[Health Column] 9 Steps to Recovering Mandibular Frontal Periodontal Damage and Tooth Loss with Implants and Autogenous Bone Grafting

 

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

 

This patient presented with loose lower front teeth, difficulty chewing, and a deterioration of the gum condition. Although the mandibular anterior teeth are small in size, they are directly involved in pronunciation and food cutting functions; furthermore, because the alveolar bone is thin, they often rapidly lose support as periodontal disease progresses. Therefore, from the initial examination, we did not view this as a simple dental issue but rather assessed the remaining amount of alveolar bone and the future prosthetic design together.

 

Implant or prosthetic treatment is not determined solely by what is visible in photographs. It is necessary to 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. Therefore, rather than proceeding hastily by comparing pre-treatment data one by one, I established a plan that prioritizes long-term stability.

 

🔎 Key factors considered when establishing a treatment plan

Rather than forcibly retaining the front teeth with a poor prognosis, the plan focused on resolving the inflammation and rebuilding the supporting foundation in necessary areas through implants and alveolar bone grafting. During treatment, temporary teeth were used to minimize gaps in appearance and function, and the final prosthesis was designed with pronunciation and cleaning in mind.

 

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.

 

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 · Confirmation of mandibular anterior alveolar bone loss and remaining teeth

In the initial panoramic X-ray, I first assessed the overall alveolar bone loss in the mandibular anterior region and the condition of the remaining teeth. Since loose anterior teeth are often caused by insufficient support from the surrounding bone rather than the teeth themselves, I used this video to determine the general direction regarding which areas needed to be trimmed and reconstructed.

 

📸 Photo 2 — Local radiography (mandibular anterior teeth)

Local radiography · Residual bone volume and prognosis assessment by tooth

Local radiographs were used to examine in greater detail the amount of bone remaining around the mandibular anterior teeth. At this stage, it was crucial to distinguish between teeth that could be preserved and those with a poor prognosis. Since forcing the preservation of teeth could lead to recurring inflammation later on, the treatment plan was explained based on long-term stability.

 

📸 Photo 3 — Oral photo before treatment

Oral cavity before treatment · Loose lower front teeth and gum condition

The pre-treatment oral photographs revealed looseness in the lower front teeth, the condition of the gums, and visible aesthetic discomfort. From the patient's perspective, this is an area where they are concerned about tooth loss and experience difficulties with pronunciation and eating. While reviewing these photos, I considered the design of both the temporary teeth and the final prosthesis after treatment.

 

📸 Photo 4 — Implant Placement and Autogenous Bone Graft

Surgical Scene · Simultaneous Implant Placement and Autogenous Bone Grafting

This is a surgical scene showing the simultaneous placement of dental implants and autogenous bone grafting. The bone width in the mandibular anterior region is often narrow, so simply placing an implant may not be sufficient. Therefore, the surgery was performed to supplement the insufficient support base and ensure the implant can be stably positioned.

 

📸 Photo 5 — Panoramic view after surgery

Confirmation of the relationship between postoperative panoramic X-ray, implant placement, and the entire dentition

In the postoperative panoramic X-ray, I verified the position of the implants in the mandibular anterior region and their relationship to the entire dentition. If the implants are too close together or misaligned, the final prosthesis may appear unnatural or become difficult to clean. Through this image, I reconfirmed that the positioning was appropriate for the subsequent prosthetic stage.

 

📸 Photo 6 — Local radiation (after implantation)

Local radiation · Checking peri-implant bone support and implant depth

In local radiographs, bone support around the implant and the insertion depth were examined in detail. Since space in the mandibular anterior region is limited, it is necessary to enhance accuracy using such local images rather than relying solely on panoramic radiographs. This data also serves as an important standard when tracking the healing process.

 

📸 Photo 7 — Panoramic view after treatment completion

Final state with completed treatment, including panoramic X-ray and prosthetics

The panoramic X-ray taken after the completion of treatment confirms that the implant prosthesis is stably connected within the entire mandibular structure. Although maintenance was initially difficult due to periodontal disease, the treatment was concluded with the goal of restoring function by clearing inflammation and rebuilding the supporting structure.

 

📸 Photo 8 — Final oral photograph

Final oral and mandibular anterior prosthetic restoration

In the final oral photograph, the lower front teeth have been restored with prosthetics, allowing for the resumption of daily speech and food cutting functions. For anterior prosthetics to last a long time, they must not only look natural but also be easy to clean. Therefore, after treatment, we advised the patient on using interdental brushes and performing regular gum care.

 

📸 Photo 9 — Before and After Treatment Comparison

Comparison before and after treatment · Initial condition and recovery results

Looking back at the pre-treatment photos, it is clear why aggressive treatment was necessary given the initial state. Since loose teeth and gum changes can worsen over time, it was crucial to address the underlying causes at the appropriate time. This case can be summarized as an example of recovery achieved step-by-step.

 

🪥 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.

 

 

 

🗣️ Frequently Asked Questions (FAQ)

Q1. Do I need implants even though my lower front teeth are small?

A. Although the mandibular anterior teeth are small in size, they are directly involved in pronunciation and food cutting functions. Since the alveolar bone is thin, support is often lost rapidly as periodontal disease progresses; therefore, rather than forcibly maintaining teeth with a poor prognosis, it is often more stable in the long term to clear inflammation and rebuild the supporting foundation.

 

Q2. Is bone grafting necessary for front tooth implants?

A. The bone width in the mandibular anterior region is often narrow, so implant placement alone may not be sufficient. In this case, we performed autogenous bone grafting along with implantation to supplement the insufficient supporting base. The necessity and extent of this procedure depend on the remaining bone volume.

 

Q3. Is the diagnosis complete based solely on the panoramic image?

A. The mandibular anterior region has limited space, making it difficult to assess based solely on panoramic radiography. Local radiographs are required to examine the residual bone volume for each tooth, bone support around the implants, and insertion depth to differentiate between areas to be preserved and those requiring reconstruction.

 

Q4. Are the front teeth missing during treatment?

A. During the treatment period, temporary teeth are used to minimize gaps in appearance and function. The final prosthesis is designed with pronunciation and ease of cleaning in mind.

 

To summarize this case

This treatment involved not merely resolving the visible issues in the photos, but systematically connecting the process to the final prosthesis after addressing the underlying causes and reinforcing the supporting base where necessary. Even with the same implant treatment, the method and duration may vary because each patient differs in terms of gum bone volume, the extent of inflammation, the prognosis of remaining teeth, and occlusal conditions. Therefore, I always thoroughly review individual records to explain the most stable approach.