|Year : 2016 | Volume
| Issue : 1 | Page : 46-48
Hemisection: A conservative approach of tooth preservation
Pankaj Mishra1, Anjna Sharma1, Sunil Kumar Mishra2
1 Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, Peoples Dental Academy, Bhopal, Madhya Pradesh, India
|Date of Submission||16-Apr-2016|
|Date of Acceptance||25-May-2016|
|Date of Web Publication||16-Jun-2016|
Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal - 462 030, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Progressive inflammatory periodontal disease, if left untreated, it will ultimately result in attachment loss. This can affect the bifurcation or trifurcation of multirooted teeth. Dentists are challenged to save those teeth that earlier would have been extracted without a second thought to save it. Hence, resective therapy has been utilized in the treatment of furcation defects. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment options for preserving remaining part of molar having sound periodontium. This case report presents a patient in whom distal half of the carious and periodontally compromised tooth was resected, and after healing, fixed dental prosthesis was given to restore proper form and function.
Keywords: Fixed partial denture, furcation, hemisection, resection
|How to cite this article:|
Mishra P, Sharma A, Mishra SK. Hemisection: A conservative approach of tooth preservation. J Curr Res Sci Med 2016;2:46-8
| Introduction|| |
Hemisection is the surgical separation of a multirooted tooth, especially a mandibular molar through the furcation in such a way that a root and the associated portion of the crown may be removed. The treatment goal is the preservation of remaining tooth structure and restoration of the function.  Once the tooth has been judged appropriate for this treatment, it must undergo endodontic therapy first and then must be prepared for complete crown coverage  because two roots are present in mandibular molars, half of the crown and associated root is removed. Hence, tooth resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. It differs from bicuspidization, in which a separation is made between two roots in the furcation area without removal of any root. The separated roots along with its crown portion are then restored as premolars. 
| Case report|| |
A 22-year-old male reported with complaints of pain and mobility of left mandibular first molar. On examination, the tooth was sensitive to percussion and revealed Grade 1 mobility. On radiographic examination, severe vertical bone loss was evident surrounding the distal root with resorption of root and involving the furcation area [Figure 1]. It was decided that the distal root should be hemisected after completion of endodontic therapy of the tooth. Working length was determined. Biomechanical preparation was done in the mesial root only. Master cone radiograph was taken. The canals were obturated with crown-down method, and the chamber was filled with silver amalgam to maintain a good seal and allow interproximal area to be properly contoured during surgical separation [Figure 2]. Under local anesthesia, full thickness flap was reflected after giving a crevicular incision from the first premolar to the second molar. Upon reflection of the flap, the crater-like bony defect along the distal root became quite evident. Curettage was performed to remove chronic inflammatory tissues. The vertical cut method was used to resect the crown with distal root. A long shank, tapered fissure carbide bur was used to make a vertical cut toward the bifurcation area. A fine probe was passed through the cut to ensure separation [Figure 3]. The distal half was extracted and the socket was irrigated adequately with sterile saline [Figure 4]. Intraoral periapical radiograph shows retained mesial half of crown and root [Figure 5]. After 1-month healing of the tissues, fixed dental prosthesis involving retained mesial half of mandibular first molar, mandibular second molar, and mandibular second premolar was given [Figure 6].
|Figure 3: Clinical photograph showing extracted distal root of mandibular molar|
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|Figure 4: Clinical photograph showing remaining mesial half of mandibular molar after Hemisection|
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|Figure 5: Intraoral periapical radiograph show retained mesial half of crown and root|
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| Discussion|| |
Hemisection is a useful alternative procedure to save those multirooted teeth which have been indicated for extraction. Before selecting a tooth for hemisection, patient's oral hygiene status, caries index, and medical status should be considered. The hemisection of multirooted teeth by endodontic approach, includes the root canal treatment of the remaining roots and restoring them with suitable restorative material and splinting it with the adjacent tooth to decrease the risk of displacement followed by a fixed prosthodontic prosthesis to maintain the occlusal balance.  The literature on distal root resection is limited as compared to mesial root in mandibular molars because of its anatomical structure. ,,, Nevertheless, hemisection is a viable option to be considered before the extraction of molars,  especially in the presence of conditions such as severe vertical bone loss (one root of a multirooted tooth), furcation destruction, unfavorable proximity of roots of adjacent teeth, preventing adequate hygiene in maintenance of proximal areas, and severe root exposure due to dehiscence. 
Recently, Park 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.  Shafiq et al. 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 the tooth can very well act as an abutment. 
Buhler observed 32% failure rate in hemisection cases attributed to endodontic pathology and root fracture, whereas other authors have shown greater success in hemisection cases in long-term studies. ,, In the present case, good prognosis was observed with proper occlusion, absence of mobility, and healthy periodontal condition up to 6 months of follow-up. Concurring with previous reports, hemisection is a valid treatment option for molar teeth in young children, which otherwise have to be extracted due to extensive caries.  Thus, conservative management of extensive carious molar tooth in young patients can not only preserve the tooth but also reduce the financial burden, psychological trauma, and occlusal dysfunction.
| Conclusion|| |
Hemisection has received wide acceptance as a conservative dental treatment and teeth so treated have fulfilled the demands of function. A dentist should discuss this with his patients during consideration of treatment options so that the patient can choose best and conservative treatment available.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]