Multiple-Tooth Implant Rehabilitation for Long-Standing Root Stumps and a Fractured Molar in a 55-Year-Old
Doctor’s Name | Dr. Namratha Chandrahari |
Patient’s Name | Tara |
Chief Complaint | Fractured upper right molar (tooth 27) with long-standing, untreated root stumps in the same quadrant, along with additional posterior gaps affecting chewing and bite alignment |
Diagnostic Method | IOPA and CBCT (Cone Beam Computed Tomography) |
Clinic Name | Enamel Dental Clinic, Banjara Hills, Hyderabad |
Patient’s Age | 55 years |
Gender | Female |
Treatment | Multiple Dental Implants with Screw-Retained Zirconia Crowns (Nobel Replace CC System) |
Patient Background
Tara, a 55-year-old patient travelling from the USA, came to Dr. Namratha Chandrahari, widely regarded as the best implantologist in Banjara Hills . After years of living with a fractured upper right molar, tooth 27, sitting alongside root stumps that had been left untreated for years. Initial assessment showed the damage was not isolated to a single tooth: several posterior sites in the upper arch needed attention, and the existing gaps had begun to affect how Tara was chewing and how her bite was distributing load.
Because she was travelling from abroad, the treatment also had to be planned so that extraction, implant placement, and final restoration could be completed across a condensed, realistic number of visits, without compromising on the standard of the surgical or prosthetic work. Following a detailed CBCT assessment, Dr. Namratha recommended moving away from a single-tooth solution toward a broader implant-supported approach that would address the fractured molar, the retained roots, and the surrounding bite together.
Presenting Symptoms
The clinical presentation documented by Dr. Namratha Chandrahari captured the following findings across Tara’s case:
- Fractured molar (tooth 27). The upper right first molar had fractured below a level that could be restored with a crown or filling, leaving no viable structure to build on.
- Long-standing retained root stumps. Old root fragments in the same quadrant had never been removed, sitting under the gum without function and carrying a risk of infection.
- Additional posterior gaps. Beyond tooth 27, other posterior sites in the upper arch were either missing teeth or supported by old, worn restorations that were no longer providing reliable support.
- Compromised chewing efficiency. With reduced occlusal contact on the affected side, Tara had shifted much of her chewing to the opposite side, which was beginning to show signs of extra wear.
- Uneven bite distribution. The combination of missing structure and old restorations meant the bite was no longer evenly distributed across the arch, placing additional load on the remaining natural teeth.
- Time-constrained treatment window. As an overseas patient, Tara needed a plan that could deliver a complete, lasting result within a limited number of trips to Hyderabad.
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Diagnostic Method
A comprehensive clinical examination was carried out to assess the condition of tooth 27, the extent of the retained root stumps, and the general health of the surrounding bone and gum tissue. An IOPA (intraoral periapical) X-ray gave an initial view of the root stumps and confirmed that the fracture in tooth 27 extended below a restorable level.
A CBCT (Cone Beam Computed Tomography) scan was then taken to build a detailed three-dimensional picture of the upper arch. The scan measured available bone height, width, and density at each proposed implant site, and mapped the position of the implants in relation to the maxillary sinus floor. In a case involving several implant sites across one arch, this level of imaging is what allows implant position, angulation, and depth to be planned with precision before any surgical step is taken.
Diagnosis
Clinical examination together with IOPA and CBCT imaging confirmed a diagnosis of a non-restorable fracture in tooth 27, long-standing retained root stumps in the same quadrant, and partial edentulism affecting additional posterior sites in the upper arch. The findings indicated that a fixed, implant-supported approach across multiple sites would give a more stable and predictable long-term result than treating each gap individually with a single, standalone restoration.
Treatment Plan
A comprehensive staged implant rehabilitation plan was developed for the affected quadrant, incorporating the following clinical steps:
- Preoperative bone assessment and surgical mapping: CBCT data was used to plan implant positions across the affected sites in the upper arch, identifying which sites had sufficient bone volume and density for direct implant placement.
- Extraction of the fractured tooth and root stumps: Tooth 27 and the retained root fragments were removed as the first surgical step, clearing the site for implant planning.
- Placement of Nobel Replace CC implants: Multiple implants were placed at the planned positions, forming part of a broader full mouth implant treatment plan that also took the surrounding natural teeth into account, following the same principle used in full mouth reconstruction cases, where implants, crowns, and existing teeth are brought together into one functioning bite.
- Healing period and monitoring: A structured healing period was built into the plan to allow osseointegration before any restorative work proceeded.
- Final screw-retained zirconia crowns: Once integration was confirmed, screw-retained zirconia crowns were planned as the definitive restoration, chosen for their strength, natural appearance, and ease of future maintenance.
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Multiple missing or damaged teeth in one area often call for a coordinated implant plan, not single fixes.
Surgical Procedure
The procedure was carried out under local anaesthesia with strict aseptic technique throughout. Tooth 27 and the retained root stumps were extracted first, and the sites were assessed against the CBCT plan before implant placement proceeded.
Nobel Replace CC implants were placed at the planned positions across the affected quadrant, with attention paid to spacing and angulation so that the eventual crowns would sit in proper alignment with the opposing teeth. Primary stability was checked at each site before the healing phase began. Periapical X-rays taken during treatment confirmed accurate implant position and depth at each site, providing a clear record of integration as healing progressed.
Periapical X-ray confirming implant position and integration — first set of implants
Periapical X-ray confirming implant position and integration — second set of implants
Post-Surgery Care and Guidelines
Detailed post-operative instructions were issued by Dr. Namratha Chandrahari to guide Tara through healing and protect the integrity of the newly placed implants:
- Oral hygiene protocol: Gentle brushing with a soft-bristled brush was advised from the second day after surgery, along with prescribed antiseptic mouth rinses for the first two weeks.
- Dietary guidelines: A soft diet was recommended through the healing period, with firmer foods reintroduced gradually once healing was confirmed at review.
- Medication compliance: Prescribed antibiotics were to be completed in full, with pain relief taken as needed to manage post-operative discomfort.
- Behavioural restrictions: Smoking and alcohol were to be avoided during healing, given their known effect on implant integration.
- Travel and follow-up planning: As an overseas patient, follow-up visits were scheduled to align with Tara’s available time in Hyderabad, with clear guidance on when it would be safe to travel between appointments.
- Long-term follow-up protocol: Review appointments were planned to monitor healing, confirm integration, and check the fit of the final crowns once placed.
Outcomes & Results
The treatment outcome for Tara was clinically satisfactory. The implants placed across the affected quadrant showed stable integration at review, with healthy surrounding gum tissue and even load distribution across the restored sites. The screw-retained zirconia crowns gave Tara a bite that matched her natural teeth in both function and appearance, and chewing on the previously affected side returned to normal.
The overall clinical assessment, conducted by Dr. Namratha Chandrahari, recorded a good prognosis, with satisfactory healing and no complications through the review period.
Before and after intraoral view — lateral profile
Before and after intraoral view — frontal profile
Occlusal view of the upper arch after final restoration
Final implant-supported restoration — occlusal view
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Long-Term Expectations
With consistent oral hygiene and the recommended review schedule, the outlook for Tara’s implants is good. The implants function as stable, bone-anchored replacements for the fractured tooth and old root stumps, and they are expected to hold up well under normal biting load over the years ahead. Periodic professional cleaning around the implant-crown margins, along with regular check-ups with Dr. Namratha Chandrahari whenever Tara is able to visit Hyderabad, will help catch any issues early and keep the restoration performing well long-term.
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Dealing with a damaged tooth and old root stumps you’ve been putting off?