Bicuspidization of Mandibular Molar;A Clinical Review;Case Report
- Dr.Vivik Periodontics Dr.Mudit Uppal Endodontics
Dr. Sumona Kumar Periodontics Dr. Gurleen Arora Prosthodontics
Dr. Maryam Jameel Dental Intern
Abstract
Bicuspidization is a surgical procedure performed on the mandibular molars for the separation of
the mesial and distal roots with their respective crown portions; this separation eliminates the existence of a
furcation and facilitates effective oral hygiene practice. This case report aims at highlighting the conservative
management of a grade III furcation-involved molar by bicuspidisation procedure and use of the treated tooth
as an abutment for fixed prosthesis
A 20-year-old
female patient reported with the chief complaint of pain and food lodgement in right mandibular first molar. On examination, the tooth was
sensitive to percussion. On radiographic examination, bone loss was evident in the intra- radicular area. Root
canal treatment was done followed by bicuspidization of tooth
Introduction
A mandibular molar is bisected into two parts post root
canal treatment to form two units of single bicuspid molars
which makes it easy for the patient to maintain the area.
1,2
Bicuspidization procedure is indicated in cases of extensive
grade III periodontal defects particularly of mandibular
molar where tunnelling procedure is required for oral
hygiene maintenance
Indications for bicuspidization are following
Root fracture Severe bone loss affecting one or more
roots untreatable with regenerative procedures
Class II or III furcation invasions or involvements
Inability to successfully treat and fill a canal
Severe root proximity inadequate for a proper embrasure space
Root trunk fracture or decay with invasion of the biological
width
Contraindications include
Poor oral hygiene
Fused roots
Unfavourable tissue architecture
Retained roots endodontically untreatable
This case report describes a multidisciplinary treatment procedure for mandibular molar with grade III furcation
involvement that includes intentional root canal therapy,orthodontics,surgical periodontal therapy with
Bicuspidization and prosthetic rehabilitation
Discussion
Management of grade III furcation involvement always presents a challenge to the periodontist. Nonsurgical management alone leads to failure due to inaccessibility of the furcation region, leading to incomplete
removal of the plaque and plaque retentive factors.
The clinician splits the mandibular molar vertically through the furcation, without removing either half,
leaving two separate roots that then are treated as bicuspids (a procedure termed "bicuspidization"). Farshchian
and Kaiser have reported the success of a molar bisection with subsequent bicuspidization . They stated that
the success of bicuspidization depends on three factors:
1. Stability of, and adequate bone support for, the individual tooth sections
2. Absence of severe root fluting of the distal aspect of the mesial root or mesial aspect of the distal root
3. Adequate separation of the mesial and distal roots, to enable the creation of an acceptable embrasure for
effective oral hygiene.
Fig1
Pre-Operative Radograph
Fig 2
RCT done for 46 ,47
.jpeg)
Fig 3
Photograph showing division of molar into two separatedCrowns
Fig 4
After 6 week
Fig 5
After crown prepration
.jpeg)
Fig 6
metal try in
Fig 7
PFM CROWN
Fig 8
Photograph showing the two separate crown restored with PFM
Conclusion
Bicuspidization may be a suitable alternative to extraction and implant therapy especially for FPM in
young children and should be discussed with patients during consideration of treatment options. With recent
refinements in endodontics, periodontics and restorative dentistry, root separation and resection have received
acceptance as a conservative and dependable dental treatment and teeth so treated have endured the demands of
function
