Annals of African Medicine
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Table of Contents
CASE REPORT
Year : 2015  |  Volume : 14  |  Issue : 1  |  Page : 69-72  

A novel approach for retreatment of multirooted tooth by partial radisection


1 Departments of Periodontics and Implantology, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
2 Mansarovar Dental college and Research, Bhopal, Madhya Pradesh, India
3 Chandra Dental College, Barabanki, India
4 Institute of Dental Sciences, Bhubneshwar, Odisha, India

Date of Web Publication7-Jan-2015

Correspondence Address:
Shivangi Gupta
Department of Periodontics and Implantology, D.J College of Dental Sciences and Research, Modinagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.148751

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   Abstract 

Modern advances in all phases of dentistry have provided the opportunity for patients to maintain a functional dentition for lifetime. Therapeutic measures performed to ensure retention of teeth vary in complexity. The treatment may involve combining restorative dentistry, endodontics, and periodontics so that the teeth are retained in whole or in part. Thus, tooth resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. This treatment can produce predictable results as long as proper diagnostic, endodontic, surgical, prosthetic, and maintenance procedures are performed. The keys to long-term success appear to be thorough diagnosis, selection of patients with good oral hygiene and careful surgical and restorative management.

   Abstract in French 

Résumé
Avances de moderne dans toutes les phases de la dentisterie ont fourni l'occasion pour les patients à maintenir une dentition fonctionnelle pour la durée de vie. Les mesures thérapeutiques effectuées pour assurer la rétention des dents varient en complexité. Le traitement peut impliquer la combinaison parodontie, endodontie et dentisterie restauratrice afin que les dents sont conservés en totalité ou en partie. Ainsi, les procédures de résection dent servent à préserver autant que possible plutôt que de sacrifier la dent entière de la structure dentaire.Ce traitement peut produire des résultats prévisibles tant que le bon diagnostic, endodontique, chirurgicaux, prothétique et les opérations d'entretien sont effectuées. Les clés de la réussite à long terme semblent être de diagnostic approfondi, sélection des patients avec une bonne hygiène buccale et de la gestion prudente de chirurgicale et réparatrice.
Mots-clés: Furcation, parodontite, amputation de racine, résection de racine

Keywords: Furcation, periodontitis, root amputation, root resection


How to cite this article:
Malhotra G, Kataria P, Shukla P, Gupta S, Sargaiyan V, Mahendra A, Subudhi SK. A novel approach for retreatment of multirooted tooth by partial radisection. Ann Afr Med 2015;14:69-72

How to cite this URL:
Malhotra G, Kataria P, Shukla P, Gupta S, Sargaiyan V, Mahendra A, Subudhi SK. A novel approach for retreatment of multirooted tooth by partial radisection. Ann Afr Med [serial online] 2015 [cited 2020 Aug 5];14:69-72. Available from: http://www.annalsafrmed.org/text.asp?2015/14/1/69/148751


   Introduction Top


According to De Van "prepetual preservation of what remains is more important than meticulous replacement of what is lost." Advances in dentistry, as well as the increased desire of patients to maintain their dentition, have led to treatment of teeth that once would have been extracted. Attachment loss in the furcation is one of the most serious anatomical sequela of periodontitis. [1]

The treatment may involve combining restorative dentistry, endodontics and periodontics so that the teeth are retained in whole or in part. Such teeth can be useful as independent units of mastication or as abutments in simple fixed bridge. [2]

As succinctly expressed by Rosenberg et al. "furcation involvement is the bane of every periodontist because it generally is not amenable to definitive management with conventional periodontal procedures… The accumulation of plaque and calculus in the furcation poses an insurmountable challenge even to the most dedicated patient attempting to maintain the interradicular surfaces free of plaque." [3] As furcation is an area of complex anatomic morphology and may be difficult to debride by routine periodontal instrumentation, it was previously avoided by dentists. However, now root resection, hemisection, root amputation, and bicuspidisation are all established dental procedure for the furcation involvement.

