A dental hemisection is a type of surgery used to save a severely damaged multi-rooted tooth. Multi-rooted teeth such as those found in the lower jaw have two separate roots that support the top chewing part of the tooth. When one of the roots has become damaged due to severe decay, deep cracks or gum disease whilst the other remains completely healthy, a dentist can perform a hemisection. During this treatment the diseased root and half of the crown are removed.

This surgery can be performed by dentists to help keep your jawbone in its natural form, keep your natural bite and avoid removing your whole tooth. Throughout this guide we will look at how this procedure works, the benefits, requirements and how to care for your tooth.

How Does a Dental Hemisection Work?

A dental hemisection divides your lower molar tooth into two halves. The damaged root and half of the crown will be removed.

  • Multi-rooted teeth: This procedure will almost always be carried out on your lower molars due to them having two separate roots.
  • Splitting the crown: The dentist will make a cut halfway down the crown.
  • Removing the damaged half: The dentist will remove the damaged half of the tooth which includes the root and half of the crown.
  • Repairing the remaining half: The dentist will reshape the remaining half of your tooth and fit it with a dental crown.

When Would I Be Recommended a Hemisection?

A dental hemisection would be recommended if one of your molar roots has become damaged.

  • Severe bone loss: One of your roots may have suffered from severe periodontitis causing severe bone loss around the root. The other root however will not have suffered any damage.
  • Un-treatable root canal: One of your roots may have become so calcified, broken or curved that your dentist will not be able to clean out the canal.
  • Deep vertical root fracture: One of your roots may have cracked down the root meaning it cannot be saved. However the other root will remain strong.
  • Severe fur-cation involvement: The infection could have spread between the roots. This causes severe bone loss in the area.

What Preparation Is Needed Before Treatment?

To ensure a successful hemisection, your dentist will carry out some preparation.

  • X-rays: Your dentist will take high quality x-rays and 3D cone beam scans to assess the bone density around the roots.
  • Root canal: Before the treatment begins, your dentist will carry out a full root canal on the healthy root.
  • Sealing the healthy root: Your endodontist will seal the healthy root canal with a filling made from gutta percha.
  • Gum disease: Your dental hygienist will scale and root plane around your tooth to remove any gum inflammation.

What Happens During a Dental Hemisection Procedure?

A dental specialist will carry out a hemisection in a sterile environment. You will be given a local anesthetic to ensure you are comfortable during the treatment.

  • Local anesthetic: Your surgeon will numb your tooth, gums and jaw.
  • Flipping over your gums: Your dentist will make a small incision in your gums and gently flip them over.
  • Cutting the tooth: Your dentist will carefully cut halfway down your crown using a fine diamond bur.
  • Removing the damaged root: Your surgeon will carefully remove the damaged half of the root.
  • Smoothing and sealing: Any sharp edges will be smoothed. Your dentist will then clean the area and stitch your gums firmly.

How Is Your Tooth Repaired After a Hemisection?

Once your wound has healed, your dentist will repair your remaining natural root to give you a strong tooth.

  • Build-up: Your dentist will add a build-up to the remaining crown to give your tooth a strong base.
  • Support post: In severe cases your dentist will add a small post into the root canal.
  • Custom crown: Your crown will be made in the lab to fit your shaped tooth.
  • Cementing: Your final crown will be cemented into place to give you full chewing power.

What Are the Benefits of a Hemisection?

There are many benefits to having a hemisection to save half of your natural tooth.

  • Natural jawbone: Having one natural root will keep your natural bite. This will stop any bone loss.
  • Stop drifting: Your neighboring teeth will not drift as there is still a root in place.
  • Natural sensation: Natural roots have nerve endings which will give you a precise feeling when chewing. This is not present with implants.
  • No need for complex bone grafting: As half of your tooth is being saved you won’t require any immediate complex bone grafting or sinus lifts.

What Are the Risks of a Hemisection?

Although this is a reliable way of saving your teeth, you should consider the risks with your endodontist or periodontist.

  • More likely to fracture: This tooth will have more pressure placed on the remaining root which can make it more likely to fracture.
  • Require skill: This procedure requires a high level of skill to ensure it is a success.
  • Gum disease: If you do not look after your teeth at home the remaining root can become infected with bacteria. This will cause further bone loss.
  • Not much support: As there is only one natural root in place, it cannot support large bridges. It will require gentle biting.

How Should You Care for Your Tooth After a Hemisection?

To speed up the healing process, ensure you follow these aftercare steps. This will reduce any discomfort and protect your new root.

  • Soft foods: Eat soft and cool foods such as yogurt, smooth soups, scrambled eggs and smoothies for 3-5 days.
  • Opposite side: Try to chew on the other side of your mouth until your dentist fits your final crown.
  • Brush gently: Brush your remaining teeth as normal. However be very gentle around the area with a soft bristle toothbrush.
  • Rinsing: Rinse with warm salt water 3 times a day 24 hours after your appointment. This will soothe your inflamed gums.
  • Don’t smoke: Avoid smoking or using any tobacco products. Nicotine will reduce the blood supply and slow down the healing of your bone.

What Should You Include in Your Dental Hemisection Checklist?

  • Ensure your tooth is a lower molar with two separate roots.
  • Ensure your dentist has done a thorough root canal on the healthy root.
  • Have a high quality 3D CBCT scan to ensure the remaining root has strong bone around it.
  • Wear a custom night guard if you suffer from clenching or grinding at night.
  • Ensure you have your final crown fitted within 3-4 weeks.
  • Brush and floss regularly around the margin of your crown.
  • Visit your dentist every 6 months for a professional clean.

What Are the Frequently Asked Questions About Dental Hemisection?

Does a Dental Hemisection Hurt?

No, your mouth will be completely numbed with local anesthetic. Once the effects have worn off you may experience slight sensitivity in your gums for a few days. This can be easily managed with painkillers.

How Long Will My Hemisection Last?

If you have had a thorough root canal, precise crown and good daily oral hygiene your hemisection can last between 10-15 years. However this will depend on keeping your gums clean.

What Is the Difference Between a Hemisection and Pre-molarisation?

During a hemisection your molar will be cut and the diseased half of the root will be removed. During a pre-molarisation your lower molar will be cut in half. Both of the healthy roots will be kept and turned into two separate single rooted premolars.

What If the Remaining Root Becomes Faulty?

If your remaining root has further decay, gum disease or a vertical fracture years later your dentist can remove the single root. This can be replaced with a standard implant or bridge.

A dental hemisection is a great conservative option to save your tooth. By just removing the diseased root you are protecting your natural jawbone, keeping your natural bite and keeping your smile. If you have severe damage to your lower molar, contact a dental specialist today for a diagnostic appointment to see if a hemisection can save your smile.