Background: Extraction of teeth in standing, sedated horses with forceps are well described. In contrast to other methods of extraction like minimally invasive buccotomy, dental repulsion or Steinmann pin repulsion, surgical access through soft tissues or bone is not required for the oral dissection of equine Cheek teeth. Objectives: The aim of the current article was to describe a novel extraction technique of equine cheek teeth using endoscopy-guided intra-alveolar dissection with rotating burs. The technique enables tooth removal when dental extraction with forceps is not feasible. To our knowledge this method has only been described in congress abstracts yet. Materials and Methods: A 3-year-old Quarter horse stallion was referred to the clinic with painful, egg-shaped swelling at the right cheek since one tooth had been extracted on the same side about 6 months earlier. On the sedated horse oral camera examination and radiological examination was performed. A fistulous tract extending approximately 70 mm in disto-apical direction, reaching the apex of 108, could be probed next to 508 cap. After sedation and cap extraction, the 108 non-erupted was dissected in mesio-distal, sagittal and midline plane with rotating burs and finally fractured with root elevator to be able to remove. During hospitalisation the horse was administered NSAIDs', AB and wound cleaning with plugs. Results and Discussion: On day 47 the alveolus was completely filled with granulation tissue and the horse went back into training. The swelling disappeared until the 6th month. At the last control (3.75 year after operation) dental drift of 109-111 mesially was diagnosed. A dentin and cementum composed malformed 108 erupted. The 106 tilted distally and closed to the malformed 108. As no inflamed peridental soft tissues were observed, the horse was sound and in training the malformed cheek tooth was not extracted. In general to successfully dissect equine premolar cheek teeth with an intraoral minimally invasive method, sharp burs of varying lengths (25-85 mm) mounted in a 90 angle on a handpiece, coupled to a flexible shaft of an electric engine are required.