Oral surgery - Coronectomy

The problem

The wisdom tooth is usually the last tooth to appear into the mouth any time after about 16 years of age.

Often there is not enough room to fit wisdom teeth and as such they do not come into the mouth normally.

When this happens, the wisdom teeth are said to be “impacted” (stuck).

Wisdom teeth are usually either stuck facing forwards into the tooth in front or backwards into the jaw bone.

An impacted wisdom tooth can cause many attacks of infection in the gum around the tooth, causing pain and swelling.

What is a coronectomy?

A coronectomy is a procedure where the top of the wisdom tooth is removed, leaving the tooth roots behind trying to reduce the risk of nerve damage.

Why do I need a coronectomy?

Lower wisdom teeth can lie close to the nerve inside the jawbone which supplies the feeling but not the movement to the lower lip and chin.

We can see this nerve on a normal x-ray but sometimes a special scan called a cone beam CT is also taken to give a 3D picture of the position of the nerve to the tooth roots.
 
If the roots of your lower wisdom tooth are thought to be close to the nerve, then you may be offered a coronectomy instead of fully removing the tooth. Deliberately leaving the roots behind lowers the risk of bruising or stretching the nerve.

This can greatly reduce the risk of permanent lip, chin, cheek, gums and tongue numbness or tingling that can happen after wisdom tooth removal. There are only certain times where this procedure is recommended.

If the tooth is decayed (bad) or has a nerve which has died, the roots will not be healthy and cannot be left behind.

If left untreated an impacted (stuck) wisdom tooth will continue to cause attacks of infection and pain.

Food getting stuck around the tooth can occur, which causes more decay in the wisdom tooth or tooth in front.

What does treatment involve?

As the wisdom tooth has not fully grown into the mouth, a small cut in the gum will be made, bone around the tooth is gently drilled away.

The top of the tooth is removed with the drill and the root surface that is left will be smoothed down.

The gum is then put back into place and stitched.

The procedure usually takes 30-40 minutes.

What can I expect after the procedure?

Swelling

This is the most common side effect and usually lasts for up to 14 days. The amount of swelling differs from patient to patient. The application of an ice pack during the first 24 hours after the surgery may help. Do not apply the ice pack directly to your skin but wrap the ice pack in a towel first.

Limited mouth opening

This is because of swelling and often settles once the swelling disappears. During this time when your mouth opening is limited you may have to change your diet, eating soft foods.

Bleeding

Although there may be a little bleeding at the time of the surgery this usually stops very quickly and is unlikely to be a problem if the area is stitched.

Should the area bleed again when you get home this can usually be stopped by putting pressure over the area for at least 10 minutes with a rolled-up damp handkerchief or swab. Swabs will be given by the department before you leave. If the bleeding does not stop, please contact the department. Exercise, heavy lifting and alcohol should be avoided for 24 hours.

Infection

You must keep your mouth as clean as possible to stop the risk of infection by brushing twice a day and using hot saltwater mouthwashes. We also ask you not to smoke for at least 24 hours.

You will be given a leaflet on the day of the surgery with all the after surgery instructions to follow.

Nerve Injury

Two nerves lie close to wisdom teeth. One provides feeling to your tongue and the other gives feeling to the lower lip and skin over the chin. These nerves may be bruised during tooth removal. A coronectomy reduces the chances of numbness to the lip and chin.

If the nerves are bruised, you may either have numbness or pins and needles in the tongue, lower lip, skin over the chin or a mix of these. Most of the time it is short lived, but it can take up to 18 months to get better. Sometimes it may not fully recover and patients may be left with patches of numbness.

It is possible that the wisdom tooth roots will have to be removed at the time of surgery if they are loose. The roots may also become infected in the future and need removing. If this happens, they usually rise upwards, away from the nerve, reducing the risk of numbness that may happen.

Contact

Oral Surgery
Appointment enquiries - 0161 206 4100
Pain after treatment - 0161 206 8203/0161 206 4733
Email: Oral.surgery2@nca.nhs.uk

Accident & Emergency (A&E)
0161 206 4841