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Endosteal implants
□ Comment: W e d id n o t lo cate th e a u th o r s ’ artic le o n a tte m p te d sterilizatio n o f d e n ta l L e t t e r s to in s tru m e n ts by m icrow aves u n til o u r a r ti t h e E d it o r cle h a d g o n e to p ress. T h e ir article h a d n o t a p p e a r e d in a n y o f o u r c o m p u te r-a ssiste d lite r a tu re se a rc h e s n o r in a n y o f th e r e fe re n c e sectio n s in o th e r articles. In a d d itio n , d rie d m ic ro o rg a n ism s, es pecially sp o re s, a re h a r d e r to kill. R ecen t e x p e rim e n ts in o u r la b o r a to r y sh o w ed th a t in c re a se d e x p o s u re tim e s w e re n e ce s sary to sterilize tu b e s in w h ich so lu tio n s o f Staphylococcus aureus h a s b e e n allow ed to d ry fo r u p to 2 4 h o u rs c o m p a re d w ith tu b e s th a t w e re e x p o se d im m e d ia te ly a fte r c o n ta m in a tio n . P rev io u s w o rk by o n e o f m ic ro w a v e s .” H o w e v e r, w e h a v e p u b th e a u th o rs d o c u m e n te d steriliz atio n o f lish e d a n e v a lu a tio n o f m icro w av es f o r tissu e c u ltu re vessels c o n ta m in a te d w ith ste rilizin g d e n ta l in s tru m e n ts .1 n in e ty p es o f b a c te ria fo llo w in g o v e rn ig h t Im p o rta n tly , w e m u s t r e p o r t th e re s u lt d ry in g .1 I f m o istu re is re q u ire d f o r e ffi fro m th a t stu d y th a t m ic ro o rg a n ism s w ere c ie n t k illing, as su g g este d by D rs. H u m e n o t killed ev en by p ro lo n g e d e x p o s u r e to a n d M a k in so n , it m ay b e a c c o m p lish e d by m icrow aves, if th ey w ere d ry , o n in s tru m e th o d s as sim p le as d ip p in g o r s p ra y in g m e n ts (u p to 1 h o u r e x p o s u re ). In o u r o b jects to b e ste rilize d b e fo r e th e y a re stu d y , sp o re te st strip s re ta in e d sp o re vital p la c e d in th e m icro w av e o v en . M o d ifica ity in d e fin ite ly if th ey w e re tr e a te d d ry ; tio n o f th e o v e n m ay in c lu d e c o n tro lle d h e rp e s sim p lex v iru s w as u n a ff e c te d by te m p e r a tu r e o r h u m id ity se ttin g s, o r b o th . p ro lo n g e d e x p o s u re to m icro w av es if th e S uch re q u ire m e n ts a re n o t u n u su a l; ste ril v iru s w as d r ie d o n th e su rfa c e o f d e n ta l izatio n by e th y le n e o x id e gas re q u ire s a in s tru m e n ts ; a n d n o n -s p o re m ic ro o rg a n c o n tro lle d relativ e h u m id ity of 30% . ism s also su rv iv ed w h en d ry . T h e m ic ro D rs. H u m e a n d M ak in so n d id n o t state biological tests w ere d o n e in d e p e n d e n tly h o w o r f o r h o w lo n g th e c o n ta m in a n ts by th e state In s titu te o f M edical a n d V e t w e re d rie d o n th e in s tru m e n ts . T h e ty p e e rin a ry S cience o f S o u th A u stra lia . o f o v e n u se d was n o t in d ic a te d . M e th o d o f D rs. R o h r e r a n d B u la rd d e sc rib e d th e e x p o s u re , p la c e m e n t in th e o v en , a n y r o ta tr e a tm e n t o f w et s p o re strip s, a n d te st tio n o f in s tru m e n ts , o r in clu sio n s o f a p a r tu b e s c o n ta m in a te d w ith m ic ro o rg a n ism s allel lo ad w ere n o t m e n tio n e d . K n o w led g e in w hich, “N o a tte m p t was m a d e to d ry th e o f th e se p a ra m e te rs w o u ld b e n ecessary to tu b es. . . . ” In only o n e e x p e rim e n t d id re p e a t th e ir e x p e rim e n t to v erify re su lts th e y allow d ry in g , a n d th e n fo r o n ly 15 a n d a re im p o rta n t facto rs, c o n s id e rin g th e m in u te s , w ith a b lo o d -v iru s m ix tu re . S u ch v a ria tio n in e n e rg y levels w ith in th e