Preservation vs extraction of carious multirooted teeth

Abstract

Hemisection refers to the surgical separation of multirooted teeth when the decay or resorption is restricted to one root, followed by removal of the affected root with preservation of the healthy root with its crown portion and its usage as abutment for subsequent prosthetic restoration. Aim: The aim of this case report was to raise awareness among dentists that preservation of tooth structure in the form of hemisection may be considered an alternative treatment modality in cases of multirooted teeth with extensive caries restricted to one of the roots. Case description: This describes the hemisection procedure of right mandibular second molar performed in a 35-year-old female referred for extraction. Intraoral examination and intraoral periapical (IOPA) radiography revealed extensive decay of tooth 47, restricted to the distal root, with satisfactory condition of the mesial root and its crown portion to be preserved by hemisection and used as abutment for a fixed prosthetic restoration. 6 weeks after the successful hemisection, a three-unit metal-porcelain fixed denture was performed, using the retained mesial root of mandibular second molar (47) and the mandibular second premolar (45) as abutments and replacing the missing mandibular first molar (46). Conclusion: Preservation of tooth structure by performing hemisection in carious multirooted teeth in cases when caries is restricted to one of the roots should be considered a valuable alternative treatment instead of extraction; therefore, it should be discussed with patients as one of the treatment options whenever suitable and possible to perform. Clinical significance: The rationale of hemisection in our case is that it enabled the preservation of tooth structure by supplying an abutment for construction of a three-unit fixed partial denture, thus providing the patient the opportunity to maintain occlusal function with reduced financial cost over dental implants.