Hemisection
A hemisection (from ancient Greek : ήμἰ (hemi) (compare: Latin semi ) "half" and Latin sectio "cutting up") is primarily understood as the severing of a lower molar with partial extraction of a tooth root . In very rare cases, the hemisection is also performed on other multi-rooted teeth. A special case of hemisection is called premolarization , in which both roots are preserved.
Indications
Hemisection is considered when one of the roots of a tooth with multiple roots is diseased and cannot be treated. This is the case when a root canal treatment cannot be performed properly. This can be the case if a root canal is obliterated or there is an incomplete root filling that cannot be revised. Another indication is if one of the two roots shows an apical change ( apical periodontitis , apical granuloma) and a revision of the root canal treatment and / or a root tip resection is not possible or not desired by the patient. A hemisection can also be indicated in the case of an exposed bifurcation , a bone pocket, root caries or a tooth or root fracture.
Therapy goal
The goal of a hemisection is to preserve the healthy tooth root (s) and part of the tooth crown , if the remaining root is still well preserved and sufficiently anchored in the bone. The diseased root is removed, healthy roots are preserved and can e.g. B. serve as a bridge pillar .
method
Local anesthesia is performed before the operation , followed by a root canal treatment of the root (s) to be preserved. Then the crown of the tooth is cut through to the bifurcation or trifurcation with a diamond-coated grinding tool or a hard metal bur . Then the separated part of the crown and the root are removed. This is followed by the manufacture of a post abutment and a restoration with an artificial crown .
X-ray of 46 before root canal treatment and hemisection (21 year old female)
X-ray image of 46 after the hemisection (mesial root removed) - the root filling on the remaining distal root 46 can be seen
X-ray of the same tooth after 16 years.
intraoral image of the situation 16 years after hemisection, the 16-year-old plastic filling is heavily abraded and insufficient, which is why the tooth has now been crowned.
costs
Under certain conditions, the hemisection is a service provided by the statutory health insurance and is performed in accordance with the assessment standard for dental services according to BEMA no. 47b was rewarded with approx. 60.05 EURO. It can only be credited as a contribution in kind if it
- to maintain a closed row of teeth and / or
- to maintain an existing prosthetic restoration
necessary is. The pillar value of the remaining root must be given, ie the preserved tooth root must be able to serve as a tooth replacement pillar in the long term due to its degree of preservation.
In private billing, billing is based on GOZ No. 3130 (€ 36.22 at 2.3 times the rate).
forecast
Since the end of the 1980s, the hemisection has increasingly been pushed into the background therapeutically, because more long-term results can be achieved with an implant restoration due to a higher pillar value .
Premolarization
A special case of hemisection is called "premolarization" (not to be confused with premolarization ). The tooth is also severed after the root canal treatment, but both roots are retained. The lower molars are primarily used for this. In this way, an exposed bifurcation is ultimately eliminated by creating two premolars , i.e. two single-rooted molars, from one molar . These are now easier to clean and recurrent inflammation is eliminated by dissolving the bifurcation. The long-term therapeutic success is rarely satisfactory, however.
The premolarization itself does not represent a contract dental care. If a premolarized tooth is a necessity for the dental prosthesis, a fixed subsidy can be paid by the health insurance. One part of the tooth is a so-called similar restoration . The second crown on the second tooth part is to be agreed privately according to GOZ. The same applies to the cast pin and screw assemblies, which are also invoiced privately.
See also
Individual evidence
- ↑ a b N. Schwenzer, oral and maxillofacial surgery, Thieme Verlag, 2010, ISBN 3-13-593504-3
- ↑ GOZ No. 3130
