精品孩子的眼睛_梦魇_3课件

Tatum Bone Expansion Illustrations Indication for Bone Expansion nBone 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. Bone Expansion Advantages nCost effective nReduces treatment time nConserves precious bone cells nEliminates difficult soft tissue closures nRestores labial contours The frontal view of the edentulous segment of the maxillae demonstrates bone of adequate height and unknown width The sagittal view of the edentulous segment of the maxillae demonstrates bone of inadequate thickness to allow conventional rotary cutting instruments to be used Bone Expansion for the Maxillary Anterior Segment nThe median palatine suture is a factor nImplants may be placed in the central incisor positions only at the initial surgery nImplants may be added to the lateral incisor positions 6wks following the initial placements Aggressive bone expansion in an attempt to place adjacent implants in thin ridges will likely result in failure due to labial plate fracture 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 Sagittal View nSingle stage surgery nPlateau or fins in bone nGrit-blasted surface may be in bone or soft tissue nPolished collar surface transmucosal Illustrated Prosthetic Results nConventional crown and bridge methods nNormal gingival contours nNormal occlusal relationships Restored “D” elliptical implant nNormal gingival contour nNormal tooth anatomy nMaximum bone- implant surface area The following diagrams and text describe basic bone expansion technique. Contact Tatum Surgical 1-888-360-5550 for educational workshops with hands on training Bone Expansion Technique nAtrophic ridges as thin as 1mm at the labio-palatal crest may be expanded nA #11 scalpel blade is utilized to bisect the crestal bone Bone entry with a scalpel nCarefully done to bisect the labial and palatal bone nThe cortical bone must be penetrated to gain access to the interstitial bone Bone expansion scapel technique nFollow the long axis of the bone to further penetrate and gain access to the medullary bone nThese are gentle procedures done with controlled force Scalpel removal from bone nAlways rotate the scalpel mesial- distal with a gentle removing force nNever rotate the scalpel labio- palatal Bone expansion access nA 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 Bone expansion instruments nThe smallest dimension bone expander is inserted in the osteotomy nIt is extremely important to expand the bone in the correct vertical axis Prevent labial plate bone fracture nPalatal bone is not plastic and does not expand nCarefully brace the labial bone with finger- thumb pressure as the expansion instruments move the bone labially and open the osteotomy Expansion instrument removal nAlways remember to remove bone expansion instruments with a gentle, mesial- distal controlled action. nNever apply a labio-palatal removal action Final size bone socket former nThe osteotomy expansion is completed to depth with a bone socket former sized exactly as the implant to be inserted Osteotomy depth measurement nEach instrument used for bone expansion has depth markings to indicate the exact implant length and location of the grit blasted collar Bone expansion implant seating nUtilize the provided seating instrument nGently drive the implant into the full depth of the expanded osteotomy Sagittal view of Osteogen barrier nSlowly resorbable Osteogen is mixed with the patients blood to provide a barrier against epithelial migration into the osteotomy Frontal-crestal view of “D” implant nView of completed surgery of elliptical implant place with bone expansion osteotomy. nOsteogen mixed with the patients blood is utilized as a barrier to prevent epithelial migration during initial healing Sagittal view healed “D” implant nSingle stage transmucosal nPlateau fins must be in bone nGrit-blasted surface relationship to bone height is determined by the thickness of the soft tissue Post guide try-in nPost guides of 0,10,20,30 degrees are available in the surgery kit to pre- determine abutment post selection nEnter this information in the record at the time of surgery Evaluate the opposing dentition nThe implant position must allow the restored implant to have a non-traumatic occlusal relationship with the opposing teeth or prosthesis Abutment post cementation nRead and understand the instruction manual on this website for cementation of the unique Tatum Unipost Abutment post preparation nGross reduction of the abutment post may be done using the post holder tool outside of the mouth nFinal preparation and paralleling is done following cementation of the abutment post Preparation requirements nThe margin of the preparation Must extend onto the body of the implant nA small anti-rotational grove is extended onto the body of the implant n Margin placement is determined by the soft tissue contour and the planned emergence profile of the final restoration Abutment selection & preparation nPrepare abutments to allow normal contour for anatomically correct prosthetics nPrepare abutments to allow proper material dimensions for strength and longevity of restorations Sagittal view of restored implant nPhysiologic contour nNormal emergence profile nMaintainable bone- circumferential soft tissue complex Single anterior Single anterior implant “D” implant in cuspid pillar “D” Posterior bridge abutments 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