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After meeting with a patient concerning their interest in implants, I usually send them to a radiology group for a CT Dental Scan. There are some key reasons for recommending this procedure prior to my surgery. Ordinary dental radiographs show a two dimensional view of the areas where the implants will be placed. The third dimension, however, is clearly shown on a Dental CT Scan. By having these “slices” of the upper and lower jaws we can avoid anatomical areas, such as nerves and sinuses when performing our surgery. From these films we can determine the bone “quality” we are dealing with. It is important to know whether the bone is very hard or very soft. The texture of the bone will determine how we prepare the bone for receiving the implant. In addition, we can clearly measure the bone width and height, and based on these measurements pick the best implant fit for that area. Implants come in various lenghts and widths. After my patient has their scan, the results are sent to my office. Using appropriate software I usually spend a few hours thoroughly viewing the films. Then the real fun begins. I actually perform the patient’s surgery on my computer. The software comes with an entire library of implants that I can chose from and actually insert them into the radiographic pictures. The end result is that I have no surprises when the day of the actual surgery arrives.
Here is an example of a typical dental radiograph. Note the absence of the third dimension view.
These are the detailed slices of a jaw produced by a CT SCAN
This is a 3D view of the skull developed from the CT Scan
Another slice of the upper jaw from a different perspective
Here are some pictures showing the pre-surgical planning completed on my computer. By having this information, I can avoid anatomical areas that may cause the patient complications. In addition, I can select the best fitting implant for the area that will receive the implant. The yellow object is the implant.
The usual fee for a scan of one arch is $450 and clearly is an expense that is worthwhile. There are circumstances where I will bypass the scan. If a patient presents with significant amounts of bone, and I can easily decide what size implant I will need from regular dental films and my exam, we skip the scan.
As I mentioned earlier, I have been placing implants for twenty years. My patients receive a local anesthetic and feel nothing during the surgery. I can’t remember the last time I called a patient after implant surgery that complained to me about post operative pain. Sometimes they are surprised I even called. Years ago I used to make significant incisions to flap open the gum to drill my hole for the implant. These incisions required quite a number of stitches to close them up. “The more aggressive the surgery, the more post operative swelling and discomfort”. Today I usually performed a closed flap procedure. Let me explain further. After deciding where my implant will be placed, I remove a small core of gum the size of the implant to be placed. Now I drill my hole for the implant through this small opening. Rarely do I need to use sutures to close the surgical site. Better yet, the patients have told me that in most instances they don’t have to take pain medication that night.
Years ago we would have to have a second surgical procedure to uncover the implant from under the gum. Today we usually do not “bury” the implant during the first surgery. Therefore, when we are ready to attach a tooth to the implant we can easily have access to the top of the implant.
After an implant is placed in the jaw, a period of time must pass in order to allow the body to grow new bone around the threads of the implant. I usually wait three months before placing a tooth on an implant. There has been a “movement” toward immediately placing teeth on newly placed implants. I believe this practice can be risky. If the implant does not have adequate bone around the threads, and a patient bites on the tooth attached to the implant, the implant may lose its initial stability. This usually will lead to an implant failure unless the situation is detected early and corrected. Once the implant is fully “integrated” in the jaw, teeth can be attached and the patient can freely chew on his new implant. It is very important that patients floss and brush around their new implants. Implants will not develop cavities like teeth but they can develop periodontal problems. Diligent home care is a must.
There are times when a patient will come to my office with the belief that they are not candidates for implants because they have insufficient bone. Today there are many procedures available to correct these situations. Using cadaver bone, cow bone, the patient’s own bone, or synthetic materials I can augment the existing bone in order to have adequate bone for an implant.