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Coronectomy vs. total removal for third molar extraction: a systematic review.
1State Key Laboratory of Oral Diseases, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
Journal of Dental Research
|May 25, 2012
Summary
Coronectomy is superior to total third molar removal for reducing inferior alveolar nerve damage. This procedure can be safely used in clinical practice for high-risk extractions.
Area of Science:
- Oral and Maxillofacial Surgery
- Dental Evidence-Based Practice
Background:
- Third molar extraction is common, but carries risks, especially nerve injury.
- Coronectomy (leaving the root) is an alternative to total removal for high-risk cases.
Purpose of the Study:
- To systematically compare outcomes of coronectomy versus total removal for third molars at high risk of nerve injury.
- To guide clinical decision-making in third molar extraction procedures.
Main Methods:
- Systematic review of randomized and non-randomized controlled trials.
- Searched PubMed, Embase, Web of Science, CENTRAL, and SIGLE (1990-2011).
- Pooled risk ratios for nerve injury, infection, dry socket, and pain.
Main Results:
- Coronectomy significantly reduced inferior alveolar nerve injury (RR 0.11).
- No significant differences in post-operative infection, dry socket, or pain.
- Root migration was common but short and away from nerves; re-operation and root exposure rates were low.
Conclusions:
- Coronectomy is a viable alternative to total removal for reducing nerve damage in high-risk third molar extractions.
- Careful patient selection is important, considering factors like root morphology and impaction type.