A hemisection is a dental procedure that is used in certain cases of serious dental disease when saving the entire tooth is not possible. This is an invasive technique in which the tooth is divided into two halves and one of them is removed. A tooth hemisection is performed to preserve the function of the tooth as well as to prevent the spread of infection or other problems to the adjacent tissues.
How is a Tooth Hemisection Performed?
A hemisection is a complex dental procedure that is usually performed by specialized oral surgeons or endodontists. Here is the general process of hemisection:
- Diagnosis and Planning: After performing an X-ray examination and evaluating the dental photograph, the dentist determines whether a tooth hemisection is the appropriate procedure for the given tooth.
- Anesthesia: Before the procedure begins, the patient is anesthetized locally to ensure a painless process.
- Separation of the Crown: Using specialized tools, the dentist separates the crown of the tooth from the root.
- Crown Removal: The crown (top part) of the tooth is removed.
- Treatment of the Root Canal: If necessary, endodontic treatment of the root canals is performed.
- Cutting the Root Canal: The root canal is cut along its extension to separate the part of the tooth that needs to be extracted.
- Removal of the Tooth Part: After the root canal is cut, the separated part of the tooth is removed.
- Treatment of the Rest: The rest of the tooth is treated to make sure there are no residual infections or problems.
- Placement of a Temporary Filling: After the procedure is completed, a temporary filling is placed on the rest of the tooth.
- Permanent Restoration: After a few weeks, when the tooth has successfully healed, the permanent restoration is made, usually by placing a crown or bridge.
When is a Tooth Hemisection Necessary?
A tooth hemisection is necessary when a multi-rooted tooth has a severe problem or damage in one root while the other root remains healthy and viable. This procedure is typically considered when other treatment options, such as root canal therapy or dental crowns, are not feasible or effective in preserving the tooth’s overall health and function.
Common Situations Where a Tooth Hemisection May Be Necessary Include:
- Severe Carious Lesions: When caries penetrates deep into the tooth and affects a significant part of the root system, hemisection may be the preferred method over extraction.
- Root Fracture: In cases where a tooth has a vertical root fracture and the fracture extends into only one root, it can be an option to preserve the unaffected root and surrounding bone.
- Periapical Infections: When one root of a tooth has a persistent periapical infection (infection at the root tip) and the infection cannot be controlled through conventional root canal therapy, hemisection may be necessary to remove the infected portion.
- Failed Root Canal Treatment: If a previous root canal treatment fails to resolve an infection or if the tooth becomes re-infected, it might be considered as an alternative to extraction.
- Root Resorption: When external or internal root resorption affects only one root of a multi-rooted tooth, it can be an option to remove the resorbed root while retaining the healthy portion.
- Fractured Tooth Structure: If a multi-rooted tooth experiences a fracture that affects only one root, hemisection may be a viable approach to saving the functional root and restoring the tooth’s chewing function.
It’s essential to consult with a qualified dentist or endodontist to assess the specific condition of the affected tooth thoroughly. They will conduct a comprehensive examination, including X-rays and possibly other diagnostic tests, to determine whether a tooth hemisection is the best course of action. Each case is unique, and the decision to proceed with a hemisection will depend on factors such as the tooth’s overall prognosis, the patient’s oral health, and their preferences and needs.
What are the Advantages of Hemisection?
- Preservation of the remaining healthy root: A tooth hemisection allows the preservation of a part of the tooth that remains functional and can be used as a support for future restorations such as crowns or bridges.
- Aesthetic appearance: Retaining part of the tooth helps to preserve the aesthetic appearance of the patient’s oral cavity and face.
- A cheaper alternative: In some cases, it can be more economical than replacing the tooth with an implant or bridge.
- Retains Chewing Function: By saving one functional root, the patient can maintain chewing ability and prevent the need for a more extensive dental prosthesis.
- Maintains Bone Density: By preserving the tooth’s root, it helps maintain bone density in the jaw, which is beneficial for oral health.
What are the Other Procedures Similar to Tooth Hemisection?
Several dental procedures are similar to hemisection in terms of their goal of preserving a portion of a tooth while removing damaged or infected structures. Some of these procedures include:
- Root Amputation: Root amputation involves the removal of one root of a multi-rooted tooth. This procedure is typically performed when one root of a tooth is severely diseased or damaged while the other roots remain healthy. The aim is to save the functional part of the tooth and surrounding supporting structures.
- Root Canal Therapy (Endodontic Treatment): Root canal therapy involves the removal of the infected or inflamed pulp (nerve) from the interior of the tooth. This procedure is performed to save a severely decayed or infected tooth from extraction. After cleaning and disinfecting the root canal system, the tooth is sealed and often restored with a dental crown.
- Apicoectomy: An apicoectomy is a surgical procedure that involves the removal of the tip of the tooth’s root and surrounding infected tissues. It is performed when a traditional root canal treatment is unsuccessful and the infection persists in the area around the root tip. The goal is to remove the source of infection while retaining the tooth.
- Resective Osseous Surgery: This surgical procedure involves the removal of a portion of the bone surrounding a tooth. It is performed to treat advanced periodontal disease, remove diseased bone, and improve the tooth’s stability.
- Hemisecting a Dental Bridge: In cases of a multi-unit dental bridge, hemisection can be applied to remove one abutment tooth (the tooth that supports the bridge) while preserving the other supporting tooth and the bridge’s pontic (the artificial tooth).
- Root Separation: Root separation is a procedure that involves separating the fused roots of a multi-rooted tooth that have become compromised by disease or trauma. The goal is to save the individual roots and restore them independently.
It’s important to note that not all cases are suitable for tooth hemisection, and the dentist will carefully evaluate each situation to determine the best treatment plan for the individual patient. In some instances, other dental treatments, such as root canal therapy or complete tooth extraction, may be more appropriate. Patients should consult their dentist for personalized advice and treatment options.