Clinical Application Of Tooth Hemisection And Of Postoperative Crown And Bridge Restoration

Objective: For mandibular molar whose part of periodontium is in unbalanced damage and cannot be treated by root canal therapy while still has some values to retain,clinic adopts,for saving the integrity of dentition,tooth hemisection to extract seriously damaged teeth and to maintain the teeth worth keeping.Meanwhile furcation involvements will be cured and appropriate restorative treatment would be chosen according to teeth conditions after the very operation.Methods: We can choose appropriate cases and perfect corresponding examinations before operations,i.e.Photographic and periodontal examination,to evaluate whether it fits surgical indications below.First,the remaining teeth roots are healthy to be under root canal therapy.Secondly,X-ray shows that alveolar bone absorption is less than 1/2 and teeth roots cannot be loose.Thirdly,integrity of crown in healthy side is in a good state.Moreover,angle of roots bifurcation is appropriate.And lastly,remaining root tips do not have shadows after the very therapy.After that,root canal therapy should be actively improved to complete preoperative preparation.We can practice gingival flap operation under local anesthesia,then we separate mesial and distal tooth surface,extract the affected root,clean thoroughly teeth extraction sockets and pathological changed tissues in original root bifurcation region,trim the alveolar bone and fill in bone dust if necessary for good alveolar bone healing.Under condition of suture of the wound and soft tissues healing,post crown repair can be partially practiced in order to protect remaining dental tissues and periodontal issues preventing pollution from saliva and food residue and to recover form and occlusion of dental issues.Three-month after the very operation,corresponding prosthodontics would be given according to tooth defect position and to state of paradental of adjacent tooth.At last,we cannot forget regular follow-up to examine dental and periodontal states.Results: 5 cases having adopted tooth hemisection associated by dentures,out of 6 heavily damaged mandibular molars,have recovered well 6-month after the operation.We can find that recovered pontic as well as marginal adaptation is stable,proximal surface has normal masticatory function,and gingival has normal colour without deep periodontal pockets.Periapical intraoral radiographic examination shows that extraction wound has healed well and new bone tissues have partially formed with normal periodontal ligament depth.In addition,there is no low-density image and teeth root tips have no inflammation shadows either.However,the other patient who has a bad oral health because of smoking history,2 packets per day,does not have a good periodontal state of adjacent teeth but relatively good root retention mobility.Therefore,we have to stop temporarily denture restoration as conditions are not qualified.Conclusion: People tend to reserve natural teeth with increasing emphasis on oral cavity.Moreover,tooth hemisection can most keep teeth to strengthen oral functionality.In the duration of treatment process,patients and medical staff are prone to keep natural tooth and its integrity for providing subsequent restorative treatment better medical conditions rather than to practice root canal therapy as it cannot cure thoroughly.In addition,periodontal diseases such as furcation involvement have difficult clinical treatment and non-ideal effects.Hence,we adopt tooth hemisection to extract the diseased tooth so as to give better probability to cure furcation involvement.Medical compliance is a necessary condition for practicing tooth hemisection,for which doctors should have excellent communication with patients to ensure well-going of the very operation.Thus,tooth hemisection could be widely adopted because of objective effects,though it has a complicated procedure accompanied by subsequent repair therapy.