[Health Column] Bilateral Molar Inflammation and Tooth Loss: 8 Steps of Recovery Considering Occlusal Accuracy, From Extraction to Final Prosthesis

 

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

 

This case involved the discovery of old prosthetics and inflammatory changes in both molar areas. Upon initial examination, some teeth were in a condition where long-term stability could not be expected through preservation alone. While the patient may have perceived the issue as merely discomfort when chewing, this was actually a case that required careful consideration of inflammation around the tooth roots, the space left by tooth loss, and future occlusion.

 

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.

 

Below, I will organize this case step-by-step, following the photographic sequence from the initial consultation to the completion of treatment.

 

🔎 Key factors considered when establishing a treatment plan

I planned the procedure by first identifying the cause of the problem with the tooth, removing inflamed tissue, and then verifying the bone conditions to ensure the implant could be stably placed. Since the bilateral molar area transmits significant chewing force, I designed the procedure not only to match the position and angle but also to consider how the prosthesis would withstand force once it was placed.

 

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 balance of the entire dentition and the condition of the molar area

First, I reviewed the initial panoramic X-ray to assess the balance of the entire dentition and any issues in the molar area. At this stage, my focus was not merely on the empty spaces, but also on the prognosis of the teeth with existing prostheses and the occlusion on the opposite side. Since focusing on only one area limits the treatment plan for implants, it was crucial to determine from the outset how far the treatment should extend within the overall structure.

 

📸 Photo 2 — Intraoral photo before treatment

Pre-treatment intraoral photographs · Confirmation of the condition around the prosthesis and the shape of the missing space

The intraoral photographs clearly showed the areas where the patient was inevitably experiencing discomfort. By examining the condition around the prosthesis, the gum response, and the shape of the missing space, I also reviewed whether the structure would allow for proper cleaning once the prosthesis was placed. Using these images, I explained to the patient why treatment of the underlying cause, rather than a simple repair, was necessary.

 

📸 Photo 3 — Extracted tooth and inflamed tissue

Confirmation of inflammatory tissue remaining around the extracted tooth and root

This image shows the extracted tooth along with inflammatory tissue. While it may appear on the surface that only a single tooth has been removed, it is actually crucial to thoroughly clean up the inflammation remaining around the root. Since leaving such inflammatory tissue behind can create an unfavorable environment for future implant placement, I prepared the surgical site with the subsequent treatment in mind right from the extraction stage.

 

📸 Photo 4 — Panoramic view after implant placement

Confirmation of position and direction of panoramic X-ray and bilateral molar areas after implantation

After implant placement, I checked the position and orientation of the molars on both sides using a panoramic X-ray. The important point in this image is not simply whether the implant has been inserted into the bone, but whether it is positioned to stably withstand chewing forces once the prosthesis is placed. I re-evaluate the progression of subsequent osseointegration and the prosthesis stage based on the image taken immediately after surgery.

 

📸 Photo 5 — Panoramic view for interim check-up before prosthetics

Pre-prosthetic panoramic X-ray · Confirmation of surrounding bone stability during the healing process

We checked the overall condition using a panoramic X-ray even before placing the connecting prosthesis. Treatment for an implant does not end immediately upon placement; the prosthetic stage must be moved on to after confirming that the surrounding bone remains stable during the healing process. This intermediate check-up is particularly important for the long-term prognosis, as the molar area is subjected to significant forces.

 

📸 Photo 6 — Local radiography

Local radiography · Verification of implant depth, surrounding bone support, and fit of the prosthetic connection

Local radiographs allowed for a more accurate assessment of the detailed condition of each implant and prosthesis. While panoramic radiographs provide an overview of the overall position, these local images allow for a detailed examination of insertion depth, surrounding bone support, and the fit of the prosthetic connection. I record this data before and after the final prosthesis placement to serve as a standard for future maintenance.

 

📸 Photo 7 — Panoramic view after treatment completion

Confirmation of stability and occlusal dispersion within the panoramic X-ray and the entire dentition after completion of treatment

After the completion of treatment, the panoramic X-ray confirms that the implant prosthesis has stably settled within the entire dentition. We did not merely address the initial problematic area; instead, we considered the entire structure to ensure that chewing forces are evenly distributed to both sides. Even after treatment, you must undergo regular checkups to ensure that the bite remains high and that there is no sensation of food getting trapped.

 

📸 Photo 8 — Final oral photograph

Final oral photographs · Checking the finishing status of the molar prosthesis

In the final oral photographs, you can see how the molar prosthetics were finished inside the actual mouth. When concluding treatment, I place greater importance on whether the structure is comfortable for the patient to chew and easy to maintain, rather than on a result that looks good on paper. In this case as well, I completed the treatment with the goal of both restoring function and ensuring long-term careability.

 

🪥 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. Should I treat the molars immediately even though they are not easily visible?

A. Since molars are not easily visible on the surface, discomfort is often felt late. However, because this is the location where the greatest chewing force is transmitted, leaving inflammation or missing spaces untreated can affect the remaining teeth and the occlusion on the opposite side.

 

Q2. Is it not possible to have an implant placed immediately after tooth extraction?

A. It depends on the situation. In cases like this one, where inflammatory tissue is identified around the root, it is safer to proceed after thoroughly clearing the inflammation and confirming the bone conditions to ensure the implant can be stably placed.

 

Q3. Is the prosthesis placed immediately after the implantation is finished?

A. No. We proceed to the prosthetic stage after confirming that the surrounding bone remains stable during the healing process. This intermediate check-up is important for the long-term prognosis, especially since the molar area is subjected to significant forces.

 

Q4. How long does the treatment take?

A. Treatment methods and duration may vary as the amount of alveolar bone, the extent of inflammation, the prognosis of remaining teeth, and occlusal conditions differ from patient to patient. We provide guidance after thoroughly reviewing individual data.

 

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.