Coronectomy: A Surgical Option for

Impacted Third Molars in Close

Proximity to the Inferior Alveolar
Nerve—A 5-Year Follow-Up Study
Giuseppe Monaco, DDS,* Mattia D’Ambrosio, DDS, MSc,y Giselle De Santis, DDS, MSc,z
Elisabetta Vignudelli, DDS, MSc, PhD,x Maria Rosaria Antonella Gatto, MD, PhD,k and
Giuseppe Corinaldesi, MD, DDS{
Purpose: The extraction of third molars is the most common surgical procedure performed in the oral
cavity. Coronectomy is a surgical protocol to reduce the risk of neurologic lesions to the inferior alveolar
nerve (IAN). We evaluated early (up to 1 month) and late (from 2 to 60 months) postoperative complications.
Materials and Methods: This prospective cohort study enrolled patients treated at the Unit of Oral and
Maxillofacial Surgery, University of Bologna. The predictor variable was the time after coronectomy with
up to 5 years’ follow-up. To assess the rate of postoperative complications, the outcome variables were
neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success
rate, need for a second surgical procedure, probing pocket depth, and bleeding on probing also were
investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards
modeling were performed to evaluate the variables.
Results: We performed 116 coronectomies in 94 healthy patients (37 men and 57 women; mean age,
28.99  8.9 years). At 5 years’ follow-up, we re-evaluated 63 patients with 76 coronectomies. In total,
30 complications were verified. No cases of neurologic lesions to the IAN or lingual nerve were observed
after surgery. In the first 3 years, the surgeons extracted migrated roots in 5 cases (6%) without any neuro-
logic lesions to the IAN. No complications were observed from the third to fifth year.
Conclusions: This prospective study on coronectomy of third molars in a close relationship with the
mandibular canal found no cases of neurologic lesions, no cases of late infection of the retained roots at
5 years, and a low rate of immediate postoperative complications. Further investigations should include
a follow-up study at 10 years and more research about the mechanism of pulp healing.
Ó 2018 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 77:1116-1124, 2019

The extraction of third molars is the most common that consists of the removal of the dental crown
surgical procedure performed in the oral cavity, and only. It has been proposed as an alternative to
the incidence of neurologic lesions in cases of mandib- complete extraction when the third molar roots are
ular third molar removal is an important postoperative close to the mandibular canal and the risk of
complication.1,2 Coronectomy is a surgical protocol postoperative neurologic damage is high.3-15 This

Received from Department of Biomedical and Neuromotor Science, Address correspondence and reprint requests to Dr D’Ambrosio:
University of Bologna, Bologna, Italy. Unit of Oral and Maxillofacial Surgery, Department of Biomedical
*Visiting Professor, Unit of Oral and Maxillofacial Surgery. and Neuromotor Science, University of Bologna, Via San Vitale 59
yClinical Fellow, Unit of Oral and Maxillofacial Surgery. 40125, Bologna, Italy; e-mail: [email protected]
zLecturer, Unit of Oral and Maxillofacial Surgery. Received October 9 2018
xClinical Fellow, Unit of Oral and Maxillofacial Surgery. Accepted December 15 2018
kResearcher, Unit of Periodontology. Ó 2018 American Association of Oral and Maxillofacial Surgeons
{Assistant Professor, Unit of Oral and Maxillofacial Surgery. 0278-2391/18/31387-9
Conflict of Interest Disclosures: None of the authors have any https://doi.org/10.1016/j.joms.2018.12.017
relevant financial relationship(s) with a commercial interest.

