Tooth hemisection - what is it and why?

Hemisection is a surgical operation that involves removing the affected molar root along with the adjacent part of the crown. Such surgical intervention is carried out in cases where the pathological process, which cannot be treated, is localized only at one of the roots of the diseased tooth. After the operation is completed, the intact roots and crown part of the tooth can still play the role of support for prosthetic structures during orthopedic treatment.

Indications

Hemisection is possible only in relation to multi-rooted teeth of the lower jaw, in situations where the source of inflammation is not accessible for treatment by non-surgical methods. At the same time, the other canals of the tooth must be healthy or subject to standard medical procedures. The main indications are:

periodontitis resulting from chronic infection;
intraosseous pockets in the root area;
vertical split of a molar;
deep caries;
structural anomalies;
dental granuloma;
infections introduced after poor-quality canal treatment.

The operation is performed on children and adolescents, which is preferable to complete tooth extraction, since implantation is possible after 25 years, when skeletal growth is completed.

Application of the technique in dentistry

The surgical technique is used by specialists in the following cases:

if surgical treatment is necessary for adolescents. Tooth extraction can negatively affect the formation of the bite;
hemisection is used to eliminate a tumor located in close proximity to the root. The use of the technique allows you to excise only the pathological area without affecting healthy tissue;
removal of only one root will solve the problem of treating its fracture and preserve the healthy part of the organ;
root amputation using hemisection allows you to eliminate long-term infectious inflammation of surrounding tissues, which cannot be treated by other methods;
surgery may be required to eliminate the purulent focus. If an accumulation of inflammatory fluid has formed in one of the roots, it is not necessary to remove the entire organ to remove it; it is enough to perform a hemisection;
in some cases, it is impossible to cure the carious process by cleaning and filling all root canals due to their complex anatomical structure. This circumstance especially concerns narrow root canals. In this case, surgical intervention will help eliminate the pathological process - excision of the root and part of the crown;
hemisection of a tooth is the most gentle way out of a situation when it is necessary to remove a dental instrument stuck in the root canal.

Contraindications

Resection is not performed in old age and in patients with severe systemic pathologies: diabetes mellitus, blood diseases, cardiovascular disorders in the acute stage. Also, surgery is not prescribed for infectious processes and disorders of the immune system. In addition, contraindications are:

fused roots;
destruction of bone tissue around the affected dental unit;
obstruction of the root canals intended for preservation;
stomatitis.

It should be noted that a tendency to allergies is not a contraindication, since modern pharmacology offers a wide selection of anesthetics for any clinical case.

Restrictions on the use of the procedure

The hemisection procedure is not used in some cases when the benefit of the intervention is not comparable to the risk to the patient. The cause of failure may be problems with blood clotting. In addition, individual intolerance to drugs and local anesthesia can become a significant obstacle to performing the operation. It is undesirable to carry out the intervention during periods of exacerbation of chronic diseases, such as diabetes mellitus and chronic heart failure.

An obstacle to intervention may be the anatomical structure of the affected tooth:

location of the roots in close proximity to the maxillary sinus. In this case, the operation of hemisection of the tooth is fraught with damage to the bone walls of the sinus and the occurrence of an inflammatory process in it (sinusitis);
a tooth whose roots cannot be separated due to fusion cannot be subjected to hemisection;
too much destruction of the crown. In this case, after the operation there will be a small part of the organ that cannot cope with the load;
an organ with too short roots may fall out after hemisection. In this situation, intervention is not recommended.
deficiency of soft gum tissue at the site of the proposed intervention. They may not be enough to close the resulting wound after the procedure.

Preparing for amputation

Resection of a part of the tooth is carried out after preliminary preparation, including collection of a medical history, instrumental diagnostics, consultations with an orthopedist and other doctors of related specialties. Surgical intervention is preceded by complete sanitation of the oral cavity and conservative treatment, during which the dentist cleans and fills healthy root canals. At the end of the manipulations, a control x-ray is taken.

The appointment includes consultation and drawing up a treatment plan with cost determination

Not ready for an in-person consultation with a doctor? Ask your question by phone

Cost of services

Consultation with an implant surgeon 0 rub.
Hemisection 2,500 rub.

Expert of the article you are reading:

Sokhov Valery Borisovich

Dentist surgeon, general dentist, implantologist, dental therapist, orthopedic dentist

Basic methods and stages of surgical treatment

The partial resection operation meets modern dental requirements aimed at preserving the patient’s own teeth without discomfort and pain. There are two main methods of hemisection.

The first option is removal from above. During the operation, vertical sawing and amputation of a segment of the coronal part of the tooth is performed along with the affected root and tissues affected by inflammation. The resulting hole is filled with osteoplastic material. To restore the tooth crown, a pin is installed, and if necessary, the surgeon sutures the mucous membrane.

The patch hemisection technique is indicated in cases where the tooth crown is not destroyed, but the root cannot be restored. Access to the affected area is carried out by detaching a gum flap, after which the damaged part of the root is amputated. At the end of the hemisection, the excised tissue is placed in place and sutured with catgut threads. If the remaining part of the crown is mobile, splinting is used.

Very often, to speed up wound healing, instead of osteoplastic mass, blood plasma is transplanted into the socket. The innovative technique eliminates the risk of rejection and significantly speeds up the recovery process. During the operation, radiography and follow-up examinations are required. Healing takes up to four months, after which the healthy part of the molar can be used as a full-fledged support for the installation of an orthopedic structure.

