[Health Column] 11 Steps to a Complex Case Including Simultaneous Front and Molar Implants and Alveolar Bone Graft

 

Hello, I am Hong-yeol Moon, Chief Director of Seoul Barun Implant Dental Clinic. 🦷

 

The case presented here was a complex treatment instance involving old prosthetics, tooth fractures, gum inflammation, and missing teeth. In particular, since both the front and back teeth were involved, it was difficult to restore overall function and aesthetics by simply addressing discomfort in a single area.

 

I first examined the full panoramic X-ray, local X-rays, and oral X-rays together to determine which teeth to preserve and which areas to reconstruct.

 

Implant or prosthetic treatment is not determined solely by what is visible in a photograph. We must also consider where the patient experiences discomfort, the prognosis of the remaining teeth and gum bone, and how chewing forces will be transmitted once the final prosthesis is fitted.

 

So, rather than rushing through the process while comparing pre-treatment records one by one, I established a plan that prioritized long-term stability. Today, I will explain the actual process step-by-step with photos. 👀

 

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🧭 Key aspects considered when establishing a treatment plan

 

The treatment plan was established to remove severely inflamed teeth and prosthetics with poor prognoses, and to proceed with implant placement and alveolar bone grafting where necessary. For the anterior teeth, aesthetics and the gum line were prioritized, while for the molars, masticatory force and occlusal stability were the primary considerations.

 

The key was to plan so that even if multiple areas were treated, they would ultimately connect naturally within a single occlusal structure.

 

In this particular case, we did not focus solely on the appearance immediately after treatment, but placed great importance on ensuring the structure remained manageable over time. We approached the issue by reinforcing areas with insufficient gum bone to the necessary extent and carefully adjusting the shape and connection method of the prosthesis to prevent excessive food impaction.

 

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🦷 Treatment process in photos

 

📸 Photo 1 — Initial Panoramic

Initial panoramic X-ray · Checking the entire maxillary anterior and molar regions

 

In the initial panoramic X-ray, I comprehensively assessed the condition of existing prosthetics, missing teeth, implants, and surrounding teeth in the maxillary anterior and molar regions. In complex cases like this, it is easy to overlook the scope of treatment when focusing on only a single symptomatic area. Through this image, I determined which areas within the overall structure needed to be addressed first.

 

📸 Photo 2 — Local radiography

Local radiography · Confirmation of support for the tooth and surrounding bone beneath the existing prosthesis

 

Local radiographs provided a more detailed examination of the condition of the tooth beneath the existing prosthesis and the surrounding bone support. Areas with old prostheses often show signs of internal decay or root-related issues, even if they appear intact on the surface. This data demonstrated that the underlying tooth must be evaluated first, rather than simply replacing the prosthesis.

 

📸 Photo 3 — Oral photo before treatment

Pre-treatment oral photographs · Identification of areas of discomfort and lost space

 

The pre-treatment oral photographs clearly showed the areas where the patient actually experienced discomfort. By examining the condition of the gums surrounding the prosthesis, the missing space, and the structure prone to food trapping, I considered how manageable the prosthesis needed to be for the future. At this stage, I explain the plan with the post-treatment appearance in mind.

 

📸 Photo 4 — Condition of the gums around the existing prosthesis

Check for gum recession and swelling around existing prosthetics

 

During the process of removing old prosthetics and teeth, internal damage and inflammation became more clearly apparent. Patients may feel that the tooth is fine simply because the prosthesis is attached, but in reality, the tooth underneath is often weakened. Properly addressing these issues is essential to ensure the stability of subsequent implant and prosthetic treatments.

 

📸 Photo 5 — Inflammatory tissue removed after tooth extraction

Inflammatory tissue removed after tooth extraction

 

This is a scene confirming the inflamed tissue removed after tooth extraction. If inflammation remains, bone recovery may be delayed, and the environment for implant placement may become unfavorable. At this stage, I did not stop at simply removing the tooth; instead, I cleaned the surgical site as thoroughly as possible, taking into account the subsequent alveolar bone graft and implantation.

 

📸 Photo 6 — Panoramic view after implant placement

Confirmation of relationship with panoramic X-rays and the entire dentition after implant placement

 

After implant placement, the panoramic X-ray confirmed the position of the newly implanted site and its relationship to the entire dentition. When treatment is performed on multiple areas simultaneously, it is necessary to assess how each implant functions within a single occlusion, rather than viewing them as isolated structures. Therefore, reviewing images immediately after surgery serves as an interim check of the treatment.