1116
MONACO ET AL 1117

technique was tested in several randomized studies, The inclusion criteria for the original study were
and a systematic review concluded that as follows: age between 18 and 70 years; American
coronectomy could be used for the treatment of Society of Anesthesiologists (ASA) 1 status accord-
third molars at high neurologic risk. This review ing to the ASA physical classification system18; pres-
suggested the need to improve surgical procedures ence of at least 1 third mandibular molar that
to reduce the possibility of coronectomy failure and needed extraction because of previous episodes of
underscored the need for long-term studies to better pericoronitis or periodontal disease distal to the
evaluate the incidence of late infection.14,16 second molar; presence on a panoramic radiograph
To minimize immediate postoperative complica- of at least 1 radiographic marker that was consid-
tions, an accurate protocol for describing the surgical ered highly predictive of close contact between
technique in a step-by-step manner has been pub- the IAN and third molar roots19 (eg, increased
lished recently.8,17 However, many clinicians are radiolucency, narrowing or diversion, and interrup-
waiting for long-term studies about the fate of the re- tion of the radiopaque border); and direct contact
tained roots before proposing this technique to between the roots and the mandibular canal, due
their patients. to the absence of cortical bone, as evaluated by
We previously published a prospective cohort study cone beam computed tomography (CBCT).
evaluating early or late complications and root migra- Unhealthy patients and patients with teeth with
tion after coronectomy followed for 3 years.9 In the deep cavities or endodontic disease were excluded
current study, we performed follow-up of the same from the study. This follow-up study included all of
patients for up to 5 postoperative years. the patients from the original study who completed
The purpose of this study was to evaluate whether 5 years of follow-up.
coronectomy is safe and reduces the risk of neurologic
lesions of the mandibular third molars in close prox-
imity to the inferior alveolar nerve (IAN). The specific STUDY VARIABLES
aims were to record and evaluate the incidence of late Predictor Variable
postoperative complications (from 36 to 60 months). The predictor variable was time: 1 month, 3 years,
Differences between 36 months and 60 months also and 5 years after coronectomy of the mandibular third
were analyzed. molar.

Outcome Variables
Materials and Methods Patients having at least 1 of the clinical situations
outlined herein were defined as having complications.
STUDY DESIGN The absence of any complication was considered a
A prospective cohort study was carried out on a success. Complications that occurred up to 1 month
study population consisting of all consecutive healthy after surgery were classified as immediate complica-
patients referred to the Unit of Oral and Maxillofacial tions; complications that occurred from 1 to
Surgery, Department of Biomedical and Neuromotor 60 months were classified as late complications.
Science, University of Bologna, between December
2009 and June 2013, for the extraction of mandibular  Neurologic damage was evaluated at suture
third molars. The patients underwent coronectomy in removal as the presence of hypoesthesia, hyperes-
the same department from 2009 to 2011. Data ob- thesia, or dysesthesia in the lower lip and mental
tained at 36 months’ follow-up were published in the region on the operated side. The presence of
Journal of Oral and Maxillofacial Surgery in 20159; any alteration of lingual sensitivity also was evalu-
the results of the present study prolong the follow- ated.
up to 5 years.  Postoperative pain was evaluated on a 10-cm hor-
The study was explained to the patients, who pro- izontal visual analog scale, with the degree of pain
vided written informed consent before undergoing intensity ranging from ‘‘no pain’’ to ‘‘unbearable
any study-related procedure. The medical protocols pain.’’ Using this form, each patient reported
of this study followed the Declaration of Helsinki, pain intensity immediately after surgery; 6 hours
and this research was approved by the Ethics Commit- after surgery; and during the following 6 days, in
tee Azienda Unita Sanitaria Locale Citta di Bologna, the morning (7 to 9 AM) and evening (8 to 9 PM).
Italy (Comitato Etico 12098). The study was carried Coronectomy was considered painful when pa-
out in accordance with the current standards recom- tients recorded a score of at least 4 cm on the
mended for the reporting of observational studies in 10-cm horizontal scale. Postoperative pain was
epidemiology (STrengthening the Reporting of Observa- considered a complication if patients reported a
tional studies in Epidemiology [STROBE] statement). score of at least 4 cm on the 10-cm scale for at least
1118 CORONECTOMY FOR IMPACTED THIRD MOLARS

