Saving a Tooth One Root at a Time: A Challenging Hemisection Case

A severely damaged tooth root does not always mean the whole tooth has to go. When the remaining roots and the bone around them are healthy, a carefully planned hemisection can preserve part of the natural tooth and help a patient avoid a dental implant. This case, treated at Dental Square in Lahore by Dr. Ali Sethi, shows how that decision is made and what it involves.

What is a hemisection?

Hemisection is the surgical division of a multi-rooted tooth — usually a lower molar — so that only the diseased or non-restorable root is removed while the healthy portion of the tooth is kept, root-filled and restored. It is a tooth-preserving alternative to extracting the entire molar and replacing it with an implant or bridge.

The patient's concern

A 31-year-old female patient presented with discomfort in the lower-left first molar region. After a detailed clinical and radiographic assessment, the lingual and distal root structures were found to be suitable for root canal treatment and restoration. The mesial root, however, was severely compromised and could not be predictably saved.

The conventional approach would have been to extract the whole tooth and later replace it with an implant or another prosthesis. The patient did not wish to undergo implant treatment, so Dr. Ali explored a more conservative alternative.

The conservative treatment plan

Because the remaining roots had a favourable prognosis, Dr. Ali planned a hemisection. The treatment involved:

• Sectioning the tooth into separate portions
• Removing the severely damaged mesial root
• Preserving the socket and the surrounding bone
• Performing root canal treatment on the remaining root structures
• Restoring the preserved portion of the tooth with a crown

This allowed the patient to retain part of her natural tooth rather than losing the molar entirely.

Why hemisection is technically demanding

Hemisection can be highly conservative and effective, but it is not a simple procedure. It requires careful diagnosis, precise sectioning of the tooth, thorough removal of the compromised root, and meticulous endodontic and restorative work.

This case was particularly challenging because the remaining tooth structure had to be protected throughout treatment. The preserved roots needed proper cleaning, shaping and sealing to prevent future infection, and the final restoration had to provide stability and distribute chewing forces appropriately.

Despite these challenges, the treatment was completed successfully. The damaged mesial root was removed, the remaining root structures and surrounding tissues were preserved, and the tooth was then treated endodontically and restored with a crown.

Benefits of preserving a natural tooth

In carefully selected cases, hemisection can offer several advantages over removing the whole tooth:

• Preservation of natural tooth structure
• Avoidance of complete tooth extraction
• Maintenance of the existing socket and supporting bone
• Potentially reduced treatment complexity compared with implant replacement
• A realistic option for patients who do not want an implant

Who is a suitable candidate?

Hemisection is not suitable for every patient. The remaining roots must have adequate bone support, healthy surrounding tissues and enough tooth structure for a restoration. Long-term success also depends on excellent oral hygiene, regular dental reviews and proper maintenance of the final crown.

The outcome

By removing only the non-restorable mesial root and preserving the healthy portion of the tooth, Dr. Ali was able to provide a conservative solution tailored to the patient's wishes. The treatment retained the remaining tooth structure and avoided the need for immediate implant replacement.

The case highlights the value of individualised treatment planning. Rather than automatically removing the entire tooth, a careful assessment of the tooth's anatomy, root condition, bone support and the patient's preferences can sometimes make it possible to preserve what is still healthy.

Conclusion

A challenging tooth does not always have to be a lost tooth. In suitable cases, hemisection provides a valuable tooth-preserving alternative to complete extraction. With careful planning, advanced endodontic treatment and a well-designed crown, even a compromised molar may be successfully retained.

Treatment outcomes vary from patient to patient. Hemisection should only be considered after a comprehensive clinical and radiographic assessment by a qualified dental professional. To discuss whether a damaged molar can be saved, book a consultation at Dental Square on Canal Bank Road, Lahore.