Coronectomy: an 8-year follow-up study

Abstract

Purpose Extraction of the lower third molar is the most frequently performed oral surgery. The possibilities of injury to the dental inferior alveolar nerve (IAN) are high in cases where the roots of the lower third molars are in close proximity to the said nerve. Injury to the IAN and the lingual nerve is one of the greatest complications associated with this type of surgery. Third molar extractions may result in different degrees of sensory alterations, which may be permanent in most cases or become chronic in some others. Technological innovations in radiology and cone beam computed tomography have been highly instrumental in helping accurately diagnose the relationship between the tooth roots and the IAN, thus shedding some more light on the surgical procedure to opt for. Coronectomy is an alternative option to treat this pathology, with reduced risk for IAN injury. In this report, we describe our coronectomy protocol and follow-up results over a period of 8 years. Methods During the period 2012 to 2020, 254 coronectomies were performed on patients of 17 to 74 years of age, of whom 118 (46.47%) were males, and 136 (53.54%) were females. Seventeen cases (6.7%) were excluded from the sample because it was necessary to remove the full molar as a result of persistent root mobility. Results Of the 237 cases, 28 (12%) reported severe pain; 123 (52%) reported moderate pain, and 86 patients (36%) reported no significant pain during the first postoperative week. None of these patients reported any degree of sensory alteration in connection with the IAN or the lingual nerve. Persistent root migration occurred in 10 cases, necessitating a second operation. Conclusions When a lower third molar in close relationship with the IAN requires some form of intervention, coronectomy appears to be a safe surgical procedure because it mitigates any injury to the IAN.