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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2013 April;24(1):33-9
Good neurological results with coronectomy in the third mandibular molar surgery: case series study
Costabile E. 1, Vignudelli E. 2, Kellezi A. 3, Monaco G. 3, Marchetti C. 4
1 Maxillofacial Surgery Aggregate Postgraduate School, University of Parma-Bologna-Ferrara, Bologna, Italy;
2 Postgraduate Master in Oral Surgery and Implantology, University of Bologna, Bologna, Italy;
3 School of Dentistry, University of Bologna, Bologna, Italy;
4 Department of Maxillofacial Surgery University of Bologna, Bologna, Italy
Aim: Damages to the inferior alveolar nerve (IAN) during the extraction of impacted mandibular third molars, in close proximity to the mandibular canal, is a postoperative complication that occurs in a percentage variable from 0.4% to the 8.4%, whereas permanent injury occurs in up to 3% of cases. The aims of this study were to describe, after a three years follow-up, a surgical protocol to improve the clinical success of coronectomy and evaluate the postoperative complications of this surgical procedure.
Methods: The authors evaluated the postoperative complications of 93 coronectomies of impacted mandibular third molars in 85 patients (35 men and 50 women), with a mean age of 29±9 years. The authors used cone-beam computed tomographic images to determine that all of the teeth that underwent coronectomy were in close proximity to the IAN.
Results: The authors did not observe any neurological injuries to the IAN or charged to the lingual nerve. The study also describes the possible migration of the affected roots and new coronal bone formation as seen during after 3, 6, 12 months post-operatively with the consequential clinical and radiographic controls. Four patient underwent a second surgery to remove the retained root fragments: three of four patient complained about intermittent pain. No neurological injuries resulted after the second surgery.
Conclusions: Coronectomy is a safe alternative to the complete extraction of third molars, to reduce neurological damage risks in cases with radiological diagnosis of inferior alveolar nerve in unsafe proximity to the tooth. The root migration is generally asymptomatic but when a second surgery is required, the extraction of a root fragment is safer because of the migration, which results in gaining distance from the mandibular canal.