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INTRODUCCIÓN
La coronectomía se considera una alternativa a la extracción total en los casos donde las raíces de los terceros molares inferiores están en íntimo contacto con el nervio alveolar inferior. Existe incertidumbre sobre si la coronectomía disminuye la incidencia de parestesia en comparación a la extracción total.

MÉTODOS
Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE.

RESULTADOS Y CONCLUSIONES
Identificamos seis revisiones sistemáticas que en conjunto incluyeron 17 estudios primarios, de los cuales, dos corresponden a ensayos clínicos aleatorizados. Concluímos que la coronectomía en comparación a la extracción total de los terceros molares inferiores probablemente se asocia a un menor riesgo de parestesia. Además, no está claro si la coronectomía en comparación a la extracción total de terceros molares inferiores podría aumentar el riesgo de infección (certeza de la evidencia es muy baja).

Authors: Matías Dallaserra[1,2,3,4], Javier Cuéllar[3,4], Julio Villanueva[1,2,3,4]

Affiliation:
[1] Departamento de Cirugía y Traumatología Bucal y Maxilofacial, Facultad de Odontología, Universidad de Chile
[2] Centro Cochrane Asociado de la Facultad de Odontología, Universidad de Chile
[3] Unidad de Cirugía Máxilo Facial, Hospital Clínico San Borja Arriarán, Santiago, Chile
[4] Proyecto Epistemonikos, Santiago, Chile

E-mail: javm@uchile.cl

Author address:
[1] Centro Evidencia UC
Pontificia Universidad Católica de Chile
Diagonal Paraguay 476
Santiago
Chile

Citation: Dallaserra M, Cuéllar J, Villanueva J. Coronectomy for lower third molars surgery. Medwave 2020;20(06):e7957 doi: 10.5867/medwave.2020.06.7957

Submission date: 7/1/2020

Acceptance date: 7/6/2020

Publication date: 9/7/2020

Origin: This article is a product of the Evidence Synthesis Project of Epistemonikos Fundation, in collaboration with Medwave for its publication

Type of review: Non-blinded peer review by members of the methodological team of Epistemonikos Evidence Synthesis Project

