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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.

If you could have fillings that matched the natural color of your teeth so well that nobody could tell the difference, would you choose them over metal?

We thought so! Both scientific studies and clinical experience have shown that tooth-colored restorations (fillings) are safe, reliable and long-lasting. Plus, they look great.

Metal fillings vs tooth-colored fillings.Not only do tooth-colored fillings offer an aesthetic alternative to “silver” (dental amalgam) fillings that's hard to match — they may also allow for a more conservative treatment method that preserves more of the tooth's structure. When you put these advantages together, it's no wonder some dentists say we're moving toward a “post-amalgam” era.

Tooth-colored fillings are made of a blend, or “composite,” of plastic resins and silica fillers. These substances mimic many of the qualities of natural tooth structure, such as wear-resistance and translucency. Dental composites also help strengthen teeth.

Based on looks alone, it's easy to see why you'd want a tooth-colored restoration in the front of your mouth. But to understand some of the other advantages composite resins offer — even for back teeth — let's look a little closer at the tooth restoration process.

The Process of Filling a Tooth

There are many reasons why a tooth may need to be filled or restored: decay and chipping are two common ones. No matter which material is chosen, the procedure is almost the same. After the area has been anesthetized (usually by a numbing injection), the tooth is “prepared” by removing decay and making it ready for the restoration. Next, the filling material is placed directly into the tooth. Once it has securely bonded to the tooth structure, the process is essentially complete.

Now, here's the difference: In order to achieve a good structural bond with a traditional amalgam filling, it is often necessary to shape the tooth by making a series of “undercuts” that help hold the material in place. This means that some healthy tooth material must be removed, leaving less of the tooth's structure intact. In time, the structurally-weakened tooth can be prone to cracking.

But composite resin fillings don't require undercutting to make a strong union — instead, they form an intimate physical and mechanical bond directly to the prepared tooth. This more conservative treatment may ultimately lead to a better and longer-lasting restoration.

When Can Tooth-Colored Fillings Be Used?

Composite resins are generally appropriate for small to moderate-sized restorations — which encompass the most common types of fillings. They are durable, fracture-resistant, and able to withstand chewing pressure. Depending on how much of the tooth needs restoration, the procedure may be accomplished in just one visit. Alternatively, if a large volume of tooth material must be replaced, a part may be fabricated outside the mouth and later bonded to the tooth.

Whatever the situation, the best way to determine whether tooth-colored fillings are right for you is to come in and consult with us. We can explain the appropriate options and help you select the best way to proceed with treatment. Either way, you'll be able to achieve — and keep — a healthy-looking smile.

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