Evaluation of the Outcomes of Coronectomy Procedure versus Surgical Extraction of Lower Third Molars Which Have a High Risk for Inferior Alveolar Nerve Injury: A Systematic Review

Postoperative Outcome After Coronectomy Versus Surgical Removal of Impacted Mandibular Third Molars - Clinical and Oral Health-Related Quality of Life Follow-Up

BACKGROUND

Coronectomy is an alternative procedure for removing mandibular third molars near the inferior alveolar nerve. Limited research exists on the effect of coronectomy on the postoperative quality of life (QoL).

PURPOSE

This study compared postoperative QoL after coronectomy and complete surgical removal of mandibular third molars during the first postoperative week.

STUDY DESIGN, SETTING, AND SAMPLE

This prospective cross-over study was conducted in the Oral and Maxillofacial Department of Amstelland Hospital, Amstelveen, The Netherlands. The study sample consisted of patients with indications for removal of both mandibular third molars, with one at increased risk of nerve injury undergoing coronectomy, while the other molar was extracted. Exclusion criteria were ibuprofen allergy, anticoagulant therapy, systemic disease, local pathology, or failure to complete the Oral Health Impact Profile-14 (OHIP-14) questionnaire.

INDEPENDENT VARIABLE

The independent variable was the surgical procedure, categorized as coronectomy or complete mandibular third molar removal. An 8-week period was maintained between procedures.

MAIN OUTCOME VARIABLE

The primary outcome measure was the mean OHIP-14 score during the first postoperative week. Secondary outcome measures were pain, self-perceived discomfort, and self-care behaviors.

COVARIATES

Sex, age, impaction patterns, and treatment order were analyzed as covariates.

ANALYSES

Nonparametric tests, including the Friedman test for within-patient differences and the Wilcoxon signed-rank test for repeated measures, were used for non-normally distributed data. Significance was set at 5%, with P value adjustments per Bonferroni correction.

RESULTS

The sample included 55 patients (18 male and 37 female) with a mean age of 24.6 ± 4.7 years. Mean OHIP-14 scores during the first 6 postoperative days were significantly higher after coronectomy compared to after surgical removal (day 1: 24.93 ± 9.82 vs 22.7 ± 9.5; day 6: 11.27 ± 10.36 vs 8.49 ± 10.93) (P < .05). Pain was significantly higher on the second to sixth postoperative days after coronectomy (day 2: 6.02 ± 1.92 vs 5.78 ± 1.73; day 6: 4.11 ± 2.49 vs 3.09 ± 2.41) (P < .05). Patients used more analgesics after coronectomy (day 2: 4.09 ± 2.53 vs 3.27 ± 1.9; day 6: 2.76 ± 2.62 vs 2.13 ± 2.49) (P < .05). We found no differences in outcomes for sex or molar impaction (P > .05).

CONCLUSION AND RELEVANCE

Coronectomy significantly impacted postoperative oral health-related QoL compared to complete surgical removal of mandibular third molars.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve

BACKGROUND

Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN).

AIM

To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction.

METHODS

Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed.

RESULTS

All IMM3s were extracted easily without symptoms of IAN injury after extraction.

CONCLUSION

Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

Is it possible to predict neurosensory alterations in impacted lower third molar removal based on preoperative imaging procedures? A prospective cohort study

BACKGROUND

Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferior alveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predict neurosensory alterations from preoperative imaging.

MATERIAL AND METHODS

A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Prior to surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance. Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its contact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) were recorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-square test, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI) of 95%.

RESULTS

In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramic radiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more types of superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in only three cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations were observed in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed.

CONCLUSIONS

Within the limitations of the present study, prediction of neurosensory alterations prior to ILTM extraction by means of preoperative imaging did not show a significant statistical correlation with post-surgical incidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predict an increased risk of IAN injury.

Knowledge and Attitude Among the Saudi Dentists Towards Coronectomy of Impacted Mandibular Third Molars

Purpose

Compared to the complete extraction of impacted third molars that are in close proximity to the mandibular canal, the coronectomy procedure is used as an alternative, owing to its minimal risk of damaging the Inferior alveolar nerve. Despite clear coronectomy concepts mentioned in the literature, the procedure is debatable. This study aimed to assess the knowledge and attitude towards the coronectomy procedure among dentists in Saudi Arabia.

Patients and Methods

The 16 close-ended questionnaire was distributed electronically to 377 dentists over the country. It included the demographic data and the options given to their patients with complicated impacted third molars, and the number of coronectomy they have performed. The retrieved data were exported and transferred to the SPSS software program for analysis. The Chi-squared and Fisher’s exact tests were used as appropriate for comparisons. A P-value <0.05 was considered significant.

Results

Only 54 (15%) participants performed coronectomy procedure, and only 28.3% of the participants advised their patients to do coronectomy. Nearly two-thirds of the participants (71.9%) were aware of coronectomy procedures, with no significant differences (P> 0.05) between the groups. About 68.9% of the participants agreed that coronectomy aims to protect inferior alveolar nerve damage. More than 60% of participants believed that coronectomy is a reliable technique, while 40.6% of participants claimed that they were capable of deciding whether to do coronectomy or extraction. No significant differences were found between the groups concerning most of the study variables (P> 0.05).

Conclusion

Knowledge of Saudi dentists towards coronectomy is good, while their attitude is still low. More learning strategies about coronectomy should be implemented.