Coronectomy - surgical decoronation of impacted teeth

December 08, 2016

  

Wisdom teeth are not always wise. In fact, most people suffer from impacted wisdom teeth, which cause many dental issues. The main reason is that the human mouth can hold up to 28 teeth so when the wisdom teeth emerge, this creates a lot of pressure on the jaw. While some people have healthy and pain-free wisdom teeth, others experience situations where the wisdom teeth grow in the wrong position and damage the healthy ones by causing them to shift or retaining debris around the adjacent molars. Dentists are still debating over why this happens, but it seems that somewhere along our genetic evolution, the human jaw became smaller and, thus, is unable to accommodate 32 teeth.

A while ago, the only solution for resolving this issue was the extraction of the wisdom teeth. And even though people still have to go through oral surgery and have those teeth extracted, this is not the only option anymore, especially if you have postponed the surgery for so long that the roots of your wisdom teeth have grown around the nerve in the lower jaw.

What is coronectomy?

Wisdom teeth usually emerge between 17 and 21 years old. But what happens if you are 35, for example, haven’t had your wisdom teeth removed yet, and they are causing all sorts of dental problems? The longer it takes for a person to get their impacted wisdom teeth removed, the more they are at risk during the surgery. Because of their location, the roots of the wisdom teeth develop a close relation with the inferior alveolar nerve and tend to grow around it. As a result, the extraction procedure gets more complicated when those roots are fully grown, with the risk of damaging the alveolar nerve (the one that provides sensation to the lower gums, chin, teeth and lips).

Coronectomy, or odontectomy, is specially designed to prevent that risk and offer an alternative to wisdom teeth extraction. It involves only the removal of the crown, while the roots are left in place. A wisdom tooth’s crown is the one responsible for dental pathologies, such as pericoronitis, caries, food impaction and cysts. When that crown is removed, the cause of the problems is solved. Coronectomy is recommended when there are clear signs that a wisdom tooth extraction will put the alveolar nerve at risk.

What is operculectomy?

How is coronectomy performed?

The good news is that this procedure can be performed underlocal anesthesia or IV sedation. The bad news is that coronectomy is still a surgical procedure and it comes with the usual side-effects: soreness and pain afterwards, swelling, limited mouth opening or sore surrounding teeth. It is a sensitive procedure that requires dexterity and skill. Firstly, the tooth is exposed through a buccal mucoperiosteal flap. Then the bone is removed, and the crown is sectioned from the roots below the cementoenamel junction. Afterward, the root stump will be reduced, and the roots of the tooth will be assessed for mobility. After the wound is irrigated, debrided and closed, a radiography will be taken to determine if there is any residual enamel.

Contraindications & Risks

Although coronectomy is your best chance if the roots of the wisdom tooth have grown around the alveolar nerve, not everybody is a candidate for this procedure. Coronectomy can only be performed on patients who do not find themselves in one of these situations:

1. The inferior alveolar nerve is already damaged or numb
2. The tooth’s roots are not touching the inferior alveolar nerve
3. The wisdom tooth has an active root tip or an infected crown
4. Pre-existing mobility of the wisdom tooth
5. The wisdom tooth is horizontally impacted along the course of the inferior alveolar nerve
6. The patient has a condition that favours local infection (diabetes, AIDS, metabolic bone diseases, etc.)

The best way to find out if you’re are a good candidate for coronectomy is to schedule an appointment with your dentist and have them assess your case. Also, if it turns out that you can go through this procedure, you need to be aware of its specific risks. Between 3 and 9% of the people who go through this procedure wake up from surgery with their entire wisdom tooth extracted. This happens because, in rare cases, the dentist discovers upon the removal of the crown that the roots of the tooth are also mobile and they need to be extracted. In 2- 6% of the cases, the roots have to be removed after some time because they irritate the adjacent tooth or the overlying tissues. However, if this happens, the inferior alveolar nerve is not at risk anymore because the roots will have migrated from their original place. Coronectomy provides a safer alternative to wisdom tooth extraction (when the extraction puts the alveolar nerve at risk), but it is still a surgical procedure. You need to be aware of its risk before deciding to go through with it.

What is the difference between coronectomy and operculectomy?

Operculectomy is a surgical procedure of removing the soft tissue around the crown of a tooth. This is usually performed after the gum inflammation, called pericoronitis. Coronectomy, on the other hand, not only removes the soft tissues around the tooth but the coronal part of the tooth as well. The roots are left in situ, after a pulpectomy is performed (removing the pulp tissue from the root canals).

What is the difference between odontectomy, coronectomy and tooth decoronation?

All these terms mean the same thing - removing the crown of the tooth and leaving the roots in place.

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