Evaluation of Outcome Following Coronectomy for the Management of Mandibular Third Molars in Close Proximity to Inferior Alveolar Nerve

Overview

Journal J Clin Diagn Res

Specialty General Medicine

Date 2016 Sep 23

PMID 27656565

Citations 9

Authors

Subhadeep Mukherjee

Bhaskarapandiyan Vikraman

Duraiswamy Sankar

Muthu Subramanian Veerabahu

Affiliations

Soon will be listed here.

Abstract

Introduction: Iatrogenic damage to Inferior Alveolar Nerve (IAN) is a significant risk factor following prophylactic or therapeutic removal of impacted mandibular third molar. The risk to IAN injury increases many fold, when the third molar root overlaps the nerve canal as identified by the radiographic imaging. Various methods like orthodontic assisted extraction, staged removal of tooth or coronectomy have been advocated to reduce the incidence of IAN injury in high risk cases with variable outcome.

Aim: The aim of present study was to evaluate the fate of the root (resorbed, exfoliated, covered by bone) after coronectomy or intentional root retention of impacted mandibular 3(rd) molars in patients with high risk for inferior alveolar nerve damage as evaluated by the intra oral periapical radiograph.

Materials And Methods: Twenty impacted mandibular third molar teeth, in 18 patients with high risk of injury to IAN based on Rood's Criteria in an intra oral periapical radiographic examination, between the age group of 18 to 40 years, were included in the study. Preoperatively the impacted third molars were evaluated clinically as well as radiographically. Pederson Difficulty Index and Winter's Classification of impacted tooth was recorded. Coronectomy was done at the cemento enamel junction leaving the roots 2-3mm below the alveolar crest and primary closure was done. Patients were evaluated periodically for two years at six months interval. Post operative pain, swelling, IAN injury or any other complications were observed and recorded.

Results: None of the patients had IAN injury and none required second surgical removal. There was no incidence of post-operative infection and none required second surgical intervention. However, two of our patients had failed coronectomy (10%) due to mobilization of roots intra operatively and the roots were removed. One patient developed profuse bleeding intra-operatively in the failed coronectomy case. One patient had temporary lingual nerve paresthesia.

Conclusion: Coronectomy procedure is effective in controlling inferior alveolar nerve injury following third molar surgery, in radiographically evaluated high risk cases and it has very low incidence of complications.

Citing Articles

Prevalence of Surgical Site Infections Following Coronectomy: A Systematic Review and Meta-Analysis.

Kostares E, Kostare G, Kostares M, Tsakris A, Kantzanou M Dent J (Basel). 2024; 12(12).

PMID: 39727436 PMC: 11674566. DOI: 10.3390/dj12120379.

Treatment decision for impacted mandibular third molars: Effects of cone-beam computed tomography and level of surgeons' experience.

Adali E, Ozden Yuce M, Isik G, Sener E, Mert A PLoS One. 2024; 19(12):e0314883.

PMID: 39637068 PMC: 11620579. DOI: 10.1371/journal.pone.0314883.

Establishing universal sectioning depth and angle for surgical coronectomy of impacted mandibular third molars: an imaging-based study.

Gaballah K, Shetty S, Kamath V, Talaat W, Renton T Front Oral Health. 2024; 5:1466076.

PMID: 39364343 PMC: 11446897. DOI: 10.3389/froh.2024.1466076.

Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery.

Issrani R, Prabhu N, Sghaireen M, Alshubrmi H, Alanazi A, Ali Alkhalaf Z Diagnostics (Basel). 2021; 11(12).

PMID: 34943519 PMC: 8700465. DOI: 10.3390/diagnostics11122282.

Evaluation of the Outcomes of Coronectomy Procedure versus Surgical Extraction of Lower Third Molars Which Have a High Risk for Inferior Alveolar Nerve Injury: A Systematic Review.

Abu-Mostafa N, AlRejaie L, Almutairi F, Alajaji R, Alkodair M, Alzahem N Int J Dent. 2021; 2021:9161606.

PMID: 34804169 PMC: 8604579. DOI: 10.1155/2021/9161606.

