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Tooth sectioning for coronectomy: how to perform?

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Abstract

Objectives

The aim of this study was to determine the increase in heat production, preparation time, and cutting surface quality of conventional, high-speed rotating instruments and piezoelectric preparation for coronectomy procedures.

Materials and methods

One hundred intact extracted molars were sectioned horizontally, sub-totally, 1 mm under the cemento-enamel line with five methods: (1) tungsten carbide torpedo (TcT), (2) round (TcR) drills using a conventional speed surgical straight handpiece (< 40,000 min−1), (3) tungsten carbide fissure (TcF), (4) diamond torpedo (DT) drills using a surgical high-speed, contra-angle handpiece (~ 120,000 min−1), or (5) a saw-like piezoelectric tip (PT). Temperatures, preparation times, and cutting surface irregularities were registered and the differences were analyzed with ANOVA, Tukey’s HSD post hoc test (temperature, time) and with chi-square test (irregular surface).

Results

Rotating instruments produced a maximal temperature increase of less than 1 °C. TcF produced the least heat (ΔT = − 3.92 °C to the baseline), while PT produced significantly the highest temperature increases (ΔT = 12.38 °C, p < 0.001). Tungsten carbide drills were the fastest for coronectomy (from 55.9 to 64.3 s), while DT (169.7 s) while PT (146.8 s) were significantly slower. TcT and TcR drills produced an irregular root surface more frequently.

Conclusions

During coronectomy, rotating instruments produced entirely acceptable heat, while PT produced unacceptable temperatures. Tungsten carbide drills performed coronectomies effectively, but the diamond torpedo and PT seemed clinically questionable. Considering heat, speed, and the cutting surface quality simultaneously, TcF in a surgical high-speed handpiece seems to be the best choice for coronectomy.

Clinical relevance

The correct insert can significantly reduce excessive heat and operation time during coronectomy procedures.

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References

  1. Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V (2017) Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg 46:230–235

    Article  Google Scholar 

  2. Al-Amery SM, Nambiar P, Naidu M, Ngeow WC (2016) Variation in lingual nerve course: a human cadaveric study. PLoS One 11:e0162773

    Article  Google Scholar 

  3. Deppe H, Mücke T, Wagenpfeil S, Kesting M, Linsenmeyer E, Tölle T (2015) Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases. Clin Oral Invest 19:149–157

    Article  Google Scholar 

  4. Ghaeminia H, Gerlach NL, Hoppenreijs TJ, Kicken M, Dings JP, Borstlap WA, de Haan T, Bergé SJ, Meijer GJ, Maal TJ (2015) Clinical relevance of cone beam computed tomography in mandibular third molar removal: a multicentre, randomised, controlled trial. J Craniomaxillofac Surg 43:2158–2167

    Article  Google Scholar 

  5. Szalma J, Bata ZS, Lempel E, Jeges S, Olasz L (2013) Quantitative pixel gray measurement of the “high-risk” sign, darkening of third molar roots: a pilot study. Dentomaxillofac Rad 42:20130160

    Article  Google Scholar 

  6. Szalma J, Lempel E, Jeges S, Szabó G, Olasz L (2010) The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal. Retrospective study of 400 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:294–302

    Article  Google Scholar 

  7. Szalma J, Lempel E, Jeges S, Olasz L (2011) Darkening of third molar roots: panoramic radiographic associations with inferior alveolar nerve exposure. J Oral Maxillofac Surg 69:1544–1549

    Article  Google Scholar 

  8. Szalma J, Lempel E, Jeges S, Olasz L (2012) Digital versus conventional panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar removal. J Craniofac Surg 23:e155–e158

    Article  Google Scholar 

  9. Szalma J, Vajta L, Lempel E, Jeges S, Olasz L (2013) Darkening of third molar roots on panoramic radiographs: is it really predominantly thinning of the lingual cortex? Int J Oral Maxillofac Surg 43:483–488