The reason many teeth do not respond to root canal treatment is because of procedural errors that prevent the control and prevention of intracanal endodontic infection. In truth, a procedural accident often impedes or makes it impossible to accomplish appropriate intracanal procedures. Thus, there is potential for failure of root canal treatment when a procedural accident occurs during the treatment of infected teeth. The root resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. [4]

The term tooth resection denotes the excision and removal of any segment of the tooth or a root with or without its accompanying crown portion. Various resection procedures described are: Root amputation, hemisection, radisection and bisection. [5]

A new technique is proposed for faulty root canal treated cases, which involves the partial radisection of the tooth and preserve as much tooth structure as possible.


   Case Report Top


A 35-year-old female patient reported to the Department of Periodontics and Implantology, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India with a chief complaint of swelling and food lodgment in the lower right back tooth region previously treated by root canal therapy 2 months back. The offending tooth was associated with localized swelling and persistent inflammation on the buccal side. Patient was relatively asymptomatic.

On examination, there was sinus formation w.r.t. 46 with a cystic lesion periapically [Figure 1]. There was persistent inflammation, shallow pockets were present and early Grade II furcation involvement. Radiographically, 46 were found to have been improperly root canal treated [Figure 2]. Ledge formation was there in mesiobuccal canal. Ledge was by passed, proper root canal treatment was done.
Figure 1: Offending tooth associated with sinus formation on the buccal side w.r.t. 46

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Figure 2: Preoperative X-ray with improper root canal

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Because bone support was adequate and tooth was firm, it was decided to first carry out re-endodontic treatment of 46 followed by the resection of the portion of mesial root of 46 along with open flap debridement for removal of cystic lesion, while retaining the distal root (as adequate bone support was present), with the vertical cut method. During the surgical procedure crevicular incision was given on 46. Full thickness mucoperiosteal flap was reflected [Figure 3].
Figure 3: Localized flap reflected w.r.t. 46

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A long shank, taper fissure carbide bur in high speed handpiece was placed along the buccal groove and a cut was made. The cut was channeled toward the center of the tooth and then directed toward the interproximal furcation opening of the mesial root. The bur was moved in the lingual and apical direction until the furcation area was reached. Once the bur had severed the floor of the pulp chamber, partial radisection of mesial root was done along with the cystic lining [Figure 4] and [Figure 5].
Figure 4: Partial resection of the mesial root while retaining the distal root

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Figure 5: Resected part of the tooth with cystic lining

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Area was irrigated with antiseptic solution and sutures placed [Figure 6]. Patient was called after 1 week for suture removal and postsurgical check-up. The surgical area healed uneventfully and was followed-up for 6 months for survival of the resected molar.Later crown placement was done [Figure 7].
Figure 6: Postoperative view of the surgical site

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Figure 7: Postoperative view with crown placement

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   Discussion Top


Establishing the original cause of an endo-perio lesion is not usually straightforward. For example, the presence of a vital (bleeding) pulp in a tooth associated with serial radiographs, which showed progressive periodontal disease, would suggest a periodontal origin to the endo-perio lesion.

Root resection therapy is a treatment option for molars with periodontal, endodontic, restorative, or prosthetic problems. Because root resection is very technique sensitive and complex, proper case selection is essential. [6] Success of root resection procedures depend, to a large extent, on proper case selection. Root resection is a useful alternative procedure to save those multi-rooted teeth, which have been indicated for extraction.

Weine has listed the various indications for tooth resection like severe vertical bone loss involving only one root of multi-rooted teeth, through and through furcation destruction, unfavorable proximity of roots of adjacent teeth, preventing adequate hygiene maintenance in proximal areas.

