Tatum Bone Tatum Bone Expansion Expansion

IllustrationsIllustrations

Indication for Bone Indication for Bone ExpansionExpansion

Bone expansion techniques for dental Bone expansion techniques for dental implant placement were developed by implant placement were developed by Dr. Hilt Tatum in 1970 and are proven Dr. Hilt Tatum in 1970 and are proven to be an efficient alternative to block to be an efficient alternative to block and particulate grafting for patients and particulate grafting for patients who have adequate bone height but who have adequate bone height but insufficient width to allow implant insufficient width to allow implant placement.placement.

Bone Bone ExpansionExpansion AdvantagesAdvantages

Cost effectiveCost effective Reduces treatment timeReduces treatment time Conserves precious bone cellsConserves precious bone cells Eliminates difficult soft tissue closuresEliminates difficult soft tissue closures Restores labial contoursRestores labial contours

The frontal view of the The frontal view of the edentulous segment of the edentulous segment of the

maxillae demonstrates maxillae demonstrates bone of adequate height bone of adequate height

and unknown widthand unknown width

The sagittal view of the The sagittal view of the edentulous segment of the edentulous segment of the

maxillae demonstrates maxillae demonstrates bone of inadequate bone of inadequate thickness to allow thickness to allow

conventional rotary cutting conventional rotary cutting instruments to be usedinstruments to be used

Bone Expansion for the Bone Expansion for the Maxillary Anterior SegmentMaxillary Anterior Segment The median palatine suture is a The median palatine suture is a

factorfactor Implants may be placed in the Implants may be placed in the

central incisor positions only at the central incisor positions only at the initial surgeryinitial surgery

Implants may be added to the Implants may be added to the lateral incisor positions 6wks lateral incisor positions 6wks following the initial placementsfollowing the initial placements

Aggressive bone Aggressive bone expansion in an attempt expansion in an attempt

to place adjacent to place adjacent implants in thin ridges implants in thin ridges

will likely result in will likely result in failure due to labial plate failure due to labial plate

fracturefracture

Implants are generally Implants are generally allowed to heal for 6 allowed to heal for 6

months in the maxillae and months in the maxillae and 4 months in the mandible 4 months in the mandible

prior to loading when prior to loading when utilizing bone expansion utilizing bone expansion

techniquestechniques

Sagittal ViewSagittal View Single stage surgerySingle stage surgery Plateau or fins in Plateau or fins in

bonebone Grit-blasted surface Grit-blasted surface

may be in bone or may be in bone or soft tissuesoft tissue

Polished collar Polished collar surface surface transmucosaltransmucosal

Illustrated Prosthetic ResultsIllustrated Prosthetic Results

Conventional Conventional crown and bridge crown and bridge methodsmethods

Normal gingival Normal gingival contourscontours

Normal occlusal Normal occlusal relationshipsrelationships

Restored “D” elliptical Restored “D” elliptical implantimplant

Normal gingival Normal gingival contourcontour

Normal tooth Normal tooth anatomyanatomy

Maximum bone-Maximum bone-implant surface implant surface areaarea

The following diagrams and The following diagrams and text describe basic bone text describe basic bone

expansion technique.expansion technique.

Contact Tatum Surgical Contact Tatum Surgical @1-888-360-5550 for @1-888-360-5550 for

educational workshops with educational workshops with hands on traininghands on training

Bone Expansion TechniqueBone Expansion Technique

Atrophic ridges Atrophic ridges as thin as 1mm at as thin as 1mm at the labio-palatal the labio-palatal crest may be crest may be expandedexpanded

A #11 scalpel A #11 scalpel blade is utilized blade is utilized to bisect the to bisect the crestal bonecrestal bone

Bone entry with a scalpelBone entry with a scalpel

Carefully done to Carefully done to bisect the labial bisect the labial and palatal boneand palatal bone

The cortical bone The cortical bone must be must be penetrated to penetrated to gain access to gain access to the interstitial the interstitial bonebone

Bone expansion scapel Bone expansion scapel techniquetechnique

Follow the long axis Follow the long axis of the bone to of the bone to further penetrate further penetrate and gain access to and gain access to the medullary bonethe medullary bone

These are gentle These are gentle procedures done procedures done with controlled forcewith controlled force

Scalpel removal from boneScalpel removal from bone

AlwaysAlways rotate the rotate the scalpel mesial-scalpel mesial-distal with a distal with a gentle removing gentle removing forceforce

NeverNever rotate the rotate the scalpel labio-scalpel labio-palatalpalatal

Bone expansion accessBone expansion access

A high-speed A high-speed handpiece using a handpiece using a thin tapered thin tapered diamond may be diamond may be used following used following scalpel access to scalpel access to the medullary bone the medullary bone if it is hard and if it is hard and cortical in naturecortical in nature

Bone expansion instrumentsBone expansion instruments

The smallest The smallest dimension bone dimension bone expander is expander is inserted in the inserted in the osteotomyosteotomy

