Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 8986

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : ZC23 - ZC26 Full Version

Coronectomy versus Extraction of Third Molar with Inferior Alveolar Nerve Proximity: A Cross-sectional Study


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/47211.15248
Bhavesh Maheshwari, Ram Parshad, Kashif Ali Channar, Ajeet Kumar Rathi, Rajesh Mali, Ishrat Begum, Narendar Parkash

1. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 2. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 3. Associate Professor, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 4. Assistant Professor and Head, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 5. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 6. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science, Jamshoro/Hyderabad, Pakistan. 7. Postgraduate Student, Department of Oral and Maxillofacial Surgery, Liaquat Un

Correspondence Address :
Bhavesh Maheshwari,
B#12/200, Phase 1HDA, Abdullah Blessing, Nasim Nagar,
Qasimabad, Hyderabad, Pakistan.
E-mail: 1110bds45@gmail.com

Abstract

Introduction: A tooth that failed to erupt in its expected time of eruption is called impacted tooth. Mandibular impacted teeth are common than any other tooth. Management of impacted teeth depends upon depth, angulations and type of impaction. Certain factors may increase the complications of tooth extraction. One of them is Inferior Alveolar Nerve (IAN) approximation with third molar roots. Coronectomy is surgical procedure through which crown of tooth can be removed at cementoenamel junction level and leaving the root part is a new procedure to avoid nerve injury.

Aim: To compare outcome of extraction of lower third molar and coronectomy in management of impacted third molar with close proximity to inferior alveolar nerve.

Materials and Methods: This cross-sectional study was conducted at Oral and Maxillofacial Surgery Department at Liaquat University of Medical and Health Science Jamshoro/Hyderabad, Pakistan. Ethical approval was sought from the ethical review committee of university. The written informed consent was taken from the patients. Total 36 patients were included in this study, divided into two groups using random number table. Patients with mandibular impacted third molar, with inferior alveolar nerve approximation diagnosed clinically and radiographically were included in this study. Group A was treated with surgical extraction and group B with Coronectomy. The data was analysed by Statistical Package for the Social Sciences (SPSS) statistical software version 20.0. The Chi-square test and Independent t-test was applied to check the statistical difference in outcomes of both treatment procedures.

Results: Total 36 patients were included in two groups and the mean age of patients were 25±2 years with male to female ratio as 1.1:1. Preoperatively, all patients were having normal mouth opening and no neurosensory deficit. Postoperatively neurosensory deficit seen in both groups at follow-up visits but, at six weeks follow-up, all patients were recovered from IAN deficit in coronectomy group with statistically significant p-value <0.001.

Conclusion: With this small sample size, it cannot be concluded which technique is better than other. With this single centre study, it was observed that coronectomy appears to be simple, easier and better procedure and more effective technique for minimising the risk to inferior alveolar nerve injury, limited mouth opening and dry socket that corresponds to impacted molar extraction.

Keywords

Inferior alveolar nerve injury, Orthopantomogram, Two point discrimination

A tooth that failed to erupt in its expected time of eruption is called impacted tooth. Any tooth of the arch can be impacted but most commonly impacted teeth are mandibular 3rd molars followed by maxillary and then canines. Management of impacted teeth depends upon type of impaction according to angulations, depth of impacted tooth, and ramus relation. Other important factor which may interfere surgical management is inferior alveolar nerve approximation. Entire surgical removal of the tooth is the conventional method for most wisdom teeth management (1),(2),(3).

Extraction of lower third molar may be associated with postoperative complications like pain at surgical site, limited mouth opening, dry socket and inferior alveolar nerve damage/lingual nerve damage. Frequency of permanent damage to inferior alveolar nerve accounts to 2-4% after surgical extraction (4). The severity of nerve injuries depends upon types of injury and ranges from neurapraxia, axonotmesis to neurotmesis, that may be expressed clinically as paraesthesia, hypoesthesia or dysesthesia to total numbness of the lower lip, teeth, gingiva and skin over the chin which considerably affects the quality of life of the patient [5,(6).

This magnitude of never damage can be decreased if it is addressed before surgery. The relation of roots of third molar and inferior alveolar nerve must be documented while planning for surgical extraction. This can be seen on conventional periapical X-ray, Orthopantomogram (OPG) or on cone beam CT scan (7),(8),(9). Radiographic signs may indicate closeness of nerve with roots; are interruption of the white line of the mandibular canal wall, darkening around the root(s), diversion of the mandibular canal, narrowing of the mandibular canal, narrowing of the root(s), and deflection of the roots (10).