3 days during the first postoperative week.8,9,20  Bleeding on probing (BoP) was measured with a
Patients also reported their use of anti- millimeter probe distal to the second molar.
inflammatory agents on a daily basis using a ques-
tionnaire. SURGICAL PROCEDURES
 Postoperative swelling was evaluated by patients
Preoperative Care
on a daily basis, starting the day after surgery, us-
Before surgery, all patients underwent professional
ing a scale from 0 to 3.8,9,20 Swelling was
tooth cleaning to remove calculus and plaque deposits
considered a complication if present for at least
if present. Immediately before surgery, all patients
2 days during the first postoperative week.
rinsed for 1 minute with a 0.2% chlorhexidine
 Fever was considered a temperature greater that
mouth rinse.
37.5 C measured by the patient and was reported
on a daily basis. Fever was considered a complica-
Intraoperative Care
tion if present for at least 2 days in the week after
All surgical procedures were performed with pa-
coronectomy.8,9,20
tients under local anesthesia by a team of oral-
 Alveolitis was considered the presence of puru-
maxillofacial surgeons who followed the operative in-
lent exudates, local edema, and pain at suture
dications described in a protocol published in
removal or during the following weeks.20
2015.8,17 A triangular intrasulcular mucoperiosteal
 Root exposure was defined as the eruption of re-
flap with a lateral releasing incision was executed to
tained roots in the oral cavity.
facilitate primary closure of the alveolus. Bone
 Pulpitis was considered pulsing severe pain
removal was performed, when necessary, with a
without any periodontal or postoperative local
water-cooled burr in a high- or low-speed surgical drill
infection or without root exposure.
to expose part of the tooth with the intention of not
exposing the cementoenamel junction to minimize
Other Variables the risk of root mobilization during crown removal.
The other variables examined were as follows: In cases of vertically impacted teeth, the tooth sec-
tion was made with a fissure burr in the mesiodistal
 Gender (male or female) was recorded. direction. The fissure burr was used at an angle of
 Smoking habit was recorded as the number of cig- about 45 to obtain the lingual cut surface 2 to
arettes smoked daily. 3 mm below the bony margin. To minimize the risk
 The reason for treatment, that is, coronectomy, of root mobilization during crown removal, a second
was noted (pericoronitis or periodontal disease). section, perpendicular to the first cut, was made by
 Failed coronectomy was considered any intrao- the surgeon. These 2 sections permitted a gentle
perative root mobilization. crown fracture in 2 small fragments removed with tis-
 Root migration was considered any postsurgical sue forceps.
radiographic movement of retained roots at 3, 6, In cases of third molars in horizontal inclusion, the
12, 24, 36, 48, and 60 months. A periapical radio- crown section was made in the buccolingual direc-
graph with a parallel technique was obtained tion, and this fragment was then sectioned in 2
immediately after coronectomy and at 3, 6, 12, pieces by a second cut made in the distomesial
24, 36, 48, and 60 months. To evaluate root migra- direction. In addition, in such cases, we gently
tion, only radiographs on which the mesiodistal removed, with a tissue forceps, the lingual and vestib-
width of the second molars was identical on all ular fragments.
subsequent radiographs were used. After crown removal, we ground the root with a
 The reoperation rate, that is, the need for a second round burr using a high-speed surgical drill. This
surgical procedure, was noted. The reason for the step is crucial to obtain a regular root surface without
second surgical procedure and type of procedure enamel spikes that avoids bone formation around the
also were recorded. root fragment. We determined that the remaining
 Secondary intention healing was considered root was at least 3 mm below the crest of the lingual
wound healing with the postoperative alveolus and buccal plates. In this way, we reduced the rate
exposed to the oral cavity. of root exposure during postoperative root migration,
 The probing pocket depth (PPD) was consid- which—as documented in our previous study9—was
ered the distance between the gingival margin observed in the first 3 years and, in cases of root erup-
distal to the second molar, in the buccal, mid- tion in the oral cavity, could require a second surgical
dle, and lingual points, and the bottom of the procedure to remove the erupted fragments.
osseous defect and was measured with a milli- The pulp was not treated but was irrigated with sa-
meter probe. line solution. Before suturing, we obtained a periapical
MONACO ET AL 1119

