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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.

Dental patient relaxing.Some people fail to receive the benefits of modern dental treatment because of a simple yet seemingly overwhelming problem: Fear. It isn't uncommon to have a little anxiety about an upcoming dental procedure. But if your fears have kept you away from the dental office when you know you really should go — take heart! Conscious sedation with nitrous oxide can help you lose that anxiety, and make the whole experience so stress-free that you may not even remember it when it's over.

Nitrous oxide, a colorless gas with a slightly sweet odor, has been used in medicine for about a century; however its outdated nickname, “laughing gas,” is undeserved. It's a safe and effective method of administering conscious sedation — which means that you'll stay awake during the procedure. But when nitrous oxide is used in combination with a local anesthetic, you won't feel pain or anxiety. In fact, many patients report a feeling of well-being during this type of sedation. All bodily functions remain normal during the administration of nitrous oxide, and its effects wear off quickly afterwards.

How Is Nitrous Oxide Administered?

Nitrous Oxide.As a form of conscious sedation, nitrous oxide is inhaled through a small mask that fits comfortably over your nose. The gas is mixed with oxygen as it is being delivered, and both gases are always kept at a level that is safe for the body. In just a few minutes, you may start to experience a floating sensation, and perhaps some tingling in the hands and feet. That's a sign that the sedation is working. Once it has been verified that you're calm and comfortable, and that the dose is correct, your dental procedure can begin.

Nitrous oxide itself isn't a substitute for a local anesthetic — it's considered an anxiolytic, which means it makes anxiety disappear. For some procedures, you may still need an anesthetic injection. The difference is, you won't mind. Yet, you won't be asleep — you'll be able to speak, be aware of what's going on, and you will remain in control during the procedure. In fact, the dose can be fine-tuned to just the level of sedation you need.

When the procedure is over, the flow of nitrous oxide is decreased to zero, and the oxygen may be increased. After resting in the chair for a few minutes, you'll be able to sit up, and soon you can resume normal activities like driving. Although the experience has been compared to “having a couple of drinks,” there is very little “hangover” effect afterward.

Who Can Benefit From Nitrous Oxide?

Most people whose anxiety would otherwise keep them out of the dental chair can benefit from conscious sedation with nitrous oxide. Before beginning treatment, we will take a complete medical history will be taken, including your use of both prescription and non-prescription medications. If you are pregnant, have COPD (Chronic Obstructive Pulmonary Disease) or some other pulmonary diseases, or are taking certain drugs, it may not be right for you. However, if you feel that you would benefit from a more stress-free experience in the dental office, ask about nitrous oxide conscious sedation.

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