Coronectomy

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This topic contains 6 replies, has 4 voices, and was last updated by  Dr. Jay Reznick Thu Apr 13, 2017 09:49 am.

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    Topic
  • #2788

    Gary Davies
    Member

    Dear Dr R,

    what are your thoughts on coronectomy for 3rd molars in intimate association with the IAD nerve?
    Kind Regards
    Gary (New Zealand)

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  • #2817

    Dr. Jay Reznick
    Keymaster

    Gary-
    I am not a big fan of coronectomy. I have had to manage a number of severe infections of roots that were left after a coronectomy. With the availability of CBCT, we can very accurately evaluate the position of the IAN and its relationship to the 3rd molar roots. Using this tool, I have been able to successfully remove many 3rd molars that were recommended for coronectomy by other surgeons.
    Knowing the exact anatomy is the key to a successful outcome.

    #2850

    Rob Mikhli
    Participant

    Is your approach different when a root tip is in contact with the IAN?
    If so, how?

    #2851

    Dr. Jay Reznick
    Keymaster

    Rob- my feeling is that with the use of CBCT to evaluate the patient’s anatomy, we know exactly where the IAN is in relationship to the root apices, and so we can plan our surgery to avoid trauma to the nerve.

    #2853

    Rob Mikhli
    Participant

    Thank you for the reply.
    How would you approach a case like the one attached? Anything different?

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    #2867

    Douglas Smail
    Moderator

    I agree with Jay’s comments on knowing where the nerve is with CBCT, and avoiding coronectomy when possible.
    One big exception for me is the ankylosed root. I’ll tell the patient that a coronectomy is possible, and we begin surgery.
    I’ll section and remove the crown, and evaluate the roots. If the roots are completely ankylosed, which is uncommon but happens, then there is no way I’m going to get those roots out without significant trauma to the area. I’ll complete the coronectomy, graft the defect, and close up. If the roots are ankylosed, I have had no healing issues post op, since the roots are essentially already turning into bone.

    #2868

    Dr. Jay Reznick
    Keymaster

    Thanks for your comments Doug. So far, I have not had a case where the roots were so ankylosed that I elected to leave them (at least for an impacted 3rd molar). Grafting and closing the site should certainly help healing and minimize the risk of the roots becoming infected.
    CBCT is a great tool to preoperatively assess whether the roots are fused to the alveolar bone. The other is clinical suspicion and experience.

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