Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Tony Pogrel, who is here to discuss benefits of coronectomy surgery. Dr. Pogrel, thank you so much for being here. 

Dr. Tony Pogrel: It’s great to be here. Thank you, Bill. 

Bill Klaproth: Absolutely, great to talk to you about this subject. So tell us, what is a coronectomy? 

Dr. Tony Pogrel: Literally, removal of a crown. It’s a nice Greek word; coroner comes from the same origin. So coronectomy is removal of the crown, in this case the crown of a tooth. 

Bill Klaproth: OK, I’ve got several of them. So, if you ever need to remove one of my crowns, it’s called a coronectomy? 

Dr. Tony Pogrel: Correct. 

Bill Klaproth: I love it. OK. When would you need to remove a crown or do a coronectomy? 

Dr. Tony Pogrel: The type of coronectomy we’re talking about here is not an artificial crown on a tooth. It’s the actual, real crown of your tooth. 

Bill Klaproth: Aha, that is a good distinction. 

Dr. Tony Pogrel: Yes. So we have a tooth where we don’t want to remove the whole tooth for some reason. We only want to remove the top half of the tooth and actually leave the roots behind. And that is essentially a coronectomy. 

Bill Klaproth: So when would you need to perform a coronectomy on a natural tooth? 

Dr. Tony Pogrel: Normally when you don’t want to remove the roots of a tooth, you just want to remove the crown. And that would occur mainly with lower wisdom teeth, but occasionally with the teeth in front, the second molars or even more occasionally the first molars. And the reason you’re doing that in the lower jaw is to avoid injuring the inferior alveolar nerve. Because the lower jaw is kind of unique in the body. It’s got a nerve that runs right in the middle of it, and an artery and veins for that matter. They’re in a canal right in the middle of the bone. And sometimes the roots of a tooth can get very close or even into the nerve canal, and we don’t want to damage that nerve. 

Bill Klaproth: So that is why removing the entire tooth sometimes is not the best choice, and that’s why a coronectomy is necessary? 

Dr. Tony Pogrel: That’s absolutely correct. Yes. 

Bill Klaproth: OK. So then in that procedure, you remove the top of the tooth, the crown of the tooth. What do you do then? 

Dr. Tony Pogrel: You need to remove a little bit more than the crown, and you’ve got to remove the top end of the roots. So the roots that are left behind are buried in the bone. And if you do that, and you bury it 3 or 4 mm – I’m afraid we’ve gone metric we don’t measure in inches anymore. But 3 or 4 mm below the bone, it will heal over in a normal way, and hopefully it will cause no problems for the rest of your life. 

Bill Klaproth: That tooth will heal over on its own? 

Dr. Tony Pogrel: Those roots will heal over, yes, so long as they’re buried in the bone. Yes. 

Bill Klaproth: Wow. Alright, so what does a patient need to know about the coronectomy procedure before you begin one? 

Dr. Tony Pogrel: Well, it needs to have a full evaluation. So normally, this will involve plain X-rays, but also in this day and age, something called a cone-beam computed tomography X-ray or CBCT. And this shows the tooth in three dimensions and shows exactly the relationship between this nerve and the roots. And if it shows the roots are, for want of a better word, intimately involved with the nerve, then your surgeon may suggest a coronectomy. And if they do, it’s very similar surgery to actually having the whole tooth out. It’s normally carried out under local anesthesia. You can be sedated if you want to be. Normally takes 20 to 25 minutes to do. And healing takes three or four days. 

Bill Klaproth: That’s interesting. I would think that it would take longer than that for this procedure. 

Dr. Tony Pogrel: No, it takes a couple of minutes longer than actually removing the tooth. It’s actually a little bit more difficult to remove half the tooth – to remove the whole tooth. 

Bill Klaproth: OK. So what are the symptoms that somebody would present with that would show you that someone would need a coronectomy? 

Dr. Tony Pogrel: We’re talking mainly predominantly about third molars, which are the wisdom teeth. So they’d be complaining of discomfort, sometimes outright pain, maybe swelling, maybe infection. Wisdom teeth can present in a variety of ways, but usually it’s a more vague discomfort that they feel at the back of the lower jaw. 

Bill Klaproth: So you’ve got to make a decision then, because most of the time, you’re talking about molars, right, wisdom teeth? 

Dr. Tony Pogrel: Correct. 

Bill Klaproth: Sometimes you have to get wisdom teeth out, sometimes it’s OK to leave them in and perform a coronectomy then? 

