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| CASE REPORT |
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| Year : 2016 | Volume
: 4
| Issue : 1 | Page : 44-47 |
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Management of hemisected molar
DS Rami1, R Sethuraman2, H Raval1, A Piyaja1
1 PG Student, Department of Prosthodontics, Crown and Bridge, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
2 HOD & Professor, Department of Prosthodontics, Crown and Bridge, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
| Date of Web Publication | 29-Aug-2018 |
Correspondence Address:
R Sethuraman
HOD & Professor, Department of Prosthodontics, Crown and Bridge, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2347-6486.240044
As the advancements occur in dentistry, as well as the increased demand of patients to retain their natural teeth, have led to treatment of teeth that would have been removed in old days. Newer advancements in dental imaging, materials and equipments have improved the prognosis of compromised teeth. Locations of tooth, Dentist’s and patient’s satisfaction are the important factors, which judge the direction of treatment. A tooth which indicated for extraction, if the patient is ready to save it, it is the dentist’s duty to make efforts in preservation of the natural tooth. Mandibular first molars are the very commonly extracted teeth due to decay and periodontal disease. These teeth are important for occlusion and also have a more pericemental area. Hence, any defect in the root either mesial or distal, removal is the common treatment planned. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment modality for preserving remaining portion of molar with good periodontium. Presented case report demonstrates the successful management of a hemisected mandibular right first molar with occlusal rehabilitation with fixed partial denture.
Keywords: Hemisection, Fixed Dental Prosthesis, Molar tooth
How to cite this article:
Rami D S, Sethuraman R, Raval H, Piyaja A. Management of hemisected molar. J Integr Health Sci 2016;4:44-7 |
| Introduction | |  |
Many times, dentist would face conditions, where patients desire a little more than what could be done.[1] A molar with gross caries may be unsuitable for restoration. In such cases, the treatment options are less and may include a removable dental prosthesis or a dental implant to replace the missing tooth. If the decay is only in one root, a hemisection may be possible. Periodontal, prosthodontics and endodontic assessment for appropriate selection of cases is important.[2]
“The term tooth resection denotes the excision and removal of any segment of the tooth or a root with or without its accompanying crown portion.”[3] “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.”[3]
Weine has listed the following indications for tooth resection.[3]
Periodontal Indications
- Severe vertical bone loss which involve only one root of multi-rooted teeth.
- Through and through furcation destruction.
- Proximity of roots of adjacent teeth which is not favorable, proper hygiene maintenance is difficult in proximal areas.
- Severe root exposure due to dehiscence.
Endodontic and Restorative Indications
- Prosthetic failure of abutments within a splint: If a single or multi-rooted tooth is periodontally compromised within a Fixed Dental Prosthesis, instead of removing the whole bridge, if the remaining abutment support is enough, the root of the involved tooth is removed.
- Endodontic failure: Hemisection is helpful in cases where there is perforation through the floor of the pulp chamber or pulp canal of one of the roots of an endodontically treated tooth which cannot be treated.
- Vertical fracture of one root: The prognosis of vertical fracture is hopeless. If vertical fracture traverses one root while the other roots are unaffected, the fractured root may be sectioned.
- Severe destructive process: This may occur due to furcation or sub gingival caries, traumatic injury and large root perforation during endodontic treatment.
Contraindications
- Strong adjacent teeth available for Fixed Dental Prosthesis abutments as alternatives to hemisection.
- Non treated canals in root to be retained.
- Root fusion-making separation impossible. Hemisection (removal of root) is the removal of compromised root portion and the associated coronal portion through deliberate excision. This represents a form of conservative dentistry, aiming to preserve as much of the original tooth structure as possible. The results are predictable and success rates are high if some basic considerations are followed.[4] This case report describes the restoration of Hemisected 46 with Fixed Dental Prosthesis.
| Case Report | | |
A 30 year old male patient referred to the Department of Prosthodontics, Crown and Bridge from the department of Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Piparia, Waghodia, Vadodara, Gujarat, India for the replacement his missing teeth. The patient had no significant medical history. Intra oral examination revealed that the lower right first molar was hemisected [Figure 1]. The hemisection of the molar was performed before three weeks in the Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Piparia, Waghodia, Vadodara, Gujarat, India. Patient had a habit of tobacco chewing before two years. A diagnostic impression was taken with irreversible hydrocolloid impression material (Imprint alginate, Dental Impression Material, DPI, India) and the casts were poured with dental plaster (Kalabhai Karson, Batch No. 31105; Mumbai, India).
