The Need Of Root Canal Treatment After Coronectomy In Mandibular Third Molars
Condition: Inferior Alveolar Nerve Injuries; Root Canal Treatment; Paresthesia; Third Molar; Impacted Third Molar Tooth; Coronectomy
MeSH terms: Mandibular Nerve Injuries; Paresthesia
Study type: Interventional

Summary: 
      The study included 24 patients with written and verbal consent Results with close proximity
      to IAN diagnosed based on radiographs and evaluation on the criteria of Howe, and Poyton were
      selected and divided into two groups by lottery method into coronectomy and coronectomy with
      root canal treatment following coronectomy groups. Patients were re-evaluated on three weeks
      for complications and three months follow-ups for radiographic evaluations of root-fragment
      migration
    

Detailed description: 
      The study enrolled 24 patients with written and verbal consent, out of which 15 were females
      and 9 were males aged between 18-30 years, with a mean age of males 24 ± 2.6 years and
      females 23.5 ± 2.8 years. Ethical approval was taken from the ethical review board of
      Altamash Institute of Dental Medicine with IRB No: AIDM/ERC/12/2022/04.

      A total of 24 impacted mandibular teeth from 24 Patients with close proximity to IAN
      diagnosed based on radiographs and evaluation on the criteria of Howe and Poyton4 were
      selected for the purpose of this study. The timeline of the study was between January 2021
      till January 2022.

      The estimated sample size calculated for the study was 12 (6 participants in each group)
      which was raised to minimum of 24 (12 participants in each group). The calculations were
      performed using 12.5% as a proportion of infection in the control group and 87.5% as the
      proportion of infection in experimentation group from the study published by Sencimen et al.1
      The software used for the sample size estimation was STATA 13.0 using "pearson's chi-squared
      test for two-samples proportions test". The following parameters were considered:

      Alpha = 0.05 Power = 0.8 Delta = 0.75 Proportions of control group = 0.125 (12.5%)
      Proportions of Experimental group = 0.875 (87.5%) Considering the high lost to followup cases
      into account the sample size was raised to 24 participants with one tooth per individual.
      (ANNEXURE-I)

      Patients were diagnosed and then referred to the Oral Maxillofacial department of Altamash
      Institute of Dental Medicine. Twenty-four patients with 24 impacted mandibular third molars
      were equally divided into a control group and a study group. Twelve patients in the study
      group had their root canal treatment after coronectomies while the other half, the control
      group only had their coronectomies done without any further procedure performed.

      All the participants were equally divided into a control group and a study group by making
      them pick concealed envelopes containing a participant code for the participant allocation
      into groups. The experimental group contained twelve participants who had root canal
      treatment following coronectomies, while on the other hand, only coronectomies were performed
      in the rest of the participants without root canal treatment.

      Patients who were willing and cooperative, along with no known uncontrolled medical
      conditions and no history of radiotherapy in the head and neck region, were included as a
      part of this research, while patients who showed resistance or were uncooperative, gave a
      history of uncontrolled medical condition, showed signs of local pathology or infection,
      history of radiotherapy in head and neck area were excluded from being included in the study.

      All surgical procedures were performed under local anesthesia by the same surgeon. None of
      the patients were prescribed prophylactic antibiotics but were give a chlorhexidine mouth was
      a given before the procedure. Patients were prescribed post operative antibiotics with
      analgesics and thorough written instructions for proper wound care. A buccal approach for
      coronectomy was performed for all of them by the surgeon. Furthermore, all the endodontic
      treatment was performed by the same endodontist.

      In the study group, the endodontist performed a pulpectomy and used a hypochlorite solution
      for irrigation of the canals. Finally, gutta-percha (GP) was used as a canal-filling
      material. All procedures performed by the endodontic followed the aseptic conditions and
      protocol.

      The surgeon decided on a buccal approach with a three-cornered envelope incision resulting in
      a full thickness mucoperiosteal flap. The incision and eventually the flap was raised
      following the principles of incision and flap in order to promote a clean surgery leading to
      an uneventful and complication-free healing. The crown along the dental follicle was
      eliminated in addition to removing one-third of the root coronally.

      The clinician decided on establishing a tilted or angled slope, the level of the slope
      descending lingually via buccal surface. This inclination resulted in a discrepancy of about
      3-4mm in the levels of the corresponding root surfaces, consequence of which was a formation
      of a sharp edge on the buccal root surface. While the lingual root was 3-4mm below the
      lingual alveolar crest level. To compensate for the height, difference the buccal and lingual
      root surfaces, a reduction in the height of the buccal surface was performed in order to
      match with the lowered lingual root portion. Winding up the surgery with copious irrigation
      with saline followed by primary wound closure The mentioned step was carried out for both the
      study and the control group but in the in the study group, after removal of the pulp and
      biomechanical preparation, the canals were filled with GP. Multiple periapical radiographs
      were taken during endodontic procedure to ensure the correct filling of the canals and
      optimum filling till the apices.

      More over the surgeon made a point to use a sharp bur for every operation in order to excise
      the crown without mobilizing the roots. In the control group the pulp was left in place.
      Follows up initially third week followed by sixth month were done with the help of panoramic
      radiograph.
    

Intervention name(s): coronectony; root canal treatment
Intervention type(s): Procedure; Procedure
Intervention description(s): root canal treatment; root canal treatment
Other intervention name(s): procedure; rct
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other