Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars—A comparison of two techniques and review of the literature

Abstract

The removal of mandibular third molar teeth is one of the most common oral surgical procedures. In a significant number of patients, it carries a degree of associated morbidity, including damage to the inferior alveolar nerve (IAN). For this reason, practitioners desire the most up-to-date guidance on the most appropriate technique, informed by the best available evidence that will produce the lowest incidence of iatrogenic complications. The aim of this study was to perform a systematic review comparing the effect of coronectomy vs complete surgical extraction of mandibular third molar teeth on the risk of IAN injury and other complications in adults. Studies were identified through Embase (1980-2016) and Ovid MEDLINE (1946-2016) database searches. Search terms included coronectomy, partial root removal, deliberate vital root retention, odontectomy, surgical removal, surgical extraction, complete tooth extraction and extract. Limits of the study included humans, English language and randomised controlled trials (RCTs). Only RCTs comparing IAN damage associated with surgical extraction of mandibular third molars vs coronectomy were included. From our database searches, we identified two unique RCTs matching the inclusion criteria. Both evaluated patients who had specific radiographic signs of intimate relationships with the IAN. Upon detailed analysis, the studies were noted to exhibit a high risk of bias in many categories, thereby rendering their results inconclusive. Although evidence from two RCTs suggests that coronectomy can reduce the risk of IAN injury compared to surgical removal of high-risk mandibular third molars, the quality of evidence is insufficient to provide definitive conclusions regarding the preferred technique.

Somatosensory changes in Chinese patients after coronectomy vs. total extraction of mandibular third molar: a prospective study

“…This prospective study systematically compared the somatosensory profiles of two groups of patients with an impacted lower third molar extracted by one of two surgical methods, by using a comprehensive QST protocol for the first time [13,14]. According to the previous studies, the Ethics Committee suggested that random grouping was not suitable for this study.…”

“…Many studies claimed that coronectomy was significantly safer than conventional extraction. However, only two studies were randomized controlled trials (RCTs) [11,12] with high-quality evidence [13,14]. Most of these studies used clinical neurosensory tests (CNTs), that is, light touch sensation or two-point discrimination, to recognize IANI [2,8,11,12].…”

How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review

“…No other type of complication has been found to be significantly more prevalent in early when compared to delayed removal of impacted third molars. One important advantage of germectomy that clinicians should take into account is that such type of intervention is less likely to cause inferior alveolar or lingual nerve damage as the roots of the molar have not yet been fully formed [22,23,24]. Therefore, there is almost a nonexistent relation of a tooth germ to the above-mentioned nerves.…”

Coronectomy - An alternative approach to remove impacted teeth in oncological patients

“…Surgeons major concern is that leaving the roots will increase the chances of postoperative infection and a consequent need for a second intervention. However, clinical trials and systematic reviews show only few cases present surgical infections, with no significant difference from complete extraction ( 1 , 11 , 17 ). Leung et al ( 18 ) reported that although 2.9% of the coronectomies presented infection in the first week, all cases could be treated with antibiotics and local measures.…”

“…Coronectomy or partial odontectomy consists of the removal the crown of a vital tooth leaving the root in the socket ( 1 ). This is an alternative procedure developed by Ecuyer and Debien ( 2 ), originally indicated for impacted mandibular third molars that are close to the inferior alveolar nerve (IAN).…”