Abstract
ObjectivesThis study aimed to quantitatively compare the somatosensory function changes of inferior alveolar nerve (IAN) after mandibular third molar extraction with a surgery protocol of coronectomy, as opposed to the conventional method.Materials and methodsPatients with a lower third molar directly contacting IAN were recruited and assigned either to a test group (coronectomy group) or a control group (conventional extraction). A standardized quantitative sensory testing (QST) battery was performed for four times: one week before surgery and the second, seventh, and 28th days after surgery. Z-scores and the loss/gain coding system were applied for each participant.ResultsA total of 140 molars (test group: n = 91, control group: n = 49) were enrolled. The sensitivity of the mechanical detection threshold (MDT) and pressure pain threshold (PPT) significantly increased after surgery more than before surgery in both groups (P ≤ 0.001). After the surgery, the sensitivities of the cold detection threshold (CDT), cold pain threshold (CPT), and heat pain threshold (HPT) were significantly higher in the test group than in the control group (P ≤ 0.027). The risk of IANI was significantly larger (P = 0.041) in the test group than in the control group.ConclusionsQST was a sensitive way to detect somatosensory abnormalities even with no subjective complaint caused by surgery. Coronectomy had less influence on IAN function than conventional total extraction.Clinical relevanceThe somatosensory function changes after mandibular third molar extraction were quantitatively studied, and coronectomy was proved a reliable alternation to reduce IAN injury rate.
Highlights
The prevalence of mandibular third molar impaction is increasing, and inferior alveolar nerve injury (IANI) after tooth extraction, one of the most serious complications [1], is attracting more attention
Coronectomy is an alternative to conventional extraction surgery; it removes the crown only and intentionally leaves the root to reduce the compression or direct contact injury to the inferior alveolar nerve (IAN), which is regarded as the origin of inferior alveolar nerve injury (IANI) [7,8,9]
Significant gender differences were detected for most quantitative sensory testing (QST) parameters except for Wind-up ratio (WUR), with females more sensitive than males (P ≤ 0.046, Table 2), with an exception for Vibration detection threshold (VDT)
Summary
The prevalence of mandibular third molar impaction is increasing, and inferior alveolar nerve injury (IANI) after tooth extraction, one of the most serious complications [1], is attracting more attention. Coronectomy is an alternative to conventional extraction surgery; it removes the crown only and intentionally leaves the root to reduce the compression or direct contact injury to the inferior alveolar nerve (IAN), which is regarded as the origin of inferior alveolar nerve injury (IANI) [7,8,9]. This technique was first described in 1984 by Ecuyer and Debien [10] and suggested as a way to prevent IANI in 1989 [7]. The sensitivity and specificity of these methods proved unsatisfactory and did not permit standard comparison among studies [15]
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