4500 140th Avenue North, Suite 112 Phone: 888-360-5550

Clearwater, Florida 33762 Fax: 727-531-6005

www.tatumsurgical.com tatumimplants@verizon.net

June, 2010 Volume 3, Issue 2

The Tatum Times

“As many of you know, in 1975, I developed the Sinus Augmentation procedure. Many said this "maverick" surgery would not accomplish anything positive and cause great harm to patients. But after observing results and predictability, I realized that this procedure was going to have a great impact on the future options and benefits of implant treatment. My goal in dentistry has been to care for my patients to the best of my ability and to treat them with the respect and compassion that I would like to receive. My goals are to restore and maintain my patients to natural contour, comfort, function, esthetics and health. How can we provide this extraordinary care for each and every one of our patients without our implant field growing and becoming more educated and aware? For several years, I have felt that a major part of what is currently being taught and practiced in implantology can be done simpler, safer, more naturally and less expensive. I call this approach, NIRISAB. (Natural Implant Restoration In Stable Alveolar Bone) NIRISAB has resulted from a 40 year attempt to restore bone loss, achieve natural esthetics and have long-term success. Today, I feel that this concept and the techniques it utilizes can change implant dentistry as we know it. This is a positive and much needed change from the excessive commercial influence which I feel is promoting entry level education and techniques as advanced education. I long to see an increase of ethics and integrity return to our implant field. For those of you who have explored this concept and have sought further education utilizing the NIRISAB philosophy, I am so proud of you. I urge the remainder of our readers to realize how this will change your practice for the better and also change the relationships that you have with your patients. We are teaching NIRISAB in several locations and on several different levels. I look forward to spending time with each of you hearing your NIRISAB success stories!”

A personal note from Dr. Tatum...

Case Presentation by Dr. Bernee Dunson

2 - 5

Upcoming Events 5

Users of the Month

6

ADII Update 6

Inside this issue: Our latest graduates from the “Journey to Remember” class of May 2010. These participants gained over 40 hours of NIRISAB training with Dr. Tatum. Our next group will be joining us the first week of August. We are only three rooms short of capacity. This is a once in a lifetime opportunity and should not be missed.

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The Tatum Times www.tatumsurgical.com

Restorative Dentistry:

Using the NIRISAB Concept

Dr. Bernee Dunson Restorative Director

Tatum Institute, USA

For more than 50 years, Hilt Tatum Jr. has pioneered the field of Implant Dentistry. Within the past decade he has entitled his approach to the field “NIRISAB”. NIRISAB is an acronym for ­Natural Implant Restoration in Stable Alveolar Bone. “NIRISAB” is a philosophy, a concept of how to approach the end goal of restoring the presenting patient to normal contour, esthetics, speech, and health, regardless of the degree of atrophy, disease, or injury to the stomatognathic system. Dr. Tatum expresses that he arrived at this name simply because every word both collectively and independently takes on an important meaning for the field of implant dentistry. “Natural Implant Restoration” is of obvious importance because the goal for all modern dentists should be to have the final prosthesis appear and function as natural as possible. Alveolar bone is crucial to success because it possesses the genetic coding to allow for greater predictability of integration, functional load capacity and long term stability, therefore providing meaning to the latter part of the NIRISAB name, “Stable Alveolar Bone.” This philosophy or concept includes but is not limited to Sinus Grafting (lateral wall subantral augmentation), Bone Expansion (Compaction and Manipulation), Soft Tissue Grafting, Bone Grafting through remote incisions, Vascularized Segmental Osteotomies and Nerve Lateralization. For the past 17 years I have been a student of Dr. Tatum, Dr. Borgner and others who subscribe to this philosophy to improve the quality of our patients’ lives. Through the vehicle of the “Tatum Times” we here at Tatum Institute International -Atlanta and The Atlanta Academy of Reconstructive Dentistry would like to present a series of cases that utilize “NIRISAB” to predictability serves our patients.

