{"1": {"fulltext": "", "height": "4685", "width": "2911", "jp2-path": "americantextboo00kirk_0001.jp2"}, "2": {"fulltext": "Class Wl\u00c2\u00a3M\\nBook JT-fJ\\nG WrightN ._C\\nTf-\\nCOPYRIGHT DEPOSIT.", "height": "4528", "width": "2820", "jp2-path": "americantextboo00kirk_0002.jp2"}, "3": {"fulltext": "", "height": "4492", "width": "2696", "jp2-path": "americantextboo00kirk_0003.jp2"}, "4": {"fulltext": "", "height": "4576", "width": "2796", "jp2-path": "americantextboo00kirk_0004.jp2"}, "5": {"fulltext": "", "height": "4556", "width": "2720", "jp2-path": "americantextboo00kirk_0005.jp2"}, "6": {"fulltext": "", "height": "4616", "width": "2820", "jp2-path": "americantextboo00kirk_0006.jp2"}, "7": {"fulltext": "", "height": "4540", "width": "2712", "jp2-path": "americantextboo00kirk_0007.jp2"}, "8": {"fulltext": "", "height": "4580", "width": "2836", "jp2-path": "americantextboo00kirk_0008.jp2"}, "9": {"fulltext": "IV", "height": "4540", "width": "2704", "jp2-path": "americantextboo00kirk_0009.jp2"}, "10": {"fulltext": "LIST OF CONTRIBUTORS.\\nANDREWS, R. R., A. M., D. D. S., F. R. M. S.\\nBURCHARD, HENRY H. M. D., D.D.S.\\nCASE, CALVIN S., M. D., D. D. S.\\nCLAPP, D WIGHT M., D.M.D.;\\nCRYER, M.H., M.D., D.D.S.;\\nDARBY, EDWIN T., M. D D.D.S.;\\nGODDARD, C. L., D.D.S.\\nGUILFORD, S. H., A.M., D.D.S., Ph. D\\nHEAD, JOSEPH B., M. D., D.D.S.;\\nJACK, LOUIS, D.D.S.;\\nKIRK, EDWARD C, D D. S\\nNOYES, FREDERICK B., B. A D.D.S.;\\nOTTOFY, LOUIS, D D. S.\\nPEIRCE, C. N., D.D.S.;\\nTHOMAS, J. D., D.D. S.\\nTHOMPSON, ALTON HOWARD, D.D.S.;\\nTRUMAN, JAMES, D.D.S.", "height": "4580", "width": "2828", "jp2-path": "americantextboo00kirk_0010.jp2"}, "11": {"fulltext": "THE\\nAMERICAN TEXT-BOOK\\nOF\\nOPERATIVE DENTISTRY.\\nIN CONTRIBUTIONS BY EMINENT AUTHORITIES.\\nEDITED.BY\\nEDWAED (VKIKK, D.D.S.,\\nProfessor of Clinical Dentistry in the University of Pennsylvania, Philadelphia;\\nEditor of The Dental Cosmos.\\nSECOND EDITION, REVISED AND ENLARGED.\\nILLUSTRATED WITH 897 ENGRAVINGS.\\nLEA BEOTHERS CO.,\\nPHILADELPHIA AND NEW YORK\\n1900.", "height": "4556", "width": "2696", "jp2-path": "americantextboo00kirk_0011.jp2"}, "12": {"fulltext": "Rvfsfci\\n71940\\nKs\\nLibrary oi Congress\\n^py 2.\\nTwo Copies Received\\nNOV 7 1900\\nCopyright entry\\n*v?\\\\ ^V ^^o^\\n\u00e2\u0096\u00a0JGLOJkSiA.**\\nFIRST COPY.\\n2nd Copy Delivered to\\nORDER DIVISION\\nNOV 24 I30u\\nEntered according to Act of Congress in the year 1900, by\\nLEA BROTHERS CO.,\\nin the Office of the Librarian of Congress, at Washington. All rights reserved.\\nWESTCOTT THOMSON,\\nELECTROTYPERS, PHILADA.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0012.jp2"}, "13": {"fulltext": "WITH THE CONSENT OF* THE CONTRIBUTORS\\nTHIS BOOK IS DEDICATED TO\\nJAMES TRUMAN, D.D.S.,\\nTHE CHARACTERISTIC OF WHOSE LONG PROFESSIONAL CAREER HAS\\nBEEN THE INCULCATION OF THE PRINCIPLES UPON\\nWHICH THE WORK IS BASED.", "height": "4532", "width": "2720", "jp2-path": "americantextboo00kirk_0013.jp2"}, "14": {"fulltext": "", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0014.jp2"}, "15": {"fulltext": "PREFACE TO THE SECOND EDITION.\\nThe preparation of a text-book upon Operative Dentistry, com-\\nposite in its authorship, was regarded by the Editor as a tentative\\nexperiment the value of which could only be determined by the test\\nof practical experience. The cordial reception of the work by dental\\nteachers and its extensive use by students afford encouraging evidence\\nthat a work so planned and executed was needed.\\nThe increasing tendency to specialization in dentistry has rendered\\nstill more remote the possibility of adequately presenting the entire\\nfield of operative dentistry through the medium of a single volume\\nof individual authorship hence the composite method, whereby the\\nseveral departments are set forth by experts in each case, seems likely\\nto afford the most generally satisfactory result.\\nThe Editor is fully aware of the importance which attaches to the\\nwork of harmonizing the treatment of the individual subjects and of\\nso coordinating them that conflicting views shall not confront the stu-\\ndent, and thus interfere with his advancement into an untrodden field;\\na recognition of this factor has served as a guiding motive both in the\\npreparation and the revision of the work.\\nSpecialization in operative dentistry has not reached the point where\\nit may be deemed best to limit the field of text-book treatment to its\\ntechnical procedures and relegate the allied subjects to separate vol-\\numes hence the chapter upon Dental Embryology has been retained\\nand the subject extended to include so much of Dental Histology as\\nbears directly upon operative procedures, and it is anticipated that the\\nadmirable chapter by Professor Xoyes will prove an acceptable addi-\\ntion. The chapter upon Porcelain Inlay work has been rewritten in\\nthe light of the most recent developments of that rapidly progressing\\nfield of study. The formal treatment of Asepsis and Antisepsis, which\\nis the basis of an added chapter by Professor Truman, needs no\\napology; the importance of a thorough appreciation of the role played\\nby oral bacteria in the causation and transmission of disease is self-\\nevident, as a recognition of the bacterial factor in oral conditions has\\nbecome a sine qua non of successful dental practice. In the present\\nedition the text has been thoroughly revised, a large number of illus-\\n7", "height": "4556", "width": "2716", "jp2-path": "americantextboo00kirk_0015.jp2"}, "16": {"fulltext": "8 PREFACE TO THE SECOND EDITION.\\nI\\ntrations and much new matter have been added, and the treatment of\\nthe whole subject brought into harmony with the latest development\\nof thought in the field which it covers.\\nThe Editor desires to thank his colleagues in the educational field\\nfor many helpful criticisms and suggestions received since the first\\nappearance of the work. These have been largely utilized in its\\nrevision. His thanks are also due to the several contributors for their\\ngenerous cooperation and acquiescence in such alterations as have\\nseemed desirable for the betterment of the work.\\nThe death of Dr. H. H. Burchard, who was so closely associated\\nwith this work both as a contributor and as a helpful guide in the\\npreparation of the first edition for the press, creates a vacancy in the\\nranks of American dental writers which will be generally deplored,\\nand especially so by his collaborators in the present work. Ill health\\nmade it impossible for him to take part in the present revision,\\nbut his contributions being based upon sound scientific principles\\nneeded but minor amendments, which the Editor has endeavored to\\nsupply in the spirit of the author.\\nE. C. K.\\nOctober, 1900.", "height": "4580", "width": "2796", "jp2-path": "americantextboo00kirk_0016.jp2"}, "17": {"fulltext": "LIST OF CONTRIBUTORS.\\nK. K. ANDREWS, A. M., D. D. S., F. B. M. S.,\\nCambridge, Mass.\\nHENRY H. BUBCHABD, M. D., D. D. S.,\\nLate Special Lecturer on Dental Pathology and Therapeutics, Philadelphia Dental\\nCollege, Philadelphia.\\nCALVIN S. CASE, M. D., D. D. S.,\\nProfessor of Orthodontia, Chicago College of Dental Surgery, Chicago, 111.\\nDWIGHT M. CLAPP, D. M. D.,\\nClinical Lecturer on Operative Dentistry, Dental Department, Harvard University,\\nBoston, Mass.\\nM. H. CRYER, M. D., D. D. S.,\\nAssistant Professor of Oral Surgery in the University of Pennsylvania, Philadelphia.\\nEDWIN T. DARBY, M. D., D. D. S.,\\nProfessor of Operative Dentistry and Dental Histology in the University of Penn-\\nsylvania, Philadelphia.\\nC. L. GODDARD, D. D. S.,\\nProfessor of Orthodontia, University of California, College of Dentistry, San\\nFrancisco, Cal.\\nS. H. GUILFORD, A. M., D. D. S., Ph.D.,\\nProfessor of Operative and Prosthetic Dentistry and Dean of the Philadelphia\\nDental College, Philadelphia.\\nJOSEPH B. HEAD, D. D. S., M. D.,\\nPhiladelphia.\\nLOUIS JACK, D. D. S.,\\nPhiladelphia.", "height": "4540", "width": "2676", "jp2-path": "americantextboo00kirk_0017.jp2"}, "18": {"fulltext": "10 LIST OF CONTRIBUTORS.\\nEDWAKD C. KIKK, D. D. S.,\\nProfessor of Clinical Dentistry in the University of Pennsylvania, Philadelphia,\\nand Dean of the Department of Dentistry.\\nFREDERICK B. NOYES, B. A., D. D. S.,\\nProfessor of Dental Histology in the Northwestern University Dental School,\\nChicago, 111.\\nLOUIS OTTOFY, D. D. S.,\\nProfessor of Clinical Therapeutics, Chicago College of Dental Surgery, Chicago\\nformerly Dean and Professor of Dental Pathology, American College of Dental\\nSurgery, Chicago, 111.\\nC. N. PEIRCE, D. D. S.,\\nProfessor of Dental Physiology, Dental Pathology, and Operative Dentistry, and\\nDean of the Pennsylvania College of Dental Surgery, Philadelphia.\\nJ. D. THOMAS, D. D. S.,\\nLecturer on Nitrous Oxid, Department of Dentistry, University of Pennsylvania,\\nPhiladelphia.\\nALTON HOWARD THOMPSON, D. D. S.,\\nProfessor of Dental Anatomy, Kansas City Dental College, Kansas City, Mo.\\nJAMES TRUMAN, D. D. S.,\\nProfessor of Dental Pathology, Therapeutics, and Materia Medica in the Uni-\\nversity of Pennsylvania, Philadelphia.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0018.jp2"}, "19": {"fulltext": "CONTENTS.\\nCHAPTER I.\\nPAGE\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH 17\\nBy Alton Howard Thompson, D. D. S.\\nCHAPTER II.\\nTHE EMBRYOLOGY OF THE DENTAL TISSUES 53\\nBy R. R. Andrews, A. M., D. D. S., F. R. M. S.\\nCHAPTER III.\\nDENTAL HISTOLOGY WITH REFERENCE TO OPERATIVE DEN-\\nTISTRY 93\\nBy Frederick B. No yes, B. A., D. D. S.\\nCHAPTER IV.\\nANTISEPSIS IN DENTISTRY 157\\nBy James Truman, D. D. S.\\nCHAPTER V.\\nTHE EXAMINATION OF TEETH PRELIMINARY TO OPERATION-\\nMETHODS, INSTRUMENTS, APPLIANCES\u00e2\u0080\u0094 RECORDING RESULTS,\\nETC 173\\nBy Louis Jack, D. D. S.\\nCHAPTER VI.\\nPRELIMINARY PREPARATION OF THE TEETH\u00e2\u0080\u0094 REMOVAL OF\\nDEPOSITS AND CLEANING OF THE TEETH\u00e2\u0080\u0094 WEDGING\u00e2\u0080\u0094 OTHER\\nMETHODS OF SECURING SEPARATIONS\u00e2\u0080\u0094 EXPOSURE OF CERVI-\\nCAL MARGINS BY SLOW PRESSURE, ETC 181\\nBy Louis Jack, D. D. S.\\nn", "height": "4560", "width": "2672", "jp2-path": "americantextboo00kirk_0019.jp2"}, "20": {"fulltext": "12 CONTENTS.\\nCHAPTER VII.\\nPAGE\\nPRELIMINARY PREPARATION OF CAVITIES-TREATMENT OF HY-\\nPERSENSITIVE DENTIN BY SEDATIVES, OBTUNDENTS, LOCAL\\nAND GENERAL ANESTHETICS\u00e2\u0080\u0094 STERILIZATION, WITH A BRIEF\\nCONSIDERATION OF THE PHYSIOLOGICAL AND THERAPEUTIC\\nACTION OF THE MEDICAMENTS USED 189\\nBy Louis Jack, D. D. S.\\nCHAPTER VIII.\\nPREPARATION OF CAVITIES\u00e2\u0080\u0094 OPENING THE CAVITY\u00e2\u0080\u0094 REMOVING\\nTHE DECAY- SHAPING THE CAVITY\u00e2\u0080\u0094 CLASSIFICATION OF\\nCAVITIES 215\\nBy S. H. Guilford, A. M., D. D. S., Ph. D.\\nCHAPTER IX.\\nEXCLUSION OF MOISTURE\u00e2\u0080\u0094 EJECTION OF THE SALIVA\u00e2\u0080\u0094 APPLICA-\\nTION OF THE DAM IN SIMPLE CASES, AND IN SPECIAL CASES\\nPRESENTING DIFFICULT COMPLICATIONS\u00e2\u0080\u0094 NAPKINS AND\\nOTHER METHODS FOR SECURING DRYNESS 239\\nBy Louis Jack, D. D. S.\\nCHAPTER X.\\nTHE SELECTION OF FILLING MATERIALS WITH REFERENCE TO\\nCHARACTER OF TOOTH STRUCTURE, VARIOUS ORAL CONDI-\\nTIONS AND LOCATION, DEPTH OF CAVITY AND PROXIMITY\\nOF THE PULP\u00e2\u0080\u0094 CAVITY LINING, WITH ITS PURPOSES 249\\nBy Louis Jack, D. D. S.\\nCHAPTER XL\\nTREATMENT OF FILLINGS WITH RESPECT TO CONTOUR, AND THE\\nRELATION OF CONTOUR TO PRESERVATION OF THE INTEG-\\nRITY OF APPROXIMAL SURFACES 261\\nBy S. H. Guilford, A. M., D. D. S., Ph. D.\\nCHAPTER XII.\\nTHE OPERATION OF FILLING CAVITIES WITH METALLIC FOILS\\nAND THEIR SEVERAL MODIFICATIONS 267\\nBy Edwin T. Darby, D. D. S., M. D.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0020.jp2"}, "21": {"fulltext": "CONTENTS. 13\\nCHAPTER XIII.\\nPAGE\\nPLASTIC FILLING MATEEIALS\u00e2\u0080\u0094 THEIE PEOPEKTIES, USES, AND\\nMANIPULATION 305\\nBy Henry H. Burchaed, M. D., D. D. S.\\nCHAPTER XIV.\\nCOMBINATION FILLINGS 345\\nBy Dwight M. Clapp, D. M. D.\\nCHAPTER XV.\\nEESTOEATION OF TEETH BY CEMENTED INLAYS 369\\nBy Joseph Head, M. D., D. D. S.\\nCHAPTER XVI.\\nTHE CONSEEVATIVE TREATMENT OF THE DENTAL PULP\u00e2\u0080\u0094 DE-\\nVITALIZATION AND EXT1EPATION OF THE PULP 401\\nBy Louis Jack, D. D. S.\\nCHAPTER XVII.\\nTHE TREATMENT AND FILLING OF ROOT CANALS 429\\nBy Henry H. Burchard, M. D., D. D. S.\\nCHAPTER XVIII.\\nDENTO-ALVEOLAR ABSCESS 479\\nBy Henry H. Burchard, M. D., D. D. S.\\nCHAPTER XIX.\\nPYORRHEA ALVEOLAEIS 505\\nBy C. N. Peirce, D. D. S.\\nCHAPTER XX.\\nDISCOLORED TEETH AND THEIE TREATMENT 535\\nBy Edward C. Kirk, D. D. S.\\nCHAPTER XXI.\\nEXTRACTION OF TEETH 561\\nBy M. H. Cryer, M. D., D. D. S.", "height": "4544", "width": "2712", "jp2-path": "americantextboo00kirk_0021.jp2"}, "22": {"fulltext": "14 CONTENTS.\\nCHAPTER XXI. (Continued).\\n1AGE\\nEXTRACTION OF TEETH UNDER NITROUS OXID ANESTHESIA 629\\nBy J. D. Thomas, D. D. S.\\nCHAPTER XXI. (Concluded).\\nLOCAL ANESTHETICS AND TOOTH EXTRACTION 639\\nBy Henry H. Buechaed, M. D., D. D. S.\\nCHAPTER XXII.\\nPLANTATION OF TEETH 645\\nBy Louis Ottofy, D. D. S.\\nCHAPTER XXIII.\\nMANAGEMENT OF THE DECIDUOUS TEETH 663\\nBy Clark L. Goddard, A. M., D. D. S.\\nCHAPTER XXIV.\\nORTHODONTIA EXCLUSIVELY AS AN OPERATIVE PROCEDURE 683\\nBy Clark L. Goddard, A. M., D. D. S.\\nCHAPTER XXV.\\nTHE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS 805\\nBy Calvin S. Case, M. D., D. D. S.\\nINDEX 843", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0022.jp2"}, "23": {"fulltext": "INTRODUCTORY.\\nA study of the advances which have of recent years taken place in\\nthe field of Operative Dentistry will reveal, besides the important addi-\\ntions to our knowledge in the shape of novel methods and improved\\ntechnique, a vastly more important advance manifested in a better and\\nmore general understanding of scientific principles, and the application\\nof dental science to dental art, resulting in a more rational practice.\\nEspecially is this true in regard to the etiology of dental and oral\\npathological conditions, and the rationale of the modes of treatment\\nindicated for the morbid states constantly confronting the dental\\npractitioner.\\nThe modifications in surgical methods and the greatly improved\\nresults which are the outgrowth of modern scientific studies in bacterial\\npathology, while they have made a considerable impress upon dental\\noperative methods, have not, however, received that universal practical\\nacceptance among dental operators which their immense importance\\ndemands. There is no field of special surgery in which the import-\\nance of exact knowledge with respect to aseptic and antiseptic treat-\\nment is more marked than in the practice of dentistry. The dental\\noperator is continually confronted Avith septic conditions, so that pre-\\ncise knowledge of their origin, causes, phenomena, and treatment are\\nessentials to the legitimate practice of the profession.\\nThe performance of any operation, and especially those which are\\nclassified as capital, with unclean hands or infected instruments would\\nin the present stage of surgical art be regarded as criminal malpractice.\\nIt should be so considered in dentistry. The loss of a patient s life as\\nthe result of surgical septic infection is no longer permissible. Lack\\nof antiseptic precautions in certain dental operations may directly lead\\nto and as a matter of fact has been the cause of fatal results. It has\\nbeen shown conclusively that a large variety of pathogenic micro-\\norganisms are almost constant inhabitants of the oral cavity. In addi-\\ntion to the numerous forms which bring about an acid reaction, there\\nare many specified organisms which produce in inoculated animals\\npyemia and septicemia in their several clinical classes. But while the\\ndental practitioner is not often called upon to face the issues of life\\n15", "height": "4548", "width": "2704", "jp2-path": "americantextboo00kirk_0023.jp2"}, "24": {"fulltext": "1 6 INTR OD UCTOR Y.\\nand death in the course of his work, his responsibilities as related to\\nthe issues with which he does deal demand of him the same care and\\nthoroughness in order to attain the character of result which the pos-\\nsibilities of modern dentistry require of him. In the following pages\\nthe importance of asepsis and antisepsis in dental operations is con-\\nstantly impressed upon the mind of the student.\\nBy the term asepsis is specifically meant the condition under which\\nare excluded those influences or causes which induce infection by patho-\\ngenic micro-organisms when a tissue or surface has been rendered\\ngerm-free it is said to be in an aseptic condition. By antisepsis is\\nmeant the means by which the septic state is combated or the aseptic\\nstate is attained.\\nUnder the aseptic condition repair of tissues takes place normally\\nwithout interference, wounds and injuries heal with a minimum of dis-\\nturbance, and the inflammatory concomitant is of the simple traumatic\\ntype, without suppuration or tendency to diffusion\\nThe aseptic state, in many operations in the mouth, is not readily\\nattainable and cannot be maintained for any length of time but in all\\noperations which involve the pulp and pulp chamber, as well as the\\nperiapical region through the pulp canals of teeth, strict aseptic con-\\nditions, as regards external infection, are perfectly attainable through\\nexclusion of the oral secretions by means of rubber dam, the use of\\nsuitable disinfectants, and sterilized instruments. It is the class of\\noperations here alluded to which are most prolific of disturbance from\\ninfective inflammations caused by ignorant or careless manipulation.\\nThe time is at hand, if indeed it has not already arrived, when puru-\\nlent inflammations following dental treatment will be regarded with\\nthe same condemnation of the dentist as of the general surgeon. The\\noperative section of this work is written in full recognition of the prin-\\nciples here indicated.", "height": "4612", "width": "2740", "jp2-path": "americantextboo00kirk_0024.jp2"}, "25": {"fulltext": "OPERATIVE DENTISTRY.\\nCHAPTER I.\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nBy Alton Howard Thompson, D.D.S.\\n1. Definition. The teeth may be properly defined as hard, cal-\\ncareous bodies situated in that portion of the alimentary canal near the\\nanterior or oral extremity. In man they are confined to the oral cavity\\nand are supported by the maxillary bones only. In the lower verte-\\nbrates they may be scattered over all of the bones and cartilages sur-\\nrounding the mouth.\\n2. Function. The main function of the teeth is the mechanical sub-\\ndivision of substances used for food, preparatory to their digestion these\\norgans therefore belong to the alimentary system. The elements of\\ntheir function are prehension, incising, crushing, mastication, and insali-\\nvation. For the performance of these various offices, different forms\\nof teeth are found in the denture of man. In lower animals food-habit\\ninduces the evolution of many various and extreme forms of the teeth.\\nThe secondary offices of the teeth in man are as adjuncts in vocal-\\nization and articulate speech they also bear an esthetic relation to the\\nmouth and face.\\nFig. 1.\\na b c d e\\nThe formation of single teeth from the single cone and its repetition in complex teeth.\\n3. Mechanical Design. All tooth forms are evolved by modification\\nfrom a simple cone, which is the primitive, typal form. The teeth of fishes\\nand reptiles are but simple cones, and those of higher mammals are\\nmodifications of the single cone or combinations of two or more cones\\n2 17", "height": "4552", "width": "2700", "jp2-path": "americantextboo00kirk_0025.jp2"}, "26": {"fulltext": "18 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nfused together. Thus in man the incisors are formed of a single cone, the\\ntruncated apex of which is compressed to form the wide cutting edge (Fig.\\n1, a). The canine or cuspid is a single cone, the apex of which is com-\\npressed into a trihedral point, or pointed pyramid (b). The bicuspids\\nare composed of two cones fused together, the forms of the cones being\\nquite distinct the entire length of the tooth, as in the upper bicuspids (c).\\nThe typal upper molar is formed by the addition of the third cone to\\nthe bicuspid form, as plainly noticed in the three roots and the primitive\\nthree cusps (d). The usual quadricuspid form is made by the addition\\nof a cingule. The lower molar consists of four cones, which may be\\nplainly distinguished by an analysis of its elements (e). Each cone in\\nthe structure of a tooth is surmounted by a cusp or tubercle. Extra cusps\\nabove the number of primary cones are but cingules or undeveloped cusps.\\nIn the genesis of tooth forms, therefore, the complex teeth, as the\\nbicuspids and molars, are formed by the repetition and addition of cones\\nand their accompanying cusps, both laterally and longitudinally of the jaw.\\n4. The Dental Arch.\u00e2\u0080\u0094 The teeth of man are arranged around the\\nmargins of the upper and lower jaws in close contact, and have no\\nFig. 2.\\nSquare. Rounded Square. Rounded. Rounded v.\\nThe main types of the dental arch.\\ninterspaces between them. The basal arch is a graceful parabolic curve,\\nwith some variations which lead from the round arch to the incomplete\\nparallelogram or even to a well-defined V shape. These variations may\\nbe classified as follows\\nFirst The square arch (Fig. 2, a). This is found usually in\\npersons of strong osseous organization, of Scotch or Irish descent i. e.\\nof Gaelic extraction and is probably derived in the first instance from\\na dolichocephalic people. The squareness is more or less dependent\\nupon the prominence of the large canines, which stand out very\\nmarkedly at the angles of the square. The incisors present a flat front\\nand project slightly, with little or no curve of the incisive line.\\nThe bicuspids and molars fall backward from the canines with no per-\\nceptible curve. The two sides are quite parallel, but sometimes there\\nmay be a slight divergence toward the cheek at the rear. This is the\\nlow form of arch which appears in the apes and some low races.", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0026.jp2"}, "27": {"fulltext": "THE OCCLUSION OF THE TEETH.\\n19\\nSecond The rounded square (Fig. 2, b). This is the medium\\narch and is the form usually met with in ordinary well-developed ro-\\nbust Americans. The canines seem to be only so prominent as to give\\ncharacter to the arch without a resemblance to the arches of the lower\\nanimals. The incisors are vertical and the line curves slightly from\\none canine to the other. The bicuspid-and-molar line curves slightly\\noutward from the canine and converges at the rear.