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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.

For the vast majority of orthodontic patients, wearing fixed appliances (commonly called braces) will be a major part of treatment — and those braces, for the most part, will be the familiar silvery-metal type. But while they're still quite popular, traditional-looking metal braces are no longer the only game in town! Let's have a look at some of the options available in orthodontic appliances.

First, we should distinguish between fixed and removable appliances. Fixed appliances like braces are attached to the teeth by metal bands or special cement. They aren't normally taken off until treatment is complete. Removable appliances, such as clear aligners, are typically worn some 22 hours per day, but may be easily taken off as needed. While clear aligners can be effective in treating mild to moderate orthodontic problems, fixed appliances are generally needed for more comprehensive treatment.

Metal Braces

Traditional Metal Braces.Typically made of high-grade stainless steel, traditional metal braces remain by far the most common type of fixed orthodontic appliances. They consist of metal bands that wrap around the molars in back, and smaller metal brackets that are cemented to the front surfaces of the other teeth. A thin, springy metal wire, running through the brackets, gently guides the teeth into a proper position. This archwire may be fixed to the brackets by flexible elastics, metal ties, or other types of clasps.

There are many good reasons why time-tested metal braces remain popular — because they offer a reliable, effective and economical treatment option. In contrast to the appliances of the past, today's braces are actually smaller, lighter, and more comfortable to wear. If you want a less traditional look, you may be able to choose colorful elastics for the brackets, or other modifications.

 

Ceramic braces

Ceramic Braces.Clear ceramic braces are a new variation on the traditional system that provides a far less noticeable method of treatment. They use the same components as traditional braces — except that the brackets on the front side of the teeth are made of a translucent ceramic material that blends in with the tooth's natural color. This system has become a favorite for adults (including some well-known celebrities) because, unless you look closely, it's hard to notice they're there.

Several types of ceramic braces are currently available, and the technology is constantly improving. Their aesthetic appeal is undeniable... but there are a few tradeoffs. The ceramic brackets can be less durable than their metal counterparts; plus, while the brackets themselves don't stain, the elastic bands that attach them to the archwire do (however, these are generally changed each month.) Ceramic braces also cost more than metal — but for many people, the benefit of having an inconspicuous appliance outweighs the costs.

 

Lingual Braces

Lingual Braces.While ceramic braces certainly offer a less conspicuous look, there is still another system that allows fixed braces to be truly invisible. In some situations, special appliances called lingual braces can be placed on the tongue side of the teeth. They work the same way other metal braces do — but even though they're made of metal, they can't be seen, because they're hidden behind the teeth themselves!

Lingual braces aren't the proper treatment for every orthodontic condition. Special training is required to install them, and they're significantly more expensive than standard braces. They also generally require a bit more time for the wearer to get used to them, and they may slightly prolong treatment. But if you want the least visible type of fixed appliance — and if you're a candidate for this treatment option — then lingual braces may be just what you're looking for.

 

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