Veterinary Dentistry Dental Cases

I have a case that I’d appreciate any experience, advice on.

I have a case that I'd appreciate any experience, advice on. I may just be impatient but don't want to proceed without some input. This is an 8yr neutered male miniature dachshund that presented 1/31/17 for a COHAT. He'd had a history of right sided facial swelling, cellulitis, drainage previously. We extracted several teeth including 108, 109 and others. 108 had lots of cottage cheese material in the extraction site. The problem I'm dealing with now is on 204. On examination the probe entered all the way on the lingual aspect. We extracted the tooth. What I didn't see on the radiograph prior to extraction was the largest oronasal fistula I've had thusfar along with more of the the cottage cheese material packed in the defect. All of the bone along the tooth root was missing. There was some gingival recession on the buccal aspect but I did a releasing incision and felt there wasn't tension on the closure. 1 week later the mouth looked good but the closure over 104 was open, tissue thickened, and receding. I put him under anesthesia and closed it again after what I thought was some more relief of tension. He came in 2 weeks after the second closure and once again the area is dehisced. All of the other places in the mouth appear well healed. I'm thinking I attempted a reclosure in the face of inflammation and the tissue just didn't hold well. I think we'll need to attempt another closure but I'm tempted to wait a few weeks and make sure all tissue is healthy. On the other hand, if the consensus is that waiting would be a big no-no I'd push up the procedure. The patient is doing well otherwise. I've closed oronasal fistulas before but haven't had this issue that I know of. Thanks- Jim

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