\\nThird The rounded arch (Fig. 2, c). This is the circular or\\nhorse-shoe arch. It is nearly semicircular, the ends curving in-\\nward at the rear, the outlines of the arch tracing a decided horse-shoe\\nshape. The canines are reduced to the level of the arch, so that there\\nis no prominence of these teeth. The bicuspids and molars follow the\\nline of the curve. This arch is quite characteristic in some races, as\\nthe brachycephalic South Germans.\\nFourth The rounded V (Fig. 2, d). In this form the round arch is\\nconstricted in front or narrowed so that the incisors mark a small curve\\nwhose apex is the centre. It is the arch of beauty and is that most\\nadmired in women of the Latin races.\\nThese are but the basal forms of the dental arch. Ordinarily, mod-\\nifications of these types occur in all degrees it is the variations, the\\ncomposites, which are most met with.\\n5. The Occlusion of the Teeth. The upper teeth describe the seg-\\nment of a circle larger than that of the lower teeth so that the edges\\nof the anterior teeth above close over those below, and the buccal cusps\\nof the grinding teeth above close outside of the buccal cusps of the\\nlower teeth (Fig. 3). By this arrangement the buccal cusps of the\\nlower grinders are received into the de-\\npressions or sulci between the buccal and\\nlingual rows of the cusps and tubercles\\nof the superior molars and bicuspids, and\\nthe lingual cusps of the upper grinders\\nare received into the sulci of the lower\\ngrinders. By this arrangement the whole\\nof the morsal surfaces of these teeth are\\nbrought into contact in the several move-\\nments of mastication, thereby rendering\\nthe performance of this function more\\neffective.\\nThen, again, the upper incisors usually\\nclose over the lower for one-third of their\\nlength. This allows of the shearing action by which the incisive func-\\ntion is performed as the edges of these teeth are drawn past each other.\\nThe line of the horizon of occlusion (Fig. 4, A-B) presents a decided\\nIncisors,\\nFig. 3.\\nBicuspids\\nMolars.\\nThe relative position of the upper\\nand lower teeth in occlusion.", "height": "4548", "width": "2692", "jp2-path": "americantextboo00kirk_0027.jp2"}, "28": {"fulltext": "20\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\ncurve from front to rear, of greater or less degree in different forms of\\nthe arch. Thus it is high at the incisors, curving downward at the bicus-\\npids, reaching its lowest point at the first molar it curves upward rap-\\nidly at the second molar, and is highest, again, at the third. In the\\nrounded arch the plane is more flattened, and it exhibits the extreme\\nFig. 4.\\nThe horizon of the line of occlusion and plane of occlusion.\\ndownward curve in the square arch. Between these extremes there\\nis of course every variety of modification. The form of the plane of\\nocclusion is shown in Fig. 4, C.\\nFig. 5.\\nThe apposition of the upper and lower teeth.\\nThe tendency of the bolus of food is toward the lowest part of the\\ncurve at the region of the lower first molar, so that the extraction of\\nthis tooth always affects the performance of mastication.\\nIn the apposition of the teeth of the opposite jaws the mechanical", "height": "4608", "width": "2744", "jp2-path": "americantextboo00kirk_0028.jp2"}, "29": {"fulltext": "THE OCCLUSION OF THE TEETH\\n21\\narrangement is such that the dynamics of mastication is subserved\\nand the greatest effectiveness secured (Fig. 5). Thus the morsal sur-\\nface of the upper central incisor is opposed to all of that of the cen-\\ntral incisor below and to the mesial half of the lateral the upper lat-\\neral opposes the distal half of the lateral below and the mesial face of\\nthe canine the upper canine, the distal half of the face of the lower\\ncanine and the mesial half of the first bicuspid the upper first bicuspid\\nopposes the distal half of the lower first bicuspid and the mesial half\\nof the second the upper second bicuspid opposes the distal half of\\nthe lower second bicuspid and part of the lower first molar the upper\\nfirst molar opposes the distal part of the lower first molar and the me-\\nsial half of the second the upper second molar opposes the distal half\\nof the lower second and part of the third and the upper third covers\\nthe remainder of the lower third molar.\\nBy this method of apposition the teeth are so arranged that two\\nteeth receive the impact of half of two of the opposite jaw, thus\\ndistributing the force of occlusion and ensuring the safety and strength\\nof the teeth. This break-joint arrangement permits each tooth to\\nbear two opposing ones, and also helps to preserve the alignment.\\nFig. 6.\\nIncisors. Canines or Premolars or Molars,\\ncuspids. Bicuspids.\\nThe classes of the teeth, comprising the left half of a full denture.\\nThen again, if one tooth be lost, the opposing teeth still rest against\\ntwo teeth, one at each side of the space. The normal condition of\\nthe articulation is rarely preserved, however, as mutilation usually dis-\\nturbs it the teeth move on account of the force of occlusion, and effec-\\ntive mastication is more or less destroyed.", "height": "4548", "width": "2692", "jp2-path": "americantextboo00kirk_0029.jp2"}, "30": {"fulltext": "22 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\n6. Number and Classes of the Teeth. Man has thirty-two teeth,\\ndivided into four classes, viz. (1st) incisors, (2d) canines or cuspids,\\n(3d) premolars or bicuspids, and (4th) molars (Fig. 6). This is\\nexpressed by the dental formula as follows\\n2\u00e2\u0080\u00942 1\u00e2\u0080\u00941 2-2 3\u00e2\u0080\u00943\\nc. bi. m. 32.\\n2-2 1 V 2\u00e2\u0080\u00942 3\u00e2\u0080\u00943\\n(1) The incisors are eight in number, four above and four below,\\ntwo on each side of the median line. The two next to the median line\\nare called the central incisors, the ones next to them distally, the lat-\\neral incisors.\\n(2) The canines are four in number, two above and two below,\\none on each side immediately approximating the lateral incisor on the\\ndistal side.\\n(3) The bicuspids are eight in number, four above and four below,\\ntwo on each side approximating the canines on the distal side.\\nThe first of these next the canine is called the first bicuspid, the one\\nnext to it on the distal side the second bicuspid. The same designa-\\ntion applies to both upper and lower bicuspids.\\n(4) The molars are twelve in number, three on each side of each\\njaw, approximating the second bicuspid on the distal side. The\\nmolar next to the second bicuspid, both above and below, is called the\\nfirst molar the next one distally is called the second molar the next\\none distally, and the last tooth in the jaw, is called the third molar or\\nwisdom tooth (dens sapientice).\\nFunctionally, the incisors are formed for cutting, as their name im-\\nplies the canines for prehension and tearing (for which purpose this\\ntooth in lower animal forms is often excessively developed). It also\\nserves in guiding the bite. The bicuspids are the crushing teeth, and\\nthe molars are formed for grinding, triturating and insalivating the\\nfood.\\nThe Incisors.\\n7. The Upper Central Incisor. This is the first tooth in the den-\\ntal series in man. It is situated in the front of the mouth, next to the\\ncentre of the arch, which is the mesial border of the intermaxillary\\nbone. In adult man these bones fuse with the anterior borders of the\\nright and left superior maxillary bones. Their junction with each other\\nmarks the centre of the dental arch.\\nThe general form is that of a truncated cone with its top flattened\\nout to form the cutting edge.\\nIts function is to cut or incise food, hence its name from the Lat.\\nincisus,", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0030.jp2"}, "31": {"fulltext": "THE INCISORS.\\n23\\nThe mechanical structure of the crown is a matter of importance. It\\nwill be observed that it consists of several elements first, a broad cut-\\nting blade (Fig. 7, a) supported by two strong lateral columns (6) on\\neach side, and that these columns\\nare upheld by two strong marginal\\nThe mechanical design of the crown of\\nthe upper central incisor a, the blade b,\\nthe two columns supporting the blade c,\\nthe marginal ridges acting as guys, brac-\\ning the columns d, the basal ridge as the\\nbase of attachment for the guys.\\nd f\\nDiagram of the labial face of the upper central\\nincisor.\\nridges (c) leading up from the lower ridge (cl). These ridges are but-\\ntresses, which guy and uphold the columns which contain and carry the\\nblade. Hence, when these ridges are destroyed by caries or in operating,\\nthe support of the column is lost and the blade readily breaks away.\\nThe form of the crown is spade-like, or a compressed-wedge shape,\\nthe edge being quite thin and the thickness increasing rapidly to the\\nbase. It is slightly bent toward the lingual side, or much curled over in\\nsome cases.\\nThe labial face is imperfectly square or oblong, the cervical margin\\nbeing rounded (Fig. 8, a). It is convex from side to side, but only\\nslightly so from cervix to edge. Two shallow depressions or furrows\\nextend the length of the face perpendicularly (6) dividing it into\\nthirds, called lobes, the mesial, (c), median (cl)\\nand distal lobes (e). These furrows and lobes are\\nquite conspicuous when the tooth is erupted, but\\nare abraded by age and the wear of use and denti-\\nfrices, until the face becomes smooth. The mesial\\nmargin is a little longer than the distal so that\\nthe cutting edge slopes upward toward the distal\\nside\\nThe lingual face is smaller than the labial,\\nbeing on the inner and smaller curve of the\\ncrown, and is narrower from side to side (Fig. 9).\\nIt is triangular in outline, being wide at the edge and narrow and\\nrounded at the base or cervix. The marginal ridges (a) are high\\nand conspicuous, and extend from the basal ridge to the edge on the\\nDiagram of the lingual face\\nof the upper central in-\\ncisor.", "height": "4544", "width": "2700", "jp2-path": "americantextboo00kirk_0031.jp2"}, "32": {"fulltext": "24\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nMesial. Distal.\\nThe mesial and distal faces and\\nedge of the upper central in-\\ncisor.\\nmesial and distal margins of this surface. The basal ridge (6) is a\\nstrong elevation continuous with the marginal ridges at the base of\\nthe crown. It is sometimes developed into a raised cusp, the ridge\\nat the base of which forms a cingulum. A ridge or lobe (c) extends\\nfrom the basal ridge to the centre of the edge, uniting with the median\\nlobe from the labial face to form the median tubercle. A depression\\nor fossa (d) is found on each side of the median lobe between it and the\\nmarginal ridges, or, when the lobe is low or entirely absent, these fossae\\nmay be continuous. A fault or fissure at its junction with the basal\\nridge forms the seat of caries in teeth of low structure.\\nThe mesial face (Fig. 10) is a rather long triangle in shape, with a\\nconcaved base at the cervix of the tooth (a),\\nand a long point toward the edge. It is\\nnearly straight in a longitudinal direction,\\nbut rounded and convex transversely. It is\\nlonger than the distal face, the edge descend-\\ning in that direction. The enamel line dips\\ndownward into this face, and there is a de-\\npression above it (b) which sometimes extends\\nupward on the root. The point of contact\\nwith the opposing tooth is near the cutting\\nedge.\\nThe distal face is also triangular in outline (Fig. 10) but it is more\\ncurved in the longitudinal axis, so that this surface is convex in all\\ndirections. It is most curved in the transverse direction. The enamel\\ndips downward into the surface (d), as in the mesial, but there is not so\\nmuch of a depression above this line. The point of contact is one-third\\nof the distance from the angle\\nThe edge, or morsal margin, of the crown is formed by the com-\\npression of the top of the truncated primitive cone. It is quite wide\\nand square except at the distal corner, which is rounded. The angle\\nwith the mesial face is acute (Fig. 10, When the tooth is first\\nerupted, the edge has three prominent tubercles (g), which correspond\\nto the ridges on the labial and lingual faces. These are soon worn off\\nwith use, so that the edge usually looks straight. The pitch of the\\nedge is toward the median line.\\nThe neck of the central incisor is a rounded pear-shape in outline,\\nthe labial half being wider (Fig. 11, a) than the lingual. There is not\\nmuch constriction of the tooth at the neck. The enamel edge curves\\nupward on the root on the labial and lingual sides, and dips down-\\nward on the mesial and distal faces. It terminates abruptly on all\\nsides, especially on the lingual, where a considerable ridge is some-\\ntimes raised (Fig. 10, c).", "height": "4604", "width": "2728", "jp2-path": "americantextboo00kirk_0032.jp2"}, "33": {"fulltext": "THE INCISORS.\\n25\\nFig. 11.\\nThe root of the upper cen-\\ntral incisor.\\nThe root is cone-shaped and tapering (Fig. 11, b). The rounded\\npear-shaped section continues almost to the end.\\nThe pulp chamber is spacious and open, and of\\nthe general form of the tooth (a and c). The radi-\\ncal portion of the canal gives free access, but the\\nflattened coronal portion is difficult to cleanse. In\\nyoung teeth the cornua or horns of the pulp may\\nproject far toward the angles (c).\\n8. The Lateral Incisor. This tooth approxi-\\nmates the central incisor on its distal side, and is\\nalso implanted in the intermaxillary bone. It is\\nof similar spade-like form and of the same architectural design as the\\ncentral, modified by the distal half being more rounded in every direc-\\ntion. As the crown is narrower than the central, the destruction of the\\nmarginal ridges on the lingual face weakens the edge still more, so\\nthat it breaks off more easily. The crown is narrower in the rnesio-\\ndistal diameter than the central, but, still almost as w T ide labio-lingually,\\nthe relative difference of thickness in the two directions is more ap-\\nparent. The tooth has the appearance of being compressed mesio-\\ndistally. The thickness increases rapidly from the edge to the neck\\n(Fig. 12, B).\\nFig. 12.\\nThe upper lateral incisor.\\nThe labial face (Fig. 12, C) is more rounded than that of the cen-\\ntral. It is half incisor and half canine (a), the mesial half toward the\\ncentral incisor resembling that tooth (6), and the distal half toward\\nthe canine resembling it (c). The mesial angle of the edge is quite\\nacute, while the distal angle is rounded and obtuse. The three lobes\\nmay be well developed, similar to those on the central incisor, but\\nare usually indistinct, although the central ridge is prominent.\\nThe lingual face (Fig. 12, D) is much depressed, but less concave\\nthan that of the central incisor. The marginal (d) and basal ridges (e)\\nare quite prominent. The basal ridge is often raised into a prominent\\ncingule or talon, an exaggerated example of which is shown in Fig.\\n13, which is a revival of the basal talon found in the apes, and\\nthe insectivora. This cingule occurs more frequently on the lateral", "height": "4540", "width": "2684", "jp2-path": "americantextboo00kirk_0033.jp2"}, "34": {"fulltext": "a\\n26 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nincisor than on any other of the anterior teeth. The depression\\nabove it is often the location of a fault, a fissure or pit, which be-\\ncomes the seat of caries. The basal ridge is\\nsometimes cut by a fissure which leads down quite\\nupon the neck of the tooth (Fig. 12,/).\\nSometimes the entire surface is full and rounded\\nwithout any concavity whatever.\\nThe mesial face (g) is of triangular form similar\\na to that of the central incisor. It is rounded toward\\nthe edge labio-lingually, but flattened at the neck,\\nwith a depression at the enamel line which leads\\nShowing unusual develop-\\nment of the cinguie or upward upon the root. The labial angle is some-\\nbasal talon on an incisor. timeg geat f a depression (h), which gives the\\n(From case reported by Dr. r\\nw. h. Mitchell, nentai Cos- angle a hook shape. The depression varies in\\nmo*, vo xxxi-v p. 1036.) w j^th and depth and may become the seat of\\ncaries. The point of contact with the central incisor is at the junction\\nof the lower with the middle third of the length of the face.\\nThe distal face is more convex in all directions and resembles the\\ncanine in form, being in harmony with the general form of the distal\\nhalf of that tooth. From cervix to edge it is rounded and the contact\\neminence in the middle third is very full (i). From this point it rounds\\noff rapidly to the edge. The upper third is depressed rapidly toward\\nthe cervix, with a considerable depression at the enamel line leading\\noff to the distal groove on the root.\\nThe edge is divided into two portions by the prominent tubercle (j)\\nin the middle which terminates the prominent central ridge of the\\nlabial face. The mesial half is straight, like that of the central.\\nWhen worn, these features disappear and the edge becomes almost\\nstraight. The pitch of the edge, like that of the central, is toward\\nthe median line.\\nThe neck is much flattened mesio-distally, and is of a compressed\\npear shape, or flattened oval on section. The enamel margin pursues\\nthe same course as on the central incisor, rounding upward toward the\\nroot on the labial and lingual sides and dipping downward on the\\ndistal and mesial. It does not terminate sO abruptly as that of the\\ncentral incisor, and presents less of a ridge at the gingival margin.\\nThe root is commonly longer than that of the central incisor, is\\nnarrower, flattened mesio-distally (Fig. 12, .1, B). It tapers gradually,\\nnot rapidly like the root of the central incisor. It is a flattened oval\\non section (e). Sometimes there is a hook at the end, curved distally.\\nGrooves sometimes occur on the mesial and distal sides.\\nThe pulp canal is flattened in conformity to the shape of the root,\\nbut is readily entered if the root be straight.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0034.jp2"}, "35": {"fulltext": "THE INCISORS.\\n27\\nThe lateral incisor is very irregular as to form, presenting various\\ndegrees of deformity or abnormality, and may sometimes be reduced to\\na mere peg. It is also erratic as to eruption, being sometimes sup-\\npressed, not appearing for several generations of a family. It follows\\nthe third molar in the frequency of its irregularities both as to form\\nand frequency of non-eruption.\\nThe third incisor of the primitive typal mammal sometimes reap-\\npears in man, and is known as a supernumerary. It rarely assumes the\\nproper incisor form and position in the arch, but usually erupts within\\nthe arch and is a mere pointed-peg-shaped tooth.\\n9. The Lower Incisors. These are most conveniently described as\\na group, as they are very similar in form, having but slight variations\\nbetween the central and lateral incisors to be noted.\\nThey are located in the anterior portion of the lower jaw, upon each\\nside of the median line, opposite the incisors above. Their function is the\\nsame as that of the upper incisors, the cutting of food, which they per-\\nform by opposing the upper. The lower central opposes only the cen-\\ntral above the lateral, both the upper central and lateral incisors.\\nThe lower central incisor is the smallest tooth in the dental series.\\nIt is of spade-like form (Fig. 14), the crown being a double wedge\\nshape (a, b). The first wedge (a) is observed on viewing the crown\\nfrom the front, the widest portion being\\nat the morsal edge and the point at the\\ncervix. The second wedge is observed\\nfrom the side (b), the widest part being\\nat the neck and the point at the morsal\\nedge of the crown. The edge is thin,\\nbut the labio-lingual diameter increases\\nrapidly to the cervix, which is the\\nwidest part. The crown is widest\\nmesio-distally at the edge, but diminishes to the neck, which is scarcely\\nmore than half the width of the edge. The tooth cone is therefore\\ncompressed in one direction at the edge, and in another at the cervix.\\nThe mechanical elements are the same as those of the upper central, but\\nwith the parts less strongly marked.\\nThe labial face is a long wedge shape (a), the widest part at the\\nedge and narrowing to the cervix. It is usually straight, or nearly\\nso, longitudinally, and straight across the edge, but round and con-\\nvex at the neck and the cervical half. Sometimes vertical ridges are\\nfound on these teeth when they are first eruptedy but these soon\\nwear off.\\nThe Ungual face is depressed and concave from edge to cervix (c),\\nbut less so from side to side. The marginal ridges are often well\\nThe lower incisor.", "height": "4548", "width": "2680", "jp2-path": "americantextboo00kirk_0035.jp2"}, "36": {"fulltext": "28 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nmarked. In the lateral incisor the fossa is often more marked and\\nthe marginal ridges more distinct.\\nThe mesial and distal sides are of wedge-like form, straight from edge\\nto cervix and widening in the same direction. A depression runs across\\nthe neck just above the enamel line.\\nThe neck is much compressed disto-mesially, and the root partakes\\nof this flattening through its entire length. The section presents a\\ncompressed oval (e). The enamel line dips downward on the labial and\\nlingual sides, and curves upward on the mesial and distal, in a manner\\ncharacteristic of the incisors.\\nThe edge is perfectly straight from side to side, after the three tuber-\\ncles, found when first erupted, are worn off.\\nThe root is flattened like the neck, and frequently a groove runs the\\nentire length on the mesial and distal sides. Occasionally complete\\nbifurcation results, which recalls the form of this tooth found in lower\\nanimals.\\nThe pulp canal (e) is of similar form to the root, and is flattened\\nand thin, so that it is often difficult to effect an entrance to it with\\ninstruments.\\nThe lateral is similar in form to the central incisor, but is wider at\\nthe edge and the distal corner of the edge is slightly rounded (d). In all\\nother features it resembles the central incisor.\\nThe Canines or Cuspids.