Removal of molars with extensive bone loss indicates that there is loss of alveolar bone in the jaw to an extent that the teeth lack proper anchorage and become lose enough resulting in teeth loss and alveolar bone loss which can progress causing severe resorption of jaw. This indicates the presence of gum disease (periodontal disease) that commonly occurs due to poor oral hygiene, systemic conditions and various health complications can lead to severe bone loss resulting in loss of molar teeth when left untreated causing infections, difficulties in eating, low self-esteem and illness in case of immune compromised patients. The condition can progress to an extent that can compromise the treatment options by creating bone defects such as loss of alveolar ridge, decrease in the width and height of bone and complete alveolar bone loss that is required for the placement of implants and dentures. Hence the intensity of bone loss must be assessed with the aid of CT scan, x-rays, medical history, or dental history and treatment can be advised based on the severity of bone loss. The alveolar bone loss can be managed initially by correcting and improving the bone defects by alveolar bone augmentation procedures followed by implant placement as the bone augmentation or grafting procedures stimulate the bone growth by increasing the size of bone structure that is strong and supportive enough to withstand the implant placement. In some cases, a sub-periosteal implant works when there is lack of sufficient bone for the placement of traditional implants and it can be considered as a long term option if the patient is unable to wear complete denture due to severe ridge resorption and jaw atrophy.
When the molars are removed, then the extracted site remodels and the healing process is associated with bone loss which can be minimized by grafting the socket and this may not be effective enough to hinder bone loss as it leads to disuse atrophy after some time as the jawbone can maintain its volume only in the presence of a physiological stimulus from the root of a tooth. Hence the best option can be to replace an extracted tooth with an implant to minimize further bone loss and these options can be considered in case of moderate bone loss. However, patients presenting with severe bone loss and jaw atrophy can benefit from a sub-periosteal implant as it provides an option of removable denture that is retained and well anchored to bone. A case study has been investigated which demonstrates that sub-periosteal implants and removable implant-borne prosthesis are considered to be the best treatment modality for elderly patients with atrophied edentulous mandibles.
Another option that can be considered in case of severe bone loss is alveolar bone grafting techniques that can regenerate the lost bone and this allows patients to have fixed teeth on implants compared to a denture as in sub-periosteal implants. The common procedures that are done to augment bone growth include bone grafting, guided tissue regeneration and alveolar ridge augmentation. The bone grafting is considered in case of severely destroyed bone around the tooth in order to regenerate bone growth and stabilize the teeth. Guided tissue regeneration is considered when the alveolar bone develops defects due to infection and a biocompatible fabric will be placed to stimulate bone growth and replace lost bone.