Bicuspidization

[Anonymous]

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.

        

[tirath]

Hemisected mandibular molars have a higher frequency of complications than those treated with implant therapy. When the back teeth of the lower jaw, the mandibular molars, are periodontally involved, treatment decisions include hemisection of the molar and extraction of the tooth, replacing it with an implant.

        

[tonyshori.perio]

Before bicuspidization one must always finish the RCT treatment first with that tooth. it is only done with the lower molars. it is generally done with through and through bone loss is present. then individual caps are then prepared. so the molar is splitted into two premolars.

        

[Anonymous]

Bicuspidation is independent of hemisection…hemisection includes splitting of the tooth and extraction of one half,,followed by a bridge
Bicuspidation includes retaining both the split sections of the tooth and capping them

        

[Drsumitra]

 A study evaluated the survival rate and incidence of complications of multirooted teeth with furcation involvement that had received perio­dontal treatment. It involved a Med­line search and handsearching of the International Journal of Perio­dontics and Res­torative Den­tistry, Journal of Clinical Perio­don­tol­ogy, Journal of Perio­dontal Re­search, and Journal of Perio­dontology, as well as reference lists of publications selected. Studies were screened and quality assessed independently by 2 reviewers. Review articles, case reports, studies less than 5 years in duration, and studies that did not provide information on tooth survival or furcation in­volvement were excluded. The 2 reviewed independently ab­stracted the data. Owing to the heterogeneity of the data, a meta-analysis could not be performed. A qualitative synthesis was conducted grouping the studies into the following areas: nonsurgical furcation therapy; surgical therapy not involving tooth structures; tunnelling surgical resective therapy (eg, root resection and/ or root separation); and guided tissue re­generation (GTR) and grafting procedures. The study found 22 publications that met the inclusion criteria. The survival rate of molars treated nonsurgically was > 90% after 5 to 9 years. The corresponding values for the different surgical procedures were: surgical therapy, 43.1% to 96% (observation period, 5 to 53 years); tunnel­ling procedures, 42.9% to 92.9% (observation period, 5 to 8 years); surgical resective procedures including amputation(s) and hemisections, 62% to 100% (observation period, 5 to 13 years); and GTR, 83.3% to 100% (observation period, 5 to 12 years). The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. It concluded that good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were ob­tained following various therapeutic approaches. Initial furcation involvement (degree 1) could be successfully managed by nonsurgical mechanical debridement. Vertical root fractures and en­dodontic failures were the most frequent complications ob­served following resective pro­cedures.

        

[drsushant]

 

 

 

 

        

[Drsumitra]

A study evaluated the survival rate and incidence of complications of multirooted teeth with furcation involvement that had received perio­dontal treatment. It involved a Med­line search and handsearching of the International Journal of Perio­dontics and Res­torative Den­tistry, Journal of Clinical Perio­don­tol­ogy, Journal of Perio­dontal Re­search, and Journal of Perio­dontology, as well as reference lists of publications selected. Studies were screened and quality assessed independently by 2 reviewers. Review articles, case reports, studies less than 5 years in duration, and studies that did not provide information on tooth survival or furcation in­volvement were excluded. The 2 reviewed independently ab­stracted the data. Owing to the heterogeneity of the data, a meta-analysis could not be performed. A qualitative synthesis was conducted grouping the studies into the following areas: nonsurgical furcation therapy; surgical therapy not involving tooth structures; tunnelling surgical resective therapy (eg, root resection and/ or root separation); and guided tissue re­generation (GTR) and grafting procedures. The study found 22 publications that met the inclusion criteria. The survival rate of molars treated nonsurgically was > 90% after 5 to 9 years. The corresponding values for the different surgical procedures were: surgical therapy, 43.1% to 96% (observation period, 5 to 53 years); tunnel­ling procedures, 42.9% to 92.9% (observation period, 5 to 8 years); surgical resective procedures including amputation(s) and hemisections, 62% to 100% (observation period, 5 to 13 years); and GTR, 83.3% to 100% (observation period, 5 to 12 years). The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. It concluded that good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were ob­tained following various therapeutic approaches. Initial furcation involvement (degree 1) could be successfully managed by nonsurgical mechanical debridement. Vertical root fractures and en­dodontic failures were the most frequent complications ob­served following resective pro­cedures

 

        

[drmithila]

Findings from a recent survey of dentists in Japan have revealed that in 2011 one in four had seen patients with health complications due to dental implant treatment. Over 90 per cent of the dentists surveyed also reported having treated patients last year with problems related to implants placed by a colleague.
Pointing to the general risks of implant procedures, the Director of the Japanese Academy of Maxillofacial Implants told the Asahi Shimbun newspaper that some of the cases might be related to dentists using clinically unsuitable methods or technologies. He called on patients suffering from problems after implant treatment to seek medical help at dental clinics immediately.

In Asia, Japan has the second highest penetration rate of dental implants after South Korea currently. According to figures from the AstraZeneca Group in London, UK, almost half a million implants were placed in the country in 2006, a figure that experts say has further increased in recent years, despite the recession and March 2011 tsunami.

Business figures from leading market players suggest that Japan’s dental implant market is growing by more than two per cent annually.

The first dental implants were placed in Japan in the early 1970s. Although not covered by national dental insurance, the procedure has become a widely accepted treatment method among patients and dentists. The International Team for Implantology, a Straumann affiliate and one of the world’s largest providers of dental implant education, recently held its first Japanese congress in Tokyo in June.

 

        

[Author]

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