\\n10. The Upper Canine. This is the third tooth from the median\\nline and approximates the lateral incisor on its distal side. It is the\\nfirst tooth posterior to the intermaxillary suture and is imbedded in\\nthe maxilla proper. It is commonly said to form the spring of the\\narch, and conveys the impression of great strength, as is indicated by\\nits strong implantation. It is more strongly implanted, and by a longer\\nand larger root, than any of the other teeth. Zoologically it is the\\nlargest tooth in the dental series, but in man is much reduced from\\nits prototype, the larger carnassial canine of lower animals, especially\\nthe carnivora. It is the principal prehensile tooth, and is therefore\\nfirst in order of function in the dental series.\\nThe canine in man preserves the typal form, for its mechanical\\nstructure is still that of a single cone, brought to a point (Fig.\\n15, a). This is the earliest form of teeth found in the lower verte-\\nbrates, the fishes and reptiles, which present only simple conical teeth\\nin all parts of the jaw. It has an older history than any other tooth,\\nand still bears the marks of the many changes through which it has\\npassed in the course of its evolution.", "height": "4608", "width": "2736", "jp2-path": "americantextboo00kirk_0036.jp2"}, "37": {"fulltext": "THE CANINES OR CUSPIDS.\\n29\\nThe crown has a spear-head shape (6), hence the name, cuspid, by\\nwhich this tooth is frequently designated, from the Lat. cuspis, point,\\npointed end. It is constructed essentially for piercing and tearing.\\nThe central cusp or point is braced in all directions the edges leading\\nup to it both mesially and distal ly (which serve for cutting as well), the\\nFig. 15.\\nc d e\\nThe upper canine.\\nstrong labial ridge coming downward from the cervix (c) to the median\\nridge leading up on the lingual surface (d), all support it in the office\\nof prehension and the laceration of flesh.\\nThe labial face (b) presents the outlines of the spear shape, more or\\nless rounded in different cases. Starting from the well-defined cusp just\\nin front of the central axis of the tooth, it widens sharply for about\\none-third of its length, whence it narrows gradually to the gum line,\\nwhich is fully rounded. In some cases the mesial and distal angles are\\nrounded and the outlines are more of a leaf shape (e). The surface\\nis slightly rounded mesio-distally, so that the sides slope roundly or\\nflatlv away from the central ridge. This ridge descends from the middle\\nof the cervical margin, curving slightly forward and then backward to\\nthe point of the cusp (c). This curve recalls the curving shape of this\\ntooth in the Felidse. It is usually a sharp, prominent ridge, but may\\nbe reduced and rounded so as to be scarcely perceptible. The three lobes\\nof the surface are imperfectly marked, the central ridge dominating\\nand dwarfing the lateral ones. The lateral furrows on each side of\\nthe central ridge separating it from the lateral lobes are more or less\\nmarked, especially toward the edge. Wear reduces in time the prom-\\ninence of the lobes and ridges and obliterates the furrows.\\nThe lingual face is of similar spear shape (d), but is more flat. It is\\nrarely concave. The thickness of the crown increases gradually to\\nthe lateral prominences, which gives a blade-like edge, then rapidly\\nto the shoulder at the base. A strong vertical ridge extends from the\\ncusp to the basal ridge (d), with a slight concave depression on each\\nside. The basal ridge is well marked and sometimes develops into\\na cingule, more or less marked. The marginal ridges lead up on each", "height": "4552", "width": "2684", "jp2-path": "americantextboo00kirk_0037.jp2"}, "38": {"fulltext": "30 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nside only so far as the lateral protuberances. They are not strongly\\nmarked as a rule. The fossae on each side of the vertical median ridge,\\nbetween it and the marginal ridges, may be quite deep but are usually\\nshallow and ill defined.\\nThe mesial face in outline is not unlike the central incisor, but its\\ncontour is very different, for it is more or less rounded in all direc-\\ntions, and the lateral eminence in the lesser third makes this part espe-\\ncially full (i). From this point the surface is depressed roundly to the\\nenamel line at the neck, where a depression of greater or less depth is\\nfound. It is somewhat flattened at the cervix. The point of contact\\nis at the eminence, which touches the lateral incisor.\\nThe distal face is of similar form to the mesial, except that it is more\\nfull and the eminence more pronounced, which gives the increased width\\nof the crown on that side. The surface descends rapidly toward the neck\\nand is rounded labio-lingually. The point of contact with the first bi-\\ncuspid is on the lateral protuberance.\\nThe morsal edge presents a prominent cusp which is almost central\\nto the long axis of the tooth. The side facets slope away, but still retain\\ntheir cutting edge (6). The distal side of the edge is longer than the\\nmesial, by reason of the increased size of the distal protuberant angle.\\nThe sharp point is soon worn off to a rounded cusp, and, as wear\\nincreases with age, it may be reduced to a straight surface between the\\nmesial and distal protuberances (g).\\nThe neck is a flattened oval on section, or the lateral direction of the\\nlabial portion may be greater than that of the lingual (A). The enamel\\nline preserves the same curves as on the incisors, i. e. rounding upward\\non the labial and lingual surfaces and dipping downward on the mesial\\nand distal. The enamel terminates gradually with but a slight ridge,\\nunless it should be on the lingual side. A depression occurs on both\\nmesial and distal sides above the curve, which may lead up as a groove\\non the root.\\nThe root is longer than that of any other tooth, and it is at least\\none-third larger than that of the central incisor. It is of a rounded\\ntrihedral form, or irregularly conical. It is usually straight, and tapers\\nto a slender point, which may be curved or very crooked. In well-\\narranged dentures, where it has erupted naturally, it is usually straight.\\nThe pulp canal is large and open, of the same form as the tooth, and\\neasily entered. It is regularly formed except in those cases where the\\nroot is curved, and even in these it can be filled if not too crooked, as\\nit is so open and accessible.\\n11. The Lower Canine. This is similar to the upper in form and\\noutline, except that it is somewhat smaller, more slender, and more\\nrounded in form (Fig. 16, a). It differs also in being more compressed", "height": "4580", "width": "2760", "jp2-path": "americantextboo00kirk_0038.jp2"}, "39": {"fulltext": "THE CANINES OR CUSPIDS.\\n31\\nmesio-distally and in being flattened in the neck and root, The crown\\nleans backward on the root so that the mesial face is almost straight the\\nentire length of root and crown. It forms the spring of the lower arch,\\nand is strongly built to oppose the strong upper canine in the act of\\nprehension and tearing. It opposes the mesial surface of the canine\\nabove and the distal surface of the upper lateral incisor.\\nc\\nThe lower canine.\\nThe labial face is a long oval (a), the cusp being blunt and the neck\\nrounded while the mesial side (c) is flattened. The lobes are indistinct\\nand the central ridge rounded from side to side. The entire face is in-\\nclined inward to accommodate the occlusion. The crown in many cases\\npresents the appearance of being blunt toward the distal side.\\nThe Ungual face (b) is flat, sometimes cup-shaped, and the marginal\\nridges are not prominent, The central ridge sometimes stands out\\nstrongly. The basal ridge is weak and is rarely developed into a\\ncingule. The crown increases gradually in thickness from the point\\nto the neck.\\nThe morsal surface presents a mere rounded eminence the cusp may\\nbe sharp in childhood, but usually it is soon reduced by wear. Some-\\ntimes it remains sharp and prominent, The lateral edges are not devel-\\noped, but are mere ridges leading down to the lateral faces, which are\\nnot prominent, except the distal (d), which is often full.\\nThe mesial face is quite flat, and straight with that face of the root.\\nThe eminence is not marked. It is rounded only at the eminence, but\\nflattened at the cervical third (c).\\nThe distal face has the most prominent eminence (d), the crown being\\nbent in that direction. The cervical third of this face is flat. It descends\\nrapidly from the eminence.\\nThe neck is usually oval or, when compressed, spindle-shaped\\nupon section (g), being depressed on the mesial and distal sides at the\\norigin of the grooves running up on the root, The enamel line is\\nnot so variable as on the incisor, but more nearly on a level on all four\\naspects.", "height": "4556", "width": "2664", "jp2-path": "americantextboo00kirk_0039.jp2"}, "40": {"fulltext": "32\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nThe root is long, flattened, and tapering 6, c). It is shorter than\\nthat of the upper canine. It is grooved on the mesial and distal sides,\\nso much so as to tend toward bifurcation. This, indeed, sometimes hap-\\npens in man, thereby recalling the form usual to the primates and some\\nother lower animals.\\nThe pulp canal is of the same general form as the root, often pre-\\nsenting the spindle shape on section. It is somewhat difficult to enter\\non account of its flattened shape and narrowed channel.\\nFig\\nb c\\nThe upper bicuspids\\nment of a root to support it.\\nThe Bicuspids.\\n12. The Upper Bicuspids. The upper bicuspid is formed by duplica-\\ntion of the primitive cone and cusp in a transverse direction (Fig. 17, a).\\nViewed from the standpoint of com-\\nparative dental anatomy, the external\\ncone is the canine cone and to this is\\nadded the internal or bicuspid cone, the\\ntooth being a double canine. The bi-\\ncuspids are the first of the complex\\nteeth. The internal cusp is formed\\nby the raising of the inner primitive\\ncusp of the canine and the develop-\\nThe distinctive feature of the architec-\\nture, therefore, is its formation from two cones, and this makes it a\\nweak tooth as regards its mechanical structure and resistance to mas-\\ntication, for the binding of the bases of the cones and cusps depends\\nupon the connecting power of the two marginal ridges (b, b), and when\\nthese are destroyed the cones readily part and split off.\\nThe bicuspids in man are homologous with the premolars of the\\nquadrumana and other lower mammals. They succeed and displace the\\nmolars or grinders of the deciduous set. They are placed next after the\\ncanines in both jaws, and midway between the cutting and grinding teeth.\\nTheir function is the crushing of food preparatory to mastication.\\nThe upper first bicuspid approximates the canine on the distal side.\\nThe buccal face (c) is of spear-head shape, similar to that of the\\ncanine. This is more apparent in some lower mammals than in man, in\\nwhom it is much reduced and rounded, so as to give usually the appear-\\nance of a long, rounded oval. The buccal cusp (c) rises sharply and\\nprominently from the lower centre of the face, from which a strong ridge\\n(d) leads up to the cervical border. The mesial and distal lobes (e, e) are\\nrarely conspicuous, and the furrows between them and the central ridge\\nlead but half way up the crown. The lobes sometimes have prominent\\npoints at the morsal margins which in lower mammals become pro-", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0040.jp2"}, "41": {"fulltext": "THE BICUSPIDS. 33\\nnounced cingules. The buccal marginal ridges descend from the\\npoints of the cusp to the points of the lateral lobes. The distal ridge\\nis usually longer than the mesial. The cervical border is rounded and\\noval from side to side.\\nThe lingual face (f) is full and rounded, more or less straight perpen-\\ndicularly and rounded mesio-distally. It is convex in both directions.\\nThe lingual cusp rises over it full, but is blunt and round the mar-\\nginal ridges are rounded, not angular, and curve sharply round to meet\\nthe mesial and distal marginal ridges.\\nThe mesial face (Fig. 18, g) is wide and flat transversely, full at\\nthe morsal surface at the marginal ridge, which is prominent, and de-\\nscending flat to the cervix, where\\na depression (h) occurs which ex-\\ntends well up the face.\\nThe distal face is of similar\\nform, but is rather more convex\\nand the portion at the marginal\\nridge more prominent. The de-\\npression from the root does not\\nextend so far up on the face. The upper bicuspids.\\nThe morsal surface shows an\\nabrupt change from that of the canine next to it, as it presents two\\ndistinct cusps or points instead of one. One cusp is on the buccal\\nmargin (j) of the crown, and one on the lingual and they are named\\nthe buccal and lingual cusps. The buccal cusp is sharp and prominent,\\nand is not unlike the single canine cusp. The lingual cusp is broader\\nand more rounded indeed it is preferable to term it a tubercle.\\nThe outline of the morsal surface is imperfectly quadrate and is bor-\\ndered by well-marked marginal ridges, named as follows\\nThe mesial marginal ridge bordering the mesial face of the crown\\nthe distal marginal ridge on the distal side (m), the buccal marginal\\nridges (n) descending from the point of the buccal cusp to meet the buc-\\ncal terminations of the distal and mesial marginal ridges at the angle\\nformed by the junction with the buccal lateral lobes (o), and the lingual\\nmarginal ridges (_p), descending from the lingual tubercle to meet the\\nlingual termination of the mesial and distal marginal ridges.\\nThe triangular ridges descend from the cusps toward the centre of\\nthe tooth and unite at the central groove. In defective teeth they do\\nnot fuse, leaving a fault or fissure which becomes the seat of caries.\\nThis groove or sulcus extends from one lateral marginal ridge to the\\nother mesio-distally and widens into the mesial and distal sulci at\\neach end. The triangular grooves (s) run from the mesial and distal\\nsulci toward the mesial and distal angles, dividing the marginal ridges\\n3", "height": "4556", "width": "2664", "jp2-path": "americantextboo00kirk_0041.jp2"}, "42": {"fulltext": "34 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nfrom the triangular. They also become the seat of caries in imperfectly\\nformed teeth.\\nThe neck of the first bicuspid is compressed or spindle-shaped (t),\\nthe enamel line rising on the buccal and lingual sides and dipping\\ndown on the mesial and distal. The enamel margin tapers off gradually\\non to the root. A wide, deep depression usually occurs (u) on the mesial\\nside of the neck, leading to the groove on the root. On the distal face\\nthis is not so well marked.\\nThe root is much flattened mesio-distally, with a decided groove ex-\\ntending up both sides. This grooving tends to cause bifurcation of the\\nroot, which actually occurs in one-third of the cases, especially in persons\\nof strong build. This bifurcation is a persistent relic of lower forms\\nof the premolars, as in the apes.\\nThe root canal is flat at the neck, and nearly always bifurcated, even\\nwhen the root is not separated. This is readily seen by holding a bicus-\\npid having one root, up to the light, when the central portion will be ob-\\nserved to be translucent. The usual bifurcation necessitates the search\\nfor both canals in every case in treating this tooth.\\nThe upper second bicuspid (w) approximates the first on the distal\\nside, and is similar to it in every way, except that it is usually smaller and\\nmore rounded in all directions. The sharp features, conspicuous ridges,\\netc. are not so strongly marked. The cusps are reduced, the ridges more\\nrounded, and the morsal face more flattened, and it is often wrinkled.\\nThe triangular ridges are more likely to be united, thus making the crown\\nstronger. The crown is thinner mesio-distally. The neck is more\\nrounded or oval.\\nA most conspicuous difference is in the root, which is narrower labio-\\nlingually, is more rounded, and is rarely bifurcated. It is sometimes\\ncylindrical or cubical in form. It is disposed to be turned, and is often\\ncrooked. The pulp canal is single and readily entered.\\n13. The Lower Bicuspids. These are placed next after the lower\\ncanines on the distal side. In form they are not truly bicuspid, for the\\nfirst is unicuspid and the second is tricuspid in the pure typal forms\\nbut they are arbitrarily termed bicuspids on account of their position as\\ncompared with the upper bicuspids, which are typically bicuspid.\\nThe architectural form of these teeth is that of the single cone, the\\ncrown being augmented in various directions by the addition of cin-\\ngules to the primitive cusp.\\nThe lower first bicuspid is a well-formed transitional tooth, for it-\\ngrades from canine to bicuspid and is typically composite. It more\\nclosely resembles a canine than a bicuspid in its usual form, because\\nthe inner cusp is almost suppressed and is rarely as large as the outer\\none (Fig. 19, a). In fact, it looks like a canine with a cingule raised", "height": "4604", "width": "2776", "jp2-path": "americantextboo00kirk_0042.jp2"}, "43": {"fulltext": "THE BICUSPIDS.\\n35\\nupon its inner face. This cusp is really a cingule, for it is rarely raised\\nto the full height of a cusp.\\nIt varies much in size from a mere point on the basal ridge (b) on\\nthrough various degrees of development, up to a full cusp as large as\\nthe buccal cusp, when the tooth becomes a true bicuspid. The tooth is\\ntherefore essentially a primitive unicuspid premolar, of the form of this\\ntooth in some of the lower primates.\\nThe buccal face (c) is caniniform, or a long oval in outline with\\nthe cusp rising as an abrupt point above it. The angle of the junc-\\ntion of the marginal ridges may stand out prominently. The face\\nThe lower first bicuspid.\\ncurves markedly toward the lingual side, so that the buccal cusp becomes\\ncentral to the long axis of the tooth (a). The cervical border is rounded\\nat its margin and convex from side to side. The lobes are not marked.\\nThe lingual face (d) is convex from side to side and straight vertically,\\nbut is not perpendicular, as it is directed toward the lingual side. Its\\nheight depends upon the height of the lingual cingule, which varies from\\na mere buccal ridge through various degrees up to the full-sized cusp.\\nThe mesial and distal surfaces are of similar form, convex from side\\nto side (a, b) slightly flattened at the cervical border and flaring out to\\nmeet the full marginal ridges, which are round and prominent. The\\nprominence of these ridges and the inward inclination of the lingual\\nface gives the crown a decided bell shape, tapering to the neck (d).\\nThe morsal surface (e) is peculiar and differs from every other tooth\\nin its great variability and the extremes which it may present, from\\nbeing a full bicuspid to a mere canine. This face is nearly circular in\\noutline, the widening of the lateral surfaces by the spreading of the\\nmarginal ridges adding to the width. The buccal cusp (g) is large\\nand prominent, and is also drawn toward the centre of the tooth to\\naccommodate the occlusion. Sometimes it is high and sharp when the\\nlingual cusp is reduced, and is low and blunt when the latter is en-\\nlarged, appearing to have an inverse ratio in size to the inner cusp.\\nThe lingual tubercle or cingule varies much in size, from a mere point\\non the basal ridge, above the cervical border, to a pronounced cingule,\\na larger cingule, a small cusp, then a full cusp, the basal ridge (h)", "height": "4544", "width": "2656", "jp2-path": "americantextboo00kirk_0043.jp2"}, "44": {"fulltext": "36 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nbeing raised with it. The ridges are the mesial and distal marginal\\nridges (i, i), which are bowed out round and full and are always pro-\\nnounced the buccal marginal ridges leading down from the buc-\\ncal cusp to form an angle with the mesial and distal marginal ridges\\nthe basal ridge, when the lingual cingule is lowered (6) and the tri-\\nangular ridge of the buccal cusp, which is always large and when the\\ninner tubercle is reduced leads down as a high central eminence. The\\nlingual cingule, as a rule, possesses no triangular ridge.\\nThe central groove usually crosses the central ridge (k), but not\\nalways, being often bowed around its lower termination. Sometimes the\\nridge is crossed by a sulcus. The groove terminates in a sulcus at each\\nend, with slight triangular grooves branching up on the buccal cusp.\\nThe neck is usually oval on section, being much constricted, the crown\\nflaring upward from the cervical portion, giving the crown the well-\\nknown bell shape. The enamel line dips but slightly, being usually\\nlevel on all four sides. The buccal border sometimes presents a prom-\\ninent ridge.\\nThe root is single, long, tapering and may be nearly round, but is\\nusually flattened mesio-distally. It is sometimes thick the greater part\\nof its length, and terminates in an abrupt, round, blunt apex (c, i). It\\nis very liable to be crooked. It is rarely bifurcated and does not pre-\\nsent grooves on its lateral faces.\\nThe pulp canal is constricted and flattened at the neck, and the back-\\nward inclination of the teeth makes it difficult to enter. The possibility\\nof the root being crooked and the peculiarity of its anatomical rela-\\ntionships l also increase the uncertainty of treatment, which makes the\\npulp canals of the lower bicuspids difficult to deal with.\\nThe lower second bicuspid approximates the first on its distal side.\\nIt resembles the first as regards the general form of\\nFlG 20 the crown, its tapering bell shape, the constriction of\\nthe neck, and the shape of the root. In all these\\nfeatures there is little difference between these teeth,\\nand the description of the first will apply also to the\\nsecond bicuspid.\\nThe morsal surface, (Fig. 20), however, differs very\\nmaterially from that of the first. This is circular in\\nThe morsai surface of outline like the first, and the buccal cusp is full and\\nthe lower second bi- s t n i i\\ncuspid rounded (a), but the inner cusp is divided by a groove\\n(b) running over it, into two parts, so that it is really\\ndivided into two tubercles. This makes the lower second bicuspid in its\\ntypal form a tricuspid tooth so that it differs from the lower first, which\\nhas but one cusp, and from the others, which have but two cusps. The\\n1 See page G06, Chapter XXI., on Extraction of Teeth.", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0044.jp2"}, "45": {"fulltext": "THE MOLARS. 37\\nlingual tubercles vary much in size, so that one may be suppressed and\\nthe tooth seem bicuspid. The mesial lingual tubercle (c) may be of\\nlarge size and be developed at the expense of the distal id) this may\\nbe a mere cingule on the distal marginal ridge and appear on the distal\\nside, but it is always present.