Intentional Coronectomy With Pulpectomy- A conservative approach
Wisdom teeth are the last teeth to erupt in the oral cavity usually when the individual is in his/her teens i.e. between 18-24 years. However, depending on the space available and the position of the teeth they might erupt only partially or stay un-erupted and embedded in the bone. This in the dental terminology is called as Impaction of wisdom tooth.
The impacted wisdom tooth/teeth might cause many problems like infection, pain of head and neck, foodlodgement & cavity of impacted tooth or preceding tooth & so-on. Therefore they have to be removed by a surgical procedure called Dis-impaction.
However, there are many potential complications and risks. One such complication is paraesthesia. It refers to a situation where post-operatively there is temporary or permanent numbness of the lip/tongue due to damage to the nerve during removal procedure. This is especially seen in cases where the impacted teeth is in very close proximity to the mandibular nerve or lingual nerve.
One such patient aged 42 years visited Fine Feather dental clinic at Nehrunagar centre, with a chief complain of persistent pain in lower left back teeth. An OPG x-ray revealed a partially erupted wisdom tooth, the roots of which were completely encircling the mandibular nerve, as was observed by subsequent CT-scan investigation.
The patient was advised removal under general anaesthesia by an oral surgeon with a very high risk of potential complication of paraesthesia. The risk was very high due to the location as well as the age of the patient, since the paraesthesia in this age group is normally permanent in nature. The patient was thus reluctant to carry out the treatment and came to Fine Feather Dental Clinic for second opinion. The team at Fine Feather comprising of Dr. Keval Shah, Dr. Anish Tiwari and D.r Partho Mukherji discussed the case and thrashed out an alternative treatment plan for the same. Dr Anish felt that Coronectomy whereby the crown is removed and the roots/root are/is left submerged might be the solution.
Based on this an inter-disciplinary treatment plan was decided. The crown that was causing the problem would be removed surgically and the roots which had the potential to cause complication during/after removal would be left in situ after carrying outpulpectomy.
At Fine Feather, the pulpectomy was performed by Root Canal specialist Dr Partho Mukherjee & the coronectomy followed by sutures was done by Dr Anish Tiwari. Care was taken to see that the roots were completely embedded 2 mm. beneath the bone by the flap. The patient was recalled after six weeks and an X-ray was taken. There was complete cessation of pain and the X-ray also showed signs of healing. The patient has been advised regular recall visits every six weeks to monitor the condition and rule out any pathology.
Dr Keval Shah feels that such conservative approach like, “intentional coronectomy with pulpectomy” may be a good treatment alternative for this kind of high risk patients as regards potential complications like permanent Paraesthesia, provided the roots that are left in situ do not undergo any pathologic changes like transformation into cyst/tumour later on. Another advantage to the patient is that the procedure can be done under local anaesthesia thus obviating the need for General Anaesthesia and its potential complications and cost escalation.