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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.

If you're like most people, you probably learned how to brush as a child… and chances are, you haven't thought about it much since then. That's understandable — but there may come a point when we find our oral hygiene techniques could use improvement. Here are a few tips on the proper way to brush your teeth… plus, a reminder of why we do it.

First, the reasons why: Brushing is an effective way to remove plaque — a sticky, bacteria-laden biofilm that clings stubbornly to your teeth. The bacteria in plaque produce acids, which erode the tooth's enamel and may lead to tooth decay. Plaque can also cause gum disease and bad breath. In fact, it's believed that over 90% of dental disease is caused by plaque accumulation alone.

Besides removing plaque, the fluoride in toothpaste strengthens tooth enamel and makes teeth more decay-resistant. Plus, brushing makes your mouth feel cleaner and your breath smell fresher. While there is no single “right” way to brush your teeth, there are a number of techniques that can help you get them squeaky-clean. So why wait — let's take a refresher course in brushing right now!

How to brush your teeth.

Proper Brushing Technique

  • To begin, select a small-headed, soft-bristled toothbrush, grasp it gently with your fingers (not your fist), and squeeze on a pea-sized dab of fluoride toothpaste.
  • Hold the bristles gently against the outside of your top teeth, near the gum line, at about a 45-degree angle upward.
  • Sweep the brush gently back and forth over teeth and gums in soft strokes — or, if you prefer, use an elliptical (circular) motion to clean the teeth.
  • Be sure to clean the spaces between teeth: You can use a sweeping motion to brush food particles away from the gums.
  • When you have done one brush-width, move to the adjacent area of your teeth and repeat. Keep going until you have finished cleaning the outside of the whole top row of teeth.
  • Move to the bottom teeth. Repeat the procedure, tilting the brush down toward the gum line at about 45 degrees. Finish cleaning the outside of the bottom teeth.
  • Go on to the inside of the top teeth. Tilting the bristles up toward the gums, clean the inside of the top teeth with gentle but thorough strokes.
  • Move to the inside of the bottom teeth. Tilt the brush down and repeat the procedure.
  • Now it's time for the chewing surfaces: Holding the bristles flat against the molars, clean the ridges and valleys of the back teeth. Do this for all the top and bottom teeth.
  • Finally, brush your tongue gently to remove bacteria and freshen breath.

Check Your Work

Tongue test.How good a brushing job did you do? One way to get an idea is by simply running your tongue over your teeth: If they feel slick and smooth, then chances are they're clean. If not, you should try again. To know for sure whether you're brushing effectively, you can use a “disclosing solution” — a special dye that highlights plaque and debris your brushing missed.

One common error is not brushing for long enough: two minutes is about the minimum time you need to do a thorough job. If you have music in the bathroom, you could try brushing along with a pop song; when the song's over, you're done! But no matter your musical taste, good brushing technique can go a long way toward maintaining tip-top oral hygiene.

Variations for Comfort

If you're having trouble with the two-finger method, here's another way to try flossing: Just tie the same amount of floss into a big loop, place all your fingers (but not thumbs) inside the loop, and work it around your teeth with index fingers and thumbs. All the other steps remain the same.

Once you've got the basics down, there are a few different types of flosses you can try, including flavored, waxed, and wider width. Some people find waxed floss slides more easily into tighter gaps between teeth or restorations — but it may not make that satisfying “squeak” as it's cleaning. Others prefer wide floss for cleaning around bridgework. But whichever way works best for you, the important thing is to keep it up!

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