\\nThe morsal groove (e) is triangular in design, passing between each\\nof the three tubercles. A well-marked triangular ridge descends from\\neach of the cusps.\\nThe tricuspid form of the morsal surface of this tooth is, of course,\\na reproduction of the trituberculate premolars of the lower primates,\\nand of still lower mammals, although the triangular form of the crown\\nis lost in man.\\nThe Molars.\\n14. The Tuberculate Teeth. Molar teeth appear early in the scale\\nof vertebrate life mere crushing teeth are found in fishes and slightly\\ntuberculate teeth in the reptiles. The grinders are of simple form in the\\nlowest vertebrates. The Bruta have simple, flat-crowned molars, which\\nare undifferentiated and used merely for crushing. Tuberculate molars\\nappeared early in the placental mammalia, the trituberculate molars being\\nfound in numerous fossil species, which are the typal form and forerunners\\nof the tuberculate molars in the higher mammalia. The simple-crowned\\ntooth with a single tubercle (haplodont, Cope), becomes duplicated and\\ndoubled, with a crown supporting several tubercles (bunodont). The\\ntransition from simple to complex teeth is accomplished by the repeti-\\ntion of the type in different directions and the addition of cusps and\\nroots both laterally and longitudinally of the jaw. The upper molar is\\nformed by the addition of the third cusp to the bicuspid type and has\\nthree roots, Avhich support three or four tubercles. Lower molars con-\\nsist of four cones which support four or five tubercles. The lower mo-\\nlar is therefore the more complex tooth. The bicuspid is more complex\\nthan the canine, the upper molar than the bicuspid, the lower than the\\nupper molar.\\nThe molar teeth of man are bunodont in form, i. e. they have simple\\nrounded tubercles on the grinding face. They are of simple and primi-\\ntive type, and indeed are most like the molars of the bears and other\\nomnivorous animals. They are not highly specialized like those of the\\ncarnivora on the one hand with high sharp blades for cutting flesh, nor\\nlike those of the herbivora on the other, which are extended laterally for\\ngrinding tough vegetable fibre. They are of low organization as regards\\ntheir functional development.\\nThe molars in man are twelve in number, three on each side of each\\njaw, and are placed at the rear of the arch, opposite the strong triturat-", "height": "4548", "width": "2664", "jp2-path": "americantextboo00kirk_0045.jp2"}, "46": {"fulltext": "38 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\ning muscles, for the purpose of crushing and masticating food. They\\nare important factors in alimentation and contribute to the function of\\ndigestion by preparing food for the stomach. Their loss impairs this\\nfunction seriously and leads to derangement of the stomach by over-tax-\\ning it with imperfectly masticated food-substances.\\n15. The Upper Molar. The typical upper molar is formed by the\\nfusion of three cones, as is plainly observed in the three roots and the\\nthree tubercles (Fig. 21, A). The tricuspid molar, therefore, is a primi-\\ntive form, and is rarely seen in man, the normal form being quadritu-\\nberculate. The fourth additional cusp, the disto-lingual (b), is merely\\na supplemental cusp added to the crown. An upper molar is, there-\\nfore, composed of three tubercles, and a cingule which has not yet\\ndeveloped a root to support it. The trituberculate molar is the primitive\\nform of this tooth, the quadrituberculate appearing later, and is found in\\nonly a few living forms, as some of the lemurs and the insectivorous\\nand carnivorous mammalia. In man there is sometimes a reversion of\\nthe upper molar to the trituberculate form, which is a marked degeneracy\\nin the form of this tooth. In an analysis of this tooth, therefore, the\\nmesio-buccal tubercle (c) is the canine cusp the mesio-lingual, the bicus-\\npid cusp (d) the disto-buccal, the molar cusp (e), and the disto-lingual\\nis but a supplemental cusp, it is not a true cusp, as it has no root to\\nsupport it.\\nThe architecture of the upper molar presents some interesting features.\\nWe observe that the crown is in a general way a geometrical form, a\\ncube when perfect and symmetrical. It is suggestive of symmetry,\\nbut when taken with the root form is not quite perfect, for it is sup-\\nported on three roots instead of four to correspond with the four tuber-\\ncles at the four corners. So it lacks the harmony of adequate sup-\\nport, which is a cardinal principle in architecture. But the crown\\nseparately is a symmetrical form, a cube, although the angles are rounded\\noff and the corners and points are toned down and not acute. We no-\\ntice that there are four strong columns, one at each of the four corners\\n(g). They are connected on the four sides by the marginal ridges acting\\nas strong connecting arches (h). These arches are related to the col-\\numns of the crown, and both are impressively proportioned. The cusps\\nmay be likened to the capitals of the columns, and the descending mar-\\nginal and triangular ridges to the cornice, gathered together to form the\\ncapitals. The triangular ridges may be considered girders (i), bind-\\ning the four together and also bracing the square obliquely. Or, the\\nfour triangular ridges running to the centre may be regarded as half-\\narches or buttresses, supporting the roof vault, the grinding face.\\nOther elements could be marked out in an architectural study of the\\ncrown of this tooth, showing its beautiful design and symmetry.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0046.jp2"}, "47": {"fulltext": "THE MOLARS.\\n39\\nThe upper first molar approximates the second bicuspid on its distal\\nside. There is a marked and abrupt change in form, as the molar has\\ndouble the number of cusps of the bicuspid,\u00e2\u0080\u0094 being formed like two\\nbicuspids fused together. The four tubercles mean an extension of sur-\\nface and a further adaptation to functional requirements. The crown\\nis large and cubical in form, and more or less rounded.\\nFig. 21.\\ng h i\\nArchitectural diagram.\\nThe upper molar.\\nThe buccal face (K) is wide and rounded. It is twice the width of\\nthe bicuspids. It is broadest at the morsal margin, narrowing upward to\\nthe cervix, where it is widely rounded or arched. A vertical depression,\\nthe buccal groove (7), extends from the cervical border to the morsal\\nmargin, dividing the face into two oblong rounded eminences, the mesial\\nand distal buccal lobes (m m).\\nThe lingual face (iV) is more rounded than the buccal, the cervical por-\\ntion being the most convex (o), the mesial and distal sides being depressed\\ntoward the single lingual root. The morsal half is divided by the\\nlingual groove (q), which descends over the lingual marginal ridge be-\\ntween two lobes, the mesial (V) and distal (p), which are usually much\\nrounded. The morsal half of the face curves toward the grinding sur-\\nface. The mesial lobe sometimes presents the lingual cingule (s), a\\nsort of fifth tubercle of greater or less size. A groove branches from\\nthe lingual groove and extends over, between the cingule and crown.\\nThe mesial face (r) is flat longitudinally, descending from the marginal\\nridge to the cervix in a nearly straight line. Bucco-lingually it is", "height": "4548", "width": "2656", "jp2-path": "americantextboo00kirk_0047.jp2"}, "48": {"fulltext": "40\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nconvex, nearly flat at the marginal ridge, and rounded at the cervix,\\nbeing depressed toward the lingual root. Sometimes a depression from\\nthe bifurcation of the mesio-buccal and lingual roots extends part way\\nup on the face (u).\\nThe distal face is similar to the mesial except that it dips more\\ntoward the cervix, and is, perhaps, more rounded toward the lingual\\nroot.\\nThe morsal surface (Fig. 22) is the most important part of this tooth,\\nand shows features that make it interesting and unique. The abrupt\\nFig. 22.\\nd h j c\\nThe morsal surface of the upper first molar.\\nchange from the bicuspid form is notable, for there are presented four\\ncusps, a doubling of the number the outline of this face presents a\\nsquare form with tubercles at each corner, the mesio-buccal (a), the\\ndisto-buccal (6), the mesio-lingual (c), and the disto-lingual (d) the lat-\\nter is erratic and may be either pronounced or quite reduced in size.\\nThere are four marginal ridges the mesial (e), buccal distal (g)\\nlingual (h), the oblique and the four triangular ridges (j). The oblique\\nridge connects the mesio-lingual with the disto-buccal tubercle and is\\nreally the remnant of the marginal ridge of the tricuspid molar the\\nfourth cusp, the disto-lingual, being raised up on the disto-lingual side.\\nThe four triangular ridges descend from the four tubercles toward the\\ncentre of the tooth, the oblique ridge being formed by the fusion of the\\ntriangular ridges of the mesio-lingual and disto-buccal cusps.\\nThere are two fossse (k), one mesial and the other distal to the oblique\\nridge. Sometimes the latter is cut by a groove or sulcus (I) which\\nextends from the mesial to the distal fossa. Sometimes by the reduction\\nof the disto-lingual lobe and cusp, the mesial fossa is extended and\\nbecomes central to the crown. A groove extends from the mesial fossa\\nover the buccal marginal ridge (m) quite on to the buccal face, dividing\\nthe mesial from the distal buccal lobes. A groove also extends over\\nthe lingual marginal ridge (n) down upon the lingual face, dividing the\\nlingual lobes. When this groove becomes a fissure, caries ensues and\\nthe disto-lingual cingule readily breaks away, this cingule being a weak\\nfeature in the mechanical design of this tooth cutting the distal mar-\\nginal ridge also weakens this cusp. The triangular grooves branch from", "height": "4580", "width": "2720", "jp2-path": "americantextboo00kirk_0048.jp2"}, "49": {"fulltext": "THE MOLARS. 41\\nthe two fossae on to the cusps, dividing the triangular from the marginal\\nridges.\\nThe neck of this tooth is of rounded rhomboid form on section (o),\\nwidest at the buccal side. The enamel is almost level on all four sides,\\ndipping downward slightly on the mesial and distal. A depression\\noccurs at the bifurcation of the buccal roots, and an inward inclination\\non the mesial and distal sides.\\nThe roots are three in number (Fig. 21), two on the buccal side,\\nwhich are small and flat or round, and one on the lingual side, which is\\nlarge and rounded. The roots are usually separated, but may be found\\nunited, by a septum of cementum, in various directions. The mesio-\\nbuccal root is the larger of the two buccal roots, and forms a second\\nturning-point or spring of the arch. All the roots are slightly bent\\nand may be very crooked.\\nThe pulp chamber branches into three canals, one in each root. The\\nlingual canal is large and open and is readily entered. The canals of the\\ntwo buccal roots are small and fine, and, with the possibility of crooked-\\nness in the roots, present the most difficult problems as to treating and\\nfilling found in the whole denture.\\nThe upper second molar is similar to the first in some respects but\\nvery different in others. It is rather smaller, is not usually full and\\nsquare, but disposed to become rhomboid in form (Fig. 23, o, 6), by\\ndisto-mesial compression.\\nThe buccal face is similar to that of\\nthe first molar, and the same description\\nwill apply to it. If any difference is\\nfound it is that the face is strongly com-\\npressed from front to back, and the disto-\\nlingual cusp is more reduced as a con-\\nstant feature.\\nThe lingual face (c) is different from 6 mi _\\na J x The upper second molar.\\nthat of the first molar in that by the sup-\\npression of the disto-lingual tubercle (d) and the distal lobe, the mesio-\\nlingual lobe is enlarged so that it occupies the entire face, which is full,\\nrounded, and convex (e). It is rarely divided into two lobes as in the\\nfirst molar, owing to the enlargement of the mesial lobe and the pushing\\nbackward of the oblique ridge, which throws the lingual groove on to\\nthe disto-lingual angle (d) or the groove may be absent altogether.\\nThe mesial and distal faces are similar in form to those of the first\\nmolar, being perhaps more flattened.\\nThe morsal face is similar to that of the first molar, except that the\\ntubercles are less pronounced and the distal ones are reduced in height\\nto accommodate the upward curve of the line of occlusion at this", "height": "4556", "width": "2664", "jp2-path": "americantextboo00kirk_0049.jp2"}, "50": {"fulltext": "42\\nMACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\npoint. The disto-lingual cingule is smaller than that upon the first\\nmolar, and is often barely marked. This throws the oblique riclge more\\nto the distal side and enlarges the mesial fossa. The various grooves are\\nthe same as on the first molar, except that one, the lingual, may be lost.\\nThe neck is less regular in outline than that of the first molar, as the\\ncrown varies so much in shape. It is more flattened mesio-distally and\\ndepressed toward the roots.\\nThe roots are the same in number and general form as in the first\\nmolar, but spread less and are more irregular in form. They may con-\\nverge or be crooked, or may be fused together. This makes the pulp\\ncanals more difficult to treat. Sometimes the three roots are completely\\nfused, as in the third molar, and the canals may coalesce or the canals\\nof the two buccal roots may run into one. The irregularity and uncer-\\ntainty of the form of the roots make this tooth difficult to deal with in\\ntreating its pulp canals.\\n16. The Lower Molars. The lower first molar approximates the\\nlower second bicuspid on its distal side. It is the first of the true grind-\\ners of the lower jaw and the largest tooth in the dental series. Unlike\\nthe upper molars the transverse diameter is less than the mesio-distal.\\nThe greater width is found across the base of the disto-buccal tubercle.\\nThe crown is square or trapezoidal in form, depending on the size of the\\nfifth tubercle. Being quinquituberculate, the crown is broadened by the\\nmulticuspid grinding face. The buccal face is inclined toward the centre\\nof the tooth, for its morsal half, to accommodate the occluding teeth.\\nArchitecturally, the tooth is formed of four cones (Fig. 24, A), and\\nArchitectural diagram.\\na f\\nThe lower first molar.\\nmay be roughly divided into four quarters. There are four primitive\\ncones with their tubercles and one cingule in the structure.", "height": "4580", "width": "2728", "jp2-path": "americantextboo00kirk_0050.jp2"}, "51": {"fulltext": "THE MOLARS. 43\\nThe morsal surface (B) is trapezoidal in outline, the buccal line\\nbeing the longest. The buccal angles are acute, while the lingual\\nare rounded and obtuse.\\nThere are five tubercles, two on the lingual margin and three on the\\nbuccal. They are named the mesio-buccal (c), median buccal (d), disto-\\nbuccal (e), disto-lingual and mesio-lingual (g). These tubercles are\\nless obtuse and more rounded than those of the other grinding teeth, the\\nmesio-buccal usually being the largest, the others are not so prominent,\\nrarely raised and sharp.\\nThe ridges are the marginal ridges buccal, distal, lingual, and\\nmesial anc the five triangular ridges descending from the five tuber-\\ncles toward the centre of the tooth.\\nThe grooves and sulci upon the morsal surface are very irregular. A\\ndeep sulcus traverses the face from the mesial to the distal marginal\\nridge. A groove runs off toward the lingual side, dividing the lingual\\ncusps (i), sometimes cutting the lingual marginal ridge, but rarely\\nreaching over on the lingual face. A groove runs toward the buccal\\nside, dividing the mesio-buccal from the median tubercle (j), cutting\\nthe marginal ridge and extending over quite on to the buccal face. This\\ngroove often becomes the seat of caries owing to the enamel structure\\nbeing faulty. Another groove extends toward the disto-buccal angle\\ndividing the median from the disto-buccal tubercle, and rarely extends\\nover on to the buccal face. A groove may extend distally cutting the\\ndistal marginal ridge and one mesially cutting the mesial marginal\\nridge (m), but these are not usually marked. The triangular groove run-\\nning up on each side of the triangular ridges (n) divides these from the\\nmarginal ridges. Supplemental grooves may divide the triangular ridges\\nagain. The pits at either end of the sulcus may become the seat of caries\\nthrough faulty formation.\\nThe buccal face (c) is an irregular trapezoid in form, the morsal margin\\nbeing longest the mesial and distal sides converge toward the cervical\\nborder, which is rounded. The morsal margin is broken by the three\\ntubercles rising upon it. The buccal face is convex in all directions,\\nthat from the morsal to the cervical borders being the most marked\\nowing to the morsal half converging toward the centre of the tooth.\\nThe buccal groove (o) leading over from the morsal face, divides the\\nface into two lobes which are full and rounded. Sometimes the disto-\\nbuccal groove cuts off another lobe, thus making three lobes on the buccal\\nface. These grooves sometimes lead .to the cervical border, but usually\\nterminate in the middle of the face in a pit, which may become the seat\\nof caries through faulty formation of the enamel.\\nThe Ungual face (D) is wide, rounded, smooth and convex, rather\\nstraight perpendicularly, leaning in the lingual direction. It forms a", "height": "4536", "width": "2636", "jp2-path": "americantextboo00kirk_0051.jp2"}, "52": {"fulltext": "44 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nsharp angle with the morsal surface, which is surmounted with two\\ntubercles. Sometimes, but rarely, the lingual groove passes over on to\\nthis face.\\nThe mesial and distal faces (s) are wide and flattened transversely,\\nbut convex vertically. They are trapezoidal in outline, the morsal\\nborder being longer. The cervical border is more convex, and dips\\ntoward the neck of the tooth.\\nThe neck (t) is very regular in outline and contour. It is approxi-\\nmately square with all four sides depressed in the centres. The mesial\\nand distal are depressed at the origins of the grooves leading down\\nupon the roots the lingual and buccal are depressed at the bifurca-\\ntion of the roots, the depression, which is wide and deep, extending up\\non to the neck, especially upon the buccal side. The enamel line is\\nquite irregular, dipping down on the lingual and buccal, and leading\\nwell up on the mesial and distal sides.\\nThe roots are two in number, placed with their longer diameter trans-\\nversely to the jaw. They are wide bucco-lingually, and flat and narrow\\ndisto-mesially, being situated distally and mesially to the crown. The\\nposterior is formed of the two posterior cones, and the anterior of the\\ntwo anterior cones (A). This is plainly shown in the formation of the\\nroots, which are grooved both distally and mesially, and in the tendency\\nto bifurcation, which sometimes actually occurs. They divide close to\\nthe crown, so that the grooves of bifurcation extend well up on the\\nneck. The distal root is thicker and more rounded than the mesial,\\nthe latter being more flattened, with the grooves deeper, and it is more\\noften bifurcated. Both are deflected from the median line.\\nThe pulp canal is shaped like the roots, with two main branches.\\nThe distal branch is the larger, being round and open, as the root is more\\nrounded. The mesial branch is flat and spindle-shaped, being difficult\\nto enter, and usually having two sub-branches following the buccal and\\nlingual divisions of the root. These sub-branches are small and hair-\\nlike and troublesome to enter.\\nThe lower second molar (Fig. 25) differs from the first in many\\nrespects. It is of the same general form, but is more quadrangular, as\\nit has but four tubercles. It is more rounded and symmetrical than the\\nfirst, the four cones and four primitive tubercles being well marked.\\nThe absence of the fifth tubercle leads to most of the differences between\\nthe second and the first molar.\\nThe morsal face (c) has but four tubercles, one at each corner of the\\nface, differing from that of the first molar, which has five. The fifth\\ntubercle rarely appears in the higher races of mankind, but is some-\\ntimes found in the low and savage races, and occurs regularly in the\\napes. It is not uncommon in the negro, but is absent as a rule in", "height": "4580", "width": "2728", "jp2-path": "americantextboo00kirk_0052.jp2"}, "53": {"fulltext": "THE MOLARS.\\n45\\nthe European races. The tubercles are symmetrical, rounded and\\nobtuse, the lingual being, however, sharper than the buccal.\\nThe sulci describe a cruciform shape, separating the four tubercles\\nsymmetrically from each other. The buccal groove sometimes continues\\non to the buccal face, rarely to the lingual. The triangular grooves\\nrun up on the morsal triangular ridges. The marginal ridges are well\\nmarked, the mesial and distal being often divided by grooves. The\\ntriangular ridges are usually well marked, leading to the centre of the\\ntooth. They are full and strong.\\nThe buccal face (d) is convex and of more regular form than that\\nof the first molar. It is divided into two lobes (e, e) by the buccal\\nFig. 25.\\nTi h\\nThe lower second molar.\\ngroove (c/), which is rarely deep. A pit is often found in the centre\\nof the face, which may become the seat of caries. The face is curved\\ntoward the centre of the tooth, as in the first molar.\\nThe lingual face is similar to that of the first molar, but may be more\\nrounded toward the morsal border. It is symmetrically convex in both\\ndirections.\\nThe mesial and distal faces (f) are similar to those of the first molar\\nexcept that, the crown being smaller, they may be more perpendicular,\\nbut are well rounded.\\nThe neck (g) is more regularly formed than that of the first molar,\\nthe margin of the enamel line being quite as irregular. It may be more\\nconstricted.\\nThe roots (h, h) are similar to those of the first molar, but are more\\nrounded in shape, are usually crooked, and on that account difficult to\\ntreat.\\nThe pulp canals are similar to those of the first molar, but the tend-\\nency to crookedness renders treatment quite difficult. The direction\\nof irregularity of form is so uncertain that no rule can be applied to it.