Abstract
The extraction of the permanent mandibular canine tooth in dogs presents unique surgical challenges due to its anatomic constraints and limited access. Inappropriate extraction technique may result in perioperative and postoperative complications, including rostral mandibular fractures, trauma to adjacent structures, including the mandibular first premolar and 3rd incisor tooth, and wound dehiscence, which is often exacerbated by the surrounding anatomy. While several extraction techniques have been described in the literature, this presentation introduces the “hybrid approach technique”, which combines both labial and lingual surgical access with coronal sectioning to overcome anatomical limitations and facilitate controlled extractions. The technique involves the creation of mucoperiosteal flaps on both labial and lingual aspects of the mandibular canine tooth. The removal of some labial bone is performed at the labial alveolar plate and interdental crestal bone between the distal aspect of the canine and the mesial aspect of the first premolar tooth. A deep lingual groove (or gutter) is created along the lingual aspect of the mandibular canine tooth, at the location of the periodontal ligament space to accommodate luxators and winged elevators. Coronal sectioning is performed to remove the curvature of the crown at approximately three-quarters of the crown from the cusp, with or without a shallow groove over the dentine at the mesial and distal aspect of the tooth, to assist in forceps placement. This triple-access strategy enhances visibility, improves instrument placement and may result in reduced risk of iatrogenic trauma.

A modified closure technique has been previously described, which anchors the lingual bony plate to the mentalis muscle using pilot holes for primary-layer sutures, followed by simple interrupted closure of the overlaying labial and lingual mucogingival flaps. This approach counters the constant tension exerted by the mentalis muscle at the labial frenulum, which is activated by everyday oral activities such as grooming, mastication, and drinking. By reducing muscle tension and gravitational stress, this technique should reduce the likelihood of wound breakdown, a common postoperative complication associated with permanent mandibular canine tooth extraction. This hybrid method offers a practical and reproducible solution for general practitioners seeking to refine their extraction techniques and improve surgical outcomes.