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tooth that would at all suit the case. I happily found a tooth, which I recognized as one that I had extracted six months previously,-a fair match in size and color, sound and dry, but the root a little too long. The diseased root was extracted, and an appointment made for the patient the following day. The root of the selected tooth was then shortened, and rounded off with a file; the nerve canal opened from the apex, cleansed, and filled with oxychloride of zinc, and completed at the apex with cohesive gold. A strip of platinum plate was then bent over the cutting-edge of the tooth, and burnished to fit the labial and lingual surfaces, terminating at both ends in sharp points at the original line of the gum. A bit of silver wire was provided and laid aside with this platinum stirrup, and the tooth placed in a vessel of glycerin to await the patient. But an almost incessant November rain kept her away until the twelfth day after the root had been extracted. The socket was found to be rapidly filling with healthy granulations, which were removed with one dextrous sweep of the lancet, and mopped out with a mixture of carbolic acid and turpentine. The tooth, which had been allowed to stand ten or fifteen minutes in warm water, was now placed in position and pressed up firmly into the socket. The silver wire was passed around this and the two adjacent teeth near the gum, and the ends twisted together with pliers until tight. The platinum stirrup was placed over the crown and the pointed ends bent outwards over the wire, which held the tooth perfectly firm. An aperient was directed for three succeeding mornings, and aconite and iodine to be painted on the gums in case of inflammation. There was no inflammation, and the patient did not complain of any pain. To make assurance doubly sure, the stirrup bandage was not removed for three months, when the tooth was found to be perfectly firm and solid, the gum pink and healthy, and it has remained so to this day. It will be five years the third of November, 1885. I have had several dentists examine the tooth, and they expressed the opinion that it would be as difficult to extract as any incisor in the mouth.—J. L. Mewborn, D.D.S., Memphis.
A Case Of Ke-implantation.— In June, 1878, a young man, Mr. B., of robust constitution, came to me at six o'clock in the evening, accompanied by his mother, who reported that two hours previously her son had had the two upper central incisors knocked out by a fall from his horse. The horse had fallen first, and the rider struck the knee of the horse in such a manner as to knock out the two teeth, which were found on the ground a half hour later. In examining his mouth I found the alveolus fractured externally, the blow having been from within outwards. The maxillary was split between the right cuspid and the right lateral incisor. Since the accident he had had continuous but slight pain, increasing much when we sought to separate the lateral incisor from the cuspid.
M. Guillermin, whose assistant I was, arrived at this moment, and we decided to attempt replacement of the teeth. Success appeared to us very doubtful, as the teeth were dry, having been picked from the sand and afterwards carried in the vest pocket. We sawed off the extremities of the roots for a length of two millimeters, and placed them in lukewarm water for a quarter of an hour. We then took an impression of the mouth, and in half an hour I made an apparatus of gutta-percha strengthened by platinum wire, leaving the necessary space for the two incisors; during which time M. Guillermin replaced the teeth in the mouth and held them with his fingers. After placing the apparatus in position, we dismissed our patient, recommending him to diet for two or three days on soups and milk. Kepeated applications of an aqueous solution of chlorate of potassa was the only other recommendation made to him.
Five days later the teeth had acquired a decided firmness, and in ten days they were perfectly solid. There was no suppuration. The reunion was made by first intention. Seven years have elapsed, and the teeth have retained their normal color, and have not changed in position.—L. Roussy, Geneva, Switzerland.
