J Oral Maxillofac Surg

4C547.1990

ARTICLE OR EDITORIAL: WHO NOSE?

To the Editor-The article “Rhinoplasty: A Humbling Experience” by E. Gaylon McCollough in the Novem- ber 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 ap- peared only as an editorial. There is not a single refer- ence to sustain any of his statements.

A statement such as “a surgeon performing rhino- plasty is considered proficient only after approximately 8 years of experience and continuing education” ap- pearing 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 McCol- lough’s article and officially categorize it as an editorial.

TIMOTHY J. CARRION, DDS Baltimore, Maryland

BONE INDUCTION IN PRIMATES BY DEMINERALIZED BONE 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 ar- ticle, “Calvarial Bone Regeneration Using Osteo- genin,” written by Hollinger et al (J Oral Maxillofac Surg 47: 1182, 1989). Dr Kaban stated “Laboratory stud- ies 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 Augmenta- tion in Macaca fascicularis Using Polysulfone With and Without Demineralized Bone Powder” (J Oral Maxillo- fat 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 in- duction in humans is hard to demonstrate for obvious

reasons, but demineralized bone powder has been used by many clinicians with remarkable success.

MOHAMED SHARAWY, BDS, PHD Augusta, Georgia

WHERE HAVE ALL THE CLICKERS GONE?

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 func- tioning well. This is just not the case.

What conclusions are obvious then? Internal derange- ments are self-limiting disorders. They are disorders that eventually seem to “self-correct” to adequate func- tion. 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?

ROBERT HIMMELFARB, DDS, FACD Hempstead, New York

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 inter- est 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 complex- ity 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.

DOUGLAS P. CLEPPER, DMD Augusta, Georgia

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