[Health Column] Inflammation and Loss of Upper and Lower Molar Teeth: 9 Steps of Recovery via Staged Implants and Prosthetics

 

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

 

This patient visited due to discomfort in multiple molar areas and issues with existing prosthetics. Initial examination revealed tooth root inflammation and alveolar bone loss in the maxillary and mandibular posterior regions, and long-term stability could not be expected in some areas with simple prosthetic repair alone.

 

I first assessed the preservation potential of each tooth, and for areas requiring extraction, I planned for implants and alveolar bone grafting after clearing inflammation. When treating multiple areas simultaneously, it is crucial to view the surgical sequence, prosthetic design, and final occlusion in a coherent manner.

 

Today, I will organize the steps of how this case unfolded by following the actual medical records.

 

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🦷 Treatment process in photos

📸 Photo 1 — Initial Panoramic

Initial panoramic X-ray · Checking the entire upper and lower molar region

The initial panoramic X-ray comprehensively assessed the issues in the upper and lower molar regions. Since existing prosthetics, inflammation, and alveolar bone loss were observed in multiple areas, treating only a single site was insufficient. Based on this image, I first organized the scope and priorities of the treatment.

 

📸 Photo 2 — Local radiography

Confirmation of alveolar bone loss due to local radiation and root inflammation

Local radiographs allowed for a more detailed visualization of the alveolar bone lost due to tooth root inflammation. Such detailed imaging is crucial for treatment decisions, particularly since issues occurring beneath existing prosthetics are often not outwardly apparent. At this stage, we identified areas requiring reconstruction rather than preservation.

 

📸 Photo 3 — Oral photo before treatment

Oral cavity before treatment · old prosthetics and lost areas

This is an oral photograph taken before treatment. I was able to actually confirm the old prosthetics in the upper and lower jaws, missing teeth, and structures prone to food trapping. Through the intraoral photographs, I evaluated the space for the prosthetics as well as the patient's ability to manage the condition.

 

📸 Photo 4 — Implant Placement and Alveolar Bone Graft

Primary Surgery · Implant Placement + Supplementation of Insufficient Bone Volume

This scene shows the implant placement and alveolar bone grafting procedure. In areas where the bone is damaged by inflammation, implant placement alone does not provide sufficient stability; therefore, the insufficient bone volume must be supplemented. This process lays the foundation upon which the prosthesis can support the tooth in the future.

 

📸 Photo 5 — Panoramic view immediately after surgery

Immediately after surgery · Check implant position and orientation

Immediately after surgery, I confirmed the position of the newly placed implants using a panoramic X-ray. In cases involving multiple areas, it is essential to verify the position and orientation of each implant, as well as the space where the final prosthesis will be connected. Based on this image, I planned the healing period and the next steps of treatment.

 

📸 Photo 6 — Additional implant placement and bone grafting

Second surgery · Stepwise progression

This scene shows the placement of additional implants and bone grafting. Rather than attempting to complete all procedures at once, it is often more stable to proceed in stages while monitoring the patient's condition and recovery process. Even at this stage, the bone shape and placement positions were meticulously adjusted.

 

📸 Photo 7 — Panoramic view after additional surgery

Post-Second Surgery · Implant Placement Arrangement

This is a panoramic X-ray taken after additional surgery. You can see that the implant placement is more organized compared to the previous stage. When multiple areas are being treated, it is important to check the location and healing status with radiographs at each stage.

 

📸 Photo 8 — Panoramic view after treatment completion

Treatment Completion · Final Prosthetic Connection Status

This is a panoramic X-ray taken after the completion of treatment. You can see that the missing spaces and inflamed areas in the upper and lower molar regions have been cleared, and the final prosthetics have been connected. I also performed occlusal adjustments to ensure that chewing forces are not concentrated on one side even after treatment.

 

📸 Photo 9 — Oral photo after treatment

Improvement of oral and masticatory environment after treatment

This is a photograph of the oral cavity taken after treatment. The area where food was trapped and the prosthesis was unstable before treatment has been cleared, improving the overall chewing environment. Since post-treatment care is crucial for implants, we provided detailed instructions on maintaining cleanliness around the prosthesis and regular check-ups.

 

🪥 About post-treatment care

Although implants do not develop cavities like natural teeth, the accumulation of plaque and food particles around the prosthesis can lead to gum inflammation or peri-implantitis. Therefore, after treatment, it is essential to carefully manage the boundary between the prosthesis and the gum using auxiliary devices.

 

 

 

 

🗣️ Frequently Asked Questions (FAQ)

Q1. Do I need to treat multiple areas at once?

A. That is not necessarily the case. Rather than rushing to complete all areas at once, there are instances where it is more stable to proceed step-by-step while monitoring the patient's condition and recovery process. In this case as well, we proceeded with additional areas after confirming the recovery status following the first surgery.

 

Q2. Is bone grafting absolutely necessary when placing implants?

A. If the bone is damaged due to inflammation, simply placing an implant is not sufficient to ensure stability. The insufficient bone volume must also be supplemented to create a foundation that allows the prosthesis to support itself in the future. The necessity and scope of this vary depending on the remaining bone volume.

 

Q3. Is an examination necessary even if I have existing prosthetics?

A. Problems that develop beneath existing prosthetics are often not outwardly apparent. Root inflammation and alveolar bone loss must be thoroughly examined using local radiographs along with panoramic X-rays to distinguish between areas to be preserved and those requiring reconstruction.

 

Q4. How long does the treatment take?

A. Even for implants in the same area, treatment methods and duration may vary depending on residual bone volume, the extent of inflammation, occlusal status, and overall health. We organize a step-by-step schedule together through a precise diagnosis before treatment.

 

To summarize this case

This treatment went beyond simply filling the empty space; it was conducted in stages after assessing the condition of the remaining teeth and gum bone to ensure stable prosthetics in the long term.

 

Even for implants in the same area, treatment methods and duration may vary depending on residual bone volume, the extent of inflammation, occlusal status, and overall health; therefore, a precise diagnosis and sufficient consultation are required before treatment.