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| Coronectomy / Intentional Partial Odontectomy |
Coronectomy is the removal of the crown of a tooth,
leaving the roots in situ.
When applied to a lower wisdom tooth or any lower un-
erupted posterior tooth, it is a measure adopted to avoid
damage to the Inferior Alveolar Nerve (IAN) (the nerve that
supplies feeling/sensation to the lip and chin) when the X-ray
has suggested an intimate relationship between the roots of
the lower wisdom tooth and the IAN and the tooth still
needed to be removed.
The expectation after removing the top of the tooth is that
the root will remain in place and eventually cover with bone.
Roots encased in bone can remain buried in the jaw for
years and rarely cause problems.
Coronectomy of lower molars is NOT carried out in the
following situations:
leaving the roots in situ.
When applied to a lower wisdom tooth or any lower un-
erupted posterior tooth, it is a measure adopted to avoid
damage to the Inferior Alveolar Nerve (IAN) (the nerve that
supplies feeling/sensation to the lip and chin) when the X-ray
has suggested an intimate relationship between the roots of
the lower wisdom tooth and the IAN and the tooth still
needed to be removed.
The expectation after removing the top of the tooth is that
the root will remain in place and eventually cover with bone.
Roots encased in bone can remain buried in the jaw for
years and rarely cause problems.
Coronectomy of lower molars is NOT carried out in the
following situations:
- Wisdom tooth roots are not touching the IAN canal
- Wisdom tooth with either active root tip or crown
infection - Pre-existing numbness of the IAN
- Pre-existing mobility of the tooth as any retained roots
may act as a mobile foreign body and become a nidus
for infection / migration. - Teeth that are horizontally impacted along the course of
the IAN as sectioning the tooth crown could endanger
the IAN. - Systemic condition predisposing to local infection such
as diabetes, AIDS and concurrent chemotherapy. - Local factors predisposing to infection such as
metabolic bone diseases (e.g. fibrous dysplasia),
history of radiotherapy to the lower jaw
You are to have a tooth decoronated. You can expect the
following:
Coronectomy / Intentional Partial Odontectomy
Specific Warnings:
Antibiotics (pre- & post-op). These are recommended to
lower the chance of infection either in the socket or the
tooth pulp. These will be given at the clinicians’ discretion.
Primary Closure. The retained roots are covered over by
the gum to facilitate healing of the pulp, socket and to
Root Canal Treatment of Retained Roots Not Necessary.
Osteocementum Growth. The root margins are trimmed
several millimetres below the crest of the socket to
encourage bone & osteo-cementum formation over the
retained roots, sealing off the roots from the mouth.
Roots inadvertently removed at the time of attempted
coronectomy. When it came to removing the crown, it was
found that the roots as well were mobile. This ranges from
3 - 9%. If the roots are mobile, we are obliged to remove
them and there is obviously the risk to the IDN (which this
procedure was trying to avoid).
Numbness of Chin, Lip ± Tongue. The Inferior Alveolar &
Lingual Nerves may still be damaged during the procedure
resulting in numbness affecting the tongue +/- the chin and
lower lip. The numbness of the tongue seems to be quite
short-lived and has a low incidence. The numbness of the
chin +/- lip tended to occur when on attempting the
coronectomy, the roots were found to be mobile and had
to be removed.
Root Migration. Subsequent migration of the roots away
from the IAN occurred in 14 - 81% of cases.
Later Removal of Roots. This can happen in up to a 2 -
6% of cases. If the roots irritate overlying tissues or the
adjacent tooth or otherwise become symptomatic, they
may need to be removed. Even though a 2nd surgery
would be needed, the possibility of nerve damage should
be negligible since the roots would have migrated away
from its original resting place next to the IAN. Since the
purpose of the coronectomy is to avoid this damage, this
goal would have been accomplished even though a 2nd
surgical procedure was necessary to remove the remaining
root.
General Surgical Warnings:
Pain. As it is a surgical procedure, there will be soreness
after the tooth removal. This can last for several days.
Painkillers such as ibuprofen, paracetamol, Solpadeine or
Nurofen Plus are very effective. Obviously, the painkiller
you use is dependent on your medical history & the ease of
the operation.
Swelling. There will be swelling afterwards. This can last
up to a week. Use of an icepack or a bag of frozen peas
pressed against the cheek adjacent to the tooth removed
will help to decrease the swelling. Avoidance in the first
few hours post-op, of alcohol, exercise or hot foods/drinks
will decrease the degree of swelling that will develop.
Bruising & Bleeding into Cheeks. Some people are prone
to bruise. Older people, people on aspirin or steroids will
also bruise that much more easily. The bruising can look
quite florid; this will eventually resolve but can take several
weeks (in the worst cases).
Swelling that does not resolve within a few days may be
due to bleeding into the cheek. The cheek swelling will feel
quite firm. Coupled with this, there may be limitation to
mouth opening and bruising. Both the swelling, bruising
and mouth opening will resolve with time.
Stitches. The coronectomy site will often be closed with
stitches. These dissolve and will ‘fall out’ within 10 – 14
days.
Mouth Opening. Often the chewing muscles and the jaw
joints are sore after the procedure so that mouth opening
can be limited for the next few days. If you are unlucky
enough to develop an infection afterwards in the socket,
this can make the limited mouth opening worse and last for
longer (up to a week or so).
Post-op Infection. You may develop an infection in the
socket after the operation. This tends to occur 2 – 4 days
later and is characterised by a deep-seated throbbing pain,
bad breath and an unpleasant taste in the mouth. This
infection is more likely to occur if you are a smoker, are on
the contraceptive pill, on drugs such as steroids and if bone
has to be removed to facilitate tooth extraction.
