The coronectomy technique for lower third molars: past and present

Abstract

Aim: To discuss the past and present evidence for the coronectomy technique for third molars. Materials and Methods: A review of the past and present literature related to the healing of extraction sockets in the presence of root fragments. Results: High-quality research studies surrounding the coronectomy procedure are lacking and it is important therefore that surgeons are aware that change of practice is not yet supported. The long-term consequences, in terms of infection or other, are not known as study follow-up is short. Conclusion: If coronectomy is to be considered then the authors would suggest that this is only for patients at high risk of potential nerve injury and that the patient is made aware of the risk of failure, the possible need for re-operation and our lack of knowledge of long-term consequences. HistoryExperiments relating to the healing of extraction sockets in the presence of root fragments date as far back as 1924 1 . This marked a peak in interest in Germany and many experiments were carried out to assess healing of post-extraction wounds in the presence of root fragments 2-4 . These were non-clinical animal studies and related to reimplantation of root fragments rather than post-extraction retained root fragments per se. Although at the time this had no effect on the management of retained roots, it created interest concerning what happens to root fragments that are reimplanted within the mandible and maxilla.The first known data collected in reference to retention of root fragments, rather than reimplantation, were in 1947, where the healing of extraction sockets in the presence of retained root fragments was assessed histologically in rats 5 . This experiment demonstrated for the first time that root remnants deep within a wound may be tolerated by the adjacent tissues and retained without symptoms. Furthermore, the retained root fragments may go on to be covered by a cementum-like peripheral layer, also suggested previously by others in the literature 6,7 .The period 1974-1976 marked a further surge in interest with regard to root retention with a focus on preservation of the alveolar ridge 8 . It was shown for the first time in monkeys that vital submerged roots which were traumatically amputated, exposed to transient bacterial invasion and covered primarily, were free of any type of inflammatory infiltrate 9 . The same experiment showed that gutta-perchafilled roots submerged in the same way were associated with a mild pericoronal inflammatory response. The technique of reducing vital roots by 2 mm below the alveolar crest bone and suturing to cover the root surfaces was described in an animal study in 1976, and showed histologically that: • Roots retained a vital pulp. • Cementum covered the cut dentine. • Periodontal membrane covered the buried roots 10 .

Coronectomy: a recognised procedure?

“…Our plan is to present migration of the teeth outcomes in studies of coronectomy in later papers. The cases of young people included in this study were included as their CBCT demonstrated that they were in the high‐risk group for transection of the IAN if the teeth were extracted.…”

Are coronectomy studies being cited? A bibliometric study

“…Data were extracted from the online Web of Science (WoS) database hosted by Clarivate Analytics. With reference to previously‐published narrative and systematic reviews on coronectomy, the search strategy was defined to be: Topic = (coronectom* OR partial odontectom*). The search included papers with the words “coronectomy” and “partial odontectomy”, and their variants in the title, abstract, or keywords.…”