    Article  Google Scholar 

  10. 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(5):415–419

    Article  Google Scholar 

  11. Pogrel MA (2009) An update on coronectomy. J Oral Maxillofac Surg 67:1782–1783

    Article  Google Scholar 

  12. Leung YY, Cheung LK (2012) Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg 70:1515–1522

    Article  Google Scholar 

  13. Landi L, Manicone PF, Piccinelli S, Raia A, Raia R (2010) A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series. J Oral Maxillofac Surg 68:969–974

    Article  Google Scholar 

  14. Bonetti GA, Bendandi M, Laino L, Checchi V, Checchi L (2007) Orthodontic extraction: riskless extraction of impacted lower third molars close to the mandibular canal. J Oral Maxillofac Surg 65:2580–2586

    Article  Google Scholar 

  15. Montevecchi M, Incerti Parenti S, Checchi V, Palumbo B, Checchi L, Alessandri Bonetti G (2014) Periodontal healing after ‘orthodontic extraction’ of mandibular third molars: a retrospective cohort study. Int J Oral Maxillofac Surg 43:1137–1141

    Article  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. Engelke W, Beltrán V, Cantín M, Choi EJ, Navarro P, Fuentes R (2014) Removal of impacted mandibular third molars using an inward fragmentation technique (IFT)—method and first results. J Craniomaxillofac Surg 42:213–219

    Article  Google Scholar 

  18. Selvi F, Dodson TB, Nattestad A, Robertson K, Tolstunov L (2013) Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars. Br J Oral Maxillofac Surg 51:868–873

    Article  Google Scholar 

  19. Susarla SM, Sidhu HK, Avery LL, Dodson TB (2010) Does computed tomographic assessment of inferior alveolar canal cortical integrity predict nerve exposure during third molar surgery? J Oral Maxillofac Surg 68:1296–1303

    Article  Google Scholar 

  20. Szalma J, Kiss C, Gurdán Z, Tóth Á, Olasz L, Jakse N (2016) Intraosseous heat production and preparation efficiency of surgical tungsten carbide round drills: the effect of coronectomy on drill wear. J Oral Maxillofac Surg 74:442–452

    Article  Google Scholar 

  21. Kwon SJ, Park YJ, Jun SH, Ahn JS, Lee IB, Cho BH, Son HH, Seo DG (2013) Thermal irritation of teeth during dental treatment procedures. Restor Dent Endod 38:105–112

    Article  Google Scholar 

  22. Lin M, Xu F, Lu TJ, Bai BF (2010) A review of heat transfer in human tooth—experimental characterization and mathematical modeling. Dent Mater 26:501–513

    Article  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. Szalma J, Lempel E (2017) Protecting the inferior alveolar nerve: coronectomy of lower third molars. Review. Orv Hetil 158:1787–1793. https://doi.org/10.1556/650.2017.30913

    Article  PubMed  Google Scholar 

  25. Queral-Godoy E, Figueiredo R, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C (2006) Frequency and evolution of lingual nerve lesions following lower third molar extraction. J Oral Maxillofac Surg 64:402–407

    Article  Google Scholar 

  26. Alvira-González J, Figueiredo R, Valmaseda-Castellón E, Quesada-Gómez C, Gay-Escoda C (2017) Predictive factors of difficulty in lower third molar extraction: a prospective cohort study. Med Oral Patol Oral Cir Bucal 22:e108–e114

    PubMed  Google Scholar 

  27. Gay-Escoda C, Gómez-Santos L, Sánchez-Torres A, Herráez-Vilas JM (2015) Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: a randomized clinical trial. Med Oral Patol Oral Cir Bucal 20:e372–e377

    Article  Google Scholar 

  28. Rullo R, Addabbo F, Papaccio G, D'Aquino R, Festa VM (2013) Piezoelectric device vs. conventional rotative instruments in impacted third molar surgery: relationships between surgical difficulty and postoperative pain with histological evaluations. J Craniomaxillofac Surg 41:e33–e38

    Article  Google Scholar 

  29. Eriksson AR, Albrektsson T (1983) Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent 50:101–107

    Article  Google Scholar 

  30. Berman AT, Reid JS, Yanicko DR Jr, Sih GC, Zimmerman MR (1984) Thermally induced bone necrosis in rabbits. Relation to implant failure in humans. Clin Orthop Relat Res 186:284–292

