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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.

What a difference straight teeth can make! A great-looking smile can boost your self-confidence and have a positive impact on social and professional opportunities. Orthodontic treatment is the original smile makeover tool — and you will be happy to know that you're never too old to take advantage of it. But it isn't all about looks: Properly aligned teeth help you to bite, chew and even speak more effectively. They are also easier to clean, which helps keep your mouth free of tooth decay and gum disease.

The amazing thing about orthodontics is that it harnesses the body's natural ability to remodel its own tissue. With the application of light, constant force, orthodontic appliances gently reshape bone and move teeth into better positions. Some examples of these appliances are traditional metal braces, inconspicuous clear or tooth-colored braces, and clear aligners, a relatively new option for adults and teens.

Bite Problems and How to Fix Them

Orthodontic Problems.

Orthodontic treatment can resolve a number of bite problems, which often become evident by around age 7. These include underbite, crossbite or excessive overbite, where upper and lower teeth don't close in the proper position; open bite, where a space remains between top and bottom teeth when the jaws are closed; and crowding or excessive spacing, where teeth are spaced too close together or too far apart.

To correct bite problems, teeth need to be moved — but doing that isn't as hard as you might think! Teeth aren't fixed rigidly in their supporting bone; instead, they're held in place by a hammock-like structure called the periodontal ligament, which is very responsive to forces placed on the teeth. Orthodontic appliances move teeth by careful application of light, constant pressure. This force can be applied via metal wires that run through small brackets attached to the teeth (braces), or via the semi-rigid plastic of clear aligners.

Orthodontics is for Children — and Adults

Having orthodontic treatment in childhood is ideal in order to take advantage of a youngster's natural growth processes to help move the teeth into proper alignment. Like the rest of the body, the teeth and jaws are now changing rapidly. So at this time it's possible (for example) to create more room for teeth in a crowded mouth by using a “palatal expander” to rapidly widen the upper jaw. This phase of growth modification can shorten overall treatment time and ensure the best result if additional orthodontic appliances are needed.

Adult Orthodontics

But remember, healthy teeth can be moved at any age, so you've never “missed the boat” for orthodontic treatment. In fact, about one in five of today's orthodontic patients is an adult. Several new technological developments — including tooth-colored ceramic braces, clear aligners and invisible lingual braces — have made orthodontic appliances less evident, and enhanced the treatment experience for grown-ups. Before treatment, adults are carefully examined for signs of periodontal (gum) disease, which will be brought under control before treatment begins.

Types of Orthodontic Appliances

Orthodontic Appliance Options.

When you imagine someone wearing braces, you probably picture small metal brackets bonded to the front of the teeth, with a thin wire running through them. This time-tested style remains very popular — but it's no longer the only option. Clear braces use brackets made of ceramic or plastic which, except for the slim archwire, are hardly visible. Lingual braces are just like traditional metal braces — except they're bonded to the back of your teeth (the tongue side) so that no one can see them.

Removable clear aligners are an alternative to fixed orthodontic appliances. They consist of a series of clear plastic “trays” that fit over your teeth exactly; each one moves your teeth a little bit, until they are in the proper position. Whether fixed or removable, each type of appliance may have advantages or disadvantages in particular situations. After a complete examination, the best treatment options for you will be discussed.

Retention & Post Orthodontic Care

Once your orthodontic treatment is completed, it's extremely important to wear a retainer as directed. That's because teeth naturally tend to drift back to their original locations — which is the last thing you want after you've gone to the trouble of straightening them! Wearing a retainer holds your teeth in their new position long enough for new bone and ligament to re-form around them, and helps keep your gorgeous new smile looking good for a lifetime.

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