J Oral Maxillofac
ARTICLE OR EDITORIAL: WHO NOSE?
reasons, but demineralized bone powder has been used by many clinicians with remarkable success.
To the Editor-The article “Rhinoplasty: A Humbling Experience” by E. Gaylon McCollough in the November 1989 issue (47: 1132) was an excellent opinion paper. This article, however, should not have appeared among “Clinical Articles.” The views expressed are solely the opinions of Dr McCollough. Although I may agree with many of his observations, this article should have appeared only as an editorial. There is not a single reference to sustain any of his statements. A statement such as “a surgeon performing rhinoplasty is considered proficient only after approximately 8 years of experience and continuing education” appearing in the clinical article section of our specialties journal is potentially a legal “kiss of death” to oral and maxillofacial surgeons who are broadening the scope of our profession. The editors of the Journal of Oral and Maxillofacial Surgery should reconsider Dr McCollough’s article and officially categorize it as an editorial.
MOHAMEDSHARAWY,BDS, PHD Augusta, Georgia WHERE HAVE ALL THE CLICKERS GONE?
TIMOTHYJ. CARRION,DDS Baltimore, Maryland BONE INDUCTION IN PRIMATESBY
To the Editor:-One of the advantages of grey hair is the opportunity to have seen “great new operations” that end up being discarded 10 years later. It is with full awareness of the storm I will produce that I ask, where are the disabled patients over 50 years old who never had the privilege of “current TMJ surgery” techniques? Certainly, if surgery were indicated today for patients in their 20s 30s and 40s we would see many patients in their 50s 60s. and 70s who have joints that are not functioning well. This is just not the case. What conclusions are obvious then? Internal derangements are self-limiting disorders. They are disorders that eventually seem to “self-correct” to adequate function. The next big question is, how many operated joints will be functioning joints in the years ahead? Are we going to see a large group of iatrogenically produced “real TMJ cripples” in the years ahead? ROBERTHIMMELFARB,DDS, FACD Hempstead, New York
DEMINERALIZEDBONE MATRIX To the Editor:-1 read with interest the discussion page written by Dr Leonard B. Kaban (J Oral Maxillofac Surg 47:1187, 1989) in which he commented on the article, “Calvarial Bone Regeneration Using Osteogenin,” written by Hollinger et al (J Oral Maxillofac Surg 47: 1182, 1989). Dr Kaban stated “Laboratory studies using demineralized bone matrix and bone-derived acid insoluble proteins in higher animals are needed to improve our understanding of bone induction.” I wish to refer Dr Kaban to our article, “Osteoinduction in Rhesus Monkeys Using Demineralized Bone Powder Allografts” (J Oral Maxillofac Surg 43:837, 1985). We also published an article, “Alveolar Ridge Augmentation in Macaca fascicularis Using Polysulfone With and Without Demineralized Bone Powder” (J Oral Maxillofat Surg 47: 1169, 1989), in the same volume in which Dr Kaban’s discussion appeared. Both of these reports clearly show that bone induction by demineralized bone matrix is not a phenomenon only in rodents and that it can occur in nonhuman primates. Evidence of bone induction in humans is hard to demonstrate for obvious
BECOMING AN EXPERT IN ORAL IMPLANTOLOGY To the Editor:-Your
editorial, “Implanting the Right Idea,” in a recent issue (J Oral Maxillofac Surg 47:1013, 1989) was excellent. Because I am a general practitioner involved with dental implants, I come under the general classification of “Implantologist.” I enjoy an extremely good working relationship with all of the oral surgeons in my area. When I started doing dental implants 11 years ago, I visited all the oral surgeons in my area and told them what my plans were regarding implants. At that time, most oral surgeons were not really interested in dental implants. Most of my early training was from other general practitioners who had developed an interest in implants. In my opinion, the person who is best equipped to do dental implants is a practitioner who is willing to put forth the effort to become expert in the field. Most oral surgeons and periodontists were not trained in implant dentistry. The oral surgeons and periodontists that I see becoming experts with implants are the ones who do not assume that their specialty status gives them credentials regarding implant dentistry. Oral surgeons, periodontists, or general practitioners can become expert in implant dentistry, but to do so requires courses and experience. Even though I do very complex surgical implant cases, I refer all extractions and all periodontal surgery. With the degree of complexity of TMJ surgery, trauma surgery, and orthognathic surgery, I doubt that an oral surgeon can become expert in all areas within oral surgery, including implants. DOUGLASP. CLEPPER,DMD Augusta, Georgia