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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 sensitivity.If your teeth seem especially sensitive after you brush them or when you consume certain foods or beverages, you're hardly alone: By one estimate, around 35 percent of the U.S. population experiences some degree of tooth sensitivity. While the difference between sensitivity and pain may be somewhat blurry, we can say that sensitive teeth usually produce discomfort in response to a stimulus like temperature, pressure, or even the sweetness of particular foods. What causes tooth sensitivity — and what should you do about it?

In general, tooth sensitivity results when dentin, the living tissue that makes up most of the “body” of the tooth, begins transmitting sensations to nerves deep in the tooth's inner core. The nerves relay these sensations to the brain, and they're felt as pain. To understand how this works, let's take an even closer look at your teeth.

Tooth Anatomy 101

Blowup of Dentin.

Dentin is a sturdy, calcified tissue, that can't usually be seen. It's normally covered by super-hard enamel on the visible part of the tooth (the crown), and by softer tissue called cementum on the tooth's roots (which typically lie below the gum line). The dentin itself is composed of many tiny tubules. When these tubules become exposed to the environment of the mouth, tooth sensitivity and pain may result.

There are several reasons why the dentin can become exposed. For one, the gums may recede (shrink down), revealing some of the tooth's root surfaces. This can be caused by genetic factors, periodontal disease, excessively vigorous brushing — or a combination of all three. This problem may be worsened if the tooth's roots weren't completely covered by cementum during their development, as sometimes occurs.

Another factor that may contribute to sensitivity is the erosion of tooth surfaces due to excessive acid in the diet. While acids occur naturally in the mouth, habitually drinking sodas and sports drinks can severely erode teeth — and brushing soon after you drink actually worsens the effect. That's because these acids soften the outer surfaces of the teeth, and brushing then makes it easy to wear them away. It's best to wait for an hour afterwards, to give your saliva a chance to neutralize the acid.

Tooth Decay.Tooth decay can also cause sensitivity. Decay may not only expose dentin, but can work its way down to the nerves themselves — at which point, your pain level may escalate. And sometimes, even dental work itself can cause sensitivity. Because the same tooth structures are involved, it may sometimes take a few days after a cavity is filled, for example, for a tooth to “calm down.”

Dealing With Tooth Sensitivity

What can you do about sensitive teeth? If it's a relatively minor irritation, try not to brush the affected teeth too long or hard. Make sure you're using a soft-bristled brush and the proper, gentle brushing technique. Always use a toothpaste containing fluoride, as this ingredient is proven to increase the strength of tooth enamel, which helps resist erosion. You can also try a toothpaste with ingredients designed especially for sensitive teeth, such as potassium. Studies show that these can be effective… but it may take approximately 4 – 6 weeks for you to notice the difference.

If sensitivity persists, however — or if your tooth pain becomes more intense — don't wait to get an examination to determine what's causing the problem. Once diagnosed, the most appropriate way to reduce the sensitivity will be recommended. Some treatments may include concentrated fluoride varnishes, prescription mouthrinses, or materials that are bonded to the outer surfaces of teeth. But tooth sensitivity may also be an early warning sign of other dental problems — and the sooner they're taken care of, the better off you'll be!

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