Third Molar Coronectomy in a Patient with Florid Osseous Dysplasia: A New Application for a known Technique
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 4
Abstract
Coronectomy, a surgical technique that has been developed for impacted mandibular third molars that their roots are in intimate vicinity to the inferior alveolar nerve, refers to the removal of the tooth crown while retaining the root/s within the jawbones. We report the first case in which coronectomy was successfully used to treat a case of a partially impacted mandibular third molar with recurrent pericoronitis in a patient diagnosed with florid osseous dysplasia. In this condition the involved bone features poor cellularity and vascularity, therefore increasing the risk of abnormal healing and secondary infection following surgical procedures. We suggest that coronectomy should be considered also in other conditions that affect the quality of the jawbones that result in contraindication for complete third molar extraction.Coronectomy has been developed as a relatively new treatment modality for mandibular third molars, when surgery is necessary in case of an intimate anatomic proximity between the inferior alveolar nerve (IAN) and the roots of these teeth [1,2]. The procedure of coronectomy intentionally retains the roots and the rational is to decrease the prevalence of IAN injury compared with the conventional total removal of the lower third molar [3]. Osseous dysplasias are a group of idiopathic processes located in the tooth-bearing areas characterized by replacement of normal bone by fibrous tissue and metaplastic bone[4] When osseous dysplasias occur bilaterally in the mandible or even involving all jaw quadrants, the condition was termed as florid osseous dysplasia (FOD) and was first described by Melrose et al [5]. FOD is commonly seen in middle aged black females and is quite rare in Caucasians and Asians [4,6,7]. These lesions are clinically asymptomatic and may be found as incidental radiological findings presenting as multilocular radiopaque lesions within peripheral radiolucent lesions located in two or more quadrants usually in tooth-bearing areas [4,6]. Lesions are not always limited to the periapical alveolar bone and they also can involve the interradicular bone up to the level of the cemento- enamel junction. Rarely, the patient may complain of dull pain and alveolar sinus tract may be present, consequent to the progressive alveolar atrophy under ill-fitted denture or following extraction of teeth in the affected area [8]. Although biopsy is required for definitive diagnosis, clinicians generally try to avoid surgical procedures in FOD patients as these might lead to unsatisfactory healing and infection due to the poor cellularity and vascularity of the bone [9]. Therefore, in some FOD cases, the diagnosis is established based on characteristic radiological features without histopathologic confirmation [10]. It is the purpose of this study to report for the first time the use of coronectomy in a FOD patient with lower jaw third molar chronic pericoronitis aimed to avoid alveolar bone infection and atrophy due to the extraction procedure.
Authors and Affiliations
Adrian Kahn, Ronen Mogilner, Lazar Kats, Dan Dayan
Keywords
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- EP ID EP591802
- DOI 10.26717/BJSTR.2018.09.001844
- Views 155
- Downloads 0
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