Top

Clinical Oral Investigations

Published in:

Open Access 03-10-2023 | Research

The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment

Authors: Ana Pacheco, Balázs Soós, Edina Lempel, Imre Simon, Péter Maróti, Stephan Christian Möhlhenrich, József Szalma

Published in: Clinical Oral Investigations | Issue 11/2023

Abstract

Objectives

The aim of this in vitro study was to evaluate the effect of a 3D-printed drill sleeve (DS) on the precision and duration of coronectomy sections.

Materials and methods

Thirty-six trainees and oral surgeons performed 72 coronectomy cuts in a 3D-printed, entirely symmetric mandible model. Coronectomy was performed freehand (FH) on one side and with a DS on the other side. The occurrence of “too superficial” (≥ 4 mm unprepared lingual tooth tissue) and “too deep” (drilling ≥ 1 mm deeper as tooth contour) cuts and sectioning times were registered.

Results

In 7 cases, the sections were “too deep” with FH, while none with DS (OR: 18.56; 95%CI: 1.02–338.5; p = 0.048). The deviation between virtually planned and real cut depths was significantly greater in the FH group (1.91 ± 1.62 mm) than in DS group (1.21 ± 0.72 mm) (p < 0.001). A total of 18 “too superficial” buccolingual sections occurred with FH, while 8 cases with DS (OR: 3.50; 95%CI: 1.26–9.72; p = 0.016). Suboptimal sections did not correlate with experience (p = 0.983; p = 0.697). Shortest, suboptimal drillings were most frequently seen distolingually (OR: 6.76; 95% CI: 1.57–29.07; p = 0.01). In the inexperienced group, sectioning time was significantly longer with FH (158.95 ± 125.61 s vs. 106.92 ± 100.79 s; p = 0.038).

Conclusions

The DS effectively reduced tooth sectioning times by less experienced colleagues. Independently from the level of experience, the use of DS obviated the need for any preparation outside the lingual tooth contour and significantly decreased the occurrence of “too superficial” cuts, leaving thinner unprepared residual tooth tissue lingually.

Clinical relevance

Coronectomy sections may result in lingual hard and soft tissue injury with the possibility of damaging the lingual nerve. The precision of the buccolingual depth-control can be improved, while surgical time can be reduced when applying a drilling sleeve.

Available only for authorised users

Klazen Y, Van der Cruyssen F, Vranckx M, Van Vlierberghe M, Politis C, Renton T, Jacobs R (2018) Iatrogenic trigeminal post-traumatic neuropathy: a retrospective two-year cohort study. Int J Oral Maxillofac Surg 47:789–793. https://doi.org/10.1016/j.ijom.2018.02.004CrossRefPubMed

Landi L, Manicone PF, Piccinelli S, Raia A, Raia R (2010) Staged removal of horizontally impacted third molars to reduce risk of inferior alveolar nerve injury. J Oral Maxillofac Surg 68:442–446. https://doi.org/10.1016/j.joms.2009.07.038CrossRefPubMed

Bonetti GA, Parenti SI, Checchi L (2008) Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing. J Clin Periodontol 35:719–723. https://doi.org/10.1111/j.1600-051X.2008.01286.xCrossRefPubMed

Tolstunov L, Javid B, Keyes L, Nattestad A (2011) Pericoronal ostectomy: an alternative surgical technique for management of mandibular third molars in close proximity to the inferior alveolar nerve. J Oral Maxillofac Surg 69:1858–1866. https://doi.org/10.1016/j.joms.2011.03.002CrossRefPubMed

Ecuyer J, Debien J (1984) Surgical deductions. Actual Odontostomatol (Paris) 38:695–702PubMed

Knutsson K, Lysell L, Rohlin M (1989) Postoperative status after partial removal of the mandibular third molar. Swed Dent J 13:15–22PubMed

