Molar replacement revisited, from standard bone-level to tissue-level implants with an individualised design: Case report with a 36-month follow-up period.

Abstract

When a tooth is lost, resorption of the surrounding hard and soft tissue occurs. If the tooth is not replaced, the bone in the area gradually deteriorates owing to the lack of functional stimulation. Replacing a tooth shortly after its loss with a fixed implant-supported restoration can help mitigate these consequences. This is particularly crucial for a first molar, which, being a primary load-bearing point, plays an essential role in the proper development of the permanent dentition and in masticatory function. Various approaches exist for implant-supported replacement of a first molar, but each has limitations in terms of cleansability, treatment cost and biomechanical performance. This case report explores a newer, clinically proven approach involving a two-piece large-diameter tissue-level implant that features an individualised neck and platform contour instead of the typical circular shape, ideally corresponding to the dimensions of the molar edentulous space. The report involves a 63-year-old man who underwent this treatment 5 years after extraction of the mandibular left first molar, and details the treatment planning, surgical procedure and prosthetic restoration. The treatment outcomes, observed over a 36-month follow-up period, were a stable marginal bone level, healthy and stable soft tissue and satisfactory aesthetics. This demonstrates that this implant can be considered the method of choice for first molar replacement.