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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.

Retained baby tooth needing extraction.The main goal of dentistry is to preserve your natural teeth and keep them healthy for as long as possible. There are times, however, when it is in your best interest (or your child's) to have a tooth extracted (removed). This could be the case for a variety of reasons. Perhaps you have a tooth that has been severely damaged by trauma or decay; or an impacted wisdom tooth that may cause trouble for you later on. Maybe your teenager will soon undergo orthodontic treatment and has insignificant space for his adult teeth, referred to as crowding. Or your younger child has a baby tooth that's stubbornly adhering, even though it's past time for it to go.

Whatever the reason, tooth extraction is more often than not a very routine procedure. How straightforward this minor surgery is will depend on where the tooth to be extracted is located in the mouth, and what its roots are like. For example, a front tooth with a single straight root is easier to remove than a molar with multiple roots. This is especially true when that molar is a wisdom tooth that is impacted, meaning it is below the surface surrounded by gum tissue and bone. Often, a wisdom tooth is blocked from fully erupting (growing in) by other teeth in its path.

Still, tooth extraction is nothing to be feared when done by an experienced hand. Keep in mind that a tooth is not rigidly fixed in its surrounding bone, though that's how some may picture it. In fact, it is attached to the bone via a network of fibers that form what's known as the periodontal ligament. By carefully manipulating the tooth, these fibers can be detached and the tooth freed without much trouble.

Reasons for Extracting a Tooth

As mentioned above, there can be a variety of reasons for extracting a tooth. Be sure to ask questions about the pros and cons of any dental treatment, including extraction.

  • Cracked tooth.Trauma or Disease — In both of these situations, there are several ways to try and save the tooth. The damaged tooth might need a full-coverage crown, a root canal treatment, or both. But sometimes even these methods are not enough to keep the tooth functioning well and looking good; it might be better to remove the tooth and replace it with a strong and lifelike dental implant.
  • Orthodontic Treatment — Teeth are sometimes extracted when there are too many of them for the size of the dental arches (jaws), a situation known as crowding. After an adequate amount of space is opened up through the extraction of one or more teeth, the remaining teeth can be aligned properly. The teeth most frequently removed for orthodontic reasons are the first premolars, which are right next to the eyeteeth (canines).
  • Impacted wisdom tooth.Impacted Wisdom Teeth — Early removal of impacted wisdom teeth can prevent damage to neighboring healthy teeth, bone, gum tissue, even nerves and blood vessels. If an impacted wisdom tooth is in a bad position, it's best to remove it before its roots are fully formed.
  • Baby Teeth — If a baby tooth is out of position or not lost in the right sequence, the permanent tooth underneath it might not erupt normally. In this case, removing the baby tooth could prevent a need for orthodontic treatment later on.

The Process of Extracting a Tooth

The first step in any extraction is a radiographic (x-ray) examination to assess the position of the tooth roots and the condition of the surrounding bone. This will allow any possible complications to be anticipated. A thorough medical and drug history is taken, to ensure that you are healthy enough to undergo the procedure, and your options for anesthesia will be discussed.

Tooth extraction is usually carried out with local anesthesia, which will numb the teeth to be removed, and the surrounding bone and gum tissues. Additional sedatives might also be used, including oral sedatives (taken in pill form), nitrous oxide (which is inhaled) and/or conscious sedation, which is given intravenously (into a vein). The latter is usually required for more complicated (or multiple) tooth extractions. By the time the sedation medication has worn off, you won't even be aware that the surgery was done.

As your tooth is being removed, steps are taken to ensure the bone that surrounds it isn't damaged. Sometimes, in the process of removing a tooth, a small amount of lab-processed bone-grafting material is placed into the socket to help preserve the bone volume there. This is particularly important when the extraction is going to be followed at some point by the placement of a dental implant, which needs to fuse to existing bone, or orthodontics, which gently moves teeth through bone.

What to Expect After Tooth Extraction

Immediately after your tooth is extracted, the socket will be covered with sterile gauze; gentle pressure will be applied for 10-20 minutes to control any bleeding. Small sutures (stitches) might also be used for this purpose. It's normal to experience some mild to moderate post-operative discomfort and/or swelling. Taking non-steroidal, anti-inflammatory drugs such as ibuprofen and/or aspirin the day of surgery should control most symptoms. Antibiotics may also be prescribed to ensure infection-free healing. Using ice packs on the outside of your jaw, and eating softer foods until you feel more comfortable can also be helpful. Within a few days, all should be back to normal.

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