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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 makes a smile beautiful? That's a complex question, but some qualities of a lovely smile are immediately identifiable: good tooth color, shape and alignment are a few of the most important ones. If your teeth could use improvement in any of these categories, porcelain veneers could be just what you're looking for.

Porcelain veneer.You may already know that a veneer is a thin covering over another surface. In dentistry, a veneer is a wafer-thin layer of super-strong porcelain that convincingly substitutes for natural tooth enamel. When bonded to your teeth, veneers can create a natural-looking, beautiful new surface. That's because dental porcelain, like natural tooth enamel, is translucent and tough. But it doesn't stain like tooth enamel does.

Recent years have brought remarkable advances in dental porcelain technology. These days, veneers can be made so thin that they can sometimes be bonded directly onto your existing tooth surface. In other cases, a very thin layer of tooth enamel — as thin as the veneer itself — needs to be removed to fit the new porcelain surface and make it look as lifelike as possible. Either way, the results are sure to make you smile.

Versatility of Porcelain Veneers

Veneers can be used to improve any of the following characteristics of your teeth:

Porcelain veneers - before and after.

  • Color — Teeth can become stained by the foods and drinks we like, from smoking, and even normal aging. Veneers are available in numerous shades, from the most natural to the brightest Hollywood white.
  • Size & Shape — Teeth can become worn down from grinding habits, or may not have the shape or size you want to begin with. For example, some people consider rounder teeth more feminine and squarer teeth more masculine. Veneers can be shaped and sized in whichever way is most flattering to your face.
  • Alignment & Spacing — Veneers can be used to close small gaps between teeth or make slight corrections in alignment while improving tooth color and shape.

Limitations of Porcelain Veneers

There are some situations in which veneers would be inappropriate. For example, if you have significantly misaligned teeth or a large gap, orthodontics might be a more appropriate solution than veneers. And if you have lost a lot of tooth structure from decay or trauma (or a particularly severe grinding habit), it might be better to restore your teeth with porcelain crowns that cover the entire tooth.

Creating a New Smile with Porcelain Veneers

The first step in creating a new smile with porcelain veneers is to communicate exactly what you don't like about your smile as it is now. It's a great idea to bring in pictures of smiles you do like, as a starting point for discussion. It's possible to see how veneers would look on your teeth in one of several ways. A model of your teeth can be created over which wax “veneers” can be placed; sometimes acrylic (plastic) or tooth-colored filling material can be placed directly onto your teeth to demonstrate the effect veneers would have on them.

Once the plan has been agreed upon, your teeth will be prepared by removing a small amount of enamel, if this step is necessary. Molds of your teeth will be taken and used by a skilled dental laboratory to create your veneers, and you will receive a temporary set of veneers to wear during the few weeks it will take to create your permanent veneers. When the veneers come back from the lab, they will be cemented onto your teeth.

Caring for Your Veneers

Just like the teeth nature gave you, teeth restored with veneers need gentle brushing and flossing every day. This will remove dental plaque and ensure good gum tissue health around the veneers. Regular checkups at the dental office will remain as important as always to your oral and general health. And keep in mind that as tough as veneers are, they may not be able to withstand forces that come from using your teeth as tools (to open packages, for example) or biting into very hard foods like candy apples — which isn't good for your natural teeth, either! And if you grind or clench your teeth at night, you might be advised to get a custom-made nightguard to protect your veneers — and your investment.

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