\\n17. The Third Molars. The upper and lower third molars can best\\nbe described together, on account of their similar eccentricities. They\\nare very irregular as to the time and to the frequency of their appearance\\nin civilized man. About one-half of the individuals of European races", "height": "4548", "width": "2656", "jp2-path": "americantextboo00kirk_0053.jp2"}, "54": {"fulltext": "46 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nerupt them at the normal period, i. e. seventeen to twenty-one years of\\nage. In one-fourth they erupt at irregular intervals to the thirtieth\\nyear, and in the remainder they may appear later, or the first, second,\\nthird, or all of them, may be absent altogether. In one series of forty\\nadult skulls observed, twelve had one or more absent. The absence and\\nother erratic peculiarities of these teeth sometimes seem to be hereditary\\nand can be traced in families through several generations.\\nThis tooth is often reduced in size and may be a mere peg (Fig. 26, a).\\nIt is of very irregular form in civilized races, but is as large and as well\\nformed as the other molars in most\\nraces low in the ethnological scale.\\nThe contraction of the jaws through\\ndisuse has much to do with the mal-\\ndevelopment of this tooth, and it is\\noften so cramped for room as to pro-\\nduce distressing irritation which ne-\\nThe upper third molar.\\ncessitates its removal. Impaction\\nand malposition of the third molars render them difficult of extraction\\nand are the fruitful source of many serious lesions. (See the chapter\\non Extraction of Teeth.)\\nThe upper third molar is more or less similar to the other upper\\nmolars when perfect and well developed, but it is very erratic as to form\\nand structure.\\nThis tooth, when well formed, is of trituberculate form (6), the\\ndisto-lingual cingule being suppressed. This cingule diminishes grad-\\nually from the first molar, in which it is well formed, to the second,\\nwhere it is reduced, then to the third, where it is almost or entirely\\nabsent. The oblique ridge thus becomes the posterior marginal ridge\\n(c), as in the typical trituberculate molar. The three tubercles are\\nreduced and rounded. The sulci usually degenerate into fissures, as\\nthe formation of this tooth is notoriously faulty. The enlarged mesial\\nfissures thus become the seat of extensive caries.\\nThe buccal face resembles that of the first and second molars, but is\\nmore rounded.\\nThe lingual face (d) is full and rounded, with but a single lobe, owing\\nto the reduction or absence of the disto-lingual tubercle.\\nThe mesial face (e) is similar to that of the second molar, but reduced,\\nand the distal face is round and short, as no tooth succeeds it in the rear.\\nThe neck is constricted and tapers toward the conate roots. It is of\\na rather rounded triangular shape.\\nThe three roots of the upper molars are, in the third, usually more\\nblunt, conate, short in form, and may curve backward. In lower races\\nand sometimes in individuals having strong osseous organizations, the", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0054.jp2"}, "55": {"fulltext": "THE MOLARS.\\n47\\nSometimes there are multiple\\nvarious directions and may\\nThe lower third molar.\\ntypical three molar roots are found,\\nroots, which are likely to be curved in\\nhave decided hooks.\\nIn the large conate root, the pulp canals usually coalesce, but in\\ncases in which the root is divided there will also be division of the\\npulp chamber.\\nThe lower third molar is similar to the other lower molars in\\ngeneral form (Fig. 27, a), but is probably not so erratic and not subject\\nto such extreme variations. The crown is\\nquadrangular in section, the angles rounded.\\nOn the morsal face (6), there are four\\nprincipal tubercles as in the second molar,\\nbut this may be supplemented by the ex-\\ntension of the disto-marginal ridge into a\\ncingule or heel (e). This heel is rather\\nerratic it may be large or small, thus\\nmodifying the size of the morsal sur-\\nface. Sometimes the face is wrinkled and, like this tooth in the\\norang utan, the sulci exhibit the cruciform shape similar to that of the\\nsecond molar. The many grooves leading away from the main sulcus may\\nbe imperfect and become the seat of caries. The buccal groove running\\nfrom the morsal on to the buccal face (a) is very subject to imperfection.\\nThe four lateral faces are similar to those of the second molar, except\\nthat the distal is more convex and full, and often very prominent if the\\nfifth cingule is well developed.\\nThe neck is of similar shape to that of the second molar.\\nThe roots are similar to those of the other lower molars, but generally\\nsmaller as compared with the crown (d). They are usually divided like\\nthe others, but the two may be fused together, or be closely opposed.\\nIn either case they are usually projected distally more or less, leading\\nbackward into and under the ramus, thereby rendering extraction of\\nthis tooth difficult and dangerous, especially where the maxilla is of\\nFig. 28.\\n39\\n5\\nft.\\nThe fourth molar.\\ndense structure or where there is impaction. The roots are usually\\nmore rounded, especially the distal one, than those of the other molars.\\nThe pulp canals are generally divided, whether the root is or not.", "height": "4548", "width": "2656", "jp2-path": "americantextboo00kirk_0055.jp2"}, "56": {"fulltext": "48 MACROSCOPIC ANATOMY OF THE HUMAN TEETH\\nAs the roots are usually crooked, the difficulty of entering them is\\nincreased, as the canals follow the form of the roots.\\nFourth molars sometimes appear as supernumerary teeth, and are\\neither fused to the upper third molar in a variety of uncouth forms\\n(Fig. 28, a) or erupt separately as mere peg-shaped teeth between the\\nbuccal faces of the second and third molars (6) or at the distal aspect\\nof the latter tooth. The fourth molar rarely appears as a full molar,\\nexcept in some of the large-toothed races, as negroes, Australians, etc.,\\nand then usually in the lower jaw. Among the negroes in Africa the\\nfourth molar is sometimes found in full form as a typical molar.\\nFig. 29.\\na\\nNegro jaw with fourth molar\\nT\\nThe Deciduous Teeth.\\n18. The deciduous teeth are those which appear in infancy and\\nserve the purpose of dental organs during the first years of the develop-\\nment of the individual, until the jaws and their environment are ready\\nfor the larger, permanent teeth to come into place. They bear a direct\\nrelationship to the conditions of the digestive apparatus and the food\\nrequired at that early stage. The food of infancy being simple and\\nrequiring little mastication, the deciduous set are small and insufficient\\nfor the reduction of more resisting substances. As these foods come to\\nform part of the dietary, the larger teeth of the permanent set appear,\\nand perform the duties of higher functional activity.\\nThe crowns of the deciduous teeth resemble, in a general way, those\\nof the permanent teeth which succeed them, except the deciduous\\nmolars (Fig. 30, a, d), which are very different from the bicuspids\\nof the permanent set which displace them.\\nThe incisors of both jaws precede the analogous teeth of the same\\nseries of the permanent set. They are similar in form, but reduced (6),\\nand do not have the main features so characteristically marked. They\\nare infantile in form and function. The roots of these teeth are", "height": "4608", "width": "2720", "jp2-path": "americantextboo00kirk_0056.jp2"}, "57": {"fulltext": "THE DECIDUOUS TEETH\\n49\\nresorbed at from the fifth to the ninth year, when the permanent incisors\\ncome into place, beginning with the lower centrals.\\nThe canines (c) of both jaws are still more reduced from the strong,\\nFig. 30.\\nc d\\nThe deciduous teeth.\\nfull form of their permanent successors, and are but little more\\nspecialized than the incisors. They are of the same general form as\\nthe permanent canines, but much less developed.\\nBut in the deciduous molars are found some important features\\nwhich mark distinctive differences. They are of true molar form as\\ncompared with the permanent molars, but they occupy the place of the\\nbicuspids. There are no bicuspids in the deciduous set, the molars being\\nof full molar pattern d).\\nThe deciduous molars of both jaws are of irregular, quadrangular\\nform on the morsal surface, diverging rapidly outward to the neck,\\nwhich presents a large buccal ridge standing out at the margin of the\\nenamel, and is rounded off suddenly to the neck, which is much con-\\ntracted. This thick ridge is characteristic of the deciduous molars and\\nis absent in those of the permanent denture. It is somewhat more\\nprominent and bulging on the buccal than on the other faces. In\\nadjusting ferrule crowns to these teeth, the gold need not be carried\\nbeyond this ridge but burnished over it slightly.\\nThe morsal surface (e) of the upper deciduous grinders presents the\\ncharacteristic pattern of the upper molars, four tubercles, oblique ridges,\\netc., but reduced and contracted. A distinctive feature is that the\\nmarginal ridges and angles are more acute and sharp than in the per-\\nmanent molars. Sometimes the two lingual cusps are reduced to one\\nand the lingual border is rounded and crescentic.\\nThe second molar is larger than the first and the morsal surface is\\nwider.", "height": "4560", "width": "2644", "jp2-path": "americantextboo00kirk_0057.jp2"}, "58": {"fulltext": "50 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nThe transverse diameter of the crowns of the upper molars is the\\nlongest.\\nThe lower molars (d) are similar to the permanent molars in pat-\\ntern, but are more irregular as to the contour of the morsal surface\\nThe tubercles may be higher than in the upper molars, and the tri-\\nangular ridges more marked. The central fossa may be large and wide,\\nor divided by the triangular ridges. The second molar is five-lobed,\\nunlike the second permanent molar, which has but four cusps. The\\nmorsal face is decidedly trapezoidal in outline, the mesio-distal diameter\\nbeing greater than the transverse.\\nThe roots of the deciduous molars are similar to those of the other\\nmolars, except that they are very divergent to accommodate the crown\\nof the advancing bicuspids. They are thin and long, and difficult to\\nenter and fill. The pulp chamber is large and open in the crown as\\na consequence of this caries soon reaches the pulp. Treatment and\\nfilling of the canals is difficult and uncertain.\\nThe Variations of Tooth Forms.\\n19. The teeth may vary quite extensively from the typal forms which\\nhave been described, and these variations may be due to a number of\\ncauses. Through all degrees of variation, however, the type is still pre-\\nserved, unless the tooth form is quite destroyed by pathological causes.\\nThe general causes of variation may be enumerated as follows\\n(1) Incompleteness of development.\\n(2) Reversion to primitive types.\\n(3) Temperamental impress.\\n(4) Pathological lesions.\\n(1) Under incompleteness of development may be grouped all\\nthose varieties of stunted growth which are the effect of disuse and\\nthe consequent effort of Nature to reduce and suppress the teeth as\\nuseless parts. The third molar teeth suffer most from these suppressive\\nattempts of Nature in the effort toward economy of growth next to\\nthese teeth, the upper lateral incisors are most frequently affected by\\nreduction of size, stunted growth and suppression. Other teeth are\\nrarely affected, or but very slightly, by this influence, except in rare\\ncases.\\n(2) Under the second head, reversion to primitive types, we have a\\nvariety of interesting phenomena in the form of parts of the human\\nteeth which seem to be a zoological legacy. These consist of conspic-\\nuous features which reappear aud seem to recall forms of the teeth\\nobserved in some of the lower animal orders, especially the quadrumana\\nand insectivora.\\nAmong these features may be mentioned the curved upper central", "height": "4580", "width": "2732", "jp2-path": "americantextboo00kirk_0058.jp2"}, "59": {"fulltext": "THE VARIATIONS OF TOOTH FORMS. 51\\nincisor with the prominent cingule on the lingual -buccal ridge, making\\na notch which recalls the incisors of the moles the prominent cingule\\non the lingual face of the lateral incisor, which is not uncommon and\\nrecalls the form found in the insectivora and some of the quadrumana\\nthe extra-long, curved canine, with extra -large median ridges, which\\nrecalls the large forms of this tooth in the baboons and in the car-\\nnivora the double root sometimes found in this tooth is also a re-\\nversion to the insectivorous type the three-rooted bicuspid is a quad-\\nrumanous reversion the upper tricuspid molar is a primitive typal\\nform, leading back to the lemurs and beyond them to the early typal\\nmammals found in fossil formations the notched and grooved incisor\\nrecalls the divided incisor of the Galeopithecus the double-rooted lower\\nincisors and canines recall insectivorous forms the unicuspid lower\\nfirst bicuspid is an insectivorous type and is often quite marked in man\\nthe fifth cusp on the lower second molar is a quadrumanous rever-\\nsion the wrinkled surface of the lower third molar is like that of the\\norang.\\nThere are other features that might be named illustrating the work-\\nings of the law of atavism, by which parts once lost in evolution may\\nreappear and be reproduced.\\n(3) Under the third head, temperamental impress, may be noticed\\nthose differences of form and structure which have relation to the domi-\\nnant temperament in the constitution of the individual. Great differ-\\nences exist between the teeth of different persons, and these are mainly\\ndictated by temperament.\\nThe teeth of the primary basal temperaments present the following\\nphysical peculiarities, which are characteristic of the particular tempera-\\nment\\nThe bilious temperament presents teeth that are of a strong\\nyellow large, long, and angular, often with transverse lines of forma-\\ntion, without brilliancy, transparency, and of but slight translucency\\nfirm and close set and well locked in articulation.\\nThe sanguine temperament has teeth that are symmetrical and\\nwell proportioned, with curved or rounded outlines, and round cusps\\ncream color, inclined to yellow, rather brilliant and translucent well\\nset, and occlusion firm.\\nThe nervous temperament has teeth which are rather long, the\\ncutting edges and cusps long and fine color pearl-blue or gray, very\\ntransparent at the apex the occlusion very penetrating.\\nThe lymphatic temperament presents teeth that are pallid or\\nopaque, dull or muddy in coloring large, broad, ill-shaped, cusps low\\nand rounded the occlusion lose and flat.\\nOf the binary combinations", "height": "4548", "width": "2656", "jp2-path": "americantextboo00kirk_0059.jp2"}, "60": {"fulltext": "52 MACROSCOPIC ANATOMY OF THE HUMAN TEETH.\\nThe SANGUiNEO-BiLious has teeth which are large, with strong edges\\nand large cusps color dark yellow, and quality good.\\nThe nervo-bilious has teeth that are long and narrow, with long\\ncusps color yellowish or bluish or both combined the enamel strong.\\nthe dentin soft.\\nThe lympho-biliotts has teeth that are large, with thick edges and\\nshort thick cusps yellowish in color enamel of good structure and\\npolish, and dentin fair.\\nThe bilio-sanguineous has teeth of average size, round arch, well-\\ndeveloped cusps and edges rich dark -cream color excellent in quality.\\nThe NERVO-SANGUINEOUS has teeth of average size, good shape, round\\narch, good edges and cusps rich cream color enamel and dentin of\\nexcellent structure.\\nThe lympho-sanguineous has teeth of more than average size,\\nshapely edges and cusps, rounded arch color grayish cream enamel\\nand dentin fairly good.\\nThe bilio-nervous has teeth variable in size and form, sometimes\\nbroad, again very long with more pointed and long cusps; the color\\ngenerally bluish enamel fairly good, dentin soft and sensitive.\\nThe sanguineo-nervous has teeth of average size, good shape,\\nround arch color grayish blue soft and frail.\\nThe bilio-lymphatic has teeth usually large, with thick edges,\\nshort thick cusps, and flat arch color yellowish quality good.\\nThe sanguineo-lymphatic has teeth of more than the average size,\\nbroad round arch color gray enamel and dentin poor.\\nThe nervo-lymphatic has teeth of average size, good shape, aver-\\nage length, rather round arch color bluish gray soft and poor.\\nCombinations of the binary temperaments are of the most common\\noccurrence in individuals, but there is usually one basal temperament\\nthat preponderates over the others and gives its characteristic to the\\nteeth as a predominating influence.\\n(4) Under the fourth head, pathological lesions, are to be included\\nall those disturbances of nutrition which eventuate in faulty formation\\nof the teeth, whether due to specific hereditary diseases, mere malnutri-\\ntion, idiosyncrasies, predispositions, defective functional life, etc. But\\nthis leads beyond the province of this chapter into the field of special\\npathology.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0060.jp2"}, "61": {"fulltext": "CHAPTER II.\\nTHE EMBRYOLOGY OF THE DENTAL TISSUES.\\nBy R. R. Andrews, A. M., D. D. S.\\nA clear understanding of the minute structure of the teeth can only\\nbe had through a study of the complex processes through which the\\ntissue elements have had their origin or have derived their forms.\\nThe teeth do not belong to the bony skeleton of the body, but, like\\nthe hair, nails, etc., are parts of the dermal system.\\nThe origin of the tissues of the teeth is from two of the three\\ngerminal layers of the blastoderm, the epiblastic and mesoblastic layers.\\nA transverse section through the blastoderm of a chick shows that the\\nepiblast, or outer layer, is formed of cells like columnar epithelium\\ntheir shape is probably due to lateral pressure of adjoining cells. It\\nis from this layer that epithelium is formed, and epithelial tissue is the\\norigin of the enamel. The mesoblast, or middle layer, is composed of\\ncells said to be derived from both hypoblast and epiblast, but princi-\\npally from the latter. 1 They are merely nucleated structures, containing\\ngranules, the nuclei of the future cells of the connective tissues. In this\\nstate they have no cell-limit or wall as they grow older they accumu-\\nlate around themselves formed material. Only in maturer stages do\\nthese cells develop, on their surfaces, an optically distinct membrane\\nor other structure. It is from the cells of the mesoblast that the em-\\nbryonic connective tissue which forms the dentinal papilla originates.\\nDevelopment of the Jaws.\\nAs stated by Prof. Sudduth, 2 the first indication of the formation of\\nthe oral cavity is seen very early in the life history of the embryo.\\nThe superior maxilla arises from three separate points on either side\\nof the embryonic head a process springs from the first pharyngeal arch.\\nThe processes pass downward and forward, and unite with the sides of\\nthe nasal process. From the frontal prominence, the third process, the\\nincisive, grows downward and fills in the space between the ends of the\\ntwo preceding processes. By a union of these three processes the supe-\\nrior maxillae are completed. The inferior maxilla is formed by buds\\ngrowing from the first pharyngeal arch these buds grow rapidly until\\n1 The three layers of the blastoderm are also designated as ectoderm, mesoderm, and\\nentoderm respectively.\\n2 American System of Dentistry, vol. i. p. 550.\\n53", "height": "4552", "width": "2640", "jp2-path": "americantextboo00kirk_0061.jp2"}, "62": {"fulltext": "54 EMBRYOLOGY OF THE DENTAL TISSUES.\\nunion occurs at the median line. The central portion of the arch thus\\nformed, very soon after the union of the two lateral processes, becomes\\ndifferentiated into a cartilaginous cord or band, which serves to strengthen\\nthe embryonic jaw. This is Meckel s cartilage. It is formed of two\\nparts arising from the mallei of the ears and traversing both sides of the\\nembyronic jaw to the point of union. While the jaw-bone is forming,\\nMeckel s cartilage disappears by absorption some authorities believe it\\nbecomes ossified, forming part of the inferior maxilla.\\nThe Embryonic Mucous Membrane.\\nIf at a time just previous to tooth formation a section across the\\nlower jaw is cut, it will be found to consist of a central mass of\\nembryonic connective tissue cells\\nV edged on every surface by the in-\\nnermost layer of the epithelium.\\ny-^ A-^ 1 This covering of epithelium is the\\nMalpighian or mother layer, most\\nj fr.. o important to the dental histologist,\\n.A* S8J?*825^^- because from it originate the en-\\n^^l ^^JBE?: amel organs of the teeth, as well as\\n^S EMy^ 3 the bulbs of the hair and the epi-\\nffl thelium of the glands. Thus early\\nV- 1 the Malpighian layer consists of\\ncells somewhat like those of the\\nconnective tissue within, but thev\\nSection of jaw, embryo of pig, showing the stain more deeply and are really\\nappearance of mucous membrane before \u00c2\u00ab,i -i- i -1-1 -i\\nthe formation of the enamel organ :l,epi- epithelial Cells, having their origin\\nthelium 2, stratum Malpighii 3, embry- f rom the Cells of the epiblast. This\\nonic connective tissue. T\\nMalpighian layer is, again, every-\\nwhere covered by epithelial cells, which are continually formed by it.\\nWhen the tissue is older, the cells of the stratum Malpighii become\\ncolumnar or prismatic in shape, standing somewhat vertically over the\\nembryonic tissue beneath. They have large round nuclei, and some\\nauthors have stated that they have no cell-wall. Just without these\\nare larger cells, sometimes called youthful cells, and external to these\\nthe cells are larger and are more polygonal in form, representing\\nthe cells in their middle life, in which the cell-wall has increased in\\nthickness, while the nucleus is found to be smaller. Those cells on\\nthe outer surface are the aged cells, consisting almost wholly of formed\\nmaterial. They in time lose their vitality, having undergone changes,\\nuntil, from the fresh mass of protoplasm, they finally become thin, lifeless\\nscales, which in adult tissue are constantly cast off during the life of the\\nindividual. They are reproduced from the cells of the stratum Malpighii.", "height": "4608", "width": "2736", "jp2-path": "americantextboo00kirk_0062.jp2"}, "63": {"fulltext": "THE DENTAL RIDGE AND DENTAL GROOVE. 55\\nFig. 32.\\nSection of jaw, embryo of pig, showing the epithelium highly magnified: 1, oldest epithelial\\ncells 2, the younger cells 3, the infant layer, the stratum Malpighii 4, the embryonic connec-\\ntive tissue.