Sir, I agree with Dr Ghaeminia's commentary on Coronectomy may be a way of managing impacted third molars and consider it to be essential reading.1

I am concerned coronectomy that can be undertaken by all is possibly being promoted as an alternative to extraction of third molars with scant evidence of patient benefit. NICE guidelines stipulate those impacted third molars suitable for extraction in the UK yet there is no mention of them in the published papers.

Following a coronectomy of an impacted third molar that satisfied NICE criteria for its extraction, would it be deemed a failure of the duty of care if the tooth remnants later became symptomatic? Would the surgery be considered inadequate2 should a patient suffer inferior dental (ID) nerve damage from the coronectomy surgical technique (undertaken to prevent it)? Should a root that is unnoticed to have been inadvertently loosened in the procedure later become symptomatic soon after the coronectomy also be a failure of the duty of care?

Cone beam CT investigation has been suggested as essential to confirm the third molar root relation to an 'at risk inferior dental nerve'3 prior to coronectomy. Does this radiation hazard negate any benefit from protection to the ID nerve by the technique? What of the risks to the lingual nerve from the surgical technique? Importantly, should research using the technique be submitted for scrutiny by an ethics committee?