Bicuspidization of Mandibular first Molar

   

   Bicuspidization of Mandibular Molar;A Clinical Review;Case Report

1.                          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

Fig 3

Photograph showing division of molar into two separatedCrowns

Fig 4

After 6 week 

Fig 5

After crown prepration 

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