Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study.

Purpose: Studies have suggested that coronectomy reduces the risk of inferior alveolar nerve injury (IANI) when a close relationship with the inferior alveolar canal is indicated on panoramic imaging. However, the relationship between the inferior alveolar canal and the root are unclear on panoramic imaging. Our aim was to compare coronectomy with traditional extraction for the treatment of mandibular third molars that had clear high IANI risks as evaluated by dental computed tomography. Patients and Methods: We designed a case-control study of subjects with high-risk signs of IANI on panoramic images evaluated by dental computed tomography before enrollment. The 220 patients enrolled were assigned to extraction (control group, n 118) or coronectomy (case group, n 102). Results: The mean follow-up time was 13 months in the extraction group and 13.5 months in the coronectomy group. Six IANIs (5%) were found in the extraction group. In the coronectomy group, 1 patient (1%) had symptoms of neurapraxia, which disappeared within 1 month. Four remaining roots had signs of postoperative infection, and the patients underwent extraction of the root. No nerve damage resulted in these patients after repeat extraction. Conclusions: Coronectomy might reduce the risk of nerve injury for patients at true high risk of IANI as evaluated by dental computed tomography. A long-term postoperative review is needed to assess the incidence of root migration and the root extraction and infection rates after coronectomy. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:1806-1814, 2009