RESECT TO RESTORE : HEMISECTION A CASE REPORT

INTRODUCTION :
Hemisection, meaning half-cut in Greek Latin is a corrective
periradicular surgery, carried usually in mandibular molars wherein one of the
two roots is devoid of bone and periodontal support !he main intention of
hemisection is to retain the part of tooth root while removing the deceased part,
which has a poor prognosis
"arrar#s proposition that, $saving part of a tooth is better than removing
it
G% &lack stated that in dental practice a valuable tooth can be retained
by amputation and removal of one of its deceased root
Indications :
'n a multirooted tooth(
) *evere bone loss around an isolated root threatening the health of other
root
+ Grade ''' and Grade '% furcation involvement Hemisection can be one
of the treatment modality
, *evere carious destruction of one of the segment of the tooth rendering
it non restorable
- .ndodontically untreatable roots because of mechanical inoperability or
refractory situation
)
CASE REPORT :
/ ,+ year old male patient reported to the 0epartment of 1onservative
and .ndodontics, 1ollege of 0ental *ciences, 0avangere, with a chief
complaint of pain while chewing in the left lower 2aw
3n clinical e4amination there was no carious involvement of any tooth
in that region !he oral hygiene status was poor with inflamed are recessed
gingival around the mesial root of ,5 3n probing there was appro4imately )6
mm pocket depth only on the mesial side
!here was Grade ' mobility and no migration of the affected tooth 7,5,
but it was involved with e4udation form the pocket !here was no intraoral
sinus !he vitality test of 7,5 showed positive response
'ntraoral periapical 8'39/: radiographic e4amination revealed a
complete 8)66;: bone loss in relation to mesial root of ,5, e4tending to the
furcation However bone was intact around the distal root of 7,5 the mesial
and distal roots were spaced apart
/ treatment plan was generated taking into account the .ndodontic and
9rosthodontic considerations and treatment was e4ecuted hand in hand
MANAGEMENT :
First Appointment :
9atient was posted for intentional root canal therapy, a day prior to
surgery Local anaesthesia was administered and an ideal access was opened in
+
tooth 7,5, following complete e4tirpation of the pulp, working length was
determined followed by biomechanical preparation and obturation in the distal
canal only /ccess cavity was filled with miracle mi4
Second Appointment :
3n the day of surgery, the patient was prescribed analgesic
8<imusulide: = hours preoperative to increase the pain threshold L/ was
administered 8+; Lignocaine with )>?6,666 /drenaline: in relation to tooth
7,5, marginal gingival was reflected around 7,5 with moons probe 8"ig): to
e4pose the furcation, while taking care not to tear the tissue "orm the buccal
furcation a marking was placed e4tending onto the lingual surface furcation to
help guide the bur path while hemisecting with the cut intended more on to the
deceased part of tooth root and preserving as much s possible the distal part of
tooth root
@ith the help of a micromotor handpiece and demand bur the tooth was
sectioned into two halves along the marking placed earlier *tarting form
buccal towards lingual 1ontinuous irrigation was carried out during cutting to
reduce the resecting temperatures near the bone /fter confirming a through
and through cut separating both the halves 8"ig+: with the help of probing /
lower premolar forceps was deeply engaged onto the mesial half of cut tooth
7,5 and e4tracted !he e4tracted mesial half of tooth-root 7,5 showed large
granulomatous tissue wrapped around the root e4tending up till the furcation
8"ig-: Aadiograph was taken to ensure clean cut and any sharp pro2ections
,
8"igB: Hemisected tooth 7,5 8"ig,:, the e4tracted socket was curetted and
thoroughly irrigated after which the distal tooth root was contoured and the
e4posed tooth restored with miracle mi4 to a contour of a premolar 8"igC:
!wo sling sutures were placed after compressing the socket one distal to
7,C and one mesial to 7,5 for an healthy gingival attachment !he distal half
of the tooth was ground out of occlusion /ntibiotics and analgesics were
prescribed, pot-operative instructions given and the patient was recalled after a
week
/t the end of first week, the patient was e4amined and sutures were
removed and the area was thoroughly irrigated /t the same appointment the
hemisected tooth was prepared along with tooth 7,C as abutment and a
provisional restoration was given with acrylic resin to maintain space and
stabiliDe the remaining tooth structures 9atient was recalled at monthly
intervals and a the , months post-surgery, radiographic evaluation of bone fill
of the socket was e4cellent
/ , unit fi4ed prosthesis was fabricated and cemented using ,,C as
abutment Later the case was clinically and radiographically evaluated after 5
months post surgery !he patient was fully satisfied by the functional aspect of
the bridge
DISCUSSION :
-
'ncreasing desire to preserve the tooth, hemisection, procedure has
gained a lot of value to retain the arch integrity .ven if one half of a tooth is
saved it can provide sufficient support to ad2acent members of the arch *ince
hemisection is done in molar teeth which freEuently serves as the most
posterior abutment, retaining even half a tooth could avoid the need for
removable prosthesis
!he mandibular first molars are more favourable than second molars, as
the root of second molars are not as divergent as the first molars and the
furcation is usually located at a more apical position on the root in relation to
the crown of the tooth than on ad2acent first molar teeth

'n the present case, the origin of the endo-perio problem was of primary
periodontal origin with secondary endodontic involvement, similar to
observations made by Hamp et al Hemisection can be done prior to or after
hemisection procedure, long term success or failure seems to be unrelated to,
which is done first, but ma2ority researchers and clinicians agree that whenever
possible, the endodontic treatment should be carried out first, as done in the
present case also
/dvantage of 9erforming .ndo !reating first are (
a: !he pulp usually vital in uncontaminated and the endodontic treatment
can be done in single visit if desired so
b: 9atient does not have pain and sensitivity after the hemisection
C
c: .ndodontist does not have to in2ect into a recently traumatiDed area
which freEuently is difficult to anesthetise and coupled with hyperemia
or pulpitis may result in pain during endodontic treatment
d: 'solation of remaining root without contamination is more difficult after
hemisection
e: "inally, the teeth with advanced furcation involvement often need
endodontic therapy first because of presence of lateral or accessory
canals in the furcation or in the interradicular areas
!he vertical cut method in hemisection of mandibular morals as
e4ecuted in the present case, is an e4cellent and time tested procedure 'f the
furcation can not be located properly, as silver point inserted inside the
furcation helps in making a cut /lways the section should be done at the cost
of tooth part to be removed
!he successful use of hemisected tooth as bridge abutment in the present
case report confirms the results of @yman et al 8)FBC:
!!
and .rpensten
8)F?,:
"
.ven teeth with markedly reduced periodontal support may be used as
bridge abutments following periodontal treatment, maintenance of a high
standard of plaEue control d the reconstruction of a stable occlusion
CONC#USION :
$We cannot change the wind.. but we can adjust the sail
5
!oday, success of preventive and conservative dentistry is to preserve
the ma4imum amount of supporting structures of the natural dentition in a state
of health and function
/ multidisciplinary approach has proven to be a valuable aid in
obtaining this ob2ective
B
REFERENCES :
) /brams, / and !rachtenberg, 0' > Hemisection techniEue and
restoration 0ent 1lin <orth /m )? > -)C----, )FB-
+ .rpenstein, H > / , year study of hemisected molars G 1lin
9eriodontal )6 ( ))6, )F?,
, Green, L< > Hemisection and root amputation G /m 0ent /sso ))+ (
C))-C)?, )F?5
- <yman, *, Lindhe, G, Lundgren, 0 > the role of occlusion for the of
fi4ed bridges in patients with reduced periodontal tissue support G 1lin
9eriodontal + ( C,-55, )FBC
?