Article type
Year
Abstract
Background: the lower third molars have a close relationship with the mandibular canal, and their complete extraction can produce an injury to the inferior alveolar nerve (IAN), generating different degrees of paresthesia. Coronectomy is a surgical alternative that is described as the removal of the crown, leaving the roots in its alveolus to avoid damaging the IAN when it has a relationship with the mandibular third molar. There is uncertainty if this procedure reduces the risk of injury to the IAN and if it is associated with infections caused by maintaining the roots in the alveolus.
Objectives: to assess coronectomy versus complete extraction for mandibular third molars at risk for IAN injury.
Methods: we conducted a search in Epistemonikos, which is maintained through searches in multiple sources of information, including MEDLINE, Embase, and Cochrane, among others. We extracted the data from the identified reviews and analysed it from the primary studies. With this information, we generated a structured summary called FRISBEE (Friendly Summaries of Body of Evidence using Epistemonikos), following a pre-established format, which includes key messages, a summary of the evidence set (presented as a matrix of evidence in Epistemonikos), meta-analysis of the total of the studies when possible, a summary table of results with the GRADE method, and a section of other considerations for decision-making.
Results: we identified 6 systematic reviews that together included 17 primary studies, including 2 randomized trials. The risk ratio for IAN injury was 0.27 (95% confidence interval (CI) 0.12 to 0.60) in favour of coronectomy. The risk ratio for infection was 1.09 (95% CI 0.41 to 2.92) favouring complete extraction.
Conclusions: coronectomy compared to total extraction of the lower third molars is probably associated with less damage to the IAN. It is not clear if there are differences between coronectomy and total extraction for the development of infection because the certainty of the evidence is very low.
Patient or healthcare consumer involvement: most likely there is variability in the decision-making regarding this intervention. Considering the results published in this article, in cases where there is an evident risk of damage to the IAN, most patients could prefer coronectomy as a surgical option. However, exceptions may occur because patients are not willing to maintain a root remnant. Also, both clinicians and patients might prefer to avoid the possible risk of infection, which is not clear based on our results.
Objectives: to assess coronectomy versus complete extraction for mandibular third molars at risk for IAN injury.
Methods: we conducted a search in Epistemonikos, which is maintained through searches in multiple sources of information, including MEDLINE, Embase, and Cochrane, among others. We extracted the data from the identified reviews and analysed it from the primary studies. With this information, we generated a structured summary called FRISBEE (Friendly Summaries of Body of Evidence using Epistemonikos), following a pre-established format, which includes key messages, a summary of the evidence set (presented as a matrix of evidence in Epistemonikos), meta-analysis of the total of the studies when possible, a summary table of results with the GRADE method, and a section of other considerations for decision-making.
Results: we identified 6 systematic reviews that together included 17 primary studies, including 2 randomized trials. The risk ratio for IAN injury was 0.27 (95% confidence interval (CI) 0.12 to 0.60) in favour of coronectomy. The risk ratio for infection was 1.09 (95% CI 0.41 to 2.92) favouring complete extraction.
Conclusions: coronectomy compared to total extraction of the lower third molars is probably associated with less damage to the IAN. It is not clear if there are differences between coronectomy and total extraction for the development of infection because the certainty of the evidence is very low.
Patient or healthcare consumer involvement: most likely there is variability in the decision-making regarding this intervention. Considering the results published in this article, in cases where there is an evident risk of damage to the IAN, most patients could prefer coronectomy as a surgical option. However, exceptions may occur because patients are not willing to maintain a root remnant. Also, both clinicians and patients might prefer to avoid the possible risk of infection, which is not clear based on our results.
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