\\nThe epithelium, as has been stated, is derived from the epiblast, and\\nis developed considerably earlier than is the embryonic connective tis-\\nsue beneath.\\nThe Dental Ridge and Dental Groove.\\nOn that portion of the jaw which is to become the alveolar border,\\nbetween the fortieth and forty-fifth days,\\nthere is seen a growth of cells, which looks\\nas though it had been pushed up in the\\nform of a smooth ridge. If a section is\\ncut across the jaw at this time, and exam-\\nined, it will be found that this ridge con-\\nsists of a mound of epithelial cells which\\nsome writers have called the maxillary\\nrampart. This growth of cells is seen to\\nhave had a more energetic growth inward\\ninto the substance of the embryonic tissue\\nthan it has had outward, so that a groove\\ncontaining epithelium is formed around the\\nentire upper border of the jaw, and in this\\ncondition has been called the tooth band.\\nFig. 33.\\nSection through the jaws of human\\nembryo, showing developing en-\\namel organs. (Section by Dr.\\nSudduth.)", "height": "4540", "width": "2656", "jp2-path": "americantextboo00kirk_0063.jp2"}, "64": {"fulltext": "56\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nFig. 34.\\n%*C\\nX.\\nSection of lower jaw, embryo of pig, showing the first stage of growth in enamel organ 1, epithe-\\nlium 2, stratum Malpighii 3, dental groove 4, commencing growth of temporary enamel\\norgan 5, Meckel s cartilage 6, forming bone of jaw. (Section by Dr. Sudduth.)\\nThe cells of the layer next the embryonic connective tissue are always\\nmore or less columnar. They are directly derived from, and are a part\\nof, the stratum Malpighii. It was the loss of this epithelial tissue, per-\\nFig. 35.\\n2, stratum\\nSection of jaw, embryo of pig, showing growth of enamel organ 1, epithelium z, siraium\\nMalpighii 3, first stage in growth of enamel organ of temporary tooth 4, embryonic connec-\\ntive tissue 5, developing bone of jaw.", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0064.jp2"}, "65": {"fulltext": "THE DENTAL RIDGE AND DENTAL GROOVE.\\nFig. 36.\\n57\\n*F\\n9\\n\u00e2\u0096\u00a0HHwHi\\nSection of jaw, embryo of pig, showing growth of enamel organ 1, epithelium; 2, Malpighian\\nlayer 3, second stage in growth of enamel organ 4, embryonic connective tissue.\\nFig. 37.\\nSection of jaw, embryo of pig, showing growth of enamel organ: 1, epithelium; 2, second stage\\nin growth of enamel organ 6, embryonic connective tissue.", "height": "4540", "width": "2664", "jp2-path": "americantextboo00kirk_0065.jp2"}, "66": {"fulltext": "58 EMBRYOLOGY OF THE DENTAL TISSUES.\\nFig. 38.\\nr\\nSection of jaw, embryo of pig, showing growth of enamel organ and zone of dentin-forming\\ntissue 1, epithelium 2, enamel organ 3, zone of dentin-forming tissue.\\nFig. 39.\\nSection of jaw, embryo of pig, showing growth of enamel organ and first stage in growth of dentin\\ngerm 1, epitbelium 2, enamel organ 3, dentin germ. (The enamel organ has been pushed\\naway from the dentin by the knife in cutting the section, leaving a space between the two.)", "height": "4580", "width": "2760", "jp2-path": "americantextboo00kirk_0066.jp2"}, "67": {"fulltext": "THE DENTAL ETDGE AND DENTAL GROOVE.\\n59\\nhaps by the action of too powerful reagents, which led Goodsir and his\\nfollowers to describe the appearance of an open groove. The Goodsir\\ntheory had no foundation in fact, because no such open groove ever\\nexisted in that situation.\\nThe various foldings found in embryonic tissue no doubt are an ex-\\npression of an economic provision on the part of Nature in caring for\\nFig. 40.\\nSection of jaw, embryo of sheep, showing growth of enamel organ and dentin germ: 1,\\nmass of epithelium 2, enamel organ 3, dentin germ 4, growing jaw.\\nlarge\\nthe tissue that is to be taken up by the expansion of the parts during\\nits growth, as eventually they are all smoothed out. Rose s models 1\\nshow that the original inflection (stratum Malpighii) at an early stage\\ndivides into two portions, one of which, the outer, is nearly perpen-\\ndicular and is intimately connected with the formation of the lip\\nfurrow, whilst that immediately under consideration passes almost\\nhorizontally backward into the tissue beneath.\\nAt about the forty-eighth day, from the lingual side of this groove,\\nat a point where a tooth is to be formed, a portion of the stratum\\nMalpighii is found growing into the embryonic connective tissue, in\\n1 Models of Developing Teeth and Jaws. By Carl Rose, M. D.", "height": "4552", "width": "2656", "jp2-path": "americantextboo00kirk_0067.jp2"}, "68": {"fulltext": "60\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nshape somewhat like a bud, and this is the first indication that a tooth\\nis to be developed the commencing growth of the enamel organ.\\nThis ingrowth increases, and assumes the shape of a tubular gland,\\npushing its way into the connective tissue. It may now be called an\\nepithelial cord, and at the end farthest from the epithelium proper\\na growth of cells takes place, this part expanding from the multiplica-\\ntion of cells within, which causes it to assume the form of a Florentine\\nflask.\\nJust at this time, at a point somewhere between this expanding part\\nand the Malpighian layer above, a budding takes place from this cord,\\nwhich is the commencing growth of the enamel organ of the permanent\\ntooth. A change is taking place in the embryonic tissue just under the\\nflask-shaped enamel organ a very active growth of cells is seen to be\\nFig. 41.\\nSection of jaw, embryo of pig, showing growth of enamel organ and dentin germ: 1, enamel\\norgan 2, dentin germ 3, growth of jaw 4, tongue.\\ngoing on, and this activity results in the formation of a papilla, the first\\nstage in the growth of the dentin germ.\\nAs the enamel organ enlarges by an increase of cells within it, the\\nborders of its base grow inward, covering the dentinal papilla like a\\ncap or hood, enclosing it at its base. The cells within the enamel\\norgan are seen to have changed they are no longer like epithelial", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0068.jp2"}, "69": {"fulltext": "THE DENTAL RIDGE AND DENTAL GROOVE.\\n61\\nformations, but form a reticulum and have a stellate appearance\\nwhen seen in section.\\nWhile the change in form of the central cells of the enamel organ is\\ntaking place, the dentin germ is assuming the form of the future tooth-\\npoint. From the base of the dentin germ, connective tissue is being\\nFig. 42.\\nSection of jaw, embryo of pig, showing development of temporary molar tooth 1, enamel organ\\n2, dentin germ.\\nformed around the enamel organ, like the outer walls of a bag, this\\nlayer being the wall of the dental sacculus and when the enamel\\norgan is nearly enclosed, the epithelial cord that connects it with the\\nMalpighian layer breaks up into epithelial clusters some of which\\nwander toward the Malpighian layer, while others cluster to the wall\\nof the sacculus, where it is supposed they become absorbed. In their\\norigin the sacculus and dentin germ are identical, springing as they do\\nfrom the embryonic connective tissue.\\nAt this time there is no evidence of a basement membrane, When\\nthe enamel organ and dentin germ become enclosed in the sacculus, it\\nand its contents become the dental follicle, at which period calcifica-\\ntion is about to commence.", "height": "4556", "width": "2660", "jp2-path": "americantextboo00kirk_0069.jp2"}, "70": {"fulltext": "62 EMBRYOLOGY OF THE DENTAL TISSUES.\\nFig. 43.\\nT~\\nSection of jaw, embryo of pig, showing development of temporary molar tooth 1, enamel organ\\n2, dentin germ.\\nThe Enamel Organ.\\nThe enamel organ is now in its perfected state. On examination\\nit is found to be composed of three distinct cellular forms. The essen-\\ntial layer is the ameloblastic layer of columnar cells which rests upon\\nthe dentin germ. These are the cells that are to become the enamel\\ncells or ameloblasts. They have become changed by pressure into very\\nsymmetrical hexagons, four or five times as long as they are broad, with\\na distinctly marked nucleus in the part farthest away from the dentin\\ngerm. Only the sides of the cells are said to have membranes they\\nare without covering at either end. These cells are longer just over the\\npoint of the dentin germ and are shorter as they approach its base, being\\nhere very much like those of the outer layer, the external epithelium of\\nthe enamel organ.\\nThis outer layer is composed of cells which are roundish, a little\\nlonger than they are wide, and seem to be losing their columnar form.\\nIndeed, soon after calcification has commenced these cells disappear. 1\\n1 It is a question what becomes of them. Some authorities think that they are the\\norigin of Nasmyth s membrane, but this is very doubtful, for investigation shows that", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0070.jp2"}, "71": {"fulltext": "THE ENAMEL ORGAN.\\n63\\nJust within these two epithelial layers there is found the second im-\\nportant layer of cells, and this layer has been named the stratum inter-\\nmedium (see Fig. 55). The cells of this layer are intermediate in shape\\nFig. 44.\\nSection of jaw, embryo of pig, showing development of dental follicle and first stage in the growth\\nof the permanent enamel organ also the formation of walls of the sacculus 1, epithelium\\n2, Malpighian layer 3, enamel organ 4, dentin germ 5, outer wall of sacculus 6, inner wall\\nof sacculus 7, bud of enamel organ of permanent tooth 8, growing jaw.\\nbetween the ameloblasts and those of the stellate reticulum. The layer\\nwas first described by Hanover, and is thought to be a supplying and\\nnourishing layer to the ameloblasts. Over these they remain, while\\neverywhere else they disappear as calcification progresses. It is prob-\\nable that they give birth to new enamel cells as the circumference of the\\nenamel layer increases by growth. By careful examination it will be\\nfound that they are connected by minute processes with the enamel cells\\nand also with the stellate cells of the central portion. Dr. Lionel Beale\\nfirst made the statement that a vascular network lies within the stratum\\nintermedium. This fact has recently been confirmed by other English\\nthey are completely lost some time before the completion of the calcification of the enamel.\\nJust after a layer of dentin has been formed, everywhere upon its surface are seen the\\nenamel cells, ready to form the enamel, and no trace of the outer epithelium can be seen.\\nIt has disappeared from that part in the perfected enamel organ.", "height": "4552", "width": "2640", "jp2-path": "americantextboo00kirk_0071.jp2"}, "72": {"fulltext": "64 EMBRYOLOGY OF THE DENTAL TISSUES.\\nworkers, for Tomes mentions the fact that Prof. Howes and Mr. Poulton\\nhave demonstrated this vascular network in the stratum intermedium\\nof the enamel organ of the rat.\\nDr. J. Leon Williams, in an article on The Formation and Struc-\\nture of Dental Enamel, l demonstrates with his photo-micrographs the\\nexistence of this vascular network in the stratum intermedium of the\\nrat which had been previously seen by these English observers, but it\\nis to be remembered that this vascular network forms after the outer\\nFjg. 45.\\n4\\nW\\nrZ-3\\nV\\nSection of jaw, embryo of pig, showing development of dentin germ and enamel organ of per-\\nmanent tooth 1, epithelium 2, enamel organ 3, dentin germ 4, buuuing of enamel organ\\nof permanent tooth 5, developing jaw.\\nportions of the enamel organ have disappeared, and only when the con-\\nnective tissue of the jaw is in contact with the cells of the stratum\\nintermedium.\\nThe third form of cells fills up the central portion they appear\\nstar-shaped, and have been called the stellate reticulum of the enamel\\norgan. Between the cells is to be found a fluid rich in albumin the\\nconsistence of this is somewhat like a jelly indeed, enamel organs\\nhave been called enamel jelly or enamel pulps. Tomes states that the\\nfunction and destination of the stellate reticulum is not very clear.\\nEnamel can be very well formed without it, as is seen among reptiles\\n1 Dental Cosmos, February, 1896.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0072.jp2"}, "73": {"fulltext": "THE ENAMEL ORGAN.\\n65\\nand fish, and even in mammalia it disappears prior to the completion of\\nthe enamel. It has been supposed to have no more important function\\nthan to fill up the space subsequently taken up by the growing tooth.\\nKolliker does not agree with this. He states that the stellate reticulum\\nis certainly of great importance in the building up of enamel, and,\\nowing to its richness in albumin and the gelatinous mass in its meshes,\\nis, figuratively speaking, a pantry from which the enamel membrane (the\\nameloblasts) derives the material for its growth, being some distance\\nfrom blood-vessels.\\nThe cells of the stellate reticulum are characterized by the great\\nlength of their communicating processes. Dr. Sudduth thinks that\\nFig\\n46.\\nJ T\\nV\\nSection of jaw, embryo of sheep, showing development of dentin germ: 1, layer (portion of) of\\nameloblasts 2, external epithelium of enamel organ (most of the stellate reticulum has been\\nwashed out); 3, enamel organ of permanent tooth; 4, dentin germ; 5, whorls of epithelial\\ncells caused by breaking up of neck or cord of enamel organ 6, part of stellate reticulum.\\nthis appearance is largely due to shrinkage. He says I fully believe\\nthat if we could examine these cells at once before any shrinkage occurs,\\nwe should be able to prove the fact that in life they are not stellate but\\n5", "height": "4560", "width": "2656", "jp2-path": "americantextboo00kirk_0073.jp2"}, "74": {"fulltext": "66\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nlarge polygonal cells. Dr. Williams has shown 1 that this supposi-\\ntion of Dr. Sudduth is a fact. In his photo-micrographs he has\\nclearly demonstrated the cell contents filling in the spaces between\\nthe stellate tissue. He shows them to be very perfect nucleated cells\\nlying in the so-called stellate reticulum, which is really the slightly\\nmodified cell wall.\\nThe stellate reticulum/ then, may be regarded as a storehouse of\\nFig. 47.\\nSection of jaw, embryo of pig, showing developing tooth (section teased away from tooth to show\\nthe fold in the enamel substance) 1, enamel organ 2, enamel substance not yet calcified\\n3, layer of formed dentin 4, a fold in the enamel substance 5, dentin pulp 6, folds at base\\nof dentin germ 7, developing bone.\\nthe calcium salts from which the first-formed layers of enamel are sup-\\nplied. That calcium salts exist in the meshes of the stellate reticulum\\nmay be proven by placing a drop of dilute nitric acid on the slide when\\nit passes under the cover-glass. The globules or granules which were\\nnoticed there disappear as the acid reaches them, and bubbles accumu-\\nlate and are forced out from under the glass cover. After the calcify-\\ning process commences and enamel is forming, the calcium salts are\\nsupplied by a rich plexus of blood-vessels now in direct contact\\nwith the cells of the stratum intermedium, all other portions of the\\nenamel organ having disappeared from this part. Indeed, it is difficult\\nto demonstrate clearly the cells of the stratum intermedium after any\\n1 Dental Cosmos, February, 1896.", "height": "4604", "width": "2776", "jp2-path": "americantextboo00kirk_0074.jp2"}, "75": {"fulltext": "THE ENAMEL ORGAN.\\n67\\nconsiderable portion of the enamel has been formed they appear to\\nhave been lost in the connective tissue which is everywhere above them.\\nThe origin of the enamel organs of the permanent teeth may be de-\\nFig. 48.\\nSection of incisor of rat (X 175) a, blood-vessels with corpuscles in situ; b, brunch of same de-\\nscending to supply capillary loops about secreting papillse; c, ameloblasts. (Dr. J. Leon\\nWilliams specimen.)\\nscribed in general as follows From the neck of the enamel organs of\\nthe twenty deciduous teeth, midway between the stratum Malpighii and\\nthe temporary enamel organ, growths in the form of buds are being\\nFig. 49.\\nfiS\\n11\\n1R\\ncHBHHH\\nJBBI\\nPM\\nSection of incisor of rat (X 80) a, capillary loops torn out of secreting papillse 5, secreting\\npapillae after removal of capillary loops c, ameloblasts d, enamel e, dentin. (Dr. J. Leon\\nWilliams specimen.)\\nformed, increasing in length, and these result in the formation of the\\nenamel organs of the permanent teeth, their grow r th taking place on\\nthe lingual surface of the temporary teeth. Soon after this, the tern-", "height": "4564", "width": "2640", "jp2-path": "americantextboo00kirk_0075.jp2"}, "76": {"fulltext": "68\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nFig. 50.\\nt\\nmi\\nHi\\nj\\n1\\nis\\nf m\\nyr\\nSection of jaw, embryo of rabbit; permanent tooth seen developing under the temporary molar:\\n1, enamel of temporary tooth 2, dental pulp 3, developing alveolar wall 4, permanent den-\\ntin germ. (Section by Dr. Sudduth.)\\nFig. 51.\\nSection of developing tooth of human embryo (X 1000) a, large nucleated cells of middle layer\\n(reticulum) of enamel organ b, stratum intermedium c, ameloblasts. (Dr. J. Leon Williams\\nspecimen.)", "height": "4608", "width": "2808", "jp2-path": "americantextboo00kirk_0076.jp2"}, "77": {"fulltext": "THE ENAMEL ORGAN.\\n69\\nporary enamel organ becomes separated from its cord. Between the\\ntemporary enamel organ and the permanent enamel bud, the cord\\nof the temporary enamel organ is seen to be breaking up and losing\\nits connection with the stratum Malpighii while the cord for the per-\\nFig. 52.\\nSection of developing tooth, embryo of calf (X 1000) a, b, nuclei of reticulum of enamel organ,\\nshowing spongiose character c, outer ameloblastic membrane d, inner ameloblastic mem-\\nbrane e,f, enamel globules faintly showing nuclear network. (Dr. J. Leon Williams speci-\\nmen.)\\nmanent tooth appears as a continuation of the Malpighian end. The\\ncord for the permanent incisor in the human embryo is formed about the\\nfifth month, and while descending into the embryonic connective tissue\\nassumes a spiral form of growth, as do the necks of most of the enamel\\norgans of the permanent teeth, growing down to take their positions\\nunder the temporary teeth, where they go through all the changes that", "height": "4556", "width": "2672", "jp2-path": "americantextboo00kirk_0077.jp2"}, "78": {"fulltext": "70 EMBRYOLOGY OF THE DENTAL TISSUES.\\nhave been spoken of in describing the growth of the temporary enamel\\norgan. Dr. Sudduth says that as a rule the cords for the permanent\\nmolars arise directly from the epithelium of the mouth, that is, the\\nMalpighian layer. Other authorities state that the first permanent molar\\nonly is from the Malpighian layer, as is the enamel organ of the tem-\\nporary tooth. Bodecker is the author of the statement that all the\\npermanent molar teeth are an offspring of the enamel organs of the\\nsecond temporary molar tooth. The enamel organ of the second per-\\nmanent molar is an outgrowth from the first permanent molar the\\nenamel organ of the third permanent molar being an outgrowth from\\nthat of the second. Von Brunn holds that the primary function of\\nthe enamel organ is that of determining the form of the future tooth.\\nHe goes so far as to assert that its calcification into enamel in some\\nanimals is a secondary function taken on later. In support of this\\nopinion, he says that enamel organs are universal, even where no\\nenamel is found. He holds that wherever dentin is to be found, there\\nis an antecedent form-building investment of enamel organ.\\nThe Dentinal Papilla.\\nThe dentinal papilla, or, preferably, the dentin germ, has its\\norigin in the embryonic connective tissue of the jaw. Sometime about\\nthe second month of fetal life, as the enamel organ of the first-forming\\nteeth assumes its flask-like shape, and the cells within its central portion\\nare seen to be differentiating, just under it is noticed an area of dense\\ntissue, in shape somewhat like a crescent. It is distinctly outlined by\\nits dense and active cell-multiplication. This is the first indication of\\nthe commencing growth of the dentin germ. As the enamel organ\\nenlarges, and assumes the shape of a surrounding cap, a papilla-like\\ngrowth takes place coincidently with it. About the ninth week it\\nassumes the pointed form of the future incisor. With these changes the\\nouter layer of the connective-tissue cells next the enamel cells will be\\nfound to have changed their form, and to have assumed a very distinct\\ncolumnar appearance, forming a layer somewhat like the enamel cells,\\nbut broader. This layer has been falsely called a membrane, mem-\\nbrana eboris or membrane of the ivory. It is not a membrane, and\\nall recent authorities ignore it as such. If the tissue has been carefully\\nprepared, minute glistening bodies are seen, under the higher powers\\nof the microscope, within the substance of the germ. These are calco-\\nspherites, and are seen everywhere near the odontoblastic layer in the\\ndentin germ, as well as in the enamel organ, near the enamel cells.\\nThey are mostly minute globules. Some are larger than others, caused\\nundoubtedly by several merging together. They indicate that the", "height": "4608", "width": "2764", "jp2-path": "americantextboo00kirk_0078.jp2"}, "79": {"fulltext": "THE DENTAL FOLLICLE. 71\\nprocess of calcification is about to begin, and are constantly present\\nwhile it is going on, throughout the process of the formation of the\\ntooth.\\nDr. Sudduth is authority for the statement that there is no real\\nunion between the dentin germ and the enamel organ. There exists\\nno intimate connection between the two surfaces other than that of per-\\nfect adaptation to each other vessels or nerves have never been dem-\\nonstrated to pass from one to the other. The relation is analogous to\\nthat sustained by the epithelium and dermal layers of the mucous\\nmembrane of the oral cavity, from which they have their origin.\\nBodecker, on the other hand, states that there is a connection between\\nthe two. He says that when the enamel organ is detached from the\\npapilla as it frequently is, in sections its outer surface appears beset\\nwith an extremely delicate fringe, the true connection between the pa-\\npilla and the enamel organ.\\nThe Dental Follicle.