Management of Equine Post-Extraction Cheek Tooth Alveoli: Application of Alveolar Plugs

Preservation of dentition remains the primary goal of equine dentistry; however, cheek tooth extraction is required in cases of severe dental pathology. Following tooth extraction, management of the post-extraction alveolus remains a significant clinical challenge due to its large size and susceptibility to contamination with feed material and bacteria. To mitigate these risks, alveolar plugs are commonly used to protect the alveolus, stabilize the blood clot, and support granulation tissue formation. This review summarizes the current case reports and research articles regarding the use of alveolar plugs following equine cheek tooth extraction, with a focus on packing materials, post-extraction management strategies, complications, and clinical outcomes. Reported packing materials include polymethyl methacrylate (PMMA), plaster of Paris (PoP), dental wax, gauze swabs, and polyvinyl siloxane (PVS). Each material has unique advantages and disadvantages, which are summarized in this review. The choice of plug material and its management protocol should be individualized for each case, as it depends on alveolar depth, tooth location, extraction method, and the presence of complications. Although standardized protocols for equine alveolar plug management have not yet been established, it may be suggested that any of the currently described packing materials can be used following routine tooth extractions. For marginally positioned teeth, gauze swab plugs may be more favorable, although they may not be the optimal choice in older horses. Regardless of whether the extraction is routine or complicated, alveolar inspection at 7-14-day intervals may be recommended. However, specific recommendations regarding alveolar inspection intervals and detailed management strategies require further research.