The incidence of nerve injuries is as high as 19% (11). If there is close proximity between the IAN and the roots, several methods have been planned to reduce inferior alveolar nerve injury like orthodontic extrusion, pericoronal ostectomy, surgical removal of third molar, coronectomy, modified coronectomy and grafting (5). Recently, coronectomy has been investigated as an alternate to conventional surgical removal of third molars, particularly for those with an increased risk of injury to the inferior alveolar nerve (12). It involves removal of the mandibular third molar crown, leaving the roots in the alveolar bone, in order to decrease the danger of trauma to inferior alveolar nerve (13). Few studies have been published in literature to provide better treatment modalities to manage impacted mandibular third molar with nerve approximation (1),(5),(14),(15). Many of these studies tried coronectomy along with extirpation of vital pulp in order to avoid pulpal pain. The present study involved coronectomy without removal of pulp. The hypothesis was coronectomy can be performed without endodontic treatment and also without any pulpal complication. The aim of this study was to evaluate the outcome of coronectomy without extirpation of pulp and without complete removal for mandibular third molar teeth root apices which are near to inferior alveolar nerve.

Material and Methods

This cross-sectional study was conducted in Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Science Jamshoro/Hyderabad, Pakistan from March 2019-February 2020 after approval of Ethical Review Committee No.LUMHS/REC/733. A written informed consent was obtained from every patient for participation in this study and all surgical procedure was explained with their outcomes and complications.

Sample size calculation: Sample size was calculated using Epitool online sample size calculator. Total 36 patients were included in this study. Two groups of 18 in each were divided by using random number table.

Group A was planned for surgical extraction of tooth and group B was for coronectomy. Detailed history was obtained. The clinical examination was done and radiographic investigation like OPG was recommended to all patients.

Inclusion criteria: Mandibular impacted 3rd molar partial or full bony impaction with recurrent pericoronitis in close proximity to inferior alveolar nerve were selected for this study, age ranges from 18 to 40 years with no gender specification and healthy individual with American Society of Anaesthesiologist classification (ASA), class 1.

Exclusion criteria: Carious third molar tooth with associated periapical infection or tooth with grade two mobility. All surgical procedures were performed by consultant having atleast five years’ experience in the field of oral and maxillofacial surgery.

Surgical Procedure

In group A, intraoral preparation was done with povidone-iodine solution. Anaesthesia was secured with 2% lignocaine hydrochloride with 1:2,00,000 adrenaline through classical inferior alveolar nerve block plus infiltration of mucosa of retromolar trigone. A standard ward’s incision or ward’s incision with distal extension was placed, the mucoperiosteal flap was reflected and the bone was exposed. Bone removal was done by guttering technique with a round bur (SME Dent) on the buccal and distal aspects of the tooth. Sectioning of tooth was performed according to the need to facilitate the tooth removal. Tooth was delivered from the socket by an elevator. Sharp bony edges was smoothen with bone files and the surgical site was thoroughly debrided and irrigated with 0.9% normal saline, closure of flap was done by using 3-0 polyglactin (Vicryl Rapid, Ethicon).

In group B, after following septic measures and local anaesthesia like in group A, bone was removed up to the cementoenemal junction by slow speed hand piece (SME Dent). Decoronation of tooth was done at 1-2 mm below the CEJ to ensure crown removal without mobilising the roots. Finally, finishing of the root surface were done with a round bur to decrease height of root 2-3 mm below the level of the surrounding alveolar bone. The surgical site was cleaned thoroughly and irrigated with 0.9% normal saline. The closure of flap was done by using 3-0 polyglactin (Vicryl Rapid, Ethicon). Postoperative instructions were given to every patient in both groups. Amoxicillin 500 mg, Metronidazole 400 mg and Paracetamol 500 mg three times a day for three days were also given in both groups (5),(6). The patients of both groups were recalled for follow-up on 1st, 3rd, and 6th week. In every postoperative follow-up, IAN deficit, dry socket and limited mouth opening were assessed.

IAN deficit was recorded with standardised neurosensory test which included a Two Point Discrimination (TPD)- in this neurosensory test, the probes of calliper device (Kawasaki, Japan) were drawn across the surface of skin or mucosa at constant pressure at the distance of 5 mm and then patients were asked to raise their left hand if two points were sensed. Positive was considered if patient identified and negative, if patient did not recognise the sensation at offending area. The minimum separation that was consistently reported as two points was termed as two-point discrimination threshold (16). Mouth opening was recorded by the Vernier calliper (Kawasaki, Japan).

Statistical Analysis

The data was analysed by Statistical Package for the Social Sciences (SPSS) statistical software version 20.0. Categorical variables are presented in frequency and percentages. Continuous variables are presented in mean and standard deviation. Chi-square test was applied for categorical variables. The p-value <0.05 was considered as significant.

