We have been relying upon the wrong tissue for success. The
pericementum was formerly supposed to be necessary for success. Dr.
G. L. Curtiss was first to remove this portion before implanting. Very
few cases are permanent successes. Reports of failure are now coming
in quite frequently. Dr. Fletcher used for experiments a goat and the
teeth of a small dog. Owing to difficulties in holding the teeth in
position, they were maintained in place by sewing over the integument.
The teeth were inserted in the bone rather than the alveolus. Parts of
the crowns were removed so as not to prove so great an irritant to the
integumentary covering. Bichlorid was used throughout.
After nine months they were opened into. In all cases periosteum had
grown over them. All but two had almost entirely disappeared. In one
case, cementum became reorganized and grew at the expense of the
dentine. The pericementum cuts no figure in implantation of teeth.
Implanted teeth can never be successful for these reasons: First,
teeth are developed from a different structure than bone. If dried
pericementum took on new life and performed its functions as before, it
would be a success. If we could implant immediately after a tooth is
extracted, success is more probable. It would be equal to skin or bone
graft. If the cementum becomes reorganized, it can grow only at the
expense of the dentine. If resorbtion takes place in vital tissues it
certainly is so in dead tissues. So it would be but a few years until
the whole root would be replaced by a new material, probably bone,
since it is produced by bone-producing tissue.
The experiments of Drs. Hopkins and Penrose were reviewed in this
connection and the following deductions drawn. First, sterilized bone
in favorable conditions undergoes organization. When acted upon by
periosteum is absorbed, and when in a narrow cavity, and not too large
in bulk, organization and absorbtion both take place. Second, these
processes go on most actively between five and eight weeks.
According to Dr. Wm. Savory, tight ivory pegs were more quickly
absorbed than loose ones. He draws the following conclusions:
First—the operation of implantation has fallen into disrepute, either
from failure or loss of confidence.
Second—when the root is covered with dried periosteum the membrane
is absorbed before union takes place, and when union does occur it
is probably that of ankylosis between vascular cementum and the
surrounding bone. In view of which, teeth with much thickness of
cementum are to be preferred, and should be denuded of the membrane
before the operation.
Third—organization takes place better when the tooth is moderately
tightly fitted in solid bone, and for this reason the cicatrix of bone
formed after the extraction of a tooth is the most favorable place for
implanting teeth.
Fourth—that the resorbtion and rebuilding of the tissues of the body
necessitate the absorbtion of the dentine of the roots of implanted
teeth, and thereby their loss. But that as a temporary replacement of
lost teeth, the operation of implantation is justifiable to those who
comprehend it to be such.
_Discussion_—DR. BUTLER:—I have not performed this operation, as I
was doubtful of its final success. The question now is whether it is
justified by its duration of three to five years, and the patient's
liability to disease, etc.
DR. SAGE:—I wish to know what was considered large or small ivory peg.
DR. FLETCHER:—The experiments of the men go to show that bone will
become organized when ivory will not. The only part of a tooth that
may be organized is the cementum. The line of reorganization or
absorbtion is a softened tissue, so when the process reaches the crown
and is about complete, the crown drops off. If a very fresh tooth is
implanted, the membrane may be accepted.
The following officers were elected for the ensuing year:
President, E. G. Betty, Cincinnati, O.; First Vice-President, J.
R. Callahan, Cincinnati, O.; Second Vice-President, G. H. Wilson,
Painsville, O.; Secretary, Otto Arnold, Columbus, O.; Assistant
Secretary, Henry Barnes, Cleveland, O.; Treasurer, C. Q. Keeley,
Hamilton, O.
H. T. Smith re-elected member Board of Examiners.