Advantages and disadvantages of the method

Like any method of treating a disease, hemisection of a tooth has its positive and negative sides.
The main advantages include the following:

hemisection retains the ability to use the diseased organ as a basis for subsequent prosthetics;
the operation will avoid the appearance of free space in the dentition and the movement of other teeth;
the preserved part of the organ will participate in chewing food, which will evenly distribute the load on the jaw;
the remaining part of the organ after hemisection of the root will allow the bone and supporting components of the jaw (such as the alveolar ligament) to continue to be included in the work. In the absence of roots, a process of loss of bone density occurs - atrophy;
hemisection can be used both in adults and in adolescents whose bite and dentition have not yet fully formed;
the use of local anesthesia and the absence of large incisions makes root amputation by hemisection a safe procedure associated with the development of a minimum of complications.

While there are positive aspects to the hemisection method, there are also disadvantages. A significant circumstance is the loss of part of the crown and one root. Ultimately, such a defect becomes the reason that the tooth will not be able to withstand the normal load that falls on it during the chewing process. In addition, unprofessional assistance provided and failure to comply with doctor’s recommendations in the postoperative period can lead to complications.

Possible complications

Innovative equipment, highly qualified doctors and the introduction of new techniques provide positive treatment prognoses even in the most difficult cases. Despite this, it should be understood that any surgical intervention entails risks of complications. After the operation the following are possible:

general malaise and increased body temperature;
loss of appetite;
swelling and pain in the operated area;
exacerbation of concomitant pathologies;
violation of fixation of the remaining part of the dental crown.

In difficult cases, the patient may be sent to a hospital and prescribed complex drug treatment with antibacterial, anti-inflammatory and immunomodulatory drugs. In rare cases, a second operation may be required to remove the remaining part of the tooth.

Operation technique

Hemisection refers to volumetric surgical interventions. The procedure lasts 1.5-2 hours. For pain relief, local or general anesthesia is used. The choice depends on the individual characteristics of the patient and the technique used.

Hemisection can be performed by two methods: access from above or by peeling off a skin flap.

When choosing the first method, the crown is sawed to the point where the roots emerge. In this way, the affected root, together with part of the crown, is separated from healthy tissue. After separation, the damaged area is removed.

The second method is carried out by cutting the gums. In the area of projection of the affected area, the flap is peeled off, part of the root is sawed off and removed. Stitches are applied.

After removing one of the roots, a void remains in the jaw. If left, it will fill with granulation tissue, which is considered an unfavorable outcome. To prevent this, artificial bone is poured into the cavity and covered with a membrane. The material is biocompatible and is rarely rejected.

Prosthetics are not performed immediately after surgery. We need to wait for complete healing. This takes at least a month. If the recovery period passes without complications, a crown can be installed. Sometimes, to increase strength, stump inlays are used to evenly distribute the load on the root and protect it from fracture.

Recommendations for rehabilitation

If the patient is aware of an allergy to medications, then to eliminate the risks of complications and a possible negative reaction of the body, the surgeon should be informed. Modern pharmacology allows you to select the most safe anesthetic for the patient’s health.

To speed up the recovery process, you should refrain from eating for two to three hours after surgery. In addition, it is necessary to exclude hard, spicy, too cold or hot foods from the diet. Physical activity and heavy lifting are not recommended for two weeks.

How is hemisection performed?

It consists of certain stages and there are several ways. Methods differ in the amount of tissue removed. In both cases, the doctor does the following:

Removes the inflamed nerve;
Fills canals;
Sanitizes the cavity.

The patient donates blood, from which plasma will be taken to fill the cavity created after part of the unit is removed. This reduces the risk of material rejection after surgery.

Patchwork technique. The volume of tooth tissue is preserved as much as possible. It is more traumatic, since it is necessary to cut and peel off a flap of soft tissue. The doctor's actions are as follows:

Anesthesia (choose local or general);
An incision is made, followed by detachment of soft tissue. Provides access to the area of inflammation;
The diseased root, affected by a granuloma or cyst, is sawed off with a drill;
The cavities are cleaned of tissue debris and disinfected;
Filled with a polymer that replaces bone tissue. A membrane is placed to prevent overgrowth by soft tissue;
The flap is returned and sutured.
The rehabilitation period takes 4-6 weeks.

Resection of the apex. This method involves a larger volume of tissue. At the same time, the trauma rate is lower. The tissue does not peel off, which leads to faster healing. The operation is performed through a crown. It is performed under anesthesia.

The crown is sawed with a drill, reaching the branching of the roots;
Using surgical forceps, the destroyed part of the unit with the root, granuloma, cyst is removed;
The cavity is cleaned and filled with polymer, a drug is introduced that prevents the germination of soft tissues;
The crown is restored by extension or using a prosthesis.

In Moscow, hemisection is performed in dentistry with personal recommendations from DemoStom. Contact experienced specialists, professional surgeons who perform the operation under sterile conditions. This will avoid complications, speed up regeneration, and reduce pain.

Features of postoperative recovery

How rehabilitation will go after hemisection of a tooth largely depends on the patient’s behavior. To prevent the development of complications, the patient should adhere to the recommendations for oral care:

In the first 2-3 days, do antiseptic baths. After this period has expired, regularly rinse your mouth with an antiseptic mouthwash.
In the first two days after surgery, avoid brushing the teeth located around the operated area. This is necessary in order not to damage the seams. On the third day, you can try to brush all your teeth with a soft toothbrush using gentle movements.
After every meal you should rinse your mouth.
In the first days after the procedure, you are allowed to take painkillers, as pain may normally be present.
Take antibiotics as prescribed by your doctor. You should not stop taking these medications ahead of schedule.
Use vitamin complexes, immunostimulants and other auxiliary medications as prescribed by your doctor.
In the first days after hemisection, avoid physical activity, as well as any thermal procedures (baths, saunas, etc.).
Until the gum mucosa is completely healed, it is better not to eat food that will irritate soft tissues (too salty, peppery, hot, hard).
Avoid drinking alcohol and tobacco until the wound is completely healed.