    Google Scholar 

  31. Gehrke SA, Pazetto MK, de Oliveira S, Corbella S, Taschieri S, Mardegan FE (2014) Study of temperature variation in cortical bone during osteotomies with trephine drills. Clin Oral Investig 18:1749–1755

    Article  Google Scholar 

  32. Sauk JJ, Norris K, Foster R, Moehring J, Somerman MJ (1988) Expression of heat stress proteins by human periodontal ligament cells. J Oral Pathol 17:496–499

    Article  Google Scholar 

  33. Zhang L, Zhou X, Wang Q, Wang Y, Tang L, Huang D (2012) Effect of heat stress on the expression levels of receptor activator of NF-κB ligand and osteoprotegerin in human periodontal ligament cells. Int Endod J 45:68–75

    Article  Google Scholar 

  34. Zach L, Cohen G (1965) Pulp response to externally applied heat. Oral Surg Oral Med Oral Pathol 19:515–530

    Article  Google Scholar 

  35. Baldissara P, Capatano S, Scotti R (1997) Clinical and histological evaluation of thermal injury thresholds in human teeth: a preliminary study. J Oral Rehabil 24:791–801

    Article  Google Scholar 

  36. Galindo DF, Ercoli C, Funkenbusch PD, Greene TD, Moss ME, Lee HJ, Ben-Hanan U, Graser GN, Barzilay I (2004) Tooth preparation: a study on effect of different variables and a comparison between conventional and channeled burs. J Prosthodont 13:3–16

    Article  Google Scholar 

  37. Ercoli C, Rotella M, Funkenbusch PD, Russell S, Feng C (2009) In vitro comparison of the cutting efficiency and temperature production of 10 different rotary cutting instruments. Part I: turbine. J Prosthet Dent 101:248–261

    Article  Google Scholar 

  38. Szalma J, Vajta L, Lempel E, Tóth Á, Jeges S, Olasz L (2017) Intracanal temperature changes during bone preparations close to and penetrating the inferior alveolar canal: drills vs. piezosurgery. J Craniomaxillofac Surg 45:1622–1631. https://doi.org/10.1016/j.jcms.2017.07.007

    Article  PubMed  Google Scholar 

  39. Siegel SC, von Fraunhofer JA (1999) Dental cutting with diamond burs: heavy-handed or light-touch? J Prosthodont 8(1):3–9

    Article  Google Scholar 

  40. Stelzle F, Frenkel C, Riemann M, Knipfer C, Stockmann P, Nkenke E (2014) The effect of load on heat production, thermal effects and expenditure of time during implant site preparation—an experimental ex vivo comparison between piezosurgery and conventional drilling. Clin Oral Implants Res 25:e140–e148

    Article  Google Scholar 

  41. Stelzle F, Neukam FW, Nkenke E (2012) Load-dependent heat development, thermal effects, duration, and soft tissue preservation in piezosurgical implant site preparation: an experimental ex vivo study. Int J Oral Maxillofac Implants 27:513–522

    PubMed  Google Scholar 

  42. Möhlhenrich SC, Ayoub N, Fritz U, Prescher A, Hölzle F, Modabber A (2017) Evaluation of ultrasonic and conventional surgical techniques for genioplasty combined with two different osteosynthesis plates: a cadaveric study. Clin Oral Investig 21:2437–2444. https://doi.org/10.1007/s00784-016-2040-8

    Article  PubMed  Google Scholar 

  43. Wong C, Collin J, Hughes C, Thomas S (2015) Surgical emphysema and pneumomediastinum after coronectomy. Br J Oral Maxillofac Surg 53:763–764

    Article  Google Scholar 

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Acknowledgements

We would like to thank Dr. Bálint Lovász for the language corrections. The present scientific contribution is dedicated to the 650th anniversary of the founding of the University of Pécs, Hungary.

Funding

This study was supported by the Hungarian Dental Association-NSK (MFE-NSK) “Young Researcher” grant and the Bolyai János Research Scholarship (BO/00074/16/5) of the Hungarian Academy of Sciences.

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Correspondence to József Szalma.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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

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