011: Root Management After A Coronectomy

Hey everyone, I recently had a viewer ask me a great follow-up question to my video about performing coronectomies on lower third molars. They wanted to know how often patients need to come back to have the retained roots removed after a coronectomy, and how long they should wait before doing so.

I initially misunderstood and thought they were asking about the timing of the post-op visit, which I'll quickly address. I like to see coronectomy patients back at one week post-op to check their healing and make sure there's no sign of infection. I also take a post-op x-ray at this visit for insurance purposes. Most insurers require this to reimburse for the procedure.

But back to the original question about removing roots - the key thing to understand is that after a coronectomy, there are two possible outcomes:

1. The roots remain in place and the site heals over them with no issues. This is the ideal scenario.

2. The roots start causing problems like pain, swelling, infection or migration, and need to be surgically removed.

In my practice, I did a retrospective analysis and found that about 94% of coronectomy patients don't require any further treatment. But in 6% of cases, the roots cause issues that require a second surgery.

So when do these problematic roots typically present? I've seen it happen as early as 2 months post-op, usually due to incomplete enamel removal on my part. But it's most common in the 12-24 month range. After 2 years, the risk decreases significantly but isn't zero.

Bonus information: retained roots can be surprisingly difficult to remove! Even when they've migrated to the surface, they often require a handpiece and bone removal to fully retrieve.

I hope this helps answer some common questions about coronectomy follow-up.

Keep those great questions coming, I'm always happy to address them.

Thanks for listening.