Clinical Approach to Coronectomyin Horizontally Impacted Mandibular Wisdom Teeth

Objective: This study is focused on the identification of comprehensible radiographical and clinical features for the risk assessment of coronectomies in horizontally impacted mandibular third molars which require surgical treatment. A classification, based on a literature review and well-defined risk assessment algorithm, has been developed to streamline the decision-making process. Methods: A PubMed, OVID Medline and Google Scholar search for articles related to keywords such as “Coronectomy, Horizontal Impacted Third Molar, Coronectomy vs Extraction” has been performed. Results: Only horizontally impacted mandibular 3rd molars which required surgical intervention were included. The relationship of the apical portion of the roots with the IAN, evaluated on the CBCT, was used to classify the tooth as low, medium or high risk for extraction. If a tooth was classified as medium or high risk for total removal, it was further assessed and classified for coronectomy. According to a literature review and to our clinical judgement, 4 indicators can beidentified as relevant in the individual risk assessment related to coronectomy. Based on a cumulative point score, the indication for a coronectomy has been appraised as ‘low risk', ‘moderate risk' or 'high risk’. Conclusion: Horizontal impactions of lower third molars are not necessarily to be considered a contraindication for coronectomy. Our classification offers a guideline in the decision-making process on whether a coronectomy represents a viable treatment option for mandibular horizontally impacted third molars.