hemisection bicuspidization

1. S A H I T H D A S A R I
I Y E A R P O S T G R A D U A T E
C O N S E R V A T I V E
D E N T I S T R Y & E N D O D O N T I C S
RESECTION FOR CONSERVATION
HEMISECTION:
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2. C O N T E N T S :
• INTRODUCTION
• DEFINITION
• INDICATIONS
• CONTRAINDICATIONS
• CATEGORIES OF CASE SELECTION
• TREATMENT OPTIONS
• A CASE REPORT
• REVIEW OF LITERARUTRE
• DISCUSSION
• REFERENCES
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3. I N T R O D U C T I O N :
• Advanced dental therapeutic techniques have made it possible to keep teeth that were
previously thought to be irreparable.
• Hemisection procedures are used to preserve as much tooth structure as possible.
• Hemisection use a multidisciplinary approach , which integrates principles
from prosthodontics, oral surgery, endodontics, periodontics, and restorative dentistry.
Hemisection: A Window of Hope For Freezing Tooth Usha Radke, Rajesh Kubde, and Aditi Paldiwal PMCID: PMC3426179 doi: 10.1155/2012/390874
PMID: 22928121
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4. • The term “hemi section” are synonyms for “root sectioning” or “bisection” and is a
treatment modality, which allows the preservation of tooth structure, alveolar bone and
cost savings over other treatment options.
• The right case selection is the most important component in determining the long-
term success.
Hemisection: A Different Approach From Extraction. Cureus. 2022 Sep 21;14(9):e29410.
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5. D E F I N I T I O N :
• Hemisection refers to sectioning of a mandibular 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.
• Hemisection is the sectioning of teeth with multiple roots, the removal of the damaged root
and its associated crown piece, and the preservation of the healthy root (with crown). When
periodontal, resorption, perforation, or caries damage is limited to one root and the other
root is still largely healthy.
Hemisection: A Different Approach From Extraction PMID: 36304357 PMCID: PMC9586421 DOI: 10.7759/cureus.29410 Prachi Taori , Pradnya P
Nikhade , Joyeeta Mahapatra
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6. I N D I C AT I O N S : A C C O R D I N G T O W E I N E
Periodontal Indications:
• Only one root of a tooth with several roots suffers from severe vertical bone loss.
• Complete destruction of the furcation.
• The roots of adjacent teeth are too close to one another, making it difficult to maintain proper
cleanliness in close quarters.
• Serious root exposure as a result of dehiscence.
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7. E N D O D O N T I C A N D R E S T O R A T I V E I N D I C A T I O N S :
• Extremely destructive process : Resorption, caries, trauma .
• Prosthetic failure of abutments within a splint.
• Endodontic failure , perforation , root fracture , instrument breakage...
• Vertical fracture of a single root.
• A post and core restoration can be supported.
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8. C O N T R A I N D I C AT I O N S : A C C O R D I N G T O W E I N E
• Strong adjacent teeth available for bridge abutments as alternatives to hemisection.
• Inoperable canals in root to be retained.
• Root fusion-making separation impossible.
• Non-strategic teeth.
Hemisection: Partial preservation of compromised tooth Ishani Saluja et al , J conserv dent 2023 may- Jun,
26(3)355-358
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9. C AT E G O R I E S O F C A S E S E L E C T I O N :
Local considerations :
• Tooth anatomy,
• Mobility,
• Crown-to-root ratio,
• Degree of attachment loss,
• Interaction between the inter- and intra-arch teeth,
• Strategic dental value for retention or removal.
Patient factors :
• Health of a patient,
• Importance of the tooth to the patient,
• Costs, and Time factor.
Hemisection: A Different Approach From Extraction PMID: 36304357 PMCID: PMC9586421
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10. Clinical aspects :
• Careful case selection process.
• Diagnostic and treatment planning abilities.
• Knowledge of available therapy alternatives.
• Clinical insight or service delivery expertise.
• The amount of bone support and degree of furcation involvement are major determinants for case
selection and prognosis.
Hemisection: A Different Approach From Extraction PMID: 36304357 PMCID: PMC9586421
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11. T R E AT M E N T O P T I O N S :
• Extraction followed by Fixed prosthesis using the mesial portion of the mandibular
premolars.
• Extraction followed by Fixed prosthesis with the mesial part of the mandibular first molar
and an inlay type restoration on the adjacent tooth (second molar).