This Case Report:

Pre-Operative Sinus Panorex

Our case for this issue is a familiar scenario for all restoring dentists. Our patient is a 53 year old female who presents with a Kennedy Class III partial edentulous maxillary arch (Fig. 1). She currently has a combination of a Fixed Prosthesis in her anterior segment with precision attachments and a removable prosthetic replacing her edentulous segments support by posterior crowns with mesial rest seats (Fig. 2). Her desire is simply to improve her smile and if possible eliminate her removable partial denture.

Figure 1

(Pre-operative

clinical without

prosthesis) Figure 2

(Pre-operative

clinical with

prosthesis)

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Volume 3, Issue 2 www.tatumsurgical.com

The approach to this case embodies the NIRISAB philosophy with a particular embrace to the “Sinus Grafting “and the “Bone Expansion/Manipulation” components. Under a surgical aseptic field and via the use of conscious I.V. sedation and local anesthesia, a crestal incision along with a Tatum papilla releasing incision was created on the patient’s right maxillary arch (Fig 3a).Then following careful periosteal reflection a window was made into the maxillary sinus via the use of a #10 round bur under copious irrigation. This was followed by a series of specially designed Tatum sinus elevators used to elevate the schneiderian lining. A collagen membrane from Salvin Dental and seven grams of irradiated cortical cancellous particulate bone from the Rocky Mountain Tissue Bank were placed into the sinus window (Fig 3b-3c). Closure was accomplished by a continuous 3-0 vicryl suture.

Following a period of four months, eight (8) endosseous transmucosal Tatum implants were placed. Seven (7) tapered in the posterior edentulous segments and one specially designed D-2 implant at the severely atrophic (2mm) edentulous right central incisor via bone expansion (Fig 4-8). Following a six month integration period the case was restored with the uniquely patented “unipost” prosthetic system with its varying post angles for ease of restorative execution (Fig 9-11).

Figure 3a (Revealing the window to the sinus cavity)

Figure 3b (Collagen membrane placed into the sinus cavity)

Figure 3c (7 gms of irradiated cancellous particulate bone mixed with patient’s PRP in Sinus cavity)

Figure 4 (Pre-operative image dis-playing a narrow atrophic ridge)

Figure 5 (#15 blade is utilized to bi-sect the crestal bone to gain access to the interstitial bone)

Figure 6 (Channel former is inserted in the osteotomy)

Figure 7 (The osteotomy expansion is completed to depth with a D-2 bone socket former)

Figure 8 (Tatum D-2 implant is lace with Biogran and patient’s PRP to provide a barrier against epithelial migration into the Osteotomy)

Figure 9 (Mirror view: D-2 implant placed in site #8 to maximize bone to implant surface area for strength in a narrow atrophic ridge site)

Figure 3d (Closure was accom-plished by a continuous 3-0 vicryl suture.)

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The Tatum Times www.tatumsurgical.com

Figure 10 (Occlusal view post implant integration with healing abutments removed)

Figure 11 (Evaluating the opposing dentition by using Tatum post guide try-in. This evaluation will allow the restored implants to have a non-traumatic occlusal relationship with the opposing teeth)

Figure 12 (Selected post compo-nents prepped for final impression)

Figure 13 (Left lateral view: Prepped post displaying normal contour for anatomically correct final restora-tions)

Figure 14 (Right lateral view: prepped post displaying normal contour for anatomically correct final restorations)

Figure 15 (Right lateral view)

Figure 18 (Final Image of frontal view: Displaying proper material dimensions for strength and longevity of restorations while maintain the normal emergence profile)

Figure 17 (Frontal view: Displaying the prepared abutments allowing normal contour for anatomically correct final restorations)

Figure 16 (Left lateral view)

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Volume 3, Issue 2 www.tatumsurgical.com

Did you know?

If you refer a dentist

to our

“Implant 101”

course,

you will receive a

Free Implant.