 

📸 Photo 7 — Implant Placement and Alveolar Bone Graft

During surgery · Simultaneous implant placement and alveolar bone grafting

 

This is a scene showing the alveolar bone graft performed during the surgery. When placing implants in areas with insufficient bone, it is important to secure a supporting foundation for the surrounding area rather than simply inserting the implant. I performed bone reinforcement to the necessary extent, specifically for both the anterior and posterior regions, considering long-term stability.

 

📸 Photo 8 — Panoramic view after additional implantation

Summary of Panoramic Revision and Treatment Scope After Additional Implants

 

The panoramic X-ray after the additional implants confirms that the treatment scope has been more clearly defined. This is the process of preparing the final prosthesis by placing implants in the necessary positions after clearing the inflamed and damaged areas in the previous step. At this stage, I reviewed the forms of both the temporary and final prostheses.

 

📸 Photo 9 — Local radiography

Local radiography · Confirmation of implant depth and surrounding bone support

 

Local radiographs allow for a detailed verification of the insertion depth of each implant and surrounding bone support. In complex treatments, both global and detailed imaging are required. The final prosthesis can only be prepared after examining the structure with a full panoramic radiograph and confirming the stability of each area with local radiographs.

 

📸 Photo 10 — Panoramic view after treatment completion

Panoramic view after completion of treatment · Recovered state within a single dentition

 

The panoramic X-ray taken after the completion of treatment shows that various areas have been stably restored within a single dentition. Initially, there was a complex interplay of issues in the maxillary anterior and molar regions, but the treatment was finalized by addressing them step-by-step, taking both function and aesthetics into account.

 

📸 Photo 11 — Final oral photograph

After treatment · The appearance of the prosthesis in harmony with the entire dentition

 

In the final oral photograph, you can see that the prosthesis harmonizes with the entire dentition after treatment. When concluding such cases, I place greater importance on whether the structure is actually comfortable for the patient to chew and maintain, rather than simply whether the teeth have been filled. Subsequently, maintaining cleanliness around the prosthesis and conducting regular occlusion checks are key to long-term maintenance.

 

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🪥 About post-treatment care

 

Maintenance is important even after treatment is completed. Since implants and prosthetics differ in structure from natural teeth, consistent care is required for the areas around the prosthetics, the gum line, and the spaces between teeth. In particular, the molar area transmits significant chewing forces and is prone to food getting trapped, so it is advisable to check the occlusion, loose screws, and gum inflammation during regular checkups.

 

I do not define the completion of treatment to patients simply as the point at which the prosthesis is fitted. Treatment can only be considered stable after verifying that chewing is smooth, there is no uncomfortable height, and the shape is manageable. Subsequently, it is important to maintain the recovered state for a long time through regular scaling and check-ups.

 

 

 

 

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🗣️ Frequently Asked Questions (FAQ)

 

Q1. Is it okay to treat the front teeth and molars at the same time?

 

A. Yes, it is possible. However, the requirements differ for the anterior and posterior teeth. For the front teeth, aesthetics and the gum line are the priority, while for the molars, masticatory power and occlusal stability are. Even if multiple areas are treated simultaneously, it is important to plan so that they ultimately connect naturally within a single occlusal structure.

 

Q2. Do I need to have old prosthetics re-examined even if they look perfectly fine on the outside?

 

A. Yes, verification is necessary. Areas with old prosthetics often have internal cavities or root-related issues progressing, even if they appear intact on the surface. Therefore, before approaching a simple prosthesis replacement, we first evaluate the affected tooth using methods such as local radiographs.

 

Q3. Why is alveolar bone grafting performed together?

 

A. When placing implants in areas with insufficient bone, simply inserting the implant may not be sufficient. A supporting foundation must be secured around the implant to ensure long-term stability. In this case, bone reinforcement was performed to the necessary extent in both the anterior and posterior regions.

 

Q4. How long does the treatment take?

 

A. Treatment methods and durations vary for each patient because the amount of alveolar bone, the extent of inflammation, the prognosis of remaining teeth, and occlusal conditions differ. It is most accurate to provide guidance after thoroughly reviewing individual data.

 

Q5. How should I manage my care after treatment is finished?

 

A. The key is to consistently manage the areas around the prosthesis, the gum line, and the spaces between teeth. In particular, for the molars, it is recommended to check the occlusion, any loose screws, and the presence of gum inflammation during regular checkups.

 

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To summarize this case

 

This treatment was not merely a matter of resolving the visible issues in the photographs; it was a step-by-step process that involved identifying the root cause, reinforcing the support base where necessary, and finally leading to the prosthesis.

 

Even for the same implant treatment, the treatment method and duration may vary because the amount of gum bone, the extent of inflammation, the prognosis of remaining teeth, and occlusal conditions differ for each patient. Therefore, I always thoroughly review individual data before explaining the most stable approach.

 

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