Pitros P, O’Connor N, Tryfonos A, Lopes V (2020) A systematic review of the complications of high-risk third molar removal and coronectomy: development of a decision tree model and preliminary health economic analysis to assist in treatment planning. Br J Oral Maxillofac Surg 58:e16–e24. https://doi.org/10.1016/j.bjoms.2020.07.015CrossRefPubMed

Patel V, Gleeson CF, Kwok J, Sproate C (2013) Coronectomy practice. Paper 2: complications and long term management. Br J Oral Maxillofac Surg 51:347–352. https://doi.org/10.1016/j.bjoms.2012.06.008CrossRefPubMed

Renton T, Hankins M, Sproate C, McGurk M (2005) 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. Br J Oral Maxillofac Surg 43:7–12. https://doi.org/10.1016/j.bjoms.2004.09.002CrossRefPubMed

10.

Martin A, Perinetti G, Costantinides F, Maglione M (2015) Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review. Head Face Med 11:9. https://doi.org/10.1186/s13005-015-0068-7CrossRefPubMedPubMedCentral

11.

de Souza LN, de Souza ACRA, de Arruda JAA (2021) Root canal treatment at the time of coronectomy increases the frequency of postoperative infections. J Oral Maxillofac Surg 79:4–5. https://doi.org/10.1016/j.joms.2020.08.041CrossRefPubMed

12.

Monaco G, Angelino C, Vignudelli E, Ferri A, Felice P (2023) What is the incidence of late complications associated with lower third molar coronectomy? 10-year follow-up results. J Oral Maxillofac Surg. https://doi.org/10.1016/j.joms.2023.06.011CrossRefPubMed

13.

Bordonaba-Leiva S, Gómez-Durán EL, Balibrea JM, Benet-Travé J, Martin-Fumadó C, Bescos Atin C, Mareque-Bueno J, Arimany-Manso J (2019) Twenty four years of oral and maxillofacial surgery malpractice claims in Spain: patient safety lessons to learn. Oral Maxillofac Surg 23:187–192. https://doi.org/10.1007/s10006-019-00756-3CrossRefPubMed

14.

Shaath M (2019) Coronectomy consent. Br Dent J 226:470–471. https://doi.org/10.1038/s41415-019-0218-6CrossRefPubMed

15.

Yeung AWK, Wong NSM, Leung YY (2019) Are coronectomy studies being cited? A bibliometric study. J Investig Clin Dent 10:e12366. https://doi.org/10.1111/jicd.12366CrossRefPubMed

16.

Wolf D, Renton T (2016) Die Koronektomie. Eine Behandlungsoption für Weisheitszähne im Unterkiefer bei sehr naher Lagebeziehung zum N.alveolaris inferior. Swiss Dent J 126:1147–1159PubMed

17.

Crameri M, Kuttenberger JJ (2018) Application and evaluation of coronectomy in Switzerland. Swiss Dent J 128:582–586PubMed

18.

Zhao S, Wang Y, Yang X, Zhou X, Wang Z, Zhang K, Yang X (2023) Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury. Clin Oral Investig 27:4279–4288. https://doi.org/10.1007/s00784-023-05044-9CrossRefPubMed

19.

Patel V, Sproat C, Kwok J, Beneng K, Thavaraj S, McGurk M (2014) Histological evaluation of mandibular third molar roots retrieved after coronectomy. Br J Oral Maxillofac Surg 52:415–419. https://doi.org/10.1016/j.bjoms.2014.02.016CrossRefPubMed

20.

Leung YY, Cheung LK (2009) Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:821–827. https://doi.org/10.1016/j.tripleo.2009.07.004CrossRefPubMed

21.

Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E (2009) Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg 67:1806–1814. https://doi.org/10.1016/j.joms.2009.04.018CrossRefPubMed

22.

Pogrel MA, Lee JS, Muff DF (2004) Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 62:1447–1452. https://doi.org/10.1016/j.joms.2004.08.003CrossRefPubMed

23.