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1. Cervera-Espert J, Pérez-Martínez S, Cervera-Ballester J, Peñarrocha-Oltra D, Peñarrocha-Diago M. Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Jul 1;21(4):e505-13.| Review. | PubMed | PMC |
2. Long H, Zhou Y, Liao L, Pyakurel U, Wang Y, Lai W. Coronectomy vs. total removal for third molar extraction: a systematic review. J Dent Res. 2012 Jul;91(7):659-65. | CrossRef | PubMed |
3. Ali AS, Benton JA, Yates JM. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature. J Oral Rehabil. 2018 Mar;45(3):250-257. | CrossRef | PubMed |
4. Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane DatabaseSyst Rev. 2014 Jul 29;(7):CD004345. | CrossRef | PubMed |
5. Martin A, Perinetti G, Costantinides F, Maglione M. Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review. Head Face Med. 2015 Apr 10;11:9. | CrossRef | PubMed | PMC |
6. Dalle Carbonare M, Zavattini A, Duncan M, Williams M, Moody A. Injury to the inferior alveolar and lingual nerves in successful and failed coronectomies: systematic review. Br J Oral Maxillofac Surg. 2017 Nov;55(9):892-898. | CrossRef | PubMed |
7. Pogrel MA, Lee JS, Muff DF. Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg. 2004 Dec;62(12):1447-52. | PubMed |
8. Frenkel B, Givol N, Shoshani Y. Coronectomy of the mandibular third molar: a retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure. J Oral Maxillofac Surg. 2015 Apr;73(4):587-94. | CrossRef | PubMed |
9. Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E. Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg. 2009 Sep;67(9):1806-14. | CrossRef | PubMed |
10. Dolanmaz D, Yildirim G, Isik K, Kucuk K, Ozturk A. A preferable technique for protecting the inferior alveolar nerve: coronectomy. J Oral Maxillofac Surg. 2009 Jun;67(6):1234-8. | CrossRef | PubMed |
11. Kohara K, Kurita K, Kuroiwa Y, Goto S, Umemura E. Usefulness of mandibular third molar coronectomy assessed through clinical evaluation over three years of follow-up. Int J Oral Maxillofac Surg. 2015 Feb;44(2):259. | CrossRef | PubMed |
12. Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2005 Feb;43(1):7-12. | PubMed |
13. Goto S, Kurita K, Kuroiwa Y, Hatano Y, Kohara K, Izumi M, Ariji E. Clinical and dental computed tomographic evaluation 1 year after coronectomy. J Oral Maxillofac Surg. 2012 May;70(5):1023-9. | CrossRef | PubMed |
14. Leung YY, Cheung LK. Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg. 2012 Jul;70(7):1515-22. | CrossRef | PubMed |
15. Patel V, Sproat C, Samani M, Kwok J, McGurk M. Unerupted teeth associated with dentigerous cysts and treated with coronectomy: mini case series. Br J Oral Maxillofac Surg. 2013 Oct;51(7):644-9. | CrossRef | PubMed |
16. Cilasun U, Yildirim T, Guzeldemir E, Pektas ZO. Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography. J Oral Maxillofac Surg. 2011 Jun;69(6):1557-61. | CrossRef | PubMed |
17. Monaco G, de Santis G, Gatto MR, Corinaldesi G, Marchetti C. Coronectomy: a surgical option for impacted third molars in close proximity to the inferior alveolar nerve. J Am Dent Assoc. 2012 Apr;143(4):363-9. | PubMed |
18. O'Riordan BC. Coronectomy (intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Sep;98(3):274-80. | PubMed |
19. Leung YY, Cheung LK. Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Dec;108(6):821-7. | CrossRef | PubMed |
20. Leung YY, Cheung LK. Coronectomy as the treatment of choice in wisdom teeth showing radiographic signs of close proximity to inferior dental nerve. Ann R Australas Coll Dent Surg. 2010 Mar;20:93-4. | PubMed |
21. Leung YY, Cheung LK. Can coronectomy of wisdom teeth reduce the incidence of inferior dental nerve injury? Ann R Australas Coll Dent Surg. 2008 Jun;19:50-1. | PubMed |
22. Kouwenberg AJ, Stroy LP, Rijt ED, Mensink G, Gooris PJ. Coronectomy of the mandibular third molar: Respect for the inferior alveolar nerve. J Craniomaxillofac Surg. 2016 May;44(5):616-21. | CrossRef | PubMed |
23. Agbaje JO, Heijsters G, Salem AS, Van Slycke S, Schepers S, Politis C, Vrielinck L. Coronectomy of Deeply Impacted Lower Third Molar: Incidence of Outcomes and Complications after One Year Follow-Up. J Oral Maxillofac Res. 2015 Jun 30;6(2):e1. | CrossRef | PubMed | PMC |
24. Leung YY, Cheung LK. Long-term morbidities of coronectomy on lower third molar. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):5-11. | CrossRef | PubMed |
25. Monaco G, De Santis G, Pulpito G, Gatto MR, Vignudelli E, Marchetti C. What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study. J Oral Maxillofac Surg. 2015 Jul;73(7):1246-53. | CrossRef | PubMed |
26. Sociedad Española de Cirugía Bucal. Diagnóstico e Indicaciones para la Extracción de los Terceros Molares. Biblioteca de guías de práctica clínica del sistema nacional de salud Nº ID: 569;2017.
27. Lopes V, Pitros P, O'Connor N. A systematic review of the complications of high- risk third molar removal and coronectomy; development of a decision tree model and preliminary health economic analysis to assist in treatment planning. PROSPERO 2018 CRD42018087510.
28. Jorba-García A, Traboulsi-Garet B, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Incidence of lingual and inferior alveolar nerve injury after third molar extraction surgery. A systematic review and meta-analysis. PROSPERO 2019 CRD42019120138.
29. Sarikov R. Inferior alveolar nerve injury after mandibular third molar extraction. PROSPERO 2014 CRD42014014231.
30. Nianhui C, Ziyu Y. Inferior alveolar nerve injuries after coronectomy of mandibular third molar: a quantitative sensory testing study. [ChiCTR1800014862].
31. Cheung L, Leung Y. Safety of Coronectomy v/s Excision of Wisdom Teeth. [NCT00752284].

Cervera-Espert J, Pérez-Martínez S, Cervera-Ballester J, Peñarrocha-Oltra D, Peñarrocha-Diago M. Coronectomy of impacted mandibular third molars: A meta-analysis and systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Jul 1;21(4):e505-13.| Review. | PubMed | PMC |

Long H, Zhou Y, Liao L, Pyakurel U, Wang Y, Lai W. Coronectomy vs. total removal for third molar extraction: a systematic review. J Dent Res. 2012 Jul;91(7):659-65. | CrossRef | PubMed |

Ali AS, Benton JA, Yates JM. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature. J Oral Rehabil. 2018 Mar;45(3):250-257. | CrossRef | PubMed |

Coulthard P, Bailey E, Esposito M, Furness S, Renton TF, Worthington HV. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane DatabaseSyst Rev. 2014 Jul 29;(7):CD004345. | CrossRef | PubMed |

Martin A, Perinetti G, Costantinides F, Maglione M. Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review. Head Face Med. 2015 Apr 10;11:9. | CrossRef | PubMed | PMC |

Dalle Carbonare M, Zavattini A, Duncan M, Williams M, Moody A. Injury to the inferior alveolar and lingual nerves in successful and failed coronectomies: systematic review. Br J Oral Maxillofac Surg. 2017 Nov;55(9):892-898. | CrossRef | PubMed |

Pogrel MA, Lee JS, Muff DF. Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg. 2004 Dec;62(12):1447-52. | PubMed |

