2nd and 3rd premolar tooth repulsion is elected when a tooth can not be extracted through the mouth with molar forceps. Usually when a cheek tooth is fractured or infected, for various reasons it is easier to pull out the tooth from the mouth due to the fact that the root is not as secure to the infundibular structures as a normal tooth. This is not always possible and for this the tooth, occasionally needs to be driven out of it’s socket into the mouth using a dental punch and mallet.

It is warranted to take radiographs before and after, to assure that no fragments are left behind, as one would do for a routine tooth extraction. Repulsion of the tooth involves trephening a hole to gain access to the base of the tooth and driving the tooth from it’s socket into the mouth. Two surgeons are required for that one would place a hand into the horses mouth and another would preform the repulsion. A mallet and a chisel are needed to access the base of the tooth. When the root of the tooth is identified the surgeon with the hand inside the horses mouth will ensure that the current tooth is being repelled and hold the punch in place when there is more then one cheek tooth to be removed.

The more caudal the tooth is the harder it will be to repel it. Signs of pathologies that involve the base of the cheek teeth are secondary sinusitis with purulent nasal discharge that does not resolve with antibiotic treatment or lavage of the sinus cavity. When the disease involves the mandibular teeth, swelling and chronic drainage can be seen from the ventral border of the mandible.

When the cheek teeth are removed a period of at least 3 weeks is necessary for granulation tissue to start filling in the gap where drainage  should be put into place at this time to insure that food does not prevent the healing process. The drainage should be changed every tow days and the material that is used for the drainage should be soaked with a solution the promotes granulation tissue to fill in.