infection. The temporary seal is most commonly
achieved with dental packing. Polymethylmethac-
rylate can be used, but should be “cold curing” and
avoid the exothermic reaction. The exothermic re-
action of some PMMAs can lead to surrounding soft
tissue damage, which may lead to premature loos-
ening. Many people also advocate the use of anti-
microbials in PMMA since the oral cavity is
impossible to aseptically prepare for the surgery and
infection of the tooth root and its surrounding tis-
sues is the most common reason for tooth removal.
With other non-biodegradable materials, the al-
veolus is only recommended to be filled to ap-
proximately 25% of the alveolus depth.
2,3
This
recommendation is made so that granulation tissue
can form without pushing the dental packing out
prematurely. Because plaster of paris is biode-
gradable, filling of the alveolus can occur to a greater
extent, but some portion of the alveolus should be
left void to allow for the formation of granulation
tissue.
We feel that plaster of paris dental packing has
many advantages over other dental packing materi-
als. Plaster of paris is readily available and less
expensive than “cold curing” PMMA and dental wax.
Like PMMA, plaster of paris does elute antimicrobi-
als to provide local antimicrobial therapy over a
period of time. Unlike PMMA, plaster of paris is
biodegradable and therefore does not need to be
removed. Plaster of paris dental packing does take
a longer period of time to completely harden or set
and therefore may not be ideal to use in standing,
sedated horses that have teeth extracted orally.
References
1. Prichard MA, Hackett RP, Erb HN. Long-term outcome of
tooth repulsion in horses: a retrospective study of 61 cases.
Vet Surg 1992;21:145–149.
2. Easley JK. Equine tooth removal (Exodontia). In: Baker
GJ, Easley JK, eds. Equine Dentistry. Philadelphia: WB
Saunders, 1999;220 –249.
3. Pascoe JR. Oral cavity and salivary glands. In: Auer JA,
Stick JA, eds. Equine Surgery. Philadelphia: WB Saunders,
1999;189 –199.
4. Mousset B, Benoit MA, Delloye C, et al. Biodegradable im-
plants for potential use in bone infection: in vitro study of
antibiotic loaded calcium sulphate. Int Orthop 1995;19:
157–161.
Table 1. Horses That Had Tooth Extraction Followed by Alveolus Packing with Antibiotic Impregnated Plaster of Paris
Signalment
Tooth–Disease Extraction
Method
Antibiotics Added to the
Plaster of Paris Outcome
16 yr, THB, F 108–Periodontal General
anesthesia sinusotomy
cefazolin, 1 g No complications
6 yr, QH, F 206–Periapical abscess Standing,
tranquilization orally
sodium ampicillin and
sulbactum,
a
1.5 g
Lost plaster of paris packing
after removing mouth
speculum, had to be repacked
10 yr, WB, MC 209–Periapical abscess General
anesthesia sinusotomy
sodium ampicillin and
sulbactum,
a
1.5 g
No complications
22 yr, QH, F 106–Periapical abscess General
anesthesia orally
sodium ampicillin and
sulbactum,
a
1.5 g
No complications
5 yr, Paint, MC 208–Periodontal General
anesthesia sinusotomy
trimethoprim-sulfa, 2 g No complications
10 yr, THB, MC 107–Periapical abscess General
anesthesia sinusotomy
trimethoprim-sulfa, 2 g No complications
3 yr, WB, F 106–Periapical abscess General
anesthesia orally
trimethoprim-sulfa, 2 g No complications
6 yr, THB, MC 208–Periapical abscess General
anesthesia sinusotomy
metronidazole, 1 g No complications
a
Unasyn–1.0 gram of sodium ampicillin and 0.5 gram of sulbactam. THB–Thoroughbred, QH–Quarterhorse, WB–Warmblood.
AAEP PROCEEDINGS ⲐVol. 46 Ⲑ2000 181
HOW-TO SESSION
Reprinted in the IVIS website with the permission of AAEP
Close window to return to IVIS
Proceedings of the Annual Convention of the AAEP 2000
