A Safer Option for Certain High-Risk Wisdom Teeth
If you have been told that your lower wisdom tooth is “too close to the nerve” or that it cannot be removed safely, you may still have options.
At Schiffman Oral Surgery, we have extensive experience treating complex wisdom teeth, including lower wisdom teeth that are very close to the inferior alveolar nerve. In some cases, the safest treatment is a specialized procedure called a coronectomy.
A coronectomy allows us to remove the part of the wisdom tooth most likely to cause problems while intentionally leaving the roots in place to reduce the risk of nerve injury.
We are one of the leading practices in Long Island for this procedure and have performed many coronectomies with excellent success.
What is a Coronectomy?
A coronectomy is a partial wisdom tooth removal. Instead of removing the entire tooth, the crown — the top portion of the tooth — is removed, while the roots are left undisturbed in the jawbone.
This is done when the roots of a lower wisdom tooth are very close to the nerve that provides feeling to the lower lip, chin, gums, and teeth.
The goal is simple: treat the wisdom tooth problem while lowering the risk of nerve injury.
A coronectomy is not the same as a tooth “breaking” during extraction. It is a planned, intentional, delicately executed procedure used in carefully selected cases.
Why would I need a Coronectomy?
Most wisdom teeth can be removed completely. However, some lower wisdom teeth have roots that are extremely close to the inferior alveolar nerve.
If that nerve is irritated or injured during wisdom tooth removal, it can cause numbness, tingling, burning, or altered sensation in the lower lip, chin, gums, or teeth. In many cases, these symptoms improve, but in rare cases they can be long-lasting or even permanent.
A coronectomy may be recommended when the wisdom tooth needs treatment, but removing the roots would create unnecessary risk.
This may be the case if your wisdom tooth is:
- Very close to the nerve on x-ray or 3D imaging
- Impacted
- Painful
- Recurrently infected
- Causing gum inflammation
- Damaging the tooth in front of it
What if I was told my wisdom tooth cannot be removed?
Many patients come to us after being told by their dentist or another oral surgeon that their wisdom tooth is too close to the nerve or too risky to remove. That does not always mean nothing can be done.
With careful evaluation, advanced imaging, and experience treating high-risk wisdom teeth, we can often help patients understand their options. In some cases, the tooth can be removed completely. In other cases, coronectomy may be the safest and most predictable approach.
We will review your imaging, explain your specific risks, and recommend the option that makes the most sense for you.
What happens to the roots after a Coronectomy?
After a coronectomy, there are three main possible outcomes.
1. The roots stay where they are
In many cases, the roots remain buried in the jawbone and never cause a problem. The gum tissue heals over the area, and no additional treatment is needed.
2. The roots slowly move away from the nerve
Sometimes, the retained roots slowly migrate upward and forward over time. This most commonly occurs during the first 6 months to 2 years after the procedure.
This movement is usually painless and may only be seen on follow-up x-rays. In some cases, it can actually be helpful because the roots may move farther away from the nerve.
3. The roots become infected and need removal
A less common possibility is that the retained roots become infected or exposed and need to be removed. When this happens, it is most common during the first several weeks after surgery, often within the first 6 weeks.
If root removal is needed later, the roots may have already moved farther away from the nerve, making removal safer than it would have been during the original surgery.
How is the procedure planned?
In high-risk cases, we will recommend a CBCT scan, which is a 3D dental scan that shows the relationship between the wisdom tooth roots and the nerve canal.
This helps us determine whether complete removal or coronectomy is the better option.
We look at:
- How close the roots are to the nerve
- Whether the nerve runs along, between, or around the roots
- The shape and direction of the roots
- Whether the tooth has decay or is infected
- Whether the tooth is a good candidate for coronectomy
Careful planning is one of the most important parts of a successful result.
What is recovery like?
Recovery after coronectomy is usually similar to recovery after wisdom tooth removal. Some soreness, swelling, and jaw stiffness are expected for the first few days.
Most patients do very well with routine post-operative care. We will give you specific instructions for eating, cleaning the area, taking medications, and knowing what symptoms to watch for.
You should contact our office if you develop worsening pain, swelling, drainage, fever, a bad taste, or symptoms that improve and then suddenly get worse.
Why choose Schiffman Oral Surgery?
Coronectomy is a technique-sensitive procedure that requires experience, proper imaging, and careful judgment.
At Schiffman Oral Surgery, we frequently treat complex wisdom teeth and have significant experience with coronectomy procedures. Patients are often referred to us because their wisdom teeth are close to the nerve or because they have been told that removal may be too risky.
Our approach is individualized. We will explain your imaging, discuss the risks and benefits, and help you choose the safest option for your situation.
If you have been told that your wisdom tooth is too close to the nerve, we would be happy to evaluate you.
Frequently Asked Questions about Coronectomy
Is coronectomy safer than wisdom tooth removal?
For certain high-risk lower wisdom teeth, coronectomy may reduce the risk of nerve injury compared with complete removal. However, it is not the best option for every wisdom tooth.
Are the roots supposed to be left behind?
Yes. In a coronectomy, the roots are intentionally left in place because removing them may place the nerve at increased risk.
Will the roots move?
They can. Root migration is common after coronectomy and usually occurs during the first 6 months to 2 years. The roots often move upward and forward, away from the nerve.
Can the roots get infected?
Yes, but this is less common. If infection occurs, it is most likely during the first several weeks after surgery. In that case, the roots may need to be removed.
Will I need a second surgery?
Most patients do not need a second surgery. A small percentage may need the roots removed later if they become infected, exposed, or symptomatic.
Can I be sedated for a coronectomy?
Yes. Depending on your medical history and the difficulty of the procedure, options may include local anesthesia, laughing gas, IV sedation, or a combination.
What should I do if another dentist said my wisdom tooth is too close to the nerve?
Schedule a consultation. We can review your imaging, obtain a 3D scan if needed, and explain whether complete removal, coronectomy, or monitoring is the best option.
Schedule a Consultation
To schedule a consultation for a high-risk wisdom tooth or coronectomy evaluation, call 516-569-1111. You will be examined in our state of the art private office in Woodmere, NY and a custom, personalized treatment plan will be tailored to suit your specific desires and needs. Schedule your wisdom teeth evaluation today at Schiffman Oral Surgery!
Dr. Leonard Schiffman and Dr. Michael Schiffman offer oral surgery services to the Five Towns in Long Island, New York and surrounding towns on the South Shore of Nassau County including Woodmere NY • Hewlett NY • Cedarhurst NY • Valley Stream NY • Woodsburgh NY • Lawrence NY • Inwood NY • Far Rockaway NY • Lynbrook NY • Oceanside NY • Rockville Centre NY
