Second Molar
Introduction to Second Molar
The second molar, a key tooth located at the back of the mouth, plays a crucial role in maintaining oral functionality and overall jaw health. When a second molar or other back teeth are lost, the effects go beyond simple aesthetics. The remaining teeth bear excessive pressure, leading to enamel wear and a reduction in vertical height. This imbalance can trigger internal derangements of the temporomandibular joint (TMJ), causing discomfort and potential long-term issues. Moreover, the surrounding teeth may begin to shift or collapse into the vacant space, which further disrupts the alignment of the bite.
Restoring a missing second molar is not just about filling a gap; it’s essential for preserving the natural mechanics of chewing, ensuring proper jaw function, and preventing further complications. By replicating the natural structure of molars, dental restorations like implants help restore optimal biting forces, support the surrounding teeth, and maintain the vertical height of the mouth.
Consequences of Not Replacing the Second Molar or Back Teeth
When molars are missing, the remaining front teeth experience excessive load, leading to enamel loss. This wear results in a reduction of vertical height, which can cause internal derangement of the temporomandibular joint (TMJ).
A missing molar can cause adjacent teeth to collapse into the vacant space, leading to rearrangement of the surrounding teeth and a subsequent loss of vertical height.
Reasons to Restore the Second Molar
The following reasons highlight why a second molar implant is essential for normal jaw function:
Replicating Nature
The TMJ functions as a Class-3 lever, where the food bolus (load) should be positioned close to the muscle (effort) for optimal mechanical advantage. If the food bolus is nearer to the premolars rather than the molars, this mechanical advantage is lost.
Molar Design for Grinding
Molars have a larger chewing surface compared to other teeth. Upper molars have three roots, and lower molars have two, providing a large root surface area designed to withstand high chewing forces.
Complete Dentures Include Second Molars
Complete dentures feature 28 teeth, including the second molars. When even a single second molar is missing, it is typically replaced. Procedures such as sinus lifts are performed to replace the first or second molars. Replacing the second molar is especially important in full-mouth dental implant reconstructions.
How to Replace the 2nd Molars?
The following flowcharts summarises the decision-making when deciding to replace the molars:
Structural and Functional Characteristics
The unique positioning and design of pterygoid implants confer several advantages over traditional implants. By anchoring in the pterygoid region, these implants can bypass areas of significant bone resorption and provide a stable foundation for dental prosthetics.
Pterygoid implants are particularly beneficial for patients experiencing severe maxillary atrophy, sinus pneumatization, or those who have undergone multiple failed implant attempts. They also offer a viable alternative for patients who are contraindicated for sinus lift procedures or extensive bone grafting.
The immediate loading capability of pterygoid implants is a significant advantage, allowing for the placement of a dental prosthesis shortly after the implant procedure. This reduces the waiting time for patients and enhances overall satisfaction by minimizing the period without teeth.
Replacement Options for Missing Upper 2nd Molar / Upper Back Teeth based on the provided details
| Criteria | Short Implant | Cantilever | Sinus Lift | Pterygoid Implant |
|---|---|---|---|---|
|
Implant Position |
2nd Molar |
Canine/Premolar area |
On 2nd Molar |
2nd Molar |
|
Full Mouth Dental Implant Technique |
All on 8 |
All on 4 |
All on 6 |
Zygomatic Implant |
|
Images |
|
|
|
|
|
Bone Below the Sinus |
At least 5mm needed |
Less than 5mm |
Less than 5mm |
Less than 5mm |
|
Crown/Bridge Replacement |
Delayed |
Delayed |
Delayed |
Immediate |
|
Time Frame |
3 – 6 Months |
3 – 6 Months |
3 – 6 Months |
3 Days |
|
1st Molar |
Present |
Usually missing or reduced in size |
Present |
Present |
|
2nd Molar |
Present |
Missing |
Present |
Present |
