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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.

Toothbrush unable to clean grooves in teeth.The most likely location for a cavity to develop in your child's mouth is on the chewing surfaces of the back teeth. Run your tongue over this area in your mouth, and you will feel the reason why: These surfaces are not smooth, as other areas of your teeth are. Instead, they are filled with tiny grooves referred to as “pits and fissures,” which trap bacteria and food particles. The bristles on a toothbrush can't always reach all the way into these dark, moist little crevices. This creates the perfect conditions for tooth decay.

What's more, a child's newly erupted permanent teeth are not as resistant to decay as adult teeth are. The hard enamel coating that protects the teeth changes as it ages to become stronger. Fluoride, which is found in toothpaste and some drinking water — and in treatments provided at the dental office — can strengthen enamel, but, again, it's hard to get fluoride into those pits and fissures on a regular basis. Fortunately, there is a good solution to this problem: dental sealants.

Dental sealants are invisible plastic resin coatings that smooth out the chewing surfaces of the back teeth, making them resistant to decay. A sealed tooth is far less likely to develop a cavity, require more expensive dental treatment later on, or, most importantly, cause your child pain.

How Sealants Are Placed

Dental Sealants - Step by Step.

You can think of a sealant as a mini plastic filling, though please reassure your child that it doesn't “count” as having a cavity filled. Because tooth enamel does not contain any nerves, placing a sealant is painless and does not routinely require numbing shots. First, the tooth or teeth to be sealed are examined, and if any minimal decay is found, it will be gently removed. The tooth will then be cleaned and dried. Then a solution that will slightly roughen or “etch” the surface is applied, to make the sealing material adhere better. The tooth is then rinsed and dried again. The sealant is then painted on the tooth in liquid form and hardens in about a minute, sometimes with the help of a special curing light. That's all there is to it!

A note about BPA: A 2012 study that received wide press coverage raised concerns that trace amounts of the chemical bisphenol-A (BPA) found in some (but not all) dental resins might contribute to behavioral problems in children. The study authors noted that while they had found an association, they had not actually proven that BPA in dental sealants causes these problems. In fact, BPA is far more prevalent in food and beverage packaging than in dental restorative materials. The American Academy of Pediatric Dentistry and the American Dental Association have since reaffirmed their support for the use of sealants.

Taking Care of Sealants

Sealed teeth require the same conscientious dental hygiene as unsealed teeth. Your child should continue to brush and floss his or her teeth daily and have regular professional cleanings. Checking for wear and tear on the sealants is important, though they should last for up to 10 years. During this time, your child will benefit from a preventive treatment proven to reduce decay by more than 70 percent.

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