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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.

Cancer is a scary word, but the more you know about it, the better able you will be to protect yourself and the ones you love. This is particularly true of oral cancer, which is very treatable if caught early. Unfortunately, about two-thirds of oral cancers are not caught until the late stages. You may think that if you are a non-smoker, particularly a young one, this topic is not of concern to you. If so, please think again.

While most oral cancer patients are smokers, the fastest-growing segment of newly diagnosed cases is young, non-smoking adults. The culprit is a particular strain of the Human Papilloma Virus (HPV). HPV is the most common sexually transmitted disease in the U.S., with about 20 million Americans infected. In fact, it is estimated that at least half of all sexually active people will contract it during their lives. Most strains (and there are over 100) lead to symptoms no more serious than warts, and in many cases a person's own immune system can rid the body of the disease within two years. The strain known as HPV16, unfortunately, is different. By inserting its own DNA into human cells, the virus can cause a mutation that turns normal cells into malignant ones. You may already be aware that HPV16 has been linked to cervical cancer. We now know it is also responsible for many new cases of oral cancer.

Signs & Symptoms

Oral cancer.Most of the lumps, bumps, and occasional sores you find in and around your mouth are completely harmless. But you should look out for changes such as white or red patches, ulcers and lumps anywhere in and around your face and neck that persist for more than a couple of weeks. A persistent sore throat or hoarseness is also cause for concern. Most oral cancers are “squamous” (scale-shaped) cell carcinomas. The sides of the tongue are the most common sites for these small lesions. Because the tongue has a rich blood supply and a direct connection to the lymphatic system (a part of our immune system), it's a site from which cancer can easily spread. The floor of the mouth under the tongue is the second most common site. Cancerous lesions on the lower lip, which are usually preceded by chronic sun exposure, are not uncommon.

Diagnosis & Treatment

Regular screening for oral cancer is one of the most important services provided to you at the dental office. Your regular dental checkup includes a visual and tactile (touch) examination for any signs of oral cancer or precancerous lesions in and around your mouth and throat. Anything that looks suspicious, may be analyzed with a routine procedure called a biopsy, in which a small amount of the suspicious tissue is sent to a laboratory for microscopic inspection. This is the best way to get a definitive diagnosis. Should the lesion turn out to be cancerous, the rest of the malignant tissue will be removed. It's possible that radiation and/or chemotherapy will be needed to eradicate the disease. As mentioned before, when treatment occurs early, the survival rates are excellent.

Prevention

There are lifestyle choices you can make to reduce your risk considerably. Giving up tobacco in all forms, along with alcohol are big ones. Avoiding risky sexual behavior is also important. Protect yourself from overexposure to the sun, and eat a healthy diet. Research has consistently found that a high intake of fruits and vegetables is protective against oral and throat cancer; a good diet will also bolster your immune system. And please remember to schedule regular checkups here at the dental office. An oral cancer screening takes just a few minutes, but it could save your life.

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