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What is a Tooth Hemisection?

A tooth hemisection is a specialized dental procedure in which half of an injured tooth is removed. This procedure is a type of endodontic therapy that treats the dental pulp and tissues surrounding the tooth.

A hemisection is only performed on molar teeth, which typically have two or three roots, compared to incisors, canines, and lower premolars, which usually only have one root each. Hemisections are usually performed on the mandibular (lower) molars rather than the maxillary (upper) molars.

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During a hemisection, the molar tooth is cut in half, and the root and crown on the affected side are removed. During this endodontic treatment, the dentist or endodontist performing the procedure will try to save most of the tooth, leaving a healthy remaining root or roots and crown. A new prosthetic crown is fitted to protect the tooth after the procedure.

The goal of a hemisection is to retain at least some of the original tooth structure as allowed by its health and anatomy. The procedure is cost-effective.

A hemisection is a type of root resection therapy, which has been used in the treatment of advanced periodontal disease for nearly 100 years. Hemisection has a success rate of approximately 60 to 70 percent.

When is a Tooth Hemisection Necessary?

A hemisection is a conservative way to preserve a compromised tooth. It is a more cost-effective alternative treatment option over extractions and dental implants. Whenever possible, dental professionals prefer to maintain natural teeth instead of extracting them and replacing them with artificial teeth.

Hemisection is an appropriate treatment when periodontal disease is restricted to one root of the tooth, and the other root has healthy periodontal support. Hemisection of an affected tooth helps to retain the tooth structure and surrounding alveolar bone. 

Typically, hemisected teeth are not strong enough to support bridges or partials. They usually function as standalone teeth. The remaining root of a hemisected molar is pretty weak and cannot bear the increased burden of a bridge or partial.

To determine whether a patient is a good fit for a hemisection, the dentist will first perform an intraoral (inside the mouth) examination to evaluate the teeth health. He or she will use x-rays to produce periapical radiographs of the teeth. Then the dentist will look for any carious lesions or cavities. They will examine the teeth' distal roots and mesial roots and look for disease and decay signs. They will also evaluate the periodontal health around each root of the potential hemisected tooth.

Several common reasons for hemisection include:

  • Root canal treatment failure
  • Vertical fracture or bone loss caused by trauma or decay
  • Furcation involvement or furcation defects when a significant amount of bone has been lost in an area between the roots of a molar
  • Damage to the pulp
  • Crowding of the proximity of roots of adjacent teeth which prevents adequate maintenance of oral hygiene
  • Root exposure due to dehiscence (splitting or bursting of a wound)
  • Severe destruction of one root due to resorption (loss of dentine), cavities, trauma, or perforation

Hemisection Procedure: How It’s Done

A tooth hemisection takes at least 1.5 hours and is performed under local anesthetic.

The dentist obtains access to the tooth by making a small incision in the gum. They examine the roots of the tooth and separate them into two parts. From here, the dentist can decide whether one of the roots can be saved or if both should be discarded.

If one root is healthy, the dentist will perform a root amputation on the damaged root and thoroughly cleanse the gap with saline solution. They will place a temporary crown to cover the remaining half of the tooth. They will make arrangements to construct a permanent custom crown, which will be fitted with dental cement at a later time to protect the tooth.

Side Effects & Complications of a Tooth Hemisection 

The common short-term side effects of a tooth hemisection include:

  • Bleeding
  • Swelling
  • Discomfort

These short-term side effects will typically pass after four to seven days.

If the patient doesn’t maintain proper oral health after surgery, they can develop severe complications. The possible complications of a hemisection include:

  • Increased risk of dental caries or cavities due to increased difficulty in maintaining proper hygiene of the area
  • Root fracture as a result of the increased stress on supporting teeth
  • Infection
  • Loss of Tooth

Many complications will occur as a result of substandard oral health. Infection develops if bacteria get into the wound during the procedure. The dentist will usually prescribe antibiotics after the surgery. Patients must complete the entire course and follow all of the dentist's instructions.

There is a chance that a hemisection could fail, and the patient may need to extract the tooth in the future. Hemisection has an overall failure rate of 30 to 40 percent. However, there is an 80 percent chance that the hemisected tooth will last at least 12 years. 

The long-term success of a hemisection depends mainly on proper case selection. The success factors include the tooth's periodontal condition, root anatomy, distance from adjacent teeth, and the patient's ability to perform adequate oral hygiene. Patients with periodontitis (gum disease) are more prone to complications following tooth hemisection and are thus less ideal candidates to undergo this procedure.

Hemisection Recovery Timeline

Immediately following a hemisection and for the first several days after, patients are likely to feel soreness, discomfort, and swelling. Light bleeding is also common during this time. Patients should avoid chewing with the affected area until all stitches are removed. Because a portion of the tooth has been extracted, it is essential that patients follow post-op instructions and treat the area as they would treat an extraction socket.