radiograph to check for complete removal of the DATA MANAGEMENT

crown enamel and to verify the presence of a smooth We designed the data collection form and data man-
root surface. Primary closure of the flap was attempted agement system, including the development of data
using No. 4-0 silk sutures in all cases. entry forms, using Excel (Microsoft Excel 2011 for
Mac, version 14.0.0; Microsoft, Redmond, WA). Data
Postoperative Care were entered by a single operator. Before entry, data
All patients were given a form on which they re- were evaluated for accuracy and completeness; logical
ported the degree and intensity of pain on a 10-cm hor- consistency was verified, and for quantitative data, the
izontal visual analog scale during the first 7 range was computed. Hard copies of data entered
postoperative days.8,20 Patients also were required to were verified and stored in individual coronectomy
make daily reports on fever, swelling, trismus, and files. Data were analyzed using the SPSS statistical
the use of anti-inflammatory medications. A surgeon package (version 11.5; SPSS, Chicago, IL).
who did not perform the coronectomy removed the For quantification of the entity of migration, the peri-
sutures and evaluated the forms. apical radiographs (Kodak DF55 Ultra Speed,
All patients were treated with antibiotic prophylaxis 2.4  4 cm; Kodak, Rochester, NY), after manual devel-
comprising 2 g of amoxicillin, as well as clavulanic acid opment, were transformed into computed images using
tablets, 1 hour before surgery, and this therapy was an Epson Perfection V750 scanner (Epson America,
continued postoperatively for 4 days (1 g every Long Beach, CA) to obtain 40,800  56,160–pixel im-
8 hours). Starting the day after surgery, patients rinsed ages at 4,800-dpi resolution. During scanning, a piece
3 times a day with 0.2% chlorhexidine for 10 days post- of millimeter paper was inserted under each radiograph
operatively. All patients were given the same type of to permit calibration of the system in millimeters. After
anti-inflammatory medication (ibuprofen tab- scanning, the radiographs were saved in JPEG (Joint
lets, 600 mg). Photographic Experts Group) format. The radiographs
Periapical radiographs were obtained via a parallel were then analyzed using OsiriX imaging software
technique immediately after coronectomy (Fig 1) and (version 4.0; Pixmeo, Bernex, Switzerland).
after 3, 6, and 12 months (Fig 2). After the first year,
we obtained a periapical radiograph every year in
the following 4 years (Figs 3, 4). The periodontal STATISTICAL ANALYSIS
probing depth after 3, 6, and 12 months and in the The association between the study variables and the
following 4 years was assessed distal to the main outcome was evaluated by the c2 test. Given the
second molar to evaluate the effect of coronectomy varying durations of follow-up for the cases, Kaplan-
on promoting pocket reduction. Meier analysis was performed. Cox hazards modeling

FIGURE 1. Preoperative periapical radiograph taken before suturing.

Monaco et al. Coronectomy for Impacted Third Molars. J Oral Maxillofac Surg 2019.
1120 CORONECTOMY FOR IMPACTED THIRD MOLARS

FIGURE 2. Periapical radiograph taken 1 year after surgery.

Monaco et al. Coronectomy for Impacted Third Molars. J Oral Maxillofac Surg 2019.

was used to measure the risk for the study variables Results
that presented a significant association with the
main outcome. Initially, a population of 94 patients (37 male and 57
We set the a level at .05. Proportions and exact 95% female patients) with 116 third molars and a mean age
confidence intervals were computed using binomial of 28.99  8.9 years (range, 17 to 56 years) was treated
distributions.21 with coronectomy. In total, 93 patients were healthy

FIGURE 3. Periapical radiograph taken 3 years after surgery.

Monaco et al. Coronectomy for Impacted Third Molars. J Oral Maxillofac Surg 2019.
MONACO ET AL 1121

FIGURE 4. Periapical radiograph taken 5 years after surgery.

Monaco et al. Coronectomy for Impacted Third Molars. J Oral Maxillofac Surg 2019.

