EWJ August 62 2025 web - Journal - Page 118
The defendant argued that even if the risks had been
explained that the claimant would still have gone
ahead with the procedure. The claimant was a speech
and language therapist and claimed that her employment had been taken from her because of the injury.
Neil Moody KC presiding over the case started his introduction with a summary of the basic anatomy
around M3Ms.
The effects of NICE guidelines on the management of
third molar teeth.
McArdle L, Renton T Br Dent J 2012; 213: E8–E8.
Change in clinical status of third molars in adults during 12
years of observation.
Ventä I, Turtola L, Ylipaavalniemi P.
J Oral Maxillofac
Surg 1999; 57: 386–9.
International Statistical Classification of Diseases and
Related Health Problems.
World Health Organization.
10th Revision. Volume 2.
Geneva: WHO; 2011
He correctly identified the LN and the IAN as being
at risk of damage. He included the defendants risk
sheet, warning of damage to the surrounding nerves,
but Mrs Winterbotham denied ever seeing the sheet.
Mrs Winterbotham thought that the risk to the LN
did not apply to her as the defendant had not pointed
it out to her.
A prospective study of clinical outcomes related to third
molar removal or retention.
Huang GJ et al.
Am J Public Health 2014; 104: 728–34.
The defendant was criticised for his lack of record
keeping and failure to gain informed consent.
Treatment of mandibular third molars and pericoronitis
in British military personnel: influence of guidelines from
the National Institute for Health and Clinical Excellence.
Pepper T, Konarzewski T, Grimshaw P, Combes J.
Br J Oral Maxillofac Surg. 2016 Dec;54(10):11111115.
It was put forward in by the KC that a coronectomy
would have :
• reduced risk to both nerves
Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience
Caissie R, Goulet J, Fortin M, Morielli D..
J Can Dent
Assoc (Tor) 2005;71:185–90.
• removed the source of the pericoronitis
The claimant had altered speech and sensation and
won substantial damages.
Summary
In my experience when a M3M is within 2mm of the
IAN canal then I always suggest a coronectomy. A
coronectomy rarely involves taking a CT scan and
healing is much quicker.
A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result
of coronectomy and removal of mandibular third molars
T. Renton et al
British Journal of Oral and Maxillofacial Surgery (2005) 43,
7—12
I still raise a buccal flap but once I have access, cutting
the crown in a horizontal fashion is quite easy to do,
but I stop before full sectioning. I then use a luxator
to lever the crown.
Comprehensive review of lower third molar management: A guide for improved informed consent
Joe Iwanaga et al.
Clinical Anatomy October 2020
Diagnosis, pathophysiology, management and future issues of trigeminal surgical nerve injuries
T. Renton1 & F. Van der Cruyssen2,
Oral Surgery 12 (2020) 389-403
Even a distoangular molar can be elevated buccally
without the need for distal bone removal.
More surgeons should offer a coronectomy approach
when there is a risk to the Lingual nerve and or the
Inferior Alveolar nerve.
Risk of lingual nerve injuries in removal of mandibular
third molars: a retrospective a case-control study
Itaru Tojyo et al
Maxillofacial Plastic and Reconstructive Surgery (2019)
41:40
Patients should be aware that coronectomy is not
without complications, but the risk to the nerves is
minimal when done with experienced hands.
Winterbotham Versus Dr A Sharak
Neil Moody KC
16-19/07/2024
Author
Dr R Kumar
BDS LDS RCS MSc ImpDent MAGDS RCSEd
PGCert Orthodontics
PGCert Facial Aesthetics
Examiner for the Royal College of Surgeons
Edinburgh
Complex tooth extraction referrals:
CT scan and report referrals:
www.forma.co.uk - admin@forma.co.uk
0207 436 9672
Located at: London Birmingham and Peterborough
Parameters for care for patients undergoing mandibular
third molar surgery
Royal College of Surgeons
2020
Oral and maxillofacial Surgery for the Clinician
K Bonantha et al
2021
Part one of this article was published in our June
issue.
If you require an expert let
us do the searching for you
call the Expert Witness free
telephone searchline on
References
Association of Oral and Maxillofacial surgeons of India
Diagnosis, pathophysiology, management and future issues of trigeminal surgical nerve injuries
T. Renton et al
Oral Surgery 13 (2020) 389--403.
EXPERT WITNESS JOURNAL
0161 834 0017
116
AUGUST/SEPT 2025
