Do People Know about Coronectomy For Management of Wisdom Teeth?

An interesting article titled “Coronectomy: a recognised procedure?” appears in the 2018 edition of Oral Surgery written by Dhanrajani and Smith (vol. 11, pp. 273-281). The article discusses a review of the literature on coronectomy to treat wisdom teeth along with a retrospective study. Coronectomy is often suggested to treat wisdom teeth when there is a high risk of nerve damage and is associated with a low rate of complications, see for example the past posts Care Guidelines for Wisdom Teeth: 2014 Finnish Guidelines, A Study of 185 Coronectomy Procedures of Wisdom Teeth, and Complications Associated with Coronectomy.

In the article by Dhanrajani and Smith the authors discuss how the inferior alveolar nerve or lingual nerve can be damaged during wisdom teeth removal and that patients seek to avoid such a complication. Coronectomy is a procedure that removes only the crown of an impacted wisdom tooth and leaves the root and pulp intact which avoids possible damage to the inferior alveolar nerve. In the article the authors describe the results of a study where 3,654 lower wisdom teeth were removed in patients who presented in Sydney, Australia with a total of 214 of these being coronectomies. Coronectomy was offered to patients when there was evidence of moderate to high risk of damage to the inferior alveolar nerve after wisdom teeth removal based on both orthopantomograph and cone beam CT (CBCT) images. What is unique about this study is that coronectomy was also offered to patient groups that are contraindicated such as those that are immunocompromed or taking medication for osteoporosis or have diabetes.

The authors found that coronectomy is of similar appropriateness for both younger and older patients. Coronectomy was performed on 27 patients who had decayed teeth or coronal caries. Coronectomy was performed on 5 patients taking medication for osteoporosis, 21 patients with diabetes, and 9 patients that were immunocompromed. It was found that some patients experienced pain, lack of wound healing, and altered nerve sensations after coronectomy.

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The authors discuss prior studies that have been performed on coronectomy including two prior randomized controlled studies. One of these showed a failure rate of 9.4% of coronectomy; however pain, dry socket, and nerve damage occurred less with coronectomy than standard surgical extraction of wisdom teeth. The other of these showed a high failure rate of 38% of coronectomy; however less nerve damage occurred with coronectomy than standard surgical extraction of wisdom teeth. The authors state

“With the increased acceptance of coronectomy, the question must be asked as to whether the procedure is being overutilised for fear of medicolegal repercussions…the discussion of coronectomy
with patients is always worthwhile where the risk of IAN [inferior alveolar nerve] injury is likely; it is clear that the severity of post-operative complications with coronectomy will be less than the neurogenic pain associated with neuropraxia”

The authors believe based on their study that coronectomies can be successfully performed in those with decayed teeth and in those with existing other systemic diseases. The authors state that this view differs from that of others. Even so the authors do not seem to provide much in the form of data and a sufficient number of patients tested in their study to support their view. It would seem a study with a larger sample size is needed and they are just relying on a small number of cases.

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