(ASA 1) and 1 patient was classified as ASA 2 for type 1 63 patients with 76 coronectomies were available for
diabetes. The sample includes 76 nonsmokers, 14 5-year follow-up.
smokers of fewer than 10 cigarettes per day, and 4 From 3 to 5 years, no complications occurred. There
smokers of more than 10 cigarettes per day. Of the were no reinterventions for extractions after the third
116 third molars treated, 56 (48.3%) were totally year after surgery. Moreover, we evaluated the PPD
impacted and 60 (51.7%) were partially impacted. At and BoP at 5 years. The mean preoperative PPD was
3 years, of the 94 patients with 116 coronectomies, 6  3 mm, and the mean PPD at 5 years was
66 patients with 87 coronectomies completed 3 years’ 4  1.5 mm. The cutoff for PPD was set at 4 mm,
follow-up, and their results were published in the Jour- and we observed a pathologic PPD in 35.5% of cases
nal of Oral and Maxillofacial Surgery in 2015.9 at 5 years. Preoperative BoP was present in 87.5% of
Among the initial sample of 94 patients with 116 cases, whereas BoP was present in 19.7% of cases
high-risk mandibular third molars, 63 patients (30 at 5 years.
male and 33 female patients) with 76 coronectomies
and a mean age of 30.54 years (standard deviation,
Discussion
10.87 years) completed 5 years’ follow-up. Of the 76
third molars treated by coronectomy, 40 were fully Coronectomy was proposed for the first time in
impacted and 36 were partially impacted. In addition, 1984 by Ecuyer and Debien3 to reduce the risk of
35 were vertically impacted and 41 were horizontal- neurologic lesions in cases with mandibular third mo-
ly impacted. lars in close proximity to the mandibular canal. In the
The immediate postoperative complications (up to subsequent years, many studies have been published
1 month after surgery) published in 2015 were as fol- about this technique, and a systematic review based
lows: no neurologic damage (0%), 5 cases of postoper- on randomized clinical trials concluded that coronec-
ative alveolitis (4%), 10 cases of postoperative swelling tomy is safer than complete extraction for the treat-
(9%), and 10 cases of postoperative pain (9%).9 The ment of third molars in a close relationship to the
late postoperative complications (1 month to 3 years IAN.16 This review pointed out that improvement of
after surgery) published in 2015 comprised 1 case of the surgical protocol was necessary to reduce the
pulpitis and 4 cases of root eruption into the oral cav- risk of immediate coronectomy failure and that long-
ity.9 In these cases, a second surgical procedure (6%) term studies were crucial to evaluate the morbidities
to extract the retained roots was necessary, with no of retained root fragments after many years. A descrip-
neurologic damage to the IAN. A second surgical tion of the surgical protocol was published in 201517;
procedure to correct the previous crown section it stressed that correct case selection, starting from a
was necessary in 4 other cases (3%). Of this sample, correct radiographic diagnosis, and appropriate
1122 CORONECTOMY FOR IMPACTED THIRD MOLARS