Prosthetic failure of abutments within a splint, endodontic failure, vertical fracture of one root, severe destructive process are some of the other indications for root resection. [7]

Although various contraindications have been documented in the literature for root resection like strong adjacent teeth available for bridge abutments as alternatives to hemisection, inoperable canals in root to be retained, root fusion, which makes the separation impossible.

Saad et al. have also concluded that hemisection of a mandibular molar may be a suitable treatment option when the decay is restricted to one root and the other root is healthy and remaining portion of tooth can very well act as an abutment. [8]

Root amputation and hemisection should be considered as another weapon in the arsenal of the dental surgeon, determined to retain and not remove the natural teeth. According to Bühler et al., hemisection should be considered before every molar extraction, because this procedure can provide a good absolute biological cost savings with good long-term success. [9]

Success of root resection procedures depend, to a large extent, on proper case selection. The long-term results of root resection are well-described in periodontal literature. The success rate is quite high when resections are performed by careful diagnosis and the procedures are appropriately performed. [10]

Similarly, the reasons for failure are equally well-known. The primary causes for failure after root resections are root fracture, caries, endodontic complications, cement washout, restorative failures and periodontal attachment loss.

Closely approximated or fused roots are poor candidates for root resection. The factors to be considered are length and curvature of roots and feasibility of endodontics and restorative dentistry in the root/roots to be retained.

Overall, the long-term success of root resection varies from 27% to 100%, respectively. Most reported failures were nonperiodontal in nature, with periodontal failures accounting for only 0-10% of the total failures.

The prognosis of root resected molars may not be as poor as previously believed. Multi-rooted, periodontally involved molars can be maintained for long periods of time with hemisection. The large variation in success and failure reported by different authors is a reflection that roots resection and hemisection is a technique sensitive procedure.


   Conclusion Top


Root resection therapy is still a valid treatment option for molars with furcation involvement and severe bone loss. Complications with these resective procedures are not rare but are usually avoidable when specific endodontic, surgical, and restorative guidelines are followed.

The prognosis of root resected molars may not be as grim as previously believed. The long-term results of root resection are well-described in periodontal literature. The success rate is quite high when resections are performed by careful diagnosis and the procedures are appropriately performed.

 
   References Top

1.
Basaraba N. Root amputation and tooth hemisection. Dent Clin North Am 1969;13:121-32.  Back to cited text no. 1
[PUBMED]    
2.
Parmar G, Vashi P. Hemisection: A case-report and review. Endodontology 2003;15:26-9.  Back to cited text no. 2
    
3.
Rosenberg MM, Kay HB, Keough BE, Holt RL. Periodontal and Prosthetic Management for Advanced Cases. Chicago: Quintessence; 1988. p. 247.  Back to cited text no. 3
    
4.
Siqueira JF Jr. Aetiology of root canal treatment failure: Why well-treated teeth can fail. Int Endod J 2001;34:1-10.  Back to cited text no. 4
    
5.
 5. Dani NH, Saquib SA. Root resection: A treatment modality for endoperio lesions. Indian J Dent Sci 2012;4:36-8.  Back to cited text no. 5
    
6.
DeSanctis M, Murphy KG. The role of resective periodontal surgery in the treatment of furcation defects. Periodontol 2000 2000;22:154-68.  Back to cited text no. 6
    
7.
Weine FS. Endodontic therapy. 5 th ed. p. 243. St Louis: Mosby-Yearbook Inc. 1996. p. 19.  Back to cited text no. 7
    
8.
Saad MN, Moreno J, Crawford C. Hemisection as an alternative treatment for decayed multirooted terminal abutment: A case report. J Can Dent Assoc 2009;75:387-90.  Back to cited text no. 8
    
9.
Bühler H. Evaluation of root-resected teeth. Results after 10 years. J Periodontol 1988;59:805-10.  Back to cited text no. 9
    
10.
Staffileno HJ. Surgical management of the furca invasion. Dent Clin North Am 1969;13:103-19.  Back to cited text no. 10
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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