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Medical Forum / General / Dentistry / December 2004

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Wisdom Tooth Coronectomy

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PeterOut - 04 Dec 2004 15:19 GMT
I am considering partial odontectomy (coronectomy) for my daughter
since she needs her wisdom teeth removed but the root tips are
sufficiently close to some nerve that there is a risk that her lip may
be permanently anaesthetized with full odontectomy.  I would be
grateful for any comments on the risks of this procedure.  I
understand that the remaining roots may migrate and may need to be
removed in the future but I am of the understanding that they would
move away from the nerve thus reducing the danger of permanent
anaesthesia of the lower lip.  I have been told that coronectomy also
carries a risk of permanent anaesthesia but that the risk is lower
than for full odontectomy.

Many thanks in advance,
Peter.
Joel M. Eichen - 04 Dec 2004 16:24 GMT
>I am considering partial odontectomy (coronectomy) for my daughter
>since she needs her wisdom teeth removed but the root tips are
[quoted text clipped - 7 lines]
>carries a risk of permanent anaesthesia but that the risk is lower
>than for full odontectomy.

Do you mean treatment for pericoronits?

One cannot do odontectomy without removing the nerve as well.

Joel

PS- The term, "partial odontectomy" is an oxymoron.

>Many thanks in advance,
>Peter.
StovePipe - 04 Dec 2004 17:58 GMT
> I am considering partial odontectomy (coronectomy) for my daughter
> since she needs her wisdom teeth removed but the root tips are
> sufficiently close to some nerve that there is a risk that her lip may
> be permanently anaesthetized with full odontectomy.  I would be
> grateful for any comments on the risks of this procedure.

Dr. Pham is an Oral and Maxillofacial Surgeon teaching and practicing at
the University of Montreal. I don't remember his first name, but I'll
try to find out. If you Google on "Pham" + "Wisdom Tooth Removal" you
may hit some articles he's done on this subject. He taught us this
procedure in a Continuing Ed course a while back, and judging from the
number of questions he fielded on it, it is not well known.

> I
> understand that the remaining roots may migrate and may need to be
> removed in the future but I am of the understanding that they would
> move away from the nerve thus reducing the danger of permanent
> anaesthesia of the lower lip.

That is what is hoped (best-case scenario), yes. The idea is to totally
remove the crown right down to the roots and then close. I don't
remember if he puts any sedative dressing on the exposed nerve tissue in
the root fragments, but I don't think so. Obviously, there are also
risks of infection and abscess/granuloma/cyst formation when one leaves
root fragments in the sockets. However, if your OMFS has done a few of
these and has had success, I'd give it serious consideration.

> I have been told that coronectomy also
> carries a risk of permanent anaesthesia but that the risk is lower
> than for full odontectomy.
>
> Many thanks in advance,
> Peter.

If we're lucky, one or both of the OMFS's that haunt this castle will
give you the benefit of their experiences.
Cheers
SP

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orthodmd - 05 Dec 2004 21:25 GMT
> I am considering partial odontectomy (coronectomy) for my daughter
> since she needs her wisdom teeth removed but the root tips are
[quoted text clipped - 10 lines]
> Many thanks in advance,
> Peter.

Peter you sound well informed and you might be familier with the
literature on this subject but it sounds like a viable technique in
the right situation.  Here is a short comment from a recent article.
More can be found at Medline.

Coronectomy (intentional partial odontectomy of lower third molars). 

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and
Endodontology, Volume  98, Issue  3, Pages  274-280

B.  O"Riordan
Conclusions Coronectomy is a worthwhile option to extraction where a
lower third molar is judged to be in close proximity to the inferior
alveolar nerve. In lower third molar removal the potential damage is
high when certain radiographic signs are present, whereas the
infection rate of roots remaining after coronectomy is, by contrast,
low.

charles j ruff, dmd
specialist in orthodontics
board certified in orthodontics
Dave King - 06 Dec 2004 16:08 GMT
>> I am considering partial odontectomy (coronectomy) for my daughter
>> since she needs her wisdom teeth removed but the root tips are
[quoted text clipped - 32 lines]
>specialist in orthodontics
>board certified in orthodontics

This is a viable treatment option but not one that I have ever
performed. I would recommend to the patient undergoing coronectomy to
make sure those areas are included in all their routine films during
check-ups. Usually small roots left behind are not a problem but I
have had to remove large root segments on many occasions. Hence the
reason why I remove the entire tooth with still a very low incidence
of paresthesia.

~~~~~~~~~~~~~~~~~~~~~
David A. King, D.M.D.
Diplomate, American Board of OMS
Fellow, American Association of OMS
HTTP://WWW.DEOMFS.COM
 
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