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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.

Cleaning With Ultrasonic Scaler.After a thorough, professional tooth cleaning, you know that your teeth look brighter and feel fresher. But tooth cleaning isn't just about appearances. It's the primary means of preventing and treating periodontal (gum) disease. Many studies have demonstrated a possible link between periodontal health and overall (systemic) health — which means regular tooth cleaning may benefit not just your mouth, but your whole body.

Why do teeth need special cleaning? Over time, dental plaque (a naturally occurring bacterial biofilm) and stains build up on tooth surfaces. Dental calculus (also called tartar), a harder deposit, can then form both above and below the gum line. A thorough dental cleaning removes these substances from the teeth, and helps keep disease-causing bacteria from proliferating.

Tooth cleaning is usually accomplished by the non-surgical technique of scaling, sometimes called “root debridement.” It's typically a relatively painless procedure in which small dental instruments are used to physically remove deposits from the surfaces of teeth. At one time, scaling was performed entirely with manual tools. But in the last several decades, the ultrasonic scaler has changed all that.

What Is An Ultrasonic Scaler?

Ultrasonic Scaler.There are different types of ultrasonic scalers, but all of them work in a similar fashion: electromagnetic forces in the unit's hand-held “wand” cause its tiny tip to vibrate rapidly. These vibrations, which occur at a rate faster than the speed of sound, effectively blast away plaque, calculus and stains from the tooth surfaces.

A small stream of water and/or antibacterial mouthwash, which emerges near the tip of the scaler, is called lavage. Lavage is used to cool the ultrasonic scaler's tip and flush away debris from the area being treated. The vibrating tip causes some of the water to break into millions of tiny bubbles, an effect called cavitation. This ruptures the walls of bacterial cells and helps create an environment that's less hospitable to harmful bacteria.

Ultrasonic Scaling vs. Hand Scaling

Studies show that a thorough ultrasonic cleaning takes about one-third less time as compared to hand scaling — which means you need less time in the chair. Many patients prefer ultrasonics to other types of scaling, possibly because it requires the clinician to use less force than a hand scaler to get the same effect. In ultrasonic scaling, only the tip of the tool touches the tooth surface, and only for a short time.

It's also possible to remove deposits of plaque and tartar from under the gum line by using an extremely small tip on an ultrasonic unit, which can cause less discomfort and result in a deeper and better cleaning. Sometimes an ultrasonic scaler is used first, and then any stubborn areas are scaled by hand.

The Experience of Ultrasonic Scaling

Anyone who has a substantial buildup of tartar or is prone to gum disease can benefit from ultrasonic scaling. It can also help to remove stains from coffee and cigarettes, for example. Yet, for all its power, most people experience little or no discomfort during the procedure.

If you have very sensitive teeth, it may be possible to alleviate some discomfort by using slimmer tips on the scaler. Alternatively, a topical anesthetic may be applied, or conscious sedation can be administered. The power range, the flow of lavage water and the frequency of tip vibration may also be adjusted for increased comfort.

Special tips are also available to clean composite or porcelain tooth restorations, titanium implants, or areas of demineralization (enamel loss) on your teeth. If you have a cardiac pacemaker, be sure to alert all dental professionals/personnel before ultrasonic scaling treatment, so precautions can be taken.

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Ultrasonic Scalers - Dear Doctor Magazine

Dental Cleanings Using Ultrasonic Scalers Rapidly changing technology has revolutionized periodontal therapy with the integration of power scaling techniques resulting in improved clinical outcomes, patient comfort, and reduced time and physical demands on clinicians... Read Article