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Updated on October 3, 2022

Hemisection

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What is a Tooth Hemisection?

A hemisection is a type of root resection therapy. It has been used in the treatment of advanced gum disease for nearly 100 years.

A tooth hemisection is a specialized dental procedure in which half of an injured tooth is removed.

It's a type of endodontic therapy that treats the dental pulp and tissues surrounding a tooth.1

A hemisection is only performed on molars, which have 2 to 3 roots. Incisors, canines, and lower premolars only have 1 root each.

Hemisections are also usually performed on the lower molars rather than the upper molars.

During a hemisection, a general dentist or periodontist cuts the molar in half. The root and crown on the affected side are removed.

They will try to save most of the tooth, leaving behind a healthy remaining root or the roots and crown. A new prosthetic crown is fitted to protect the tooth after the procedure.

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

When is a Tooth Hemisection Necessary?

A hemisection is an affordable way to preserve a compromised tooth. It's a more cost-effective treatment option than extractions and dental implants.

Dental professionals prefer to maintain natural teeth instead of extracting them and replacing them with artificial teeth.

A hemisection is an appropriate treatment when periodontal disease is restricted to one root, and the other root has healthy periodontal support. The procedure helps 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. It can't bear the increased burden of a bridge or partial.

The dentist will first perform an intraoral (inside the mouth) exam to determine whether a patient is a good fit for a hemisection. This exam evaluates teeth health.

The dentist will use x-rays to produce periapical radiographs of the teeth. Then they'll look for any carious lesions or cavities.

They'll also examine the distal roots and mesial roots to look for signs of disease and check the periodontal health around each root.

Several common reasons for a 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. It's performed under a local anesthetic.

A dentist gets access to the tooth by making a small incision in the gum.

Then they examine the roots of the tooth and separate them into two parts. From here, they'll decide whether one of the roots can be saved or if both should be removed.13

If one root is healthy, the dentist will perform a root amputation on the damaged root. Then the area is cleaned and stitched up.

The dentist will place a temporary crown to cover the remaining half of the tooth.

They will make arrangements to construct a permanent custom crown. This crown 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 4 to 7 days.

If you don't maintain proper oral health after surgery, you can develop severe complications.

The possible complications of a hemisection include:

  • Increased risk of dental caries or cavities. This occurs 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 occur from poor oral health. Infection develops if bacteria get into the wound during the procedure.

Dentists usually prescribe antibiotics after the surgery. You must complete the entire course and follow all the dentist's instructions.

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

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

People with periodontitis (gum disease) are more prone to complications following a tooth hemisection. They're less ideal candidates for this procedure.

Tooth Hemisection Recovery Timeline

Since a portion of the tooth has been extracted, it's essential to follow post-op instructions. 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 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).

How Much Does a Tooth Hemisection Cost?

A hemisection 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.

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.

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

Many dentists also have monthly payment plans if you can't pay for the procedure up front.

If you can't afford a hemisection, consider dental college clinics. These clinics 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 dentists may also consider extraction as an alternative to save money. However, many dentists strongly advise against tooth removal to save money. Extraction should only be considered when medically necessary.

The costs of tooth removal may also be greater than a hemisection when considering the cost of dentures, bridges, or implants, plus the extraction.

A 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.

13 Sources Cited
Last updated on October 3, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Babaji, Prashant, et al. Hemisection: A Conservative Management of Periodontally Involved Molar Tooth in a Young Patient. 2015
  2. 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
  3. 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 : 920-4
  4. “Endodontists’ Guide to CDT© 2017.” American Association of Endodontists, American Dental Association., 2017
  5. “How Much Does an Apicoectomy Cost?” CostHelper
  6. Mokbel, Nadim et al. “Root Resection and Hemisection Revisited. Part I: A Systematic Review.” The International journal of periodontics & restorative dentistry vol. 39,1 : e11-e31. doi:10.11607/prd.3798 
  7. 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
  8. Nowakowski, Anthony T., et al. “Hemisection as a Treatment Option: A Case Report.” Oral Health Group, Newcom Media Inc., 28 Feb. 2010
  9. Pell, Nicholas. “How Much Does a Root Canal Cost?” The Simple Dollar, Red Ventures, 26 Sept. 2019
  10. 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
  11. 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
  12. 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
  13. Radke, Usha et al. “Hemisection: a window of hope for freezing tooth.” Case reports in dentistry vol. 2012 : 390874. doi:10.1155/2012/390874
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