Coronectomy: A Safe Alternative for Impacted Wisdom Teeth

A coronectomy is a specialized oral surgery procedure in which the crown (top portion) of a tooth is removed while leaving the roots in place. This technique is typically recommended for impacted wisdom teeth that pose a high risk of nerve damage if extracted entirely. The procedure is designed to minimize complications while preserving nerve function, ensuring a safer approach to complex extractions.

When is a Coronectomy Recommended?

A coronectomy is usually advised for wisdom teeth (third molars) that are:

• Located close to the inferior alveolar nerve, which supplies sensation to the lower lip and chin.
• Difficult to remove completely without an increased risk of nerve injury.
• Positioned in a way that makes full extraction unsafe due to anatomical constraints, such as being deeply embedded in the jawbone or having roots entwined with nerves.
• At risk of causing permanent numbness, pain, or altered sensation if removed entirely.

Benefits of a Coronectomy

• Reduces the risk of nerve damage: By preserving the roots, the inferior alveolar nerve remains undisturbed, reducing the chances of numbness or altered sensation.
• Minimizes complications: A coronectomy is a conservative approach that prevents complications associated with complex extractions, such as nerve injury or jaw fractures.
• Promotes healing: The surrounding bone naturally fills in over time, stabilizing the area while maintaining nerve integrity.
• Preserves jaw structure: Keeping the roots intact helps prevent significant changes in jawbone density and shape that can occur with full extractions.

What to Expect During the Procedure

• Consultation and Evaluation: Dr. Press or Dr. Silverman will assess your wisdom teeth using advanced imaging, such as panoramic X-rays or 3D CBCT scans, to determine if a coronectomy is the best option.
• Anesthesia and Sedation: The procedure is performed under local anesthesia, IV sedation, or general anesthesia, depending on patient needs and complexity. Our team ensures you are comfortable throughout the process.
• Surgical Process:
  1. The gum tissue around the affected tooth is gently opened to access the crown.
  2. The crown of the impacted tooth is carefully sectioned and removed while the roots are left intact to avoid nerve disturbance.
  3. Any sharp edges are smoothed to promote proper healing.
  4. The surgical site is thoroughly cleaned and sutured to facilitate healing.
• Closure and Healing: The surgical site is closed with dissolvable or removable stitches, and detailed post-operative instructions are provided.

Recovery and Aftercare

• Mild discomfort and swelling are common in the first few days and can be managed with prescribed or over-the-counter pain medication.
• Soft foods and limited physical activity are recommended for the first few days to support healing and prevent complications.
• Oral hygiene instructions will be provided, including how to gently rinse with salt water or prescribed mouthwash to reduce infection risk.
• Follow-up visits ensure the area heals properly and that no complications arise, such as infection or root exposure.
• In rare cases, the roots may become symptomatic over time, requiring further treatment or removal.

Potential Risks and Considerations

While a coronectomy is generally safe, there are some risks involved, including:

• Root Migration: In some cases, the retained roots may shift slightly over time but often remain asymptomatic.
• Infection: Like any surgical procedure, there is a minor risk of post-operative infection, which can be managed with antibiotics and proper aftercare.
• Delayed Healing: Some patients may experience prolonged healing, particularly if post-operative instructions are not followed closely.

Is a Coronectomy Right for You?

If you have an impacted wisdom tooth that is closely associated with a nerve, a coronectomy may be a safer alternative to full extraction. At Madison Avenue Oral & Maxillofacial Surgery Associates, LLC, our surgeons prioritize patient safety and long-term oral health. Contact us today to schedule a consultation and discuss your treatment options.