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658 PLANTATION OF TEETH.

The Operation of Implantation.
Implantation, in order to yield the best results, should be confined
to mouths which are habitually clean and free from disease, and to a
part of the individual's life during which the power of the developed
mental processes is not impaired. Unclean personal habits, the ex-
cessive use of stimulants, and occupations calling for an unusual ex-
penditure of nerve force are unfavorable. A suitable case having been
selected, an impression of the space and of the teeth adjoining it is
taken. A plaster cast is made, the proper-sized socket drilled therein,
the tooth is selected and prepared, either with or without an artificial
crown in the manner previously described, the occlusion is adjusted,
and a retention cap is made. These preliminaries having been satis-
factorily accomplished the case is ready for the operation. Under the
heading of General Considerations the question of anesthesia has been
already treated.
The first step in the operation is the making of an incision through
the gum tissue. A number of different kinds of incisions have been
recommended by different operators, nearly all of them looking toward
the preservation of the largest amount of gum tissue. Some recom-
mend a crucial incision X, turning back the four corners of the gum
tissue. Others have recommended an incision in the shape of the letter
H, turning back the two flaps thus made.
The principal objection to all of the incisions recommended lies in
the fact that they all look toward the preservation of the gum tissue
e{|ually for the labial and lingual surfaces ; Avhile, as a matter of fact, if
proper provision is made for the protection of the cervical line on the
labial surface, the lingual surface will take care of itself, for it will be
noticed in cutting through the gum tissue that it is much thinner where
it reflects over the alveolar border upon its labial aspect than upon its
lingual. Hence, frequently, if no attention whatever has been paid to
the retention of gum tissue on the lingual surface, the neck of the
tooth will nevertheless be sufficiently protected.

Fig. 581.

Incision In gum for implantation.
Another serious objection to an incision which leaves two or more
points or margins to be preserved, is that the tenacity of the gum tissue