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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.

Options for replacing all teeth with dental implants.

If you have lost an entire arch of teeth (top and/or bottom), or are soon to have your remaining teeth removed because they are too unhealthy to save, you have three choices for implant-supported tooth replacement:

  • Fixed bridgework, which is a set of lifelike dental crowns that serve as permanent replacements for your missing teeth. This is ideal for those who have not yet experienced the loss of jawbone density and volume that is inevitable with tooth loss. Learn more about implant-supported fixed bridgework.
  • Fixed dentures, which, like bridgework, are never taken out of the mouth but contain not only replacement teeth but also replacement gum tissue. This works well for those who have experienced loss of gum tissue height and bone and want to prevent further deterioration while restoring a youthful facial appearance. Learn more about implant-supported fixed dentures.
  • Removable dentures, which hook onto two or more dental implants so they won't slip while you're wearing them and also offer protection against deterioration of the jawbone. Learn more about implant-supported removable dentures.

How It Works

Dental implants serve the same purpose as the roots of natural teeth: They anchor the replacement teeth to your jawbone. Just like natural tooth roots, they lie under the gum line and therefore are not visible in the mouth. Only the lifelike prosthetic teeth or removable denture attached to them can be seen by you or anyone else. Because dental implants are made of titanium, a metal that has the unique ability to fuse to living bone, they are extremely stable and reliable (Learn More).

So do you need one implant for every tooth you are replacing? Definitely not. Replacing an arch of teeth with dental implants is somewhat like building a roadway bridge. You wouldn't need to put a support under every foot of road; you'd only need enough to ensure the bridge can hold up under normal stresses. Likewise, your implant teeth will be subjected to the stresses of biting and chewing, and need to be planned accordingly. Each individual has unique conditions; depending on the volume and density of the bone in your jaw, you will need as few as four and as many as six for your implant teeth to function as well as a set of healthy, natural teeth. A removable lower denture can be supported with as few as two implants; an upper removable denture will ideally need four to achieve stability.

What to Expect

The surgery to place dental implants is a simple, routine procedure carried out in the dental office under local anesthesia in most cases. If you need to have failing teeth removed, that will be done first. After numbing the area, the appropriate number of implants will be placed in your jaw at precisely planned angles and positions to maximize support and avoid anatomical structures such as nerves and sinuses. Depending on how many implants you will need, the surgery can take anywhere from one to three hours. Most people who have dental implants placed find that any post-operative discomfort can be managed with over-the-counter anti-inflammatory medication such as ibuprofen or acetaminophen. Some don't even need to take that.

What happens immediately after surgery will depend on what's best to promote healing in your case. Sometimes a set of temporary teeth can be attached immediately, so that you can leave the office with new teeth; a few months later, your permanent replacement teeth with be installed. In other cases, the implants will be left to heal for several months before any teeth are attached. Sometimes that is the best way to insure that the implants remain undisturbed as they go through the process of fusing to your jawbone, which is known as osseointegration.

In either case, you will need to go easy on your newly placed implants during the crucial healing phase following surgery. We will instruct you to eat a softer diet and avoid hard, chewy foods until the process of osseointegration is complete — about two to three months. While this may seem like a long time, keep in mind that people who wear removable dentures without implants often avoid these foods permanently. The good news is that once your implants have fused to your jawbone and your new teeth are attached, you will be able to eat anything you want. In fact, you are likely to forget you even have dental implants!

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