Coronectomy of mandibular third molars: A clinical protocol to avoid inferior alveolar nerve injury

2015 ◽  
Vol 43 (8) ◽  
pp. 1694-1699 ◽  
Author(s):  
Giuseppe Monaco ◽  
Elisabetta Vignudelli ◽  
Michele Diazzi ◽  
Claudio Marchetti ◽  
Giuseppe Corinaldesi
Keyword(s):  
Nerve Injury ◽  
Inferior Alveolar Nerve ◽  
Third Molars ◽  
Clinical Protocol ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

scholarly journals Coronectomy - A viable alternative to prevent inferior alveolar nerve injury

2015 ◽  
Vol 11 (3) ◽  
pp. 1-5
Author(s):  
Alok Sagtani ◽  
Reshu Agrawal Sagtani ◽  
Mehul Jaisani ◽  
Leeza Pradhan
Keyword(s):  
Nerve Injury ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Viable Alternative ◽  
Third Molars ◽  
Dry Socket ◽  
Root Exposure ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

Background and Objectives: Coronectomy is a relatively new method to prevent the risk of Inferior Alveolar Nerve (IAN) injury during removal of lower third molars with limited scientific literature among Nepalese patients. Thus, a study was designed to evaluate coronectomy regarding its use, outcomes and complications.Materials and Methods: A descriptive study was conducted from December 2012 to December 2013 among patients attending Department of Oral and Maxillofacial Surgery, College of Dental Sciences, BP Koirala Institute of Health Sciences, Dharan, Nepal for removal of mandibular third molars. After reviewing the radiograph for proximity of third molar to the IAN, coronectomy was advised. A written informed consent was obtained from the patients and coronectomy was performed. Patients were recalled after one week. The outcome measures in the follow-up visit were primary healing, pain, infection, dry socket, root exposure and IAN injury. The prevalence of IAN proximity of lower third molars and incidence of complications were calculated.Results: A total 300 mandibular third molars were extracted in 278 patients during the study period. Out of 300 impacted mandibular third molar, 41 (13.7%) showed close proximity to inferior alveolar nerve . The incidence of complications and failed procedure was 7.4% among the patients who underwent coronectomy. During the follow up visit, persistent pain and root exposure was reported while other complications like inferior alveolar nerve injury, dry socket and infection was not experienced by the study patients.Conclusion: With a success rate of 92.6% among the 41 patients, coronectomy is a viable alternative to conventional total extraction for mandibular third molars who have a higher risk for damage to the inferior alveolar nerve.JCMS Nepal. 2015;11(3):1-5.

scholarly journals Inferior alveolar nerve injury assessment after surgical removal of mandibular third molar.

2020 ◽  
Vol 27 (03) ◽  
pp. 530-534
Author(s):  
Abdul Wahid Bhangwar ◽  
Muhammad Irfan Khan ◽  
Hira Fatima ◽  
Salman Shams
Keyword(s):  
Nerve Injury ◽  
Local Anesthesia ◽  
Maxillofacial Surgery ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Surgical Removal ◽  
Third Molars ◽  
Mandibular Third Molar ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

To assess the nerve injury (inferior alveolar nerve) after surgical removal of mandibular third molars under local anesthesia. Study Design: Observational study. Setting: Oral & Maxillofacial Surgery Department LUMHS Jamshoro/Hyderabad. Period: From 11th November 2015 to 10th May 2016. Material & Methods: This study consisted of one hundred patients. Inclusion criteria’s were patients with impacted mandibular third molar, patient’s age from 18 to 45years and irrespective of gender. Exclusion criteria were patients younger than 18yrs of age of above 45 years, patients having neurological disorders, medically compromised patients, patients receiving radiotherapy or chemotherapy, patients with known allergy to local anesthesia, patients having pathology due to mandibular third molars, patients radiographicaly root is very near to inferior dental canal. Results: Out of 100 patients incorporated in this research 66 were male (66%) and 34 female (34%). The mean age was 29+3.20 years. Common indication of extraction were recurrent pericoronitis  52(52%) cases followed by deep caries/ pulpitis in 28(28%)  cases, orthodontic reason in 11(11%) cases and caries to adjacent tooth in 9(9%) cases. Third molar impaction according to winter’s classification were Mesioangular in 54(54%) cases followed by Horizontal in 26(26%) cases and Vertical in 11(11%). Radiographic showed Narrowing of root in 21% cases and narrowing of inferior dental (ID) canal 20% cases, followed by diversion of ID canal in 16 % cases, deflection of root 14 % cases and darkening of root in 11% cases. After surgical removal of mandibular third molar, the inferior alveolar nerve injury was observed in 6(6%) cases. Conclusion: We conclude that inferior alveolar nerve paresthesia occurs in 6% after surgical removal of mandibular third molars.

