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Letters to the Editor Dear Sir An article containing recommendations about devices to be used or abandoned by the dental profession should be based on a meticulously performed litature review by investigators not committed to one of those devices. In the recent article (Albrektsson & Sennerby 1991), the currently used endosseous implants are reviewed per system. The per-osteal mandibuiar implants, the Transmandibular Implant and the Mandibuiar Staple Bone Plate, are reviewed as being "Transmandibular Staple Implant". The two not only differ in the material they are made of but also in indication and use. The Mandibuiar Staple Bone Plate is a prosthetic fastener, the prosthesis being totally tissue borne and contra-indincated in inadequate bone height (Small & Stines 1981). The Transmandibular Implant is loaded by an implant-borne prosthesis and especially used for patients with severe mandibuiar atrophy with a bone height as minimal as 4 mm. The success rate of the Transmandibular Implant determined according to the protocol described in the thesis, "The Transmandibular Implant" (Bosker 1986), was found to be 97,8% and measured in 366 patients, 55 over 10 to 12 years and 149 over 5 years follow-up (Bosker & Van Dijk 1989) and was not estimated by just "some complications in the form of infection and gingival hyperplasia". Besides this, the authors, however, add to the review of the Transmandibular Implant the serious complications of cellular carcinoma, and osteomyelitis to the presence of "transmandibular plates". Such complications are unknown in relation to the Transmandibular Implant, Reviewing the references of the authors shows: • a case report of a squamous cell carcinoma around a pin of the Mandibuiar Staple Bone Plate (Friedman & Vernon 1983) and not the Transmandibular Implant. • a case report of 2 patients with thermal trauma at surgery again around the pins of the Mandibuiar Staple Bone Plate (Davenport et al. 1985)
and not the Transmandibular Implant. The remark of the authors with regard to these complications being related to "transmandibular plates" is misleading.
plant systems, despite a terrible lack of clinical background data in the great majority of cases. In our review, we discussed 2 types of implant under the heading "Transmandibular Staple Implant", namely the Small and the Bosker types. We are aware of several other Yours faithfully transmandibular designs as well as nuRaymond J. Fonseca merous endosseous designs that, because University of Pennsylvania of a relative lack of reporting, were not School of Dental Medicine included in our review. We did, in fact, point out that the Bosker implant is of 4001 Spruce Street Philadelphia, PA 19104-6003 a gold aUoy and we did carefully report not only the reported complications with USA the Bosker device but also that only 6 of 368 patients had had their devices reReferences moved, a figure that, to the uncritical observer, may lead to the conclusion that Albrektsson, T, & Sennerby, L, (1991) State there is a success of the order of 98%. of the art in oral implants, /, Clin. PerioHowever, such figures do not in reality dontol. 18, 474-481, represent proper success figures but Bosker, H, (1986) The transmandibular imrather survival rates, which is a considerplattt. Dissertation, University of Utrecht, The Netherlands, able difference that has been pointed out Bosker, H, & Van Dijk, L, (1989), The by us in several publications (Albrektstransmandibular implant: a 12-year folson et al. 1986, Albrektsson & Lekholm low-up study, J. Oral Maxillofac. Surg 1989, Albrektsson & Sennerby 1990). 47, 442-450, This is why we avoided quoting a speciDavenport, W, L., Heldt, L, & Bump, R, fic success rate which we do not believe L, (1985) Salvage of the mandibuiar stahas been truly observed by Bosker, but ple bone plate following bone infection, instead presented the relevant figures, as /, Oral Maxillofac. Surg, 43, 981-986, far as we can see it, a fair approach. The Friedman, K. E. & Vernon, S, E, (1983) Squamous cell carcinoma developing in cited serious complications were not conjunction with a mandibuiar staple specifically related by us to the Bosker bone plate, J, Oral Maxillofac. Surg. 41, implant, but were nevertheless relevant 265-266, under the given heading TransmandibuSmall, J, A, & Stines, A, V, (1981) Manlar Staple Implants. At the time of writdibuiar staple botte plate; a reconstructive ing our paper, we avoided including a operation for the atrophic mandible. Zimcritical analysis of the relatively small mer Inc, USA, amount of biomaterials research that is behind the type of gold alloy used in the Bosker transmandibular implant. In essence, by quoting correct figures from the paper by Bosker & Van Dijk (1989) as well as a couple of other reports, including the one where Fonseca himself is Dear Sir Our review on the State of the art in oral a co-author, we believe to have honestly implants was an invited paper to the reported on the knowledge available on Journal of Clinical Periodontology. We as- the Bosker implant at the time of subsume one reason for the invitation to mitting our paper. write this review must have been based on that we are knovm to apply the same Yours faithfully rigorous success criteria to any implant Tomas Albrektsson and Lars Sennerby system, irrespective of its origin. We reBiomaterials Group gard this as an important task for the Department of Handicap Research critically oriented scientist in the light of University of Goteborg the continued usage of several oral im- . . Sweden
