Joseph R. Natiella

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.

Degradative effects of conventional steam sterilization on biomaterial surfaces

Prior to implantation trials in animals, the effect of steam sterilization on the surface properties of metallic and coated biomaterials was studied. Pure germanium plates and cast surgical Vitallium discs and subperiosteal implants were treated to present three standard types of biomaterials surfaces prior to steam sterilization, ranging from scrupulously clean, high-energy metals to uniformly low-energy organic layers. Both before and after sterilization, the sample surfaces were characterized by a variety of nondestructive physiochemical techniques. The results indicate that steam sterilization is likely to compromise the properties of otherwise carefully prepared biomedical implants by depositing hydrophobic organic and hygroscopic salt contaminants over the implant surfaces.

Diagnosis and reconstruction of the human temporomandibular joint after trauma or internal derangement.

This study reviewed the standardized records of 1100 patients with the symptoms of temporomandibular joint syndrome. Of these patients, only 4.5 percent required surgical intervention. The remaining patients were found to have masticatory muscle spasm and were treated by conservative dental methods. Over half the surgical patients had significant macrotrauma to the jaws in their past history. In addition, electromyographic measurement of the masseteric silent period duration in these patients did not reveal muscle spasm. These factors further serve to differentiate the surgical patient from the patient with myofascial pain dysfunction. The patients selected for surgery demonstrated moderate to severe joint disease and required arthroplasty with partial meniscectomy. A surgical technique is presented demonstrating the reconstruction of the meniscus with silicone implant. This same surgical technique is studied in 10 monkeys, and their joints are examined histologically. The results of surgery reveal that 87 percent of the patients reported improvement 1 year after surgery. In all patients complaining of temporomandibular joint clicking or crepitus, surgery produced complete alleviation of these symptoms. The results of surgery were also associated with a 62 percent increase of jaw opening. Histologic evaluation of the human meniscal resections revealed that in addition to an anatomic displacement of the meniscus, there are also significant cellular changes. These changes consisted of calcification, a decrease in cellularity, hyperemia, and a decrease in elastin content.

Artifacts in oral biopsy specimens

More than proper surgical technique is required to facilitate the proper diagnosis of an oral biopsy specimen. The proper preparation of the tissue for microscopic analysis depends on steps taken by the surgeon, assistant, and histotechnician to reduce the inclusion of artifacts. There are many ways that the exact interpretation of tissue specimens can be compromised. Unfortunately, many practitioners seem to be unaware of the extent of this problem, as well as how easily artifacts can be prevented.

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.

Structural studies of human saliva

Samples of mixed saliva and of parotid and sublingual/submandibular saliva fractions from four donors were subjected to instantaneous solidification in liquid nitrogen followed by sectioning in a microtome/cryostat. The sections were stained with hematoxylin-eosin, periodic acid-Schiff, Alcian blue, Oil-red-O, or Sudan Black B and then examined at the light-microscopic level. In all the sectioned samples several previously never described features were observed, the most pronounced of which were a loose overall network structure and collections of lipoid droplets often in a loose arrangement. In the mixed saliva sample sections many of the microorganism-like structures were observed in large bunches associated with epithelial cells and densely staining saliva components. The present method was tested in a series of experiments for possible errors.

Evaluation of the crypt surface adjacent to metal endosseous implants: An electron microscopic study in clinically successful implants

Abstract The tissue lining the implant crypt surface in the upper and lower jaws of rhesus monkeys was examined by means of electron microscopic techniques. No epithelium or periodontal-like membrane was observed adjacent to the body of the blade but rather a highly vascular connective tissue with osteogenic potentialities. In general, no form of soft-tissue attachment to the titanium blade existed. This tissue has an outer dense cellular layer of fibroblast-like cells or mesenchymal cells, a middle layer of highly vascular osteogenic connective tissue which resembles an embryonic fibrous tissue with preosteoblasts, and a layer of osteoblasts next to osteoid matrix and bone.

The use of elemental microanalysis in verification of the composition of presumptive amalgam tattoo

Routine histochemistry, special stains, and energy dispersive x-ray microanalysis (EDX) were used to analyze 15 cases of presumptive amalgam tattoo. Histologically, the fine, spherical, golden brown granules of amalgam were remarkably similar to hemosiderin and melanin granules, and routine and special stains were not always reliable in differentiating one from the others. EDX provided a simple, fast, inexpensive, and reliable method for identifying the precise elemental composition of the pigmented material.

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.