Should Air-chambers Be Used In Artificial Dentures?—;I take the negative, for two very important reasons. First, an air-chamber causes a large protuberance in the mouth, which in many instances produces a very unpleasant sensation to the wearers of plates constructed in that manner. Second, so much thickness is added to the plate that it often makes it quite difficult to articulate plainly, especially where the roof is flat. The proof of the uselessness of the airchamber can be made by the dentist. If, after he finds that the plate fits the patient's mouth perfectly, he removes the plate and fills the air-chamber with plaster of Paris or wax, upon again inserting the plate he will find just as good adhesion as before the chamber had been filled. All of us have seen plates with the soft tissues completely filling the air-chamber, and the artificial denture holding as firmly without the vacuum as when the plate was first inserted. In thirty years' practice, in which time I have constructed over 3,200 upper sets, not one of them has an air-chamber. The great secret in making a suction-plate is to keep the air from entering at the heel of the plate. If the palatine arch is soft, I make four or five grooves or marks across the heel of the cast, from one condyle to the other, say one-sixteenth of an inch apart. If the palate is hard, I do not cross the ridges over it, but make them quite deep each side of it,—that is say, about onesixty-fourth of an inch. If the plate bears too hard on any one part, I pare off a little. In conclusion, I am happy to say that all of my patients still retain natural, healthy mouths, instead of deformed and spongy ones.—Stephen Lee, Pawtucket, R. I.
Curious Case Of Epistaxis Resulting From An Abscessed Tooth.—A lady of full habit, about forty-five years of age, recently presented herself to me for the extraction of the right superior lateral incisor. Her face in the immediate vicinity of the tooth was considerably swollen, with intense pain. For several days previous she had had, at intervals, a severe hemorrhage from the right nostril. After removing the tooth, there was some discharge of pus and blood from the socket, and also a profuse hemorrhage from the nose, that soon subsided and has not since occurred.—H. E. Johnson, D.D.S., North Attleboro, Mass.
Engine Brush.—Some months since I devised and used a small brush in the dental engine, and suggested the manufacture of them to The S. S. White Dental Manufacturing Co. for the benefit of the profession. I have found them exceedingly useful in cleaning teeth and finishing fillings. A special use to which I call attention is as follows: Take equal parts of tincture of iodine and glycerin; while the engine is in motion saturate the brush; then apply to a stained tooth. By this means the iodine is not spread over the gums or lips, as is apt to be the case when used in any other manner. Then follow with fine pumice. I think anyone so using this little device will be gratified with the result.—J. W. Lyder.
A Practical Hint.—Your readers may be interested to know of a useful substitute for the ordinary slab on which oxyphosphate and other stoppings are mixed. It is a two-inch cubic block of glass, with beveled edges, usually sold as a letter-weight. Its advantages are' obvious,—always a firm grip on your block, and six sides for mixing instead of two. To clean quickly, rub the surfaces of two blocks together, using a little fine sand and water.—George Pedley, London, Eng.
Vol. XXVII. PHILADELPHIA, DECEMBER, 1885. No. 12.
THE MEEITS AND CLAIMS OF AETIFIOIAL OBOWN AND
BY J. L. WILLIAMS, D.D.S., PHILADELPHIA, PA.
A Former paper upon this subject written, nearly two years ago, closed with these words: "As the introduction of the cheaper forms of artificial dentures was the inauguration of an era which has been prolific of evils that may not be remedied in one generation, and which, by degrading the prosthetic element in dentistry, has tended to destroy public appreciation of all efforts which demand a price in proportion to the skill and art displayed; therefore, the introduction of any improvement which will tend to elevate the standard of dentistry by securing to the patient a form of denture which shall be more compatible with nature's laws, and to the dentist a more equitable compensation for his services, should receive the hearty indorsement of every progressive man in the profession."
While I have received, since the appearance of the former paper referred to, hundreds of earnest letters of inquiry from members of the profession concerning this work, yet I am sure it has not received, at the hands of many leading men, that recognition which its merits demand. I cannot but believe that the work has outlived every objection which has been made against it, and demonstrated that, in the hands of those who can and will handle it in a skillful and judicious manner, it is one of the most valuable phases of the practice of modern dentistry. I am well aware that the possibilities for abuse in this work are great. Skill, good judgment, and keen perception of pathological conditions are.necessary to the highest degree of success. The failure which may follow the non-observance of these Vol. Xxvii.—45.
conditions will be greater or less in proportion to the magnitude of the operation attempted.