The occlusal scheme was designed to be a mutually-protected implant occlusion. The centric contacts on the implant restorations were nonexistent in light- centric and present in tight- centric. Lateral excursion provided disclusion of the implant restorations. Ultimately, the use of NIRISAB philosophy provided a predictable approach to restore this patient to a state of health, contour, function and esthetics. She has tolerated the course of the procedures well and expressed extreme pleasure with the restorative outcome.

Kodak 9500

CBCT

Image/

Panorex/

Final

Images

Natural

Implant

Restoration

In

Stable

Alveolar

Bone

Atlanta, Georgia

July 23 - 24, 2010

Implant 101

NIRISAB Concepts:

Dx and Tx planning,

Anatomy, Case Selection,

Osteotomy Preparation,

Implant Placement, Post

Placement, Impressions,

And Lab Considerations.

Atlanta, Georgia

Sept. 10 –11 , 2010

Sinus Manipulation

Bone Expansion

Atlanta, Georgia

Nov. 5-6, 2010

Bone Grafting

Nerve Repositioning

Segmental Osteotomy

Upcoming Events Congratulations to the 2009-2010

graduating class of The Advanced Dental Implant Institute’s

AAID Maxi-course.

Did you know?

We now offer Tatum

analogs and transfers to

allow less chair time for

preparations.

The Tatum Times www.tatumsurgical.com

Users of the Month We are pleased to announce our Users of the Month for January, February, and March 2010. For this accomplishment, these clinicians will receive 4 complimentary implants of their choice.

January Dr. Norman Peets

Gainesville, GA

Did you know? Rocky Mountain Tissue

Bank has developed a great predictable alternative to particulate bone grafts...

Cortical/Cancellous Bone Blocks

Page 6

Visit us at: www.tatumsurgical.com

Dear Doctors: It is such a pleasure for me to witness the enthusiasm and sense of satisfaction of the doctors participating in A Comprehensive Training Program on Oral Rehabilitation and Implant Dentistry! Just picture the scene: Dr. Tatum and Dr. Pedroza, absolutely immersed in teaching what has become their mission; to pass on to other passionate doctors their huge knowledge and expertise in oral implantology. Not to a crowd, but to you. Not from the podium, but next to you, while you watch, assist or perform surgery. Five days every month, for ten months. By the time they complete the Program, they would have participated in around fifty (50!) surgeries, from implant placement to soft tissue and sinus grafting, bone manipulation, to Ramus Frame implants. They also get a robust training on IV Sedation, plus anatomy, pharmacology, surgical complications, complex case discussions, lab exercises, among other topics and activities. The students don’t want to end the training! Our 2009-2010 program will be concluding this month and we will celebrate with a Graduation and Awards Ceremony. It will be as highly rewarding for them as for us, the directors, instructors and coordinator. They should be able to maintain the close mentorship developed during the Program and keep bringing their surgical patients to future sessions at no additional cost! Our mantra is that each of our students should be challenged; again and again, and according to your own level of expertise, until you reach a higher level of proficiency. Great clinicians and mentors such as Dr. Tatum and Dr. Pedroza won’t settle for less. Our next program begins September 23, 2010. If you are ready for an extraordinary training program, then this opportunity is for you! Contact me for more information. Email: miriam.montes59@yahoo.com, or call 787-642-2708. www.theadii.com I’ll be more than pleased to assist you! Best Regards,

Miriam Montes-Mock Program Coordinator

The Puerto Rico MaxiCourse is an excellent experience that I highly recommend. It has expanded my surgical skills and improved my ability to treat complex situations. The course is distinguished by the practical surgical orientation. Participants see many different surgical procedures and management of complications. Thanks to the course I feel comfortable doing bone grafting procedures and posterior mandibular bone manipulation in my office that I had not done before. I appreciate the camaraderie with all involved in the course."

Dr. Greg Cyra Minocqua, Wisconsin

February Dr. Thomas Carroll

Galveston, TX

March Dr. Akash Lapsi Mission Viejo, CA

Dr. José Pedroza: Surgical Director of Tatum Institute, USA and Founder and Director of The Advanced Dental Implant Institute. Miriam Montes-Mock: The Advanced Implant Institute Program Coordinator