Sigurd P. Ramfjord

Healing of gingival mucoperiosteal flaps

Abstract 1. 1. Surgical mucoperiosteal flaps separating the gingiva from the teeth healed without any significant loss of periodontal attachment in all of the fifteen cases examined. 2. 2. Presence or absence of presurgical inflammation or variation in occlusal forces did not seem to influence the healing. 3. 3. By means of serial sectioning, it was possible to observe foreign bodies in the zones of previous surgery in six of the fifteen cases. Focal chronic inflammation was rather severe in three of these six cases three to four months after the flap procedure. 4. 4. Calculus should be removed routinely prior to flap operations, and suction should be used rather than sponges during the operation in order to avoid implantation of foreign bodies.

Anterior displacement of the mandible in adult rhesus monkeys

Abstract An anterior displacement of the mandible of about 1.5 mm. was instituted in five adult rhesus monkeys by placement of cast splints on the mandibular anterior teeth. Appropriate tissues were studied by histologic means. The monkeys could masticate well with the splints in place. No traumatic injury occurred to the functioning surfaces of the temporomandibular joints. A slight mesial or forward positioning of the condyles induced mild adaptive changes in the joints. However, these changes seemed insignificant, nonprogressive, and possibly reversible without treatment. There was evidence of severe trauma and significant adaptive changes in the periodontium of the teeth involved in the dysfunctional occlusal relationship. The main accommodation to the induced anterior mandibular displacement took place in the dentition rather than in the temporomandibular joints. The results of this experiment confirm the importance of adapting the occlusion to the temporomandibular joints rather than hoping for the joints to adapt to the occlusion.

Increased occlusal vertical dimension in adult monkeys

Splints which opened the vertical dimensions on all posterior teeth in five rhesus monkeys were studied over a period of 3 to 36 months. Findings were as follows: 1. The increased vertical dimension of occlusion did not have a pathologic effect on the TMJs. 2. The posterior teeth attached to the splint and the teeth opposing the splint were intruded into the alveolar processes. 3. The nonoccluding incisor teeth extruded, but the epithelial attachment remained close to the cementoenamel junction. 4. The vertical dimension as measured between the markers in the bones of the mandible and maxillae gradually returned toward the pretreatment vertical dimension, although complete closure to this position was not accomplished during the time period of the experiment. 5. The relationship between the epithelial attachment and the cementoenamel junction remained undisturbed by the experiment. 6. After completion of growth, there appeared to be a definite tendency for rebound to the normal pretreatment vertical dimension following increase of the vertical dimension. This was recorded by measurable movements of the teeth.

Anterior displacement of the mandible in adult rhesus monkeys: Long-term observations

Abstract The mandibles of three adult female monkeys were forced into an anterior displacement by means of splints. This displacement was maintained for 1.5 to 3 years. No significant adaptive or pathologic changes due to the altered occlusion were observed in stress-bearing parts of the temporomandibular joints. In one instance, there was evidence of trauma and repair to the lateral part of the joint. This might have been painful for as long as 1½ years. The occlusal relations were permanently changed by splints with a resultant “open bite” of the anterior teeth. Progressive periodontitis with deepening of periodontal pockets developed as a result of irritation associated with the occlusal splints. The pathways of extension of the gingival inflammation did not seem to be related to the presence or absence of trauma from occlusion.

Distal displacement of the mandible in adult rhesus monkeys

Abstract Cast gold splints were cemented on the teeth of four adult rhesus monkeys. The splints were made in such a way that forces of occlusion were directed distally against the temporomandibular joints. The monkeys were killed after 2, 8, 16, and 35 weeks. The traumatic changes in the periodontal structures were much more severe than the changes in the joints. The teeth moved bodily with the splints until posterior occlusal contacts were re-established. At that time, a slight distal displacement of the condyle had taken place. However, in the 35-week-experimental animal, where the teeth had been in occlusal function for the last 15 weeks, the joints were undergoing reversal changes, placing the condyles toward their original position. In no instance was there bone resorption in the inferior surface of the glenoid fossae or in the superior surface of the condyles.

