Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review
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HEAD & FACE MEDICINE
REVIEW
Open Access
Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review Andrea Martin, Giuseppe Perinetti, Fulvia Costantinides* and Michele Maglione
Abstract The aim of this systematic review was to evaluate the clinical effectiveness of the surgical technique of coronectomy for third molars extraction in close proximity with the inferior alveolar nerve. A literature survey carried out through PubMed, SCOPUS and the Cochrane Library from inceptions to the last access in January 31, 2014, was performed to intercept randomised clinical trials, controlled clinical trials, prospective cohort studies or retrospective studies (with or without control group) that examined the clinical outcomes after coronectomy. The following variable were evaluated: inferior alveolar nerve injury, lingual nerve injury, postoperative adverse effects, pulp disease, root migration and rate of reoperation. Ten articles qualified for the final analysis. The successful coronectomies varied from a minimum of 61.7% to a maximum of 100%. Coronectomy was associated with a low incidence of complications in terms of inferior alveolar nerve injury (0%-9.5%), lingual nerve injury (0%-2%), postoperative pain (1.1%-41.9%) and swelling (4.6%), dry socket infection (2%-12%), infection rate (1%-9.5%) and pulp disease (0.9%). Migration of the retained roots seems to be a frequent occurrence (2%-85.3%). Coronectomy appears to be a safe procedure at least in the short term, with a reduced incidence of postoperative complications. Therefore, a coronectomy can be indicated for teeth that are very close to the inferior alveolar nerve. If a second operation is needed for the remnant roots, they can be removed with a low risk of paresthesia, because the roots are generally receded from the mandubular nerve. Keywords: Coronectomy, Inferior alveolar nerve, Review
Introduction Extraction of an impacted mandibular third molar has the potential risk of causing temporary or permanent neurologic disturbances of the inferior alveolar nerve (IAN) [1]. The incidence of IAN injury (IANI) reported in the literature ranges from 1.3% to 5.3% [2-6]. The risk of this complication depends mainly on the position of the impacted tooth in relation to the inferior alveolar canal before surgery [3]. If there is close proximity between the IAN and the roots, the incidence may be as high as 19% [7]. Injury to the IAN can occur from compression of the nerve, either indirectly by forces transmitted by the root during elevation or directly by elevators. The nerve may also become transected by rotary instruments or during removal of a tooth whose root is grooved or perforated by the IAN. Several researches have tried to correlate * Correspondence: [email protected] Unit of Oral Surgery, School of Dental Sciences, University of Trieste, Trieste, Italy
radiographic markers to the relationship between the IAN and the root of the tooth [8-10]. These radiographic signs only indicate to surgeons that there is an increase
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