• Extraction followed by Fixed prosthesis with the mesial part of the mandibular first molar
and an occlusal rest on the adjacent tooth (second molar).
• Extraction followed by implant.
Hemisection: Partial preservation of compromised tooth Ishani Saluja et al , J conserv dent 2023 may- Jun,
26(3)355-358
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12. A C A S E R E P O R T :
• OP NO :2311110228
• NAME OF PATIENT : S.KUMARI
• Age : 22
• Sex : FEMALE
• Area : Vemagiri
• CHIEF COMPLAINT :Patient complains of decayed tooth in the lower right back tooth
region since 2 years.
• HISTORY OF PRESENT ILLNESS : patient gives history of pain 2 years back which was
sudden in onset , intermittent , throbbing type , moderate intensity aggravated at night and
relived by itself
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13. • CLINICAL FINDINGS : chronic irreversible pulpitis
irt 46
• RADIOGRAPHIC FINDINGS :radiolucency
involving enamel dentin and pulp in the distal
aspect of the tooth extending up to furcation area
with widening of PDL space, discontinuity in
lamina dura and diffuse peri apical radiolucency irt
46
• FINAL DIAGNOSIS : chronic irreversible pulpitis
with apical periodontitis irt 46
• TREATMENT PLAN :advised root canal treatment
followed by hemisection irt 46
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14. Working length Master cone selection
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15. Obturation and post
endodontic restoration
Post obturation Clinical
photograph
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16. Extracted distal root
Post operative photograph
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17. POST OP X RAY AFTER 2
WEEKS
EXTRA CORONAL RESTORATIONS
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18. D I S C U S S I O N :
• Hemisection is a useful alternative procedure to save those multirooted teeth which have been
indicated for extraction.
• .Hemisection of mandibular molar may be viable treatment modality when one root has poor
treatment prognosis, and the other root is healthy and that portion of tooth can be act as abutment.
• Correct case evaluation is a key to this treatment's success
• We consider that hemisection, a multidisciplinary approach to treatment that combines endodontic,
restorative, and prosthodontic procedures, represents an additional option for maintaining teeth
and bone structure
• Nevertheless, hemisection is a viable option to be considered before the extraction of molars,
especially in the presence of conditions such as severe vertical bone loss (one root of a
multirooted tooth), furcation destruction, unfavorable proximity of root.
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19. R E V I E W O F
L I T E R A R U T R E :
Basten et al. reported that 92% of all resected molars survived an average of 12 years,
Langer et al. found that 36% of root-resected mandibular molars failed over 10 years, most commonly due
to endodontic or restorative problems and not periodontal disease.
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20. • Bühler reported that failure rates of two treatment alternatives were not substantially different
with an average reported failure rate of 13.1% among hemisected teeth.
Fugazzotto found that cumulative success rates were 96.8% for root-resected molars while 97.0% for molar
implants
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21. C O N C L U S I O N :
• Hemisection is an alternative, effective, and conservative treatment modality over
conventional procedure or extraction of periodontally and endodontic affected teeth.
• Also reduces the financial burden, psychological trauma, and occlusal dysfunction
associated with tooth loss
• Hemisection has received wide acceptance as a conservative dental treatment and teeth so
treated have fulfilled the demands of function. A dentist should discuss this with his patients
during consideration of treatment options so that the patient can choose best and
conservative treatment available
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22. R E F E R E N C E S :
• Hemisection: Partial preservation of compromised tooth. Saluja I, Kamath AK, Pradeep S, Gupta
R, Duggal K. . J Conserv Dent. 2023 May-Jun;26(3):355-358.
• Hemisection: A conservative management of periodontally involved molar tooth in a young
patient. Babaji P, Sihag T, Chaurasia VR, Senthilnathan S. J Nat Sci Biol Med. 2015 Jan-
Jun;6(1):253-5.
• Hemisection as a Conservative Management of Grossly Carious Permanent Mandibular First
Molar.Sharma S, Sharma R, Ahad A, Gupta ND, Mishra SK. J Nat Sci Biol Med. 2018 Jan-
Jun;9(1):97-99.
• Hemisection: A Different Approach From Extraction. Taori P, Nikhade PP, Mahapatra J. . Cureus.
2022 Sep 21;14(9):e29410.
• Hemisection: A Window of Hope For Freezing Tooth Radke U, Kubde R, Paldiwal A. Case Rep
Dent. 2012;2012:390874.
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23. THANK YOU
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