Discussion: Sagittal factures of the upper cheek teeth are thought to occur from weakened infundibula due to decay and erosion of the internal cementum. The most commonly affected teeth are the upper 1st molars. Genetics may also play a role since this is often a bilateral condition. Oral extraction of these types of fractured teeth is indeed a challenge for the oral practitioner and requires team effort. Proper instrumentation, digital radiographs, and effective nerve blocks are a necessity before attempting these complicated extractions on a standing horse.