Hemisection – A Tooth-Preserving Solution for Vertical Root Fracture at Herident

Explore a clinical case of treating a vertical root fracture using the hemisection technique at Herident Dental Clinic  – a solution to preserve natural tooth structure and restore safe chewing function for elderly patients.

Vertical root fracture It is a serious dental injury that is often overlooked due to its difficulty to detect with conventional diagnostic tools. If not properly diagnosed and treated, this condition may lead to complete tooth loss.

At Herident Dental Clinic, we applied the hemisection technique – a modern solution that helps preserve natural tooth structure and effectively restore chewing function, especially suitable for elderly patients or those with systemic health conditions.

The patient, N.T.L, female, 69 years old, presented with a dull, persistent pain in the upper and lower right molar regions lasting for nearly a month. The pain significantly affected her eating, sleep, and overall health.

The patient has a medical history of chronic bronchitis and hypertension—two important factors to consider when planning treatment. She previously had dental crowns and bridges placed several years ago and has maintained a consistent oral hygiene routine.

Intraoral Examination

• Tooth #16 (upper right first molar): This tooth had previously undergone root canal treatment and was restored with a dental crown. Upon examination, it showed tenderness to percussion, suggesting a possible recurrence of periapical inflammation (periradicular infection).

• Tooth #46 (lower right first molar): The tooth was restored with a porcelain-fused-to-metal (PFM) crown but had no history of root canal treatment. Currently:

  • The porcelain layer is fractured, exposing the underlying metal substructure.

  • The patient reported pain upon percussion, but no signs of swelling were observed.

  • Panoramic radiograph: no obvious abnormalities detected.

  • CBCT (3D imaging) revealed a vertical root fracture on the mesial root of tooth #46.

The panoramic radiograph did not clearly reveal the lesion.

Conclusion: This is a typical case of vertical root fracture—a condition that can easily be overlooked on conventional radiographs but may lead to irreversible tooth loss if not properly managed.

After a clinical case conference, the team of doctors at Herident, led by Dr. Dang Trieu Hung, developed a personalized treatment plan.

• Extraction of the mesial root of tooth #46 (fractured and non-restorable)
• Preservation and root canal treatment of the distal root of tooth #46, as the surrounding periodontal tissue remains stable with no signs of bone loss.
• Hemisection technique was performed to preserve the tooth and restore masticatory function.

Fortunately, the distal root of tooth #46 remained healthy, with no bone loss, meeting the criteria for hemisection. This allowed preservation of the viable portion of the tooth instead of extracting the entire tooth.

The treatment team proposed three restorative options tailored to the patient’s condition and needs.

– Option 1: Fabricate a new crown on the remaining distal root

• Advantages: Minimally invasive and quick to perform

• Disadvantages: Lack of force sustainability

– Option 2: Immediate implant placement in the extracted mesial root site, combined with a crown restoration on the preserved distal root.

• Advantage: Ensure good chewing functions, high aesthetics

• Disadvantage: Needs surgery and long time- and money-consuming

– Option 3: Fabricate a dental bridge from tooth #45 to the distal root of tooth #46

• Advantage: No surgery needed, time- and money-saving, and more durability than option 1.

The patient was thoroughly informed about each treatment option, including effectiveness, longevity, invasiveness, cost, and treatment duration. After careful consideration, Mrs. L. decided to proceed with extraction of the mesial root, root canal treatment of the distal root, and placement of a dental bridge from tooth #45 to the distal root of tooth #46.

With the patient's agreement, Doctor Dang Trieu Hung starts the treatment:

• Eliminate the tooth neartooth #46 gently

• Root canal treatment was successfully completed on the distal root of tooth #46

• Periapical tissue was monitored for healing and inflammation control

• After the healing phase, a dental bridge was fabricated from tooth #45 to the distal root of tooth #46

Post-treatment radiograph showing the removal of the mesial root of tooth #46.

Post-treatment results: The patient reported complete resolution of pain, regained stable chewing function, and is pleased with the restorative results.

Hemisection techniqueis an effective method for managing vertical root fractures in multi-rooted teeth.
Key Advantages:

• Preserves natural tooth structure and reduces alveolar bone resorption.

• Less invasive compared to full tooth extraction.

• Maintains natural proprioception and chewing sensation.

• Particularly suitable for elderly patients or those with systemic conditions who prefer to avoid major surgery.

Applicable in cases of localized root fractures, where the surrounding periodontal tissues remain stable and the patient's overall health allows for conservative intervention.

• Early diagnosis using CBCT is key to detecting vertical root fractures — a type of lesion that is often easily overlooked.
• Hemisection is an optimal treatment option in cases where part of the tooth's root remains healthy, helping to avoid complete extraction.
• At Herident, every treatment plan is personalized—taking into account the remaining tooth structure, systemic health conditions, and the patient’s preferences—ensuring a key foundation for successful outcomes.

Herident Dental Clinic is committed to accompanying you through every stage of treatment, with a strong focus on preserving natural teeth whenever possible. Herident is a trusted choice for both local and international patients seeking safe, aesthetic, and long-lasting dental solutions.If you are experiencing a similar dental issue, don’t hesitate to contact Herident’s team of experienced doctors for a thorough consultation and timely care.