Coronectomy as an alternative technique to complete extraction of mandibular third molars with risk of nerve injury

Abstract

Background: Extraction of mandibular third molars (MTM) is one of the most frequent surgical procedures in Oral Surgery. This intervention is not without risks, as one of the most common is an injury of the inferior alveolar nerve (IAN). The main objective of this systematic review is to compare the coronectomy technique with conventional extraction of MTM with a high risk of injury to the IAN, thus determining whether coronectomy is an effective surgical alternative in preventing nerve injuries. Material and Methods: A bibliographical search was conducted in October 2024 in the Pub-Med and Cochrane-Database databases, and 211 studies were obtained. Finally, 16 studies were included in the systematic review, with a total sample of 2551 patients. 2280 coronectomy procedures and 841 extractions were performed. Results: 6.22% of the coronectomies performed were unsuccessful. The incidence of IAN injury was 6.53% in the extraction group, while in the coronectomy group, it was only 0.56%. Permanent IAN injury was 1.18% and 0.13%, respectively. The most common complication in both groups was postoperative pain, with similar results, 15.69% in the extraction group vs. 14.21% in the coronectomy group. Lingual nerve injury was infrequent and transient in both groups, affecting 0.12% of extractions and 0.26% of coronectomies. The complication with the highest incidence in the coronectomy group was root migration, mainly during the first 6 months. Conclusions: Coronectomy is a safe and effective alternative technique for the management of MTM with a high risk of IAN injury.