Hemisection as an Alternative Treatment for Resorbed Multirooted Tooth - A Case Report Jain et al.

CASE REPORT

Hemisection as an Alternative Treatment for Resorbed

Multirooted Tooth - A Case Report
Atul Jain1, Rachana Bahuguna2, Vineet Agarwal3

The term tooth resection denotes the excision and removal of

ABSTRACT any segment of the tooth or a root with or without its
accompanying crown portion. Various resection procedures
Advances in dentistry, as well as the increased desire of described are: root amputation, hemisection, radisection and
patients to maintain their dentition, have lead to treatment bisection. Root amputation refers to removal of one or more
of teeth that once would have been removed. In order to roots of multirooted tooth while other roots are retained.
carry out this present day mandate, periodontally diseased Hemisection denotes removal or separation of root with its
teeth with severe bone loss may well be retained by removal
accompanying crown portion of mandibular molars.
of one or more of their roots. Hemisection of a mandibular
Radisection is a newer terminology for removal of roots of
molar may be a suitable treatment option when the decay
maxillary molars. Bisection / bicuspidization is the separation
or resorption is restricted to one root and the other root is
of mesial and distal roots of mandibular molars along with its
healthy.this article describes a simple procedure for
crown portion, where both segments are then retained
hemisection in mandibular molar by vertical cut method
individually.1
and its subsequent restoration. Hemisection and prosthetic
rehabilitation yielded a satisfactory result. Root amputation procedures are a logical way to eliminate a
Keywords : Hemisection, Resorption, Prosthetic weak, diseased root to allow the stronger to survive, whereas
Rehabilitation. if retained together, they would collectively fail. Selected root
removal allows improved access for home care and plaque
control with resultant bone formation and reduced pocket
depth. 2 Hemisection procedure represents a form of
INTRODUCTION
conservative dentistry, aiming to retain as much of the original
Modern advances in all phases of dentistry have provided tooth structure as possible.3,4
the opportunity for patients to maintain a functional dentition
for lifetime. Therapeutic measures performed to ensure CASE REPORT
retention of teeth vary in complexity. The treatment may
involve combining restorative dentistry, endodontics and A 35- years old male patient reported to the department of
periodontics so that the teeth are retained in whole or in part. conservative and endodontics, K M Shah Dental College,
Such teeth can be useful as independent units of mastication Vadodara, India, with the chief complaint of pain in lower
or as abutments in simple fixed bridges.1 Thus tooth resection right back teeth since past one week. Patient was relatively
procedures are used to preserve as much tooth structure as asymptomatic before then. He developed continuous and
possible rather than sacrificing the whole tooth.1 throbbing pain in this region, which got aggravated during
mastication and sleep. Patient gave past dental history of
root canal treatment in 47, approximately 2 years back. Patient’s
1
medical history was not contributory.
Department of Conservative Dentistry & Endodontics,
2
Department of Pedodontics & Preventive Dentistry, Saraswati
On intra-oral examination, 46 was found to be grossly carious
Dental College & Hospital, Lucknow, 3 Department of Conservative
Dentistry & Endodontics, KM Shah Dental College, Baroda, India and full metal crown was present in relation to 47. On vertical
Address for Correspondence: percussion 46 was found to be sensitive. On probing, deep
Dr. Rachana Bahuguna periodontal pocket was found in relation to 46. Vitality testing
H D 48, Sector I, Jankipuram, Lucknow.
Contact No: +918756896109 Email: [email protected]
of 46 yielded no response.
Date of Submission : 22-01 -2011
Review Completed : 05-02 -2011 On radiographic examination (figure 1), grossly carious 46
Date of Acceptance : 08-02 -2011 was evident along with the external root resorption of both

44 Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011
Jain et al. Hemisection as an Alternative Treatment for Resorbed Multirooted Tooth - A Case Report

Figure 1- Pre-Operative Radograph Figure 3 - Hemisection by Vertical Cut Method

the mesial and distal roots. 47 was found to have been A fine probe was passed through the cut to ensure separation.
improperly root canal treated. After seperation, the severed portion of the mesial root was
removed with a extraction forceps (figure 4). The socket was
In the view of above findings, it was decided to first carry out irrigated with sterile saline to remove bony chips and debris.
re-endodontic treatment of 47 followed by the hemisection of
the mesial root of 46 while retaining- the distal root (as
adequate bone support was present), followed by root canal
treatment of the distal root and fabrication of crown and bridge
over 45 and47 using distal root of 46 as an abutment.

after the removal of full metal crown from 47, retreatment of

the mesial canals was carried out (figure 2). After the proper
obturation of 47, hemisection was carried out in relation to 46,
with the vertical cut method.

