Coronectomy as an alternative to extraction for mandibular third molars with high risk of paresthesia: a case report

Coronectomy, a surgical alternative to dental extraction, involves the removal of the crown and retention of the intraosseous roots at least 3 mm below the alveolar crest. This report presents the clinical case of a 55-year-old woman who sought care due to pain and food accumulation in the region of the mandibular left third molar. Clinical evaluation and imaging tests revealed that the impacted tooth was close to the mandibular canal, and coronectomy was selected to avoid possible injury to the inferior alveolar nerve and consequent short- or long-term paresthesia. After administration of anesthesia and elevation of a full-thickness envelope flap, osteotomy was performed, and the crown was sectioned from the root buccolingually at the cementoenamel junction in such a way as to preserve the alveolar bone crest. The crown was carefully removed using elevators, and then the remaining root and surrounding bone were recontoured to maintain the root at least 3 mm below the margin of the alveolar crest without causing injury to the inferior alveolar nerve. Clinical and radiographic evaluations 2 years after the procedure revealed excellent tissue healing and good bone repair without root migration. The favorable outcome in this patient supports coronectomy as a viable and conservative treatment alternative in specific cases selected based on clear indications and careful planning, supported by adequate diagnostic imaging. It is important to schedule periodic follow-up evaluations to observe the behavior of the remaining roots.