Tusk extraction

By Willem Schaftenaar and Yves Debosschere

Introduction

The primary indication for tusk extraction is the cessation of tusk growth. In all other cases, determining the exact point at which treatment should shift from conservative management of pulpitis to extraction can be challenging. Consequently, there is not always complete agreement regarding the optimal treatment strategy. In an attempt to provide some help in decision making, a group of interested zoo vets and dentists (Elephant Dental Vets, 2025) produced a guideline for this purpose.

In general, oblique tusk fractures that extend deeply into the gingival sulcus are more likely to require extraction than fractures in which the exposed pulp can be adequately protected through partial pulpectomy and placement of a suitable dental filling. When the fracture site remains accessible and a reliable seal of the pulp cavity can be achieved, preservation of the tusk is the preferred option.

In cases where the prognosis is uncertain, a conservative approach may initially be adopted. This involves managing pulpitis and maintaining pulp vitality through repeated irrigation of the exposed pulp with lactated Ringer’s solution, while monitoring for continued tusk growth. Ongoing growth may gradually bring the fracture site into a position where definitive restorative treatment becomes feasible.

However, when tusk growth has ceased, or when continued growth fails to expose the fracture sufficiently for successful restorative treatment, conservative management is unlikely to provide a long-term solution. In such cases, tusk extraction becomes the treatment of choice and represents the only definitive method of resolving the condition.

It is highly recommended to make an X-ray before starting the treatment, as it will help to evaluate the condition of the tusk and the sulcus.

Positioning of the X-ray machine and the plate to catch the alveolus.

Procedure

In most cases, tusk extraction is performed under general anesthesia, particularly in adult elephants. More recently, successful tusk extractions have also been performed under standing sedation in younger animals. The first reported cases involved the extraction of two tusks from an eight-year-old Bornean elephant (Roopan, 2025), followed in 2026 by the extraction of two tusks from a 3.5-year-old Asian elephant (Roopan, 2026, pers. comm.). In addition to sedation, regional anesthesia was achieved through an attempted nerve block in the infraorbital foramen combined with perialveolar infiltration of 20 mL of 2% lidocaine hydrochloride (Roopan, 2025).

When general anesthesia is selected, sufficient expertise is required to position the elephant in lateral recumbency with the affected tusk facing upward. If the animal inadvertently falls onto the opposite side during induction, it can be rolled over its back into the desired position.

If bilateral tusk extraction is indicated, the procedures should be performed during separate anesthetic events. Repositioning an elephant onto the opposite side after it has remained in prolonged lateral recumbency is contraindicated due to the increased anesthetic and physiological risks associated with such manipulation (lung hypostasis).

Although only limited descriptions of tusk extraction techniques are available in the literature, all methods share a common prerequisite: complete disruption of the periodontal attachment between the tusk and the alveolar sulcus.

The choice between standing sedation and general anesthesia, as well as between segmental and in toto extraction, should be based on the age of the elephant, tusk anatomy, available equipment, operator experience, and the anticipated difficulty of the procedure. In most contemporary cases, complete in toto extraction is considered the preferred approach whenever technically feasible.

Tusk extraction performed under general anesthesia

Block anesthesia in the foramen infraorbitalis (Courtecy: N. Roopan)

Periodontal separation

Before beginning the procedure, the total length of the sulcus should be determined. This can be achieved using a sufficiently long probe inserted into the pulp canal until the osseous boundary is encountered. It should be remembered that the base of the sulcus is formed by the extremely thin bony wall separating the tusk cavity from the adjacent sinus. If the pulp cavity is blocked by a plug of tertiary dentine, a hole should be drilled in this plug by using a steel drill.

Drilling a hole in the dentine plug

Measuring the alveolar length

Next, the soft tissue connection between the sulcus and the tusk (coronary band or gingiva) must be severed. This can be accomplished by using a scalpel.

Incision of the coronary band or gingiva

Separation of the periodontal tissues requires the use of custom-made tusk periotomes. These instruments consist of long, narrow steel blades, several millimeters thick, that must be sufficiently flexible to follow the natural curvature of the tusk while remaining strong enough to withstand repeated hammering with a dead-blow hammer. The tip of each blade should be sharpened to facilitate transection of the periodontal ligament.

Observations from (at least one) clinical case indicate that the firm periodontal ligament does not extend all the way to the apex of the tusk. The apical portion, representing approximately 40–50% of the total sulcus length, is very thin and exhibits minimal attachment to the sulcus wall. Consequently, periotome length only needs to correspond to approximately 50–60% of the measured sulcus depth.

