Coronectomies: assessment and treatment planning

Bhola, Surina; Pellatt, A.

doi:10.1038/sj.bdj.2018.535

Cited by 4 publications

(9 citation statements)

References 29 publications

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“…Essas imagens auxiliam o cirurgião a indicar, contraindicar ou modificar sua técnica para a realização dos procedimentos cirúrgicos (Bhola;Pellatt, 2018;Crameri;Kuttenberger, 2018). Diante de terceiros molares inferiores, podem ser indicados como tratamento a exodontia, a proservação ou ainda, a coronectomia.…”

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Coronectomia intencional como alternativa para evitar lesões ao nervo alveolar inferior: Relato de caso clínico

Silva

Almeida

2021

RSD

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Introdução: O dano ao Nervo Alveolar Inferior (NAI) é fator de risco significativo após remoção de terceiro molar impactado. São tidos como sinais considerados de alto risco de lesão nervosa a ausência de osso cortical entre a raiz dental e o canal mandibular, bem como a constrição do mesmo por onde passa a raiz do dente. Objetivo: Relatar um caso de coronectomia intencional de terceiro molar inferior direito, devido contato íntimo com o canal mandibular. Paciente, sexo feminino, 19 anos, compareceu ao Centro de Especialidades Odontológicas do Recife, indicada para exodontia dos terceiros molares. A radiografia panorâmica revelou impactação horizontal do dente 48, contato da coroa com as raízes do segundo molar e aparente contato com o NAI. Solicitou-se tomografia computadorizada de feixe cônico, confirmando íntima relação. A conduta escolhida foi realização de coronectomia intencional e sepultamento das raízes. Conclusão: A literatura comprova que essa técnica reduz significativamente a lesão do nervo alveolar inferior sendo uma alternativa eficaz e segura para evitar complicações nervosas.

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Section: Introductionunclassified

Coronectomia intencional como alternativa para evitar lesões ao nervo alveolar inferior: Relato de caso clínico

Silva

Almeida

2021

RSD

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“…1The primary principle of the procedure is crown removal and retention of vital root(s) with a non-inflamed pulpal tissue to be surrounded by normal bone.The literature states that coronectomy is contra-indicated when this principle has been compromised. 2 It is rational then, to list caries with pulpal changes, apical pathology, tooth mobility, and cystic changes associated with the root apex as contraindications to coronectomy. [2][3][4][5] The theoretical…”

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“…2 It is rational then, to list caries with pulpal changes, apical pathology, tooth mobility, and cystic changes associated with the root apex as contraindications to coronectomy. [2][3][4][5] The theoretical…”

mentioning

confidence: 99%

“…The literature states that coronectomy is contra-indicated when this principle has been compromised. 2 It is rational then, to list caries with pulpal changes, apical pathology, tooth mobility, and cystic changes associated with the root apex as contraindications to coronectomy. [2][3][4][5] The theoretical…”

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confidence: 99%

“…Other contra-indications to coronectomy frequently cited include patients who are immunocompromised, such as those undergoing chemotherapy or patients due to undergo head and neck radiotherapy. 2 There is a theoretical assumption of an increased risk of infection from coronectomy roots that become non-vital in patients whose oncological disease can result in the development of secondary or acquired immunodeficiency. Additionally, should patients who have undergone head and neck radiotherapy or treatment with certain bone modulating drugs require coronectomy root retrieval as a secondary procedure, there could be a risk of osteoradionecrosis (ORN) or medication-related osteonecrosis of the jaw (MRONJ).…”

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Coronectomy of mandibular third molar in oncology patients

et al. 2022

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Aim Coronectomy of mandibular third molars deemed to be at risk of inferior alveolar nerve injury (IANI) has become an increasingly common treatment modality. The primary principle of the procedure is the removal of coronal tissue and retention of vital root(s) with non‐inflamed pulpal tissue to be surrounded by normal bone. Oncological treatment is currently considered a contraindication for coronectomy due to the theoretical assumption that there is an increased risk of infection from non‐vital coronectomy roots in patients whose oncological disease can result in the development of secondary or acquired immunodeficiency. Additionally, patients with oncological conditions who have undergone head and neck radiotherapy (RT) or received bone modulating agents could be at risk of osteonecrosis either following coronectomy or future root retrieval. This mini case series aims to investigate the outcomes following coronectomy concentrating on oncology patients. Methods Between 2011 and 2017, seven patients prior to commencing head and neck RT or chemotherapy underwent coronectomy of nine mandibular third molars (M3Ms). Results Clinical and radiographic follow up for a mean of 15 months (range 3–48) had shown healing with no report of persistent pain or infection. Fifty‐six per cent of roots demonstrated migration radiographically. No cases required root retrieval or experienced post‐operative IANI or osteonecrosis of the jaw. Conclusion This mini case series provides some early insight into the use of coronectomy in oncology patients, however, requires a larger patient population and longer follow up.

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How do we review coronectomies? A national survey

Turner,

Cousins,

Wemyss

et al. 2024

Oral Surgery

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IntroductionCoronectomy of a mandibular third molar is a surgical procedure which aims to protect the inferior alveolar nerve (IAN) by removing the crown of the tooth, whilst leaving the roots in‐situ. There is an anecdotal variation in practice regarding the post‐operative clinical and radiographic review of patients who have undergone this procedure, which may be attributable to a lack of high‐quality evidence or guidance. The aim of this study was to establish current practice within the United Kingdom (UK) for a post‐operative review following a coronectomy.Materials and MethodsAn online survey was distributed to 50 Oral Surgery speciality registrars working within Oral Surgery and Oral and Maxillofacial departments across the UK during June 2022. Two reminder emails were sent, and participants were asked to respond on behalf of their departments.ResultsTwenty responses were received from trainees, on behalf of 20 separate departments. Fifty percent (n = 10) of the responding departments discharged patients without intra‐operative complications immediately following the procedure. The remaining 50% of departments discharged patients at points ranging from 2 weeks to 12 months. Departments who review patients who have undergone a coronectomy without intra‐operative complications do so between 1 and 3 times, with the most common time for the first review being at 1‐month post‐procedure (n = 3). When reviewing these patients, 54.5% (n = 6) of departments utilise face‐to‐face only reviews, whereas 36.4% (n = 4) of departments utilise a combination of face‐to‐face and remote reviews. Sixty‐five percent (n = 13) of departments do not routinely take postoperative imaging for these patients. Many departments also reported variation in practice within their departments, regarding discharge timing, clinical review and radiographic review.ConclusionThis survey has suggested that there is variation in practice within the secondary and tertiary care Oral Surgery and Oral and Maxillofacial Surgery centres within the United Kingdom in relation to the post‐operative clinical and radiographic coronectomy review. Consideration should be given to further high‐quality research into these areas, including the merits of patient‐initiated reviews and the development of guidelines for post‐operative management of coronectomy patients.

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Coronectomies: assessment and treatment planning

Cited by 4 publications

References 29 publications

Coronectomia intencional como alternativa para evitar lesões ao nervo alveolar inferior: Relato de caso clínico

Coronectomia intencional como alternativa para evitar lesões ao nervo alveolar inferior: Relato de caso clínico

Coronectomy of mandibular third molar in oncology patients

How do we review coronectomies? A national survey

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