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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.

Interdental cleaning.Almost everyone understands the importance of regular brushing and flossing to their oral health. You've heard it many times before, at office visits and checkups: Proper oral hygiene is your first line of defense against tooth decay and gum disease. Yet, while most of us brush regularly, many people don't floss as often as they should… or at all!

Why not? Sometimes, it's because we don't have the manual dexterity to handle the floss, or because braces or partial dentures get in the way; or, perhaps we just never got in the habit. Yet proper cleaning of the interdental areas (the small spaces between teeth) is crucial — and here's why:

Consistent brushing with fluoride toothpaste has been proven effective at removing dental plaque from the tooth's surfaces and making them more resistant to decay. But regular toothbrushes simply can't get into the small gaps between teeth, or the tiny crevices where teeth meet gums. Unfortunately for our oral health, that's exactly where tooth decay and gum disease starts — and that's where the tools called “interdental cleaners” can help.

There are several different types of interdental cleaners available, including special brushes and irrigation devices (commonly called “water picks”). None of them, by themselves, are a substitute for brushing and flossing. However, as part of a regular program of oral hygiene, they can be effective at fighting plaque and reducing the incidence of tooth decay and gum disease.

The Interdental Brush

Interdental brush.This specially designed toothbrush (sometimes called an interproximal brush or proxabrush) can be successfully utilized to clean the small gaps between teeth, as well as the gums and the areas around braces, wires, or other dental appliances. Because it has a handle not unlike a standard toothbrush, many people with limited dexterity find it easy to use. Plus, numerous clinical studies have demonstrated its effectiveness at reducing plaque and controlling gingivitis (gum inflammation).

The cleaning surface of an interdental brush is similar in shape to a small, conical pipe cleaner. Its short bristles radiate from a thin central wire, which is small enough to pass through a very tight space. The brushes are available with both coated and uncoated wire, and come in different widths to accommodate an individual's particular dental anatomy. When needed, they can also be used to apply antibacterial or desensitizing agents to certain areas of the teeth or gums.

Oral Irrigation Devices

Available to consumers for over 50 years, these devices (sometimes known as water jets or water picks) can also play a role in interdental hygiene. While their popularity has gone up and down over the decades, many studies have shown that they provide a safe and effective method of diluting the acids produced by plaque. Irrigation devices typically use pulsed or steady jets of pressurized water to remove food particles from the hard-to-clean interdental spaces, as well as in some subgingival (below the gum line) pockets.

Proper brushing and flossing is still generally considered the gold standard of at-home oral hygiene. But if you have trouble flossing regularly — or if you're at increased risk for developing dental or periodontal disease — then using these interdental cleaners might be right for you.

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