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SPONGE-GRAFTING. 987

formed witli the root of tlie tooth. Third, we may suppose that the
cells or granulations from the soft parts grow into the root of the tooth
and remove a portion of the old tissue of the cementum by absorption
and reform so much of it as may be necessary, and in this way reattach-
ment occurs. However it may be, it is certain that the peridental
membrane will attach itself to the root of a dead tooth, for otherwise
Hunter Mould not have succeeded in any case in obtaining the attach-
ment of the peridental membrane to the root after boiling the tooth,
and yet this mode of preparing teeth for the purpose of replanting was
recommended by him in 1778. In this case we must assume the reat-
tachment of the peridental membrane to be that of the second or third
of the supposititious forms above mentioned. In a large proportion of
the chronic cases, at least, of this disease, the reattachment must be in
the same Avay.
In the treatment of phagedenic pericementitis the complete reforma-
tion of the peridental membrane should be expected in all cases if the
gingival margin has remained intact. Just so far as the margin of the
gum may have receded from its normal position, just so far will we fail
of regaining the reformation of the peridental membrane—that is to
say, if a portion of the root of the tooth is uncovered, we cannot expect
a reformation of its peridental membrane at that point.
The renewal or reformation of the alveolar wall is far more uncer-
tain, yet in most cases this will also be reformed. I have examined my
cases very carefully on this point, and have found that in most of them
the alveolar wall has been slowly reproduced, yet in some in which the
reformation of the peridental membrane has been complete the alveolar
wall has not reformed during the two or three years the cases have been
under observation.
These, so far as I have yet observed, are all cases in which there was
much eversion of the alveolar wall, which was not cut away at the time
of the treatment. These observations have determined m€ hereafter to
cut away much more freely.
Sponge-grafting suggests itself as a means of renewing the gingivae
and lower border of the peridental membrane when lost from this dis-
ease. Soon after the introduction of this operation in general surgery,
a few years ago, I made trials of it in the mouth with the view of test-
ing its efficiency in the restoration of lost parts. For this purpose very
fine sponge thoroughly freed of sand is prepared by macerating it in
dilute hydrochloric acid, to remove any calcareous material it may con-
tain. It should then be rendered aseptic by maceration in some one of
the antiseptic solutions — preferably, one that will be the most nearly
non-irritant to the granulations to which it may be applied. Thus pre-
pared, the sponge is cut to a suitable size and applied to the granulating
sore in such position, form, and quantity that it will represent the lost
part, due allowance being made for after-shrinkage of the newly-formed
tissue. The granulations will quickly grow into all of the meshes of the
sponge and completely fill every space. The growth of the granulations
seems to be stimulated and greatly accelerated by the presence of the
sponge, while its meshes seem to act as a ladder on which they climb,
so that the form of the sponge directs the form of the growth. The