[Health Column] Implant Restoration Considering Missing Upper Left Molar and Lower Molar Condition Together: 6 Steps to Restore Occlusal Balance

 

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

 

This patient was in a case where the upper left molar was missing, resulting in insufficient chewing power, so it was necessary to examine the lower #36 area as well. Upon reviewing the initial panoramic X-ray, I determined that rather than approaching this simply as a matter of filling the missing tooth, I needed to assess how the upper and lower occlusions interlock and the condition of the remaining prosthetics.

 

The maxillary molar region is close to the maxillary sinus, so the height and direction of the bone must be checked in detail when placing implants. Therefore, I reviewed pre-treatment photos and radiographic data together to formulate a plan that seamlessly connects the implant placement in the maxillary region, the feasibility of prosthetics in the lower molar region, and the final restoration of occlusion.

 

Below, I will organize this case step-by-step, following the sequence of photos from the initial panoramic X-ray to the before-and-after comparison images.

 

🔎 Key factors considered when establishing a treatment plan

If a molar is missing on one side, the issue does not end with just that specific spot. Chewing forces are concentrated on the opposite side or the remaining teeth, placing a heavy burden on the teeth in the opposing arch and potentially affecting existing prosthetics. Therefore, instead of focusing solely on the missing area, I first examined the balance of the entire dentition.

 

In particular, the maxillary molar area is a site where the distance from the maxillary sinus must be carefully checked. When determining the placement location, depth, and direction, we reviewed pre-treatment data to ensure that the bone height was sufficient and that the implant would fit into a position capable of supporting the final prosthesis. At the same time, we incorporated the feasibility of a prosthesis for the lower #36 area into the same plan, aiming for a configuration where the upper and lower teeth could distribute the force during actual chewing.

 

🦷 Treatment process in photos

📸 Photo 1 — Initial Panoramic

Initial panoramic X-ray · Checking the site of the missing upper left molar and the condition around lower #36

In the initial panoramic X-ray, I examined the missing upper left molar and the condition of the area around lower #36. Since a missing molar on one side can place significant stress on the teeth in the opposing arch, I assessed the balance of the entire dentition first, rather than looking at the missing area in isolation. Based on this image, I determined that multiple implants are required in the upper jaw, while the lower jaw requires management that includes the condition of the existing prosthetics.

 

📸 Photo 2 — Intraoral photo before treatment

Pre-treatment intraoral photographs · Confirmation of spaces requiring implant placement and prosthetic gaps

In the pre-treatment oral photographs, the chewing discomfort actually experienced by the patient and the gap in the prosthesis were more clearly visible. If the upper molar remains missing for a long period, food frequently gets trapped, and the remaining tooth bears the burden instead. Looking at these photos, I focused not merely on filling the empty space, but on creating a shape that would allow the patient to chew stably again.

 

📸 Photo 3 — Panoramic view after implant placement

Post-implant placement: Panoramic view, placement in #24, #25, and #26 sites, and verification of #36 site.

This is a panoramic X-ray taken after implant placement. Implants were placed at sites #24, #25, and #26 in the upper left, and site #36 in the lower left was also included in the treatment flow. At this stage, we verified whether each implant was positioned to support the final prosthesis, whether the distance from the maxillary sinus was sufficient, and whether the configuration was designed to distribute occlusal forces.

 

📸 Photo 4 — Detailed radiograph after implantation

Post-implantation local radiography · Confirmation of implantation depth and surrounding bone response in the maxillary implant and mandibular #36 area

In the detailed post-implantation radiographs, I examined the maxillary implant and the mandibular #36 site up close. While panoramic radiographs show the overall flow, these localized images allow for a more precise assessment of the implant depth and surrounding bone response. Before moving on to the prosthetic stage, I always go through the process of verifying the stability of the area around the implant using these images.

 

📸 Photo 5 — Panoramic view after treatment completion

After the completion of treatment, the panoramic X-ray and upper left molar area are connected to the prosthesis, restoring the masticatory structure.

The panoramic X-ray taken after the completion of treatment confirms that the upper left molar area is connected to the prosthesis, restoring the overall masticatory structure. The space that was empty at the initial consultation has been stably filled with the implant prosthesis, and the relationship with the lower molars has also been resolved. The treatment outcome is significant not merely because a tooth was created, but because it restored the chewing balance that had been disrupted to one side.

 

📸 Photo 6 — Before and after treatment comparison

Comparison before and after treatment · Finished to ensure a natural connection to the left molar line

Comparison photos before and after treatment reveal the changes the patient actually experiences more clearly. Before treatment, there were gaps in the molars and prosthetic imbalances, but after treatment, the line of the left molars was finished to connect naturally. In cases like this, when reviewing the final photos, I check first whether the structure allows the patient to chew comfortably, rather than focusing on color or shape.

 

🪥 About post-treatment care

This treatment was performed by considering both the upper left tooth defect and the condition of the lower molars. Rather than viewing the implant placement and prosthetic direction separately, the plan was based on how force is transmitted during actual chewing. Even after the treatment is completed, consistent care around the prosthesis and occlusal checks must be continued to ensure long-term stability.

 

 

🗣️ Frequently Asked Questions (FAQ)

Q1. Why do I need to examine the lower molars as well when the upper molars are missing?

If one side of the molars is missing, chewing forces can be concentrated on the remaining teeth and the opposite arch, potentially increasing the burden. To ensure stable chewing balance after treatment, it is necessary to consider not only how the upper and lower teeth interlock but also the condition of the existing prosthetics, rather than simply filling the missing area.

 

Q2. Are there any specific precautions required for upper molar implants compared to lower ones?

Because the maxillary molar region is close to the maxillary sinus, the height and orientation of the bone must be meticulously checked when placing implants. Therefore, the placement site and depth are reviewed in advance using pre-treatment photographs and radiographic data, and the distance from the maxillary sinus is reconfirmed after placement using panoramic and local radiographs.

 

Q3. Why are detailed radiographs taken separately after implantation?

Panoramic radiography allows you to view the overall flow, while localized images provide a more accurate view of the implantation depth and surrounding bone response. This process verifies the stability of the area around the implant before proceeding to the prosthetic stage, and it is necessary to complete this step to proceed with a prosthesis capable of withstanding actual chewing forces.

 

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

It is necessary to use interdental brushes and dental floss in combination to prevent food particles from accumulating in the gums surrounding the implant. Additionally, since the prosthesis touching too high or uneven pressure can affect the long-term prognosis, the occlusion and gum condition must be checked during regular checkups.

 

To summarize this case

This treatment is a case where the implant placement and prosthetic direction were planned together based on how force is actually transmitted during chewing, rather than viewing the missing upper left molar and lower #36 site separately. The significance of the treatment lies not merely in the restoration of a tooth, but in the restoration of the chewing balance that had been disrupted to one side. Even for implants in the same location, treatment methods and duration can vary depending on residual bone volume, distance from the maxillary sinus, occlusal status, and overall health; therefore, a precise diagnosis and thorough consultation are necessary before treatment.