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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 Bonding - Step by Step.Firmly anchored in your jaw and protected by an outer coating of tough enamel, your teeth are remarkably strong — yet it's still possible for them to chip, crack, or even break. In fact, there is some evidence that today, our teeth are developing cracks at a record rate. This may be due to the fact that people are living longer (giving teeth more time to accumulate damage), or that our stress levels are increasing (which may cause teeth clenching and grinding).

Biting on hard objects, receiving a blow to the mouth, or having large cavities (or old amalgam fillings) that weaken the tooth's structure are also common causes of tooth fractures. But no matter of the cause, there are a number of symptoms that indicate a tooth may be cracked, and several treatments we can offer, depending on the severity of the injury.

Small chips on the edges or cusps of teeth often cause no symptoms, and can be treated by cosmetic bonding or other methods. Deeply fractured teeth, on the other hand, may be a serious problem. The sooner they are treated, the more likely it is that the affected tooth can be saved. Let's take a look closer look at the types of fractures teeth can develop, and the symptoms they may produce.

Minor Cracks (craze lines)
These tiny fissures in the outer enamel of the tooth often cause few or no symptoms; in fact, most don't require treatment. If you are having tooth pain, however, these cracks will need to be evaluated and possibly treated. That's because without a careful examination, there is no way to know for sure whether these cracks go into only the enamel, or if they penetrate into the dentin (inner body) of the tooth. While the tiniest craze lines don't show up on X-rays, they can often be detected by feel (using a small instrument called an explorer), by having you close down on a “bite stick,” or by using special dye stains or high-magnification instruments.

Vertical Cracks
Cracked tooth.This type of crack often starts at the chewing surface and extends toward the roots — but may it also begin in the root and continue toward the crown. Either way, it doesn't completely separate the tooth into two parts. Depending on the extent of the fracture, you may feel only minor discomfort that occurs in response to temperature changes (with hot or cold beverages, for example); or, it may produce sharp pain when you chew. In any case, you shouldn't ignore the symptoms, because cracked teeth require dental treatment quickly to keep them from progressing further. If the cracks continue to progress, tooth extraction may become necessary.

Deep Fractures or Split Teeth
When serious fractures occur, you'll know it: The distinct parts of the tooth can be separated from each other, and tooth's pulp is often inflamed and painful. This condition requires immediate treatment, and it's rarely possible to save the affected tooth.

Treatment for Cracked Teeth
What treatment is best for a cracked tooth depends on the extent and the severity of the damage. If a small crack is detected early enough, it's often possible to seal the fissure with restorative materials. For larger cracks that involve the pulp of the tooth, root canal treatment is generally required. Afterward, the visible structure of the tooth may be restored with a crown or “cap.” Sometimes, additional procedures may be recommended to try and save the tooth. In the most severe cases, however, the tooth will need to be extracted.

The preferred treatment for cracked teeth is — you guessed it — prevention! Wearing proper protective equipment (including a custom-fitted mouthguard) when playing sports, and staying alert to dangerous situations (like distracted or impaired driving) can help keep you safe. So can regular dental checkups, where your teeth are examined carefully for early signs of a problem. However, if you experience any symptoms that could indicate a cracked tooth, don't wait: The sooner it's treated, the better the chance that we can save it.

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