The development of a significant horizontal component to one or more furcations of a multi rooted teeth or the development of a vertical component to the furca post additional problems.
Such advanced lesions do not respond to conservative periodontal treatment modalities.
Indicated in multi rooted teeth with grade II to IV furcation involvement.
It is preferable to get the tooth endodontically treated before resection of the root.
In general teeth planned for root resection include the following,
- Teeth of critical importance to overall dental treatment plan. For example, teeth serving as abutments for fixed or removeble restorations.
- Teeth that have sufficient remaining attachment for function.
- Molars with advance bone loss in the interproximal and interradicular zones, unless the lesions have three bony walls , are not candidates for root amputation.
- Teeth for which a more cost effective measure or therapy is unavailable. Eg. Teeth that have been endodontically treated successfully in the past but now present with a vertical root fracture, advanced bone loss, decay on the root surface.
WHICH ROOT TO REMOVE?
Remove the root that will eliminate the furcation and result in a maintenable architecture on the remaining roots.
Remove the roots with the greatest amount of bone and attachment loss.
Teeth with horizontal bone loss are poor candidates to undergo this procedure.
Remove the root that best contributes to the elimination of periodontal problems of adjacent teeth.
Remove the tooth with maximum anatomic problems like severe curvature, root flutings, developmental grooves.
Roots that ensure complication for future periodontal maintenace should be opted for resection.
Hemisection is the splitting of a multirooted tooth into two seperate portions.
Also called as bicuspidization or seperation.
Most likely to be performed on buccal and lingual class II or III furcation defects.
After seperation of the teeth 1 or both the tooths can be retained.
ROOT RESECTION/ HEMISECTION TECHNIQUE
Administration of local anesthesia.
Full thickness mucoperiostal flaps elevated. The flap should provide adequate access for visualization and instrumentation of the furcation defect.
Thorough debridement and complete exposure of the furcation on the root to be removed.
In case of accessability problems, removal of a small portion of facial/ palatal bone may be required.
A cut is then directed from apical to the contact point, through the tooth, and to the facial and distal orifices of the furcation, with a high speed surgical length fissure length carbide bur.
In case of a vital root resection a more horizontal cut is preferred to an oblique one since it exposes less surface area of the radicular pulp chamber.
This root stump can be removed by odontoplasty after the completion of the endodontic therapy.
While elevating the root from its socket care must be taken to avoid damage to the adjacent bone and roots.
If necessary, the now visible furcation area can be treated to remove any plaque retentive areas.
For hemisection a vertical cut is made faciolingually through the pulp chamber, and through the furcation.
If there is a metallic restoration in the surgical zone, it should be cut before the elevation of the flap. This prevents contamination of the surgical field with metallic particles.
Furcation defects with significant three walled or two walled defects are ideal candidates for bone grafting, guided tissue regeneration procedures. these procedures are designed to induce either new attachment or reattachment in the defect area.
Extraction of teeth is the prefered treatment in a through and through furcation defects with advanced attachment loss in individuals who cannot or will not maintain oral hygiene.
Patient with high level of caries activity or who have other socio or economic factors should not undergo complex therapy.
The keys to long term success of furcation therapies appear to be,
- Thorough diagnosis
- Selection of co-operative and compliant patients,
- Carefully conducted restorative and surgical procedures.
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