BDS, MFDS, MBChB, MRCS, FRCS, Consultant Oral and Maxillofacial Surgeon, Gloucestershire Hospitals NHS Foundation Trust, Department of Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Coronectomy is most commonly associated with the management of impacted lower third molars where complete removal poses a high risk of inferior alveolar nerve damage. However, coronectomy may be indicated for the management of other teeth with a significant risk of morbidity. A case of a LL6 extended coronectomy is presented. The aim was to prevent inferior alveolar nerve damage, and ensure adequate crown and root removal to facilitate orthodontic alignment of the teeth. Surgery was aided by cone beam CT, and a piezo-surgical technique.
CPD/Clinical Relevance: This case demonstrates the novel application of a coronectomy to manage an infra-occluded lower left first molar, facilitating orthodontic treatment, where complete removal posed a high risk of inferior alveolar nerve damage.
Article
Standard coronectomy is the technique where the crown of a tooth is sectioned and removed just below the amelo-cemental junction, leaving a substantial portion of roots in situ and untouched. It is frequently indicated for the management of impacted lower third molars, which carry a high risk of inferior alveolar nerve injury (IANI).1 IANI can cause altered sensation, such as numbness or pain to the lower lip and chin.2 This can have a profound effect on an individual's ability to eat and speak, their social interactions and, as a consequence, their quality of life.3,4
Case selection for coronectomy is important and should be limited to vital teeth with a high risk of IANI, in patients who are not immunocompromised and have good healing potential. Mobilization of roots at the time of surgery indicates need for extraction of the whole tooth, and is important for patients to understand during the consent process. Renton et al reported a 38% failure rate of coronectomy.5 Appropriate follow up, and ability to manage any complications such as infection, root migration and need for further surgery, is also important.6
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