o v en . a m ix tu re m ig h t n o t lose all w a te r in 15 I f n o m o d ifica tio n s to th e o v e n w e re m a d e m in u tes. a n d if it w as o p e ra te d w ith o u t a p arallel W e c o n c lu d e d th a t m icro w av es d o n o t lo a d , th e m a g n e tro n m ay h a v e o v e rh e a te d by th em selv es kill d ry v iru ses o r b a c te ria ; a n d c u t o f f d u r in g th e lo n g e x p o s u re s r e m icrow aves w o u ld a p p e a r to kill o n ly in d i p o rte d . W ith o u t a n in d ic a to r o f m ic ro rectly, by p ro d u c tio n o f h e a t, w hich r e w ave e x p o s u re w ith in th e cavity, su ch as q u ire s th e p re se n c e o f w ater. M icrow ave th e in d ic a to r lig h t tu b e s w e u se d , th e r e is tr e a tm e n t w o u ld th e r e f o r e a p p e a r to be n o a s s u ra n c e th a t e x p o s u re s w e re c o n e q u iv a le n t to b o ilin g a n d w o u ld re q u ire tin u o u s. w etness fo r efficacy. F inally, it sh o u ld b e p o in te d o u t th a t T o a d v o cate th e u se o f m icrow aves as a c o n tro v e rsy still exists c o n c e rn in g w h e th e r m e c h a n ism fo r sterilizatio n w ith o u t m a k ste riliz a tio n is th e re s u lt o f th e r m a l o r in g this p o in t very c le a r to p o te n tia l u se rs n o n th e r m a l in activ a tio n o f o rg a n ism s. o f th e te c h n iq u e w o u ld b e, in o u r o p in io n , O u r a rtic le w as w ritte n to r e p o r t e x p e r d a n g e ro u s . im e n ts sh o w in g th e p o te n tia l o f m ic ro W. R. HUME w ave e x p o s u r e as a steriliza tio n m e th o d . O. F. MAKINSON UNIVERSITY OF ADELAIDE O b v io u sly , a g re a t d e a l o f w o rk re m a in s to ADELAIDE, AUSTRALIA b e d o n e b e fo r e th is m e th o d will b e re c o m m e n d e d as a clinically p ra c tic a l a n d p ro v e d te c h n iq u e . 1. H um e, W.R., and Makinson, O.F. Sterilizing dental instrum ents: evaluation o f lubricating oils and microwave radiation. O per Dent 3:93-96, 1978.
162 ■ JADA, Vol. 112, February 1986
MICHAEL D. ROHRER, DDS, MS UNIVERSITY OF OKLAHOMA OKLAHOMA CITY
1. Sanborn, M.R.; Wan, S.K.; and Bulard, R.A. Mi crowave sterilization o f plastic tissue culture vessels for reuse. Appl Environ Microbiol 44(4):960-964, 1982.
Endosteal im plants □ F ro m th e re s u lts o f th e 1978 re c o m m e n d a tio n s o f th e c o n se n s u s d e v e lo p m e n t c o n fe re n c e o n d e n ta l im p la n ts,1 it seem s c le a r th a t th e m etallic b lad e im p la n t was th e on ly e n d o ste a l im p la n t selected (to be u se d w ith g u id elin es) a n d o th e r e n d o ste a l im p la n ts w e re c o n sid e re d to be in th e c a t e g o ry o f clinical trials. A c c o rd in g to th e re c o m m e n d a tio n s, th e e n d o ste a l b la d e im p la n t is c o n sid e re d to “h av e a n a ccep tab le b e n e fit/risk ra tio ” in th e h a n d s o f “p ro p e rly tr a in e d p ra c titio n e rs .” O f p a r a m o u n t im p o rta n c e h e re is th e last p h ra s e , “p ro p e rly tr a in e d p ra c ti tio n e rs .” O th e r e n d o ste a l m o d alities w ere n o t re c o m m e n d e d in th is m a n n e r. T h is w o u ld a p p e a r to illu stra te th a t m y e n d o ste a l b lad e system w as th e only system acce p tab le to th e im p la n t a u th o ritie s p r e s e n t a t th e c o n f e r e n c e . . . . C o lle a g u e s h a v e b e e n le ft u n a w a re o f th e efficacy a n d clinical success o f th e L in k o w e n d o ste a l b la d e d e sig n d u r i n g m a n y y e a rs o f clinical u s e .. . . LEONARD I. LINKOW, DDS NEW YORK 1. Schnitman, P.A., and Schulman, L.B. Recom m endations o f the consensus developm ent conference on dental implants. JADA 98(3):373-377, 1979.
