The removal of wisdom teeth can involve a straightforward extraction, with the teeth simply being pulled (under anesthetic). The process becomes more complex when wisdom teeth have deeply ingrained tooth roots, making a simple extraction difficult. In such a scenario, a dentist may need to break the tooth into sections (again, under anesthetic) and remove it in pieces. And then there are patients who need wisdom teeth removal but have a unique oral anatomy that makes it complicated.
A Crucial Function
The inferior alveolar nerve has a crucial function in your mouth and extends throughout your oral cavity. It supplies feeling to your lower (mandible) set of teeth, as well as your lower lip and chin. Any damage to this nerve can limit sensation in your lower teeth, making it difficult for you to notice the warning signs of an oral infection or similar condition. You can also lose feeling in your chin and lower lip. This important nerve can be located within close proximity to lower wisdom teeth.
A dentist will not plan wisdom teeth removal without comprehensive diagnostic testing. You'll receive an x-ray, and may even need 3D cone-beam computed tomography to create a three-dimensional image of your jaw. If it's noted that your inferior alveolar nerve is close enough to your wisdom teeth to create an unacceptable margin of error, a more specialized approach will be needed.
Although a general dentist can perform a simple wisdom tooth extraction, you may be referred to an oral surgeon for a procedure known as a coronectomy. This is a minor surgical procedure wherein the tooth's crown is removed, but its root system is left intact.
Performed under local anesthetic, the wisdom tooth is first treated with a handheld bur, which helps the surgeon manually erode some of the tooth's outer surface. The tooth can then be drilled, helping it to segment. The dental pulp (the tooth nerve inside the tooth) is severed, before the tooth's crown is fractured, allowing the bulk of the tooth to be removed. The remaining open root is treated with a surgical disinfectant to prevent infection and promote healing (chlorhexidine is commonly used). A small gum flap is then created to cover the intact tooth root and is sutured into place.
Don't be concerned if your dentist needs to refer you to a surgeon for a coronectomy. This procedure reduces any risk to your inferior alveolar nerve and actually serves the same general purpose as wisdom tooth extraction.