Salvage of the mandibular staple bone plate following bone infection.

Two cases of previously unreported complications associated with implantation of a mandibular staple bone plate are presented. One was a proven case of chronic osteomyelitis, and the other had a close clinical and radiographic resemblance to osteomyelitis. It is suspected in both cases that complications were due to the use of a dull twist drill that caused local tissue injury. Differences in the clinical courses are believed to be related to the degree of oral hygiene after surgery, with a more severe infection occurring in the patient who maintained extremely poor home care. There is the possibility that some degree of osteoporosis was present in the same patient that may also have influenced the clinical course. While the salvage of implants in areas of osteomyelitis is controversial, it was shown to be justifiable in these cases. Crucial to such salvage is the selection of an antibiotic that is effective against the organisms involved and safe for prolonged use. Cefotaxime and clindamycin were used in the cases reported and proved to be effective and without adverse effect. Although it will take time to see to what degree bone refills the affected areas, it appears at present that the resorptive process has ceased and that bone regeneration is in progress. Prevention of the complications reported here is believed to be possible with the use of sharp drills, slow drilling speed, copious cool irrigation, appropriate antibiotic prophylaxis, and meticulous oral hygiene.

Hyperbaric oxygenation: prosthodontic responsibilities.

This article discussed the use of hyperbaric oxygen in the treatment of chronic osteomyelitis, osteoradionecrosis, and nonhealing wounds. The fabrication of custom-fitted oxygen applicators is presented, and specific recommendations are made for their use. The prosthodontist serves as a valuable member of the hyperbaric treatment team. His professional knowledge and technical expertise allow him to construct treatment applicators which are professionally sound and provide comfort for the patient.

Rehabilitation of grossly deficient mandibles with combined subperiosteal implants and bone grafts.

1. This study has described the osseous reconstruction of deficient edentulous ridges in adult rhesus monkeys. The rebuilt osseous ridges did not resorb under complete prosthetic function over a 4 month period. 2. Remodeling of the graft proceeded along the usually observed patterns with mature cortices forming in the grafted areas within 6 months. 3. This procedure has been duplicated for clinical patients with reasonably good results, restoring function in otherwise untenable prosthetic situations whic had been refractory to other types of prosthetic and surgical treatment. 4. In the future, this method of marrow-bone grafting with a simultaneous subperiosteal implant may restore function in many edentulous patients who have experienced extreme resorption over the mandibular ridge and in whom conventional implant techniques or the usual type of bone grafting procedures has not been successful.

The use of woven ceramic fabric as a periodontal allograft.

1. The grafted material appears extremely compatible with the animals tested for the observed time periods. 2. The procedures used led to the obliteration of surgically created one-wall infrabony periodontal pockets with fibrous connective tissue and/or bone. 3. The ready access, ease of placement and flexibility of the woven ceramic materials appear to provide some definite advantages over autogenous bone and many of the alloplastic materials presently being used in the correction of infrabony periodontal pockets. 4. Although in the experimental animals the graft materials appeared to be nontoxic, nonantigenic and compatible with the growth of new bone, long-term studies are indicated to determine is compatibility and potential to obliterate "chronic" periodontal lesions.