Managing Complex Extractions with Tooth Sectioning: A Complete Clinical Overview

Jul 16, 2025Mr. Bur

What is Tooth Sectioning?

Tooth sectioning refers to the process of cutting a multi-rooted tooth at the furcation (where roots diverge) or crown to isolate individual roots or segments. It is employed in two primary contexts:

Endodontic Treatment: To treat or remove a single problematic root while preserving the remaining tooth structure (e.g., hemisection or trisection).
Surgical Extraction: To divide a tooth into smaller segments for easier removal, particularly when roots are divergent, ankylosed, or impacted.

Common procedures include:

Hemisection: Removal of one root of a two-rooted tooth (e.g., mandibular molar).
Trisection: Division of a three-rooted tooth (e.g., maxillary molar) into individual roots.
Bicuspidization: Separating a molar into two functional units for periodontal or restorative management.

Mr. Bur Tooth Sectioning Diamond 77L Bur for precise crown and root sectioning in third molar extractions, offering deep posterior access with smooth, controlled cutting.

Indications for Tooth Sectioning

Tooth sectioning is indicated when preserving part of the tooth or simplifying extraction is preferable to complete removal. Key scenarios include:

Endodontic Issues:

Localized root canal failure in one root (e.g., perforation, resorption, or untreatable infection) where the other roots are salvageable.
Root fractures confined to one root.

Periodontal Conditions:

Severe bone loss or furcation defects affecting one root, where resection allows retention of the remaining tooth.

Extraction Challenges:

Multi-rooted teeth with divergent or curved roots that cannot be extracted intact without risking bone or soft tissue damage.
Impacted or ankylosed teeth requiring segmentation for removal.
Teeth with extensive decay or fractures extending into the furcation.

Contraindications

Insufficient bone or periodontal support for the remaining tooth structure.
Poor overall tooth prognosis, where extraction and replacement (e.g., implant) are more predictable.
Patient factors such as inability to maintain oral hygiene or comply with post-treatment care.

Tools for Tooth Sectioning

Effective tooth sectioning requires specialized tools designed for precision and control:

Root Sectioning Burs:

Design: Long, tapered, narrow burs (e.g., tapered fissure or surgical-length carbide/diamond burs) for accessing the furcation and cutting through dense dentin.
Features: Sharp, aggressive cutting edges to handle calcified tissues; often surgical-grade for durability.
Examples: Mr. Bur Diamond Tooth Sectioning 77L

High-Speed Handpiece: Essential for delivering the torque and speed needed for precise cuts, often with water irrigation to prevent overheating.
Elevators and Forceps: Used post-sectioning to mobilize and remove individual segments.
Piezoelectric Devices: In advanced settings, ultrasonic tips can be used for ultra-precise cutting with minimal trauma to surrounding tissues.
Imaging: Pre-operative X-rays or CBCT scans to assess root anatomy, bone support, and proximity to vital structures (e.g., inferior alveolar nerve).

Technique for Tooth Sectioning

1. Pre-Operative Assessment

Imaging: Use periapical radiographs or CBCT to evaluate root number, divergence, and surrounding bone.
Diagnosis: Confirm the need for sectioning (e.g., localized pathology vs. full extraction).
Treatment Planning: Discuss with the patient whether preservation (e.g., hemisection) or extraction is the goal, including risks and restorative follow-up (e.g., crown placement).

2. Anesthesia and Access

Administer local anesthesia (e.g., lidocaine with epinephrine) to ensure patient comfort.
Reflect a soft tissue flap if needed, especially for subgingival access or surgical extractions.
Expose the furcation or crown as required using a scalpel or periosteal elevator.

3. Sectioning Process

Endodontic Sectioning (e.g., Hemisection):

Use a root sectioning bur to cut through the furcation, isolating the diseased root.
Remove the affected root and perform root canal therapy or resection on the remaining roots.
Smooth the cut surfaces to prevent sharp edges and ensure compatibility with restorations.

Extraction Sectioning:

Divide the tooth into segments (e.g., mesial and distal roots for mandibular molars) by cutting through the crown or furcation.
Use elevators to mobilize each segment, removing them individually to minimize bone loss.

Irrigation and Cooling: Continuously irrigate with saline to prevent thermal damage to the tooth or bone.

4. Post-Sectioning Management

For Preservation:

Restore the remaining tooth structure with a crown or filling.
Ensure periodontal health with scaling or bone grafting if needed.

For Extraction:

Debride the socket, remove debris, and suture the site as necessary.
Discuss replacement options (e.g., implants, bridges) with the patient.

Follow-Up: Monitor healing, manage complications (e.g., infection), and verify restorative outcomes.

Clinical Considerations

Precision: Sectioning requires careful planning to avoid damaging adjacent teeth, bone, or nerves (e.g., inferior alveolar nerve in mandibular molars).
Bone Support: Adequate alveolar bone and periodontal health are critical for preserving sectioned teeth.
Restorative Planning: Coordinate with prosthodontists for crowns or bridges post-sectioning to ensure long-term success.
Patient Selection: Assess patient compliance, as sectioned teeth require diligent oral hygiene to prevent failure.
Risks:

Fracture of remaining tooth structure.
Post-operative infection or dry socket (in extractions).
Failure of preserved segments due to periodontal or restorative issues.

Advantages of Tooth Sectioning

Preservation: Allows retention of healthy tooth structure, delaying or avoiding extraction.
Minimally Invasive Extraction: Reduces trauma to bone and soft tissues compared to forceful whole-tooth extraction.
Cost-Effective: Can be a viable alternative to implants or prosthetics in select cases.

Challenges and Alternatives

Complexity: Requires advanced skills and precise tools, increasing chair time and procedural difficulty.
Prognosis: Sectioned teeth may have a guarded long-term prognosis compared to implants.
Alternatives:

Full tooth extraction followed by implants or bridges.
Non-surgical endodontic retreatment for localized root issues.
Periodontal surgery to address furcation defects without sectioning.

Conclusion

Tooth sectioning is a vital technique for managing complex multi-rooted teeth in endodontic and surgical contexts, offering dentists the ability to preserve natural dentition or facilitate atraumatic extractions. Tools like the Mr. Bur Diamond Tooth Sectioning 77L and Spiral Cool Cut Tooth Sectioning Diamond Bur (Super Coarse) enhance precision and efficiency, enabling clean cuts through dense dentin while minimizing thermal damage. By combining advanced imaging, meticulous technique, and robust restorative planning, dentists can optimize outcomes for challenging cases. Though implant technology continues to evolve, tooth sectioning remains a relevant skill for select scenarios, supported by specialized tools and careful case selection. Dentists are encouraged to refine their expertise through hands-on training and stay abreast of innovations in surgical burs, such as those from Mr. Bur, to elevate their practice.

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