Coronectomy of the wisdom teeth: the dental extraction alternative

Abstract

Background. Coronectomy of the wisdom teeth is an alternative surgical procedure to tooth extraction, which aims to preserve the roots of the wisdom teeth in the dental socket after surgical separation of the crown, in order to avoid the injury of the inferior alveolar vascular-nervous bundle. Purpose. Minimizing the damage to the inferior alveolar nerve when extracting lower third molars caused by the intimate relationship between the nerve and the roots of the teeth, by using the technique of coronectomy, or intentional root retention. Material and Methods. Patients who reported to University Dental clinic during the period 2020–2021 for surgical removal of impacted L3M were screened for nerve–root relationship with OPG or CBCT. 15 patients underwent coronectomy as a procedure to remove the crown and upper third of the roots of a lower third molar to reduce the risk of damage to the inferior alveolar nerve. Results. 15 patients were enrolled in this study, with a total of 17 lower third molars. Sixteen sites healed primarily, but in 1 case the sockets on both sides opened and failed to close secondarily. In this case, the root fragments were later removed and found to be mobile. Conclusion. Coronectomies are safer to perform than complete extractions in situations in which the third molar is in close proximity to the mandibular canal. The technique appears to be associated with a low incidence of complications and the removal of remaining roots is required in around 6-7% of cases due to the mesial migration of the fragment and not any symptoms or reinfection.

Risk determination of inferior alveolar nerve injury after mandibular third molar extraction

“…discuţii Extracţia molarilor de minte este deseori asociată cu dezvoltarea diverselor complicaţii intra-și postoperatorii, printre care și trauma nervului alveolar rounding structures, (e.g. mandibular canal) [1,2]. Determining the degree of difficulty of the intervention and the risk of other complications, e.g.…”

“…De aceea, este necesară o evaluare minuţioasă a fiecărui caz clinic cu studierea particularităţilor anatomo-morfologice a molarilor incluși, dar și relaţia lor cu structurile învecinate, (ex. canalul mandibular) [1,2]. Determinarea gradului de dificultate a intervenţiei, dar și a riscului de survenire a altor complicaţii, spre exemplu traumă a NAI, vor permite medicului să planifice intervenţia în așa mod, încât să minimizeze aceste riscuri.…”

“…The introduction of these risk prediction models into practice allows the clinician to adopt techniques to avoid IAN injury, either coronary/ radicular separation during extraction, changing the vectorsof force application by instruments, or choosing alternative extraction techniques [1]. Patients will also be informed about all complications that may occur intra-and postoperatively.…”

“…Introducerea în practică a acestor modele de calculare a riscurilor permit medicului adoptarea unor tehnici care să evite lezarea NAI, fie separarea coronară/radiculară în timpul extracţiei, schimbarea vectorilor de aplicare a forţelor de către instrumente, sau alegerea unor tehnici alternative de extracţie [1]. De asemenea, pacienţii vor fi informaţi despre toate complicaţiile ce pot surveni intra-și post-operator.…”