HEMISECTION

A ray of hope for the hopeless

1. A ray of hope for the hopeless: Hemisection of mandibular molar with socket preservation Presented by AJINS CB

2. INTRODUCTION Advances in dentistry have made it possible to maintain a functional dentition for a lifetime. The terms ‘hemi-section’ and ‘root amputation’ are known collectively as ‘root resection’ Hemisections have been used in cases of advanced bone loss in furcation involvements.

3. HEMISECTION Hemisection refers to sectioning of a molar into two halves followed by removal of the diseased root and its coronal portion. The retained root is endodontically treated and the furcation area is made self-cleansable. Since hemisected teeth fail by root fractures, it is important to restore them adequately by an extra-coronal restoration

4. PERIODONTAL INDICATIONS Severe vertical bone loss involving only one root of multi-rooted teeth Through and through furcation destruction Unfavourable proximity of roots of adjacent teeth, preventing adequate hygiene maintenance in proximal areas Severe root exposure due to dehiscence

5. ENDODONTIC AND RESTORATIVE INDICATION Prosthetic failure of abutments within a splint Endodontic failure Vertical fracture of one root Severe destructive process

6. CONTRAINDICATIONS Poorly shaped roots or fused roots Poor endodontic candidates or inoperable endodontic roots Patient unwilling to undergo surgical and endodontic treatments

7. CASE REPORT Chief complaint : A 46 year old male patient, reported with the chief complaint of pain and sensitivity in left, lower, posterior region, since 3 months. The pain occurred on mastication and was relieved, once the stimulus was removed

8. CASE HISTORY PAST DENTAL HISTORY : Patient had undergone extraction of 37 due to caries which was uneventful PAST MEDICAL HISTORY : No relevant medical history PERSONAL HISTORY : He was a tobacco chewer for past 10 years

9. INTRAORAL EXAMINATION On intraoral examination, the probing depth of 13 mm was found on buccal and distal surfaces, along with grade III furcation involvement in tooth Also, the tooth showed grade I mobility and was sensitive to percussion.

10. RADIOGRAPHIC FEATURES IOPA radiograph revealed periodontal bone loss which obliterated the coronal third of the distal root as compared with mesial root and periapical rarefaction with both the roots

11. DIAGNOSIS Localized chronic periodontitis in relation to 36

12. TREATMENT PLAN Treatment options included extraction of 36, followed by placement of implant, a fixed partial denture or a removable partial denture. The patient did not wish to have the tooth removed, so conservative treatment was selected, which included hemisection of the distal root of 36, followed by prosthetic replacement.

13. PROCEDURE local anesthesia is administered a mucoperiosteal flap was reflected to expose the area of hemisection . Hemisection was carried out in 36 Distal root was extracted the defect was packed with bone graft

14. PROCEDURE The flap was repositioned sutured with 3-0 silk non- resorbable interrupted sutures Periodontal dressing was placed Antibiotics and analgesics were prescribed for one week. The sutures were removed 10 days later. The patient was monitored on a weekly schedule

15. PROCEDURE

16. POSTOPERATIVE FEATURES The tooth had good bone support after 8 months and it was decided to give him a fixed prosthesis involving 35,36,37,38. Occlusally , the tooth 36 was contoured as a molar on hemisected tooth, which provided more surface area for occlusal table. He had good masticatory efficiency with the prosthesis and was very satisfied with treatment outcome

17. OBJECTIVES To facilitate maintenance To prevent further attachment loss To obliterate furcation defects as a periodontal maintenance problem

18. CONCLUSION With recent refinements in endodontics , periodontics and restorative dentistry, hemisection has received acceptance as a conservative dental treatment for a hopeless tooth. The keys to long term success appear to be thorough diagnosis, selection of patients with good oral hygiene, careful surgical and restorative management. It was shown that such teeth can function successfully for long periods.

19. REFERENCES Newell DH. The role of the prosthodontist in restoring root resected molars: A study of 70 molar root resections. J Prosthet Dent 1991;65:7-15. 3. Kurtzman GM, Silverstein LH, Shatz PC. Hemisection as an alternative treatment for vertically fractured mandibular molars. Compend Contin Educ Dent 2006;27:126-9.

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