The Use of Coronectomy to Manage Symptomatic Mandibular Third Molars: Techniques, Pitfalls and Suggested Guidelines

Dental Update ◽  
2021 ◽  
Vol 48 (3) ◽  
pp. 217-223
Author(s):  
Robert Bolt ◽  
Murtaza Hirani ◽  
Elena Kyriakidou ◽  
Abdurahman El-Awa ◽  
Simon Atkins ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Nerve Injury ◽  
Significant Variation ◽  
Inferior Alveolar Nerve ◽  
Surgical Removal ◽  
Decision Making Process ◽  
Third Molars ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

Coronectomy is a valuable technique in the management of symptomatic mandibular third molars at high risk of inferior alveolar nerve injury. When applied appropriately, the technique may reduce the incidence of inferior alveolar nerve injury in comparison to full surgical removal. Currently, no definitive guidelines exist on when to opt for coronectomy versus full surgical removal, and therefore significant variation in clinical practice exists. This article summarizes the surgical stages involved in the coronectomy procedure, reviews the indications and hazards of the technique, and finally provides suggested guidelines to assist the practitioner in the decision-making process of when to opt for coronectomy versus full surgical removal in the management of symptomatic mandibular third molars. CPD/Clinical Relevance: To review the coronectomy technique and highlight potential hazards with inappropriate application of the technique.

scholarly journals 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

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Nedal Abu-Mostafa ◽  
Lulwah M. AlRejaie ◽  
Fahad A. Almutairi ◽  
Ruba A. Alajaji ◽  
Maram M. Alkodair ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Nerve Injury ◽  
Randomized Clinical Trials ◽  
Inferior Alveolar Nerve ◽  
Control Group ◽  
Third Molars ◽  
Surgical Extraction ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

Background and Objectives. Surgical extraction of mandibular third molars (3rd M) may cause inferior alveolar nerve injury (IANI), whereas in coronectomy the crowns of 3rd M are removed, keeping the roots intact to avoid IANI. This study aims to review the literature which evaluated coronectomy effectiveness as an alternative for surgical extraction of 3rd M that have a high risk of trauma to the inferior alveolar canal. A computerized literature search was conducted on the databases PubMed, SCOPUS, and ScienceDirect to gather information regarding the coronectomy procedure from inception till June 5, 2020. A total of 97 articles were identified, and seven studies were finally included for conducting qualitative analysis: 3 randomized clinical trials and 4 clinical controlled trials. Cochrane Collaboration’s tool was used for assessing risk of bias. Coronectomy procedures were performed on 15–171 teeth. In the control group, extraction procedures were done on 15–178 teeth. Results. No study reported permanent inferior alveolar nerve injury (p-IANI) regarding coronectomy; however, transient inferior alveolar nerve injury (t-IANI) was reported in 0–2.20% of successful coronectomy and 0–8% of failed coronectomy. Postextraction t-IANI ranged from 0% to 16.66% while p-IANI from 0% to 3.63%. In 5 studies, root migration occurred in 2% to 85.3% of cases and the distance rate was 2.33–3.43 mm at 6 months postoperatively; then the migration gradually decreased and stopped at 12 months. Conclusion. This systematic review revealed that coronectomy is an efficient alternative for the management of impacted 3rd M with a high risk of IANI. Patients who got antibiotics postcoronectomy procedures had lower infection rates than those who did not receive antibiotic therapy. We recommend further research on coronectomy with longer follow-up periods to assess the retained roots’ long-term outcomes and to assess the effect of antibiotics administration on postcoronectomy infection rate. This systematic review is registered under number CRD42020198394.

