Hemisection

Hemisection is the process of cutting a tooth with two roots in half. Each half tooth consists of half the crown (top of the tooth) and one root. Hemisection literally means "dividing in two." It often is done by a periodontist, a specialist in gum disease. But any experienced dentist, endodontist or oral surgeon can do the procedure.

Not all teeth have two roots. Each of the front teeth has a single root. Upper molars usually have three roots. For this reason, if they need to be divided, the dentist could remove one or two roots and leave the crown intact. This is called a root resection.

A hemisection is done when decay or bone loss from periodontal disease extends into the area between the two roots. This area is called the bifurcation. It can be hard to clean, and just as difficult for the dentist to reach to treat the infected bone. A hemisection provides easy access to the area. This allows you to clean it with dental floss or an interdental toothbrush. It also allows your dentist to treat the area.

Once the roots have been separated, your dentist will evaluate each half of the tooth and its root and will decide whether each part can be saved. Any part that is saved will need to be restored with a crown.

Some teeth also may need crown lengthening of one or both roots if there is severe decay of the tooth's natural crown. Crown lengthening involves opening the gum and removing bone from around the root of the tooth. This will expose more of the root. In some cases, your dentist may decide that one of the tooth halves or roots has too much decay or bone loss to be saved. Therefore, it will be removed. The remaining root and half of the tooth will need to be restored with a new crown.

Hemisection is less common than it used to be. In some cases, it's now possible to grow new bone in the bifurcation area. In other cases, people choose to have the tooth removed. Then, after bone has grown into the area where the roots were, the old tooth can be replaced with an implant. The best option depends on the amount of decay or bone loss and whether a crown can be placed successfully. 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. He or she will look to see how much decay and periodontal disease you have.

Before the procedure, you will be given a shot to numb the area.

The dentist often needs to make a small cut in the gum to expose the roots. Once the roots are exposed, the dentist will cut the tooth in half, between the roots. Then your dentist will remove any decay and parts of the tooth and roots that can't be saved. The area will be rinsed with sterile salt water. If necessary, stitches may be used to close the wounds.

The dentist will cover the two parts of the natural crown with two small temporary crowns. Later, these will be replaced with two permanent crowns.

A hemisection usually takes about an hour from start to finish. The exact time can vary, however. It will take longer if you have a lot of decay or severe periodontal disease or if you need other procedures.

You probably will have some discomfort, swelling and light bleeding for the next day or two. Avoid chewing in the area until the stitches are removed. Your dentist may prescribe a mouth rinse that kills germs.

After 7 to 10 days, you will visit your dentist to have the stitches removed. The dentist also will check to see how your gums are healing.

After a few months, the teeth should be healed enough for your dentist to place two permanent crowns. Then you will be able to floss between them. Flossing will help you keep the area free of debris so the bone can heal.

The decision to hemisect a tooth is based upon a loss of supporting bone. Therefore, the tooth will not be as strong as it was, especially if half the tooth has been removed. If the bone fails to grow back enough to support the roots, one or both halves may need to be extracted (removed).

If you are concerned about the level of pain, swelling or bleeding in the days after the procedure, contact your dentist.