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PICO questionDo oral or minimally invasive cheek tooth extraction techniques reduce the incidence of post-operative complications in the horse when compared to repulsion methods?Clinical bottom lineThere is evidence that both oral and minimally invasive cheek tooth extraction techniques may reduce the incidence of post-operative complications in the horse when compared to repulsion methods. However, the published literature covering equine cheek tooth extraction techniques is sparse and of low evidential quality, so a definitive answer on the optimal methods available is not easily determined. Bearing this in mind, the results of this PICO suggest the use of oral extraction, after periodontal stretching, as the first line treatment due to its apparently more favourable success rate. Where an alternative approach is required, such as with fractured teeth or loss of clinical crown, which can prevent the use of routine oral extraction methods, results indicate that minimally invasive extraction techniques may result in a better outcome, with fewer complications, than repulsion methods. Further research that accurately categorises the various minimally invasive techniques available and compares them to repulsion and conventional oral extraction methods is needed.