training of the surgeon are important for improving the security of knowing about the long-term safety of
clinical success. this surgical procedure, and some oral surgeons
In 2016, Leung and Cheung22 published the first resisted recommending this choice to patients with
long-term study, which included 126 cases of coronec- third molars in a close relationship with the mandib-
tomy evaluated at 5 years, and did not report any cases ular canal. In a survey of Swiss oral-maxillofacial
of late infection. In 2018, Pedersen et al23 published a surgeons, 51.6% of respondents considered coronec-
study on 231 cases of coronectomy with a mean tomy ‘‘non-reliable.’’
follow-up period of 5.7 years. They reported 3 cases The finding of no late infection in these 76 cases at
of IAN injury and absence of late complications. 5 years could be considered the most important result
In this study, we report on 116 coronectomies of this study. Our results confirm those of Leung and
without any cases of neurologic lesions and with a Cheung22 regarding the absence of late infection in
low incidence of immediate postoperative complica- the retained roots after 5 years. In addition, a physio-
tions. This is the only study that reports no incidence logical PPD was recorded at 5 years. Good periodontal
of neurologic lesions; this could be related to the strict healing distal to the second molars was recently
observance of a step-by-step surgical procedure that observed at 9 months28 and 36 months.29 Our data
permits the surgeon, even an inexperienced one, to showed that a physiological PPD also was maintained
minimize the possibility of failure. at 5 years after surgery.
Consistent with Leung and Cheung,22 we In this study, 5 cases of root extraction were re-
reported a low rate of immediate postoperative ported, and removal was performed for pulpitis at
complications. The incidence of pain and swelling 6 months in 1 case. Some studies have reported that
was lower than in studies of complete extractions of dental pulp has the intrinsic capacity of self-repair af-
partially or completely impacted third molars.24-26 ter trauma.30,31 In our study, the only case of pulpitis
Coronectomy is a less invasive surgical procedure was observed in a patient treated by a student
than complete extraction because less bone surgery undergoing postdegree training in oral-maxillofacial
is needed to remove the crown and grind the root. surgery. As reported in previous studies, coronectomy
The frequency of alveolitis was similar to that is a surgical procedure that needs a learning curve to
reported in previous studies about complete improve clinical success. Surgeons with less than
extractions.26 10 years of experience took longer to complete the
The 4 cases of reintervention in the first month after coronectomies and should follow the standardization
coronectomy were performed for the removal of resid- proposed in the published protocol to obtain better
ual enamel that a less experienced surgeon did not results in terms of reduction of immediate and late
grind down during the first surgical procedure. This complications.17
correction was necessary to permit bone healing In this case, the root migration occurred in the first
around the roots. As reported earlier, this surgical 6 months, which permitted a safer extraction of root
mistake confirms that coronectomy has a remnants that had moved away from the mandibular
learning curve. canal. Another case of root removal, although asymp-
Among the 116 cases of coronectomy, we could re- tomatic, was performed at the request of a patient
evaluate 76 cases at 5 years with radiographs and clin- who was moving to another city. In 1 case, a vertically
ical visits, whereas 40 cases were lost to follow-up impacted root fragment erupted in the oral cavity, and
because of changes in addresses or phone numbers; removal was necessary to maintain good hygiene. In 2
many of these patients were referred to the Dental cases, root fragments of third molars that had been
Clinic of the University of Bologna from private prac- horizontally impacted were removed because migra-
tices outside the region. In addition, this study did tion led to contact between the roots and the distal sur-
not include a control group with which to confirm faces of the second molars. In all these cases, the
and compare these results. However, it was not appro- second surgical procedure for root fragment removal
priate to recruit a control group to be treated by com- did not cause neurologic lesions because the roots
plete extraction owing to the high neurologic risk were distant from the mandibular canal. In cases of
associated with the third molars. horizontal impaction, it is important to grind the
None of the patients who were re-evaluated pre- root remnants by at least 4 mm to avoid any impact
sented with late infection at the radiographic examina- of the root on the distal surface of the second molar
tion, bone formation was evident in all cases, and with consistent migration.
periodontal probing showed a healthy periodontium The possibility of a second surgical procedure was
distal to the second molar. Until now, as also reported described to the patients during the discussion of
by Crameri and Kuttenberger,27 clinicians did not have the treatment plan and was part of the informed
MONACO ET AL 1123