\\nThe walls of the dental sacculus have their origin in the area of\\ntissue which is so plainly marked by its increasing growth, seen just\\nunder the enamel organ while in the shape of a flask. At this early stage\\nare seen, from the outer edges of this area of tissue, encircling processes\\nwhich, as the dentin germ forms, grow rapidly up, surrounding the\\nenamel organ on all sides (see Fig. 53). Some authorities have stated\\nthat the dental sacculus does not wholly cover the enamel organ, but\\nin the collection of the writer are specimens where its walls are seen\\nto completely cover the dentin germ, so that it apparently is wholly\\nenclosed. The bone of the jaw is now forming rapidly about it (mak-\\ning a nest, as it were, in which the sacculus and its contents, now\\nthe dental follicle, rest. The cells within the tissue of this sac are\\nfound to have separated by growth into two layers. They have not\\nchanged their form, but remain connective-tissue cells. The outer\\nlayer is seen to be much denser and very much more vascular than\\nthe inner one, and this is to form the dental periosteum the inner one\\nis said to form the cementum of the root.\\nThis differentiation of a portion of the dental sac into a softer and\\nlooser tissue, but little firmer than that of the stellate reticulum of the\\nenamel organ, has been thought by Magitot to be sufficiently pronounced\\nto justify him in calling it a distinct organ, the cement organ. But\\nthe existence of such an organ is doubted by many authorities. Prof.\\nSudduth is of the opinion that the tissues of the sacculus do not arise\\nwholly from the base of the dentin germ, but largely from a conden-\\nsation of the fibrous connective tissue in which the enamel organ lies.\\nThe follicular wall just over the surface of the enamel organ is often-", "height": "4548", "width": "2660", "jp2-path": "americantextboo00kirk_0079.jp2"}, "80": {"fulltext": "72\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\ntimes found in folds. These have been called papilliform eminences,\\nand are seen to be projecting into or near the enamel cells. To this\\nappearance some authors attach considerable importance, but it is\\nFig. 53.\\nSection of jaw, embryo of pig, showing dental follicle: 1, dental follicle, consisting of enamel\\norgan, dentin germ surrounded by the sacculus within the substance of the jaw 2, jaw-bone\\n3, tongue 4, papillary layer of tongue.\\ndoubtful if it has any significance. It, like the folds in many other\\nembryonic tissues, is to be taken up by the expansion of the part by\\ngrowth.\\nIn regard to the cement organ Tomes says In those creatures\\nwhich have cementum upon the roots of the teeth only, no special cov-\\nered organ exists but osteoblasts, which calcify into cementum, are\\nfurnished by the tooth sac.\\nThe g-ubernaculum is a thin fibrous cord of dense tissue, connecting\\nthe permanent tooth follicle in its bony shell with the gum tissue just\\nback of the neck of the corresponding temporary teeth. It is a struct-\\nure of no importance.", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0080.jp2"}, "81": {"fulltext": "CA L CIFICA TION. 73\\nCalcification.\\nCalcification is a process by which organic tissues become hardened\\nbv a deposition of salts of calcium within their substance. In the intercel-\\nlular tissue and in the substance of the cells themselves, these salts are\\ndeposited by the rich blood supply always near. They are deposited in\\nminute particles and in such fine subdivisions as to make it difficult\\nto demonstrate many of them even with the higher powers of the mi-\\ncroscope. The intercellular substance, either a protoplasmic or gelati-\\nnous fluid or semifluid, contains the calcium particles. In it they change\\ntheir nature chemically, uniting with the albuminous organic substance\\nof the part, and form small globular bodies which have been called\\ncalco-spherites and these, blending or coalescing at the point of cal-\\ncification, form a substance called calco-globulin. This calco-globulin,\\nwhich is a lifeless matter, has been deposited through the cells into the\\ngelatinous substauce, where, by a further hardening process, it becomes\\nthe fully calcified matrix.\\nMr. Rainey, and later Prof. Harting and Dr. Ord, have devoted\\nmuch time to the study of this substance. Mr. Rainey found that if\\na soluble salt of calcium be slowly mixed with another solution capable\\nof precipitating it, the resultant calcium salt will go down as an amor-\\nphous powder, and sometimes as minute crystals. But when the cal-\\ncium salts are precipitated in gelatin, the character of the calcium salts\\nis materially altered. Instead of a powder, there were found various\\ncurious, but definite, forms quite unlike the crystals or powder produced\\nwithout the intervention of the organic substance. Mr. Rainey found\\nthat if calcium carbonate be slowly formed in a thick solution of albu-\\nmin, the resultant salt has changed in character it is uoav in the form\\nof globules, laminated, like tiny onions, which coalesce into a laminated\\nmass. In this Mr. Rainey claims to find the clue for the explanation\\nof the development of shells, teeth, and bone.\\nAt a more recent date, Prof. Harting took up this line of investiga-\\ntion and found that other calcium salts would behave in a similar man-\\nner. The most important addition to our knowledge made by Prof.\\nHarting lay in the very peculiar constitution of the ealco-spherite,\\nby which name he designated the minute globular forms seen and\\ndescribed by Rainey. Mr. Rainey found that albumin actually en-\\ntered into the composition of the globule, since it retained its form\\neven after the action of acids. Prof. Harting has shown that the\\nalbumin left behind after treatment of a calco-spherite with acid is\\nno longer ordinary albumin it is profoundly modified, becoming\\nexceedingly resistant to the action of acids. For this modified albu-\\nmin he proposes the name calco-globulin. Microscopic glistening", "height": "4552", "width": "2664", "jp2-path": "americantextboo00kirk_0081.jp2"}, "82": {"fulltext": "74\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nglobules like those described above are constantly seen at the edges\\nof tissue where enamel, cementum, dentin, or bone are to be formed\\nor are forming. Robin and Magitot have described isolated spherules\\nof calcium salts as occurring abundantly in the young pulps of human\\nteeth, as well as those of other animals, and Tomes suggests that per-\\nhaps all deposits of calcium salts commence in this way. These micro-\\nscopic globular bodies are calco-spherites.\\nCALCIFICATION OF THE DENTIN.\\nAlthough the enamel organ is first formed, with its layer of amelo-\\nblasts all ready to commence the process of calcification, it is at the\\ntip and within the substance of the dentin germ where this process\\nreally begins. The papilla has assumed the form of the point of the\\nfuture tooth crown the cells everywhere upon its outer surface the\\nFig. 54.\\nH h\\nmmm\\nSection of growing tooth of calf at birth, showing the layer of odontoblasts and fibril cells\\nattached to the forming dentin.\\nodontoblastic layer are found to be actively at work forming the first\\ncap of dentin. They are seen to be imbedded in a transparent and\\nstructureless gelatinous substance, in which small globular masses are\\nalready forming. The cells are clearly defined, being somewhat broader\\nthan the ameloblasts just above them, and like them are seen to be in a\\nsingle layer, which has been named the membrana eboris, but it is\\nnot a true membrane (see Figs. 55 and 56). The cells are found to vary\\nin form, according as the formation of the dentin is actively going on\\nor not. During the period of their greatest activity they are broad at\\nthe end directed toward the dentin cap, so as to look almost abruptly\\ntruncated, having as many as three or four, in some instances as many\\nas six, dentinal processes proceeding from a single cell, Boll having\\ncounted as many as six. The cells are finely granular, and are, accord-\\ning to Waldeyer and Boll, destitute of membranes. The nucleus is", "height": "4608", "width": "2728", "jp2-path": "americantextboo00kirk_0082.jp2"}, "83": {"fulltext": "CALCIFICATION.\\n75\\noval and lies in that part of the tell farthest from the dentin, and is\\nsometimes prolonged toward the dentinal processes so as to be ovoid\\nor almost pointed. The dentinal process passes into the canals of the\\nSection of developing tooth, embryo of pig\\n1, stellate reticulum of enamel organ 2,\\nstratum intermedium; 3, internal epithe-\\nlium of enamel organ (ameloblasts); 4,\\nforming odontoblasts 5, pulp tissue.\\nFig. 56.\\nSection of jaw, embryo of pig 1, ameloblasts\\nshowing Tomes processes 2, layer of formed\\ndentin 3, odontoblasts 4, pulp tissue. (Sec-\\ntion by Dr. Sudduth.)\\ndentin, and it frequently happens that the layer of odontoblasts is\\nslightly separated from the dentin in making a section, when these\\nprocesses, which constitute the dentinal fibrils, may be seen stretching\\nacross the interval in great numbers. Intermediate between the per-\\nmanently soft central fibrils and the general calcified matrix is that\\nportion which immediately surrounds the fibril, namely, the dentinal\\nsheath.\\nIn 1891 Mr. Mummery noted, as the dentin was forming, the\\nappearance of connective-tissue fibers, or bundles of fibers, just in ad-\\nvance of the main line of calcification. Their high refractive index\\nsuggested their partial calcification, the processes being continuous from\\nthe formed dentin to the general connective tissue of the dentin germ.\\nHe found in a young developing tooth a distinct reticulum of fine fibers\\npassing between and enveloping the odontoblasts. By careful focussing,\\nlie saw these fibers gathered into bundles and incorporated with the\\nmatrix substance of the dentin, out of which they seemed to spring.\\nThe origin of these fibers seems to be from connective-tissue cells, which\\nare found everywhere in the formative pulp next the odontoblastic layer,\\nand also, as he has demonstrated, between the odontoblasts themselves.\\nThese fibers are the scaffolding on which the tooth matrix is built up\\nthey are incorporated in the matrix of the dentin, and form really the\\nbasis of its substance.", "height": "4544", "width": "2656", "jp2-path": "americantextboo00kirk_0083.jp2"}, "84": {"fulltext": "76 EMBRYOLOGY OF THE DENTAL TISSUES.\\nThe odontoblasts are modified connective-tissue cells that superin-\\ntend the deposition of the calcific material which is to form the calcified\\nmatrix. The thickening of the dentin is by successive deposits of this\\nmaterial in the form of layers which calcify. Fibrils from the odonto-\\nblasts remain within the formed and forming dentin as the persistent\\norganic contents of the canals. This forming of the dentin is at the\\nexpense of the dentin germ, which is thus gradually reduced until it\\nbecomes, when the tooth is fully formed, its pulp. Thus it is seen that\\ndentin is a secretion in the form of calcific material coming from the\\nabundant blood supply in the pulp tissue near the odontoblasts. The\\nmaterial is given out from the cells in a globular form (calco-spherites)\\ninto a protoplasmic fluid, or semifluid, found everywhere against the\\ncalcifying dentin. In this substance is the scaffolding of fine con-\\nnective-tissue fibers spoken of by Mr. Mummery, of London. The\\ncalco-spherites meeting against the formed dentin coalesce into a\\nlayer of calco-globulin, and this, becoming fully calcified, forms an\\nadditional layer of dentin, and the process continues until the tooth\\nis formed.\\nBy the deposition of calcium salts into the protoplasmic layer calco-\\nglobulin is formed, and by its calcification the dentin tissue becomes a\\nhomogeneous mass, penetrated by many parallel canals filled with the\\npersistent dentinal fibrils. Beside these parallel canals with their\\nfibrillar contents many lateral canals are seen branching off from the\\nmain canals and anastomosing with neighboring canals.\\nExceptions may be taken to many of the statements of histologists\\nin this field many or most mistakes are traceable to faulty methods\\nof technique. Processes which involve the securing of specimens\\nwhile they are yet warm are greatly preferable. These are placed in\\na quarter of one per cent, to one-half of one per cent, solution of\\nchromic acid, which is changed several times a day, for three or four\\ndays. At the end of this time the edges of the dentin which were\\ncalcified are found to be sufficiently softened to make a number of\\nsections. The teeth are then taken from the acid solution, washed in\\ndistilled water, placed in a solution of gum arabic for several hours, and\\nnext transferred to a solution of alcohol to abstract the water. Paraffin\\nand lard are melted together and poured into a convenient mould.\\nWhen this clouds in the process of cooling, the tooth, which has had its\\nouter surface dried as much as possible with bibulous paper, is placed in\\nit and the whole allowed to cool. The microtome for this purpose should\\npermit the immersion of both tissue and knife when the sections are\\ncut. These sections float off in the fluid, and remain there until used.\\nSections are cut until the calcified tissue is reached. The sections\\nare placed in distilled water for a few minutes to dissolve out the", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0084.jp2"}, "85": {"fulltext": "CALCIFICATION.\\n77\\ngum, and then mounted in glycerin jelly. The difference in the\\nappearance in the tissue prepared by this method is marked. It is\\nseldom necessary to stain tissues which are to be studied under the\\nhigher powers of the microscope.\\nThe dentin matrix is mainly a connective-tissue calcification, and\\nit should be remembered in examining sections of forming dentin that\\nFig. 57.\\nv.\\nI\\nI\\nSection of growing tooth of calf at birth, showing the formed dentin, the layer of calco-globulin\\nand two odontoblasts a fibril is seen at the side of one of thern.\\nsections are seen at that stage of growth at which the death of the\\npart left it. In some the odontoblasts are seen square and abrupt against\\nthe calcified matrix, having no appearance of other tissue between them.\\nFig. 58.\\nSection of growing tooth of calf at birth, showing the layer of odontoblasts square and abrupt\\nagainst the forming dentin; some of the fibril cells, or dentin corpuscles, that are pear-\\nshaped, are seen running between them.\\nIn others the odontoblasts are seen square and abrupt against a layer\\n\u00e2\u0096\u00a0of a fibrous, gelatinous tissue, which is seen to be filling with globular", "height": "4548", "width": "2688", "jp2-path": "americantextboo00kirk_0085.jp2"}, "86": {"fulltext": "78\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nmasses (Fig. 57). This layer is between the odontoblasts and the cal-\\ncified matrix. A section from another embryo will show a different\\npicture. Here is seen a layer of mostly pear-shaped cells, not quite\\nagainst the calcified matrix, showing their fibrils drawn out and run-\\nning into the canals of the matrix (Fig. 58). There is no appearance\\nof a gelatinous layer, while here and there against the calcified matrix\\nare what appear to be used-up odontoblasts, only portions of them\\nshowing. The cells in this picture rarely show more than one fibril\\nrunning into the canals of the matrix. Again, a section from another\\ntooth will show layers of calco-globulin merging together and forming a\\nnew layer of the matrix, and, in this, parts of the odontoblasts seem to\\nlose their identity (Figs. 59-61). An important fact not to be lost sight\\nFig. 59.\\nSection of developing tooth of calf at birth cross section showing first-forming layer of dentin\\nmatrix. The calco-spherites are seen forming a layer of calco-globulin which by further calci-\\nfication is to become the matrix.\\nof is that all of these appearances indicate the different stages in the\\ngrowth of the dentin matrix. Conclusions cannot be drawn from any\\none of them, so all must be studied. These appearances are not found\\nat the early stages alone they are also seen when the matrix is nearly\\nformed.\\nThe odontoblasts are masses of protoplasm without membranes, and\\nare at a certain stage of growth square and abrupt against the matrix\\n(Fig. 58). It is an easy matter to find among them, and immediately\\nadjacent, large numbers of pear-shaped cells, tapering into the dentinal\\nfibril. The odontoblasts, when calcification is active, are scarcely\\nmore than masses of protoplasm, filled with minute globules (Fig. 62).\\nThe fibrils which appear to come from them, described by Tomes as\\npulp, lateral, and dentin processes, originate probably from a fibril-", "height": "4604", "width": "2768", "jp2-path": "americantextboo00kirk_0086.jp2"}, "87": {"fulltext": "CALCIFICATION.\\nFig. 60.\\n79\\nn\\nr\\\\\\nj\\nj i\\nr I\\n*ir*\\nt\\n1 i \\\\*V\\\\ a i\\ni\\\\ 1 v v f\\n_ i _ i V\\nSection of growing tooth of calf at birth, showing fibrils, fibril cells and odontoblasts also the\\nlayer of calco-globulin and the forming dentin.\\nFig. 61.\\nI\\nt i\\ns V*V f V4Y;\\nSection of growing tooth of calf at birth, showing fibrils, fibril cells, and odontoblasts. The pulp,\\nhas been teased away, leaving these cells clinging to the formed dentin.\\nFro. 62.\\ni JLM;- A*\\nMl\\nSection of growing tooth of calf at birth, showing odontoblasts and fibril cells.", "height": "4556", "width": "2668", "jp2-path": "americantextboo00kirk_0087.jp2"}, "88": {"fulltext": "80\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nforming cell. These pass through the soft substance of the odonto-\\nblasts (protoplasm) and seem to be a part of them, but in fresh, young\\nsections the so-called processes move in the substance of the odonto-\\nblasts by pressure on the cover-glass, and the fibril may be traced to\\na pear-shaped cell beyond (Fig. 62). There will usually be found as\\nmany processes going out from sides or ends of the odontoblasts toward\\nthe pulp as there are going into the matrix from the dentin end of the\\ncell. In cross sections of the odontoblasts, delicate light spots are seen\\nin the substance, which are probably the cut fibers. When the layer\\nof odontoblasts is teased away from the forming dentin, fibrils are seen\\nbridging the gap, apparently offshoots from the odontoblasts but on\\ncareful examination there will usually be found a decided line of demar-\\ncation across the fiber at the point where it meets the square end of the\\nFig. 63.\\nSection of growing tooth of calf at birth; odontoblasts that were square and abrupt against the\\nforming dentin, showing the line of demarcation between the cell and the fibril. They are\\nattached to the pulp.\\nodontoblast (Fig. 63). This line seems to show that the fibril was not\\ncontinuous with the protoplasm of the cell. Other sections which have\\nbeen separated by teasing, show odontoblasts having their side masses\\nof protoplasm drawn away from the fibril which apparently has run\\nthrough it. Some of this protoplasm is left upon the fibril, giving it\\na ragged appearance as it passes from a canal in the matrix across to\\nthe separated pulp tissue, bridging the gap.\\nThe pear-shaped cell has perhaps a more important function than\\nthe odontoblast proper. It is to supply the life and nourishment to\\nthe whole of the calcified matrix, as the bone corpuscle within its\\nlacuna supplies life and nourishment to bone and cementum.\\nMinute calcium globules or calco-spherites are seen to be arranging\\nthemselves against the already formed matrix, where they collect in large", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0088.jp2"}, "89": {"fulltext": "CALCIFICATION.\\n81\\nFig. 64.\\nSection of human tooth, showing globules of calco-globulin which have been deposited in the\\ngelatinous layer by the odontoblasts these have been pulled away in making the section.\\n(Section by Mr. Mummery.)\\nFig. 65.\\nig. m.\\nFrc. 6/\\nSections of growing tooth of calf at birth, showing formation of layer of masses of calco-globulin\\nto form layer of dentin.", "height": "4556", "width": "2668", "jp2-path": "americantextboo00kirk_0089.jp2"}, "90": {"fulltext": "82\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nnumbers, and lose their individuality by merging into one another, form-\\ning larger globules, of various shapes and sizes (Fig. 64), seeming to\\ntake into their substance portions of the odontoblast. These globules\\nenlarge until they reach their typal width, expand laterally, meeting\\nand coalescing with others. The minute globules are seen within the\\nodontoblasts of different sizes, all having a glistening appearance, some-\\nthing like fat globules in cells. The early layers formed by the glob-\\nules are about the width of the band of formative cells. (See Figs.\\n65, 6Q y 67).\\nCALCIFICATION OF THE ENAMEL.\\nThe statement made by Tomes and others that enamel is formed\\nby the actual conversion of the enamel cells into the enamel rods is an\\nerroneous one. The enamel cell does not calcify it superintends the\\nlaying down of calcific material which is to form the rod. For the\\nearliest deposit of enamel the calcium salts are stored in the meshes\\nof the so-called stellate reticulum, and as the first enamel forms, the\\nenamel organ proper disappears at this point. Only the two inner-\\nmost layers remain these are the layer of the columnar cells (amelo-\\nblasts) over the forming enamel, and a layer of cells somewhat resem-\\nbling connective-tissue cells (the stratum intermedium) over these. The\\ntwo layers are separated by what\\nappears to be a line of tissue which\\nhas been called a membrane. The\\nembryonic connective tissue of the\\njaw is now in direct communication\\nwith the stratum intermedium, and\\na rich blood supply is developing\\nnear the point of juncture. The\\nfunction of the cells of the stratum\\nintermedium is supposed to be the\\nsupplying of new cells to the amelo-\\nblastic layer as they may be needed by\\nthe increase in the circumference of\\nthe enamel, as new enamel is formed\\nto furnish the organic fluid in which\\nthe calcium salts are deposited\\nand to supply the fine network of\\nfibers, the scaffolding upon which\\nthe enamel rods are to be built. Prof. Sudduth is the authority for\\nthe statement that enamel is nothing more or less than a coat of mail\\nsupplied by Nature to protect the dentin.\\nEnamel cells that have been properly prepared and not shrunken\\nwill be seen filled with minute globules. The authorities who speak of\\nFig. 68.\\nSection of human developing tooth, showing\\ncalcification of enamel 1, globules of cal-\\nco-globulin deposited on dentin cusps\\nfrom the enamel cells 2, dentin (the\\nenamel cells have been cut away in prepar-\\ning the section).", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0090.jp2"}, "91": {"fulltext": "CALCIFICATION.