An innovative approach to salvage a fractured endodontically treated tooth – A case report of resection, regeneration and restoration

Introduction: The progressing inflammatory periodontal disease, if untreated, results in attachment loss. This can affect the furcation region of multirooted teeth. Hemisection is the splitting of two rooted tooth into two separate portions accompanying crown portion of two-rooted teeth most likely mandibular molars. In the healing phase after hemisection, alveolar bone undergoes additional atrophy as a result of the natural remodelling process. Post-extraction Alveolar Ridge resorption may have an impact on dental implant placement, since sufficient vertical and horizontal volume of alveolar bone should ideally be present at the site of insertion. Alveolar ridge preservation (ARP) procedures have been introduced for aesthetic concern, as well as to prevent alveolar ridge atrophy and maintain adequate dimensions of bone in order to facilitate implant placement in prosthetically driven positions. Case Description: A 51 years old systemically healthy male patient came with a chief complaint of pain and swelling in his lower left back tooth region. On clinical examination, Endodontically treated mandibular first molar manifested bucco-lingual fracture, grade 2 mobility of mesial component, 10 mm probing depth in mesial region and grade 3 furcation involvement. The treatment of the tooth included proposed hemisection of the mesial component followed by socket augumentation and delayed implant placement. After phase 1 therapy, hemisection was performed and mesial root socket was augumented with zenograft and PRF membrane. After 8 months, Osteotomy site was prepared with flapless procedure then narrow, two piece implant of size 3.3 × 11.5 mm was placed in hemisected region of mandibular molar which was followed by provisional restoration at 3 weeks. Conclusion: An innovative approach for a periodontally compromised fractured endodontically treated tooth which was undertaken with a definitive treatment. Keywords: Early loading, Furcation, Hemisection, Mandibular fir