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Terceiros molares inclusos: coronectomia vs exodontia
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| Projeto de pós-graduação_39617 | 513.82 KB | Adobe PDF |
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Abstract(s)
A remoção de terceiros molares erupcionados, parcialmente impactados ou totalmente impactados continua a ser uma das operações de cirurgia oral mais comuns. Embora o procedimento seja amplamente praticado, pode resultar em diversas complicações, incluindo danos nos nervos alveolar inferior e lingual. Estes acidentes são frequentemente causados pela íntima relação entre o nervo e as raízes dos dentes. A técnica de coronectomia foi proposta como uma maneira de remover a coroa de um dente enquanto preserva as raízes, reduzindo assim a possibilidade de danos nervosos. As radiografias panorâmicas podem revelar sinais associados a um alto risco de lesão nervosa durante a remoção. O primeiro conjunto de indicadores da possível conexão inclui escurecimento da raiz, deflexão da raiz, estreitamento da raiz e estreitamento do canal do nervo. A tomografia computorizada de feixe cónico pré-operatória oferece estimativas de risco mais concretas e a sua eficácia é maior comparativamente à radiografia panorâmica. Assim, o objetivo desta revisão sistemática é avaliar se a coronectomia pode ser considerada uma técnica fiável para reduzir as lesões do nervo alveolar inferior, avaliando adicionalmente as restantes complicações que podem surgir. Para isso, foi efetuada uma pesquisa bibliográfica nas bases de dados PubMed e Elsevier utilizando os critérios PICO, onde a população estudada incluiu indivíduos que necessitam de extração de terceiros molares e que apresentam possível dano para o nervo alveolar inferior. A intervenção analisada foi a coronectomia dos terceiros molares, comparada com a exodontia de terceiros molares em contacto com o nervo alveolar inferior. O outcome considerado foi a incidência de lesão do nervo alveolar inferior, bem como possíveis complicações pós-cirúrgicas. Foram incluídos sete estudos clínicos, prospetivos e retrospetivos publicados nos últimos 10 anos. A sua avaliação metodológica foi feita através das ferramentas elaboradas pelo Joanna Briggs Institute. Da análise destes estudos verifica-se que a técnica de coronectomia, ou odontectomia parcial intencional, reduz de maneira significativa, comparada à exodontia, os riscos de lesões ou danos ao nervo alveolar inferior, bem como as complicações que podem surgir posteriormente. No entanto, deve-se ter em conta que o sucesso desta técnica depende não só da habilidade técnica do médico dentista, como também da correta indicação e seleção do paciente, pelo que se deve realizar uma avaliação pré-operatória bastante cuidadosa, com a ajuda de exames de imagem, para a obtenção de diagnóstico e indicação da coronectomia.
Removal of erupted, partially impacted, or fully impacted third molars remains one of the most common oral surgery procedures. Although widely performed, this procedure can lead to several complications, including damage to the inferior alveolar and lingual nerves. These injuries often result from the close relationship between the nerve and the tooth roots. The coronectomy technique has been proposed as a method to remove the tooth crown while preserving the roots, thereby reducing the likelihood of nerve damage. Panoramic radiographs may reveal indicators of a high risk of nerve injury during removal, such as root darkening, root deflection, root narrowing, and narrowing of the nerve canal. Preoperative cone beam computed tomography provides more accurate risk assessments and has greater effectiveness compared to panoramic radiography. The aim of this systematic review is to evaluate whether coronectomy can be considered a reliable technique for reducing inferior alveolar nerve injuries, while also assessing other complications that may arise. A bibliographic search was conducted in the PubMed and Elsevier databases using the PICO criteria, where the studied population included individuals requiring third molar extraction and presenting a potential risk of inferior alveolar nerve injury. The intervention analyzed was third molar coronectomy, compared with third molar extraction in cases where the tooth is in contact with the inferior alveolar nerve. The considered outcome was the incidence of inferior alveolar nerve injury, as well as possible post-surgical complications. Seven clinical, prospective, and retrospective studies published in the last 10 years were included. Their methodological assessment was conducted using tools developed by the Joanna Briggs Institute. The analysis of these studies indicates that coronectomy, or intentional partial odontectomy, significantly reduces, compared to extraction, the risks of injuries or damage to the inferior alveolar nerve, as well as complications that may arise postoperatively. However, the success of this technique depends not only on the technical skill of the dentist but also on the correct indication and patient selection. Therefore, a thorough preoperative evaluation, supported by imaging exams, is crucial to determine the diagnosis and suitability for coronectomy.
Removal of erupted, partially impacted, or fully impacted third molars remains one of the most common oral surgery procedures. Although widely performed, this procedure can lead to several complications, including damage to the inferior alveolar and lingual nerves. These injuries often result from the close relationship between the nerve and the tooth roots. The coronectomy technique has been proposed as a method to remove the tooth crown while preserving the roots, thereby reducing the likelihood of nerve damage. Panoramic radiographs may reveal indicators of a high risk of nerve injury during removal, such as root darkening, root deflection, root narrowing, and narrowing of the nerve canal. Preoperative cone beam computed tomography provides more accurate risk assessments and has greater effectiveness compared to panoramic radiography. The aim of this systematic review is to evaluate whether coronectomy can be considered a reliable technique for reducing inferior alveolar nerve injuries, while also assessing other complications that may arise. A bibliographic search was conducted in the PubMed and Elsevier databases using the PICO criteria, where the studied population included individuals requiring third molar extraction and presenting a potential risk of inferior alveolar nerve injury. The intervention analyzed was third molar coronectomy, compared with third molar extraction in cases where the tooth is in contact with the inferior alveolar nerve. The considered outcome was the incidence of inferior alveolar nerve injury, as well as possible post-surgical complications. Seven clinical, prospective, and retrospective studies published in the last 10 years were included. Their methodological assessment was conducted using tools developed by the Joanna Briggs Institute. The analysis of these studies indicates that coronectomy, or intentional partial odontectomy, significantly reduces, compared to extraction, the risks of injuries or damage to the inferior alveolar nerve, as well as complications that may arise postoperatively. However, the success of this technique depends not only on the technical skill of the dentist but also on the correct indication and patient selection. Therefore, a thorough preoperative evaluation, supported by imaging exams, is crucial to determine the diagnosis and suitability for coronectomy.
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Keywords
Terceiro molar Impactado Nervo alveolar inferior Lesão Extração dentária Coronectomia Third molar Impacted Inferior alveolar nerve Injury Tooth extraction Coronectomy