Page 978 - My FlipBook

988 DISEASES OF THE PERIDENTAL MEMBRANE.
sponge, wlien enclosed by the granulations, is absorbed ; in other words,
it is digested or dissolved in a material elaborated by the granulations
in contact with it, and in this form taken into the circulation. It is
thus removed completely, leaving newly-formed tissue in its place.
This new tissue is, of course, scar or cicatricial tissue, and shrinks very
much after the absorption of the sponge ; it is therefore necessary that
the sponge should be abundantly large when first applied.
Under favorable conditions the granulations grow into the sponge
with such flicility and so rapidly that it seems to offer a wonderful
opportunity for the restoration of lost parts. The sponge can be
trinnned to any form desired, so that the space left by the sloughing
of the j)art or tissue destroyed by accident can be very perfectly refilled.
In practice, however, some serious objections to its use have been de-
veloped, which, as they have come to be understood, have very much
modified the opinion of surgeons as to its general usefulness. In the
first place, in those cases in which the sponge-graft seems to have done
well, the new tissue that has grown is often very poor in quality and
liable to excessive shrinkage. The second, and worst, objection to its
use is that the sponge-graft is especially liable to become septic. It
seems to offer a remarkably favorable harbor for septic micro-organ-
isms, and not unfrequently non-pathogenic forms will fill the sponge
in such numbers as to do great mischief. When these pests have once
gained a foothold in the sponge, it is next to impossible to dislodge
them with any antiseptics that can be applied with safety to the granu-
lations. All this is true in any case in which the sponge-graft can be
applied, and has caused its abandonment by the careful surgeon in all
but the most necessary, and at the same time most promising, cases.
These are cases of loss of tissue on exposed parts where antiseptics can
readily be applied, and where the wound is not subject to irrigation by
any of the secretions but its own. AYounds of the hands or feet in
which the parts, wound, sponge-graft, and all, can be frequently im-
mersed in an antiseptic lotion or can be perfectly sealed by dressings
impervious to micro-organisms, offer the most favorable conditions for
the sponge-graft, while, on the other hand, the natural cavities of the
body, ii:i which these precautions are impossible, are the most unfavor-
able positions for this procedure.
In my efforts at sponge-grafting for the renewal of the peridental
membrane and gingival margin I have proceeded in this wise : After
determining by examination the size and form of the space, a suit-
able piece of prepared sponge is cut as near the required form as
practicable and placed well up into the pocket, between the remaining
])ortion of the gum and the root of the tooth. It should be of such
form and size that when thus placed it will cover the exposed portion
of the cementum and extend farther down on the crown of the tooth
than the gum should do, so that it may be secured in position by a liga-
ture passed about the tooth. The space for the reception of the graft
can often be improved and its form more accm'ately determined by tent-
ing with antiseptic cotton for a few hours before the application of the
sponge. If the case progresses favorably, the granulations will within
twenty-four hours have grown into the meshes of the sponge to such an