George W. Greene

The replantation and transplantation of teeth: A review

Abstract The factors which controlled or influenced incorporation of the replant or transplant into the host site were complex and vague. Certain similarities between animal and human studies were noted. Preservation of the periodontal membrane seemed to be an important consideration, as did proper storage of teeth, even for short times prior to replanting or transplanting. Although long-term results were favorable in many cases, resorption of the root was often seen. This resorption was unpredictable in its degree and onset. Generally, where pulpal elements were left intact, degeneration of vital elements followed and eventually produced a pulp that was replaced with a bonelike substance. Both replants and transplants showed successful clinical results well beyond 2 years. Rarely did periodontal pocket formation result from the procedure, and teeth were usually immobile and functional in a relatively short period of time. Root radiolucencies were infrequent, and the regeneration of bone about the root of the tooth was the usual finding. Partially formed teeth did have the ability to complete amelogenesis and cementogenesis, as well as to re-establish a normal periodontal membrane space. The variations in the odontoblast layers seen in normal teeth 146 made this a difficult measure of transplant success, although odontoblasts were observable in many successful transplants. Only brief mention of the “inductive effect” of tooth transplants was made in the literature. The interesting possibilities of this concept parallel those seen in other types of hard tissue graft and transplant. The immunologic implications of tooth transplantation remains a subject of loose interpretation. The literature reflects the need for more sophisticated measures in assessing this important aspect. The storage of tooth tissues in various ways must be a part of the investigation. The uses for replantation and transplantation of teeth are more varied than many would imagine. The fact cannot be denied that enough is now known about these procedures to consider them a part of any dental practice. Long-term results compare favorably with those of other types of therapy, such as fixed prosthetics. It is necessary, however, to pay strict attention to proper case selection and to follow the steps which, to date, have seemed to work the best. The dentist must make every effort to make his case data known, so that the assessment of many of these procedures may be more statistically valid. Furthermore, the basic science challenge has been offered to dentistry in an area where much of dentistry can participate. The reward of our participation is great—better therapy for our patients.

Metastatic tumor to the tongue. Report of twelve cases.

Abstract The authors have reviewed twelve autopsies of metastatic tumors to the tongue. All twelve cases had documented primary tumors in extraoral sites. This rare phenomenon occurred mostly in patients with generalized dissemination of tumor. Four of the twelve patients had clinical manifestations of lingual metastases before death. In this reported series, most metastases were discovered in the basal region of the tongue.

Benign nerve sheath myxoma: light and electron microscopic features of two cases.

Two new cases of the rare benign nerve sheath myxoma (NSM) are presented. The light microscopic findings are compared with previously reported cases. In addition, the ultrastructural features of three constitutent cell types are described. The lesion is confirmed as a neural sheath neoplasm, and its similarities to other myxomas are discussed.

Traumatic neuroma of the oral cavity: Report of thirty-one new cases and review of the literature

Abstract Thirty-one cases of oral traumatic neuroma are presented. The clinical, light microscopic, and ultrastructural features are discussed in relation to the previous literature on the subject. Consideration is given to the possible mechanisms by which neuromas cause pain. The evidence supports the concept that traumatic neuromas in the oral cavity may account for some cases of atypical facial pain and trigeminal neuralgia.

An evaluation of early bone changes after the insertion of metal endosseous implants into the jaws of rhesus monkeys

Abstract Twenty metal endosseous implants were placed into the jaws of rhesus monkeys. Clinical, radiographic, and histologic analysis of specimens for periods of up to 3 months after placement showed that, generally, the implants were well tolerated by these primate tissues.

