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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 wear.Teeth grinding and clenching are common habits, but that doesn't mean they are harmless. Stresses from the powerful forces generated by grinding and clenching (also known as “bruxing”) can wear down teeth or even loosen them. Teeth that have enamel worn away or scraped off from this repeated rubbing action may become sensitive to hot or cold. And dental work such as crowns and fillings may get damaged. Bruxism can also lead to jaw pain and/or headaches.

Even if you have experienced some of these signs and symptoms, you may not realize you are a bruxer — particularly if your habit is nocturnal, as is often the case. Yet the evidence of tooth damage may become obvious during your regular checkup and cleaning. Dentists can also help you break the habit, relieve any pain you are experiencing, and repair any damage to your teeth or dental work.

Why do we grind or clench our teeth?

The most common reason for grinding/clenching habits is stress, which can affect our health in various ways. Some people experience stomach pain or skin breakouts; bruxing is yet another manifestation. Sometimes people grind their teeth because of misaligned teeth or other bite problems. Using stimulating substances such as caffeine, alcohol, tobacco and illegal drugs can also put you at risk. Additionally, teeth grinding is believed to be an uncommon side effect of certain medications.

What can be done?

Sometimes simply becoming aware of the habit can help you to get it under control. If stress is the issue, try to find healthy ways of managing it: exercise, meditation, listening to relaxing music, or a warm bath may help. Your teeth will be monitored over time at the dental office to make sure the problem is not worsening.

Custom nightguard.If damage to your teeth or existing dental work is evident, we may recommend a custom-made nightguard, also known as an “occlusal guard,” may be recommended. It resembles an athletic mouthguard. Made of comfortable plastic, the guard is worn at night to keep your teeth from actually contacting each other. It also helps protect your jaw joints from excessive force.

If a bite problem exists where some teeth are hitting before the others (all of your teeth should hit at the same time), it can sometimes be treated by removing a tiny bit of enamel from an individual tooth that is sticking up a bit (and therefore receiving too much force) to bring it in line with the others. This is known as a bite adjustment. If your malocclusion (bad bite) is more serious, orthodontics might be recommended. Replacing any teeth that are missing can also help stabilize your bite by inhibiting the shifting of teeth that occurs when extra space is left open by missing teeth.

A word about kids: Teeth grinding is very common in children, especially when they are shedding their baby teeth. Since they often outgrow it, treatment is not usually recommended.

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