Warm Regards, Tony Fiorello and the Tatum Surgical Staff

Transcription

1 Volume 4, Issue 2 June, th Avenue North, Suite 112 Phone: Clearwater, Florida Fax: tatumimplants@verizon.net The Tatum Times INSIDE THIS ISSUE: A Simple and Quick Approach to Maxillary Sinus Floor Elevation with Immediate Dental Implant Placement. 2-5 Users of the Month 6 Appreciation to Dr. John Lin 6 Journey to Remember Dates 6 Hello Everyone, In the last newsletter, we promised our readers that we would be showing you first hand examples of how Tatum Surgical is building on our strengths and implementing positive changes. We have had a breakthrough in our implant driver design. Our past drivers worked very well for years, but with the superior design of the Tatum Tapered Implants, we have really been putting them to the test. With the increased torque needed to place some of the larger implants, the drivers started to wear prematurely. We sent them out for testing, and they showed stability up to 226 Newton Centimeters. Tatum Surgical consulted with German Engineers and they recommended we use a new material. We have completed manufacturing of the new drivers and recently performed a strength test. I was amazed! The new "Gold Standard" drivers were stable until 451 N-cm. Tatum Institute International Update Welcome Minal Mistry 6 I tested one myself and found that the handle of the ratchet was flexing before the driver failed at 497 Newton Centimeters. I seriously don't feel that this amount of pressure will be used in your practices. These "Gold Standard Drivers" are available now, and I think you will be very pleased with them. Warm Regards, Tony Fiorello and the Tatum Surgical Staff 2011 Summer Implant Special! Buy 20 implants for only $2000! We have found a great way for you to easily sharpen your surgical instruments! This belt sander puts a great edge on Microtomes, Osteotomes, etc. A sharp instrument will make surgeries much easier on you and your patients! The compact height is 14 inches, and only 11 inches wide so it can easily be used within your laboratory. Only $159.00

2 The Tatum Times A Simple and Quick Approach to Maxillary Sinus Floor Elevation with Immediate Dental Implant Placement. Submitted by Dr. Timothy Hacker thacker@thackerdds.com The placement of dental implants in the posterior maxillary arch is restricted by several anatomical landmarks, most notably the pneumatized maxillary sinus. This is a very popular subject with dentists who want to help their patients chew better by replacing their missing posterior maxillary teeth. A search in Pub-Med on maxillary sinus elevation surgery revealed 876 articles. The purpose of this paper is to describe a protocol of very safely lifting the maxillary sinus floor and immediate implant placement that is consistent with NIRISAB concepts. The most common site will be the maxillary first and second molar region. The maxillary second premolar is less frequent, followed by the first premolar. The cuspid is almost never involved. However, a careful evaluation of the patient s presenting anatomy and any panoramic and CT images are useful in planning your surgical case. It is also wise to have an in-depth understanding of the maxillary sinus boundaries including neurovascular supplies. (1)(2) The patient should be free of complicating medical issues, as well as consensual for the procedure. Be sure to advise your patient before the procedure of any dental complications such as severe bruxism, periodontal disease and smoking. The radiographic, clinical and soft tissue evaluations should include adequate clearance from the opposing dentition for the definitive restoration, adequate alveolar width of at least 4mm (free of encroaching undercuts) and alveolar height below the sinus floor of at least 5mm. The interproximal space for implantation should be adequate for implant width plus 2mm-3mm for soft tissue biologic width between any tooth and implant. The alveolus should be healed >4 months following any surgery including extraction and socket grafting. (Figure 1) Figure 1-case selection Figure 2-measure space. Page 2

3 Volume 4, Issue 2 1. The patient is admitted with appropriate consent forms signed. Vital signs are recorded. Any pre-op anxiolitic/antibiotic/steroid protocol of choice is noted on the anesthetic record. 2. The patient does a chlorohexidine rinse for 2 minutes, and undergoes a thorough intraoral and extraoral Betadine swab. They are then sterile draped for surgery, and the Dr. and surgical assistant are sterile gowned appropriate for aseptic surgery. 3. The patient can then have sedation and local anesthetic of choice administered. 4. The implant site is located using ridge calipers and interproximal calipers to establish the implant s trajectory with in stable alveolar bone. A slightly palatal position allows for buccal bone expansion. Also angle the trajectory parallel with the buccal cortical architecture. (Figure 2) 5. A periodontal probe may be used for initial bone expansion in severely atrophic cases, followed by a #15 scalpel blade and graduated tapered bone chisels, and osteotomes or. In some cases of very dense bone a #2- #4 surgical bur can be used to initiate the osteotomy and a graduated drill protocol is used. The initial osteotomy depth is to with-in 1 mm of the radiographic sinus floor. (Figure 3) Figure 3-Expansion 6. As the graduated osteotomes are inserted and malleted to length, the surgeon may feel with their thumb or finger the resultant buccal bone expansion. Take care to go carefully and slowly so as not to tear the buccal periosteum. The tapered osteotome for this step shouldnot penetrate the sinus floor. Take care to tap the osteotome while holding the index finger on the mallet head for full control while striking the osteotome in short deliberate double strikes. This may require an assistant to use the mallet, while the implant surgeon braces the alveolus and osteotome. The osteotome diameter should be 4mm-4.5mm. 7. A straight osteotome of 1mm smaller diameter than the last tapered osteotome (tapered drill) is selected and inserted into the osteotomy. (Figures 4 & 5) The osteotome should easily go up to with-in 2mm of the radiographic sinus floor. The mallet is used to gently take the osteotome through the established radiographic alveolar bone height. The surgeon can feel the up-fracture of the sinus floor at that time as the firmness of the bone gives way. Some alveolar bone particles will be taken ahead of the osteotome flat surface as you form a new dome like sinus floor. A 1cm square collagen tape is prepared by hydrating it with Lincocin 300mg/cc. The collagen tape is placed atop the straight osteotome. The osteotome is placed back into the osteotomy to length, which at that time may be about 10mm as measured from the tissue crest. (Figure 6 & 7) Use the concave surface of the straight osteotome to place.2cc-.3cc of bone grafting particles of choice into the osteotomy (250 micron particle size). The particles are delivered in small increments, and the straight osteotome is taken to length with each delivery. (Figure 8) It may be advisable but not required to hydrate the grafting material with Lincocin 300mg/cc solution. The flat osteotome may then be advanced 2mm-3mm beyond the alveolar radiographic length. This will be measured again at about 10mm to 11mm from the soft tissue crest. (3)(4) Page 3