Osteoid osteoma of the jaws: Report of a case

Abstract It was worthy of note that many similarities existed between the osteoid osteomas of the jaws and those found in much more favored sites, such as the femur, tibia, etc. The jaw lesions attained the usual expected size of 1 cm. in diameter. If conclusions can be drawn from such a small number of cases, it appeared that it was not rare for a nidus to appear as an area of increased density or obvious radiopacity. There were no outward clinical signs of inflammation except swelling, although in none of the reported jaw cases were bacteriologic tests employed. As all of these lesions were treated surgically, no comments concerning spontaneous regression of the jaw lesions can be made at this time. Pain, usually dull and boring and accentuated by tenderness, was the most common clinical symptom motivating treatment. The ability of osteoid osteoma to refer pain to adjacent structures should be considered in the differential diagnosis of unexplainable pain in the maxilla and mandible. Adequate local surgical excision of the nidus was the preferred method of treatment. The use of radiation therapy was discouraged in several studies. We are in agreement with those who believe that radiation should not be used in the treatment of osteoid osteoma. We are not certain as to the exact nature of this lesion, but we will agree with its classification as an entity distinct from benign osteoblastoma, embryonal remnants, or a form of bone abscess or osteomyelitis. Certain fibro-osseous lesions, such as ossifying fibroma and fibrous dysplasia, should not be confused with osteoid osteoma, since they are asymptomatic, grow to a large size, cause displacement of teeth, and lack a nidus. Various stages of cementoma may mimic the roentgenographic appearance of osteoid osteoma; however, multiplicity of sites, association with the apices of teeth, and absence of pain or tenderness would distinguish the cementoma from the osteoid osteoma. It is obvious that the small number of reported cases of osteoid osteoma in the mandible and maxilla prohibits any lasting deductions concerning this lesions behavior in the jaws. It is not unreasonable to assume that its occurrence in these areas is more common than the literature would indicate, and it is hoped that the dentists awareness of it will result in additional cases being reported in the literature.

Effects of Plaster of Paris Implants on Osteogenesis in the Mandible of Dogs

Plaster of Paris has been used to fill defects in the extremities of man and animal (L. F. Peltier, Amer. J. Surg., 97:311-15, 1959; L. F. Peltier and D. Orn, Surg. Forum, 8:571-74, 1957; L. F. Peltier and R. Lillo, Surg. Forum, 6:556-58, 1955), and it has been tolerated as an implant in the mandible of dogs (N. R. Calhoun, Quart. nat. dent. Ass., 21:13-15, 1962) without any apparent detrimental effects. Dental plaster of Paris (CaSO4) was mixed with water, made into standardized blocks, and sterilized by dry heat. Under general anesthesia, the mandibular left fourth premolars and a section of adjacent bone equal to approximately the mesiodistal diameter of the tooth were excised from 24 mongrel dogs (Group 1). The ostectomy produced a surgical fracture. Separation of the bone edges equal to ap-

The crypt surface of blade-vent implants in clinical failure: An electron microscopic study

Abstract An electron microscopic investigation was undertaken in an attempt to ascertain the nature of the blade-vent implant crypt wall in clinical failures. All observations were made on tissues removed from the crypt surface of endosseous metal implants placed in the jaws of both human subjects and rhesus monkeys. From the information currently available and the results obtained in this investigation, two conclusions appear to emerge with some degree of clarity. First, animal experimentation has demonstrated a highly vascular osteogenic connective tissue lining the implant crypt in clinically successful cases. Second, electron microscopic analysis of tissue obtained from both man and monkey and from all levels of the implant crypt surface of clinically failing blades revealed: (1) delayed osteogenesis, (2) epithelial cell migration along the entire crypt surface, (3) persistent inflammation, and (4) a thick subepithelial connective-tissue component composed of collagen fibers and inflammatory cells.

The failing blade-vent implant

Abstract The histopathologic events that follow the placement of metal endosseous blade implants are discussed. Cases were selected from groups of animals in which implants remained in place for 6 months to 2 years. In most cases, clinical symptoms correlated directly with microscopic findings. It is concluded that mobile dental implants of this type should be removed.

Squamous-cell carcinoma of the floor of the mouth.

This study was based on the analysis of 100 cases of squamous-cell carcinoma of the floor of the mouth. The male/female ratio was 4.25:1. The peak incidence in women was in the 50 to 59 year age group; in men there was equal frequency in each age group above 50. The five-year survival rate decreased from 86 per cent to 0 as the stage of disease progressed from I to IV. The five-year survival for all stages of disease was 52.7 per cent. Thirty-three per cent developed new primary malignancies; 22 per cent were of the upper alimentary and respiratory tracts. Distant metastases were present in 21 per cent. Fifty per cent were heavy smokers, 33 per cent were heavy drinkers, 28 per cent were both heavy smokers and heavy drinkers, and 21 per cent were nonsmokers and nondrinkers.