References

Rood J, Shehab B . The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990; 28(1):20-5. DOI: 10.1016/0266-4356(90)90005-6. View

ORiordan B . Coronectomy (intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98(3):274-80. DOI: 10.1016/S1079210404000496. View

Goto S, Kurita K, Kuroiwa Y, Hatano Y, Kohara K, Izumi M . Clinical and dental computed tomographic evaluation 1 year after coronectomy. J Oral Maxillofac Surg. 2012; 70(5):1023-9. DOI: 10.1016/j.joms.2011.09.037. View

Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E . Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg. 2009; 67(9):1806-14. DOI: 10.1016/j.joms.2009.04.018. View

Landi L, Manicone P, Piccinelli S, Raia A, Raia R . A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series. J Oral Maxillofac Surg. 2010; 68(5):969-74. DOI: 10.1016/j.joms.2009.09.097. View

Khan I, Halli R, Gadre P, Gadre K . Correlation of panoramic radiographs and spiral CT scan in the preoperative assessment of intimacy of the inferior alveolar canal to impacted mandibular third molars. J Craniofac Surg. 2011; 22(2):566-70. DOI: 10.1097/SCS.0b013e3182077ac4. View

Knutsson K, Lysell L, Rohlin M . Postoperative status after partial removal of the mandibular third molar. Swed Dent J. 1989; 13(1-2):15-22. View

Dolanmaz D, Yildirim G, Isik K, Kucuk K, Ozturk A . A preferable technique for protecting the inferior alveolar nerve: coronectomy. J Oral Maxillofac Surg. 2009; 67(6):1234-8. DOI: 10.1016/j.joms.2008.12.031. View

Fareed K, Khayat R, Salins P . Vital root retention: a clinical procedure. J Prosthet Dent. 1989; 62(4):430-4. DOI: 10.1016/0022-3913(89)90176-5. View

10.

Ahmed C, Wafae E, Bouchra T . Coronectomy of third molar: a reduced risk technique for inferior alveolar nerve damage. Dent Update. 2011; 38(4):267-8, 271-2, 275-6. DOI: 10.12968/denu.2011.38.4.267. View

11.

Anthony Pogrel M, Lee J, Muff D . Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg. 2004; 62(12):1447-52. DOI: 10.1016/j.joms.2004.08.003. View

12.

Phillips C, Norman J, Jaskolka M, Blakey G, Haug R, Offenbacher S . Changes over time in position and periodontal probing status of retained third molars. J Oral Maxillofac Surg. 2007; 65(10):2011-7. DOI: 10.1016/j.joms.2006.11.055. View

13.

Leung Y, Cheung L . Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108(6):821-7. DOI: 10.1016/j.tripleo.2009.07.004. View

14.

Dodson T, Cheifetz I, Nelson W, Rafetto L . Summary of the proceeding of the Third Molar Multidisciplinary Conference. J Oral Maxillofac Surg. 2012; 70(9 Suppl 1):S66-9. DOI: 10.1016/j.joms.2012.05.001. View

15.

Tay A, Zuniga J . Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg. 2007; 36(10):922-7. DOI: 10.1016/j.ijom.2007.03.012. View

16.

Whitaker D, SHANKLE R . A study of the histologic reaction of submerged root segments. Oral Surg Oral Med Oral Pathol. 1974; 37(6):919-35. DOI: 10.1016/0030-4220(74)90445-9. View

17.

Johnson D, Kelly J, Flinton R, Cornell M . Histologic evaluation of vital root retention. J Oral Surg. 1974; 32(11):829-33. View

18.

Juodzbalys G, Daugela P . Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2014; 4(2):e1. PMC: 3886113. DOI: 10.5037/jomr.2013.4201. View

19.

Lieblich S, Kleiman M, Zak M . Dentoalveolar surgery. J Oral Maxillofac Surg. 2012; 70(11 Suppl 3):e50-71. DOI: 10.1016/j.joms.2012.07.031. View

20.

Renton T, Hankins M, Sproate C, McGurk M . A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2004; 43(1):7-12. DOI: 10.1016/j.bjoms.2004.09.002. View