Advances in

Dentistry & Oral Health

Case Report Adv Dent & Oral Health

Volume 2 Issue 2 - July 2016 Copyright © All rights are reserved by Jamal Aqrabawi

Root Amputation: A Prudent Alternative to Tooth

Extraction
Jamal Aqrabawi*
Department of Dentistry, University of Jordan, Jordan
Submission: June 15, 2016; Published: July 14, 2016
*Corresponding author: Jamal Aqrabawi DDS, DMD, DSc, Diplomate of the American Board of Endodontists, Professor of Endodontics, Faculty
of Dentistry, University of Jordan, Amman, Jordan, Tel: ; Email:

Abstract
Compromised teeth often pose a significant challenge to the clinician, complicating the treatment plan and compromising long term
prognosis. Upper molar teeth showing periodontal attachment loss, caries or fractures involving the furcation area are prime examples of
such challenges. Treatment option for affected teeth can be roughly divided into maintenance of the tooth through root resection therapy, or
extraction and replacement. Root resection therapy involves removal of the diseased root along with its coronal portion while retaining the
relatively healthy parts.
The indication, contra-indications and technique of root resection therapy are described in this case report of an upper molar in which
combined resection, endodontic and prosthetic management resulted in a successful outcome.
Keywords: Root resection; Endodontic and prosthetic management; Oral hygiene; Mesiobuccal root amputation

Introduction reported survival rates was attributed to the technique sensitivity,

case selection, patient compliance with oral hygiene instructions
Root resection is a technique for maintaining a portion of a
and proper restorative treatment [4].
diseased or injured molar by removal of one or more of its roots
[1]. In lower molars, root resection can be achieved by hemi Due to this disparity in reported outcome and perceived high
sectioning the whole tooth in half and removing the diseased root outcome or success rate of dental implants, the clinician is often
along with its crown part. However, in upper molars root resection faced by the dilemma of choice between root resection therapy and
is mostly carried out by removal of the diseased root alone (root implant replacement. As one may devise, it is extremely difficult
amputation) with rounding of the crown. to directly compare the two treatment modalities. Unfortunately,
studies comparing the two treatment modalities’ outcome are
Root resection therapy outcome was investigated in a few
very few. In a private practice retrospective study the survival rate
studies showing a variable “success rate” or survival of resected
of 701 resected molars was compared to that of 1472 implants in
teeth depending on the study. Langer et al. [2] showed in a
molar areas after more than 15 years of function [6]. No significant
randomized retrospective study that resected molars tend to
difference could be demonstrated between the cumulative success
have an acceptable success rate albeit non-lasting, with lower
rate of the two treatment modalities (root resection therapy
molars more frequently failing due to root fracture while uppers
=96.8%; implants= 97%). The highest failure rate was noted in
failed due to periodontal breakdown progression. They concluded
resected molars or implants that were lone standing (terminal
that at least a 10 year recall should be implemented in outcome
abutments) [6].
studies to get a meaningful outcome as failure tended to happen
between the 5th or 7th year postoperatively. About 38% of these As a result of the lack of more evidence, the clinician is
teeth failed during the 10 year observation period [2]. A relatively increasingly confronted by the pressure of choosing the treatment
similar survival rate was reported by a different study showing modality for managing a compromised molar with furcation
83% survival rate at 5 years dropping to 68% at 10 year recall involvement. Case selection for root resection therapy should
time [3]. The authors concluded that the resection itself may take into consideration the skills and expertise of the clinician
remove the diseased root but may also create another nidus for [4,7]. The indications and limitations of root resection therapy
new aggravating factors such as overhanging restorations [3]. On were discussed in a comprehensive literature review [8] and some
the other hand; Carnevale et al. [4] reported a survival rate about guidelines were suggested in a recent review [7]. The acceptable
93% over a 10 year follow up, which was corroborated by the indications of root resection therapy from an Endodontic point of
results reported in a more recent study [5]. The disparity in the view are [1,8].

