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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.

You probably know that it's never too late to begin orthodontic treatment — but when it comes to your youngster's teeth, did you know that earlier may be better than later? According to the American Association of Orthodontists, kids should have an initial orthodontic screening at age 7. What makes early evaluation — and potentially, early treatment — so important?

Orthodontic Problems.

There are several ways that kids can benefit from an orthodontic evaluation at an early age. But it's important to recognize that early evaluation isn't necessarily followed by early treatment; in most cases, if orthodontic work is needed, your child's growth patterns are simply monitored until it's time for treatment to begin. This creates an opportunity to get the best results in the most efficient way, and to help prevent future problems.

Although every child's development is different, in most kids the first adult molars have typically started to emerge by around age six. At this point it is possible to evaluate the basic alignment of the teeth, from front to back and side to side. It may also be possible at this point to determine whether there is adequate room in the mouth for all of the permanent teeth — and, if not, to take action.

When Earlier Treatment Is Better

Treatment for common orthodontic problems typically begins around age 9-14, when all of the baby teeth are gone and many of the permanent ones are in place. But there are some conditions that are much easier to treat if they're caught at an early age, when a child's natural growth processes are going full speed ahead.

Crossbite.One is severe crossbite, a condition where the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it's especially effective when the jaw itself hasn't fully developed. If one waits too long, a more complicated treatment — or even oral surgery — might be required to correct the problem.

 

Crowding.Another condition that may benefit from early treatment is severe crowding. This occurs when the jaws are too small to accommodate all of the permanent teeth. Either palatal expansion or tooth extraction may be recommended at this point, to help the adult teeth erupt (emerge from below the gums) properly. Even if braces are required later, the treatment time will likely be shorter and less complicated.

 

Protruding teeth.Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child's self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances, including braces and headgear, can be successfully used to correct these problems at this stage, when the child's development is in full swing, thereby increasing the chances that surgery can be avoided.

Correcting Bad Habits

Dangers of Thumb Sucking.

At one time or another, anyone may pick up a bad habit. But there are some situations where a youngster's parafunctional (detrimental to health) habits can actually influence the development and function of his or her teeth, jaws and mouth. Some examples of these are persistent thumb sucking, tongue thrusting and mouth breathing.

The sucking reflex is natural in early childhood; it usually disappears between ages 2 and 4. But if it persists much later, the pressure of the digit on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaws to change shape. This can lead to the orthodontic problem called “open bite,” and may impair speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth (tongue thrusting).

Mouth breathing — an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs — is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that's hard to break.

Various orthodontic treatments are available to help correct these parafunctional habits — and the sooner they're taken care of, the less damage they may cause. But these potential problems aren't always easy to recognize. That's one more reason why you should schedule an early orthodontic screening for your child.

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