This document describes a case study of hemisection of the distal root of tooth 36 in a 46-year-old male patient with localized chronic periodontitis. The patient presented with pain and sensitivity in the left, lower, posterior region for 3 months. Intraoral examination revealed 13mm probing depth and grade III furcation involvement on tooth 36. Radiographs showed bone loss obliterating the distal root. After hemisection of the distal root and extraction, bone grafting was performed and the area healed well. At 8 months post-op, a fixed prosthesis involving teeth 35-38 was placed, restoring the hemisected tooth 36. The case study demonstrates that hemisection can be a conservative treatment

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.

20. THANK YOU