Retained Wisdom Tooth Root Fragment Versus Complete Extraction for Preventing Inferior Alveolar Nerve Injury in High-Risk Patients
DOI:
https://doi.org/10.61919/c2pkd876Keywords:
Coronectomy; Inferior Alveolar Nerve; Mandibular Third Molar; Nerve Injury; Oral Surgery; Randomized Controlled Trial; Tooth Extraction.Abstract
Background: Inferior alveolar nerve disturbance remains an important complication of mandibular third molar surgery, particularly when preoperative imaging shows close proximity between the roots and mandibular canal. Coronectomy, involving removal of the crown while retaining a healthy apical root fragment, may reduce nerve trauma by avoiding apical manipulation in high-risk cases. Objective: To compare coronectomy with complete surgical extraction for reducing short-term inferior alveolar nerve disturbance in patients with radiographically high-risk mandibular third molars. Methods: A parallel-group randomized controlled trial was conducted in the Islamabad–Rawalpindi region over five months. Seventy-two adults aged 18–40 years with impacted mandibular third molars showing radiographic proximity to the inferior alveolar canal were randomized equally to coronectomy or complete extraction. Neurosensory function was assessed using light-touch and two-point discrimination testing at baseline, 1 week, 4 weeks, and 8 weeks. Pain, facial swelling, and infection were also recorded. Results: Sixty-seven participants completed follow-up, including 33 in the coronectomy group and 34 in the complete extraction group. At 8 weeks, inferior alveolar nerve disturbance was lower after coronectomy than complete extraction, 6.1% versus 23.5% (p=0.041). Two-point discrimination was also better after coronectomy, 5.2 ± 1.1 mm versus 6.8 ± 1.5 mm (p<0.001). Early postoperative pain and swelling were significantly lower in the coronectomy group, while infection rates did not differ significantly. Conclusion: Coronectomy reduced short-term inferior alveolar nerve disturbance and improved early postoperative recovery compared with complete extraction in selected high-risk mandibular third molars.
References
1. Mancini A, Inchingolo AM, Blasio MD, Ruvo ED, Noia AD, Ferrante L, et al. Neurological complications following surgical treatments of the lower molars. 2024;2024(1):5415597.
2. Rieder M, Remschmidt B, Schrempf V, Schwaiger M, Jakse N, Kirnbauer BJ. Neurosensory deficits of the mandibular nerve following extraction of impacted lower third molars: a retrospective study. J Clin Med. 2023;12(24):7661.
3. Putrino A, Zaami S, Cassetta M, Altieri F, De Paola L, Marinelli S. Inferior alveolar nerve impairment following third-molar extraction: management of complications and medicolegal considerations. J Clin Med. 2025;14(7):2349.
4. Kim SG, Oh JH, Hwang DS. Management of complications in tooth extraction. In: Advanced Strategies for Tooth Extraction in Dentistry: Beyond Basics. Springer; 2024. p. 65-93.
5. Wayland J. Impacted third molars. John Wiley & Sons; 2023.
6. Hwaiti HS, Al-Rubidi YA, Al-Ashwal A, Al-Hadi Y, Al-Kibsi T, Al-Wesabi MA. Inferior alveolar nerve relocation and immediate dental implant placement in severely resorbed mandibles: a prospective clinical case series. BMC Oral Health. 2026;26(1):119.
7. Ramalingam S, Bhargava D. Advances in surgical extraction of the mandibular third molars. In: Transalveolar Extraction of the Mandibular Third Molars. CRC Press; 2022. p. 163-75.
8. Barnes S, Griffin J. Mandibular orthognathic surgery. Clin Rev Oral Maxillofac Surg. 2024:297.
9. Farzad P, Kamal M. Mandibular trauma. Oral Maxillofac Surg. 2025:772-805.
10. Jean TY, Hou KWS, Lin GSS, Wun JLS, Ko WLL, Nasir WNA. MAOMS Annual Scientific Meeting on Friday, 3rd June 2022. 2022.
11. Shah UH, Patel HD, Pandya HB, Dewan HS, Bhavsar BC, Amar RJ. CBCT based anatomic juxtaposition of mandibular canal to deeply impacted mandibular third molar: a rationale for coronectomy. Acta Sci Dent Sci. 2023;7(9).
12. Van Sickels J, Salman SO. Complications in orthognathic surgery. In: Peterson’s Principles of Oral and Maxillofacial Surgery. Springer; 2022. p. 2039-69.
13. Ness GM, Blakey GH, Hechler BL. Impacted teeth. Peterson’s Principles of Oral and Maxillofacial Surgery. 2022:131-69.
14. Derbishi AA, Altayyar RA, Alsubaiei AS, Alghannam RJ, Albalushi A, Mubarki O, et al. Coronectomy versus total extraction for third molar surgery: a systematic review and meta-analysis. 2026;18(3).
15. Logvynenko I, Bursova V. Chinese Journal of Plastic and Reconstructive Surgery.
16. Hooshiar MH, Yari A. Intra- and postoperative complication management in implant and grafting procedures. In: Handbook of Oral and Maxillofacial Surgery and Implantology. Springer; 2026. p. 1-104.
17. Bagatin T, Bjelica R, Biočić J, Dinjar K, Zore IF, Gabrić D, et al. Book of abstracts of the congress: 11th Congress of the Croatian Society of Oral Surgery and 17th Congress of the Croatian Society of Maxillofacial, Plastic and Reconstructive Surgery of the Head and Neck. 2025;59(4):449-73.
18. Kata J. Az alsó bölcsességfogakhoz kapcsolódó nervus alveolaris inferiort körülölelő gyökérmorfológia és a preeruptív intrakoronális reszorpció röntgenjeleinek elemzése. 2023.
19. Pham TD, Holmes S, Chatzopoulou D, Coulthard P. AI in diagnosing cranio-maxillofacial trauma. In: Artificial Intelligence in Facial Trauma, Oral Diseases, and Systemic Health. Springer; 2026. p. 91-142.
20. Awode N, Jatania A, Jangwad S. Distraction osteogenesis. Mahi Publication; 2024.
21. Sakr M, Koraitim T. Surgery of the salivary glands. In: Head and Neck and Endocrine Surgery: From Clinical Presentation to Treatment Success. Springer; 2024. p. 31-86.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Sumblina Amin, Aqsa Amin, Alkesh Kammal, Haadia Arooj, Farheen Khan, Hafsa Liaqat, Ghazal Rahu (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
.png)