Face bow record was made and transferred to a semi-adjustable articulator and maxillary cast was mounted. Mandibular diagnostic cast was mounted using interocclusal record, to check for any occlusal prematurities and interferences and necessary occlusal corrections were carried out. Fixed Dental Prosthesis (Porcelain fused to Metal) was selected as treatment option using 45 and 46 as an abutment teeth. Shade selection was done followed by tooth preparation with intracrevicular finish line. Gingival retraction was carried out with #00 retraction cord (Ultra pack, South Jorden) [Figure 2]. The impression was made with elastomeric impression materials using putty wash two stage impression technique (Honigum, DMG, Hamburg, West Germany) [Figure 3].
After the coping trial done, porcelain buildup of the selected shade was done and the prosthesis was glazed. A mutually protected occlusion was planned for longevity of the prosthesis and confirmed at the final stage of bisque trial. The aesthetic appearance of the final prosthesis was confirmed with the patient and then, luted with resin modified glass ionomer cement. The excess cement was removed from the margins of the prosthesis [Figure 4]. | Figure 4: Final cementation of fixed dental prosthesis a. Palatal View. b. Facial View
Click here to view |
The radiograph of the prosthesis after cementation is shown in [Figure 5]. The Pre-operative and Post-operative photographs are shown in [Figure 6]. Oral hygiene instructions were given to the patient. Interdental brush was prescribed for maintenance of hygiene between the prosthesis. {Figure 5{
| Discussion | | |
When the teeth lose its root support, it will require a restoration to perform function independently or serve like an abutment for Fixed Dental Prosthesis or splint. Thus, restoration is necessary for function and stabilization of occlusion.[2] Restoration can contribute to periodontal destruction, if margins are defective or occlusal surfaces do not have physiologic form. An improperly shaped occlusal contact area converts acceptable forces into destructive forces leading to failure of hemisection. Hemisected abutment are given a taper more than 6–10 degree for a path of insertion compatible with the anterior abutment and to compensate for this buccal and lingual vertical grooves are placed in the abutment. Occlusal table is smaller in size to reduce the forces on the hemisected root. Cuspal inclines are less steep to reduce the lateral forces.
Buhler stated that hemisection should be thought as a treatment option before every molar extraction,[5],[6] because it provides a good, absolute and biological cost saving alternative with good long term success. The hemisection is a useful alternative treatment to save the multirooted teeth by endodontic treatment, which includes the root canal treatment of the remaining roots and restoring them with an appropriate restorative material to splinting it with the adjacent tooth to reduce the risk of displacement followed by a Fixed Dental Prosthesis to maintain the occlusal balance specially in 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.[6]
Buhler (1988) observed 32% failure rate in hemisection attributed to endodontic pathology and root fracture while other authors (09%) have shown a greater success in hemisection in the long-term studies.[2],[6],[7] Concurring with earlier reports, hemisection is a reasonable treatment option for the molar teeth, which otherwise have to be removed due to gross caries.[8] 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 is a baton for the extracting teeth. Careful case selection determines the long term success of the procedure. It is an important treatment in the field of dentistry which will help in increasing desire to retain natural teeth. It is also an effective and conservative treatment over conventional treatment or extraction of periodontally and endodontic compromised teeth. The keys to long term success include thorough diagnosis, selection of patients with good oral hygiene, careful surgical and restorative management. Hemisection may be a suitable alternative to extraction and implant therapy 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.
| Acknowledgement | | |
I would like to acknowledge the department of conservative for their clinical expertise in the endodontic treatment and hemisection of the concerned tooth.
| References | | |
| 1. | Balsaraf OD, Abraham S, Chacko L, Kakde D. Management of an endodontically compromised multirooted tooth with hemisection and platelet rich fibrin: A case report. Scientific Journal of Dentistry.2014;1(1);30-4  |
| 2. | Radke U, Kubde R, Paldiwal A. Hemisection: A Window of Hope for Freezing Tooth. Case reports in dentistry. 2012 Aug 14, 1-4. |
| 3. | Heda A, Gundappa M., Mohan R. Hemisection- A Case Report. Tmu J Dent 2014;1(4): 149-51. |
| 4. | Behl AB. Hemisection of a multirooted tooth-A case report. Open Access Sci Rep. 2012;1:1-3. |
| 5. | Desanctis M, Murphy KG. The role of resective periodontal surgery in the treatment of furcation defects. Periodontology 2000. 2000 Feb 1;22(1):154-68. |
| 6. | Babaji P, Sihag T, Chaurasia VR, Senthilnathan S. Hemisection: A conservative management of periodontally involved molar tooth in a young patient. Journal of natural science, biology, and medicine. 2015 Jan;6(1):253-5. |
| 7. | Shah S, Modi B, Desai K, Duseja S. Hemisection-A conservative approach for a periodontally compromised tooth-A Case Report. Journal of Advanced Oral Research. 2012 Aug 15;3(2):21-5. |
| 8. | Shafiq MK, Javaid A. Hemisection: An option to treat apically fractured and dislodged part of a mesial root of a molar. J Pak Dent Assoc. 2011 Jul;20(3):183-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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