Results

(Table/Fig 1)a,b shows preoperative OPG depicting impacted teeth with close apices with IAN. Total 36 patients were reported in this study, the mean age of patients were 24.5 years. Out of 36, 47% were females and 53% were males (Table/Fig 2).

Mean mouth opening in both groups was 38.5 mm and no inferior alveolar nerve impairment was seen preoperatively (Table/Fig 3).

The variable analysed in postoperative visits were mouth opening, dry socket, and status of IAN. Mouth opening was reduced markedly in group A in 1st postoperative visit at 1st week from 39 mm to 28 mm and improvement seen in follow-up visit. While in group B mouth opening was also reduced from 39 to 31 mm, significant difference was observed in 1st week (p< value 0.01) (Table/Fig 4).

On the other hand, IAN damage was more in group A than group B (39% were positive in group A). Till last follow-up visit (6th week) no IAN deficit was seen in group B (p<0.002) (Table/Fig 5). Dry socket a complication of surgical extraction was only seen in 16% patients in group A and no such complication was observed in group B, (p<0.004) (Table/Fig 6).

Discussion

This study was conducted in oral and maxillofacial surgery, with special emphasis on postoperative complication related to third molar surgery. In this study male to female ratio was 1:1, the findings of this study are similar to studies conducted by Aslam F, Dolanmaz D et al., and Hatano Y et al., (1),(4),(14). Preoperative all patients were in normal state of inferior alveolar nerve on two-point discrimination test. Bhat P and Cariappa KM conducted study on 400 patients, all have showed normal neurosensory normal values (17).

Inferior alveolar nerve assessment damage seen in 11% in group A while 6% in group B in 1st week of follow-up. The nerve damage in further follow-up visits suggested no case for nerve damage in group B. These results are comparable with two studies done by Dolanmaz D et al., and Pogrel MA et al., (2004) who reported inferior alveolar nerve injury that ranged from 2.2% and 4.8% (4),(8). According to Hatano Y et al., only 1% coronectomy group patients were with a transient inferior alveolar nerve injury and six patients of the control group (5%) were with inferior alveolar nerve injury (14). Leung YY and Cheung LK found postoperative inferior alveolar nerve injury in coronectomy group was 0.6% and 5.10 % in control group (15).

In current study, the preoperative mouth opening assessment was 38±2 mm in both groups, our results are similar to Singh K et al., study. On postoperative follow-up, the mouth opening was greater in coronectomy and the result was statistically significant with p-value of 0.012, 0.503 and 0.153. Singh K et al., in their study measured intergroup comparison of the mouth opening on 1st and 7th postoperative day and were statistically analysed using independent sample t-test and p-values were found to be 0.212 and 0.284 at postoperative interval of 1st day and on the 7th day, respectively (18).

In the study by Cilasun U et al., two cases of transient inferior alveolar nerve injury (2.8%) were observed in the control group (87 teeth) while no patients of the study group (88 teeth) developed inferior alveolar nerve injury (19). Renton T et al., reported that inferior alveolar nerve damage occurred in 19% patients underwent complete removal of the impacted third molar and no patient who underwent successful coronectomy. In same study, 8% patients experienced irritation of the inferior alveolar nerve after failed coronectomy (20).

The result was statistically not significant thereby, implicating that there was no difference in the intensity of mouth opening in both groups either pre or postoperative periods (18). Another study was conducted by Hatano Y et al., on postoperative 7th day, mouth opening assessment was greater in coronectomy group which was 41.2 mm (14). On the postoperative 1st week, the dry socket was found in 16% patients who undergone surgical extraction while this complication was not seen in coronectomy. The result was statistically significant with p-value of 0.004, comparable with the study of Hatano Y et al., where they observed that dry socket within the control group was 8.5% and in coronectomy group, it was 2% (14). Leung YY and Cheung LK found no case of dry socket in the coronectomy group, whereas 2.8% in 178 of cases in the control group developed dry socket in the 1st postoperative week (15). Cilasun U et al., reported one case of dry socket infection within the 1.1% control group and no cases within the coronectomy group (19) in comparison with the study done by Renton T et al., wherein authors found a similar incidence of dry socket infection in the 9.6% control group, 12% coronectomy group and 11.1% failed coronectomy group (20). With this small scientific work, it was observed that coronectomy appears to be simple, easier and better procedure and more effective technique for minimising the risk to inferior alveolar nerve injury, limited mouth opening and dry socket that corresponds to impacted molar extraction.

Limitation(s)

Small sample size and type of impaction was the major limitation in our study. This research can be planned with larger scale with more number of patients and comparison between each groups according to type of impaction may give more accurate result.

