253 Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1

Case Reports

Hemisection: A conservative management of periodontally involved molar tooth in a young patient

Abstract

Hemisection is sectioning of multi-rooted teeth with its crown portion, with the loss of periodontal attachment and is performed to retain the original tooth structure and attain the fi xed prosthodontic prosthesis. We describe hemisection of a mandibular molar tooth followed by adequate restoration in a young patient.

Key words: Endodontic, hemisection, mandibular molar, prosthodontic periodontal, root resection

Prashant Babaji, Tarun Sihag1, Vishwajit Rampratap Chaurasia2,

Sivaramalingam Senthilnathan3

Departments of Pedodontics, Sharavathi Dental College, Shimoga, Karnataka, 1Vyas Dental College, Jodhpur, Rajasthan, 2Department of Conservative Dentistry and Endodontics, KLE Dental College, Belgaum, Karnataka, 3Department of Periodontology, Rajas Dental College, Chennai, Tamil Nadu, India

Address for correspondence: Dr. Prashant Babaji, Department of Pedodontics, Vyas Dental College, Jodhpur - 342 001, Rajasthan, India. E-mail: babajipedo@rediffmail.com

INTRODUCTION

Advances in dentistry has provided an opportunity to maintain a functional dentition for lifetime.[1] Loss of the posterior teeth is eventful and undesirable often leading to teeth drifting, loss of masticatory function and loss of arch length, which requires prevention and maintenance measures.[2] The oral cavity has the potential to harbor at least 600 different bacterial species, and in any given patient, more than 150 species may be present.[3,4] These bacteria’s are responsible for various dental health issues such as dental caries and periodontal problems. Management of periodontally involved molars with extensive decay is a challenging and is limited to dental extraction and replacement with implants.[5] Nevertheless, treatment strategy to retain such teeth involves periodontal, prosthodontic and endodontic assessment for appropriate selection to allow for stronger survival.[1] Hemisection is a conservative way of preserving tooth. The term “hemi section” or “root amputation” are synonyms for “root sectioning” or “bisection” and is a treatment modality, which allows the preservation of tooth structure, alveolar bone and cost savings over other treatment options.[6]

CASE REPORT

A 13-year-old girl reported to the Department of Pedodontics and Preventive Dentistry, with a chief complaint of pain in the lower right back tooth region since 10 days. Pain was mild and intermittent in nature, which

aggravated on mastication. Clinical examination revealed deep caries with no other detectable abnormality.

On intraoral examination, tooth was tender on percussion and deep caries was present in relation to lower right fi rst and second molar teeth with a deep periodontal pocket on the mesial surface of the fi rst molar. Root stumps were present with lower left fi rst molar [Figure 1a]. On radiographic examination, vertical bone loss was evident on mesial root of lower permanent right fi rst molar with furcation involvement [Figure 1b]. Hemisection of mesial root was decided after the completion of endodontic treatment for the distal root. Post-endodontic restoration was performed with light cure Glass ionomer cement (GC Fuji, LC). Hemisection of mesial root was done [Figure 2a] followed by splinting of second premolar, fi rst molar and second molar with composite resin [Figure 2b]. At 1 month recall visit, healing was uneventful with the absence of mobility. Tooth preparation of the distal portion of fi rst permanent molar and second premolar was performed followed by ceramic bridge restoration [Figure 3a]. Radiographic success observed at 1, 3, and 6 months of recall visit indicated the absence of the periodontal ligament widening and bone formation at an extraction site [Figure 3b and c]. Healing of treated tooth was uneventful at recall visits.

DISCUSSION

The hemisection is a useful alternative treatment to extraction to save the multi-rooted teeth by endodontic

254Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1

Case Reports

Figure 3: (a) Clinical image of molar tooth after ceramic bridge placement, (b) radiographic view of hemisectioned molar with bridge at 1 month recall visit, (c) radiographic view of hemisectioned molar at 3 months recall visit, showing absence of the periodontal ligament widening and bone formation at an extraction site

a b

c

a

b

Figure 1: (a).Clinical image of cariously involved lower right molar and root stumps on left molar, (b) preoperative radiographic view of periodontally involved lower right molar with

a

b

Figure 2: (a) Radiographic view of lower right molar after endodontic treatment and hemisection of mesial port of root, (b) splinting of second premolar, first molar and second molar with composite resin

approach, which includes the root canal treatment of the remaining roots and restoring them with suitable restorative material to splinting it with the adjacent tooth to decrease the risk of displacement followed by a fi xed prosthodontic prosthesis to maintain the occlusal balance.[7] The literature on distal root resection is limited as compared to mesial root in mandibular molars because of its anatomical structure.[7,8] Nevertheless hemisection is a viable option to be considered before the extraction of molars[9] specially in the presence of conditions such as severe vertical bone loss (one root of a multi-rooted tooth), furcation destruction, unfavorable proximity of roots of adjacent teeth, preventing adequate hygiene in maintenance of proximal areas and severe root exposure due to dehiscence. Endodontic/restorative conditions which requires hemisection are prosthetic failure of piers or abutments within a splint, endodontic failures, vertical fracture of one root, non-restorable portion of a multi-rooted tooth.[10]

Buhler (1988) observed 32% failure rate in hemisection cases attributed to endodontic pathology and root fracture while other authors (0-9%) have shown a greater success in hemisection cases in the long-term studies.[5,9,10] In the present case, good prognosis was observed with proper occlusion, absence of mobility and healthy periodontal condition up to 6 months of follow-up. Concurring with previous reports, hemisection is a valid treatment option for the molar teeth’s in young children, which otherwise have to be extracted due to extensive caries.[8] Thus, conservative management of extensive carious molar tooth in young patients can not only preserve the tooth but also reduce the financial burden, psychological trauma and occlusal dysfunction.

