Bone expansion techniques for dental implant placement were developed by Dr. Hilt Tatum in 1970 and are proven to be an efficient alternative to block and particulate grafting for patients who have adequate bone height but insufficient width to allow implant placement.
2. Indication for Bone
Expansion
■ Bone expansion techniques for dental
implant placement were developed by
Dr. Hilt Tatum in 1970 and are proven
to be an efficient alternative to block
and particulate grafting for patients
who have adequate bone height but
insufficient width to allow implant
placement.
3. Bone Expansion
Advantages
■ Cost effective
■ Reduces treatment time
■ Conserves precious bone cells
■ Eliminates difficult soft tissue closures
■ Restores labial contours
4.
5. The frontal view of the
edentulous segment of the
maxillae demonstrates
bone of adequate height
and unknown width
6.
7. The sagittal view of the
edentulous segment of the
maxillae demonstrates
bone of inadequate
thickness to allow
conventional rotary cutting
instruments to be used
8.
9. Bone Expansion for the
Maxillary Anterior Segment
■ The median palatine suture is a
factor
■ Implants may be placed in the
central incisor positions only at the
initial surgery
■ Implants may be added to the
lateral incisor positions 6wks
following the initial placements
10. Aggressive bone
expansion in an attempt
to place adjacent
implants in thin ridges
will likely result in
failure due to labial plate
fracture
11.
12. Implants are generally
allowed to heal for 6
months in the maxillae and
4 months in the mandible
prior to loading when
utilizing bone expansion
techniques
13. Sagittal View
■ Single stage surgery
■ Plateau or fins in
bone
■ Grit-blasted surface
may be in bone or
soft tissue
■ Polished collar
surface
transmucosal
14.
15. Illustrated Prosthetic Results
■ Conventional
crown and bridge
methods
■ Normal gingival
contours
■ Normal occlusal
relationships
20. Bone Expansion Technique
■ Atrophic ridges
as thin as 1mm at
the labio-palatal
crest may be
expanded
■ A #11 scalpel
blade is utilized
to bisect the
crestal bone
21.
22. Bone entry with a scalpel
■ Carefully done to
bisect the labial
and palatal bone
■ The cortical bone
must be
penetrated to
gain access to
the interstitial
bone
23.
24. Bone expansion scapel
technique
■ Follow the long axis
of the bone to
further penetrate
and gain access to
the medullary bone
■ These are gentle
procedures done
with controlled force
25.
26. Scalpel removal from bone
■ Always rotate the
scalpel mesial-
distal with a
gentle removing
force
■ Never rotate the
scalpel labio-
palatal
27. Bone expansion access
■ A high-speed
handpiece using
a thin tapered
diamond may be
used following
scalpel access to
the medullary
bone if it is hard
and cortical in
nature
28.
29. Bone expansion instruments
■ The smallest
dimension bone
expander is
inserted in the
osteotomy
■ It is extremely
important to
expand the bone
in the correct
vertical axis
30.
31. Prevent labial plate bone
fracture
■ Palatal bone is not
plastic and does not
expand
■ Carefully brace the
labial bone with finger-
thumb pressure as the
expansion instruments
move the bone labially
and open the
osteotomy
32.
33.
34.
35.
36.
37.
38. Expansion instrument
removal
■ Always remember
to remove bone
expansion
instruments with
a gentle, mesial-
distal controlled
action.
■ Never apply a
labio-palatal
removal action
39.
40.
41. Final size bone socket former
■ The osteotomy
expansion is
completed to
depth with a bone
socket former
sized exactly as
the implant to be
inserted
42. Osteotomy depth
measurement
■ Each instrument
used for bone
expansion has
depth markings
to indicate the
exact implant
length and
location of the
grit blasted collar
43.
44. Bone expansion implant
seating
■ Utilize the
provided seating
instrument
■ Gently drive the
implant into the
full depth of the
expanded
osteotomy
45.
46. Sagittal view of Osteogen
barrier
■ Slowly resorbable
Osteogen is
mixed with the
patient’s blood to
provide a barrier
against epithelial
migration into the
osteotomy
47.
48. Frontal-crestal view of “D”
implant
■ View of completed
surgery of elliptical
implant place with
bone expansion
osteotomy.
■ Osteogen mixed
with the patient’s
blood is utilized as a
barrier to prevent
epithelial migration
during initial healing
49.
50. Sagittal view healed “D”
implant
■ Single stage
transmucosal
■ Plateau fins must be
in bone
■ Grit-blasted surface
relationship to bone
height is determined
by the thickness of
the soft tissue
51.
52. Post guide try-in
■ Post guides of
0,10,20,30 degrees
are available in the
surgery kit to pre-
determine abutment
post selection
■ Enter this
information in the
record at the time of
surgery
53.
54. Evaluate the opposing
dentition
■ The implant
position must
allow the restored
implant to have a
non-traumatic
occlusal
relationship with
the opposing
teeth or
prosthesis
55.
56. Abutment post cementation
■ Read and
understand the
instruction
manual on this
website for
cementation of
the unique Tatum
Unipost
57.
58. Abutment post preparation
■ Gross reduction of
the abutment post
may be done using
the post holder tool
outside of the
mouth
■ Final preparation
and paralleling is
done following
cementation of the
abutment post
59.
60. Preparation requirements
■ The margin of the preparation Must
extend onto the body of the implant
■ A small anti-rotational grove is
extended onto the body of the implant
■ Margin placement is determined by the
soft tissue contour and the planned
emergence profile of the final
restoration
61.
62. Abutment selection &
preparation
■ Prepare abutments
to allow normal
contour for
anatomically correct
prosthetics
■ Prepare abutments
to allow proper
material dimensions
for strength and
longevity of
restorations
63. Sagittal view of restored
implant
■ Physiologic
contour
■ Normal
emergence profile
■ Maintainable
bone-
circumferential
soft tissue
complex
