Coronectomía en terceros molares mandibulares como alternativa de tratamiento seguro en la prevención del daño al nervio alveolar inferior: revisión bibliográfica y reporte de 30 casos / Coronectomy in third mandibular molars as an alternative treatment to prevent damage to the inferior alveolar nerve: bibliographic review and 30 cases report

La lesión del nervio alveolar inferior (NAI) al extraer los terceros molares mandibulares esa menudo causada por la íntima relación entre el nervio y las raíces dentarias. La técnica de coronectomía ola retención intencionada de raíz, podría mitigar este problema. Treinta pacientes fueron sometidos a coronectomia en 30 terceros molares mandibulares con seguimiento de al menos 6 meses. Todos los pacientes fueron radiografiados antes de la intervención, inmediatamente después de la operación, y después de 6meses. La técnica se realizó con protección del nervio lingual como parte del procedimiento quirúrgico. Todas las raíces quedaron al menos 3 mm por debajo de las tablas óseas bucal y lingual. No hubo ningún caso de daño del NAI. Hubo un caso de afectación transitoria del nervio lingual, probablemente por el uso del retractor lingual. Un paciente requirió la retirada posterior de las raíces de los terceros molares, debido a la falta cicatrización, y otro paciente requirió la retirada posterior de una raíz a causa de migración posterior ala superficie. La migración de las raíces se observó en aproximadamente el 30 % de los pacientes durante un período de 6 meses. La coronectomia parece ser una técnica viable en aquellos casos en que la extracción completa del diente podría poner al NAI en un riesgo considerable de daño. La técnica parece estar asociada con una baja incidencia de complicaciones, pero la migración posterior de las raíces puede ser un problema en el largo plazo.

The inferior alveolar nerve (IAN) injury to remove the third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. Coronectomy technique or intentional root retention, may minimize this problem. Thirty patients underwent coronectomy in 30 third molars with follow up of at least 6 months. Coronectomy technique deliberately protected the lingual nerve as part of the surgical procedure. All roots were at least 3 mm below the buccal and lingual bony walls. All patients were radiographed preoperatively, immediately postoperatively, and after 6 months. There were no cases of IAN damage involved in this study of 30 patients who underwent 30 coronectomies. There was one case of transient lingual nerve involvement, probably by the use of lingual retractor. One patient required subsequent removal of the roots of both lower third molars, due to lack of healing, and one patient required subsequent removal of a root cause of migration back to the surface. migration of the roots was observed in approximately 30 percent of patients during a period of six months. Coronectomy seems to be a viable technique in those cases where the removal of all tooth could put the IAN at considerable risk of damage. The technique appears to be associated with a low incidence of complications, but the subsequent migration of the roots can be a problem in the long term.

Coronectomia em terceiro molar inferior: relato de casos / Coronectomy in lower third molar: case reports

O princípio da coronectomia ou odontectomia parcial intencional é a remoção da coroa do dente, deixando a raiz in situ. Essa técnica, quando aplicada para a remoção de um terceiro molar ou qualquer dente posterior incluso na mandíbula, tem o intuito de evitar danos ao nervo alveolar inferior. O objetivo do presente estudo foi relatar dois casos clínicos de terceiro molar inferior incluso apresentando suas raízes em íntima relação com o canal mandibular, e, para o tratamento, foi realizada a técnica da odontectomia parcial intencional. Informações sobre o déficit neurosensorial, infecção pós-operatória, tempo do pós-operatório e a taxa de sucesso são enfatizadas no estudo. Conclui-se que a odontectomia parcial intencional é uma técnica previsível e de fácil execução, podendo ser realizada em ambiente ambulatorial. Trata-se de um procedimento alternativo, útil nas extrações de terceiros molares inferiores inclusos que apresentam relação de proximidade com o canal mandibular... (AU)

