When damage affects only one root of a multi-rooted tooth, complete extraction may not always be the only treatment considered. Hemisection is a tooth-preserving procedure that removes the compromised root and its associated crown portion while retaining the healthier part of the tooth.
This approach combines endodontic, periodontal, surgical and restorative treatment, making careful diagnosis and case selection essential before treatment begins.
Quick Answer: What Is Hemisection?
Hemisection is the surgical division of a multi-rooted tooth so that one damaged root and its corresponding crown portion can be removed while the healthier root is preserved. It may be considered in selected cases involving periodontal destruction, root fracture, perforation, endodontic failure or extensive root caries.
When Is Hemisection Indicated?
Hemisection may be considered when disease or structural damage is mainly confined to one root and the remaining portion of the tooth has adequate support and restorative potential.
Possible indications described in the literature include:
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Severe vertical bone loss affecting one root
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Furcation destruction
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Perforation involving a root canal or pulpal floor
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Vertical fracture limited to one root
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Selected endodontic failures
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Extensive root or subgingival caries
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Other destructive processes affecting only part of a multi-rooted tooth
The objective is not simply to avoid extraction. The retained root must be healthy enough to support continued function after endodontic and restorative treatment.
Hemisection may not be appropriate when the roots are fused and cannot be separated, the root intended for retention cannot be adequately treated, or the remaining tooth has poor strategic or restorative value.
How Is Hemisection Performed?
Hemisection involves several coordinated treatment stages rather than a single surgical cut.
1. Diagnosis and Case Selection
Clinical and radiographic assessment is used to evaluate the affected root, periodontal support, furcation area, tooth anatomy, mobility and restorability of the remaining segment.
The clinician must also consider whether the retained root can be successfully treated and maintained over time.
2. Endodontic Treatment
When required, root canal treatment is completed for the portion of the tooth that will remain.
In the published case by Taori and colleagues, the mandibular first molar underwent endodontic treatment before the surgical procedure. The root selected for retention was prepared and obturated before hemisection.
3. Tooth Sectioning and Root Removal
During the surgical stage, access is created to allow controlled separation of the tooth.
In the reported case, the clinicians reflected a full-thickness flap and used a long-shank tapered fissure carbide bur to create a vertical cut through the crown toward the bifurcation.
Complete separation was confirmed before the compromised root and its associated crown portion were removed.
This is an important distinction: the aim of sectioning is to separate the affected part of the tooth while preserving the root and crown segment selected for retention.
What Dental Burs Can Be Considered for Hemisection?
Bur selection during hemisection depends on factors such as tooth anatomy, cutting depth, access, bur geometry and handpiece compatibility.
The published hemisection case specifically used a long-shank tapered fissure carbide bur for the vertical sectioning procedure.
Another tooth-sectioning instrument that may be considered, depending on the planned clinical approach, is the MR.BUR 77L Tooth Sectioning Diamond Bur.
The MR.BUR 77L is an FG coarse diamond bur designed with an elongated profile for deeper access. MR.BUR lists tooth sectioning and tooth separation among the applications for this bur, particularly in wisdom-tooth procedures.
Because hemisection also requires controlled separation of tooth structure, the 77L may be evaluated as an instrument option when its geometry and cutting characteristics match the required sectioning pathway.
However, it is important to distinguish product application from published clinical evidence. MR.BUR 77L was not the bur used in the referenced hemisection case, and it should not be described as a bur specifically designed or clinically validated for hemisection.
The appropriate dental bur should ultimately be selected according to the clinical situation and the dentist's intended surgical technique.
What Factors Affect Hemisection Success?
The condition of the tooth that remains is one of the most important considerations.
Factors that may influence treatment planning include:
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Root anatomy and accessibility
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Remaining periodontal and bone support
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Tooth mobility
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Crown-to-root relationship
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Periodontal attachment
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Occlusal relationships
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Restorability of the retained segment
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Patient oral hygiene
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Ability to maintain the treated area
Published research reviewed in the case report has shown favourable long-term outcomes in appropriately selected root-resected molars. However, outcomes vary according to the clinical situation and quality of treatment.
Reported causes of failure include endodontic problems, root fracture, inadequate resection and restorative complications, reinforcing the importance of managing hemisection as a complete treatment rather than an isolated surgical procedure.
What Happens After Hemisection?
Treatment does not end after the compromised root has been removed.
The remaining tooth structure must be restored with suitable contours, margins and occlusal relationships. Poor restorative design may make plaque control more difficult or place inappropriate forces on the retained root.
This restorative stage is therefore important for maintaining both periodontal health and function.
Conclusion
Hemisection can provide a tooth-preserving treatment option when damage is primarily confined to one root of a multi-rooted tooth and the remaining segment has a favourable clinical condition.
Successful treatment depends on careful case selection, appropriate endodontic management, controlled tooth sectioning and suitable final restoration.
During tooth separation, the clinician should select a dental bur according to the required access, cutting pathway and handpiece system. While the published case used a long-shank tapered fissure carbide bur, a tooth-sectioning instrument such as the MR.BUR 77L may also be considered when its design is appropriate for the planned procedure.
Ultimately, hemisection is not simply about removing half of a tooth. The goal is to preserve a healthy, maintainable and restorable portion of the natural tooth whenever clinical conditions allow.
