Technology, and What It Changes for You
Equipment matters only for what it does for the patient. Here is what we use, what the evidence supports, and where it does not.
3D Imaging (Cone-Beam CT), in Our Office
A cone-beam CT scan shows the jaw in three dimensions: bone height and width, the position of the nerve canal and the sinus, and the shape of a bony defect. For implant planning that is the recognized standard of care. In its position statement on selection criteria for radiology in dental implantology, the American Academy of Oral and Maxillofacial Radiology recommends that cross-sectional imaging be used for the assessment of all dental implant sites, and that cone-beam CT is the imaging method of choice for obtaining that information.
A scan is not a free look. In a meta-analysis of published dosimetry in Dentomaxillofacial Radiology, Ludlow and colleagues reported mean adult effective doses from standard protocols of 84 microsieverts for a small field of view, 177 for a medium field, and 212 for a large one, with reported values across machines and protocols ranging from roughly 5 to more than 1,000 microsieverts, and concluded that the ranges are wide enough that cone-beam doses cannot be generalized. So a scan is taken when the three-dimensional information will change the plan, at the smallest field of view that answers the question. It is not part of a routine checkup, and it is not taken for periodontal diagnosis that ordinary films already answer.
The scanner is in our office, so when a scan is indicated it is taken at your consult and reviewed with you on screen the same visit.
Guided Implant Surgery
We place a single, well-documented implant system with decades of published follow-up and components the labs around Austin stock; the system is named on our page for referring dentists. The implant position is planned on the 3D scan, in software, against the tooth your dentist will make. Where the case calls for one, a surgical guide is printed from that plan and used during placement.
How close that gets an implant to its plan has been measured. In a systematic review and meta-analysis in Clinical Oral Implants Research, Tahmaseb and colleagues pooled 2,238 guided implants in 471 patients and found a mean deviation from plan of 1.2 millimeters at the entry point, 1.4 millimeters at the tip, and 3.5 degrees of angle. They concluded that guided placement is accurate enough for the majority of clinical situations, that accuracy is better in partially edentulous cases than in fully edentulous ones, and that a safety margin of at least 2 millimeters should still be respected.
Those numbers describe how closely the implant lands on the plan. They are not a measure of whether guided implants do better than freehand implants years later, which is a different question and not one that review set out to answer. Guidance is used here where it turns the clearance around the nerve and the sinus into a decision made in advance rather than an estimate made at surgery, and where it gives your dentist a position built around the tooth being restored. It is not used on every case. A single implant in good bone, with a tooth on either side to reference, generally does not need one, and guided implant surgery, and when it actually helps sets out where the line falls.
Platelet-Rich Fibrin (PRF)
A small amount of your own blood, spun in a centrifuge, separates into a fibrin clot carrying the platelets and white cells from that draw. There is nothing foreign in it and nothing added to it. Dr. Verrett takes the blood draw himself.
What it does depends a great deal on what it is used for, and the honest summary is that the evidence is mixed. In an umbrella review of systematic reviews for the International Journal of Dentistry, Ardila and colleagues found that platelet derivatives used in periodontal intrabony defects gave significantly greater attachment gain, greater pocket depth reduction, and greater radiographic bone fill than surgery alone, but that for covering exposed roots a connective tissue graft or an enamel matrix derivative produced better results regardless of how much PRF was used.
For the use pictured above, PRF placed with a bone graft or into an extraction site, the evidence is weaker still. Reviewing the randomized trials for the Journal of Clinical Periodontology, Castro and colleagues found the published data too heterogeneous to pool into a meta-analysis at all, and concluded in their own words that despite the lack of strong evidence, PRF might have a positive effect on bone regeneration and osseointegration. That is a plausible benefit, not a demonstrated one, and this page will not describe it as more than that. PRF is used here because it is drawn from the patient at the same visit, introduces nothing foreign, and may help. It is not a reason to expect a better result than the graft would give on its own.
Digital Impressions
A digital scanner replaces impression trays for most cases: no tray, no impression material, and the file goes to your dentist and the lab electronically the same day. That is a description of the workflow, not a claim of superior accuracy. For long-span and full-arch work a conventional impression is sometimes still the better record, and Dr. Verrett will take one when it is.
Sedation Monitoring
During IV sedation the monitoring is what the American Dental Association’s Guidelines for the Use of Sedation and General Anesthesia by Dentists require for moderate sedation: oxygen saturation measured continuously by pulse oximetry, ventilation observed and monitored, and blood pressure and heart rate evaluated continually. A trained team member watches those monitors and does nothing else during the procedure.
The Texas State Board of Dental Examiners issues a separate permit for nitrous oxide and for each level of sedation, from minimal through deep sedation and general anesthesia, and a Texas dentist may administer only the level the permit covers. Dr. Verrett holds the permit for moderate (IV) sedation, and the office is inspected and equipped for it. Sedation and comfort options.
Magnification and Digital Radiographs
Every procedure is done under magnification. Radiographs here are digital, so the image is on screen within seconds and reaches your dentist the same day. Films are taken when the diagnosis requires them and not on a schedule.