The Role Of Root Resection

The Role of Root Resection in the Age of Dental Implants


Traditional Concepts Periodontal attachment loss associated with marginal periodontitis around multi-rooted teeth can progress to the furcation area. Because of the physical inaccessibility for hygiene procedures, infections in this area present a considerable therapeutic challenge with the potential for continued periodontalbreakdown. Consequently, the objective of periodontal furcation treatment is to eliminate the plaque-retentive areas in the exposed furcation and make the area more accessible for maintenance. Success depends on the magnitude to which the periodontal infection has invaded the furcation area. Early furcation involvement (just into the fluting of the furcation-typically, Degree I)1 may be treated bytherapeutically debriding the area, addressing the etiologic factors (eg, overhanging restorations, enamel projections) and improving hygiene access to the furcation entrance through odontoplasty. However, moderate to advanced furcation involvement, which includes destruction of the bone and connective tissue distinctively into or through the furcation (typically, Degrees II or III)1 may present more of atherapeutic challenge. Studies suggest that because it may be impossible to effectively remove plaque and calculus from some furcations,2-4 the prognosis for these teeth may deteriorate sharply.5-7

with Laura Minsk, DMD

Traditional Concepts

Periodontal attachment loss associated with marginal periodontitis around multi-rooted teeth can progress to the furcation area. Because of thephysical inaccessibility for hygiene procedures, infections in this area present a considerable therapeutic challenge with the potential for continued periodontal breakdown. Consequently, the objective of periodontal furcation treatment is to eliminate the plaque-retentive areas in the exposed furcation and make the area more accessible for maintenance. Success depends on the magnitude to which theperiodontal infection has invaded the furcation area. Early furcation involvement (just into the fluting of the furcation-typically, Degree I)1 may be treated by therapeutically debriding the area, addressing the etiologic factors (eg, overhanging restorations, enamel projections) and improving hygiene access to the furcation entrance through odontoplasty. However, moderate to advanced furcationinvolvement, which includes destruction of the bone and connective tissue distinctively into or through the furcation (typically, Degrees II or III)1 may present more of a therapeutic challenge. Studies suggest that because it may be impossible to effectively remove plaque and calculus from some furcations,2-4 the prognosis for these teeth may deteriorate sharply.5-7
Moderate to advanced furcationinvolvement, or through-and-through furcation involvement, often requires surgical intervention. However, surgical debridement of the furcation alone may not be sufficient to improve the long-term prognosis. The long-term success of the treatment depends on the access for plaque removal and the patient's ability to perform daily plaque debridement. To achieve this, clinicians may choose to remove 1or more of the involved roots in a procedure known as root resection.8 The conventional indications and contraindications for a root resection are shown in Table 1. This article describes the technique of a root resection, gives new information about outcomes, and analyzes the role of this treatment modality in the era of dental implants.

Root Resection Technique
The first step in performing aroot resection is to determine which root will be removed. Radiographs and clinical examinations (including periodontal probing) are used to assess the extent of the furcation involvement, the amount of attachment loss, the morphology and proximity of the roots, the ability to perform endodontic therapy, the proximity of anatomical structures, and the existence of caries or root resorption. It...