Abstract
Coronectomy is an alternative surgical technique for the management of high-risk third
molars. It involves the removal of the crown of a tooth and the deliberate retention
of the roots, thereby avoiding injury to the inferior alveolar nerve (IAN). Previous
studies have suggested that it reduces the risk of nerve injury when compared with
surgical extraction. The purpose of this study was to systematically review the incidence
of complications following coronectomy such as IAN injury, pain, dry socket, infection,
root migration, and need for re-operation. A comparative cost analysis of coronectomy
and surgical extraction was done based on the results of the review. This provides
an insight into the economic implications of the two procedures. A search through
the MEDLINE database via Ovid, PubMed, Scopus, EMBASE via Ovid, and Web of Science,
was carried out to extract randomised and non-randomised controlled trials. Four studies
fulfilled the inclusion criteria. A meta-analysis was conducted to measure the overall
effect of each outcome. The pooled odds ratio (OR) for IAN injury was 0.16 (95% CI
0.01 to 0.39). Coronectomy reduced this risk by 84%. Dry socket may occur less frequently
following coronectomy whereas infection did not show a higher incidence with either
intervention. Root migration was found to occur in 13%–85% of cases and the average
incidence of re-operation was 2.2%. The ratio of the average costs was 1.12 favouring
coronectomy if cone-beam computed tomography (CBCT) was not done prior to the procedure.
If a scan was taken routinely for coronectomy, the cost ratio marginally favoured
extraction. Coronectomy reduced the risk of nerve injury in high-risk third molars.
Definitive conclusions, however, cannot be made for outcomes such as the need for
re-operation, which may alter the cost ratio of coronectomy:extraction, as higher
quality studies with longer follow-up are needed.
Keywords
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Article info
Publication history
Published online: August 13, 2020
Accepted:
July 13,
2020
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
