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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.

Tooth contouring and reshaping.Sometimes little defects in teeth can attract more than their fair share of attention. The eye often seems drawn to the tiny chip in a front tooth; the slight mismatch in tooth size among adjacent teeth; the extra-pointy canine. If you find yourself staring at these subtle yet distracting features in your own smile, help is available — often with a minimally invasive, relatively inexpensive procedure known as tooth contouring (reshaping).

Tooth contouring involves removing a tiny amount of tooth enamel with a drill to sculpt a more pleasing shape and make the tooth fit in better with its neighbors. The tooth is then polished for a smooth finish. The procedure is most often used on the upper front incisors and canines, which are your most visible teeth.

Cosmetic problems that can be corrected with tooth contouring include: small chips, uneven tooth length, slight overlaps, and tooth edges that are too flattened or pointy. It can even be used to correct minor bite problems from teeth touching unevenly during contact. Conversely, your teeth should not be reshaped if any bite imbalances could result from it. In that case, one of several other highly effective cosmetic dental procedures would be recommended. Tooth contouring can also be used to give teeth a more feminine or masculine shape, simply by rounding or squaring the edges.

What to Expect
The first step in the contouring procedure is to examine your teeth and diagnose how the reshaping will accomplish your goal of smile enhancement or correct a bite problem if you have one. This will ensure that the teeth being reshaped will not only look better but also will be healthy. Sometimes a reshaping of the root surfaces is required to protect you from gum disease. In that case, an x-ray may be necessary to isolate and protect the sensitive inner tissue (the pulp). However, most often tooth contouring only involves the removal of a bit of enamel — the hard outer covering of the tooth. Because enamel is not living and contains no nerves, you will likely not need even a local anesthetic.

You will probably feel some vibration as your tooth is gently sculpted, and then polished smooth. Reshaping one tooth usually takes less than half an hour — and the results will be obvious as soon as you look in the mirror! Sometimes reshaped teeth can be a little sensitive to hot or cold after the procedure, but this should last no more than a day or two.

Tooth contouring can be combined with whitening for a dramatically younger-looking smile. It's also often used in conjunction with cosmetic bonding or dental veneers — both of which can be used to reshape teeth with larger imperfections.

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