Due to rapid bone loss after upper teeth are removed and continued bone loss from the pressure of removable bridges and dentures, the amount of bone available for the placement of dental implants has been limited.

In 1974, Dr. Hilt Tatum developed a procedure for adding the necessary bone for dental implants to replace upper missing teeth. This procedure is now done all over the world and has become the most predictable grafting site in the intraoral region.

These procedures have been divided into 4 types, depending on the amount of bone left at the time implant therapy is contemplated. These divisions of treatment include SA1,SA2,SA3 & SA4.

In SA-1, there is enough bone left to place the implants in a normal fashion without the addition of any extra bone.

In SA-2, there is enough bone to secure the implant of the proper length and width. In this procedure, the necessary bone for the implant is created by expanding the bone in width and height from within the implant site, thereby creating a new sinus floor.

In SA-3, there is just barely enough bone to secure the implant and a total lack of bone for the proper placement of a implant of necessary length and width. In this procedure, the necessary bone is added in the form of a graft which creates a new sinus floor. Since there is enough bone initially present to stabilize the implants, it is possible to place the implants at the same time as the SA-3 procedure.

In the case of a SA-4, there is so little bone left that initial stabilization of the implants is impossible. The same procedure that is covered in the SA-3 is performed with the difference being that the implants are not placed at this time. A four month period that allows the bone graft to mature is followed by the conventional placement of the implants. A variety of graft materials can be used in these procedures.

Restoration of SA-1,2,3 and 4 is done by conventional crown and bridge techniques after a maturation period of 6 to 10 months. It is important that the initial loads placed on these implants be light and then gradually increased over time.