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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.

Bone grafting for dental implants.

Replacement teeth supported by dental implants function so well and last so long because, like natural teeth, they are securely anchored in the jawbone for maximum support. In order to benefit from this remarkable technology, however, you need to have enough tooth-supporting bone in your jaw to hold a dental implant in place. Unfortunately, after tooth loss, the surrounding bone almost always deteriorates — decreasing in width, height and density — and this process starts immediately. The longer a tooth has been missing, the more the bone that used to surround it resorbs (melts away). If you want a dental implant but don't have enough bone to support it, can anything be done? Yes. Very often you can still get the replacement tooth you want, thanks to routine bone grafting procedures.

How It Works

Bone grafting, normally a minor surgical procedure done in the dental office, is used to build up new bone in the area of your jaw that used to hold teeth. A small incision is made in your gum to expose the bone beneath it, and then grafting material is added. Most often, the grafting material is processed bone that serves as a scaffold, around which your body will actually deposit new bone cells. The grafting material will eventually be absorbed by your body and replaced by your own new bone.

The grafting material needed can come from a variety of sources. Sometimes it comes from your own body. Very often, however, it is bone from an animal or human donor that is processed by a laboratory to make it sterile and safe. Grafting material can even be synthetic. It comes in a variety of forms: powder, granules, putty or even a gel that can be injected through a syringe.

Types of Bone Grafts

There are a variety of sources of bone grafting material used for preserving or augmenting bone for dental implants. All of these bone grafting materials are backed by significant research. They are processed (except autografts, which do not need processing) so that they are safe to use, eliminating the potential for rejection or disease transmission.

  • Autograft: If you are already familiar with the concept of bone grafting, an autograft is probably what you're thinking of: taking bone from one site in your body and moving it to another. This is the only type of bone graft that involves creating two surgical sites: the one from which the bone is harvested and the one where it is deposited.
  • Allograft: This refers to laboratory-processed human bone from a deceased donor that comes from a tissue bank.
  • Xenograft: This bone grafting material comes from an animal — usually a cow.
  • Alloplast: This type of graft uses synthetic (man-made) materials.

What to Expect

The procedure for placing a bone graft usually requires only local anesthesia, though oral or IV sedatives can also be used to achieve a higher state of relaxation. Because a small incision in your gum tissue needs to be made to access the underlying bone that will receive the graft, you may experience some soreness in the area after the surgery; this can usually be managed by over-the-counter anti-inflammatory medication and/or pain relievers as well as ice therapy after the procedure. Though you will soon feel completely back to normal, it may take your body up to seven months for bone maturation to take place to receive your dental implant. The waiting time allows us to be sure the healing process has had enough time to achieve the desired result: ideal support for replacement teeth that look great and will last a lifetime.

Learn more by reading frequently asked questions about bone grafting.

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Bone Grafting - Dear Doctor Magazine

Can Dentists Rebuild Bone? Yes they can! It is very important to maintain bone volume following removal of a tooth so that dental implants remain a viable option for tooth replacement. This is easily accomplished with today's routine bone-grafting techniques... Read Article