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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 pain.When you experience pain in your mouth, it's sometimes abundantly clear which tooth is causing it. At other times, the sensation of discomfort is more diffuse, generalized or hard to pinpoint. On occasion, it can even be challenging to determine exactly what problem or combination of problems is causing the symptoms you're experiencing. This may be the case when an infection exists in the root canals of a tooth as well as the gum tissue adjacent to it.

In this situation, the infection may have begun in the pulp of the tooth itself; or, it may have started in the gums. Over time, it has spread from one location to the other — and now it's causing a confusing set of symptoms that are difficult to sort out. Regardless of where the problem started, a thorough analysis will be necessary before treatment can begin, to give you the best chance of saving the tooth.

Confusing Symptoms

Root canal infection leading to gum disease.

From time to time, many people experience oral discomfort that's dull or intermittent. Occasionally, a more insistent pain may be triggered by a stimulus like temperature (from hot or cold foods or beverages) or pressure (from biting down on something). Sometimes, it may feel as though the ache is coming from a group of teeth rather than one single tooth — or even from the sinus area above the back teeth.

These symptoms can indicate a number of dental issues, including root canal and gum problems, and shouldn't be disregarded. However, if you manage to ignore the acute pain, in many cases it will fade in time. But this isn't good news: It generally means that the infected tissue in the pulp of your tooth has died, and the nerve is no longer functioning. That's when the problem may become more serious.

Chicken or Egg?

Gum disease leading to root canal infection.

When the pulp tissue inside your tooth becomes severely infected, it's possible for the disease to move through openings at the end (apex) of the root, and outside of the tooth. It can then spread to the periodontal ligament, which anchors the tooth to the surrounding bone and gum tissue. From there, the infection may extend to the gum tissue and cause periodontal disease, or even result in a painful gum abscess. At that point, you may have pain — even severe pain that will let you know exactly which tooth is affected.

But it's also possible for the infection to be spread by the exact opposite pathway. In this case, an infection that originated in the gums (commonly due to periodontal disease caused by a buildup of plaque) may have has traveled through small passageways called accessory canals, which are located in between a tooth's roots, or on the sides of the roots. The infection can then extend into the tooth's pulp. If your teeth are fractured, it's even easier for disease to spread.

Treatment Methods

When dental problems involves both root canals and gum disease, saving the affected tooth can prove challenging. This is when it matters where the infection started: If it's primarily a root-canal problem that later moved into the gums, the outlook for the tooth is reasonably positive if it receives immediate treatment. If gum disease came first, however, the prospects often aren't as good; by the time the infection has moved into the tooth, it's possible that much bone has already been lost, making the tooth's long-term prognosis poor.

In either case, the cause of the tooth pain will need to be diagnosed and an effective treatment plan developed. The sooner that happens, the better: Root canal and gum problems simply don't get better on their own.

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Confusing Tooth Pain - Dear Doctor Magazine

Confusing Tooth Pain It is occasionally difficult to pinpoint the origin of tooth pain, which can result from an infection of the tooth itself, or of the gum, or even spread from one to the other. Nevertheless, it's always important to sort out what's going on so that the right treatment can be selected and the tooth saved... Read Article