Coronectomy

Decreasing the Probability of Nerve Damage

Background

As you can see from our information on wisdom teeth, some wisdom teeth (third molars) grow with the roots in intimate contact with the Inferior Alveolar Nerve. This nerve gives you feeling in the lip, chin, and teeth on one side of the lower jaw. Nerve injury can cause a change in sensation to these structures, including increased or decreased sensation, tingling, pain, or even complete numbness.

Recently, studies have been done the United States on an alternative to complete removal of the wisdom tooth--the coronectomy.

Coronectomy

The procedure known as “coronectomy” (corona=crown; -ectomy=to cut out) involves removing the “crown”, the top or biting portion of the tooth, while leaving the roots in place. The purpose is to decrease the possibility of damaging the nerve when the roots are removed.

What happens to the root?

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.

The literature and my personal experience has shown that in a significant percentage of cases, these roots begin to drift upward, away from the nerve, before being covered with bone. In my experience, this has been clinically insignificant.

What else could happen to the root?

It would be possible for the root to drift to the surface of the jaw. If this root irritated the tissue or the adjacent tooth, or otherwise became symptomatic, it would necessitate removal. Even though a second surgery would need to be performed, the possibility of nerve damage should be negligible, since the root would have migrated away from it's original resting place next to the nerve. Since the purpose of the coronectomy is to avoid this damage, this goal would have been accomplished, even though a second surgical procedure was necessary to remove the remaining portion of the tooth.

The root tip could also become infected in the post-operative phase and necessitate removal. Antibiotics are normally given pre-operatively or at the time of surgery, as well as post-operatively, to minimize this risk.

Click this link to see the abstract of the article on coronectomy.