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New Teeth Today

Computer/Digital Guided Anatomic Dental Implant Reconstruction

Follow-Up and Supportive Care for the Long-Term

It is imperative - critical - extremely important - a huge deal - meganecessary - for dental implant patients to be seen routinely every 3 months by a skilled dental hygienist for professional plaque biofilm control in addition to the personal home care of the patient which should include the daily use of both a WaterPik Waterflosser and a Sonicare toothbrush.  Supportive periodontal/peri-implant maintenance therapy (SPMT) or what has been simply referred to as maintenance is THERAPY as the formal name states clearly.  This means that just because the ailing, failing, hopeless and infected teeth were removed and brand new shiny dental implants with a beautiful prosthetic bridge has been placed in their stead, it does not mean an end to diligent personal plaque biofilm removal - i.e. patient home care.  Nor does it mean an end to diligent professional plaque biofilm removal - i.e. SPMT - with routine annual or semi-annual evaluation by either Dr. Ismaj or Dr. Avanessian as well as routine radiographic evaluation of bone levels around the implants.  Yes, x-ray radiographs are part of the deal on at least an annual if not semi-annual basis.  This is very important for these patients because they had initially demonstrated a risk for chronic inflammatory oral disease, either decay or periodontitis or both, and risks remain for peri-implantitis that results in bone destruction around dental implants.  

Final/Long-Term Prosthetic Bridge(s)

Following the surgery, we will see the patient periodically for post-operative evaluation and supportive care.  The bridges the patient has at this point are provisional or temporary.  They are not designed to be the long-term/final prosthetic bridges, but they are intended to be worn for a period of time from 6 months to 1 year until the dental implant fixtures have had enough time to fully osseointegrate with the supporting bone.  Osseointegration is a process by which the bone heals around the implant fixtures by forming a very strong bond to the dental implant surface.  If there should be a problem with any of the dental implant fixtures this healing period also provides us with the time necessary to take corrective action should that become necessary.  At that time when Drs. Ismaj and Avanessian determine that the implant fixtures and bone integration has healed optimally, then there will be another 1-hour records appointment for finalizing the design of the teeth - shapes, lengths, widths, color and shades - as well as impressions and a new bite registration/confirmation.  Once these records are shipped off to nSequence, there is another waiting period of approximately 4 weeks prior to receiving the final/long-term bridge prosthesis to be delivered in one final 1-hour visit.  This is where the real smiles and tears (of joy!) start.  

Patient-Specifc Anatomic Guided Surgery

On the day of surgery, the patient will be made extremely comfortable and an anesthesiologist will begin the preliminary preparation for the patient's conscious IV sedation.  For edentulous patients, i.e. those already missing all of their teeth and wearing complete dentures, the process of placing the dental implant fixtures begins fairly quickly.  For partially edentulous or partially dentate patients, i.e. those with some or most of their teeth quite often with multiple sites of active infection, we will begin by removing all of the remaining teeth followed by placement of the dental implant fixtures and assembly of the immediate implant-supported prosthetic bridge (one bridge if one jaw and two bridges if both jaws) to the dental implant fixtures and prosthetic abutments.  The patient wakes up from the anesthesia with solid, comfortably functioning, and beautifully esthetic teeth.  These are only the provisional or temporary bridges to be worn for 6-12 months during the implant/bone healing period.  And this always brings out the biggest smile, and quite often accompanied by tears of joy.    His or her life is forever transformed, and the benefits are so numerous and so important to quality of life, overall health, self-esteem, general comfort, self-confidence and human dignity.   

Virtual Pre-Surgical Treatment Planning Session

About 7-10 days is necessary following initial records for the data, impressions and bite registration material to be sent to nSequence Dental Center where expert biomaterials and maxillofacial anatomists will prepare the data for Drs. Ismaj and Avanessian to jointly conduct a virtual on-line pre-surgical treatment planning session.  Conducted with nSequence technicians this virtual treatment planning session is where all the key decisions will be made by Drs. Ismaj and Avanessian to finalize the case parameters for the day of surgery.  Following this planning session, nSequence requires approximately 3-4 weeks to prepare, validate, verify accuracy and precision of the surgical guides, anatomic patient models and instrumentation to be used for the surgical procedure.  It is at this point that we will schedule the surgical date for the patient and begin ordering the surgical, regenerative (if necessary), dental implant and prosthetic materials, parts and components necessary for the surgery.  

Initial Records

One hour will be necessary for initial records at which time dental impressions will be taken of both the upper and lower dental arches, a registration of the patient's occlusal bite, digital clinical photographs, fabrication of a radiographic imaging guide which will be used for the diagnostic 3-D cone beam CT scan imaging.  

Informed Consent and Financial Agreement

Upon the patient accepting and committing to the treatment recommendations presented by Drs. Ismaj and Avanessian, the New Teeth Today Team will be working with the patient to ensure that his or her consent is truly informed and being given freely without any hesitation or feelings of undue pressure from any source.  Then the financial arrangements will be settled paving the way to begin the nSequence Patient-Specific Anatomic Reconstruction protocol.


Drs. Ismaj and Avanessian will evaluate each patient's individual condition and needs together forming a preliminary plan by clinically evaluating the patient as well as radiographically evaluating the patient with a 2-D panoramic image or 3-D cone beam CT scan images.  There will be a detailed presentation of their findings to the patient (and patient's spouse or family) with discussion of diagnosis, prognosis, treatment options, risks versus benefits of different treatment options, and a detailed opportunity for patient and/or patient's spouse/family to have all of their questions answered.