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      Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature

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          Abstract

          Background

          Coronectomy is an alternative to complete removal of an impacted mandibular third molar. Most authors have recommended coronectomy to prevent damage to the inferior alveolar nerve during surgical extraction of lower third molars. The present study offers a systematic review and metaanalysis of the coronectomy technique.

          Material and Methods

          A systematic review and meta-analysis was performed based on a PubMed and Cochrane databases search for articles published from 2014 and involving coronectomy of mandibular third molars located near the inferior alveolar nerve canal, with a minimum of 10 cases and a minimum follow-up period of 6 months. After application of the inclusion and exclusion criteria, a total of 12 articles were included in the study.

          Results and Discussion

          Coronectomy results in significantly lesser loss of sensitivity of the inferior alveolar nerve and prevents the occurrence of dry socket. No statistically significant differences were observed in the incidence of pain and infection between coronectomy and complete surgical extraction. After coronectomy, the remaining tooth fragment migrates an average of 2 mm within two years.

          Conclusions

          Coronectomy is indicated when the mandibular third molar is in contact with the inferior alveolar nerve and complete removal of the tooth may cause nerve damage.

          Key words:Coronectomy, included third molar, inferior alveolar nerve injury.

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          Most cited references26

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          A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars.

          We randomised 128 patients who required operations on mandibular third molars and who had radiological evidence of proximity of the third molar to the canal of the inferior alveolar nerve to one of two operations: extraction [n=102], and coronectomy [n=94]. Some roots were dislodged during intended coronectomy and were therefore removed, resulting in two subgroups (successful coronectomy n=58, and failed coronectomy n=36). The mean (S.D.) follow up was 25 (13) months. Nineteen nerves were damaged (19%) after extraction, none after successful coronectomy, and three (8%) after failed coronectomy (p=0.01). The incidence of dry socket infection was similar in the three groups (10/102, 10%, 7/58, 12%, and 4/36, 11%, respectively). No root required removal or reoperation. To our knowledge this is the first clinical trial of the efficacy of coronectomy in preserving the inferior alveolar nerve. The length of follow up was about 2 years, which for the assessment of delayed eruption of the root fragments is not sufficient as this process may continue for up to 10 years. However, it seems that coronectomy reduces the incidence of injury to the inferior alveolar nerve without increasing the risk of dry socket or infection.
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            • Record: found
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            • Article: not found

            Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions.

            The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury. We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury. Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model. Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. Older patients were at a higher risk for suffering permanent injuries.
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              • Record: found
              • Abstract: found
              • Article: not found

              Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial.

              The objective of this study was to compare the surgical complications and neurosensory disturbances of coronectomy and total excision of lower wisdom teeth with roots in close proximity to the inferior dental nerve (IDN).
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                Author and article information

                Journal
                Med Oral Patol Oral Cir Bucal
                Med Oral Patol Oral Cir Bucal
                Medicina Oral S.L.
                Medicina Oral, Patología Oral y Cirugía Bucal
                Medicina Oral S.L.
                1698-4447
                1698-6946
                July 2016
                31 March 2016
                : 21
                : 4
                : e505-e513
                Affiliations
                [1 ]Resident of the Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
                [2 ]Master in Oral Surgery and Implant Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Spain
                [3 ]Collaborating Professor of the Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
                [4 ]Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
                Author notes
                Clínicas Odontológicas Gascó Oliag 1 46021 - Valencia, Spain , E-mail: miguel.penarrocha@ 123456uv.es

                Conflict of interest statement: The authors have declared that no conflict of interest exist.

                Article
                21074
                10.4317/medoral.21074
                4920466
                27031064
                a190f15b-8c8e-430c-a8da-6bd2aee8dd50
                Copyright: © 2016 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 January 2016
                : 28 September 2015
                Categories
                Review
                Oral Surgery

                Surgery
                Surgery

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