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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.

There are times when a tooth suffers damage (from decay, for example) that is too extensive to be treated with a simple filling — but not extensive enough to need a full-coverage crown. In these cases, the best option for restoring the tooth may be an inlay or onlay.

Inlay, Onlays and Crowns.

Both inlays and onlays are considered “indirect” fillings, meaning that they are fabricated outside the mouth (generally at a dental laboratory), and then bonded to the tooth by the dentist. This is in contrast to a “direct” filling, which is applied directly to the cavity by the dentist in one office visit.

An indirect filling is considered an “inlay” when it fits within the little points or “cusps” of a back (premolar or molar) tooth. It is an “onlay” if it covers one or more of these cusps. Either way, the procedure for placing an inlay or onlay is the same.

How It Works

Getting an inlay or onlay is very much like what you would experience having a crown placed, with one important distinction: less of your natural tooth structure will need to be removed by drilling when you receive an inlay or onlay. When you get a crown, the tooth needs to undergo significant reshaping so that it will fit inside its new covering. Since dentistry's goal is to preserve as much of your natural tooth structure as possible, inlays and onlays may be recommended instead of crowns when a tooth can be restored with this more conservative type of treatment.

The first steps in getting an inlay or onlay are numbing the tooth and surrounding area with a local anesthetic, and then removing the decay. This is done in order to prevent the decay, which is actually a type of infection, from progressing deeper into the tooth.

Once the tooth has been prepared, an impression of it is made (either digitally or with a putty-like material) and sent to the dental laboratory. There, the impression is used to make a model of your tooth for the creation of your inlay/onlay. The final restoration can be made out of gold or a tooth-colored ceramic or resin.

Before you leave the office, a temporary filling will be attached to your tooth to protect it until the permanent restoration is ready. At your second visit, the permanent inlay/onlay will be attached to your tooth with either a resin that hardens when exposed to a special light source, or a type of permanent cement.

Inlays and onlays are strong, long-lasting, and require no greater level of care than any other tooth. Conscientious daily brushing and flossing, and regular professional cleanings at the dental office are all you need to make sure your restoration lasts for years to come.

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