To prevent further destruction of the periodontium in multirooted teeth, in may be necessary to remove one or occasionally two roots. As this treatment will involve root canal therapy and periodontal surgery, the operator must consider the more obvious course of treatment, which is to extract the tooth and provide some form of fixed prosthesis. As a guide, the following factors should be considered before root resection:
1 Functional tooth. The tooth should be a functional member of the dentition.
2 Root filling. It should be possible to provide root canal treatment which has a good prognosis. In other words, the root canals must be fully negotiable.
3 Anatomy. The roots should be separate with some inter-radicular bone so that the removal of one root will not damage the remaining root(s). Access to the tooth must be sufficient to allow the correct angulation of the handpiece to remove the root. A small mouth may contra-indicate the procedure.
4 Restorable. Sufficient tooth structure must remain to allow the tooth to be restored. The finishing line of the restoration must be envisaged to ensure that it will be cleansable by the patient.
5 Patient suitability. The patient must be a suitable candidate for the lengthy operative procedures and be able to maintain a high standard of oral cleanliness around the sectioned tooth.
A tooth that requires a root to be resected will need root canal treatment. The surgery must be planned with care, particularly with respect to the timing of the root treatment. Ideally, the tooth should be root filled prior to surgery, except for the root to be resected. The pulp is extirpated from the root to be removed, the canal widened in the coronal 2 3 mm and restored with a permanent material. This means a retrograde filling will not have to be placed at the time of surgery a procedure which is difficult to perform owing to poor access and blood contamination of the filling and the likelihood of the restorative material falling into the socket.