O’Riordan BC (2004) Coronectomy (intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:274–280. https://doi.org/10.1016/S1079210404000496CrossRefPubMed

24.

Steel BJ, Surendran KSB, Braithwaite C, Mehta D, Keith DJW (2022) Current thinking in lower third molar surgery. Br J Oral Maxillofac Surg 60:257–265. https://doi.org/10.1016/j.bjoms.2021.06.016CrossRefPubMed

25.

Monaco G, Vignudelli E, Diazzi M, Marchetti C, Corinaldesi G (2015) Coronectomy of mandibular third molars: a clinical protocol to avoid inferior alveolar nerve injury. J Craniomaxillofac Surg 43:1694–1699. https://doi.org/10.1016/j.jcms.2015.07.006CrossRefPubMed

26.

Szalma J, Vajta L, Olasz L, Lempel E (2019) Tooth sectioning for coronectomy: how to perform? Clin Oral Investig 23:519–527. https://doi.org/10.1007/s00784-018-2466-2CrossRefPubMed

27.

Pogrel MA (2009) Coronectomy to prevent damage to the inferior alveolar nerve. Alpha Omegan 102:61–67. https://doi.org/10.1016/j.aodf.2009.04.011CrossRefPubMed

28.

Pippi R, Spota A, Santoro M (2017) Prevention of lingual nerve injury in third molar surgery: literature review. J Oral Maxillofac Surg 75:890–900. https://doi.org/10.1016/j.joms.2016.12.040CrossRefPubMed

29.

Sisk AL, Hammer WB, Shelton DW, Joy ED Jr (1986) Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 44:855–859. https://doi.org/10.1016/0278-2391(86)90221-1CrossRefPubMed

30.

Emery RW, Korj O, Agarwal R (2017) A review of in-office dynamic image navigation for extraction of complex mandibular third molars. J Oral Maxillofac Surg 75:1591–1600. https://doi.org/10.1016/j.joms.2017.03.031CrossRefPubMed

31.

Szalma J, Lovasz BV, Lempel E, Maroti P (2019) Three-dimensionally printed individual drill sleeve for depth-controlled sections in third molar surgery. J Oral Maxillofac Surg 77:704.e1-704.e7. https://doi.org/10.1016/j.joms.2018.11.028CrossRefPubMed

32.

Colby LE, Watson DP (2023) Fully guided tooth bud ablation in pigs results in complete tooth bud removal and molar agenesis. J Oral Maxillofac Surg 81:456–466. https://doi.org/10.1016/j.joms.2022.12.009CrossRefPubMed

33.

Zeng J, Jiang Y, Liu Y, Hu Y, Guo C, Zhou L (2023) Research on a novel digital tooth sectioning guide system for tooth sectioning during mandibular third molar extraction: an in vitro study. J Stomatol Oral Maxillofac Surg 124:101383. https://doi.org/10.1016/j.jormas.2023.101383CrossRefPubMed

34.

Feng J, Qi W, Duan S, Bao C, Zhang X, Cai B, Liu X (2021) Three-dimensional printed model of impacted third molar for surgical extraction training. J Dent Educ. https://doi.org/10.1002/jdd.12760CrossRefPubMed

35.

Padam S (2012) Sample size for experimental studies. J Clin Prev Card 1:88–93

36.

Appiah-Anane S, Appiah-Anane MG (1997) Protection of the lingual nerve during operations on the mandibular third molar: a simple method. Br J Oral Maxillofac Surg 35:170–172. https://doi.org/10.1016/s0266-4356(97)90557-xCrossRefPubMed

37.

Yan ZY, Yan XY, Guo CB, Xie QF, Yang GJ, Cui NH (2020) Somatosensory changes in Chinese patients after coronectomy vs. total extraction of mandibular third molar: a prospective study. Clin Oral Investig 24:3017–3028. https://doi.org/10.1007/s00784-019-03169-4CrossRefPubMed

38.

