SHOULD I HAVE A CORONECTOMY FOR MY WISDOM TOOTH?

There have  been a number of articles in the literature (particularly in the European circles) proposing that a procedure called a Coronectomy (removal of the tooth crown) be performed for lower wisdom teeth (third molar teeth) where the root structure is in close proximity to the neurovascular bundle. The nerve structure in the lower jaw provides feeling to the area of the lower lip, chin, lower front teeth, and gums. The idea is that you remove the crown and then let the roots erupt more to remove at a second procedure where the risk may be less. I have very strong feelings about this subject with general opposition. I will premise my comments with a qualifier that we have been performing surgical removal of third molar teeth in our practice with over 30 years experience. We treat the most difficult cases and our incidence of nerve injury of any kind is a fraction of one percent – very low. We attribute that to proper training, experience, care in treatment, skill in treatment, and appropriate preparation – imaging, etc.

• My first comment is my feeling that this treatment has been suggested to create extra surgical procedures and extra billing. Under managed care systems and government healthcare systems this can be a way to justify several procedures over time rather than one procedure.
• Second, any experienced oral surgeon can see that this procedure – leaving tooth structure (roots) in place – creates a number of variables and new risks at the surgical site and adjacent teeth and structures. Several excellent examples are that residual tooth structure typically causes quite a bit of discomfort; and also the residual tooth structure represents an ongoing risk of infection at the site and possibly affecting the adjacent tooth.
• Third, with cone beam scanning technology we are now able to visualize the tooth roots and nerve position before surgery in 3 dimensional space and help to further reduce the risk with surgical awareness of these relationships.
• Lastly, I feel that the best treatment for all but the most extreme cases is to face the risk with best information and have the impacted teeth removed.

Make sure you have a board certified oral and maxillofacial surgeon providing your care. Meet them and make sure they are caring and concerned and that they appropriately address your risk concerns. Ask for a cone beam scan to best visualize these risk concerns and do the treatment as early as possible, age 15 in my view is an ideal time where these risks are very low. The risks just increase as we age.

I have other information on my website about wisdom teeth and our philosophy toward wisdom teeth. This includes information about the white paper on third molar extractions which was published in combination with the ADA and AAOMS.