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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.

Impacted wisdom tooth.In most people, the third set of molars, generally called “wisdom teeth,” start coming in around age 17-25. However, the arrival of these teeth is often far from trouble-free. The extraction (removal) of one or more third molars is a relatively common procedure, performed on some 5 million patients every year. After a thorough examination and diagnostic tests such as x-rays or a CT scan, you may be told that you should have your wisdom teeth extracted. Here are some typical reasons why:

  • Your jaw may be too small to accommodate all your teeth, leading to excessive crowding and the chance of your wisdom teeth becoming impacted — that is, unable to emerge from the gums, and potentially harmful to adjacent bone or teeth
  • Your wisdom teeth may be erupting (coming in) in a crooked orientation, which can damage other teeth or anatomical structures in the jaw, and/or cause bite problems
  • If your wisdom tooth does not fully erupt (emerge from the gums), it can increase the chance for bacterial infection
  • A cyst (a closed, fluid-filled sac) may develop around the unerupted wisdom tooth, which can cause infection and injury to the adjacent bone or nerve tissue

Whether it is aimed at preventing future problems or needed to alleviate a condition you already have, the extraction of wisdom teeth can be an effective treatment. But, as with all medical procedures, its benefits must be weighed against the small risk of complications, and should be discussed in detail.

The Extraction Procedure

X-ray of an impacted wisdom tooth.Wisdom tooth extraction is usually an in-office procedure which may be performed by a dentist or an oral surgeon. It's quite possible to have the treatment done with only a local anesthetic (numbing shot) to keep you from experiencing any pain; however, if multiple teeth are being extracted at one time (as is often the case), a general anesthetic or conscious sedation may be administered. The type of anesthesia that's best for you will be determined before the procedure.

Once you have been appropriately anesthetized, the gum tissue at the extraction site may need to be opened if the tooth is impacted. The tooth itself will then be gently removed. When the extraction is complete, you may need to have the site sutured (stitched) to aid healing. After the procedure is over, you will rest for a short time before going home. Depending on what type of anesthesia you have had, you may need another person to drive.

After the Procedure

The recovery period after wisdom tooth extraction generally lasts only a few days. During this time, you should rest when possible to encourage healing, and take any pain medication as prescribed. It's normal to experience some bleeding at the extraction site; this can be controlled by gently biting on gauze pads, changing them as needed, and resting with the head elevated on pillows rather than flat.

Holding an ice pack on the outside of your cheek for a few minutes at a time (for example, 5 minutes on / 5 minutes off) may help reduce swelling on the first day after the procedure. Starting on day 2, the warm moist heat of a washcloth placed on the cheek may make you more comfortable. Rinsing the mouth with warm salt water a few times a day can also help relieve discomfort.

You may want to eat soft foods for a few days after the extraction; likewise, be careful when brushing or putting anything in your mouth until your healing is complete. Be sure to follow the postoperative instructions you are given, as each situation is a little different; this will help you to be as comfortable as possible.

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Wisdom Teeth - Dear Doctor Magazine

Wisdom Teeth – To Be Or Not To Be Wisdom teeth, which typically make their appearance between the ages of 17 and 25, can cause significant problems when there is not enough room for them to grow in properly. As a person ages, the effects of retained and impacted wisdom teeth can be more consequential. This article reviews the issues associated with wisdom teeth and whether or not they should be removed... Read Article