Cilasun U, Yildirim T, Guzeldemir E, Pektas ZO (2011) Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography. J Oral Maxillofac Surg 69:1557–1561. https://doi.org/10.1016/j.joms.2010.10.026CrossRefPubMed

39.

Pichler JW, Beirne OR (2001) Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: a systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91:395–401. https://doi.org/10.1067/moe.2001.114154CrossRefPubMed

40.

Lee J, Feng B, Park JS, Foo M, Kruger E (2023) Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: a systematic review and meta-analysis. PLoS One 18:e0282185. https://doi.org/10.1371/journal.pone.0282185CrossRefPubMedPubMedCentral

41.

Xu W, Shen J, Li K, Zhao T, Xie B, Chen J, He Y (2023) A mechanical and three-dimensional finite element study of the optimum tooth sectioning depth during the extraction of low-level horizontally impacted mandibular third molar. Odontology. https://doi.org/10.1007/s10266-023-00822-zCrossRefPubMedPubMedCentral

42.

Menziletoglu D, Tassoker M, Kubilay-Isik B, Esen A (2019) The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study. Med Oral Patol Oral Cir Bucal 24:e130–e135. https://doi.org/10.4317/medoral.22596CrossRefPubMed

43.

Momin MA, Matsumoto K, Ejima K, Asaumi R, Kawai T, Arai Y, Honda K, Yosue T (2013) Correlation of mandibular impacted tooth and bone morphology determined by cone beam computed topography on a premise of third molar operation. Surg Radiol Anat 35:311–318. https://doi.org/10.1007/s00276-012-1031-yCrossRefPubMed

44.

Huang C, Zhou C, Xu M, Zou D (2020) Risk factors for lingual plate fracture during mandibular third molar extraction. Clin Oral Investig 24:4133–4142. https://doi.org/10.1007/s00784-020-03286-5CrossRefPubMed

45.

Ge J, Zheng JW, Yang C, Qian WT (2016) Variations in the buccal-lingual alveolar bone thickness of impacted mandibular third molar: our classification and treatment perspectives. Sci Rep 6:16375. https://doi.org/10.1038/srep16375CrossRefPubMedPubMedCentral

46.

Emes Y, Oncu B, Aybar B, Al-Badri N, Issever H, Atalay B, Yalcin S (2015) Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography. J Oral Maxillofac Surg 73:13–17. https://doi.org/10.1016/j.joms.2014.06.460CrossRefPubMed

47.

Parhiz SA, Bakhtiary P, Mosavat F, Kharazifard MJ (2019) Thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography scans. Front Dent 16:279–289. https://doi.org/10.18502/fid.v16i4.2087CrossRefPubMedPubMedCentral

48.

Monaco G, De Santis G, Pulpito G, Gatto MR, Vignudelli E, Marchetti C (2015) What are the types and frequencies of complications associated with mandibular third molar coronectomy? A follow-up study. J Oral Maxillofac Surg 73:1246–1253. https://doi.org/10.1016/j.joms.2015.01.016CrossRefPubMed

Title: The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment
Authors: Ana Pacheco
Balázs Soós
Edina Lempel
Imre Simon
Péter Maróti
Stephan Christian Möhlhenrich
József Szalma
Publication date: 03-10-2023
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 11/2023
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-023-05289-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 11/2023

Influence of antiresorptive/antiangiogenic therapy on the surgical treatment outcomes of experimentally induced peri-implantitis lesions

Clinical evaluation of sodium hypochlorite/amino acids and cross-linked hyaluronic acid adjunctive to non-surgical periodontal treatment: a randomized controlled clinical trial

Biological properties of experimental dental alginate modified for self-disinfection using green nanotechnology

Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis

Retrospective clinical study of 1472-unit monolithic zirconia restorations with feather-edge margins realized with digital workflow

The relationship between Helicobacter pylori infection and recurrent aphthous stomatitis: a systematic review and meta-analysis