Extracting only one of three tooth roots - procedure name?

[BeenThere]

My molar (upper left #7, beside an empty wisdom tooth socket), has really deep pockets (> 18mm, which is deep enough to reach between the roots, so cannot be properly cleaned - an absess was noted during this week's cleaning). This tooth has been problematic for about 15 years due to deep gum pockets.

My periodontist appears to think only one of my 3 roots for that tooth is involved so is suggesting extraction of just the problem root (after: root canal treatments and a crown), to end up with a weak yet functional molar for that location.

What is the name of this partial extraction procedure? Has anyone had it done? My first thought is: what's to stop the area where the root's been cut off, from decaying? Or, is that concern a non-issue below the gumline

 

[Busybee]

I'm not a dentist but didn't realise it was possible to do such a thing. I'll be fascinated to hear how it turns out if you go ahead. Are you in the US?

 

[BeenThere]

no

(this forum design allows you to 'watch' threads, by being updated when they've fresh content)

 

[Busybee]

I just wondered where in the world they attempt such a procedure.

 

[BeenThere]

yes, I deduced that was your intent earlier

 

[MattKW]

My molar (upper left #7, beside an empty wisdom tooth socket), has really deep pockets (> 18mm, which is deep enough to reach between the roots, so cannot be properly cleaned - an absess was noted during this week's cleaning). This tooth has been problematic for about 15 years due to deep gum pockets....

Hemisection. You have to be fairly desperate to try this on a 2nd molar, especially an upper 2nd molar; the roots are not always well separated, unlike a 1st molar. If you still have a 1st molar in good condition, maybe you should just let the 27 go. And it would depend which root was badly affected - if it's the palatal to be extracted, then the chances of the buccal roots being of any use are zilch.
Anyway, if you first do a good RCT, then section off the dodgy root, then place a small crown (gold alloy), you might get away with it. It'll be hard to clean due to the odd shape, and there will be an increased risk of fracture. I'd like to hear from you if this goes ahead.

 

[BeenThere]

Thanks to receiving that term from you, I was readily able to google the procedure to get a better sense of its history and assorted risks. It sounded like a new and speculative approach on first hearing of it last week. I remember all too well the early days of dental implants where so many of them failed (great improvements thankfully have followed in that field).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812084/ appears to be a good overview of an example that highlights the assorted concerns along with providing an estimate of the likely outcome. It's useful to have the facts and hazards pointed out as material to query and confirm, and part of reaching an informed decision (my background's chemistry & health care, I have had much dental work done but have no training in that field).

I'm considering it only because I'm apprehensive about an extraction so close to my sinus cavity and possible complications. My (former, now retired) dentist referred me to an oral surgeon a couple of years ago regarding the extraction approach, whose treatment plan included/insisted upon "deep I.V. sedation" (a scary concept to me) so I backed off. There was no abcess back then.

I'm coming to see this hemisection approach as an expensive, (perhaps more than) somewhat iffy way of postponing a full extraction, my new dentist and I will review the periodontist's treatment plan within the coming couple of weeks. If I conclude the health risks appear lower than a full extraction (over the long term), I'll likely give it a try. The improved chewing function from retention is seen as only a modest benefit for me, my motivation is safety oriented.

[I retained my much earlier extracted #7, lower right tooth on the other side of my mouth, and find it helpful having a visual aid to help picture dealing with such a small object so awkwardly placed. A larger than life model would be even more useful so I'll see if my dentist has one in her office. Meanwhile I'm seeking out a second periodontist so I can obtain a second opinion from someone not actively involved in performing elements of the procedure.

 

[MattKW]

If your main concern is the sinus, then I would downplay this significance in your decision making. The most troublesome upper 2nd molars to extract are those standing alone, usually with bulbous roots and solid bony surrounding. Then there's a risk of fracturing the tuberosity and creating an oro-antral fistula (OAF). In 35 years, I've fractured a fair few tuberosities, but only ever had 2 OAF occur - the sinus lining is fairly tough. In your case with perio damage to the bone, it would be even less risk (without benefit of Xray). It's been said that a lot of OAFs aren't even noticed, and heal spontaneously.

 

[BeenThere]

attached, my latest x-ray: 20180510 (last week)

 

[MattKW]

attached, my latest x-ray: 20180510 (last week)

You have bone loss well in between the roots, so even if you section the tooth and try to hang onto any roots, they are already compromised badly. There is no point trying anything fancy on this tooth. And your first molar looks good, and is already crowned, so that's very good. I see nothing difficult about extracting the 2nd molar at all; get rid of it.

 

[BeenThere]

Thank you, I agree that bone loss is the major issue, and may well prove insurmountable.

I'm hopeful the problem root (at the rear, cheek side) is the only root with that problem, so I expect my focus will be on local opinions on how the remaining roots sit (eg. >50% bone support is desired if not essential according to http://www.endoexperience.com/userfiles/file/root_resection.pdf).

I'm a senior, non-smoker and (now) have excellent oral hygiene (if dental hygiene along with its benefits were more carefully explained much, much earlier, I believe I could have avoided most of the current dental problems I've faced decades later).

 

[MattKW]

Thank you, I agree that bone loss is the major issue, and may well prove insurmountable.
I'm hopeful the problem root (at the rear, cheek side) is the only root with that problem, so...

Thanks for the article link, very interesting, and I've filed it away. Resections used to be more common before the advent of implants, but the statistics in the review are better than I expected, comparing favourably with implants. Good luck with the path you choose. And yes, we all have 20/20 vision in hindsight...

 

[BeenThere]

Well, the procedures have been completed successfully and the site's had a few months to fully settle down.

(~$4,700 Cdn in total, as $2,020 for the surgery itself [including some bone graft material], preceded by $1500 in root canals [temporary crown added], and followed by $1,175 for a full gold crown). Seeing a couple of youtube videos of the surgery beforehand was greatly reassuring (puts the process in better perspective, else it's hard to get a sense of it when it's impossible to see the area).

Reading up on it, I noted emphasis for success was placed on: using an expert/experienced practitioner (that eliminated the initial periodontist suggesting the procedure). She quoted me a rate of less than 1/3rd of our province's suggested fee rate for the surgery (well, you gotta practice somewhere I suppose, but not on me, thank you, and certainly not where I've read articles that emphasize practitioner experience makes a notable improvement in outcome). As well, excellent after care hygiene is needed (the long term failures are attributed to periodontal issues).

I've been diligently using: a sulcrabrush, waterpik, flossing and the larger size mini-tapered brush head meant for between dentures & larger tooth spaces to keep the back of my rear molar spotless. By far the most effective in removing missed debris for that location is the waterpik (heated cold tap water with or without some dissolved rocksalt added). Using a sulcrabrush is new to me, I'm finding it surprisingly effective when used on other gumline areas that are sensitive and where chlorhexidine rinse wasn't helping much.

I sure wish I'd started life with a far more thorough education in proper dental hygiene, along with they whys and consequences of not adhering to a good habit pattern.