Clinical Observation Of Hemisectionapplied In The Treatment Of Severe Lesions Of Mandibular Molars

Objective: To observe the clinical effects hemisection can made on the reserve ofthe mandibular molars with severe unbalanced lesions, which could not be curedthrough conventional root canal therapy and initial therapy of periodontal treatment.Fixed prosthesis was made after the hemisection.Methods:10clinical cases of hemisection were collected, including5cases of rootfracture,4cases of periodontitis with severe lesions on one root,1case of endodonticperforation. We got clinical examination and X-ray before the operation to observe theperiodontal status. The cases should be involved in those indications:(1) Those couldget perfect root canal therapy;(2)Alveolar bone was enough to support the root;(3)Fracture on one root;(4)The heathy root should be longer than7mm;(5)The apex of theroot to be reserved was in good condition or had inflammation but could be cured afterroot canal therapy. we could not operate on the tooth if those indications were involved:(1)Those could not get perfect root canal therapy;(2) The root did not get enoughalveolar bone to support itself and the prognosis was still to be poor through bone graft;(3)The tooth furcation was too low;(4)The patient could not cooperate or come forsubsequent visit on time during the treatment.We operated perfect root canal therapy on the teeth fitting the indications, thengetting flap surgery and hemisection. For the teeth whose alveolar crest’s height andwidth were not enough, we opetared bone graft to plump the alveolar crest and stablishthe reversed root. We also made post and core if the tooth defect too much. Temporarycrowns were also made to recruit the original shape of the tooth, to maintain the spaceand to perform better self-cleaning to protect the periodontal tissue. After3to6month we executed subsequent visit, to ensure that the teeth healed well, then fixed prosthesiswas feasible if the periodontal status was markedly improved and stabilized. This casestudy mostly used the reserved root and one adjacent tooth as abutment teeth for fixedprosthesis. Which could disperse the occlusal forces, reduce the reserved root’s occlusalforces and protect the abutment teeth, then get perfect long-term curative effects.Results: After operating hemisection on the10severe lesions of mandibularmolars, the reserved roots’ periodontal status were fine, with inflammationdisappeared. Among them3cases to increase the height and fullness of the alveolarbone also got bone graft, we selected bone grafting materials with bone guidingfunction, and there were new alveolar bone formation postoperatively, recovering well.The prosthesises of the cases were firm and chewing function got restored, theperiodontal status of the abutment teeth maintained good and X-ray showed the alveolarbone stopped absorbing. One case was found the reserved root’s parodontiumbroadening in subsequent visit, and remitted after reducing diameter of the crown andocclusal reduction. All10patients said the original symptoms disappeared after thetreatment and adapted well now.Conclusions: With comprehensive periodontal treatment and root canal therapy,hemisection could maximumly save the severe damaged mandibular molars whichcould not be healed by conventional root canal therapy and initial therapy of periodontaltreatment. Those with alveolar bone resorption may consider using bone graft, theprognostic effect could be better. The prosthesis with reserved root and one adjacenttooth as abutment teeth was better. Hemisection on molars could maximumly reservethe natural teeth and also prevent the alveolar bone getting disuse atrophy, maintainingits height and width and had obtained curative effects in clinical practice.