PDF: Lower third molar surgery – consent and coronectomy

This article reports a brief overview of the risks associated with lower third molar extractions, and the claims that coronectomy may be useful as a treatment modality in managing some aspects of those risks. 

It discusses the position in terms of consent, and reports that some cases suggest that clinicians who do not offer coronectomy in appropriate circumstances may be vulnerable to litigation.

Lower third molar extractions can be associated with a significant degree of posttreatment morbidity. Some is not dissimilar to that of more routine extractions and tends to be self-limiting, commonly posttreatment swelling, bruising, bleeding, jaw stiffness, and pain.

More significantly they can be associated with iatrogenic injury to the inferior alveolar nerve (IANI), leading to a temporary or permanently altered sensation to the lower lip, the skin over the chin, the teeth and gingivae on the injured side.

The degree and description of altered sensation is variable and includes reduced sensation (hypo-aesthesia), abnormal sensation (paraesthesia) and unpleasant painful sensation (dysaesthesia).

Although the percentage risk is relatively low, extraction of lower third molars is a very common procedure and it is argued that a significant number of patients may be affected by IANI.

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