consent form signed by the patients before application 6. Dolanmaz D, Yildirim G, Isik K, et al: A preferable technique for
protecting the inferior alveolar nerve: Coronectomy. J Oral Max-
of the coronectomy protocol. For this reason, we did
illofac Surg 67:1234, 2009
not consider the second surgical procedure for root 7. Leung YY, Cheung LK: Safety of coronectomy versus excision of
fragment removal a postoperative complication, and wisdom teeth: A randomized controlled trial. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 108:821, 2009
none of the patients experienced any fear during this 8. Monaco G, De Santis G, Gatto MR, et al: Coronectomy: A surgical
recall surgical procedure. option for impacted third molars in close proximity to the infe-
In a previous study, we showed how migration was a rior alveolar nerve. J Am Dent Assoc 143:363, 2012
9. Monaco G, De Santis G, Pulpito G, et al: What are the types and
continuous and physiological movement in the first frequencies of complications associated with mandibular third
3 years and reported how root migration increased molar coronectomy? A follow-up study. J Oral Maxillofac Surg
every 12 months by 0.844 mm.9 This migration was 73:1246, 2015
10. Freedman GL: Intentional partial odontectomy. J Oral Maxillofac
related to bone formation distal to the second molar Surg 55:524, 1997
in a manner similar to what happens during 11. O’Riordan BC: Coronectomy (intentional partial odontectomy
orthodontic-assisted extraction.32 of lower third molars). Oral Surg Oral Med Oral Pathol Oral Ra-
diol Endod 98:274, 2004
As reported by many authors, the roots’ migration is 12. Pogrel MA, Lee JS, Muff DF: Coronectomy: A technique to pro-
greater in young patients, in women, and in teeth with tect the inferior alveolar nerve. J Oral Maxillofac Surg 62:1447,
conical roots.15 In addition, a recent work by Yeung 2004
13. Renton T, Hankins M, Sproate C, et al: A randomized controlled
et al33 evaluated root migration on CBCT scans and
clinical trial to compare the incidence of injury to the inferior
underlined how the migration is distal and lower in alveolar nerve as a result of coronectomy and removal of
multiple-rooted teeth and mesial and higher in mandibular third molar. J Oral Maxillofac Surg 43:7, 2005
14. Martin A, Perinetti G, Costantinides F, et al: Coronectomy as a
single-rooted teeth. Moreover, we do not agree with surgical approach to impacted mandibular third molars: A sys-
the conclusion of Leung and Cheung22 that ‘‘Another tematic review. Head Face Med 11:9, 2015
focus of coronectomy research may be the methods 15. Kohara K, Kurita K, Kuroiwa Y, et al: Usefulness of mandibular
third molar coronectomy assessed through clinical evaluation
to reduce root migration’’ because migration can over three years of follow-up. Int J Oral Maxillofac Surg 44:
improve periodontal healing distal to the 259, 2015
second molar,28,29 and in cases of reintervention, this 16. Long H, Zhou Y, Liao L, et al: Coronectomy vs. total removal for
third molar extraction: A systematic review. J Dent Res 91:659,
reduces the risk of neurologic lesions. 2012
This prospective study on coronectomy of third mo- 17. Monaco G, Vignudelli E, Diazzi M, et al: Coronectomy of mandib-
lars in a close relationship with the mandibular canal ular third molars: A clinical protocol to avoid inferior alveolar
nerve injury. J Craniomaxillofac Surg 43:1694, 2015
reported no cases of neurologic lesions, a low rate of 18. American Society of Anesthesiologists. ASA physical status clas-
immediate postoperative complications, and no cases sification system. Available at: www.asahq.org/clinical/
of late infection of the retained roots from the third to physicalstatus.htm. Accessed March 1, 2012
19. Monaco G, Montevecchi M, Bonetti GA, et al: Reliability of pano-
fifth year of follow-up. This technique should be ramic radiography in evaluating the topographic relationship
planned before surgery and after an accurate diagnosis between the mandibular canal and impacted third molars. J
is made using CBCT to reduce intraoperative root Am Dent Assoc 135:312, 2004
20. Monaco G, Staffolani C, Gatto MR, Checchi L: Antibiotic therapy
mobilization. Further investigations should include a in impacted third molar surgery. Eur J Oral Sci 107:437, 1999
follow-up study at 10 years and more research about 21. Bland M: An Introduction to Medical Statistics (ed 3). Oxford,
the mechanism of pulp healing. Oxford University Press, 2000
22. Leung YY, Cheung LK: Long-term morbidities of coronectomy
on lower third molar. Oral Surg Oral Med Oral Pathol Oral Radiol
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23. Pedersen MH, Bak J, Matzen LH, et al: Coronectomy of mandib-
We express our gratitude to Professor Claudio Marchetti for crit- ular third molars: A clinical and radiological study of 231 cases
ically reviewing the article. with a mean follow-up of 5.7 years. Int J Oral Maxillofac Surg
47:1596, 2018
24. Bagain ZH, Karaky AA, Sawair F, et al: Frequency estimates and
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