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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.

If you have lost any of your teeth, you no doubt realize there are consequences to living without them: Your smile may not look the way you want it to; eating, speaking and intimacy may be more difficult; and your self-confidence may fade. Though serious, these are not the only impacts. There are hidden consequences of losing teeth that affect not only your appearance but also your health.

Tooth Loss and Premature Aging

Tooth loss and premature aging.

Importantly, a loss of jawbone inevitably follows tooth loss. In just the first year of tooth loss, there is a 25% decrease in bone width. This is followed over the next few years by an overall 4 millimeters decrease in height. If enough teeth are lost, and as bone loss continues, the distance from nose to chin can decrease and the lower third of the face partially collapses. With a lack of structural support, the lips sag; that's why toothless people often appear unhappy and prematurely aged. Also, extreme loss of bone can make an individual more prone to jaw fractures.

Besides helping a person without teeth look and feel great again, dental implants actually prevent bone loss. That's because they are made of titanium, which has a unique ability to fuse to living bone. By actually becoming a permanent part of the jawbone, dental implants stabilize and stimulate the bone to maintain its volume and density. Learn more about tooth loss and premature aging.

The Dangers of Removable Dentures

Other than dental implants, your tooth-replacement options include fixed bridgework that incorporates or uses the adjacent teeth, and removable dentures. You should be aware, however, that the disadvantage of these options is that they may damage the anatomical structures on which they rest. Removable full dentures present the greatest risk to your health of any tooth-replacement option as they press on the bony ridges that used to support the teeth, accelerating the bone loss that began when the teeth were lost in the first place.

Removable dentures and bridgework using natural teeth are both less expensive than dental implants, but only when viewed in the short term. Since dentures and bridgework may cause new problems and will likely need replacement themselves, they don't offer the same long-term value. When viewed as an enduring investment in your comfort, health and well-being, implants offer the best return by far. Learn more about the dangers of removable dentures.

Cost of Not Replacing Missing Teeth

There is another option you may be considering: not to replace your missing teeth, at least not right away. This is not something we would recommend. In fact, the quicker you act to replace missing teeth, the less expensive the procedure will be. That's largely due to the inevitable bone loss that follows tooth loss as described above.

As discussed, dental implants are your best option for replacing missing teeth in appropriate circumstances. However, if your tooth-supporting bone has begun to degenerate, there may be problems that need to be addressed before your implants are placed. For example, the bone may have shrunk down so much that the nerve running through it is now too close to the surface to risk placing an implant in the ideal location without first building up the bone volume there. This would require a bone-grafting procedure, which is quite routine these days but adds cost and time to the treatment plan. Certain situations involving bone loss could require additional implants to be used. So it's best to act sooner rather than later to get back your smile. Learn more about the cost of not replacing missing teeth.

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Losing Teeth - Dear Doctor Magazine

The Hidden Consequences of Losing Teeth For those missing even one tooth, an unsightly gap is actually the least significant problem. What's of far greater concern is the bone loss that inevitably follows tooth loss. Dental implants can preserve bone, improve function and enhance psychological well-being. Learn how implants serve both as anchors to support replacement teeth and preserve bone... Read Article