It is extremely It is extremely important to important to expand the bone in expand the bone in the correct vertical the correct vertical axisaxis

Prevent labial plate bone Prevent labial plate bone fracturefracture

Palatal bone is not Palatal bone is not plastic and does not plastic and does not expandexpand

Carefully brace the Carefully brace the labial bone with finger-labial bone with finger-thumb pressure as the thumb pressure as the expansion instruments expansion instruments move the bone labially move the bone labially and open the and open the osteotomy osteotomy

Expansion instrument Expansion instrument removalremoval

AlwaysAlways remember remember to remove bone to remove bone expansion expansion instruments with a instruments with a gentle, mesial-gentle, mesial-distal controlled distal controlled action.action.

NeverNever apply a labio- apply a labio-palatal removal palatal removal actionaction

Final size bone socket formerFinal size bone socket former

The osteotomy The osteotomy expansion is expansion is completed to completed to depth with a bone depth with a bone socket former socket former sized exactly as sized exactly as the implant to be the implant to be insertedinserted

Osteotomy depth Osteotomy depth measurementmeasurement

Each instrument Each instrument used for bone used for bone expansion has expansion has depth markings depth markings to indicate the to indicate the exact implant exact implant length and length and location of the location of the grit blasted collargrit blasted collar

Bone expansion implant Bone expansion implant seatingseating

Utilize the Utilize the provided seating provided seating instrumentinstrument

Gently drive the Gently drive the implant into the implant into the full depth of the full depth of the expanded expanded osteotomyosteotomy

Sagittal view of Osteogen Sagittal view of Osteogen barrierbarrier

Slowly resorbable Slowly resorbable Osteogen is Osteogen is mixed with the mixed with the patient’s blood to patient’s blood to provide a barrier provide a barrier against epithelial against epithelial migration into the migration into the osteotomy osteotomy

Frontal-crestal view of “D” Frontal-crestal view of “D” implantimplant

View of completed View of completed surgery of elliptical surgery of elliptical implant place with implant place with bone expansion bone expansion osteotomy.osteotomy.

Osteogen mixed with Osteogen mixed with the patient’s blood is the patient’s blood is utilized as a barrier utilized as a barrier to prevent epithelial to prevent epithelial migration during migration during initial healinginitial healing

Sagittal view healed “D” Sagittal view healed “D” implantimplant

Single stage Single stage transmucosaltransmucosal

Plateau fins must be Plateau fins must be in bonein bone

Grit-blasted surface Grit-blasted surface relationship to bone relationship to bone height is determined height is determined by the thickness of by the thickness of the soft tissuethe soft tissue

Post guide try-inPost guide try-in

Post guides of Post guides of 0,10,20,30 degrees 0,10,20,30 degrees are available in the are available in the surgery kit to pre-surgery kit to pre-determine abutment determine abutment post selectionpost selection

Enter this Enter this information in the information in the record at the time of record at the time of surgerysurgery

Evaluate the opposing Evaluate the opposing dentitiondentition

The implant The implant position must position must allow the restored allow the restored implant to have a implant to have a non-traumatic non-traumatic occlusal occlusal relationship with relationship with the opposing teeth the opposing teeth or prosthesisor prosthesis

Abutment post cementationAbutment post cementation

Read and Read and understand the understand the instruction instruction manual on this manual on this website for website for cementation of cementation of the unique Tatum the unique Tatum UnipostUnipost

Abutment post preparationAbutment post preparation

Gross reduction of Gross reduction of the abutment post the abutment post may be done using may be done using the post holder tool the post holder tool outside of the mouthoutside of the mouth

Final preparation Final preparation and paralleling is and paralleling is done following done following cementation of the cementation of the abutment postabutment post

Preparation requirementsPreparation requirements

The margin of the preparation The margin of the preparation Must Must extend onto the body of the implant extend onto the body of the implant

A small anti-rotational grove is A small anti-rotational grove is extended onto the body of the implantextended onto the body of the implant

Margin placement is determined by the Margin placement is determined by the soft tissue contour and the planned soft tissue contour and the planned emergence profile of the final emergence profile of the final restorationrestoration

Abutment selection & Abutment selection & preparationpreparation

Prepare abutments to Prepare abutments to allow normal contour allow normal contour for anatomically for anatomically correct prostheticscorrect prosthetics

Prepare abutments to Prepare abutments to allow proper material allow proper material dimensions for dimensions for strength and strength and longevity of longevity of restorationsrestorations

Sagittal view of restored Sagittal view of restored implant implant

Physiologic Physiologic contourcontour

Normal Normal emergence profileemergence profile

Maintainable Maintainable bone-bone-circumferential circumferential soft tissue soft tissue complexcomplex

Single anteriorSingle anterior implant

“D” implant in cuspid pillar

“D” Posterior bridge abutments