_^^ _““_ __^”x”““,““__ “_“.”

xI”,_I”^___

J Oral Maxlllofac 49:1361-1362.

“__

_^~~^^“““_“__

Surg

1991

throughout the immune system.” Dr Homsy’s letter references “foreign-body reaction” as being “a biological response directly analogous to wound healing.” It seems to me that the two statements are in direct contradiction. Over 1,500 personal injury claims have been filed against the Vitek bankruptcy, including mine. Does he believe that 1,500 patients failed to follow their physician’s instructions‘? I think not. I am enraged that Dr Homsy could blatantly blame thousands of innocent people for someone else’s mistake. I have personally had 15 TMJ surgeries as a direct result of Vitek’s implant and am personally acquainted with four other people who have also had multiple surgeries. The number of operations on these four people resulting from the Vitek implant is in excess of 65. I now have total, bilateral (Christensen type) prosthetic joints and one of my friends has had bilateral costochondral graft reconstruction. We are innocent victims whose lives have been destroyed by catastrophic health problems and insurmountable medical bills (many of which, I might add are not recoverable from our insurance companies) due to an inferior product. People like myself are not the cause of this problem, Dr Homsy. we are the result!

No FLAP ABOUT THIS PROCEDURE TO the Editor:--1 read with great pleasure the recent article authored by Drs Yih and Morita on management of large bony defects (J Oral Maxillofac Surg 48:689, 1991). I have been using this technique for the past 28 years, having published a case report in the September 1964 issue of the then Journal ofOral Surgery, and I believe it is surgically sound and an excellent procedure following removal of large cysts from the jaws. My only comment is that I like to have a wider base in the development of the osteoperiosteal flap. I also found that the osteoperiosteal flap is easily fractured at the base of the pedicle. To maintain the bone, I simply pack the defect with Gelfoam after the cavity is carefully debrided and irrigated with copious amounts of saline. I also wish to commend the editor for putting this article in the Journal. It seems as though sometimes the articles published are dedicated solely to orthognathic surgery and various other major surgical procedures. It is refreshing to we “oral surgeons in the field” to read articles written about procedures that are the “bread and butter” of our daily practice. MICHAELJ. SMIRNE.DDS Scranton, Pennsylvania THE PATIENT’S VIEWPOINT ON TMJ IMPLANTS

PAULA BEAULIEU. CDA, EFDA. EFODA Portland, Oregon FURTHER LESSONS ABOUT THE

TO the Editor:-1

would like to respond to the letter entitled “Reasons For Failure Of Proplast/Teflon Disc Replacements” (J Oral Maxillofac Surg 49:778, 1991) by Charles A. Homsy, ScD. former President of the defunct Vitek, Inc. Houston. Texas. I am personally offended by Dr Homsy’s letter, which basically put the blame of failure of the Vitek implant on the patients. To quote him directly, “Patients who fail to follow instructions to unload their joints have caused procedure failure.” If the failure of these implants is simply due to the inability of the patients to follow proper, postoperative instructions, why did the FDA issue a Safety Alert on May 16, 1990? I would like to quote from the FDA report dated January 15, 1991. “The ProplastiTeflon material is not substantially equivalent to Silastic. TMJ IPIs made from this material may fragment, delaminate or otherwise be damaged or punctured in a load bearing position. Debris in the joint from the implants can contribute to progressive bone degeneration of the condyle of the mandible and/or glenoid fossa and to foreign body response which could start in this area and be carried

PROPLAST-TEFLONTMJ IMPLANT To the Editor:--This letter comments on Dr John Kent’s letter “Important Lesson about Biomaterials in the TMJ” (J Oral Maxillofac Surg 49:442. 1991). Since he takes issue with Vitek’s testing of the ProplasUTeflon Interpositional Implant (PTIPI), I believe it is important to clarify his role in its development and marketing. In the 1970s Dr Kent worked jointly with Vitek in designing TMJ implants (condyles) and facial implants. His experience with the use of ProplastiTeflon laminations for TMJ disease began in 1974, when he used them as interpositional implants to restore lost vertical dimension following high condylectomy.’ His early impressions of the safety and efficacy of the laminations for this use were very encouraging. In his experience, no alternative implant material, such as silicone rubber sheeting or autogenous tissue, had proven satisfactory up to that time. In September of 1978, he joined with colleagues to report the clinical results of 1 to 4 years’ experience with the ProplastiTeflon laminations.2 His continued satisfactory use of the laminations was reported in September 19813 in a review of 81 patients who were treated over a 7-year period. By letter in early 1982 he reported analogous results of others” to Vitek. We discussed the previous wear testing, which showed the high resistance to wear of the Teflon FEP polymer used for articulation in the Proplast/Teflon laminates under the maximum expected load determined by using the Hylander and Smith data.’ Most importantly was what Dr Kent and other surgeons observed in those cases where the Proplast laminated to

1361

The patient's viewpoint on TMJ implants.

_^^ _““_ __^”x”““,““__ “_“.” xI”,_I”^___ J Oral Maxlllofac 49:1361-1362. “__ _^~~^^“““_“__ Surg 1991 throughout the immune system.” Dr Homsy’s...
174KB Sizes 0 Downloads 0 Views