“…The pathogenic mechanisms of this refractoriness to treatment, however, have remained obscure. Contributory factors include bacterial virulence properties, such as slime production (4,10,23,31,56,60), as well as properties of specific biomaterials which increase microbial adherence or alter inflammatory changes (1,2,7,9,12,23,24,27,30,51,53,58,70,71,77,78) and impaired phagocytic host defenses even in the absence of microbial colonization (34-36, 57, 59, 64, 78, 79).…”