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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.

All-on-4 replacement teeth.What do you think of when you hear the word “dentures?” Is it a set of removable teeth that sits in a glass when not in use? That type of removable denture does still exist, but these days there's a far better alternative: Implant-supported fixed dentures.

An implant-supported fixed denture is a lifelike set of false teeth — complete with prosthetic gum tissue — that stays in your mouth all the time. It is securely and comfortably anchored by several dental implants that become an integral part of your jawbone once inserted during a minor surgical procedure done in the dental office.

Implant-supported fixed dentures are ideal for people who have experienced deterioration of the gums and jawbone, which is an inevitable effect of tooth loss. Bone is a living tissue that needs constant stimulation to maintain its volume and density. That stimulation normally comes from the teeth; when they are lost, the bone that used to surround and support them starts to break down. If this is allowed to continue, your facial features may begin to sag — giving you a more aged appearance (View Example). Unfortunately, wearing removable dentures actually accelerates this process; but wearing fixed dentures halts it — while restoring the underlying support to your facial features (cheeks and lips) that your jawbone structure used to provide. This will make you look younger. Learn more about fixed vs. removable dentures.

How It Works

All-on-4 step by step.A dental implant is a small, screw-shaped post that serves as a replacement tooth root. Like a natural tooth root, it is housed in the bone beneath the gum. Implants are made of titanium, which has a unique ability to fuse to bone in a process called osseointegration. That's what makes implants so sturdy and reliable (Learn More).

Today's state-of-the-art implant systems enable a minimum number of implants to support a maximum number of teeth. That means as few as four implants can be used to support a full arch (upper or lower jaw) of fixed, non-removable replacement teeth. What's more, it is sometimes possible to accomplish this remarkable, life-changing process in just one day!

Implant-supported dentures offer a more efficient and cost-effective strategy for permanent tooth replacement than using a single dental implant for every missing tooth, which is impractical and not recommended — particularly where bone loss has occurred. In order to restore the natural proportions of your teeth and gums with less bone volume, we need to create a lifelike prosthesis (replacement) that contains both teeth and gums; otherwise, any permanent replacement teeth would look overly long.

What to Expect

Three-dimensional (3-D) x-rays of your jaw may be taken to pinpoint the location of anatomical structures such as bone, sinuses and nerves. This will enable us to determine how many implants you need and the ideal location for them. For each implant we will need to make a small channel in the bone. You will feel nothing during the implant-placement surgery, which usually requires only local anesthesia. We will discuss your individual anesthesia options with you beforehand and make sure you are comfortable.

Once your implants are in place, we will attach a temporary set of teeth, which stays in your mouth approximately three months until the implants are fully fused to your bone and healing is completed. Because implant surgery is very precise and well-planned, people generally have little post-operative discomfort and begin functioning with their new temporary teeth almost immediately. However, it's a good idea to avoid crunchy, chewy or tough foods for at least six to eight weeks.

When the process of osseointegration is complete, we attach permanent teeth that fit your healed gum tissues more precisely than the temporary ones did. With these teeth you can eat anything you want — and they will look as good as they feel! Your new teeth will require the same care as natural teeth: daily brushing and flossing, and regular checkups and professional cleanings. With conscientious oral hygiene, implant-supported fixed dentures should last a lifetime.

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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