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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.

Cerec Same Day Crowns.A tooth that has been structurally damaged by decay or trauma sometimes needs to be crowned or “capped” so that it can look good and function properly again. A crown is a durable covering that is custom-made to fit over the entire tooth from the gum line up. Crown fabrication traditionally takes place in a dental laboratory. But these days, there's a much more convenient alternative: same-day crowns made in the dental office.

Advanced dental technology known as Computer-Aided Design/Computer-Aided Manufacturing, or CAD/CAM, makes it possible to fabricate laboratory-grade crowns and other dental restorations in minutes. It's an amazing innovation when you consider that traditionally, crowns take two or three visits and just as many weeks of waiting. Now you can have a restored tooth without the wait.

Best of all, studies have shown that CAD/CAM tooth restorations are just as successful as crowns made with traditional materials and techniques. And the amazingly lifelike appearance of a same-day crown means that no one will know your tooth has been restored.

How It Works

Scanning Wand.

The process of crowning a tooth starts out the same way, whether it's a same-day crown or traditional crown: with “preparation” of the tooth. This involves removing any decay that's present, and shaping the tooth with a dental drill so that it will fit perfectly inside the crown. But the similarities end there.

If you were getting a traditional crown, the next step would be to take an impression (mold) of your teeth with a putty-like material, and use it to construct a model on which to create the crown. With a same-day crown, your teeth are simply given a light dusting of reflective powder and then a small scanning wand attached to a computer is used to take digital pictures inside your mouth. In seconds, the computer will generate a highly accurate 3D model of your teeth. But it gets even better.

Milling Machine.

Dental Crowns.With the help of the CAD/CAM software, your crown will be designed while you wait. The software can even be used to create a mirror-image twin of the same tooth on the other side of your mouth, for the most natural-looking result possible. Then a block of dental ceramic material is chosen in the shade that most closely matches your own teeth. The computer's digital design is transmitted to a milling machine that carves the crown from the ceramic block in about five minutes.

Once the crown's fit has been verified, and any necessary aesthetic enhancements have been made to the crown's surface (staining and glazing, for example), the crown will be bonded to your tooth. With a traditional crown, you would have to wear a temporary restoration for several weeks while the permanent crown was being fabricated at the lab. With a same-day crown, you walk out with the real thing.

Caring for Your Same-Day Crown

Crowned teeth require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the build-up of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of professional cleanings at the dental office. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment. A well-cared-for same-day crown will last for years to come.

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