Figure 4 - After Removal Of Mesial Root

The remaining portion of the distal tooth was trimmed to

remove any ledges or sharp spicules, as these structures are
potentially detrimental for periodontal maintenance. Bone
Figure 2 - Intra-Oral Photograph Before Hemisection graft material (perioglas, novabone products,usa) was placed
inside the socket of the mesial root. Silk sutures (trulon,
A long shank, taper fissure carbide bur in high speed sutures india pvt ltd) were placed to approximate the flap
handpiece was placed along the buccal groove and a cut was (figure 5) and periodontal pack (coe-pak, gc america inc.,usa)
made. The cut was channeled towards the center of the tooth was applied.
and then directed towards the interproximal furcation opening After 7 days, the sutures were removed and the root canal
of the mesial root. The bur was moved in the lingual and treatment of the remaining portion of distal root was carried
apical direction until the furcation area was reached. Once out. The working length was determined and the canal was
the bur had severed the floor of the pulp chamber, root was biomechanically prepared by step back technique. The canal
seperated from the remaining portion of the tooth (figure 3). was obturated with lateral condensation method.

Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011 45
Hemisection as an Alternative Treatment for Resorbed Multirooted Tooth - A Case Report Jain et al.

Recently, Park et al.7 have suggested that hemisection of

molars with questionable prognosis can maintain the teeth
without detectable bone loss for a long-term period, provided
that the patient has optimal oral hygiene. Saad et al.8 have
also concluded that hemisection of a mandibular molar may
be a suitable treatment option when the decay is restricted to
one root and the other root is healthy and remaining portion
of tooth can very well act as an abutment. In the present case,
the mesial root was extremely resorbed while the distal root
could act as an abutment for the future prosthesis. As there
was a bone loss from the mesial surface of the distal root of 46
and adequate bone support was present on the distal surface
of the distal root, in order to provide better bone support and
faster bone healing, bone graft material was placed inside the
socket of the extracted mesial root as well as on the mesial
surface of the distal root.
Figure 5 - Sutures Applied After Removal Of Mesial Root
Root amputation and hemisection should be considered as
After obturation composite built up was done in both 46 and another weapon in the arsenal of the dental surgeon,
47 and crown preparation was completed on 46, 47 and 45 and determined to retain and not remove the natural teeth. With
fixed metal bridge was fabricated (figure 6). recent refinements in endodontics, periodontics and
restorative dentistry, hemisection has received acceptance
as a conservative and dependable dental treatment and teeth
so treated have endured the demands of function. 9 In
conclusion, hemisection can be considred a suitable
alternative to extraction and should be discussed with
patients, during consideration of treatment options. The
results of hemisection are predictable, and success rates are
high if certain basic considerations are taken into account.10

REFERENCES
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Figure 6 - Post-Operative Radiograph After Prosthetic full coverage to relieve crowding and lingual displacement of a
Re habilitatio n pulpo-periodontally involved mandibular first molar.
Endodontology, Vol. 12, 2000.
3. Kost WJ, Stakiw JE. Root amputation and hemisection. J Can
Dent Assoc 1991; 57(1):42–5.
DISCUSSION
4. Kurtzman GM, Silverstein LH, Shatz PC. Hemisection as an
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In the present case, because of excessive destruction of the treatment for decayed multirooted terminal abutment: a case
mesial root due to the external root resorption and fair amount report; J Can Dent Assoc. 2009 jun;75(5):387-90.
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composite and used as an abutment in crown and bridge after alternative treatment for vertically fractured mandibular molars.
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46 Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011