Bill Klaproth: All three of those options: leaving them in, doing a coronectomy, removing the whole tooth. A lot of it’s age-dependent. Let’s remember that most people get their wisdom teeth out in the late teens. It’s almost just a tradition, almost a rite of passage. And at that age, they’re relatively easy to remove. The bone is still fairly soft, it will give way, and the roots of the teeth are usually not fully formed. So they often don’t go down as far as the inferior alveolar nerve. But if you want your wisdom teeth out when you’re 35 or 45, by that time the bone is less forgiving. It’s more rigid. It’s a little bit more brittle. I mean 45 doesn’t seem old, but in biological terms, you’re getting up there. 

The other thing is the roots of the teeth are more fully formed and may have grown right down to the nerve. And that’s when you have to evaluate whether you should remove the tooth at all. And if so, should it be a coronectomy and leave those roots in the nerve alone, or whether you should attempt to remove the whole tooth. 

Bill Klaproth: Wow. Does anybody ever say to you, I want you to remove the whole tooth and nothing but the tooth? 

Dr. Tony Pogrel: Some purists don’t like leaving little bits of teeth behind. I mean, let’s face it, when I was a dental student, we were taught not to leave bits of teeth behind in the jaws. And we changed our minds over the years. We now know that it’s, as long as you do it properly and scientifically, it’s perfectly safe to leave roots behind in the jawbones. 

Bill Klaproth: So as far as postoperative care then, what steps need to be taken? 

Dr. Tony Pogrel: Well, very little because we always stitch the wound together at the end. So there’s no actual hole to look at; it’s all sewn over. So it’s very similar to having a regular wisdom tooth out. You need to keep your mouth clean for three or four days. Because if this was on your skin, we’d have put a Band-Aid on it. We don’t have Band-Aid for the mouth, so you’ve just got to keep it as clean as you can. Nature is wonderful, and it will heal it for you. 

Bill Klaproth: And you said the tooth does repair itself or heal itself, as well. 

Dr. Tony Pogrel: Yes, the bone grows over those roots. Take an X-ray in two or three years, you’ll see, it’s buried in the bone and there’s bone above it. 

Bill Klaproth: OK. So then what are the benefits of coronectomy surgery for someone facing this? 

Dr. Tony Pogrel: The main benefit is a much lower risk of damaging the inferior alveolar nerve. And that nerve is not a motor nerve. It doesn’t move anything. But it gives sensation to your gum on that side. But more importantly than the gum is your lower lip on that side. So if that nerve is damaged, you will have some numbness in your lower lip and chin. And although that’s usually temporary, it can occasionally be permanent. So the main benefit of coronectomy is you don’t have that risk. 

Bill Klaproth: So you don’t want to disrupt that nerve. You don’t want to damage that nerve because it could result in lower lip numbness and chin as well, which you said generally will resolve. But if that hangs on, that would be tough to live with. 

Dr. Tony Pogrel: And even more than that, sometimes it’s not just numbness. They get funny feelings, tingling feelings, pins and needles feelings, which some people find very annoying. 

Bill Klaproth: Absolutely. How often do you have to do a coronectomy? 

Dr. Tony Pogrel: As I say, it’s normally not for the teenagers, the ones that are having their wisdom teeth out at the normal age. It’s the ones that are having them out later in life. 

Bill Klaproth: The old 45-year-olds. 

Dr. Tony Pogrel: You got it, yes. 

Bill Klaproth: If they’re 45; they’re getting up there. 

Dr. Tony Pogrel: You’ve got it. If you run that kind of dental practice, you’re going to run into those kinds of patients. 

Bill Klaproth: That is good to know. Anything you want to add about coronectomy surgery? 

Dr. Tony Pogrel: No, it’s a fair – I mean, you would think it’s an old-fashioned procedure, but it’s actually only gained popularity in the last 15 years. In fact, the American Dental Association only accepted it as a conventional treatment in 2011. So, it’s still fairly new in some aspects. Some dentists are still a bit suspicious of it. But it does seem to be a very viable technique, and it works and does protect the nerve. 

Bill Klaproth: So, 15 years ago, it was two options: leave the tooth/remove the tooth. 

Dr. Tony Pogrel: That’s correct. 

Bill Klaproth: Alright. See, I’m a fast learner, Dr. Pogrel. How about that? 

Dr. Tony Pogrel: Impressive. Very impressive. 

Bill Klaproth: Well, thank you. I appreciate that. Thank you so much for your time. This has been great. 

Dr. Tony Pogrel: It’s been an absolute pleasure. Thank you, Bill. 

Bill Klaproth: You bet. Once again, that is Dr. Tony Pogrel. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast helpful, please share it on your social channels, and don’t forget to subscribe. 

Thanks for listening.