Root resection and hemisection is a treatment option for furcated molars, and the prognosis of this technique has been well documented. The aim of the present paper is to systematically review studies examining the survival and/or failure rate of root resection and hemisection and to determine the factors behind the variability in the outcome reported. A Medline (PubMed), Embase, and Google Scholar search was undertaken, looking for articles published up to September 2016. A total of 1,012 publications were screened. Two reviewers analyzed the articles and extracted the data. Case series studies required a minimum of 5 cases, and all levels of evidence were accepted. A total of 22 studies met the inclusion criteria. Survival rate and follow-up times differed widely: survival rate ranged from 40.3% to 100% and follow-up from 6 months to 23 years. Half of the studies had a survival rate > 90% with a follow-up period ranging from 5 to 23 years. Therefore, root resection and hemisection are associated with high survival rates, making it a reliable option for treatment of furcated molars that should be considered before every extraction and implant placement. In a great number of studies, incomplete information was found concerning case selection and endodontic, restorative, and maintenance therapy, which makes one question the obtained results and the occasional reports of low survival rates. These concerns should encourage more detailed, long-term clinical trials, with respect to each phase requirement for the procedure, for a better assessment of survival rate.