4 The Tatum Times Figure 4-Mallet technique. Figure 6-A bone grafting product. Figure 5-Tapered and straight Osteotomes Figure 7-Collatape and Lincocin. 8. Final implant site preparation is preformed with graduated tapered osteotomes of appropriate length and width for the final chosen implant size. For example, the final tapered osteotome length may be 15mm, even for resident bone that was only 5mm in initial height. The final osteotome is measured from the soft tissue crest. Therefore, in a case where the soft tissue is 2mm-3mm in thickness, the sinus floor will be raised 5mm-7mm. The final implant diameter may be 4.5mm for a ridge that had only 4mm pre-operative width! (Figure 9) Figure 8-Placing grafting material with the osteotome. Figure 9-Set of tapered osteotomes, and straight osteotomes required for the procedure. 9. The implant package is opened and the implant is delivered into the osteotomy either by finger fixture mount or hand piece driven fixture mount. The implant should exhibit finger tightness, or about 25n/cm torque. Page 4

5 Volume 4, Issue Usually, no sutures are required. (Figure 10) A final radiograph is taken to confirm the small dome of radio-opaque zone above the implant apex. (Figures 11 & 12) 11. The patient is discharged with an ice pack to face, post-operative antibiotics, analgesics, and steroids of choice with post-operative instructions given. The patient is seen in the clinic for post-op the following day, and one week. 12. There are usually very little pain, swelling, or infection complications with this procedure. Most patients who have not had conscious sedation may return to normal activity, including work, immediately following the procedure. There are no dietary restrictions. 13. The implant may be restored following a >4 month integration period. Figure 10-Final implant position. Figure 11- Post-op radiograph showing dome of grafted bone and lifted sinus floor. Figure 12- Post-op radiograph showing dome of graft around implant apex. This is a different case. (1) Clin Oral Implants Res Feb;10(1): Blood supply to the maxillary sinus relevant to sinus floor elevation procedures. Solar P, Geyerhofer U, Traxler H, Windisch A, Ulm C, Watzek G. (2) nt J Oral Maxillofac Implants. 2007;22 Suppl: Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Ahaloo TL, Moy PK. University of California at Los Angeles (UCLA) School of Dentistry, Los Angeles, California , USA. (3) J Periodontol Feb;72(2): Porous bovine bone mineral in healing of human extraction sockets: 2. Histochemical observations at 9 months. Artzi Z, Tal H, Dayan D. Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel. zviartzi@ccs (4) J Periodontol Jun;79(6): Bone formation following implantation of bone biomaterials into extraction sites. Molly L, Vandromme H, Quirynen M, Schepers E, Adams JL, van Steenberghe D. Page 5

6 The Tatum Times Users of the Month We are pleased to announce our Users of the Month for January, February, and March. For this accomplishment, these clinicians will receive four complimentary implants of their choice. January Dr. Marco Munoz San Jose, Costa Rica February Dr. Chad Lewison Canton, SD March Dr. Vincent Liang Milpitas, CA Did you know? This website is a great resource for indentifying implants that walk in the door and are in need of help. Appreciation goes out to Dr. John Lin for all your technical support and mentorship on the West Coast! We are offering 4 complimentary Tatum Dental Implants for anyone who refers a future attendee to a Journey to Remember class in Normandy, France. Tatum Institute International had a very productive series this year. We thank the participants for attending, and hope that each one knows how humbled we are that you chose Tatum Institute for your continuing education. Thank you for the great reviews and testimonials. We are always pleased when we can add value to your practices with the information in the module series. Each attendee also brought something interesting and unique to the class. Our hope is that the relationships we create through teaching will last a lifetime. We look forward to seeing each and everyone of you at the Tatum Institute booth during the AAID meeting in Las Vegas. Every student that refers a friend to the course will receive a free implant of their choice! It has been reported to Rocky Mountain Tissue Bank by clinicians that: Irradiated Allogenic Cancellous Bone & Marrow graft material gives results closest to those obtained by autogenous bone. This relates to the predictability, speed, and quality of new bone formation. Indications: Sinus Augmentation Sinus Lift On-Lay Grafts Periodontal Defects Segmental Osteotomies Tatum Institute International 2012 Class Schedule Module 1: January 20 and 21 Module 2: March 16 and 17 Module 3: May 11 and 12 You are cordially invited to join Dr. Tatum at his home on July 31 Aug 8, 2011 for a "Journey to Remember" in Normandy, France. For more information, tatumimplants@verizon.net. Tatum Surgical would like to welcome Minal Mistry, President of Implant Solutions. A proud addition to our California Dental Implant Support Team. Integrity is the concept of consistency of actions, values, methods, measures, principles, expectations, and outcomes. Page 6