Episode 211 - Save or Extract? Bone Loss & Smarter Dental Decisions in Dogs

Take the next step in your veterinary dentistry journey — get a FREE online course with 1 hour of RACE-approved CE when you subscribe to our newsletter: https://ivdi.org/free ---------------------------------------------------------- Host: Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM ---------------------------------------------------------- In this episode of The Vet Dental Show, Dr. Brett Beckman answers advanced, case-based questions from recent online veterinary dentistry trainings, focusing on real-world decision-making in general practice. The discussion covers extraction technique modifications, bur selection for challenging teeth, and evidence-based use of hyaluronic acid and bone grafts in periodontal and surgical cases. Dr. Beckman explains why he has shifted away from routine vestibular bone removal for certain extractions—particularly the mandibular third and fourth premolars—and instead emphasizes controlled sectioning, gentle elevation, and patience to reduce root fracture risk. He shares practical tips on finger pressure, visualization with loupes, and how this technique improves efficiency and outcomes in both clinical cases and wet labs. The episode also explores the biological role of hyaluronic acid in extraction sites and periodontal defects. Dr. Beckman and colleagues clarify the differences between PerioVive and OralVive, explain why retention is not the primary goal of hyaluronic acid therapy, and discuss its benefits for clot stabilization, pain modulation, angiogenesis, and soft tissue healing. The conversation addresses when hyaluronic acid should be used in extraction sites, how it integrates with blood clots and bone grafts, and why products like ClinDoral no longer have a role in these scenarios. Finally, Dr. Beckman dives into one of the most challenging topics in veterinary dentistry: deciding when to save a tooth versus extract it. He breaks down why percentage-based bone loss alone is not a reliable extraction rule, and instead emphasizes case selection based on tooth function, patient age, defect type, and—most importantly—owner commitment to long-term follow-up and home care. This episode delivers thoughtful, experience-driven guidance to help veterinarians make confident, ethical, and practical dental decisions. ---------------------------------------------------------- What You'll Learn: ✅ When vestibular bone removal may increase root fracture risk ✅ How to approach difficult premolar extractions with minimal force ✅ Why sectioning and gentle elevation can replace aggressive bone removal ✅ Proper bur selection for sectioning thick alveolar bone ✅ The biological role of hyaluronic acid in clot stabilization and healing ✅ Key differences between PerioVive and OralVive ✅ Why retention is not the primary goal of hyaluronic acid therapy ✅ When and why to use hyaluronic acid in all extraction sites ✅ How bone grafts and blood clots support alveolar ridge preservation ✅ How to decide when a tooth is worth saving versus extracting Key Takeaways: ✅ Root fractures often occur at the interface between mobile and immobile bone ✅ Gentle, controlled elevation reduces complications more than force ✅ Removing less bone can sometimes improve extraction outcomes ✅ Hyaluronic acid is rapidly absorbed and supports natural healing pathways ✅ Pain modulation is a major benefit of HA in extraction sites ✅ Blood clots function as natural bone grafts ✅ Percentage of bone loss alone should not dictate extraction decisions ✅ Patient age, tooth function, and owner compliance matter most ✅ Long-term success depends on consistent rechecks and home care ✅ Some teeth can be saved—but not always in the patient's best interest Questions This Episode Answers: ❓ Should fissure burs be used for mandibular premolar extractions in dogs? ❓ Why do roots fracture after vestibular bone removal? ❓ How much pressure should be used during elevation? ❓ What is the difference between PerioVive and OralVive? ❓ Does hyaluronic acid need to "stay in place" to be effective? ❓ Should hyaluronic acid be used in every extraction site? ❓ Is a blood clot considered a bone graft? ❓ When should a tooth with severe bone loss be saved instead of extracted? ❓ How important is owner compliance in periodontal case selection? ❓ Is there still any indication for ClinDoral use? Get a FREE veterinary dentistry course with 1 hour of RACE-approved CE when you sign up for our newsletter: 👉 https://ivdi.org/free ---------------------------------------------------------- Questions? Leave a comment below with your thoughts, experiences, or case selection challenges in veterinary dentistry! ---------------------------------------------------------- Veterinary Dentistry, IVDI, Vet Dental Show, Brett Beckman, Veterinary Extractions, Bone Loss, Hyaluronic Acid, PerioVive, OralVive, Bone Grafting, Periodontal Disease, Veterinary Surgery, Dog Dental Care, Veterinary CE, Veterinary Education