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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.

Dental exam.When you come into the dental office for an examination, you might assume that the focus is on your teeth. That's often correct — but don't forget that there are a number of other parts of the oral and facial anatomy that are examined as well. These include areas around and inside the mouth (such as the lips, gums, hard and soft palate, and the tongue) as well as outside the mouth (the skin, muscles and glands in the neck, and the temporomandibular joint). In fact, when it comes to detecting certain oral or systemic (whole-body) diseases, a thorough dental exam may be your first line of defense.

How are diseases in the mouth discovered? Most of the time, it's simple: You will be asked about any changes you have noticed, or symptoms you may be experiencing. Your face, mouth, and neck will then be visually inspected, and certain areas may be palpated (gently touched or pressed with fingers) or probed (touched with a small instrument). If needed, additional tests or diagnostic imaging (X-rays or other methods) may be used to aid in diagnosis.

Occasionally, an abnormality such as a lesion (an unusual localized change in your tissues) is found that needs to be examined further. Lesions may resemble white or red spots or lumps (tumors), but they are typically benign. However, it is often better to err on the side of caution and perform a biopsy to be sure. This may involve making a small incision and removing a part of the suspicious area. The tissue sample will be sent to a pathologist, who examines it under a microscope for signs of disease.

Some Oral Diseases To Look For

Oral diagnosis and biopsies.Oral cancer is perhaps the most significant disease to look for in an examination — both because it can be life-threatening, and because early detection is proven to increase the survival rate. But it's important to remember that a large majority of unusual growths are found to be benign. Some other oral diseases that may be screened for include:

  • Fibroma, a thickened mass that may feel like a lump in the lining of the mouth.
  • Leukoplakia, a condition that causes white patches to form inside the mouth. While usually benign, the lesions may be precancerous and are often biopsied.
  • Lichen Planus, an inflammatory disease that sometimes causes discomfort.
  • Mucous Membrane Pemphigoid, an autoimmune disease that may cause oral lesions, but is not life threatening.
  • “Pregnancy Tumors,” benign red swellings that may form on gum tissue of pregnant women due to hormonal changes.

In addition, some systemic diseases (such as diabetes, Crohn's disease, and heart disease) may produce effects that can be observed in the mouth. We are always on the lookout for signs of these potentially serious conditions.

When a Biopsy Is Needed

Although the majority of oral lesions are benign, if there is any possibility that the growth could be cancerous or pre-cancerous, it's likely that a biopsy will be performed. Depending on how much tissue needs to be removed, this may be a simple in-office procedure, or it may be done in a hospital setting. Typically, the procedure requires only local anesthesia, and it doesn't take long. If incisions are made, they are often closed with self-dissolving sutures (stitches) that don't need to be removed.

Because the oral tissues are rich in blood vessels, some bleeding is normal for a period of time afterward. You will be given follow-up instructions as needed, including how to manage swelling and discomfort, when to take medication, and what to eat and drink. Getting some rest and maintaining good oral hygiene will also help you get back to normal as quickly as possible. When the pathology report is complete (usually in a few days), you will be given the results.

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