If antibiotics are given, they are likely to react with alcohol
and/or the Contraceptive Pill (that is, the ‘Pill’ will not be
providing protection).
Surrounding Teeth. The surrounding teeth may be sore
after the extraction; they may even be slightly wobbly but
the teeth should settle down with time. It is possible that
the fillings or crowns of the surrounding teeth may come
out, fracture or become loose. If this is the case, you will
need to go back to your dentist to have these sorted out.
Every effort will be made to make sure this doesn’t
happen. In very rare instances, the surrounding teeth may
actually come out as well as the intended tooth.
Failure of Anaesthesia. In rare cases, the tooth can be
difficult to ‘numb up’. This can be due to a number of
reasons. The more common ones include inflammation ±
infection associated with the tooth, anatomical differences
& apprehension. If the tooth fails to ‘numb up’ then its
removal will be rescheduled with antibiotic cover or
perhaps done under sedation or even a GA.
following:
Coronectomy / Intentional Partial Odontectomy
Specific Warnings:
Antibiotics (pre- & post-op). These are recommended to
lower the chance of infection either in the socket or the
tooth pulp. These will be given at the clinicians’ discretion.
Primary Closure. The retained roots are covered over by
the gum to facilitate healing of the pulp, socket and to
Root Canal Treatment of Retained Roots Not Necessary.
Osteocementum Growth. The root margins are trimmed
several millimetres below the crest of the socket to
encourage bone & osteo-cementum formation over the
retained roots, sealing off the roots from the mouth.
Roots inadvertently removed at the time of attempted
coronectomy. When it came to removing the crown, it was
found that the roots as well were mobile. This ranges from
3 - 9%. If the roots are mobile, we are obliged to remove
them and there is obviously the risk to the IDN (which this
procedure was trying to avoid).
Numbness of Chin, Lip ± Tongue. The Inferior Alveolar &
Lingual Nerves may still be damaged during the procedure
resulting in numbness affecting the tongue +/- the chin and
lower lip. The numbness of the tongue seems to be quite
short-lived and has a low incidence. The numbness of the
chin +/- lip tended to occur when on attempting the
coronectomy, the roots were found to be mobile and had
to be removed.
Root Migration. Subsequent migration of the roots away
from the IAN occurred in 14 - 81% of cases.
Later Removal of Roots. This can happen in up to a 2 -
6% of cases. If the roots irritate overlying tissues or the
adjacent tooth or otherwise become symptomatic, they
may need to be removed. Even though a 2nd surgery
would be needed, the possibility of nerve damage should
be negligible since the roots would have migrated away
from its original resting place next to the IAN. Since the
purpose of the coronectomy is to avoid this damage, this
goal would have been accomplished even though a 2nd
surgical procedure was necessary to remove the remaining
root.
General Surgical Warnings:
Pain. As it is a surgical procedure, there will be soreness
after the tooth removal. This can last for several days.
Painkillers such as ibuprofen, paracetamol, Solpadeine or
Nurofen Plus are very effective. Obviously, the painkiller
you use is dependent on your medical history & the ease of
the operation.
Swelling. There will be swelling afterwards. This can last
up to a week. Use of an icepack or a bag of frozen peas
pressed against the cheek adjacent to the tooth removed
will help to decrease the swelling. Avoidance in the first
few hours post-op, of alcohol, exercise or hot foods/drinks
will decrease the degree of swelling that will develop.
Bruising & Bleeding into Cheeks. Some people are prone
to bruise. Older people, people on aspirin or steroids will
also bruise that much more easily. The bruising can look
quite florid; this will eventually resolve but can take several
weeks (in the worst cases).
Swelling that does not resolve within a few days may be
due to bleeding into the cheek. The cheek swelling will feel
quite firm. Coupled with this, there may be limitation to
mouth opening and bruising. Both the swelling, bruising
and mouth opening will resolve with time.
Stitches. The coronectomy site will often be closed with
stitches. These dissolve and will ‘fall out’ within 10 – 14
days.
Mouth Opening. Often the chewing muscles and the jaw
joints are sore after the procedure so that mouth opening
can be limited for the next few days. If you are unlucky
enough to develop an infection afterwards in the socket,
this can make the limited mouth opening worse and last for
longer (up to a week or so).
Post-op Infection. You may develop an infection in the
socket after the operation. This tends to occur 2 – 4 days
later and is characterised by a deep-seated throbbing pain,
bad breath and an unpleasant taste in the mouth. This
infection is more likely to occur if you are a smoker, are on
the contraceptive pill, on drugs such as steroids and if bone
has to be removed to facilitate tooth extraction.
If antibiotics are given, they are likely to react with alcohol
and/or the Contraceptive Pill (that is, the ‘Pill’ will not be
providing protection).
Surrounding Teeth. The surrounding teeth may be sore
after the extraction; they may even be slightly wobbly but
the teeth should settle down with time. It is possible that
the fillings or crowns of the surrounding teeth may come
out, fracture or become loose. If this is the case, you will
need to go back to your dentist to have these sorted out.
Every effort will be made to make sure this doesn’t
happen. In very rare instances, the surrounding teeth may
actually come out as well as the intended tooth.
Failure of Anaesthesia. In rare cases, the tooth can be
difficult to ‘numb up’. This can be due to a number of
reasons. The more common ones include inflammation ±
infection associated with the tooth, anatomical differences
& apprehension. If the tooth fails to ‘numb up’ then its
removal will be rescheduled with antibiotic cover or
perhaps done under sedation or even a GA.
Useful Articles:
Coronectomy (intentional partial odontectomy of lower third
molars).
Coronectomy: A Technique to Protect the Inferior Alveolar
Nerve.
Coronectomy - An Alternative Therapy for the symptomatic
impacted 3rd molar - Report of 9 cases
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