Unilateral function and the temporomandibular joint in rhesus monkeys

Abstract The left mandibular teeth were extracted in five adult rhesus monkeys, and the monkeys were killed after 3 weeks and 3, 6, 14, and 18 months, respectively. Serial sections of all temporomandibular joints were studied and compared with similar sections from five control monkeys without occlusal alterations. There was no evidence of trauma or altered joint morphology as a result of the induced unilateral function. Osteoarthritic changes within the joint did not seem to be related to functional stress or trauma.

Condylar Growth in Rhesus Monkeys

Growth of the mandibular condyle was studied in four rhesus monkeys of different ages. Indexes of 3H-thymidine labeling indicated high premitotic activity, which decreased with age, in the interniediate zone of cartilage and the zone of erosion and bone formation. Premitotic uptake in the articular zone was independent of age.

Changing concepts in periodontics

This article has concentrated on aspects of periodontics where research over the last decade has demonstrated that old concepts are outmoded and for the patients benefit should be changed in clinical practice. The following statements were made. Periodontal pockets do not need to be reduced surgically to a 3 mm limit to save teeth. Bone and soft tissues do not need to be sculptured to uniform horizontal atrophy at the level of the deepest pocket. Treated teeth can be maintained without loss of periodontal support with less than perfect plaque control if professional tooth cleaning every 3 months is practiced. Furcation involvement complicates the treatment of periodontitis, but such teeth have a better prognosis than has been commonly thought. Deep pockets have a relatively good prognosis after treatment. The problem is access for efficient root planing. Advanced periodontitis can be stopped in most patients. Gingival curettage does not improve the results of scaling and root planing. Support for teeth can be maintained without attached gingiva. Gingival blanching in response to lip pull is meaningless. Splinting is not needed for most teeth with increased mobility after periodontal therapy. It was acknowledged that in other controversial aspects of periodontics scientific information still is not available to support firm concepts that may guide clinical practice. One problem in dentistry is the lag that often exists between the publication of research findings and their application in clinical practice if there is no inherent economic reward in the new procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of Root and Alveolar-Bone Growth Associated with Development and Eruption of Teeth in Rhesus Monkeys

Tritiated proline was used to follow the patterns of root growth and alveolar-bone production associated with tooth eruption in rhesus monkeys. Alveolar-bone deposition was seen around the apical regions of both erupting and functioning teeth, which indicated that the apical region was not spatially stable.

The histopathology of inflammatory gingival enlargement

Abstract Meso- and ectodermal inflammatory gingival hyperplasia have been illustrated and discussed. The relation between the various types of hyperplastic gingival lesions has been stressed, and it has been shown that lesions such as puberty gingivitis, pregnancy gingivitis, granuloma gravidarum, granuloma pyogenicum, and giant cell epulis are inflammatory in nature and they all have a similar tendency to undergo fibrosis, scarring, and partial ossification resulting in a so-called “fibroepithelial papilloma,” fibroid or ossifying fibroid epulis. Peripheral zones of irritation and inflammation, found mainly in the crevicular areas and at the base of protruding lesions, seem to act as a stimulus for continuous growth of the lesions. The fibrotic hyperplastic gingival tissues will, to a large extent, persist even following elimination of the initial source of irritation, and those anatomical changes may predispose to future irritation. Traumatization or other circulatory disturbance will initiate mucoid degencration of collagenous lesions. The possibility for one type of inflammatory reaction becoming or coexisting with other types of proliferative responses has been shown. The alteration in character and inflammatory response of the gingival tissues following previous episodes of injury has been emphasized. The complex of local and systemic factors which determines the variations in gingival inflammatory response to injury is only partially known. It is of basic importance in the management of these lesions that an exact differential histologic diagnosis be made of the different types of gingival enlargements. An understanding of the inflammatory nature of the lesions which have been discussed in this paper should encourage a different and more conservative management than would be utilized for neoplastic disease.