Abstract
INTRODUCTION: Bicuspidization is a surgical technique aimed at preserving mandibular molars with furcation involvement, a condition that compromises periodontal health and can lead to tooth loss. This procedure involves separating a molar into two functional units, facilitating improved access for oral hygiene and promoting long-term tooth retention. Iatrogenic furcation perforations, a complication of endodontic treatment, can further complicate these cases. This report presents a successful application of bicuspidization in a compromised mandibular molar. CASE DESCRIPTION: A 14-year-old male presented with masticatory pain. Clinical examination revealed a pulpal floor perforation in a previously root canal-treated tooth #46. Radiographic evaluation showed furcation involvement. After unsuccessful initial management with Mineral Trioxide Aggregate (MTA), bicuspidization was performed. The procedure involved flap elevation, debridement, vertical sectioning of the tooth, and suture placement. Postoperative care included analgesics, oral hygiene instructions, and follow-up appointments. Crown lengthening and a single-unit cast metal crown were delivered at a later appointment. Clinical and radiographic evaluations at follow-up appointments (6, 9, and 18 months) demonstrated satisfactory healing and function. CONCLUSION: Bicuspidization is a viable treatment option for managing mandibular molars with furcation involvement, particularly when aiming to preserve natural dentition. This case demonstrates that bicuspidization can effectively address furcation perforations, improve periodontal health, and provide a functional alternative to extraction. CLINICAL SIGNIFICANCE: Bicuspidization preserves compromised molars with furcation involvement, offering an alternative to extraction by improving periodontal health, hygiene access, stability, and tooth prognosis. HOW TO CITE THIS ARTICLE: Aggarwal S, Zacharias L, Shetty R, et al. Bicuspidization-A Conservative Approach in Pediatric Dentistry: A Case Report. Int J Clin Pediatr Dent 2026;19(1):105-109.