Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-06, 08:52:14 | version 1.38.0
| trends & applications Root canal therapy and coronectomy Drs Mirna Hobeika, Ali Hajj Hassan, Edgard Jabbour & Philippe Sleiman, Lebanon Introduction Coronectomy is a procedure that generally spares the vital coronal pulp and is performed to avoid the risk of damaging the inferior alveolar nerve (IAN) during the sur- gical procedure when extraction of mandibular third mo- lars is indicated or needed. Coronectomy is the removal of the crown of the mandibular third molar without ex- posing the pulp.1 The coronectomy procedure is per- formed only on the third molar crown, leaving the roots in the socket. This procedure is now known for its ben- efits and success rate, in contrast to the contemporary belief that the roots left behind will be a source of prob- lems.2 Risk factors for nerve injury include root proximity, the surgeon’s experience, surgical procedures, the pa- tient’s age and pre-existing disease. Several studies have shown that coronectomy significantly decreases the risk of iatrogenic injury to the IAN and lowers the complication rate.3 Coronectomy has been associated with a low inci- dence of complications in terms of IAN injury (0.0–9.5 %), lingual nerve injury (0.0–2.0 %) and pulp disease (0.9 %),4 in addition to other rare events, such as swelling, fever, alveolitis, pulpitis and root exposure.5 Coronectomy to prevent IAN damage was first pro- posed by Ecuyer and Debien in 1984,6 and it remained controversial owing to the possibility of infection and other pathologies arising from the roots left behind.2 Potential complications include deep dry sockets, local postopera- tive infections, postoperative pain, pulpitis, root canal ne- crosis and infection, and an increased risk of IAN infection, which is known as failed IANI.7 The point of discussion is whether it is necessary to perform root canal therapy simultaneously with coronec- tomy if the pulp is going to be exposed during the surgical procedure. A new method combining coronectomy with root canal therapy, when necessary, in order to decrease the risk of infection, pain and other complications is intro- duced in this paper. Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 1: Partially erupted third molar and inflammation of the gingiva distally. Fig. 2: Pre-op radiograph showing a hook-like curve of the mesial root, as well as the relationship between the pulp chamber position and the bone level. Fig. 3: CBCT scans showing the intimate relation between the mesial root and the IAN and confirming the bone level relative to the pulp chamber. Fig. 4: File in a mesial canal showing the abrupt curvature. Fig. 5: A complete root canal therapy was performed. Fig. 6: Bitewing radiograph taken during the surgical procedure, showing the level of the surrounding bone and the remaining part of the tooth. 16 roots 1 2018