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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.

Replacing One Tooth With a Dental Implant.Replacing a single missing tooth with a dental implant offers many advantages over your other choices: a removable partial denture or fixed bridgework. A dental implant stays securely anchored in your jaw, giving you a replacement tooth that looks, feels and functions exactly like a natural tooth. A partial denture, on the other hand, needs to hook onto existing teeth. This added stress may cause the anchor teeth to become loose over time. Fixed bridgework, likewise, presents problems for the natural teeth that are used as supports: In order to hold a bridge in place, we need to prepare or file down and crown (cap) at least two natural teeth, one on either side of the space left by a missing tooth. This may cause those support teeth to become more susceptible to decay. Implants can never decay because they are made of titanium, a highly biocompatible metal.

How It Works

Dental Implants 101.The titanium dental implant becomes the root-part of your missing tooth. During a minor surgical procedure, it is placed beneath the gum, into the jawbone. Over the course of a few months, it will actually become part of your jawbone by fusing to it in a process known as osseointegration. That's what makes implant teeth the most natural replacement teeth that exist today.

The implant will be capped by a dental crown that has been created to match your existing teeth. Often there is a connecting piece that goes between them called an abutment. Like the implant itself, this part won't be visible in your mouth. Only the lifelike crown can be seen.

Sometimes a temporary crown is attached at the same time as the implant is placed so that you can go home that day with a replacement tooth. More commonly, the implant is left undisturbed for several months to complete the osseointegration process before the crown is attached. We will let you know which method would work best in your case. Implants are forever, so we want to make sure it's done right!

What to Expect

The surgery to place a dental implant is a simple, routine procedure carried out under local anesthesia in the dental office. First the area will be numbed so you won't feel a thing. Then the implant will be inserted into your jaw at a precisely planned angle and position to maximize support for your new tooth and avoid anatomical structures such as nerves and sinus cavities. The surgery should take an hour or less, and post-operative discomfort should be minimal. Many patients find over-the-counter anti-inflammatory medication such as ibuprofen or acetaminophen is all that is needed; others find they don't need to take anything at all. It will be important to avoid chewing on the surgery site for several weeks; we will advise you as to any diet modifications you need to make during this time.

Once your permanent crown is attached, your new implant tooth will feel just like all your other teeth, and that's exactly how you should care for it — as if it grew there naturally. While it cannot decay, the implant's connection to your bone can be threatened by gum disease. In order to avoid this, keep up your regular oral hygiene routine of brushing, flossing, and coming in for regular professional cleanings. If you keep your mouth healthy, your implant should last a lifetime.

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