Hemisection denotes removal or separation of root with its accompanying crown portion of mandibular molars. This procedure represents a form of conservative dentistry, aiming to retain as much of the original tooth structure as possible. The results are predictable and success rates are high. In this paper a case is presented in which hemisection was done because the tooth was grossly carious along with furcation involvement. Mesial half of tooth was extracted and the remaining tooth was restored as premolar which helped to reduce the masticatory load.
Hemisection (removal of one root) involves removing significantly compromised root structure and the associated coronal structure through deliberate excision. Because of two roots present in mandibular molars, one half of the crown and associated root is removed. Thus 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 the two roots in the furcation area without removal of any root. The separated roots along with its crown part are then restored as premolars. Selected root removal allows improved access for homecare and plaque control with resultant bone formation and reduced pocket depth.
This procedure is indicated:
If there is severe bone loss limited to one root or involvement of a Class III furcation that could produce a stable root after hemisection.
If the patient is unable to perform appropriate oral hygiene in the area.
Extensive exposure of the roots because of dehiscence is another indication for excision of one root.
Indicated for failure of an abutment within a fixed prosthesis, provided a portion of the tooth can be retained to act as the abutment for the prosthesis.
Untreatable endodontic failure due to perforations and broken instruments.
Vertical root fracture confined to a single root of a multirooted tooth or any severe destructive process that is confined to a single root, including caries, external root resorption and trauma.
Before selecting a tooth for hemisection, patient’s oral hygiene status, caries index and medical status should be considered. Also the accessibility of root furcation for ease of operation as well as good bone support for the remaining roots should be assessed. The furcation region is carefully smoothed, to allow proper cleansing and thus to prevent accumulation of plaque.4 Root fracture is the main cause of failure after hemisection, so occlusal modifications are required to balance the occlusal forces on the remaining root.5
Contraindications include the presence of a strong abutment tooth adjacent to the proposed hemisection, which could act as an abutment to prosthesis. The remaining root may be inoperable for the necessary root canal treatment6. Also, fusion or proximity of the roots may prevent their separation3.
Hemisection may be a suitable alternative to extraction and implant therapy and should be discussed with patients during consideration of treatment options.
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