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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.

Denture in Glass.When you think of dentures, you may picture a full set of upper and lower teeth, complete with pink gums... sitting in a glass full of water on the bedside table. But did you know that the word “dentures” is actually used to refer to several different types of prosthetic teeth? For example, there's the fixed partial denture (commonly called a “bridge”), the removable partial denture, and the removable full denture (the one in the glass). It's also possible to have a full set of dentures which are securely fixed in the mouth.

What's the difference between all of these “dentures”? Essentially, a removable denture (as the name implies) is easy for you to take out, while a fixed denture can only be removed at the dental office. But when you're choosing between these two types, what's at issue is more than just removability — there are major implications for your health and self-confidence, too.

Removable Dentures Accelerate Bone Loss

Once upon a time, removable full dentures were the best — and indeed, the only — prosthetic teeth-replacement system dentistry could offer. However, removable dentures come with problems. Their instability in the mouth often requires the wearer to make constant adjustments and compromises, such as eating primarily soft foods and being extra-careful when speaking and chewing. In time, even after one has learned to get by with them, they eventually lose their fit. This happens because wearing them accelerates bone loss in the jaw, which inevitably occurs after tooth loss. Accelerated bone loss results from the pressure dentures place on the bony ridges that formerly supported the teeth.

The loss of bone tissue inside the jaw is invisible; its effects, however, eventually become easy to see. When teeth are lost, the nearby bone is resorbed (melted away) by the body's natural processes. In time, bone volume and density decrease significantly; that's why dentures stop fitting correctly. As the bone shrinks, the distance between your nose and chin decreases too, and support for facial features collapses. Let go long enough, it can make you look prematurely aged and unhappy — whether you're wearing your dentures or not (View Example).

Implant-Supported Dentures Prevent Bone Loss

Implant supported dentures vs removable dentures.While removable dentures don't stop bone loss, there is a way to permanently replace a full set of teeth and prevent bone loss as well:  implant-supported dentures that are fixed in your mouth.  Anchored firmly into the living bone tissue, dental implants provide the stimulation and support needed to prevent bone from being lost. The bone in your jaw actually fuses to the implant, due to the remarkable osseophilic (bone-loving) properties of titanium, the metal of which dental implants are made.

Because of their firm anchorage, implants form a strong and solid foundation for fixed dentures. It can take as few as four implants to hold a complete set of upper or lower replacement teeth. When dentures are attached to implants, you never have to worry that they will loosen or slip. That means you can eat whatever you want, speak normally, and forget all about bothersome denture creams and adhesives.

People who choose fixed over removable dentures report that this system feels much more like their own natural teeth, and that it improves their quality of life. On the other hand, over half of people who wear lower removable dentures report they are unsatisfied with their stability and comfort. Though implant-supported teeth are more expensive initially, they are the best long-term investment as they will never need to be replaced or remade. We would be happy to discuss the costs and benefits of each of these options with you at your next consultation.

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