Response
Letters to the Editor Dear Sir An article containing recommendations about devices to be used or abandoned by the dental profession should be based on a meticulously performed litature review by investigators not committed to one of those devices. In the recent article (Albrektsson & Sennerby 1991), the currently used endosseous implants are reviewed per system. The per-osteal mandibuiar implants, the Transmandibular Implant and the Mandibuiar Staple Bone Plate, are reviewed as being "Transmandibular Staple Implant". The two not only differ in the material they are made of but also in indication and use. The Mandibuiar Staple Bone Plate is a prosthetic fastener, the prosthesis being totally tissue borne and contra-indincated in inadequate bone height (Small & Stines 1981). The Transmandibular Implant is loaded by an implant-borne prosthesis and especially used for patients with severe mandibuiar atrophy with a bone height as minimal as 4 mm. The success rate of the Transmandibular Implant determined according to the protocol described in the thesis, "The Transmandibular Implant" (Bosker 1986), was found to be 97,8% and measured in 366 patients, 55 over 10 to 12 years and 149 over 5 years follow-up (Bosker & Van Dijk 1989) and was not estimated by just "some complications in the form of infection and gingival hyperplasia". Besides this, the authors, however, add to the review of the Transmandibular Implant the serious complications of cellular carcinoma, and osteomyelitis to the presence of "transmandibular plates". Such complications are unknown in relation to the Transmandibular Implant, Reviewing the references of the authors shows: • a case report of a squamous cell carcinoma around a pin of the Mandibuiar Staple Bone Plate (Friedman & Vernon 1983) and not the Transmandibular Implant. • a case report of 2 patients with thermal trauma at surgery again around the pins of the Mandibuiar Staple Bone Plate (Davenport et al. 1985)
and not the Transmandibular Implant. The remark of the authors with regard to these complications being related to "transmandibular plates" is misleading.
plant systems, despite a terrible lack of clinical background data in the great majority of cases. In our review, we discussed 2 types of implant under the heading "Transmandibular Staple Implant", namely the Small and the Bosker types. We are aware of several other Yours faithfully transmandibular designs as well as nuRaymond J. Fonseca merous endosseous designs that, because University of Pennsylvania of a relative lack of reporting, were not School of Dental Medicine included in our review. We did, in fact, point out that the Bosker implant is of 4001 Spruce Street Philadelphia, PA 19104-6003 a gold aUoy and we did carefully report not only the reported complications with USA the Bosker device but also that only 6 of 368 patients had had their devices reReferences moved, a figure that, to the uncritical observer, may lead to the conclusion that Albrektsson, T, & Sennerby, L, (1991) State there is a success of the order of 98%. of the art in oral implants, /, Clin. PerioHowever, such figures do not in reality dontol. 18, 474-481, represent proper success figures but Bosker, H, (1986) The transmandibular imrather survival rates, which is a considerplattt. Dissertation, University of Utrecht, The Netherlands, able difference that has been pointed out Bosker, H, & Van Dijk, L, (1989), The by us in several publications (Albrektstransmandibular implant: a 12-year folson et al. 1986, Albrektsson & Lekholm low-up study, J. Oral Maxillofac. Surg 1989, Albrektsson & Sennerby 1990). 47, 442-450, This is why we avoided quoting a speciDavenport, W, L., Heldt, L, & Bump, R, fic success rate which we do not believe L, (1985) Salvage of the mandibuiar stahas been truly observed by Bosker, but ple bone plate following bone infection, instead presented the relevant figures, as /, Oral Maxillofac. Surg, 43, 981-986, far as we can see it, a fair approach. The Friedman, K. E. & Vernon, S, E, (1983) Squamous cell carcinoma developing in cited serious complications were not conjunction with a mandibuiar staple specifically related by us to the Bosker bone plate, J, Oral Maxillofac. Surg. 41, implant, but were nevertheless relevant 265-266, under the given heading TransmandibuSmall, J, A, & Stines, A, V, (1981) Manlar Staple Implants. At the time of writdibuiar staple botte plate; a reconstructive ing our paper, we avoided including a operation for the atrophic mandible. Zimcritical analysis of the relatively small mer Inc, USA, amount of biomaterials research that is behind the type of gold alloy used in the Bosker transmandibular implant. In essence, by quoting correct figures from the paper by Bosker & Van Dijk (1989) as well as a couple of other reports, including the one where Fonseca himself is Dear Sir Our review on the State of the art in oral a co-author, we believe to have honestly implants was an invited paper to the reported on the knowledge available on Journal of Clinical Periodontology. We as- the Bosker implant at the time of subsume one reason for the invitation to mitting our paper. write this review must have been based on that we are knovm to apply the same Yours faithfully rigorous success criteria to any implant Tomas Albrektsson and Lars Sennerby system, irrespective of its origin. We reBiomaterials Group gard this as an important task for the Department of Handicap Research critically oriented scientist in the light of University of Goteborg the continued usage of several oral im- . . Sweden
Response