Because of the curvature of the tusk, periotomes tend to deviate from the intended path. It is therefore advisable to leave one periotome in place after it has been advanced to the desired depth. This periotome then serves as a guide for subsequent blades. By progressively inserting multiple periotomes and leaving several in position, the periodontal attachment can be disrupted circumferentially around the entire tusk.

Advancement of the periotomes is accomplished through controlled hammering with a dead-blow hammer. The separation of the tusk from the sulcus wall is a time-consuming activity, which can take several hours in an adult elephant.

A periotome is inserted into to space between tusk and alveolus

The periotome is advanced using a dead-blow hammer

The periotome is advanced over a distance of 30 cm.

Extraction techniques

Once the periodontal attachment has been disrupted as completely as possible, two extraction techniques may be employed.

1. Segmental extraction

Historically, tusks were removed by dividing them into longitudinal segments using a reciprocating saw (Welsch, 1989). This technique has several disadvantages. There is an increased risk of damaging the sulcus wall, as it can be difficult to accurately determine the depth of saw penetration into the dentine. After the tusk has been divided into multiple longitudinal sections, each segment can be removed individually.

Although less commonly used today, this method remains a valuable alternative when complete extraction of the tusk cannot be achieved using the in toto extraction technique described below.

Extracted segments of the necrotic tusk of a 25 yr-old adult Asian elephant bull

2. In toto extraction

Currently, complete removal of the tusk as a single unit is generally preferred.

After disruption of the periodontal attachment, extraction is achieved through repeated application of traction and rotational forces. Successful application of these forces requires a secure grip on the tusk.

2a. Extraction of a protruding tusk

When a sufficient portion of the tusk extends beyond the sulcus, a transverse hole can be drilled through the protruding tip of the tusk using a steel drill bit. A solid steel pin (10 mm diameter) is then inserted through the hole.

To generate rotational force, a hollow steel pipe can be placed over one end of the protruding pin, creating a lever arm. A sustained rotational force should be applied in one direction and maintained for at least one minute. This prolonged loading stretches the remaining intact periodontal fibers, promoting their rupture. In addition, fluid is expressed from the damaged connective tissue structures, further weakening the attachment between the tusk and its socket.

The procedure is then repeated in the opposite direction by transferring the pipe to the other end of the steel pin. Alternating rotational forces, combined with traction, progressively loosen the tusk until extraction becomes possible.

Traction can be increased by connecting the steel pin to a belt tensioner photo equipped with a ratchet mechanism (video extraction Taru). In one reported case involving an eighteen-year-old Asian elephant, additional rotational force was generated using a hydraulic spreader (see photo) positioned beneath the end of the steel pipe. Such equipment is commonly used by fire and rescue services, although a conventional automotive jack may provide a similar mechanical advantage.

The sequence of rotation and traction must typically be repeated many times before complete release of the tusk is achieved.

Solid steel pin inserted in the tusk to allow pulling and rotating

On each side of the tusk, a steel pipe is placed over the steel pin.

A hydraulic spreader is used to increase the rotational power.

Final extraction of the tusk. Note the straps and the belt tensioner with ratchet. By increased pulling force and manual rotation force the last pieces of the fibrous connection between tusk and alveolus ruptured, allowing the tusk to be extracted.

An extracted tusk that protruded 7 cm outside the sulcus. Note the slight narrowing at 22 cm (44% of total alveolar length). The peridontal ligament was severed only in the distal 27 cm (56% of the total alveolar length) of the tusk.

This image shows the projection of the tusk on the skull. Note that the tusk reaches byond the orbita.

2b. Extraction of a non-protruding tusk

If insufficient tusk projects beyond the sulcus to permit direct application of traction and torsion, a custom-made internal tusk extractor may be used (photo Oosterhuis and Fagan).

This device consists of a hollow steel shaft with a T-handle. An expandable internal mechanism is inserted into the lumen of the tusk and subsequently expanded until it securely engages the internal dentinal walls. Once adequate purchase has been obtained, extraction proceeds according to the same principles described for protruding tusks, utilizing alternating rotational and traction forces.

In toto extraction of a tusk that did not protrude ouside the sulcus using a custom-made extraction device.

Post-extraction management

Following removal of the tusk, the entire sulcus should be carefully explored manually to identify any damage to the bony walls or remnants of dentine inside the sulcus.

