CORONECTOMY and THE NEED FOR REOPERATION

If you have read my blogs on the subject you know that I am almost completely opposed to the procedure of coronectomy as a treatment for impacted third molar teeth. I base this on a number of factors including – we rarely have problems with complete removal in the first place; the procedure leaves “the problem” in place; our experience is that we end up having to care for these patients in the future with removal of the tooth; it is my belief that the reason this procedure was introduced was to create the need for a second surgical procedure and additional billing in light of socialized dental care and manage care situations. (J Oral Maxillofac Surg 77:1108-1115, 2019)

The stated article claims that the reoperation rate for the coronectomy procedure is about 5%. In the conclusion, they recommend that a follow up study for more than 6 months is recommended! I’d say! We are starting to see these cases come through where some practitioner (usually not an oral surgeon) performs the coronectomy and then, when it becomes a problem, they refer it to us to solve and treat. In many cases the risks with the procedure, such as to the feeling nerve, adjacent teeth, or sinus, end up being much greater than they would have been had we done the complete procedure in the first place. We also see many more collateral problems such as infection or bone loss on the adjacent teeth in these situations.

There is no question, based on my experience, that proper care with early complete removal of third molar impactions is the correct treatment. There are very few exceptions and we will consider the coronectomy procedure when it is appropriate.