Wisdom Teeth and Coronectomy

A coronectomy involves removing only the crown while leaving the roots intact, reducing the risk of IAN damage. Studies indicate that root migration towards the mandible's superior border occurs in 14% to 81% of cases. This middle-aged patient was referred for symptomatic impacted tooth #17, where ankylosed roots are common. Given the proximity of the roots to the IAN, we discussed the option of a coronectomy to reduce nerve damage. Although the initial plan was full extraction, the ankylosed roots led to a coronectomy. Intraoperative photos showed clean root tips with no pathology, and post-op radiographs confirmed that the coronectomy minimized IAN injury risk. A follow-up the next day confirmed no neurosensory damage. Here's a statement from a white paper published by the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2014: "When imaging suggests an intimate relationship between the roots of the lower third molar and the IAN, and the tooth still needs to be removed, consideration should be given to coronectomy with retention of the portion of the roots associated with the IAN. Since there are only five papers in the literature describing more than single cases, there is no standard of care regarding this technique. Until more information is available, this technique should be considered as an alternative only."