Tooth Hemisection: What It Is, When It's Necessary, and More

What Is a Hemisection of a Tooth?

A hemisection is an endodontic treatment that involves removing half of a multi-rooted tooth, including the overlying crown. It's a type of endodontic therapy that preserves the structure and functionality of the treated tooth.

A hemisection is only performed on molars with at least two roots. Incisors, canines, and lower premolars have only one root each. Hemisections are also usually performed on the lower molars rather than the upper molars.

Hemisection is a conservative and cost-effective alternative treatment to molar extraction. When a tooth is pulled, it creates a space at the extraction site. A dental implant or bridge will fill the gap, but these treatments can be expensive.

How Much Does a Tooth Hemisection Cost?

A hemisection typically costs $210. This procedure is covered by insurance. It's up to the individual policy or plans to determine what is covered and at what level. Medicare and Medicaid also cover hemisection surgery.

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What Additional Costs Are Associated with Hemisection?

A hemisection typically requires:

• Antibiotics
• A follow-up exam
• X-rays

These extra expenses may not be included in the quoted price. They can cost between $10 and $250.

How to Get Help Paying for a Hemisection

For additional healthcare cost savings, you can use a Flexible Spending Account (FSA) or Health Savings Account (HSA). Other options include:

• Asking your dentist about in-house financing
• Checking dental college clinics for reduced rates
• Using CareCredit or a zero-interest credit card

How Is a Hemisection Procedure Performed?

Hemisection takes about 30 minutes. It uses a local anesthetic to numb the treatment area, so you’ll be awake during the procedure.

Here’s what to expect:

1. First, your dentist will perform an exam to determine your candidacy for a hemisection. They will check your teeth for signs of disease and decay. 
2. You will get X-rays to show the distal root and mesial root of the affected tooth.
3. Your dentist will access the tooth roots by making a small incision in the gum. At this point, they will know if one root can be saved.
4. If there’s a healthy root, the dentist will perform a root amputation on the damaged root and leave the surviving root intact.
5. They will clean the treatment area and place a temporary crown to cover the remaining half of the tooth.
6. They will make arrangements to construct a permanent custom crown. This crown will be fitted with dental cement to protect the tooth.

What Is the Success Rate of a Hemisection of a Tooth?

Tooth hemisection has high success rates. A review of 22 case studies found that more than half of cases reported > 90% success rate in follow-up periods ranging from 5 to 23 years.⁶

The long-term success of a hemisection depends mainly on proper case selection. Factors include:

• The tooth's periodontal condition
• Root anatomy
• Distance from adjacent teeth
• Oral hygiene levels

What Are the Side Effects of 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 4 to 7 days.

What Are the Potential Complications?

If you don't maintain proper oral health after surgery, you can develop severe complications. People with periodontitis (gum disease) are more prone to complications following a tooth hemisection. They're less ideal candidates for this procedure.

The possible complications of a hemisection include:

• Increased risk of dental caries or cavities
• Root fractures as a result of the increased stress on supporting teeth
• Infection
• Tooth loss

There is also a chance that a hemisection could fail. You may need to extract the tooth in the future.

When Is a Tooth Hemisection Necessary?

A hemisection essentially cuts a molar tooth in half, removing the damaged root and preserving the healthy root. It’s a restorative treatment that helps retain the tooth structure and surrounding alveolar bone. 

There are several common reasons for a hemisection. These include:

1. Root Canal Treatment Failure

Root canal therapy (endodontic therapy) involves removing damaged pulp from the inner chamber of the tooth. Then, the dentist or endodontist disinfects the tooth and seals it with a crown. 

If a root canal isn’t successful, the dentist may recommend a hemisection to preserve as much healthy tooth structure as possible.

2. Vertical Root Fracture

Trauma or decay can cause a vertical fracture in an otherwise healthy molar. In this case, a hemisection can save the unaffected tooth root.

3. Bone Loss

Severe bone loss can leave the tooth root without a sufficient attachment point, threatening the tooth structure. A hemisection can save the more stable root.

4. Bifurcation

Bifurcation is when periodontal disease (gum disease) affects the area between two roots. Hemisection is appropriate when periodontitis is restricted to one root, and the remaining root(s) have healthy periodontal support. 

5. Pulp Chamber Damage

Extensive decay or cavities (caries) can leave the inner pulp of a tooth vulnerable to oral bacteria. A hemisection can save the healthy tooth region and seal it from infection.

6. Severe Root Exposure

Infection or injury can cause the gum tissue to open, exposing a tooth root. A hemisection can remove this root while leaving the remaining root intact. 

Tooth Hemisection Recovery Timeline

Since a portion of the tooth has been extracted, following post-op instructions is essential. Treat the area as you would treat an extraction socket.

Immediately following a hemisection, and for the first several days after, you'll likely experience:

• Soreness
• Discomfort
• Swelling
• Light bleeding

You'll return to your dentist after 1 to 2 weeks to get the stitches removed. Avoid chewing with the affected area until then.

Your dentist will also check for any soft tissue inflammation and ensure proper occlusion. Occlusion is the alignment of the upper and lower jaws.

After a few months, the tooth will be healed enough to place a crown or prosthesis. After crown placement, you'll be assigned routine maintenance care (typically annual visits to the dentist).

Summary

Hemisection is a conservative and cost-effective alternative treatment to tooth extraction. It involves removing half of a molar with more than one root. The damaged root and overlying crown is removed so that the remaining tooth is preserved.

This restorative treatment maintains the healthy tooth structure and prevents the empty space that would be left by an extraction.