When is a coronectomy recommended for a wisdom tooth?

Doctor's Answers 1

A coronectomy (removal of only the crown of the tooth, leaving the roots behind) is a useful form of treatment for impacted wisdom teeth that have roots in close proximity to the inferior dental nerve (IDN). The proximity of this nerve that runs inside a bony canal (the inferior dental canal) to the roots of the wisdom tooth can be assessed on a dental x-ray.

When the roots of the wisdom tooth are in close proximity to the IDN, there is a risk of nerve damage (bruising and compression) occurring during the extraction. If this occurs, the patient may experience numbness (pins and needles, or loss of sensation) in the affected area (lower lip and chin on the same side as the wisdom tooth). Most of the time, temporary numbness (lasting less than a month) will improve without further treatment. Numbness that does not improve within a month will most likely end up being permanent.

If the nerve was severed (cut) during the extraction, which is very rare but possible when dealing with a very deeply impacted wisdom tooth, then the numbness will be permanent. Microneurosurgery may be able to restore nerve function but not in all cases.

Patients who have numbness in this area of the face may face speech and eating difficulties because of the lack of sensation/feeling in this area. The IDN is NOT a motor nerve that controls the movement of the muscles so the loss of IDN function does not result in muscle paralysis. However, this can still be very distressing to experience.

If a patient has a profession that depends heavily on speaking (lawyer, motivational speaker, actor, newscaster etc), then a coronectomy may be a better choice instead of a conventional surgical extraction.

Some potential complications from a coronectomy include:

  1. Pain from exposed pulp tissue in the residual wisdom tooth roots
  2. Infection of the remaining roots
  3. The remaining roots may come to the surface at a later date (these can be much more easily and less traumatically removed at this stage)

If a coronectomy is unsuccessful, then a conventional surgical extraction will be needed.

Similar Questions

For someone considering wisdom tooth extraction, braces and gum contouring, in what order should I get the treatments?

In preparation for orthodontics, some orthodontists may advise the removal of impacted wisdom teeth to reduce the risk of relapse. However, this is not always necessary and the decision has to be made by the orthodontist in consultation with the patient. Gum contouring is a separate issue to orthodontics and there are many ways that this can be done. Do note that the gums can relapse after contouring if nothing is placed to maintain the gum margins.

Photo of Dr Kevin Ong

Answered By

Dr Kevin Ong

Dentist

What treatments are available for a soft tissue impacted wisdom tooth?

One option would be to get the soft tissue cut out. However, I would recommend removing the wisdom tooth alongside at the same time as cutting the soft tissue out. This is because cutting just the soft tissue may cause a repeated problem. Soft tissues can regrow back over time. The soft tissue will try to revert to how it was before it was cut.

Photo of Dr Jacqueline Feng

Answered By

Dr Jacqueline Feng

Dentist

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