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Imagine this: An implant surgeon is performing a thorough examination of your mouth. The surgeon rotates your jaw from side to side and up and down, looking for the optimal sites in which to place dental implants — and the proper size, shape and orientation for the implants to have. He or she may test several alternatives, considering the underlying anatomical structures, and the bone density and quality that the examination reveals. Finally, a surgical plan is developed: This includes a set of precise specifications for implant position, size and depth, and a template for creating a perfectly fitting set of replacement teeth. But no invasive procedures of any type have been performed so far. In fact, you aren't even present.

Welcome to the world of computer-guided dental implant surgery. What we have described is one step in the process that allows you to receive a set of replacement teeth with the minimum amount of surgery (and time spent in the dental chair), and the maximum level of preplanning foresight. It can result in faster overall treatment time, less discomfort, and an outcome that pleases everyone. Let's look a little more closely at the entire process of computer-guided implant surgery — a procedure at the forefront of dental implant technology.

The First Phase: Making A Virtual Model

It all begins with a complete examination and modeling of your existing teeth, gum and jaw structures. In many cases, a physical impression (replica) of the jaws is made, which will aid in planning the location of the new teeth. But the modeling doesn't stop there: A high-tech, three-dimensional CT (computed tomography) scan is also performed. This allows us to examine the structures (including bone, nerve tissue and sinus cavities) which lieinside the jaw. It is often accomplished using “cone-beam” CT technology, in which the scanning device quickly captures a complete digital image of internal structures as it rotates around your head.

The next step of the process relies on powerful computers and sophisticated software to take the raw CT scan data and translate it into a 3-D model of the jaw. This virtual model can be manipulated on a computer screen — rotated, measured, even “operated” on — so that we can visualize the placement of dental implants and determine their optimum position with a high degree of accuracy. Using this technology, it's now possible for us to evaluate anatomical structures virtually — structures it once would have taken surgery to reveal — and to plan out the implant procedure accordingly.

The 3-D model we have developed is then used for two purposes: to create a precise guide for the implant surgery, and to allow the dental laboratory to pre-manufacture a set of replacement teeth that will fit precisely in the jaw. An advanced set of CAD/CAM (computer aided design/manufacture) processes is used to generate the physical objects — in this case, the surgical guide and the prosthetic teeth. Depending on your individual situation, the new teeth may be attached the same day as implant surgery, or after a healing period of 6 to 12 weeks. In either case, our precision modeling ensures that they will fit perfectly with the implants and the jaw.

Implant Surgery: Following the Plan

The implant surgery itself is typically performed under local anesthesia, and often requires no sutures (stitches). In the surgical procedure, the template we have produced (which resembles a nightguard or athletic mouthguard) is securely (but temporarily) fixed in position on the jaw. The openings in this template form precise guides for the placement of the implants — accurate in terms of position, width and depth. In fact, the implants fit so perfectly into these prepared sites that we can have new teeth placed the same day as implant surgery.

Since so many of the details have been accomplished in the planning stages, computer-guided implant surgery is typically uneventful for the patient. It can result in shorter time in the chair, less discomfort during recovery — and a highly pleasing result. It has even been called the most significant innovation in implant technology since osseointegration — the fundamental process by which a dental implant becomes fused with the bone.

We are proud of the ways in which dentistry can restore broken or decayed teeth to full beauty and function. One of the easiest and least expensive ways of doing this is with dental bonding.

Before and After Tooth Bonding.Bonding uses tooth-colored materials to replace missing tooth structure or hide cosmetically unappealing minor defects in a tooth — chips, discoloration, and even minor spacing irregularities. Bonding materials are called “composite resins” because they contain a mixture of plastic and glass, which adds strength and translucency. The composite actually bonds, or becomes one, with the rest of the tooth.

Composite resins come in a variety of tooth shades for truly lifelike results. When bonding is done with a skilled hand and an artistic eye, it may be impossible to distinguish the bonded tooth from its neighbors. Though bonding will not last as long as a dental veneer, it also does not require the involvement of a dental laboratory and, most often, can be done without drilling of the tooth. It's a particularly good solution for teens, who often need to wait until their teeth have finished maturing before choosing a more permanent type of dental restoration.

The Bonding Process

Tooth Bonding - Step by Step.Because it does not involve dental laboratory work, tooth bonding can usually be accomplished in a single visit to the dental office. Expect the whole procedure to take 30 minutes to an hour. First, the surface of the tooth to be bonded will be cleaned so it is plaque-free. The surface will then need to be “etched” with an acidic gel that opens up tiny pores in the surface. After the etching gel is rinsed off, the liquid composite resin in a well-matched shade is painted on in a thin layer, filling these tiny pores to create a strong micromechanical bond. A special curing light is used to harden this bonding material. Once the first layer is cured, another layer is painted on and cured. Layers can continue to be built up until the restoration has the necessary thickness. The bonding material is then shaped using a dental drill to give it just the right form. Once the tooth not only looks great but fits in perfectly with your bite, it will receive a final polishing.

Caring for Bonded Teeth

Bonded teeth should be brushed and flossed daily, and professionally cleaned at the dental office twice per year, just the same as the rest of your teeth. The most important thing to keep in mind about caring for your bonded tooth is that composite resin can absorb stain, just as natural teeth can. Therefore, you will want to avoid smoking, red wine, coffee and tea to the extent possible. Also, while composite can darken, it cannot be lightened. So if you are thinking about having your teeth whitened, it should be done before your tooth is bonded so that a composite shade can be selected to match the lighter color of your whitened teeth. If you whiten your teeth after bonding, the bonded tooth may not match all the rest. Finally, try not to bite your nails, hold writing implements in your mouth, or use your teeth in other ways that could put excessive force on the bonding material and chip it. With proper care, a bonded tooth should stay beautiful for 3 to 10 years.

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Repairing Chipped Teeth A composite restoration or “bonding” is an ideal material choice for a growing teenager. Composites can be made in a wide range of tooth colors allowing for near perfect color matching with existing teeth — in artistic hands they can be made to look very natural and lifelike... Read Article

Composite Resin - Dear Doctor Magazine

Artistic Repair of Front Teeth With Composite Resin Cosmetic dentistry is about creating invisible art — recreating teeth that look totally natural so that no one can tell the difference! It involves a detailed understanding of natural tooth composition and form, choosing the right composite resin to rebuild and restore lost tooth structure, and understanding light and color. Oh, and a dental artist who can put them all together... Read Article