Frenkel B, Givol N, Shoshani Y. Coronectomy of the mandibular third molar: a retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure. J Oral Maxillofac Surg. 2015 Apr;73(4):587-94. | CrossRef | PubMed |

Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E. Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg. 2009 Sep;67(9):1806-14. | CrossRef | PubMed |

Dolanmaz D, Yildirim G, Isik K, Kucuk K, Ozturk A. A preferable technique for protecting the inferior alveolar nerve: coronectomy. J Oral Maxillofac Surg. 2009 Jun;67(6):1234-8. | CrossRef | PubMed |

Kohara K, Kurita K, Kuroiwa Y, Goto S, Umemura E. Usefulness of mandibular third molar coronectomy assessed through clinical evaluation over three years of follow-up. Int J Oral Maxillofac Surg. 2015 Feb;44(2):259. | CrossRef | PubMed |

Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2005 Feb;43(1):7-12. | PubMed |

Goto S, Kurita K, Kuroiwa Y, Hatano Y, Kohara K, Izumi M, Ariji E. Clinical and dental computed tomographic evaluation 1 year after coronectomy. J Oral Maxillofac Surg. 2012 May;70(5):1023-9. | CrossRef | PubMed |

Leung YY, Cheung LK. Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg. 2012 Jul;70(7):1515-22. | CrossRef | PubMed |

Patel V, Sproat C, Samani M, Kwok J, McGurk M. Unerupted teeth associated with dentigerous cysts and treated with coronectomy: mini case series. Br J Oral Maxillofac Surg. 2013 Oct;51(7):644-9. | CrossRef | PubMed |

Cilasun U, Yildirim T, Guzeldemir E, Pektas ZO. Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography. J Oral Maxillofac Surg. 2011 Jun;69(6):1557-61. | CrossRef | PubMed |

Monaco G, de Santis G, Gatto MR, Corinaldesi G, Marchetti C. Coronectomy: a surgical option for impacted third molars in close proximity to the inferior alveolar nerve. J Am Dent Assoc. 2012 Apr;143(4):363-9. | PubMed |

O'Riordan BC. Coronectomy (intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Sep;98(3):274-80. | PubMed |

Leung YY, Cheung LK. Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Dec;108(6):821-7. | CrossRef | PubMed |

Leung YY, Cheung LK. Coronectomy as the treatment of choice in wisdom teeth showing radiographic signs of close proximity to inferior dental nerve. Ann R Australas Coll Dent Surg. 2010 Mar;20:93-4. | PubMed |

Leung YY, Cheung LK. Can coronectomy of wisdom teeth reduce the incidence of inferior dental nerve injury? Ann R Australas Coll Dent Surg. 2008 Jun;19:50-1. | PubMed |

Kouwenberg AJ, Stroy LP, Rijt ED, Mensink G, Gooris PJ. Coronectomy of the mandibular third molar: Respect for the inferior alveolar nerve. J Craniomaxillofac Surg. 2016 May;44(5):616-21. | CrossRef | PubMed |

Agbaje JO, Heijsters G, Salem AS, Van Slycke S, Schepers S, Politis C, Vrielinck L. Coronectomy of Deeply Impacted Lower Third Molar: Incidence of Outcomes and Complications after One Year Follow-Up. J Oral Maxillofac Res. 2015 Jun 30;6(2):e1. | CrossRef | PubMed | PMC |

Leung YY, Cheung LK. Long-term morbidities of coronectomy on lower third molar. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan;121(1):5-11. | CrossRef | PubMed |

Monaco G, De Santis G, Pulpito G, Gatto MR, Vignudelli E, Marchetti C. What Are the Types and Frequencies of Complications Associated With Mandibular Third Molar Coronectomy? A Follow-Up Study. J Oral Maxillofac Surg. 2015 Jul;73(7):1246-53. | CrossRef | PubMed |

Sociedad Española de Cirugía Bucal. Diagnóstico e Indicaciones para la Extracción de los Terceros Molares. Biblioteca de guías de práctica clínica del sistema nacional de salud Nº ID: 569;2017.

Lopes V, Pitros P, O'Connor N. A systematic review of the complications of high- risk third molar removal and coronectomy; development of a decision tree model and preliminary health economic analysis to assist in treatment planning. PROSPERO 2018 CRD42018087510.

Jorba-García A, Traboulsi-Garet B, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Incidence of lingual and inferior alveolar nerve injury after third molar extraction surgery. A systematic review and meta-analysis. PROSPERO 2019 CRD42019120138.

Sarikov R. Inferior alveolar nerve injury after mandibular third molar extraction. PROSPERO 2014 CRD42014014231.

Nianhui C, Ziyu Y. Inferior alveolar nerve injuries after coronectomy of mandibular third molar: a quantitative sensory testing study. [ChiCTR1800014862].

Cheung L, Leung Y. Safety of Coronectomy v/s Excision of Wisdom Teeth. [NCT00752284].