Root Resective Procedures: A Case Series of Tooth Hemisection and Bicuspidization with Prosthetic Rehabilitation in...

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth ≤ 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases.