Concept of root resection of single rooted teeth: Case report with 8-months follow-up

As we approach the millennium, much is spoken about the decline in dental caries and periodontal disease, yet there is a tendency to ignore our aging population with its often extensively restored dentitions. The management of restoration failure will become an ever-increasing challenge to the profession [1]. The patient with a failed restored dentition may present with pain, inability to function, fractured tooth/ root, infl ammatory swelling or bleeding gums [2]. Among other factors on which the decision is based, economic potential of the patient is one of the important parameter for treatment planning in countries where dental insurance is yet to come.


Introduction
As we approach the millennium, much is spoken about the decline in dental caries and periodontal disease, yet there is a tendency to ignore our aging population with its often extensively restored dentitions. The management of restoration failure will become an ever-increasing challenge to the profession [1]. The patient with a failed restored dentition may present with pain, inability to function, fractured tooth/ root, infl ammatory swelling or bleeding gums [2]. Among other factors on which the decision is based, economic potential of the patient is one of the important parameter for treatment planning in countries where dental insurance is yet to come.
In cases of Fixed Partial Denture (FPD), supported by multiple abutments or full coverage restorations that are often connected to provide the benefi t of splinting; endodontic/ periodontal involvement of even a single abutment negatively affects the prognosis of the prosthesis as a whole. Often the decision made by clinician to remove the fi xed bridge or Multiple Connected Full-Coverage Restorations (MCFCR), extract the tooth in question and make a new FPD is not appreciated by the patient.
Over the years we had been talking about root resection in multirooted teeth [3][4][5]. This article describes the technique of a root resection in single rooted teeth, gives new information about its application and analyzes the role of this treatment modality in the management of a failing MCFCR.

Discussion
Root resection has been performed in dentistry since the late 1800s and is accepted as a valid treatment option with reasonable long-term effectiveness [6][7][8][9][10][11]. Routine management of MCFCR cases, that involves removing the prosthesis, then treating the tooth/teeth in question and fabricating new prosthesis, may raise certain biological, psychological and fi nancial questions. An additional possibility is that there could be fracture of the crown or trauma to the periodontal ligament of remaining abutments while removing this MCFCR. Secondly, while fabricating a new FPD in that area, clinician may have to remove additional tooth structure to reshape the abutments. Not to mention the additional extra cost patient will have to bear for the complete treatment along with the cost of new FPD and their time and efforts to get the treatment done.
Success of any root resection procedures depend, to a large extent, on proper case selection. Indications and contraindications reported in the literature apply to root resection in multirooted teeth [4,12]. In addition to those, following are some indication and contraindications for root resection in single rooted teeth.

Indicated when one of the multiple abutments:
1. Have severe bone loss, which cannot be repaired.
2. When the tooth in question is not a distal terminal abutment in case of FPD supported by multiple abutments.
3. Requires RCT, which cannot be performed without removing the prosthesis.

Contraindications:
1. When the risk of removing the root exceeds the benefi ts of fabricating a new FPD.
2. When an FPD is supported only 2 abutments-Resection of root of one abutment will severely compromise the force distribution.
3. When the tooth is question is a terminal abutmentresection will lead to development of cantilever bridge.
4. When other abutments would not be able to support the bridge after removing the root of tooth in question.

Conclusion
This technique is not only simple to perform but also has tangible benefi ts in terms of psychological and fi nancial aspects.
There is no report of any documented case of root resection in single rooted teeth in the literature. Although this technique may not be indicated in all cases of failing MCFCR's or FPD's, however within the limits of indications and contraindications, it can defi nitely be considered as another weapon in the arsenal of the dental surgeon, determined to retain and not remove the fi xed prosthesis.