Conclusion

Coronectomy is a better option with less complications as compared to surgical extraction in selected cases where inferior alveolar nerve is in close proximity with roots of mandibular third molar.

References

1.
Aslam F. Inferior alveolar nerve injury caused by coronectomy or conventional method in third molar extractions. Journal of Rawalpindi Medical College. 2017;21(2):122-26.
2.
Ali AS, Benton JA, Yates JA. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature. J Oral Rehabil. 2018;45:250-57. [crossref] [PubMed]
3.
Punjabi SK, Khoso NA, Butt AM, Channar KA. Third molar impaction: Evaluation of the symptoms and pattern of impaction of mandibular third molar teeth. J Liaquat Uni Med Health Sci. 2013;12(1):26-29.
4.
Dolanmaz D, Yildirim G, Isik K, Kucuk K, Ozturk A. A preferable technique for protecting the inferior alveolar nerve: Coronectomy. J Oral Maxillofac Surg. 2009;67:1234-38. [crossref] [PubMed]
5.
Mukherjee SD, Vikraman BD, Sankar DS, Veerabahu MS. Evaluation of outcome following coronectomy for the management of mandibular third molars in close proximity to inferior alveolar nerve. J Clin Diag Res. 2016;10(8):57-62. [crossref] [PubMed]
6.
Channar KA, Tareen MK, Hamad J, Warraich RA. Role of antibiotics in surgical removal of asymptomatic mandibular third molar impaction. J Liaquat Uni Med Health Sci. 2014;13(03):112-15.
7.
Moreno-Vicente J, Schiavone-Mussano R, Clemente-Salas E, Marí-Roig A, Jané-Salas E, López-López J. Coronectomy versus surgical removal of the lower third molars with a high risk of injury to the inferior alveolar nerve. A bibliographical review. Medicina Oral, Patologia Oral Y Cirugia Bucal. 2015;20(4):e508. [crossref] [PubMed]
8.
Pogrel MA, Lee JS, Muff DF. Coronectomy: A technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg. 2004;62:1447-52. [crossref] [PubMed]
9.
Loescher AR, Smith KG, Robinson PP. Nerve damage and third molar removal. Dent Update. 2003;30(7):375-80, 382. [crossref] [PubMed]
10.
Kouwenberg AJ, Stroy LPP, RijtEdV-vd, Mensink G, Gooris PJJ. Coronectomy for the mandibular third molar: Respect for the inferior alveolar nerve. J Craniomaxillofac Surg. 2016;44(5):616-21. [crossref] [PubMed]
11.
Martin A, Perinetti G, Costantinides F, Maglione M. Coronectomy as a surgical approach to impacted mandibular third molars: A systematic review. Head Face Med. 2015;11:9. [crossref] [PubMed]
12.
Gady J, Fletcher MC. Coronectomy indications, outcomes, and description of technique. Atlas Oral Maxillofacial Surg Clin. 2013;21:221-26. [crossref] [PubMed]
13.
Leung YY, Cheung KY. Root migration pattern after third molar coronectomy: A long-term analysis. Int J Oral Maxillofac Surg. 2018;01:015. [crossref]
14.
Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E. Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: A case-control study. Journal of Oral and Maxillofacial Surgery. 2009;67(9):1806-14. [crossref] [PubMed]
15.
Leung YY, Cheung LK. Safety of coronectomy versus excision of wisdom teeth: A randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:821-27. [crossref] [PubMed]
16.
Meshram VS, Meshram PV, Lambade P. Assessment of nerve injuries after surgical removal of mandibular third molar: A prospective study. Asian Journal of Neuroscience. 2013;2013:291926. [crossref]
17.
Bhat P, Cariappa KM. Inferior alveolar nerve deficits and recovery following surgical removal of impacted mandibular third molars. J Maxillofac Oral Surg. 2012;11(3):304-08. [crossref] [PubMed]
18.
Singh K, Kumar S, Singh S, Mishra V, Sharma PK, Singh D. Impacted mandibular third molar: Comparison of coronectomy with odontectomy. Indian Journal of Dental Research. 2018;29(5):605. [crossref] [PubMed]
19.
Cilasun U, Yildirim T, Guzeldemir E, Pektas ZO. Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography. Journal of Oral and Maxillofacial Surgery. 2011;69(6):1557-61. [crossref] [PubMed]
20.
Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. British Journal of Oral and Maxillofacial Surgery. 2005;43(1):07-12. [crossref] [PubMed]

DOI and Others

10.7860/JCDR/2021/47211.15248

Date of Submission: Oct 15, 2020
Date of Peer Review: Dec 07, 2020
Date of Acceptance: Apr 10, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 16, 2020
• Manual Googling: Mar 26, 2021
• iThenticate Software: May 22, 2021 (24%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com