Introduction:
Hemisection is a conservative dental procedure involving the removal or separation of a root with its accompanying crown portion, primarily performed on mandibular molars. This technique aims to preserve as much of the original tooth structure as possible rather than extracting the entire tooth. Hemisection is considered a viable treatment option for cases with furcation involvement, endodontic failure, or carious destruction.
Chief complain: A 40-year-old man reported to the department of periodontology with a complaint of dull pain and sensitivity in the lower left back tooth region of jaw for the past 1 year.
Diagnosis:
Clinical features: Though the pain was dull and intermittent in nature, yet it aggravated on mastication. No history of any systemic disease was reported.
Radiographic features: The intraoral periapical radiograph showed extruding gutta percha on the distal root of 36 along with furcation involvement. The bone support of the mesial root was completely intact.
Treatment plan : Hemisection of distal root.
Treatment procedure :Prior to surgery, extraoral and intraoral soft tissue were rubbed with chlorhexidine 2% antiseptic solution. Mandibular block anesthesia was done with lidocaine + 1:80.000 adrenaline
Before hemisection, the separation site was determined in mesio-distal and apico-coronal aspect to achieve a precise separation. With long thin coarse diamond bur, the distal and mesial roots of 36 was separated right at the furcation level.
Surgical elevator was used to engage between the roots and ascertain separation is complete. Then, the distal root was elevated and extracted.
Furcal roof was subsequently probed and smoothened with fine diamond bur to eliminate any roughness present. The extraction socket was then irrigated with saline to remove debris
Periapical radiograph was taken to evaluate the hemisection procedure. The patient was given prescription of antibiotics and antiinflammatory medications as well as post-hemsiection instructions.
suture removal: 1 week after hemisection, the soft tissue healed unevently. Sutures were removed