Any remaining pulp tissue should be removed as completely as possible. However, accessibility and available anesthetic time frequently limit the extent of debridement. The confined dimensions of the sulcus provide little room for arm movement, and the dense, soft consistency of the pulp often creates a vacuum-like effect around the operator's arm. Introducing a flexible plastic tube alongside the arm may facilitate air displacement and improve access.

If the procedure has already been prolonged and continuation of anesthesia is considered undesirable, residual pulp tissue may be left in situ. Such tissue is no longer viable following extraction and will undergo necrosis.

It is recommended to gently debride the alveolus following extraction using stiff brushes or custom-made curettes (Woody, 2022). Control postoperative bleeding by tightly packing the alveolus with shaved ice.

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Potential complications

Retained dentine deposits and ankylosis

Occasionally, hard dentinal masses may be encountered within the sulcus. These structures are the result of chronic pulpitis and are comparable to tertiary dentine pearls observed in other species. Such deposits may be extremely hard and difficult to remove as they may be strongly attached to the alveolus (ankylosis). Long periotomes and long-jawed extraction forceps should be used to remove them as completely as possible. Persistent retention of these mineralized structures can significantly interfere with normal healing of the extraction site.

Parts of the periodontal ligament may have formed ankylosis between tusk and alveolar. Removing these parts may require the removal of some alveolar bone (Woody, 2022).

Extracted tusk from a 5 yr-old Asian elephant bull. Note the formation of tertiary dentine ("pearls") at the apex.

Damage to the alveolar wall

Trauma to the thin osseous wall of the alveolus, particularly in the region adjacent to the sinus cavity, may occur during periotome insertion or sawing procedures. Careful instrumentation and thorough post-extraction inspection are therefore essential. Loose pieces of necrotic bone can sometimes be found in the sulcus during the weeks after the extraction. If large enough, they may obstruct the passage through the sulcus opening. They should be removed, if needed under standing sedation.

Incomplete periodontal disruption: failure to completely disrupt the periodontal attachment may result in excessive extraction forces, prolonged procedural times, or fracture of the tusk during removal.

Fragment of necrotic bone tissue from the alveolus, recovered 6 months after tusk extraction

Aftercare

The extraction cavity should be flushed twice daily with lukewarm water. High-pressure irrigation must be avoided, as the purpose of flushing is solely to remove necrotic tissue and inflammatory exudate.

This regimen should continue until the sulcus has completely closed and no further fluid drainage is observed.

Regular clinical monitoring is recommended throughout the healing period to assess tissue contraction, drainage, and the development of any complications.

Required equipment

Anesthesia and monitoring

General anesthesia equipment
Monitoring equipment
Local anesthetic agents

Radiography equipment

Irrigation and debridement

Flushing pump
Chlorhexidine solution
Irrigation tubing

Periodontal separation

Multiple tusk periotomes (minimum of four) of various periotome lengths and thicknesses photos
Dead-blow hammer

Tusk cutting and drilling

Reciprocating saw
Steel drill and drill bits

Extraction equipment

Custom-made internal tusk extractor
Solid steel pin
Hollow steel pipe
Straps
Ropes
Belt tensioner with ratchet
Hydraulic spreader or automotive jack

Surgical instruments

Long-jawed extraction forceps
Long probe for sulcus measurement
Additional instruments for pulp debridement and exploration of the extraction cavity. The use of finger knives and a fetotome should be considered for removal of the pulp.

Assortment of perotomes and dead-blow hammer

Assortment of plyers with long jaws

Custom-made internal tusk extractor

Hydraulic spreader

References

Roopan N, Buranapim N, Sripiboon S, Balakrishnan Y, Sipangkui S, and Tum TC. 2025. Extraction of Nonvital Tusks in a Standing Sedated Bornean Elephant Using a Simple Noncollapsing Rotational Extraction Technique: A Case Report. Journal of Veterinary Dentistry 43 (3) 1-8. https://doi.org/10.1177/08987564251339734.

Welsch B, Jacobson ER, Kollias GV, Kramer L, Gardner H, Page CD. 1989. Tusk Extraction in the African Elephant (Loxodonta africana). Journal of Zoo and Wildlife Medicine,1989. Vol. 20, No. 4, pp. 446-453.

Woody AD, Fagan DA, and Oosterhuis JE. 2022. Large mammal dental surgery. In: Surgery of Exotic Animals, First Edition. Edited by R. Avery Bennett and Geoffrey W. Pye. © 2022 John Wiley & Sons, Inc. Published 2022 by John Wiley & Sons, Inc. Pag. 370-375.

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