Patients’ concerns about AIDS □ As th e A ID S e p id e m ic s p re a d s , we a re b e in g fo rc e d to c o n s id e r h o w o u r lives a re a ffe c te d by th is d isease. I t is e s tim a te d th a t m o re th a n 1 m illio n A m e ric a n s h a v e b e e n e x p o se d to th e A ID S v iru s a n d m o re th a n 1 3 ,0 0 0 a c tu a lly h a v e th e d is e a se . T h e n u m b e r o f n ew r e p o r te d cases h a s d o u b led e v ery y e a r sin ce 1979. . . . B ecau se th e v iru s is fatal, w e h av e a n u m b e r o f issues to a d d re s s , su c h as leg al, c o n s titu tio n a l, social, m o ra l, e c o n o m ic , a n d b e h a v io ra l c o n sid e ra tio n s. M an y o f th e so lu tio n s to th e p ro b le m h a v e re s u lte d fr o m h y s te ria a n d p a n ic w ith o u t c o n s id e ra tio n o f th e fu ll sco p e o f th e p ro b le m . T o e stab lish w h a t o u r p a tie n ts believe a b o u t c o n tro l m e a s u re s, tr e a tm e n t o f vic tim s , a n d d is e a s e p r e v e n tio n , w e c o n d u c te d a su rv ey o f 100 p a tie n ts , selected
162 ■ JADA, Vol. 112, February 1986
MICHAEL D. ROHRER, DDS, MS UNIVERSITY OF OKLAHOMA OKLAHOMA CITY
1. Sanborn, M.R.; Wan, S.K.; and Bulard, R.A. Mi crowave sterilization o f plastic tissue culture vessels for reuse. Appl Environ Microbiol 44(4):960-964, 1982.
Endosteal im plants □ F ro m th e re s u lts o f th e 1978 re c o m m e n d a tio n s o f th e c o n se n s u s d e v e lo p m e n t c o n fe re n c e o n d e n ta l im p la n ts,1 it seem s c le a r th a t th e m etallic b lad e im p la n t was th e on ly e n d o ste a l im p la n t selected (to be u se d w ith g u id elin es) a n d o th e r e n d o ste a l im p la n ts w e re c o n sid e re d to be in th e c a t e g o ry o f clinical trials. A c c o rd in g to th e re c o m m e n d a tio n s, th e e n d o ste a l b la d e im p la n t is c o n sid e re d to “h av e a n a ccep tab le b e n e fit/risk ra tio ” in th e h a n d s o f “p ro p e rly tr a in e d p ra c titio n e rs .” O f p a r a m o u n t im p o rta n c e h e re is th e last p h ra s e , “p ro p e rly tr a in e d p ra c ti tio n e rs .” O th e r e n d o ste a l m o d alities w ere n o t re c o m m e n d e d in th is m a n n e r. T h is w o u ld a p p e a r to illu stra te th a t m y e n d o ste a l b lad e system w as th e only system acce p tab le to th e im p la n t a u th o ritie s p r e s e n t a t th e c o n f e r e n c e . . . . C o lle a g u e s h a v e b e e n le ft u n a w a re o f th e efficacy a n d clinical success o f th e L in k o w e n d o ste a l b la d e d e sig n d u r i n g m a n y y e a rs o f clinical u s e .. . . LEONARD I. LINKOW, DDS NEW YORK 1. Schnitman, P.A., and Schulman, L.B. Recom m endations o f the consensus developm ent conference on dental implants. JADA 98(3):373-377, 1979.
Patients’ concerns about AIDS □ As th e A ID S e p id e m ic s p re a d s , we a re b e in g fo rc e d to c o n s id e r h o w o u r lives a re a ffe c te d by th is d isease. I t is e s tim a te d th a t m o re th a n 1 m illio n A m e ric a n s h a v e b e e n e x p o se d to th e A ID S v iru s a n d m o re th a n 1 3 ,0 0 0 a c tu a lly h a v e th e d is e a se . T h e n u m b e r o f n ew r e p o r te d cases h a s d o u b led e v ery y e a r sin ce 1979. . . . B ecau se th e v iru s is fatal, w e h av e a n u m b e r o f issues to a d d re s s , su c h as leg al, c o n s titu tio n a l, social, m o ra l, e c o n o m ic , a n d b e h a v io ra l c o n sid e ra tio n s. M an y o f th e so lu tio n s to th e p ro b le m h a v e re s u lte d fr o m h y s te ria a n d p a n ic w ith o u t c o n s id e ra tio n o f th e fu ll sco p e o f th e p ro b le m . T o e stab lish w h a t o u r p a tie n ts believe a b o u t c o n tro l m e a s u re s, tr e a tm e n t o f vic tim s , a n d d is e a s e p r e v e n tio n , w e c o n d u c te d a su rv ey o f 100 p a tie n ts , selected