|  | |  | | | | Hemisection
Hemisection is the process of cutting a tooth with two roots in half, creating a front half and a back half. It often is done by a periodontist, but any experienced dentist, endodontist or oral surgeon can do the procedure. Hemisection literally means "dividing in two."
Because upper molars have three roots, a hemisection cannot be done on an upper molar. However, your dentist could divide an upper molar into three parts (sometimes referred to as trisection), or could remove one or two roots (root resection).
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A hemisection is done when decay or bone loss from periodontal disease extends into the area between the two roots, called the bifurcation. The procedure allows your dentist to reach the affected area and provide treatment. Once the roots have been separated, your dentist will evaluate each half of the tooth and its root separately and determine whether they can be restored with crowns. In some situations, this may require crown lengthening of one or both parts of the tooth and roots. Crown lengthening involves the removal of gum tissue, bone or both to exposure more of a tooth's structure. In other situations, your dentist may decide that the decay or bone loss is too extensive to allow restoration of one of the halves and roots. In this case, the severely affected half will be removed (resected).
Hemisection is less common than it used to be. In certain instances, guided tissue regeneration can be used to regrow bone in the bifurcation area. In many cases, people choose to have the tooth removed and replaced with an implant. The best option depends on the amount of decay or bone loss affecting the tooth and the probability that it can be successfully restored. You should talk with your dentist about your options.
Ideally, a tooth needing a hemisection should first receive root canal treatment if that has not already been done.
Before hemisection, your dentist also will look at your X-rays and examine your teeth to pinpoint the areas of decay and the extent of periodontal disease.
You will be given local anesthesia for the procedure.
Your dentist often needs to make a small incision in the gum to expose the deeper tooth structures. Once the tooth is exposed, he or she will separate the tooth's roots. Then your dentist will remove any decay and parts of the tooth that cannot be saved, which could include one of the roots.
The area will then be cleaned by rinsing with sterile saline solution. If necessary, stitches may be used to close the incisions.
The tooth will be covered with a temporary filling or crown, which will later be replaced with a permanent crown.
A hemisection usually takes about an hour from start to finish, but it depends on the amount of decay and periodontal disease present and whether other procedures are necessary.
You probably will feel some discomfort and swelling and have light bleeding for the next 24 to 48 hours. Avoid chewing with the tooth until the stitches are removed. Your dentist may prescribe an antimicrobial mouth rinse.
After 7 to 10 days, you will visit the dentist to have stitches removed. Your dentist also will check to see how your gums are healing.
After a few months, the tooth should be healed enough for your dentist to place a crown. You may receive one crown that fits over both halves, leaving a space between the two roots to allow easy access for oral hygiene. Alternatively, the two halves of the tooth can be restored as individual teeth by placing two separate crowns, one on each root. It is even possible to use individual tooth roots to help support bridges. For example, if you had two adjacent teeth hemisected and the two middle halves removed, your dentist could put a bridge in the space and support it with the two remaining halves.
A tooth that has been hemisected may be more difficult to keep clean. Also, the tooth will not be as strong as it was, especially if one of the roots has been removed, and is therefore more susceptible to fracture.
If the tooth develops further complications, it may need to be extracted.
If you are concerned about the level of pain, swelling or bleeding in the days after the procedure, contact your dentist.
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