Private Practice, Adelaide, South Australia, Australia.
Aust Dent J. 2021 Jun;66(2):136-149. doi: 10.1111/adj.12825. Epub 2021 Mar 10.
Extraction of mandibular third molars (M3M) close to the inferior alveolar nerve (IAN) has a higher risk of neurological disturbance. This review aims to evaluate the evidence supporting the use of the coronectomy technique compared to complete extraction for such M3Ms. Case studies by a specialist oral and maxillofacial surgeon are included to illustrate clinical practice.
Three databases (Cochrane Library, Embase, PubMed) were searched (November 2020). Additional articles were sought by hand searching the reference list of included articles. All studies published in English comparing outcomes of coronectomy with complete extraction with at least 50 subjects and 6 months follow-up were included.
Of the six included studies, five reported a lower rate of IAN disturbance after coronectomy compared with complete extraction. There were no reported cases of lingual nerve disturbance. Other outcomes of coronectomy such as pain, infection, alveolar osteitis were either similar or lower compared to complete extraction. There were high rates of root migration but low rates of exposure and reoperation. Follow-up protocols varied considerably.
There is medium quality evidence to support the option of coronectomy for high risk M3M cases. Further studies to develop follow-up protocols to assist general dental practice is warranted.
下颌第三磨牙（M3M）靠近下牙槽神经（IAN）的拔除存在更高的神经损伤风险。本综述旨在评估与完全拔除相比，冠向切除术在这类 M3M 中的应用证据。纳入了一位口腔颌面外科专家的病例研究，以说明临床实践。
在 Cochrane Library、Embase 和 PubMed 三个数据库中进行检索（2020 年 11 月）。通过手动检索纳入文献的参考文献列表来寻找其他文章。纳入了所有发表于英文期刊、比较冠向切除术与完全拔除的 50 例以上患者和至少 6 个月随访的结局的研究。
纳入的六项研究中，五项研究报告称冠向切除术后 IAN 损伤的发生率低于完全拔除。未报告舌神经损伤的病例。与完全拔除相比，冠向切除术的其他结局，如疼痛、感染、牙槽骨炎，要么相似，要么更低。根迁移的发生率较高，但暴露和再次手术的发生率较低。随访方案差异很大。
有中等质量证据支持将冠向切除术作为高风险 M3M 病例的选择。需要进一步研究以制定随访方案，以辅助一般牙科实践。