The work may also have been in many instances so constructed that it was not possible for the patient to keep it perfectly %lean, and an offensive condition of the mouth has resulted. What I am disposed to criticise in the remarks sometimes made by members of the profession in good standing is, not their condemnation of particular cases of this work,—for in those cases I should undoubtedly be in full agreement with them,—but their indiscriminate condemnation of the 'principles of the work. But men are too often creatures who act from preconceived notions and stubbornly adhere to opinions formed without mature thought or careful examination of premises. The work is sometimes condemned as uncleanly when the fault is wholly with the patient wearing it. This is rarely if ever taken into consideration by those who are disposed to pass hasty judgment. The dentist who should say, on examining a mouth full of natural teeth which were in a filthy condition because of neglect on the part of the patient, "That is not a desirable condition for the mouth to be in, and the best way to overcome the difficulty is to extract the teeth," would be just as reasonable as another who would say on examining an extensive piece of bridge-work which the patient had neglected to keep clean, "* That is a filthy thing to have in one's mouth, and the only wajr out of the difficulty is to remove it and substitute a plate for it." I have heard men make this statement without even asking the patient a question; not knowing whether they understood how to properly use a brush or whether they ever attempted to use one. Unless one possesses the spirit of a philosopher, he is likely to lose patience with men who will make such unreasonable assertions. I have even heard dentists remark, on looking into the mouths of patients containing this work which was kept scrupulously clean, "Oh, yes, that looks well now, but it will get filthy after a time;" as though a condition of cleanliness which had been kept up for a year or two years, as the case might have been, could not be maintained for an indefinite length of time.
A criticism which 1 not infrequently hear passed upon the work is, that the pulpless roots upon which bridge-work is sometimes fast, ened may successfully support it for a time, but will eventually become the source of trouble. There are several replies which might be made to this criticism. We frequently meet with pulpless teeth in a healthy condition, and upon inquiry we find that the pulps have been removed ten or fifteen years. Why does not the treatment of pulpless teeth always result in this satisfactory manner? In ninety-nine per cent, of the failures it is because the conditions necessary to long-continued health of a pulpless root were not observed in its treatment prior to and while being filled. Crown or bridge-work should never be placed upon roots which cannot be brought into a healthy condition. But every dentist of reputation knows that thousands of pulpless teeth and roots are almost daily sacrificed which might have been restored to a state of health. A dead tooth or root should never be permitted to remain in the jaws,— nature will not long allow it to remain there,—but there is no little misapprehension concerning what constitutes a dead tooth. Knowing the extent of this misapprehension, both in the medical and dental professions, I devoted considerable space in my former papers upon this subject to demonstrating, both by the histological arrangement of the parts and analogical reasoning, that not only is a pulpless tooth not necessarily a dead tooth, but that when the pulp of a tooth is removed in a true surgical manner, as it may nearly always be, and the pulpless root is properly treated, the condition of that portion which is in contact with its investing pericementum remains unchanged. The various pathological manifestations which have followed the attempt to retain pulpless teeth and roots in the jaws are not to be regarded as in any sense consequent upon the loss of the pulp, but as the result of dead, putrescent, septic matter which is confined within the tooth, and which becomes an irritant to the living tissue with which it comes in contact. So important is this point to be considered, that attention must be called to it again and again in order that its full significance may be realized. I am well aware that many eminent practitioners openly discourage the attempt to remove all of the devitalized portions of the pulp from the terminal parts of the root-canals; and I have no doubt the system of treatment which they advocate and practice is successful for the time. But I am also certain that danger lies in ambush around the ends of roots so treated. If the health of the individual is maintained, such roots may remain for many years without annoyance. But if the combined forces of the systemic life become weakened, a condition usually spoken of as one of low vitality, then the parts become much more sensitive to anything of an irritant nature, and the patient becomes conscious of a sense of uneasiness in the region of the pulpless tooth, and a more or less grave pathological condition may follow, or symptoms of an obscure nature may be manifested. Perfect safety lies only in the complete removal of all subtances that may become a source of irritation, and a perfect closure of the foraminal opening in the end of the root; and when that is accomplished I believe the danger of future trouble about the roots of pulpless teeth is not greater than that attending the perfect healing which follows any other minor surgical operation *