Aim: This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant.
Background: Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root.
Case description: A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported.
Conclusion: Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up.
Clinical significance: This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.
Silva-Junior MF, Sousa ACC, Batista MJ, et al. Oral health condition and reasons for tooth extraction among an adult population (20-64 years old). Cien Saude Colet 2017;22(8):2693–2702. DOI: 10.1590/1413-81232017228.22212015.
Farrar J. Radical and heroic treatment of alveolar abscess by amputation of roots of teeth. Dental Cosmos 1884;26:79–81.
Gottlieb B OBZEuuZL. (Gingival Inflammation and Loosening of the Teeth). Berlin, Germany; 1933.
Messinger TF, Balint O. Elimination of periodontal pockets by root amputation. J Periodontol 1954;25:213–215. DOI: 10.1902/jop.1922.214.171.124.
Basaraba N. Root amputation and tooth hemisection. Dent Clin North Am 1969;13(1):121–132.
Staffileno HJ. Surgical management of the furca invasion. Dent Clin North Am 1969;13(1):103–119.
Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent 2019;84:9–21. DOI: 10.1016/j.jdent.2019.03.008.
Levin L, Halperin-Sternfeld M. Tooth preservation or implant placement: a systematic review of long-term tooth and implant survival rates. J Am Dent Assoc 2013;144(10):1119–1133. DOI: 10.14219/jada.archive.2013.0030.
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015;42(Suppl. 16):S158–S171. DOI: 10.1111/jcpe.12334.
Zembic A, Kim S, Zwahlen M, et al. Systematic review of the survival rate and incidence of biologic, technical, and esthetic complications of single implant abutments supporting fixed prostheses. Int J Oral Maxillofac Implants 2014;29(Suppl.):99–116. DOI: 10.11607/jomi.2014suppl.g2.2.
Park HE, Song HY, Han K, et al. Number of remaining teeth and health-related quality of life: the Korean National Health and Nutrition Examination Survey 2010-2012. Health Qual Life Outcomes 2019;17(1):5. DOI: 10.1186/s12955-019-1078-0.
Giannobile WV, Lang NP. Are dental implants a panacea or should we better strive to save teeth? J Dent Res 2016;95(1):5–6. DOI: 10.1177/0022034515618942.
Lindhe J, Pacey L. There is an overuse of implants in the world and an underuse of teeth as targets for treatment. Br Dent J 2014;217(8):396– 397. DOI: 10.1038/sj.bdj.2014.930.
Setzer FC, Shou H, Kulwattanaporn P, et al. Outcome of crown and root resection: a systematic review and meta-analysis of the literature. J Endod 2019;45(1):6–19. DOI: 10.1016/j.joen.2018.10.003.
Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006;32(7):601–623. DOI: 10.1016/j.joen.2005.12.010.
Dommisch H, Walter C, Dannewitz B, et al. Resective surgery for the treatment of furcation involvement: a systematic review. J Clin Periodontol 2020;47(Suppl 22):375–391. DOI: 10.1111/jcpe.13241.
Livada R, Fine N, Shiloah J. Root amputation: a new look into an old procedure. N Y State Dent J 2014;80(4):24–28.
Murali KV, Govind S, Jena A, et al. Root amputation as an alternative treatment for decayed multi-rooted tooth: a review of 3 case reports. J Res Adv Dent 2016;5:10–13.
Derks H, Westheide D, Pfefferle T, et al. Retention of molars after root-resective therapy: a retrospective evaluation of up to 30 years. Clin Oral Investig 2018;22(3):1327–1335. DOI: 10.1007/s00784-017-2220-1.
Khan AA. Root resection: an alternative treatment option to extraction. J Dent Health Oral Disord Ther 2017;6(5). DOI: 10.15406/jdhodt.2017.06.00212.
Haskell EW. Vital root resection: a case report of a long-term follow-up. Int J Periodontics Restorative Dent 1984;4(6):56–61.
Nabhi K, Mehra P, Sharma B. Root resection of maxillary first molar: a case report. IOSR J Dent Med Sci 2017;16:103–107.
Huynh-Ba G, Kuonen P, Hofer D, et al. The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol 2009;36(2):164–176. DOI: 10.1111/j.1600-051X.2008.01358.x.
Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312(7023):71–72. DOI: 10.1136/bmj.312.7023.71.