Hemisection refers to the surgical separation of a multi-rooted tooth with the extraction of one root along with the overhanging crown.It is performed to retain the original tooth structure and attain the fixed prosthodontic prosthesis. A 39 year old female patient reported to the Department of Conservative Dentistry and Endodontics, Saraswati dental college, lucknow .
Presented with a chief complaint of pain in left mandibular first molar since 2 weeks. (RCT treated 2 years back) Re-root canal procedure was started in the tooth 36.
All the filling material and carious structure on the pulpal floor was removed using a round bur.
Gutta percha removal was done from the distal canal first using retreatment files (Dentsply)
While removing gutta percha from mesial canal there was a stony hard resistance felt around 13 mm of canal(ML Canal).
Cross checked with radiograph, left GP seen in apical third of mesial canal,while attempting to remove GP ,ledge was found in mesiolingual canal,while mesiobuccal canal is negotiated till 17mm .
Patient was informed about the prognosis of the treatment and patient was very keen on saving the tooth .
So the treatment plan was modified and it was decided to do re-root canal therapy of the distal root followed by hemisectioning of the mesial half of the tooth. The patient was informed about the treatment plan, informed consent was obtained.
Working length was determined in distal canal.
Biomechanical shaping and cleaning was done with rotary files (till 30.06%)
Passive mechanical irrigation with 5.25% sodium hypochlorite solution followed by thorough saline irrigation, final irrigation with chlorhexidine.
An interappointment intracanal dressing of calcium hydroxide was given for one week after which obturation was completed.
Post endodontic buildup was done with paracore material.
Patient was recalled the next day for the hemisection procedure.
The mesial and distal roots were sectioned at the level of the furcation using long tapered fissure diamond point and a radiograph was taken to confirm the complete separation.
After completion of the sectioning, the mesial root was luxated and along with the coronal part it was removed from the socket.
The socket was irrigated adequately with normal saline to remove bony chips. A finishing diamond bur was used to smoothen the mesial surface of the distal root and its coronal portion.
Patient was recalled after 3 days for evaluation. At this visit clinical examination revealed healthy granulation tissue, thus irrigation with betadiene was done to wash out the debris collected in the socket which can interfere in healing.
Patient has been advised to come after seven days for suture removal.
Patient advised for prosthesis wrt 36 .It should be such that a self cleansing area between premolar and molar is present.
Patient kept on follow up for visualising bone status with time and periodontal health too.