Root Resection and Hemisection Revisited. Part I: A Systematic Review.

Root resection and hemisection is a treatment option for furcated molars, and the prognosis of this technique has been well documented. The aim of the present paper is to systematically review studies examining the survival and/or failure rate of root resection and hemisection and to determine the factors behind the variability in the outcome reported. A Medline (PubMed), Embase, and Google Scholar search was undertaken, looking for articles published up to September 2016. A total of 1,012 publications were screened. Two reviewers analyzed the articles and extracted the data. Case series studies required a minimum of 5 cases, and all levels of evidence were accepted. A total of 22 studies met the inclusion criteria. Survival rate and follow-up times differed widely: survival rate ranged from 40.3% to 100% and follow-up from 6 months to 23 years. Half of the studies had a survival rate > 90% with a follow-up period ranging from 5 to 23 years. Therefore, root resection and hemisection are associated with high survival rates, making it a reliable option for treatment of furcated molars that should be considered before every extraction and implant placement. In a great number of studies, incomplete information was found concerning case selection and endodontic, restorative, and maintenance therapy, which makes one question the obtained results and the occasional reports of low survival rates. These concerns should encourage more detailed, long-term clinical trials, with respect to each phase requirement for the procedure, for a better assessment of survival rate.

Root Resection and Hemisection Revisited. Part II: A Retrospective Analysis of 195 Treated Patients with Up to 40 Years of Follow-up.

Root resection and hemisection is a well-documented treatment option for extending the life span of furcated molars. The aim of the present study was to retrospectively evaluate the long-term results of root resection and hemisection of 195 patients with up to 40 years of follow-up. Records of 195 patients who had undergone root resection or hemisection were reviewed. A minimum follow-up of 5 years was needed. A molar was recorded as a survival if it was still present and functional without any signs of discomfort, pain, or pathology from restorative, endodontic, and periodontal points of view. Ninety-eight patients were excluded for not accomplishing the minimum 5-year observation period. Of the 97 remaining patients, 5 teeth were lost during the first 5 years of treatment and 92 teeth survived the follow-up period, ranging from 5 to 40 years. The overall survival rate was 94.8%. When up to 40 years of follow-up data were analyzed, it was found that high survival rates can be obtained with root resection and hemisection. The results are satisfying when a proper case selection, endodontic treatment, restorative design, and good maintenance program are given. This treatment option should always be considered before every extraction and implant placement.

Oral Rehabilitation of a Severe Periodontally Involved Patient with Mucous Membrane Pemphigoid: A 15-Year Follow-Up Case Report.

Mucous membrane pemphigoid (MMP) refers to a group of chronic autoimmune subepithelial diseases distinguished by erosive lesions of the mucous membranes and skin. Its treatment consists of inhibition of the inflammatory reaction by means of corticosteroids and symptomatic medication. This is a report of a patient suffering from a combination of MMP and severe generalized chronic periodontitis. The patient has been treated with oral corticosteroids, initial phase therapy, extraction with immediate implant placement, and periodontal surgery where the prognosis was questionable. The case has been followed up for 15 years. Periodontal therapy with immediate implant placement was determined to be a viable modality to achieve a total rehabilitation of a case suffering from MMP combined with severe generalized chronic periodontitis.