Indication and Survival of Hemisectioned and Root Amputated Teeth

There are only few longtime studies on the survival of teeth after hemisection and root amputation published. These investigations often lack information about case selection and subsequent restoration. Furthermore there are conflicting data about the survival of the remaining fragment (3% - 38% for ten yrs.) and a wide range of reasons for failure of hemisection and root amputation is presented (root fracture, progression of periodontitis, endodontic complications and caries). Objectives: The aim of this study was an evaluation of the indication, survival time and failure of teeth after hemisection and root amputation over a 15 year period. Material and Methods: 39 hemisectioned and root amputated teeth in 36 patients were followed up clinically and radiographically over 15 years. The majority of teeth scheduled for corrective surgery were mandibular molars (22 - 1st mand. molars, 9 - 2nd mand. molars, 5 - 1st max. molars, 3 - 2nd max. molars; average age of patients - 42 yrs.). In 36 cases, indication for surgical intervention was due to an endodontic failure. Only in 3 cases surgery was indicated because of periodontal problems. All but two teeth were restored with cast posts and partial crowns or full crowns. Results: There was a drop out of 2 cases. 6 teeth were extracted within the 10 year period, 11 teeth within the 15 year period. All 3 teeth hemisectioned because of periodontal problems were removed within 5 years. Within the 15 year period, 9 teeth failed because of root fractures. The highest incidence of failures was found in maxillary molars (6 out of 8). Conclusions: Strong factors affecting success of hemisection and root amputation are indication and quality of subsequent prosthodontic treatment minimising the risk of root fracture. Due to an acceptable survival rate the hemisection and root amputation of endodontically compromised teeth is a safe treatment option.