scholarly journals Predicting the Risk of Inferior Alveolar Nerve Injury in Impacted Lower Third Molars Using Panoramic Radiography and Cone Beam Computed Tomography

2021 ◽  
Vol 10 (34) ◽  
pp. 2910-2914
Author(s):  
Abhishek Verma ◽  
Stuti Verma ◽  
Anushikha Dhankhar ◽  
Nitin Kumar Moral ◽  
Nidhi Nagar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Nerve Injury ◽  
Cone Beam Computed Tomography ◽  
Panoramic Radiography ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
Inferior Alveolar Nerve Injury

BACKGROUND A serious complication of surgical removal of impacted lower third molars is inferior alveolar nerve (IAN) injury. Evaluation of radiographic factors to predict IAN injury using CT and panoramic radiography includes root morphology assessment, follicular sac size, mandibular bone density, inferior alveolar nerve and vessels, condition of the overlying tissues, relation of the impacted tooth with the body and ramus of the mandible and the adjacent teeth. This study was done to evaluate the radiological features of the impacted lower mandibular teeth and their relationship with IAN through panoramic radiography and CT and to assess the most predictable radiological criteria for inferior alveolar nerve injury in impacted third molar surgery. METHODS All the patients indicated for lower third molar extraction were included in the study and pre-operative conventional panoramic radiographs (Planmeca Proline PM 2002 CC, Helsinki, Finland) and CBCT (Kodak CBCT) were taken. Any post-operative nerve injuries detected were followed up after 15 days or 1 month. Fisher’s exact test was done to find the association between the outcome variable and explanatory variables. RESULTS Only 11.4 % (N = 4) of all participants had IAN injury following surgical disimpaction. All the participants with IAN injury showed narrowing of the canal on their preoperative panoramic radiographs and presence of nerve approximation with the tooth in cone beam computed tomography (CBCT) reports (P < 0.05). CONCLUSIONS A statistically significant association exists between IAN injury and nerve exposure, radiographic signs of nerve involvement for panoramic radiograph, level of third molar impaction, and nerve approximation in CBCT. KEY WORDS Inferior Alveolar Nerve Injury, Lower Third Molar Impaction, Panoramic Radiography, CBCT

scholarly journals Frequency and risk factors for injury of the inferior alveolar nerve during surgical extraction of the impacted lower third molars

2019 ◽  
Vol 76 (12) ◽  
pp. 1240-1244
Author(s):  
Dejan Dubovina ◽  
Stevo Matijevic ◽  
Filip Djordjevic ◽  
Jelena Stanisic ◽  
Branko Mihailovic ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Statistical Significance ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Mandibular Canal ◽  
Sensory Disturbance ◽  
Third Molars ◽  
Root Tips ◽  
Surgical Extraction ◽  
Inferior Alveolar Nerve Injury

Background/Aim. The injury of inferior alveolar nerve during a surgical extraction of impacted lower third molars, followed by sensory disturbance, is, for the patient, an extremely unpleasant complication. The aim of this study was to determine the frequency of this complication after the third molar surgery and its frequency depending on a tooth position and tooth relation to the mandibular canal. Methods. In this study, 800 surgical extractions of the impacted lower third molar were performed. The position of the impacted tooth was recorded according to the Winter classification, as well as the ratio of their root tips to the mandibular canal using the Tanaka et al. and Rood and Shebab classifications. Results. The frequency of the recorded post extraction sensory disturbance was 2.25%, most frequently when teeth were in the mesioangular position. Concerning Tanaka and al. classification, the incidence of injuries was inversely proportional to the increase of distance between roots and mandibular canal with the statistical significance in cases where mandibular canal overlaps more than a half of the root of the tooth (p = 0.001). Considering the radiological signs recommended by Rood and Shehab, a higher frequency of the inferior alveolar nerve injury was recorded when illumination in the area of the root tips was present and when the loss of linear overshadowing characterized by the ?roof? and the ?bottom? of the mandibular canal were observed, or diversion of the canal and root deflection, but without a statistical significance. Conclusion. The superposition of the mandibular canal with the lower third molar roots at the panoramic radiographies may increase a possibility of the inferior alveolar nerve injury. The angulations of the impacted lower third molar as well as the vicinity of the tips of its roots to the content of the mandibular canal, do not significantly affect the frequency of the nerve injury.

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