Patients usually return to the dentist after a week or two, and the dentist will remove the stitches. They will check for any inflammation of the soft tissue and ensure proper occlusion (alignment of upper and lower jaws). After a few months, the tooth will be healed enough to place a crown or prosthesis.

After crown placement, patients will be assigned routine maintenance care and will check in with their dentist annually.

How Much Does a Tooth Hemisection Cost?

A hemisection is covered by insurance. It is up to the individual policy or plans to determine what is covered and at what level. Medicare and Medicaid also cover hemisection surgery.

The typical out-of-pocket cost for a tooth hemisection is $200 to $500. Without insurance, a tooth hemisection costs between $900 to $1,500.

A hemisection typically requires antibiotics, a follow-up exam, and x-rays, which may not be included in the quoted price and come at an extra cost. These additional expenses can run between $10 and $250.

For additional healthcare cost savings, patients can use a Flexible Spending Account (FSA) or a Health Savings Account (HSA) to save for their hemisection surgery. Many dentists also have monthly payment plans, so patients don’t need to pay for the surgery upfront.

Patients who can't afford a hemisection may consider dental college clinics, which often offer reduced rates on services performed by supervised students or faculty. Some low-income patients report paying $600 to $650 for root surgery performed by a postgraduate student. Some dental organizations also pay partial fees for low-income patients.

Some may consider extraction as an alternative to save money. Most dentists strongly advise against tooth removal to save money. Extraction should only be considered when medically necessary. Hemisection preserves the bite and reduces the financial burden, psychological trauma, and occlusal dysfunction (misalignment of the upper and lower jaw) caused by tooth loss. The costs of tooth removal may be greater than a hemisection when considering the cost of dentures, bridges, or implants, plus the extraction.

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Resources

Babaji, Prashant, et al. Hemisection: A Conservative Management of Periodontally Involved Molar Tooth in a Young Patient. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367053/

Bell, Ashima Ball. “Hemisection of a Multirooted Tooth-A Case Report.” Luxmi Bai Institute of Dental Sciences and Hospital, Sirhind Road, Patiala, Punjab, India, Open Access Scientific Reports, 2012, www.omicsonline.org/scientific-reports/2161-1122-SR-336.pdf

Bohnenkamp, David M, and Lily T Garcia. “Fixed restoration of sectioned mandibular molar teeth.” Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) vol. 25,11 (2004): 920-4. https://pubmed.ncbi.nlm.nih.gov/15643772/

“Endodontists’ Guide to CDT© 2017.” American Association of Endodontists, American Dental Association., 2017, www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/aae_2017guidetocdt.pdf

“How Much Does an Apicoectomy Cost?” CostHelper, https://health.costhelper.com/apicoectomy.html

Mokbel, Nadim et al. “Root Resection and Hemisection Revisited. Part I: A Systematic Review.” The International journal of periodontics & restorative dentistry vol. 39,1 (2019): e11-e31. doi:10.11607/prd.3798 https://pubmed.ncbi.nlm.nih.gov/30543727/

Napte, Bandu, and Srinidhi Surya Raghavendra. “Management of Periodontally Compromised Mandibular Molar with Hemisectioning: A Case Report.” Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, Journal of ICDRO, 2014, www.jicdro.org/article.asp?issn=2231-0754;year=2014;volume=6;issue=2;spage=130;epage=133;aulast=Napte

Nowakowski, Anthony T., et al. “Hemisection as a Treatment Option: A Case Report.” Oral Health Group, Newcom Media Inc., 28 Feb. 2010, www.oralhealthgroup.com/features/hemisection-as-a-treatment-option-a-case-report/

Pell, Nicholas. “How Much Does a Root Canal Cost?” The Simple Dollar, Red Ventures, 26 Sept. 2019, www.thesimpledollar.com/save-money/how-much-does-a-root-canal-cost/

Saad, M Najeeb, et al. “Hemisection as an Alternative Treatment for Decayed Multirooted Terminal Abutment: A Case Report.” Clinical Practice, Journal of the Canadian Dental Association, 2009, www.cda-adc.ca/jcda/vol-75/issue-5/387.pdf

Sharma, Shweta, et al. “Hemisection as a Conservative Management of Grossly Carious Permanent Mandibular First Molar.” Journal of Natural Science, Biology, and Medicine, Medknow Publications & Media Pvt Ltd, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812084/

Zafiropoulos, Gregory-George, et al. “Mandibular Molar Root Resection Versus Implant Therapy: A Retrospective Nonrandomized Study.” Journal of Oral Implantology, Allen Press, 1 Apr. 2009, https://meridian.allenpress.com/joi/article/35/2/52/2213/Mandibular-Molar-Root-Resection-Versus-Implant

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Updated on: November 4, 2020
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