[Health Column] Loss of Lower Right Molar: 7 Steps to Restoring Chewing Function with Alveolar Bone Graft and Implant

 

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

 

This patient complained of discomfort caused by uneven chewing force and food getting trapped due to the loss of a lower right molar. Although there may not be significant pain immediately even with a missing molar, over time, the surrounding teeth may tilt or the opposing teeth may shift downward, disrupting the occlusion.

 

The examination results indicated that an implant was necessary at site #47, and due to the long-standing void, the width and shape of the alveolar bone also had to be considered. I planned the treatment not merely to insert the implant, but to create a foundation that would allow for stable chewing once the prosthesis was placed.

 

Below, I will organize this case step-by-step, following the sequence of photos from the initial panoramic X-ray to the one after treatment completion.

 

🔎 Key factors considered when establishing a treatment plan

Molar implants are not a treatment that ends simply with the implant being placed into the bone. Since molars are the part of the body that receives the most chewing force, I formulated a plan before the surgery after checking the height and width of the remaining alveolar bone, the occlusion with surrounding teeth, the space for the prosthesis, and the feasibility of maintaining hygiene.

 

In particular, areas that have been toothless for a long time often have thinner or sunken bone than they appear on the surface, so we aimed to create an environment where the implant could be stable in the long term by reinforcing the deficient areas with alveolar bone grafting if necessary.

 

🦷 Treatment process in photos

📸 Photo 1 — Initial Panoramic

Initial panoramic X-ray · Confirmation of loss in the lower right #47 area

I first identified the missing lower right molar in the initial panoramic X-ray. Looking at the image, the area around tooth #47 was empty, and I had to consider the possibility that this space had been empty for a long time. At this stage, I did not simply look for the presence of a space, but also assessed the occlusion with surrounding teeth and how chewing forces would be transmitted once a prosthesis was placed.

 

📸 Photo 2 — Intraoral photo before treatment

Pre-treatment intraoral photographs · Confirmation of the space required for implant placement and gum shape

Intraoral photographs were used to verify the actual space for implant placement and the shape of the gums. While radiographs show bone height, intraoral photographs allow for a direct view of the space for the prosthesis and the feasibility of maintaining oral hygiene. Since this area is a molar and subjected to significant chewing forces, the placement of the prosthesis must be considered starting from the time of surgery.

 

📸 Photo 3 — Condition of the alveolar bone confirmed during surgery

Confirmation of alveolar bone and sunken alveolar bone during surgery

This is the condition of the alveolar bone confirmed during the surgery. As shown in the photo, areas where teeth have been missing for a long time may have bone that is thinner or sunken than it appears on the surface. After personally inspecting this condition, I proceeded by reinforcing the deficient areas to ensure the implant could settle stably.

 

📸 Photo 4 — Implant Placement and Alveolar Bone Graft

Implant placement and alveolar bone grafting · Reinforcement of bone shape around the implant

This scene shows the alveolar bone graft performed alongside implant placement. For long-term stability, an implant procedure is not complete simply by inserting the implant into the bone; sufficient surrounding bone support is essential. In this case, the focus was on complementing the bone structure to create an environment where the implant could be stably maintained.

 

📸 Photo 5 — Panoramic view immediately after surgery

Panoramic view after implant placement · Verification of placement position and direction

Immediately after surgery, I checked the position and orientation of the implant using a panoramic X-ray. I always perform this verification process right after surgery because the insertion depth, angle, and relationship with surrounding structures directly influence the subsequent prosthetic stage. This image also serves as a reference point for comparing the healing process.

 

📸 Photo 6 — Local radiography during the healing process

Healing process: Local radiation · Checking the recovery status of the bone surrounding the implant

This is a local radiograph taken during the healing process. It is a step to verify whether the bone surrounding the implant is recovering stably, and it is a process that must be checked before placing the final prosthesis. Stability must be confirmed at this stage before proceeding to the prosthesis stage, which is capable of withstanding actual chewing forces.

 

📸 Photo 7 — Panoramic view after treatment completion

Area #47 restored with panoramic X-ray and implant prosthetics after completion of treatment

This is a panoramic X-ray taken after the completion of treatment. As the missing lower right molar area was restored with an implant prosthesis, a structure was created that allows the patient to chew food again. After the treatment is finished, it is important to maintain long-term stability through hygiene management around the prosthesis and occlusion checks.

 

🪥 About post-treatment care

Although implants do not develop cavities like natural teeth, plaque and food particles accumulating around the prosthesis can lead to gum inflammation or peri-implantitis.

 

 

🗣️ Frequently Asked Questions (FAQ)

Q1. Do I need immediate treatment even if I have just one missing molar?

Although there may not be significant pain immediately, leaving the empty space untreated for a long time can cause surrounding teeth to tilt or the opposing teeth to descend, disrupting the bite. Additionally, the width and shape of the alveolar bone may shrink, making future treatment more complex.

 

Q2. Why is alveolar bone grafting necessary when getting dental implants?

Areas that have been toothless for a long time may have bone that is thinner or sunken than it appears on the surface. Since sufficient bone supporting the implant is necessary for long-term stability, we reinforce the deficient areas with grafts to create an environment where the implant can be stably maintained.

 

Q3. What is the reason for waiting instead of placing the prosthesis immediately after surgery?

It is necessary to verify, using methods such as local radiographs, whether the bone surrounding the implant is recovering stably. Only when stability is confirmed at this stage can the process proceed to the prosthetic stage, which is capable of withstanding actual chewing forces.

 

Q4. How should I care for the implants after treatment is finished?

Although implants do not develop cavities, the accumulation of plaque and food particles around the prosthesis can lead to gum inflammation or peri-implantitis. It is important to maintain the boundary area using interdental brushes, dental floss, and a water flosser, and to undergo regular checkups to monitor occlusion, loose screws, and prosthesis wear.

 

To summarize this case

This treatment goes beyond simply filling the empty space; it is a step-by-step process designed to ensure long-term, stable prosthetics after assessing the condition of the remaining teeth and gum bone. Even for implants in the same area, treatment methods and duration can vary depending on residual bone volume, the extent of inflammation, occlusal status, and overall health; therefore, a precise diagnosis and thorough consultation are required before treatment.