Removing wisdom teeth is a common everyday procedure at the oral surgery office, but it is not without risks. One potential complication is an injury to the inferior alveolar nerve. This nerve actually sits within the jaw bone and can course very close to or even touch the roots of lower teeth. Injury to this nerve is very rare and when injured it is usually temporary, lasting several months, but can be permanent. The nerve supplies sensation to the lower lip, chin, teeth and gums on that side of the lower jaw and an injury can cause numbness, hypersensitivity, or even pain in the areas supplied by this nerve. Unfortunately, for some patients, their anatomy puts them at higher risk of injury to this nerve because of their intimate relationship between the tooth and the nerve.
During your consultation appointment, the proximity between the tooth and the nerve can be determined. If necessary, we can take a 3D CBCT scan at our office to determine exactly this relationship between the tooth and the nerve. If the advanced imaging shows that taking the tooth out completely would result in a higher risk of injury to the nerve, then a coronectomy procedure may be discussed as an alternative.
A coronectomy is also known as an intentional partial tooth extraction. It is a technique sensitive procedure best performed by your oral and maxillofacial specialists. The tooth is sectioned into upper and lower halves. The crown is removed in its entirety along with part of the roots. The remaining part of roots that are in close proximity to the nerve is left behind intentionally. This decreases the risk of a nerve injury. We then take a post-operative x-ray to confirm the current position of the remaining roots.
Recovery from a coronectomy is similar to having a conventional tooth extraction. Most of the time the bone heals over the roots and do not cause a problem again. In some cases, the remaining roots become symptomatic and become infected, although this is uncommon. In other cases, the roots migrate upwards and may require removal, except now it has moved away from the nerve!
Your oral surgeon will have to see you for a few post-operative visits and take additional radiographs to make sure there is a good healing and your coronectomy procedure is a success.