CONCLUSION

Hemisection is an alternative, effective, and conservative treatment modality over conventional procedure or extraction of periodontally and endodontic affected teeth.

REFERENCES

1. Jain A, Bahuguna R, Agarwal V. Hemisection as an alternative treatment for resorbed multirooted tooth — A case report. Asian J Oral Health Allied Sci 2011;1:44-6.

2. Behl AB. Hemisection of a multirooted tooth — A case report. Open Access Sci Rep 2012;1:1-3.

3. Saini R, Saini S, Sharma S. Oral sex, oral health and orogenital infections. J Glob Infect Dis 2010;2:57-62.

4. Saini R. Dental air force home dental cleaning system: A revolutionary oral hygiene device to prevent systemic diseases caused by periodontal infection. Int J Med Res Health Sci 2013;2:431-8.

255 Journal of Natural Science, Biology and Medicine | January 2015 | Vol 6 | Issue 1

Case Reports

5. Radke U, Kubde R, Paldiwal A. Hemisection: A window of hope for freezing tooth. Case Rep Dent 2012;2012:390874.

6. She y P, Meshramkar R, Lekha K, Patil K, Nadiger R, Lokwani GB. Hemisection — A window of hope for a perishing tooth. Int J Clin Dent Sci 2011;2:4-7.

7. Saad MN, Moreno J, Crawford C. Hemisection as an alternative treatment for decayed multirooted terminal abutment: A case report. J Can Dent Assoc 2009;75:387-90.

8. Shafi q MK, Javaid A, Asaad S. Hemisection: an option to treat apically fractured and dislodged part of a mesial root of a molar. J Pak Dent Assoc 2011;20:183-6.

9. Shah S, Modi B, Desai K, Duseja S. Hemisection – A conservative approach for a periodontally compromised tooth – A case report. J Adv Oral Res 2012;3:31-5.

10. Weine FS. Root amputation. In: Endodontic Therapy. 6th ed. Osaka: Mosby-Year Book, Inc.; 2004. p. 606-39.

How to cite this article: Babaji P, Sihag T, Chaurasia VR, Senthilnathan S. Hemisection: A conservative management of periodontally involved molar tooth in a young patient. J Nat Sc Biol Med 2015;6:253-5.

Source of Support: Nil. Confl ict of Interest: None declared.

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DOI:10.4103/0976-9668.149212

Prune Belly syndrome: A rare case report

Abstract

Prune Belly syndrome (PBS) is a rare congenital anomaly of uncertain etiology almost exclusive to males. We report a case of term male baby born to a 39-year-old grand multipara with previous four normal vaginal births. There was no history of genetic or congenital anomaly in her family. Examination of the baby revealed hypotonia, defi cient abdominal muscle, cryptorchidism, palpable kidney, and bladder. Ultrasound examination of the abdomen revealed bilateral gross hydronephrosis and megaureter. Provisional diagnosis of PBS was made and the baby was admitted in neonatal intensive care units for further management. Routine antenatal care with ultrasonography will help in detecting renal anomalies, which can be followed postnatally. Early diagnosis of this syndrome and determining its optimal treatment are very important in helping to avoid its fatal course.

Key words: Cryptorchidism, hydroneprosis, megaureter, Prune Belly syndrome

Sunil Kumar Samal, Setu Rathod

Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Address for correspondence:Dr. Sunil Kumar Samal, T-D, Type II Staff Quarters, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry - 607 402, India. E-mail: drsksamal1981@gmail.com

INTRODUCTION

Prune Belly syndrome (PBS) is a rare congenital disorder affecting about 1 in 30,000 births[1] of which about 96% of those affected are male.[2] It is characterized by defi cient development of abdominal muscles that causes the skin of the abdomen to wrinkle like a prune, bilateral cryptorchidism, abnormalities of the urinary tract such as bilateral gross hydronephrosis, megaureter and megacystitis.[2] The exact etiology of PBS is not known; however, some of the studies reveal the possibility of genetic inheritance and possible association with trisomy 18 and 21.[2,3] The prognosis of babies with PBS is poor with stillbirths and early infant deaths being common. We report a case of male baby with PBS because of its rarity and term birth.

CASE REPORT

A 39 years old unbooked G5P4L4A0 at 39 weeks 5 days of gestation was admitted to our labor room complaining of labor pain. She had four previous normal vaginal deliveries. There was no history of prior antenatal care and she belonged to a tribal community with lower socioeconomic status. There was history of consanguineous marriage with her husband who was 42 years old and a daily laborer. There was no history of drug intake, radiation exposure or fever with rashes in this pregnancy. Neither was she a known case of diabetes nor was there any history of genetic or congenital anomaly in her family.

On examination, she was in the second stage of labor