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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.

Flossing  teeth.You always brush twice a day, avoid sugary snacks between meals, and go to the dentist regularly. Do you still have to floss your teeth?

The short answer: Yes, at least once a day. Flossing is probably your single most important weapon against plaque, the clingy bacterial biofilm that sticks to the surfaces of your teeth. Plaque is the principal cause of tooth decay; but it is also the cause of periodontitis (gum disease), bad breath, and other maladies. Brushing is a good start — but flossing removes plaque in places a brush can't reach, like the small gaps between teeth and under the gums. It also polishes tooth surfaces and decreases the risk of gum disease.

Some people may think they don't have time to floss, but once you get the hang of it, flossing only takes few minutes. If you are going to floss only once a day, it's best to do it at night just before going to sleep. That's because there is less saliva present in your mouth when you are sleeping, so plaque is more concentrated and potentially more harmful. Just in case you never really learned proper flossing techniques, here's a step by step approach including some easy tips for doing a great job.

Proper Flossing Technique

  • Cut off a piece of floss about 18 inches long. Wind it around the middle finger of both hands leaving a gap of around three or four inches. You will now be able to use different combinations of your thumbs and index fingers to correctly position the floss between your teeth for all areas of your mouth.

    TIP: The most common mistake people make while flossing is that they tighten their lips and cheeks making it impossible to get their fingers into the mouth. Relax your lips and cheeks.

  • Now, guide the floss gently into the space between your teeth.

    TIP: Even if the gap is tight, try not to snap the floss into your gums as you're inserting it. A side-to-side sawing motion is good to use here, but only when slipping the floss gently between the teeth.

  • How to floss your teeth.There are two sides to each space between your teeth and you must floss each side separately so as not to injure the triangle of gum tissue between your teeth. Run the floss up and down the surface of the tooth, making sure you are going down to the gum line and then up to the highest contact point between the teeth. Apply pressure with your fingers away from the gum triangle, letting it curve around the side of the tooth forming the letter “C” with the floss.

    TIP: You want your fingers as close to the front and back of the tooth as possible so both fingers move in harmony up and down until you hear a squeaky clean sound. This is easier with unwaxed floss. The smaller the amount of floss between your fingers, the more control you have flossing.

  • Next, move your fingers to the top contact area between the teeth and slide across to the other side of the space. Apply pressure with your fingers in the opposite direction and repeat.
  • Slide the floss out from between the teeth. If it's frayed or brownish, that's good: you're removing plaque! Unwind a little new floss from the “dispenser” finger, and take up the used floss on the other finger.
  • Repeat the process on the next space between teeth. Work all around the mouth — and don't forget back sides of the last molars.

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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