Why Is Mandibular Third Molar Coronectomy Successful Without Concurrent Root Canal Treatment?

PURPOSE: Coronectomy is performed to avoid injury to the inferior alveolar nerve when mandibular third molars (M3s) in close proximity to the inferior alveolar nerve are indicated for extraction. Concern has been raised regarding the fate of submerged roots with exposed pulp tissue and whether this will serve as a nidus for infection. The study purpose was to answer the following clinical question: Among patients undergoing coronectomy, do those treated with concurrent root canal treatment (RCT), when compared with those not treated with RCT, have a decreased frequency of postoperative infections? The specific aims of this study were to 1) perform a comprehensive review to compare postoperative infection rates in M3 coronectomies with and without concurrent RCT and 2) review relevant animal and human studies pertaining to pulpal physiology as it relates to coronectomy. MATERIALS AND METHODS: The study was designed as a comprehensive review to identify controlled studies that compared outcomes of M3 coronectomies with and without concurrent RCT published through January 2020. Studies included in the sample needed to meet the following criteria: 1) studies published in English, 2) human studies, and 3) studies that reported the postoperative infection outcomes. The predictor variable was concurrent RCT at the time of coronectomy. The outcome variable was postoperative infection. RESULTS: The database search identified 107 publications for initial review. After application of the inclusion and exclusion criteria, the final sample included only 1 publication. The frequencies of postoperative infection with and without concurrent RCT were 87.5% and 12.5%, respectively. CONCLUSIONS: The one study identified for detailed review showed that RCT at the time of coronectomy does not decrease the frequency of postoperative infections. This result supports the recommendation that it is unnecessary to perform concurrent RCT on M3 roots that are retained. The finding that intentional submersion of roots does not require RCT also is supported by multiple animal and human studies.

3D Printing Technologies and Protocols to Enhance the Dental Workflow.

The implementation of digital technologies for interdisciplinary treatment planning and fabrication of monolithic ceramic restorations is a standard protocol in modern dentistry. Teeth with severe discoloration, soft-tissue defects, and multiple diastemas are common challenges clinicians face when performing restorative dentistry. The objective of this article is to describe to clinicians and dental technicians a novel approach regarding a digital workflow that combines the use of different CAD/CAM software programs to successfully address the challenge of achieving esthetic success in difficult cases. The "ReShape" concept for morphological and esthetic enhancement of monolithic ceramic restorations presents a unique digital workflow that facilitates production of restorations with natural morphology and surface texture, less need for post-milling characterizations, and excellent esthetic results. This approach is aimed at improving the quality of monolithic ceramic restorations fabricated via CAD/CAM technology by combining the acquisition software of an intraoral scanner with a design software.