Dan E. Tolman

Maxillary antral and nasal one-stage inlay composite bone graft: Preliminary report on 30 recipient sites

A one-stage antral and nasal inlay composite bone grafting procedure is described. Preliminary statistical data (1 to 6 years experience with the procedure) is presented for 30 recipient sites in 20 patients. A complete bone-supported fixed prosthesis was used and has provided continuous function in all patients to date. Implant survival has approached that of implants placed in uncompromised maxillary or mandibular bone.

Tissue Integration in Oral, Orthopedic and Maxillofacial Reconstruction

This work contains papers from an international congress on tissue integration in oral, orthopaedic and maxillofacial reconstruction, held at the Mayo Clinic in 1990. It includes 50 presentations along with the consensus reports from four panels on tissue-integrated prostheses.

Keratocysts of the jaw. Clinicopathologic study of 79 patients

A study of 79 patients with keratocysts of the jaws revealed that 72% of the cysts were in the mandible, predominantly in the ramus. The most common symptom was a painful swelling in the jaw. Enucleation was used in 69.2% of the cases. The recurrence rate was 39%. Total removal of the lining of the keratocyst is essential to prevent recurrence.

Endosseous implants in an irradiated tissue bed

Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.

Dental Implants: Tissue-Integrated Prosthesis Utilizing the Osseointegration Concept

As an alternative to conventional removable dentures, osseointegrated dental implants can now be used in carefully selected edentulous or partially edentulous patients. The implant consists of a dental prosthesis and an anchorage unit made up of screw-connected components. The implantation procedure is performed in two phases: fixture installation and fixture uncovering and abutment connection. After completion of these surgical procedures, the dental prosthesis is fabricated and inserted. Follow-up examinations are scheduled at 1, 3, and 6 months and then annually thereafter. During a 2-year period at the Mayo Clinic, 358 osseointegrated dental fixtures were implanted in 70 patients. The overall success rate in this consecutive series of patients was 98%, and the associated complications were minimal and easily resolved.

Extraoral application of osseointegrated implants

The use of osseointegrated implants to provide support for craniofacial prostheses has provided the clinician with another approach to the treatment of complex craniofacial reconstructive problems. The surgical technique is reviewed and the Mayo Clinic experience is presented.

Tissue-Integrated Dental Prostheses: The First 78 Months of Experience at the Mayo Clinic

During a 78-month period at the Mayo Clinic, 1,778 Brånemark endosseous dental implants were placed in the edentulous or partially edentulous jaws of 353 consecutive patients who ranged in age from 8 to 82 years. The largest treatment category involved edentulous mandibles, which accounted for 53% of the total restorations. Approximately 76% of the threaded cylindrical implants supported 312 oral prostheses at the end of the study period. The implant survival rate was 97.8% in the mandible and 88.8% in the maxilla. Complications associated with this treatment included loss of implant anchorage in bone, soft tissue problems, and mechanical difficulties related to design and function of the prostheses. All complications were managed without loss of continuous function of the prostheses, except in four patients who resumed wearing a conventional removable maxillary complete denture. This experience demonstrates that Brånemark endosseous dental implants are predictable and can provide lasting integration under function when placed and loaded in accordance with the recommended protocol.

A new method for fixation of external prostheses.

As more extensive craniofacial resections for recurrent orbital and nasoethmoidal carcinoma are performed, the need for complex external prostheses increases. A new method of stabilization for large prostheses using osseointegrated implants is presented. This is illustrated in a typical patient who underwent a large naso-orbital maxillary resection for recurrent basal cell carcinoma.

The use of panoramic radiography in the medical center

Abstract There are innumerable indications and applications for the panoramic radiographic examination of maxillomandibular structure and teeth. This procedure can be used in diagnosis, treatment planning, treatment, and follow-up service. In the medical center, the dentist should make it known that panoramic equipment is available if it is not located within the general radiologic facility. The otolaryngologist, the plastic surgeon, and the head and neck surgeon, especially, will have occasion to use this radiographic technique to advantage and should be aware of its possible applications.

Nerve Endings in Gingival Tissue

In man the gingiva is a form of transitional mucous membrane, and its sensory capacity and sensory topography are of great interest to both clinician and patient. Previous investigations of the innervation of the gingiva have produced between fifteen and twenty descriptive terms for gingival nerve endings. A few investigators have concluded that the gingiva has relatively few nerves, while others have emphasized a rich innervation. A number of reviews of the literature on gingival innervation have been made and these disparate views have not been reconciled. One hypothesis states that a specific relationship exists between modalities of sensation, such as pain, temperature, and touch, and certain characteristic nerve endings. In recent years, the work of Weddell, Palmer, and Palliet and Winkelmann2-5 has shown that there is no specific feature that will distinguish a nerve ending in its capacity to perceive a specific sensation. This work has demonstrated that all the separate endings recognized in human skin are capable of perceiving the same sensation and, conversely, that the dermal nerve network is similarly capable of perceiving all the sensations that may be perceived.i I The mucocutaneous end organ, the Meissner corpuscle, and the Vater-Pacini corpuscle are the only specialized endings present in man, and these are found in specialized regions of hairless skin. Over the broad surface of the body, sensation is perceived by the dermal nerve networks and the hair-follicle nerve networks. Information about the nerve end-