High Tech Oral Surgery – What the Dental Tourist Needs to Know

This article discusses recent developments in the use of advanced digital X-ray imagery and CAD/CAM to reduce chair visits to the dentist, improve accuracy and increase predictability of outcomes from oral surgery.

Predictability is the Keynote in Oral Surgery!

Many patients seek dental care in Mexico because the advanced restorative dentistry they need – crown-and-bridge work or, more recently, dental implant restorations – is prohibitively expensive at home. But every patient’s jaw anatomy is different, and many have lost bone since losing teeth. Your implant dentist has to create, using a hand-held drill a hole of exactly the right size and position during your dental implant surgery, using the best diagnostic imaging available. Traditional modes of diagnostic imaging for oral surgery were two-dimensional:

This demanded great skill on the part of your oral surgeon, and inevitably

• Led them to ‘play safe’ during dental surgery – allow greater safety distances from critical structures.
• Resulted in teeth implants not being ideally placed for the replacement teeth they were intended to support. The prosthetist would struggle bravely, and create a denture that fitted, but in a way that compromised some or all of the following:
  • Aesthetics
  • Function
  • Phonetics
  • Long-term durability

In the 1990s, dental surgeons began using CT scans to enhance their diagnostic imaging and improve the accuracy of their dental implant restorations. CT scans are slice-by-slice X-rays that allow a skilled interpreter to construct a mental 3-dimensional visualisation of the bony anatomy of the jaw before the oral surgery. However CT scanners were then:

• rare,
• expensive,
• usually found in large hospitals,
• carried a high radiographic dose.

Thankfully, a new generation of low-radiation imaging devices is proliferating among US, Canada, and Mexico radiography service providers, providing high-quality x-ray imagery in a 3D format. The information these scanners capture is digital, so that it can be easily piped through the internet. This makes collaboration between dental specialists easier during oral surgery and full mouth restorations, so much so that the term ‘collaborative responsibility’ was coined by Dr Carl Misch to characterise the way he thought advanced implant dentistry should be handled in future.

Computerised Implant Planning for Advanced Oral Surgery

No sooner had CT scans become a mainstream than a bunch of brainy types started look at ways of compressing and manipulating CT data to produce a virtual, computerised model of the patients’ dental anatomies. Here’s what the dental surgeon in Mexico might see on his screen:

Notice that the dental surgeon’s implant software allows him to

• place ‘virtual’ implants in the your bone, (numbered 1,2,3,4)
• choose the best type and size of titanium implant post to use,
• place the dental implants with the precise angulation required to
  • make better use of your available jaw bone,
  • reduce tooth implant safety margins and
  • provide a strong basis for your full bottom jaw restoration
• create a preoperative surgical plan showing the exact sizes of the teeth implants he is using, and the precise angulation and position of each tooth implant position before the oral surgery.

CAD/CAM reduces chair visits for oral surgery

We’ve seen how advanced imaging techniques can help at the diagnostic/consultation stage by allowing the dental surgeon to examine the key aspects of the patient’s anatomy without having him in his chair. But the same scanners are driving a CAD/CAM revolution in the mouth, shrinking multi-stage surgical procedures and bringing closer the Holy Grail of dental implant dentistry – a full set of replacement teeth in a day. Traditionally dental implant treatments have been forced to include several chair visits to allow implants to heal and integrate after the oral surgery, and for bridges and similar devices to be adjusted for fit. This is not so bad if your dentist is local, but a big consideration if he is in another country! It was quickly seen that the greater predictability and accuracy provided by these new dental implant surgical techniques could only be realised if there were some way to transfer the dental surgeon’s plan from his computer screen to his patient’s mouth, it might be possible to eliminate one or more of these teeth restoration steps. Here’s where CAD CAM really enters the mouth! The dentist’s plan can be uploaded to a fabricator who uses rapid-prototyping to create a surgical drill-guide that fits precisely over the patient’s jaw anatomy. The oral surgeon in Mexico can thus put his virtual plan into effect with great accuracy, in a much-abbreviated surgical procedure. So is that all? No! So far, we have:

• improved dental implant surgery predictability,
• reduced the risk of unforeseen obstacles to surgery, and
• speeded up and improved the accuracy of surgery of oral surgery in Mexico.

But we haven’t yet got any teeth – just a row of beautifully-placed implants to mount them on! Traditionally, an impression has to be taken of the tops of the healed implants, and used to fabricate the replacement teeth – a lengthy procedure. But hold on just a moment! Didn’t we just see that the patient’s X-ray data could be used to create an accurate drill guide? So could it also be used to create the replacement teeth themselves, with all the pick-up points in the right place, ready to fit and – dare we hope – use? And that’s exactly what’s happening immediate loading implants. So it’s now possible to:

• Learn far more about a patient’s anatomy before oral surgery,
• In many cases, where dental bone is sufficient, in one chair visit,
  • dental implants can be placed and
  • temporary replacement teeth fitted to enable
  • immediate use for a soft diet,

…eliminating much of the social discomfort and functional deprivation associated with extensive implant treatments. To discuss advanced oral surgery in Mexico for you or a loved one, contact Dayo Dental at 877-987-3296.