Update on coronectomy. A safer way to remove high risk mandibular third molars.

UNLABELLED: Decoronation of high risk mandibular third molars (M3Ms) has become common practice in parts of UK and USA. With the introduction of Cone Beam CT scanning, there has been an evolution in the practice, with avoidance of unnecessary coronectomies based on CBCT findings. Also, additional anatomical features found only on CBCTs have introduced possible additional indications to undertake intentional coronectomy. Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. Iatrogenic injuries to the third division of the trigeminal nerve remain a common and complex clinical problem. Altered sensation and pain in the orofacial region may interfere with speaking, eating, kissing, shaving, applying make-up, toothbrushing and drinking; namely just about every social interaction we take for granted. Usually after oral rehabilitation, the patient expects and experiences significant improvements, not only regarding jaw function, but also in relation to dental, facial, and even overall body image. Thus these injuries have a significant negative effect on the patient's self-image and quality of life and the iatrogenesis of these injuries lead to significant psychological effects. CLINICAL RELEVANCE: Coronectomy is an alternative procedure to complete removal of a mandibular third molar in situations where there is high risk of damage to the inferior alveolar nerve.