The principle of coronectomy or intentional partial odontectomy is the removal of the tooth crown, leaving the root in situ. This technique aims to prevent damage to inferior alveolar nerve while applying to removal a third molar or posterior tooth impacted in mandible. In this study, we report two clinical cases with the impacted lower third molar presented roots in close proximity to the mandibular canal and the treatment was performed by intentional partial odontectomy. Neurosensory deficits, postoperative infection, periods off follow up and surgical outcomes were emphasized in this study. We concluded that the intentional partial odontectomy is a foreseeable technique and easy to perform in an outpatient setting. It is an alternative procedure in the extraction of impacted lower third molar that has a close relationship with mandibular canal... (AU)

Anestesia local controlada en procedimientos de odontectomía / Controlled local anesthesia in odontectomy procedures

La cirugía de terceros molares (Odontectomía), es uno de los procedimientos más frecuentemente realizados en cirugía oral. La mayoría de las veces es realizada en el consultorio bajo anestesia local convencional. En algunas ocasiones a solicitud del paciente o por la complejidad del procedimiento se realiza en salas de cirugía bajo anestesia general. Sin embargo cierto numero de pacientes del grupo de anestesia local recuerda el procedimiento como algo traumático; otros pacientes no se someten al procedimiento por miedo o temor con las consecuencias patológicas que se pueden derivar de esto como la posibilidad de infecciones, migraciones dentarias, reabsorción radicular, resorción ósea, quistes y tumores, etc. La anestesia general es de mayor riesgo para el paciente, por la toxicidad de los agentes y medicamentos utilizados. Igualmente es mucho más costosa por la necesidad de contar con un anestesiólogo y una sala de cirugía. Una posibilidad intermedia es la realización del procedimiento en el consultorio con anestesia local controlada, utilizando además del anestésico convencional (lidocaína al 2 % con epinefrina 1:80.000), fentanyl 2mcg/kg y midazolam 0. 1mg/kg. En el presente estudio se obtuvieron 76 pacientes los cuales fueron monitorizados con oxímetro de pulso, presión arterial, frecuencia cardiaca y cardioscopio vigilados por un anestesiólogo, Las características de la sedación fueron excelentes en 60 pacientes (79%), buena en 14 pacientes (19%) y mala en 2 paciente (2,6%). No se presentó ningún efecto secundario en 22 pacientes (29%), somnolencia en 36 pacientes (47.4%), dificultad respiratoria leve en 8 pacientes (10%), mareo en 6 pacientes (7.9%), hipo en 2 pacientes (2.6%) y cefalea moderada transitoria en 2 pacientes (2,6%).

The molar third surgery, is one of the procedures most frequently accomplished in oral and maxillofacial surgery. Most of times is accomplished in the dental office under conventional local anesthesia. Occasionally to request of the patient or by the complexity of the procedure is accomplished in surgery rooms under general anesthesia. However, certain number of patients of the group of local anesthesia recalls the procedure as something traumatic; other patients reject the procedure by fear or dread with the pathological consequences that they can be derived from this as the possibility from infections, migrations, reabsorption, dental and bone resorption bony, cysts and tumors, etc. The resource of the general anesthesia is in and of itself a great resource morbidity for the patient, by the toxicity of the agents and used medicines. Equally it is much more costs by the need of counting on anaesthesiologic and a surgery room. An intermediate possibility is the accomplishment of the procedure in the doctor's office with controlled local anesthesia, using in addition to anaesthetic conventional (lidocaina to the 2% with epinephrine 1:80.000), fentany l2mcg/kg and midazolam 0,1 mg/kg. In the present study were taken 76 patient those which were monitored with oximeter of pulse, arterial pressure and cardiac frequency monitored by an anaesthesiologic. The characteristics of the sedation were excellent in 60 patient (79%), good in 14 patient (19%) and wrong in 2 patient (2.6%). There were not present any sound effect in 22 patient (29%), drowsiness in 36 patient (47.4%), mild respiratory difficulty in 8 patient (10%) dizziness in 6 patient (7.9%), checs spellis in 2 patient (2.6%) and transient cefalea in 2 patient (2.6%).