This study seeks to assess the clinical, radiographic, and patient-reported outcomes of hemisection versus implant over a 12 months period, generating robust evidence to guide clinical decision-making and enhance patient care.

Inclusion Criteria:

• Good oral hygiene and motivation for follow-up care.
• Ability to understand and sign informed consent.
• Localized Root/Periodontal Disease: Severe attachment loss or bone loss (e.g., severe localized periodontitis) affecting the mesial root, while the other root remains healthy.
• Furcation Involvement: Class II or III furcation involvements where the disease cannot be treated by conventional methods.
• Vertical root fracture confined to the mesial root.
• Non-treatable perforation in the mesial root.
• Extensive sub-gingival root caries affecting the mesial root.
• Extensive un-treatable internal and external root resorption related to the mesial root.

Exclusion Criteria:

• Uncontrolled systemic diseases (e.g., diabetes mellitus, bleeding disorders, immunosuppression).
• Fused or poorly shaped roots,
• Active periodontal or endodontic infection at adjacent teeth that may interfere with treatment outcomes.
• Severe bruxism or occlusal parafunction.
• History of radiation therapy in the head and neck region.
• Pregnancy or lactation.
• Poor compliance or inability to attend follow-up visits.
• Smoking more than 10 cigarettes per day.