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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.

Brushing with braces.

You know how important it is to brush and floss properly when you're wearing braces — but what's the best way to do that? Let's start with the basic brushing tools: Either a soft-bristle brush or a bi-level brush (one that has shorter bristles in the middle and longer bristles at the edges) can be effective. Used carefully, an electric toothbrush can work just as well. But be sure the electric brush is set to a moderate power level, and don't let its vibrations cause the back of the brush to hit the braces!

You should brush with a fluoride toothpaste at least two times per day (preferably after meals), for at least two minutes each time. Remember to brush all of the tooth surfaces: the outside, the inside, and the chewing surfaces as well. Be especially careful to clean the areas between wires and teeth, and between brackets and gums — that's where food particles can easily become trapped.

Here's a suggested brushing technique: Beginning at the outside surfaces, place the tips of the bristles flat against your teeth, and use small circular motions to gently polish them clean. For areas between braces and gums, tilt the brush toward the gum line (down for the bottom teeth, up for the top) while keeping up the circular motions. Next, move on to the chewing surfaces of upper and lower teeth, using a firm back-and-forth motion. Finally, finish up by carefully brushing the inside surfaces of the teeth the same way you did the outside surfaces.

Special Brushing Tools

Interdental toothbrush.

If you're having trouble cleaning the areas near brackets and wires, there are some special tools that may help. One is the interdental toothbrush, or proxabrush. It has a small tuft of bristles that stick up all around, like a pipe cleaner. Use it gently and carefully to clean the tiny spaces under wires and around bands and brackets.

Another special cleaning tool is the oral irrigator or “water pick.” This device shoots a small stream of pressurized water at your teeth, which can help dislodge bits of food that become trapped in nooks and crannies. While it's easy to use, an oral irrigator isn't a substitute for a toothbrush or dental floss — but when used along with proper brushing and flossing techniques, it can be very effective.

Floss Fundamentals

Floss threader.

To keep your teeth and gums clean and healthy, you need to floss at least once per day. But how do you get floss under the archwire of your braces? It's not so hard with the help of a floss threader. Using this device is somewhat like threading a needle: You pull one end of floss through the threader, and then push the threader — carrying with it the free end of the floss — under the archwire. Now grasp the floss on each end and slide it up and down the sides of both teeth, and all the way under the gums until you hear a squeaky sound. Finally, pull it out and use a new section of floss for the next area.

Full Disclosure

Ever wonder how effective your tooth-cleaning techniques really are? There's an accurate way to tell, using special vegetable dyes called “disclosing solutions” or “disclosing tablets.” As they dissolve in the mouth, these dyes highlight plaque and food debris that brushing has missed. You can then easily remove the dyed spots — and you'll know for sure if your oral hygiene methods need a little “brushing up.”

Keeping your teeth and gums healthy now is an investment in your future. It enables you to get the best results from your orthodontic treatment, and starts you toward a brighter smile that can last for a lifetime.

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