Introduction: If impacted teeth show a close relationship to the inferior alveolar nerve, surgical removal poses a high risk of nerve damage. Performing a coronectomy, which leaves the root in place, can reduce this risk. This case demonstrates a coronectomy followed by implant-prosthetic rehabilitation.
Materials and Methods: A patient presented with a distoangulated impacted tooth 45 and secondary caries on the mesial crown margin of tooth 47. Teeth 45 and 46 had been replaced by pontics for decades, with teeth 44 and 47 serving as abutments. 3D imaging showed the inferior alveolar nerve enclosed by the root of tooth 45. A coronectomy on tooth 45 was recommended and performed under IV sedation and perioperative antibiotics. A bony lid was created using the MicroSaw. The tooth crown and the coronal third of the root were removed, and the remaining root was left in place due to its proximity to the nerve. The bony lid was repositioned. After healing, tooth 47 was removed following the failure of a preservation attempt. Two months postoperatively, implantation was performed in regions 45 and 47 with bone augmentation using the split bone block technique and bone core technique. Autologous bone was harvested locally at the implantation site and from the ipsilateral retromolar area. After implant exposure, prosthetic restoration was completed without any sensory impairment.
Conclusion: A coronectomy can be an alternative to complete tooth removal when there is a close relationship with the inferior alveolar nerve. The bony lid approach preserves surrounding bone and enables subsequent implantation.