SURGICAL MANAGEMENT OF HIGH-RISK MANDIBULAR THIRD MOLARS: CORONECTOMY VERSUS TOTAL EXTRACTION IN THE PREVENTION OF INFERIOR ALVEOLAR NERVE PARESTHESIA

Abstract

The surgical removal of high-risk mandibular third molars may be associated with inferior alveolar nerve paresthesia, especially when there is a close relationship between the dental roots and the mandibular canal. In this context, coronectomy has been proposed as a conservative alternative to total extraction, aiming to reduce the risk of this complication. This study aims to analyze, through an integrative literature review, scientific evidence from the last ten years on the surgical management of high-risk mandibular third molars, comparing coronectomy and total extraction in the prevention of inferior alveolar nerve paresthesia, as well as their indications, complications, and clinical implications for safe surgical planning. The bibliographic search was conducted in PubMed/MEDLINE, SciELO, and ScienceDirect databases, considering publications from 2016 to 2026 in Portuguese, English, and Spanish. Clinical studies, observational studies, clinical trials, systematic reviews, and meta-analyses related to the topic were included. The findings suggest that coronectomy may reduce the risk of paresthesia in carefully selected cases, although it has limitations such as root migration, exposure of root remnants, and eventual need for reintervention. It is concluded that coronectomy represents a relevant conservative alternative to total extraction in high-risk mandibular third molars, provided that it is indicated based on clinical and imaging assessment, informed consent, and adequate postoperative follow-up.