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Jean-Marie Megarbane, DMD, CAGS, FAIDS, FICD1 Various treatment options with high
Abdel Rahman Kassir, DDS2 survival rates have been suggested
Nadim Mokbel, DDS, MSc, PhD, FICD3 throughout the years for different
Nada Naaman, DDS, PhD4 degrees of furcation involvement.1,2
In the advanced degree, resective
therapy—such as root resection/
Root resection and hemisection is a well-documented treatment option for amputation or hemisection—is a
extending the life span of furcated molars. The aim of the present study was to relatively common treatment.3,4
retrospectively evaluate the long-term results of root resection and hemisection Root amputation was originally in-
of 195 patients with up to 40 years of follow-up. Records of 195 patients who had
troduced more than 100 years ago
undergone root resection or hemisection were reviewed. A minimum follow-up of
5 years was needed. A molar was recorded as a survival if it was still present and as “radical and heroic,”5 and it con-
functional without any signs of discomfort, pain, or pathology from restorative, tinues to be an effective therapy for
endodontic, and periodontal points of view. Ninety-eight patients were excluded extending the functional life span of
for not accomplishing the minimum 5-year observation period. Of the 97 remaining treated teeth. It enhances profes-
patients, 5 teeth were lost during the first 5 years of treatment and 92 teeth sional and self-performed plaque
survived the follow-up period, ranging from 5 to 40 years. The overall survival rate
control by converting multi-rooted
was 94.8%. When up to 40 years of follow-up data were analyzed, it was found that
high survival rates can be obtained with root resection and hemisection. The results teeth into nonfurcated single-root
are satisfying when a proper case selection, endodontic treatment, restorative teeth. Thus, it delays the progres-
design, and good maintenance program are given. This treatment option sion of attachment loss around the
should always be considered before every extraction and implant placement. remaining roots.6
Int J Periodontics Restorative Dent 2018;38:783–789. doi: 10.11607/prd.3797 These days, when a deep fur-
cation involvement is diagnosed,
tooth extraction and replacement
by dental implant has unfortu-
nately become the treatment of
choice. However, the reported high
prevalence of peri-implant compli-
cations7–10 and the unpredictabil-
Professor in Periodontology, Private Practice, Masters Dental Clinic, Beirut, Lebanon.
1
ity of their treatment may lead to
Resident, Periodontology Department, Faculty of Dental Medicine, Saint-Joseph University
2
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784
© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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785
© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
786
© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
787
© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
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788
a b
d
Fig 4 (above) Resection of the mesial roots of mandibular left
first and second molars for endodontic reasons (perforation).
Radiographic examination (a) preoperatively and (b) after 33
years. Intraoral view (c) after prosthesis delivery and (d) at the last
follow-up examination.
amputation is not always necessary. dibular roots, no reliable conclusion some recommend their routine use
However, concerning mandibular can be made on this subject. Each as abutments for fixed partial den-
molars, it is still not well-defined in case is different, and depending on tures,23 others do not agree.24
the literature whether to use the re- the ampunt of periodontal residual The empty alveolus socket of
sected teeth as abutments for par- structure and type of occlusion, it the extracted root can be filled with
tial dentures (to protect them from is up to the clinician to decide how biomaterials25 in order to limit bone
occlusion) or to utilize their remain- to proceed: The tooth can be incor- resorption distal or mesial to the re-
ing capacity to withstand forces and porated into a fixed prosthesis with maining root while also preserving
leave them as self-sufficient.20 In the intact adjacent teeth; otherwise, the bone for a possible future implant
present study, only two mandibular tooth can be restored as a premolar placement in that site. In fact, dental
second molars with a resected dis- and left nonsplinted with a reduced implants were first utilized solely to
tal root were restored as premolars occlusal table. replace missing or hopeless teeth;
and kept self-sufficient; both had a The utilization of mandibular re- now, teeth that are endodontically,
follow-up period of 10 to 15 years sected molars as terminal abutments periodontally, and restoratively
and are surviving. Considering the for fixed partial dentures is still con- compromised are being removed
low number of nonsplinted man- troversial in the literature. While when they can be treated safely and
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789
successfully with resective or restor- References 14. Hamp SE, Ravald N, Teiwik A, Lundström
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© 2018 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.