Coronectomy Root Retrievals: A review of 92 cases

Abstract Background Coronectomy has become an increasingly prescribed surgical treatment for mandibular third molars deemed to pose a risk to the inferior dental nerve. The retention of the roots can have subsequent potential for root retrieval in the future if symptoms are reported. The long term outcome and symptoms leading to coronectomy root retrieval have not been well documented or studied which has understandably led to hesitation by some clinicians offering the procedure. The current series assesses the patients who have undergone root retrieval and their reported indication for removal as well as the histopathological status of the removed roots. Method A total of 92 coronectomy root retrievals were carried out at Guy's Dental Hospital and included in this analysis. Data was collected retrospectively from patient records regarding; patient symptoms, clinical and radiographic findings, function of the inferior dental nerve (IDN) and histological results. Results The mean age of patients in the study group was 31.6 years (range 19-70), with a female to male ratio of 62:18 (77.5% female). The mean time to the second surgery for root retrieval was 17.0 months. In ‘successfully’ performed coronectomies, 75.3% (n=61/81) of root pulps histopathologically appeared vital. Mucosal tenderness (39/81, 48.1%) was the most common symptom leading to root retrieval. Conclusion Root retrieval following coronectomy should be based on sound clinical and radiographic examination. Where obvious indications are present such as an unhealed socket due to retained enamel or soft tissue infection following eruption of the roots, then retrieval should be performed with confidence in resolution. However, if the coronectomy root appears an unlikely culprit, then the clinician should consider and investigate alternative diagnoses such as over erupted upper third molars causing trauma, temporomandibular dysfunction and the dental status of the adjacent tooth as potential causes of symptoms.