Frenkel Boaz, Givol Navot, Shoshani Yitzhak
Oral and Maxillofacial Specialist, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
Oral and Maxillofacial Specialist, Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Ramat Gan, Israel.
J Oral Maxillofac Surg. 2015 Apr;73(4):587-94. doi: 10.1016/j.joms.2014.10.011. Epub 2014 Oct 22.
A prevalent complication associated with mandibular third molar extraction is inferior alveolar nerve (IAN) injury. This study evaluated the success rate of coronectomy and, in the event of failure of the procedure, retreatment.
One hundred seventy-three patients underwent 185 coronectomy procedures of the mandibular third molar to prevent IAN injury. The coronectomy was performed along the cementoenamel junction. Residual roots were trimmed 3 to 4 mm below the crest margin. No pulp treatment was performed and the roots were left vital. A postoperative orthopantogram was recorded immediately after the procedure or at follow-up 1 month later. Two additional orthopantographic views were taken at 6- and 12-month follow-up appointments. Statistical analyses were performed to assess differences in root migration, pain, wound healing and failure by age, gender, and time elapsed from coronectomy. Statistical data were considered significant at a P value less than .05.
Statistical differences in the migration of residual roots from 6 to 12 months were found. Migration of the roots was found in younger patients. In a total of 10 cases of failure, 4 were treated with repeat coronectomy. The other 6 cases were treated with reoperation (ie, removal of residual roots).
Immediate postoperative radiographic imaging is recommended, as well as, follow-up evaluation 12 months after surgery. In addition, repeat coronectomy is recommended for cases in which enamel retention is diagnosed to prevent residual roots from becoming infected.
下颌第三磨牙拔除常见的并发症是下牙槽神经（IAN）损伤。本研究评估了冠切除术的成功率，以及该手术失败后的再治疗情况。
173例患者接受了185次下颌第三磨牙冠切除术以预防IAN损伤。冠切除术沿牙骨质牙釉质界进行。残留牙根在牙槽嵴边缘下方3至4毫米处修整。未进行牙髓治疗，牙根保持活力。术后立即或1个月后随访时记录全景X线片。在6个月和12个月随访时再拍摄两张全景X线片。进行统计分析以评估牙根迁移、疼痛、伤口愈合及冠切除术后不同年龄、性别和时间的失败差异。P值小于0.05时，统计数据被认为具有显著性。
发现6至12个月期间残留牙根迁移存在统计学差异。年轻患者中发现牙根有迁移。总共10例失败病例中，4例接受了重复冠切除术治疗。另外6例接受了再次手术（即去除残留牙根）。
建议术后立即进行影像学检查，并在术后12个月进行随访评估。此外，对于诊断为有牙釉质残留的病例，建议重复冠切除术以防止残留牙根感染。
