Hope for the Hopeless- A Multidisciplinary (Perio-Endo-Prostho) Management of Teeth- A Case Report

Abstract

Introduction: Preservation of natural dentition is the primary goal of dentistry. Patients, today, not only value their teeth, but also express a desire to save their natural dentition in favour of extraction whenever possible. Hemisection is one of the alternative conservative treatment which aims to preserve the remaining healthy tooth structure and prevent numerous undesirable sequel. Apicoectomy and bone grafting are the stepping stones to achieve that goal. Aim: To re-create healthy functional periodontium. Methodology: A 54-year old patient got vertical fracture of tooth #36 involving the half of the mesial root. Simultaneously he had peri-apical lesion in tooth #35 along with Class II gingival recession and Grade III mobility #35, #36. So it was decided to perform root canal treatment #35, #36 and to resect the fractured mesial root of #36, followed by placement of bone graft in the extraction socket. Apicoectomy was performed in #35. Surgical area was allowed to heal by minimizing the forces on the root for 8 weeks. After healing of the tissues, fixed bridge involving retained distal half of mandibular molar, second and first premolar with pontic is planned. Results: Uneventful healing was seen in terms of periodontal consideration. Mobility of teeth #35 and distal half of #36 were reduced after 4weeks. 6 months later, crown & bridge was placed. Conclusion: This case highlights the interdisciplinary approach of molar hemisection, apicoectomy, bone regeneration with prosthetic rehabilitation as an innovative approach providing better results with minimum patient apprehension and long term stability.