An interesting article titled “What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study,” appears in the 2015 Journal of Oral and Maxillofacial Surgery (vol. 73, pp. 1246-1253) and written by Giuseppe Monaco. The article explores the likelyhood of complications occuring with coronectomy procedures.
Coronectomy is an alternative surgical procedure to extract wisdom teeth with roots that are close to the mandibular canal. The article describes a research study to determine whether coronectomy decreased neurologic damage in cases of mandibular third molars in close proximity to the inferior alveolar nerve. The study looked at 94 healthy patients with a mean age of ~30 who had 116 mandibular third molars (wisdom teeth) treated with coronectomy. A total of 28 patients dropped out of the study during the 3 year follow up period. Of the 116 wisdom teeth treated, 56 (48.3%) were totally impacted and 60 (51.7%) were partially impacted. The teeth were treated by coronectomy due to having pericoronitis (47.4%), periodontal disease (18.1%), or both of the mentioned diseases (32.9%).
No neurological injuries occurred to the inferior alveolar nerve or to the lingual nerve with the coronectomy procedures. A total of 30 complications occurred with most of them happening within 1 month. Immediate postoperative complications (up to 1 month after surgery) included 5 cases (4%) of postoperative alveolitis, 10 cases (9%) of postoperative swelling, and 10 cases (9%) of postoperative pain. Late postoperative complications (1 month to 3 years after surgery) consisted of 1 case of pulpitis and 4 cases of root eruption into the oral cavity. Those surgeons who had less than 10 years of training exposed patients to a greater risk of complications (95% confidence interval, 1.004-4.263). An overall success rate of 74% for the coronectomy procedures at 6 months was estimated and it became necessary for a second surgery in 6% of cases to remove root fragments.
The authors state
“Although a coronectomy is a time-consuming surgical procedure, it is less aggressive than a complete extraction with regard to the surrounding soft and mineralized tissues. As a consequence of this decreased intraoperative trauma, few cases of pain or swelling during the first postoperative week were observed…The weakness of this study was the small number of cases. Further studies with a larger number of cases are necessary to investigate postoperative complications; in addition, the relation between such complications and patient age should be evaluated, because patient age generally affects the rate of complications.”
It is interesting to see coronectomy performed successfully in many patients. I agree that additional studies with more cases to better assess complications that can occur is beneficial.