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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.

Dental implants vs bridgework.

If you're missing a tooth, you're in good company: Some 70% of the U.S. population is also missing at least one, usually a back tooth (molar). Adult teeth are often lost due to decay, gum disease, failed root canal therapy, or fracture — particularly if they have already been heavily restored with fillings or crowns. When it comes to replacing a lost tooth (or even two or three adjacent teeth) there are generally two treatment options available: the old standby, fixed bridgework; or the modern, high-tech solution, dental implants.

While either one can offer an aesthetically pleasing and functional replacement, there are some important differences between the two methods of treatment. To help you decide which one is right for you, let's take a closer look at each technology.

A Bit of Dental History

Although an early type of dental bridge was used by the Etruscans around 700 BC, the modern bridge (also called a fixed partial denture) first became available in the early 20th century. The part which replaces missing teeth, called a “pontic” (French for bridge), is fixed in place by attachment to adjacent, healthy teeth, called “abutments.” The pontic is made to resemble a row of natural teeth joined together; how many teeth it will consist of depends on how many are missing.

For example, if just one tooth is gone, a three-unit fixed bridge will be needed. This consists of a replacement for the missing tooth (the pontic), plus a crown for each of the two teeth adjacent to the gap. If more teeth are missing, more units would be required in the bridge. A seven-unit bridge might be needed for three missing teeth; this would consist of three replacement teeth, plus four crowned abutment teeth — two on each side of the gap — to handle the extra stresses.

Caution: Failing Bridge

The crowns fit over the tops of the abutment teeth, which must be prepared (re-shaped by the removal of tooth structure) to receive them — and therein lies a problem. In order to securely attach the crowns, the enamel (and some dentin) must be removed from the abutment teeth. This renders these otherwise healthy teeth more susceptible to decay; it may also necessitate root canal treatment. Additionally, if existing crowns are present, they will have to be removed and redone.

The potential problems don't end when a bridge is in place. Because of the way bridgework “sits” below the gums, there is an increased potential for gum disease in the area. Plus, because a bridge requires that two teeth do the work of three (or more), the forces at work in the mouth generally cause the system to fail over time. Ten years is considered a good lifespan for a well-cared-for bridge.

The Modern Standard: Dental Implants

Beginning in the late 1970s, dental implants became available in the United States. This remarkable system for tooth replacement relies on the osteophilic (bone-loving) properties of titanium, the metal from which the below-gum part of the implant tooth is made. Placed directly into the bone of the jaw, an implant fuses with the living bone tissue, making it sturdy and long-lasting. The lifelike crown on top makes it virtually indistinguishable from the natural teeth.

If you have one missing tooth, you need just one implant — healthy adjacent teeth aren't affected. A greater number of lost teeth can often be replaced by a smaller number of implants, with no need to compromise the teeth nearby. Plus, while the chance of tooth decay is eliminated, the potential for gum disease isn't increased. In fact, with normal brushing and flossing, a dental implant can last a lifetime.

Implants generally cost more than bridgework initially — but they have been shown to be the most cost-effective long-term option. They also have other advantages, including one that no other tooth replacement system offers: the ability to stop the loss of bone, which invariably occurs after tooth loss. So when you're weighing your tooth-replacement options, it pays to consider the long-term value of dental implants.

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