Adv Dent & Oral Health 2(2) : ADOH.MS.ID.555582 (2016) 0033

 Advances in Dentistry & Oral Health

1. Severe vertical root fracture involving one root the treatment started by giving the patient local anesthesia. A long
2. Undermined furcation areas due to caries, or shank tapered fissure diamond bur was used to make vertical cut
perforations. toward the furcation. A fine probe was passed through the cut to
ensure separation which was confirmed on the radiograph (Figure
3. Perforation of one of the roots of a molar not allowing
2). The furcation area was trimmed to ensure that no spicules were
adequate access to the original root canal hindering canal
present. The mesiobuccal root was removed in 2 pieces (Figure 3).
disinfection procedures.
4. Failure of one of the abutments within a fixed partial
denture because of periodontal disease, if the remaining
abutments support is adequate.
5. Inability to manage endodontic obstructions or
complications in one root of a molar tooth
While root resection therapy would be contra-indicated if
root separation is difficult due to fusion of the roots, in-operable
endodontic complication or obstruction in the root to be retained,
presence of a strong and good adjacent abutments for a bridge as Figure 2: A radiograph showing removal of the mesiobuccal one
an alternative [1]. Of course, should the clinician lack the expertise [MB1].
needed for proper surgical management and subsequent
restoration, root resection should not be carried out.
In this case report, an upper molar with endodontically
complicated mesiobuccal root canals was managed using root
resection therapy in a keen and compliant patient.
Case report
A 54year old female reported to my office with the chief
complaint of pain on the upper left quadrant. On clinical exam
tooth #14(UL6) has already prepared as an abutment for 3 unit
bridge, percussion test 0n #14(UL6) revealed tenderness and Figure 3: A radiograph showing removal of mesiobuccal two
discomfort. [MB2].

On radiographic examination, tooth 14(UL6) has a RCT with 2months later after complete healing of the socket an
short fill and stripping of the mesiobuccal root (Figure 1). The impression was taken and 3 unit bridge was fabricated and since
root canal on the destobuccal root and the palatal one seems to be then the patient has no complaint. Five years later a radiograph
satisfying. Probing around tooth 14(UL6) was within normal limit. was taken and showed no sign of problem (Figure 4).

Figure1: Radiograph of tooth UL6. The root canal filling is

satisfactory, where as the mesiobuccal root has a short filling Figure 4: A radiograph showing the three unit bridge in place
and striping of the walls which may indicate vertical fracture. after 5 years.

Upon further investigation we came to conclude that the

mesiobuccal root is the source of the patient pain. Discussion
The treatment plan was presented to the patients who include The main aim of root resection therapy is to maintain a
removal of the whole mesiobuccal root (MB root amputation) and diseased tooth as an alternative to extraction and replacement.
keeping the palatal and the destobuccal roots. Upon agreement, Dental implants, extensive bridgework and custom-made tooth

How to cite this article: Jamal A. Root Amputation: A Prudent Alternative to Tooth Extraction. Adv Dent & Oral Health. 2016; 2(2): 555582. DOI: 10.19080/
0034
ADOH.2016.01.555582
 Advances in Dentistry & Oral Health

replacement can be expensive and time-consuming. Generally, 2. Langer B, Stein SD, Wagenberg B (1981) An Evaluation of Root
root resection and the necessary crown work are less expensive Resections: A Ten–Year Study. J Periodontol 52(12): 719-722.

and can be completed in 1-3 short visits. 3. Blomlof L, Jansson L, Appelgren R, Ehnevid H, Lindskog S (1997)
Prognosis and mortality of root-resected molars. Int J Periodontics
Case selection affects the outcome of root resection as a Restorative Dent 17(2): 190-201.
treatment of choice where endodontic complications affecting 4. Carnevale G, Pontoriero R, di Febo G (1998) Long-term effects of root-
one root of multi-rooted tooth. Factors such as occlusal forces, resection therapy in furcation-involved molars. A10-year longitudinal
study. J Clin Periodontol 25(3): 209-214.
tooth restorability, and the value of the remaining roots must
be examined before treatment [9]. Success of root resection 5. Yuh DY, Cheng GL, Chien WC, Chung CH, Lin FG, et al. (2013) Factors
affecting treatment decisions and outcomes of root-resected molars: a
procedures depends significantly on proper case selection and nationwide study. J Periodontol 84(11): 1528-1535.
definite treatment plan discussed together with the endodontist, 6. Fugazzotto PA (2001) A comparison of the success of root resected
periodontist and the restorative dentist. Unfortunately, as molars and molar position implants in function in a private practice:
mentioned earlier, a restoration can contribute to periodontal results of up to 15-plus years. J Periodontol 72(8): 1113-1123.
destruction, if the margins are defective or if non-occlusal surfaces 7. Kasaj A (2014) Root resection procedures vs implant therapy in the
do not have physiologic form. Also, an improper shaped occlusal management of furcation-involved molars. Quintessence Int 45(6):
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contact area may convert acceptable forces into destructive forces
8. Kinsel RP, Lamb RE, Ho D (1998) The treatment dilemma of the
and predispose the tooth trauma from occlusion and ultimate
furcated molar: root resection versus single-tooth implant restoration.
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How to cite this article: Jamal A. Root Amputation: A Prudent Alternative to Tooth Extraction. Adv Dent & Oral Health. 2016; 2(2): 555582. DOI: 10.19080/
0035
ADOH.2016.01.555582