Coronectomy of lower wisdom teeth


With the advent and much more common use of CBCT dentists can have a much more accurate view of the proximity of lower wisdom teeth to the Inferior Alveolar Nerve.  With this knowledge we can more precisely evaluate the risk of nerve damage from removal.  When the risk is deemed moderate or higher, a coronectomy may be recommended.  That is the surgical removal of the top half of the tooth (all enamel) and allowing the bottom half that is near the nerve to stay in place.  A new 3 year study Leung 2012 on this procedure has shown it to be very successful and I feel very comfortable recommending patients to do this if their wisdom teeth are NOT infected in the bone and are close to the nerve.  More info Ahmed 2011

If the tooth is closely associated with the IAN canal radiographically, 20% of patients having these teeth removed are at risk of developing temporary IAN nerve injury and 1‑4% are at risk of permanent injury.  Radiographic signs indicative of possible IAN risk include: Renton 2012
  • Diversion of the canal
  • Darkening of the root
  • Narrowing of the root/canal
  • Interruption of the canal lamina dura
  • Interruption of the juxta‑apical area

Systemic Review Long 2012 says same thing.  Another systemic review Ghaeminia 2013 =same

Some of these roots later erupted, but they erupt up and away from the nerve so they can then be safely removed.


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