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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.

Healthy vs unhealthy.

You already know that maintaining good oral hygiene is important for everyone — but when you're having orthodontic treatment, it's even more critical. Why? Because, while the appliances (such as braces or clear aligners) you may need to wear during treatment are very effective in correcting misaligned teeth, they can also trap food particles easily. Keeping your teeth (and your appliances) clean is a little harder — but you can do it! Here's a look at why good oral hygiene is so important during orthodontic treatment, and some tips on how you can keep it up.

The major enemy of oral health is plaque. Food that becomes trapped near tooth surfaces can lead to the formation of plaque — a thin coating of microorganisms and organic debris (biofilm) containing potentially harmful bacteria. Braces or other appliances make it harder to remove plaque. The bacteria in plaque digest the sugars in food, producing acids which may erode teeth and irritate gums. This can cause cavities, white spots on teeth, gum disease and bad breath.

Keeping plaque under control is one of the most effective means of maintaining strong, healthy teeth and gums. There are three general ways to do it: through diet, daily maintenance, and regular professional care. Taken all together, they're your teeth's best defense.

Diet and Decay

Controlling your diet involves avoiding foods that could increase your risk of developing tooth decay. That means cutting down or eliminating foods with an excess of sugar, like soda, sweets, and ice cream. It also means avoiding foods that could easily become stuck in your braces, like toffee, gum, licorice and caramels.

Foods that are very hard or extremely sticky can also cause physical damage to orthodontic appliances. Certainly braces or retainers with broken wires or loose brackets aren't working to straighten your teeth! You should avoid foods like hard candies or nuts, beef jerky and hard pizza crust. Keep eating healthy foods like carrots and apples — but cut them into bite-sized pieces first! And don't chew on ice, pencils, or your nails: these habits can cause damage to your appliances, and even result in chipped teeth!

Daily Maintenance

You know how important brushing and flossing are for keeping a healthy smile — especially now that you're in orthodontic treatment. But sometimes it's harder to clean your teeth effectively around an appliance's brackets and wires. Here are some tools and tips you can try for better tooth cleaning.

Either a soft-bristle or a bi-level toothbrush (one with longer bristles on the edges and shorter ones in the middle) can be effective in plaque removal — even with braces. An electric toothbrush can also be used, on a moderate setting. For hard-to-clean areas, try an interdental brush, or proxabrush. The small bristles of this special tooth-cleaning aid, which is shaped like a pipe cleaner, can get in between wires, brackets and teeth. With gentle and persistent effort, it's possible to reach into the smallest nooks and crannies, and control plaque buildup.

You should floss at least once a day during orthodontic treatment. While it's a little harder to do with braces, there are some special products available — including floss threaders and particular kinds of floss — that can help you get the floss between wires and gum line. The office staff will review proper brushing and flossing techniques with you when your braces are put on — but if you ever have questions, don't hesitate to ask!

Depending on your situation, an in-office or at-home supplemental fluoride treatment may be recommended to boost your cavity resistance. An antiseptic rinse may also be recommended, to ease minor gum inflammation or irritation.

If you have a retainer, it should be brushed daily, the same way you brush your teeth. A cleaning solution may be recommended — but never put hot water on your retainer, because it can distort the soft plastic and make it unusable! And always keep it in a case when it's not in your mouth.

Professional Care

During orthodontic treatment, it's as important as ever to make sure your teeth stay healthy with thorough examinations, cleanings and preventive care. Your orthodontic treatment is a team effort where everyone has an important role to play. And the team has just one goal: giving you a winning smile.

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