Coronectomy: a surgical option for impacted third molars in close proximity to the inferior alveolar nerve: a 5-year follow-up study

Publication date: Available online 31 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Giuseppe Monaco, Mattia D'Ambrosio, Giselle De Santis, Elisabetta Vignudelli, Maria Rosaria Antonella Gatto, Giuseppe Corinaldesi

ABSTRACT

Purpose

The extraction of third molars is the most common surgical procedure performed in the oral cavity. Coronectomy is a surgical protocol to reduce the risk of neurologic lesions to the inferior alveolar nerve (IAN). The authors look for early (up to 1 month) and late (from 2 to 60 months) postoperative complications.

Materials and Methods

This prospective cohort study enrolled patients treated at the Unit of Oral and Maxillofacial Surgery of the University of Bologna. The predictor variable was the time after coronectomy up to 5 years follow-up. To assess the rate of postoperative complications, outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate, the need for a second surgery, probing pocket depth (PPD) and bleeding on probing (BoP) were also investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables.

Results: We performed 116 coronectomies on 94 healthy patients (37 men and 57 women, mean age 28.99+-8,9 years). At 5 years follow-up the authors revalued 63 patients with 76 coronectomies. In total, 30 complications were verified. No cases of neurological lesions to the IAN or the lingual nerve (LN) were observed after surgery.

In the first 3 years, the surgeons extracted migrated roots in 5 (6%) cases without any neurologic lesion to the IAN. No complications were observed from the third to the fifth year.

Conclusions

This prospective study on coronectomy of third molars in a close relationship with the mandibular canal found no cases of neurologic lesions, no cases of late infection of the retained roots at 5 years, and a low rate of immediate postoperative complications.Further research should include a follow-up study at 10 years and more research about the mechanism of pulp healing.

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