We report the case of a 25-year-old male patient who came to the clinic for repeated episodes of pain and inflammation around the semi-included left lower third molar.
The patient's medical history did not reveal any medical history of interest; he did not follow any medication daily, except antibiotics and medications, due to the current problem, was not a smoker and was in perfect health conditions.
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After clinical examination, an orthopantomography was requested as the first diagnostic test.
In this work, we can observe how the apex in question finds an apex in close relationship with the canal of the NDI, detecting curvature as clear indicators of high risk of nerve injury during distal canal extraction.
Although orthopantomography showed a fairly clear image, request CT to correctly plan the case before deciding on the therapeutic procedure.
The CT images show that the contact between the cord and the IDC is real and that, therefore, the risk of damage during extraction is high.
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Given this situation, we inform the patient of the possibility of performing a coronectomy or partial extraction of the symptomatic third molar.
With this technique we intend to eliminate the clinic caused by pericoronaritis, since we achieve a direct closure of the wound and roots, including the integrity of the IDC.
The patient was informed of the possibility of an infectious complication of pulpal cause, which would force us to reoperate to complete the extraction.
Reentry would also be necessary if, in the long term, there was migration of roots, and these roots returned to generate clinical pericoronaritis due to exposure.
Only if this occurs, the relationship of roots with the NDI would probably not be as clear, nor would extraction, therefore, be so compromised.
After obtaining informed consent from the patient, we proceeded to the coronectomy following the following surgical technique : Administration of antibiotic prophylaxis.
Perform a bayonet incision and lifting of a full-thickness flap similar to that used for complete removal of a cord.
Cutting the crown with a fissure burr from the vestibular table, following an assemblage of approximately 45o.
This section is complete in order not to exert force on the roots with the buttons, which requires careful when approaching the lingual table in order not to injure the lingual nerve.
Later, more dental tissue is still eliminated, with the same fissure burr or with a round burr seized from the upper part.
The latter is a bit easier than with the fissure burr.
The section thus remains at least 3 mm below the bone crests.
This is intended to make it easier for the bone to grow on the roots and to englobe them within the jaw.
The exposed root surface should not be treated.
Finally follicle remnants are eliminated, without mobilizing roots, remaining tooth and suture the wound with loose points that are removed in one or two weeks.
Controls should be performed monthly, at six months and annually.
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All these steps were performed in our case, and the patient had no complications in one year after the intervention.
