Coronectomy Consent

Where the roots of a lower wisdom tooth sit directly against the nerve that supplies the lip and chin, removing the whole tooth carries a meaningful risk of permanent numbness. A coronectomy removes the crown of the tooth and deliberately leaves the roots in place, below the bone, so the nerve is not disturbed. The gum is closed over them.

This is a planned, deliberate retention of the roots. It is not an incomplete extraction.

Coronectomy is chosen specifically to lower the risk of nerve injury compared with removing the whole tooth. In the published literature, nerve injury after coronectomy is uncommon and is consistently reported as lower than after full removal in comparable high-risk teeth.

• The retained roots very commonly migrate — they move away from the nerve as healing continues, usually most in the first six months, and typically slow or stop by about a year. Migration is expected, not a complication in itself.
• If a root later migrates far enough to appear through the gum, or becomes infected or symptomatic, a second procedure is needed to remove it. This is uncommon. When it is needed, the roots are by then further from the nerve, which is why the second procedure carries a lower nerve risk than the original extraction would have.
• The roots may loosen during surgery. If they do, they must be removed at that visit — which returns the procedure to a full extraction and its nerve risk. You are consenting to that possibility now.
• Nerve injury can still occur, causing numbness or altered feeling of the lip, chin, or tongue; usually temporary, uncommonly permanent.
• Infection, dry socket, pain, swelling, bleeding, and delayed healing.
• A deep gum pocket behind the second molar.
• Follow-up X-rays are required so the roots can be monitored. You are agreeing to attend those reviews.

• Complete removal of the tooth, accepting its higher risk of permanent nerve injury; leaving the tooth and monitoring it; treating symptoms only; referral; or no treatment.