An interesting article titled “Coronectomy: A Surgical Option for Impacted Third Molars in Close Proximity to the Inferior Alveolar Nerve—A 5-Year Follow-Up Study,” appears in the 2019 edition of the Journal of Oral and Maxillofacial Surgery written by Monaco et al. The article discusses a study that explores complications up to five years after coronectomy. Coronectomy is often suggested to treat wisdom teeth when there is a high risk of nerve damage see for example Do People Know about Coronectomy For Management of Wisdom Teeth?.
In the article the authors build upon a prior study they published that evaluated early or late complications and root migration for up to three years after coronectomy by extending the time period to up to five years after coronectomy. The study evaluated 94 patients who presented for lower wisdom teeth removal at the University of Bologna in Italy, between December 2009 and June 2013 and underwent coronectomy on 116 wisdom teeth. The authors classified complications that occured within 1 month after coronectomy as early complications and those anytime for after 1 month to 60 months as late complications.
A total of 66 patients with 87 coronectomies completed a 3 year follow-up for the authors prior study. The early complications found were 5 cases of dry socket (4%), 10 cases of swelling (9%), and 10 cases of pain (9%) along with no neurological injuries after 3 years. The late complications found were 1 case of pulpitis and 4 cases of root eruption after 3 years all of which required a second surgical procedure for root extraction. A total of 63 patients with 76 coronectomies completed the 5 year follow-up with 40 fully impacted, 36 partially impacted, 35 vertically impacted, and 41 horizontally impacted wisdom teeth. The authors found that from the time period three years to five years after coronectomy no complications occurred and there were no additional surgical procedures performed. The probing pocket depth and bleeding on probing was evaluated at 5 years after coronectomy. The probing pocket depth was found to decrease from an average of 6 mm to an average of 4 mm at 5 years. Bleeding on probing was found to be present in 87.5% of the wisdom teeth site prior to coronectomy and this declined to being present in 19.7% of the wisdom teeth site after coronectomy.
The authors point out a few other recent studies that have been conducted regarding coronectomy and in cases in those studies inferior alveolar nerve injury occurred. The authors believe the lack of nerve injury in their study is due to following a strict step-by-step surgical procedure. The authors state
“This prospective study on coronectomy of third molars [wisdom teeth] in a close relationship with the mandibular canal reported no cases of neurologic lesions, a low rate of immediate postoperative complications, and no cases of late infection of the retained roots from the third to fifth year of follow-up.”
The authors feel that the fact that there were no cases of late infection of the retained roots at 5 years was the most important finding from their study. The authors plan to conduct another study at the 10 year follow-up point.