\\n83\\ngranules of calcium salts have described them as seen in the shrunken\\ncells in the tissue as it is usually prepared. They are really globular,\\nthough minute. If, just as calcification commences, a few drops of\\ndilute nitric acid be placed on the slide near the edge of the cover-\\nglass, the liquid will, by capillary attraction, run under, and these re-\\nfractive granular bodies in the stellate reticulum will disappear, as will\\nFig. 69.\\nFig. 70.\\nMm\\nSections from growing tooth of calf at birth, showing how enamel rods are formed from the globu-\\nlar masses of calco-globulin.\\nFig. 71.\\nM\\nSame as Figs. 69 and 70.\\nthose that are in the enamel cells themselves. Large numbers of small\\nbubbles will accumulate, and force themselves out from under the cover-\\nglass. This would seem a positive demonstration of the presence, in the\\nstellate reticulum and enamel cells, of calcium carbonate just previous\\nto commencing calcification. In teasing off portions of active enamel\\ncells, we find the surface of the dentin on which it is being formed\\ncovered with layers of globules that have been deposited there by the", "height": "4556", "width": "2664", "jp2-path": "americantextboo00kirk_0091.jp2"}, "92": {"fulltext": "84\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nFig.\\nenamel cells (Fig. 68). These, given out from the cell continually,\\nform the enamel rods. One rod is separated from another by a proto-\\nplasmic cement substance.\\nDr. Graf Spee says that when the tissue is properly prepared and\\nhe lays great stress on this point at the time of the formation of the\\nenamel, the globules are always to be found. Their entire absence at\\nearlier stages is an indication that\\nthese globules are an enamel sub-\\nstance. He gives to them the name\\nenamel drops, and says he saw\\nthese enamel drops, when enamel\\n3 is to be formed, appear only in the\\nhalf of the enamel cells which rests\\nj on the dentin afterward they were\\nto be seen farther up in the cell, but\\nnot quite to the region of its nucleus.\\nMany of them were so small as to be\\nscarcely measurable, and they are al-\\n\u00e2\u0080\u0094.!._ ways spherical. Great numbers of\\nsection of developing tooth of caif at birth, t em are co n ec t e d at the periphery,\\nshowing first-forming layer of enamel. The -i i\\nglobules of caico-giobuiin are seen arranged and appear here either to be completely\\nin lines where rods are to be formed: 1, merRed or to fuse Wether. The\\nenamel cells containing calco-spherites 2,\\nglobules arranged to form rods; 3, first- lower part of the Cell contains the\\norming ayer o ename 4, entm. larger enamel drops, which merge\\nwithout sharp boundaries into the substance of the enamel rods. This\\nthen appears as a part of the enamel cell, in which the originally iso-\\nlated enamel drops have run together into a continuous mass, and\\nthe growth of the enamel rod, once begun, appears to take place by the\\naddition of new enamel drops.\\nThe minute globular forms described by Dr. Spee are calco-spherites\\nthe larger ones, his enamel drops, are globules of calco-globulin which\\nare to form the rods (Fig. 72).\\nAppearances of calcined fibers projecting beyond the line of calci-\\nfication are seen when studying sections of forming young enamel, and\\nthese are evidences that fine processes of fibers from the cells of the\\nstratum intermedium pass down through and among the ameloblasts to\\nthe forming enamel beneath. These are probably the processes which\\nMr. Tomes saw and described as connecting the enamel cells with the\\nstratum intermedium. If one separates slightly the enamel cells from\\nthe stratum intermedium the parted cells will have the appearance of\\nbroken processes or fibers, and we may be able to see fibers crossing\\nfrom the enamel cells to the stratum intermedium.\\nA longitudinal section of a human tooth at birth, just after the", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0092.jp2"}, "93": {"fulltext": "CALCIFICATION. 85\\nprocess of calcification in the enamel has begun, will show, between\\nthe enamel cells and the formed enamel, a thin layer which has been\\ncalled, by earlier investigators, the membrana prceformativa. It was\\nmisunderstood then it is not a membrane. It is the latest deposition\\nof enamel from the enamel cells, composed of globules or masses of\\ncalco-globulin and around these globules there seems to be a fibrous\\nnetwork. Connecting with this fibrous network, and running to the\\nformed enamel beneath, are innumerable thread-like processes, in ap-\\npearance like fibers. There are indications of fibers which have been\\nbroken on the upper portion of this thin layer these appear as\\nthough they had been broken off in the separation of the layer from\\nthe enamel cells. In a longitudinal section of the tooth of a calf at\\nbirth, when the recently formed layer of enamel is still in contact with\\nthe fully calcified enamel, this younger portion may be teased off,\\nexposing to view what appear to be fibrils standing out from the sur-\\nface. These have apparently been drawn out from the only partially\\ncalcified new tissue. In other sections this appearance is more marked.\\nThey may appear so large that it is probable they have been enlarged\\neither by the action of reagents or by calcific matter clinging to a\\nfiber, if one is there, and they are undoubtedly partially calcified.\\nThey are very much coarser than the fine fibrils seen between the\\nenamel cells. Deeper within, these processes are seen to surround the\\nglobules or masses which have been deposited by the enamel cells, and\\nwhich are forming the rods. In other sections from the tooth of the calf\\nthe younger layer of forming enamel shows a network of fibers they\\nare surrounding the recent deposition of globules. It is only in this\\nlayer that this appearance is clearly shown this network in more\\nfully formed enamel cannot be seen, yet a distinct network is always\\nvisible in the layer first deposited. It is probable that these pro-\\ncesses have their origin among the cells of the stratum intermedium\\nthat they pass either within or between the enamel cells, and thus on,\\nto form a very fine fibrous substructure, throughout which are deposited\\nthe globules which are to form the future enamel rods. When the cal-\\ncification of the rod is complete, the calcium salts have been so densely\\ndeposited as to entirely obscure the appearance of any fiber.\\nTo sum up there probably exists in developing enamel, as has\\nalready been found in developing bone and dentin, a fibrous sub-\\nstructure on and throughout which the enamel globules are deposited.\\nAfter the enamel is wholly formed, this structure seems to be wholly\\nblotted out in the dense calcification of the tissue (Figs. 73, 74). In\\nsections of completely formed enamel the writer has been unable to\\ntrace it, although the methods of those who claim to have seen it\\nhave been faithfully followed. In regard to a protoplasmic reticulum", "height": "4544", "width": "2672", "jp2-path": "americantextboo00kirk_0093.jp2"}, "94": {"fulltext": "86\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nFig. 73. Fig. 74.\\nSections of very young enamel (human), showing the appearance of a fibrous structure 1, enamel\\ncells 2, newly forming enamel 3, dentin.\\nof living matter in formed enamel, it is undemonstrable. Klein states\\nthat it is improbable that nucleated protoplasmic masses are contained\\nin the interstitial substance of the enamel of a fully formed tooth.\\nCALCIFICATION OF THE CEMENTUM.\\nIn the year 1858, Magitot, a French histologist, claimed to have\\nfound within the follicle of a developing tooth a special organ for the\\ndevelopment of the cementum. In 1861 Robin and Magitot made a\\npresentation of the same facts. With the exception of these authors,\\nno other authority has recognized the presence of this special organ\\nwhile Kolliker, Waldeyer, Herz, and others had formerly denied its\\nexistence. Although there are appearances, in a fully formed follicle,\\nof a tissue between the calcifying dentin germ and the outer covering\\nof the sacculus, which might admit of the supposition of the existence\\nof such an organ, it cannot be traced with certainty. The appearance\\nmay be noted in sections from embryos of the pig and calf. At a later\\nstage when the crown is further developed there are also to be seen\\ninfoldings of the tissue at the base of the germ which may develop\\ninto a special organ for the formation of the cementum, as stated by\\nMagitot but in teeth more matured, where the cementum has already\\ncommenced its growth, there are no indications of a special organ.\\nIf the developing tooth is examined just after the cementum has\\nbegun to form, its matrix will be found to be made up of masses\\nlooking like scales of a tissue found everywhere on the borderland of\\ncalcification. It is calco-globulin, and has been formed from globules.\\nAt this early stage the calcific material is in the osteoblasts, and is\\ngiven from them to the dentin, where a thin layer is forming. The", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0094.jp2"}, "95": {"fulltext": "THE DENTAL PULP. 87\\nosteoblasts are filled with minute, glistening globules. As the growth\\ncontinues, these cells appear to fuse into the cementum already formed.\\nAt the neck of the tooth outside this layer, which is forming the matrix\\nof the cementum, a row of cells is seen which, according to Roller, re-\\nsembles an epithelium. They are really new osteoblasts or cemento-\\nblasts filled with the minute glistening bodies. Just exterior to these\\ncells, roundish nucleated cells with innumerable processes are seen\\nslightly resembling a stellate reticulum. Outside of these is a con-\\nnective-tissue layer which will become the periosteum. This slight\\namount of stellate tissue is probably what has been called the special\\ncement organ. Across the developing matrix of the cement are found\\nnumerous connective-tissue fibers seen and described by Sharpey and\\nnamed after him Sharpey s fibers. They become calcified within the\\nmatrix. As the cementum grows thicker we find infolded within its\\nsubstance nucleated bodies which appear to be connective-tissue cells.\\nThey appear larger than the osteoblasts and are forming the regular\\nlacunae of the cementum. Their function is to give nourishment to\\nthe matrix of the cementum, anastomosing with one another by means\\nof many fine canals, many of which run in the direction of the termi-\\nnation of the dentinal canals as though connecting with them. They\\nare not as regular as those in true bone, and are often very much larger.\\nThe processes of these cells anastomose with the dentinal canals through\\nthe interglobular spaces of the so-called granular layer of Tomes. Thus\\nthe matrix of the cementum is formed from the cementoblasts which\\nhave become filled with calcific material from the blood supply every-\\nwhere near. They rest against already formed dentin and become\\nmerged into a layer of calco-globulin, which in turn becomes calcified\\ninto the first layer of cementum. Layer after layer is formed, and\\nthis gives to the cement the peculiar laminated appearance so often\\nseen in it.\\nThe Dental Pulp.\\nThe tooth pulp is that which remains of the dentin germ after cal-\\ncification is completed. It is very generally but erroneously called the\\nnerve. In the young tooth it is composed of connective-tissue matrix\\nwhich contains the nerves and vessels supplying the dentin. These\\nare more numerous near the odontoblastic layer, the nerve fibers appear-\\ning to terminate here. The odontoblasts cover the surface of pulp like\\nan epithelium. Just within these is a layer of cells consisting of a\\ncomparatively pale and transparent zone, and this has been called the\\nbasal layer of Weil. It is described as consisting of fine connective-\\ntissue fibrils which communicate with the processes of the odontoblasts.\\nVon Ebner doubts the existence of this layer, as does Rose.", "height": "4536", "width": "2680", "jp2-path": "americantextboo00kirk_0095.jp2"}, "96": {"fulltext": "88\\nEMBRYOLOGY OF THE DENTAL TISSUES.\\nh a\\nS5\\n\u00c2\u00a7d\u00c2\u00ab\\n3 go\\n,d bco\\n03\\n.s^\\no\\nd bJc.S\\nO fl -H\\nD Cc3\\nCO\\n2 ft^\\nd co\\nO CD ft\\nft bco\\nft\\n?N\\n\u00c2\u00b00\\nd. d\\no bo\\nH\\no\\n5.S\\no?r\\nH\\n^pl\\nS d\\nCOO\\no o\\n^ss\\n4:ft\\ng\\nA\\n0 o\\n*H ft\\ncc\\nO\\ns^\\n\u00e2\u0096\u00a0so\\nPi\\nJ5 H -i-i\\nd\u00c2\u00abw\\noi o\\nr\\n6\\nSrt\\n6\\n1\\no\\nH\\nM\\n-d fl\\nft S\\nCO\\nO)\\nCO\\nCU\\nOi\\nCO\\no\\n[3\\no\\no\\n.do\\nftd\\nO g\\n0S5\\nPoo\\n\u00c2\u00a3o2\\n21\\no .2\\nIs\\nd\\n,3\\n;g\\nOP or,\\na\\n5*1\\no\\no\\no\\nH d\\nd o d\\no\\n0)\\n0)\\nai^-o\\n\u00c2\u00a3.2\\no\\no\\no\\nc3\\noso 3\\nO O CD\\no\\npi 3\\nftdd\\no a\\nOh\\no\\no\\no\\nft\\n5\\nh\\nO.^^JOco-cD O\\np So \u00c2\u00a3pft 2p 0P\\nOf^J M o\\n-d d 3-d\\n,d p d\\nft^\\nO-H\\nSit\\nrH H CU\\nft S\\ndg\\na) A o\\ncd^ fl d cs^ o-^-wd\\nbJOO o d ^t*-, 5\\np p o 5 S o ts\\no^.-SO^ S d be\\no d ftopl Pi M Or^J\\no d d^ -rSd b\\n.2 b a3 v Z \u00c2\u00ab=5 g,2\\n\u00e2\u0096\u00a0^.SjCS fc-K oh oi fto\\nrS C d\\nO d co\\nco g W)\\nO CD\\npoo\\nP CD-U\\no d\\nCD +J\\nS\\nPh\\nO\\nm 1\\nft\\nW\\nH\\nO\\no\\nH\\nft\\nH\\nH\\nft\\nall\\nCN O\\nfto d^ g\\n^,d Or-H\\n.plo o.| S\\n^Sl CO\\n-d o\\no3 j-, N 0\u00c2\u00abm\\n0+= O H q\\nao ci co to\\nfe h o\\n^d^o^\\n-^d-^ co l\\no o\\n0 02\\nrtfflg\\n52 -d d\\n^d!-\u00c2\u00a3 bD\\n2 O co pi\\n552d\\nOP o\\n\u00e2\u0080\u00a2HQ H\\nft^d a\\n.2 o 5\\n5dd\\nco o-h\\nO 2 D\\nd d eg\\nd C d\\nd O D\\no be\\npi\\nCD^\\no o o\\no^ q\\ngpd\\no a +3\\n^d\\nO\u00e2\u0080\u0094 +3\\nco.O O\\nO 5 CD\\n7j o P\\n\u00c2\u00aed P o\\n.2-^00\\nP^O*\\ng o\\n3.2\\n^d\\nAm\\n5g2^\\n\u00c2\u00b0.2\\no\\nIs\\n+j co\\nd*3\\no\\nH\\nH\\nHi\\no\\nbe\\nd o\\nO)\\no\\no\\no\\no\\no\\nW\\nO\\nd\\npq\\nPd ^p\\nO be\\n\u00c2\u00b0ftS\\no\\n-d\\no\\nd\\no\\nrd\\no\\no\\nd\\no\\nd\\nto\\nH\\nw\\ncid\\nCO\\nPI\\n2 2\\nO 00\\nc\u00c2\u00bb (N\\nW\\nH\\ng-ggj\\nrH (M\\nO\\no\\nO\\nfloO H\\n\u00c2\u00abi\\nC^d^ 01\\nCO\\nEh\\no d o-d\\nS o\\nCO H 01,0\\nOi 00\\n00 I-\\nI cO\\nO 00\\no o^\\nCO\\n1-h CO\\niC OM\\nooo\\nO r-5\\nrH^tH\\nth ^CN\\nLO\\ni-: t-\\nh", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0096.jp2"}, "97": {"fulltext": "CHRONOLOGY OF TOOTH DEVELOPMENT.\\n89\\no\\no\\nc\\nSoSo\\na.s\\no\\n1-6\\nfl\\nft\\n03\\n,4 -C\\nS c\\no\\nrr\\na\u00c2\u00a7\\nc5 ci\\nfl\\n.2 fl\\nclosure of the w\\nrupture of the b\\no\\no\\no\\na\\na\\ns\\nc3\\no\\nft\\no\\np\\nOS o\\no\\nO\\ncusps of denti\\nriginate upon\\nral apices of\\nn organ h\\nlesced.\\n\u00c2\u00abo 3\\n3^\\nft 2\\no6n\\ncpOcp^oJ\\n0)0^1\\nQjO rG\\nft\\nft\\nH\\nft\\nrG\\nrCj\\nfl\\nfl\\ni\\nH\\n5\\nH\\nH\\nEH\\nH\\nSi\\ngs\\nt\u00c2\u00bb\\nCD\\nco\\nco\\no\\nCO\\nCO\\n^3\\nft 03\\nCD\\nC5\\nC\\nO\\n8\\nC\\n03 -g\\no3 c3\\nr\u00e2\u0080\u0094 73\\nft\\n3\\n11\\nX) o\\nft d\\nCo\\n5 M\\n0J\\nCO o\\nft\\n1\\nft\\nsis\\nI\\nSo\\nc3\\n2 3\\n3\\no\\n\u00e2\u0080\u00a251\\n111\\no o o\\nrt-- 1\\nss*\\no\\nc\\ns\\no\\n\u00e2\u0080\u00a2a\\no\\n03\\no\\nI\\nCO\\n03\\no\\ng\\nr-J boo3\\n03 S-oj\\n2\\ni|a\\nC\\nC\\nc\\nc\\na\\no\\nft-\\n03\\nl-s 8\\n2\\n.2\\n5 C\\nC0+J ft\\nC\\nft\\nft\\no\\no\\nO\\nH\\nE- 1\\nO\\na\\nu\\nPC\\nCN\\nft^\\n^5 I\\nC\\nH ^l\\nCN -5\\n^5\\nx 2\\nLH CO\\ni-i CN\\n^5\\no o\\nCOfcjg\\nx\\nC? 3\\nCTi\\nSSE\\nS3 \u00c2\u00ab3", "height": "4536", "width": "2672", "jp2-path": "americantextboo00kirk_0097.jp2"}, "98": {"fulltext": "90 EMBRYOLOGY OF THE DENTAL TISSUES.\\nIn a recent paper on the Histology of the Pulp, by Erwin Hoehl, he\\nstates that the cells of the pulp show in the different life periods cha-\\nracteristic differences in form and number. Three kinds are found,\\nwhich arise from one another by metamorphosis in the following way\\n(1) Round cells with large nucleus and scanty protoplasm. (2) Irregu-\\nlarly shaped cells with many freely anastomosing processes. (3) Spindle-\\nshaped cells with the same character as the foregoing. The changes of\\nthe cell form begin at the periphery and proceed toward the centre of\\nthe pulp. The outermost peripheral layer of the branched cells contains\\nthe elementary or primary odontoblasts. Central ward from these is a cell\\nlayer which, with reference to the function of its elements, is called the\\nconjugation cell layer. The secondary odontoblasts arise by conjugation\\nof the primary odontoblasts with the conjugation cells, and they form\\nthe dentin. The conjugation processes probably cease only with the\\ncompletion of growth in the tooth.\\nOf the peripheral processes of the primary odontoblasts the larger\\none represents what will be the future dentin fibril. The increase of\\ncells seems to be dependent upon the development of the capillaries,\\ninasmuch as more cells are found where the distribution of capillaries is\\nmost dense, i. e. on the periphery of the pulp. The gradual decrease\\nof the number of branch cells in the centre of the pulp during the\\ncourse of development is because only trunk vessels are found here*\\nIn the place of these destroyed cells we find a delicate cellular network\\nwhich is probably derived from the numerous anastomoses of the cell\\nprocesses. Next to or just within the odontoblastic layer is seen a bright\\nzone variable in width this is the so-called WeiVs layer. Between this\\nand the fibrous or central portion of the pulp is an intermediate layer\\nwhich forms a contrast with the delicate fibrous elements of Weil s layer,\\nand in this way WeiPs layer is made visible.\\nThe ground substance of the pulp by a certain method of treatment\\nshows a dense interlacing of fibrillar which are arranged parallel to one\\nanother and seem to run in the direction of the axis of the tooth.\\nThe Gum.\\nGum tissue is the same as that of the general mucous membrane of\\nthe mouth. It is more dense because it is bound down to the bone\\nby numerous fibers of its own, and it is also united with the periosteal\\ntissue which spreads into it in every direction. Numerous large single\\nand compound papilla? are seen. The blood supply is abundant, but\\nnerve tissue is not often found. The histological appearances which\\nlook like young enamel organs are the glands of Serres. Near develop-\\ning teeth epithelial clusters are frequently seen, the remains of the dis-\\nappearing necks of the enamel organs. The cells of the stratum Mai-", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0098.jp2"}, "99": {"fulltext": "THE PERICEMENTUM OB ALVEOLO-DENTAL MEMBRANE. 91\\npighii of the epithelium are seen to be in columns, and from these\\nnew cells are formed, which flatten and lose their vitality as they\\nnear the outer surface, where they are given off as lifeless scales.\\nThe Pericementum or Alveolo-dental, Membrane.\\nThis is a formation of fibrous connective tissue, having its origin\\nfrom the outer layer of the sacculus (Fig. 75). It differs from the gum\\ntissue in that it is not so dense. Tomes speak of it as having a rich\\nsupply of nerve fibers.\\n\u00e2\u0096\u00a0MB\\nFig. 75.\\n;~;v\\nAlveolar dental membrane (sect\\nlembrane 2, bone\\nif alveolus\\nThe pericementum passes into the gum at the tooth neck, where it is\\nthicker than at any other part. It is seen to be everywhere connected\\nwith the periosteal membrane of the alveolar process. The general\\ndirection of its fibers is across, slightly wavy, downward from the\\nalveolus to the tooth root. In the young tooth there are no breaks in\\nthe continuity. There is no appearance of two separate membranes,\\none for the root and the other for the alveolus but simply a mem-\\nbrane common to both surfaces.", "height": "4548", "width": "2668", "jp2-path": "americantextboo00kirk_0099.jp2"}, "100": {"fulltext": "92 EMBRYOLOGY OF THE DENTAL TISSUES.\\nThe pericementum forms an elastic membrane and acts as a cushion\\nto lessen the concussion when the teeth come together during mastica-\\ntion. Its connective-tissue fibers are seen to pass into the cementum,\\nand within that substance are supposed to be Sharpey s fibers. Where\\nthe cementum is thicker it is rich in cellular structure. TKe pericemen-\\ntum, then, connects with the cementum by its fibers; these in turn con-\\nnect with the branches of the cement corpuscles, through these with the\\ngranular layer of Tomes, and thence on to the fibrils of the dentin.\\nNasmyth s Membrane.\\nConcerning this structure Tomes states that\\nUnder the name of Nasmyth s membrane, enamel cuticle, or per-\\nsistent dental capsule, a structure is described about which much differ-\\nence of opinion has been, and indeed still is, expressed. Over the\\nenamel of the crown of human or other mammalian teeth, the crown of\\nwhich is not coated by a thick layer of cementum, there is an exceed-\\ningly thin membrane, the existence of which can only be demonstrated\\nby the use of acids, which causes it to become detached from the surface\\nof the enamel. When thus isolated it is found to form a continuous\\ntransparent sheet, upon which, by staining with nitrate of silver, a\\nreticulated pattern may be brought out, as though it were made up of\\nepithelial cells. The inner surface of Nasmyth s membrane is, however,\\npitted for the reception of the ends of the enamel prisms, which may\\nhave something to do with this reticulate appearance. It is exceedingly\\nthin, Kolliker attributing to it a thickness of only one twenty-thousandth\\nof an inch. But, nevertheless, it is very indestructible, resisting the\\naction of strong nitric or hydrochloric acid, and only swelling slightly\\nwhen boiled in caustic potash. Notwithstanding, however, that it resists\\nthe action of chemicals, it is not so hard as the enamel, and becomes\\nworn off tolerably speedily, so that, to see it well, a young and unworn\\ntooth should be selected.\\nThe writer s investigations lead to the inference that the membrane\\nis nothing more than the layer of cells of the internal epithelium of the\\nenamel organ, the ameloblasts, which, having performed their function,\\nhave filled with calco-globulin and have partially calcified, becoming\\nsomewhat like that tissue which we find on the borderland of calci-\\nfication.\\nIt is probable that the lacunae found occupying a fissure between\\nthe cusps of the teeth, in the enamel, are nothing more than a little of\\nthe connective tissue which has become infolded and ossified before\\nthe eruption of the tooth.", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0100.jp2"}, "101": {"fulltext": "CHAPTER III.\\nDENTAL HISTOLOGY WITH REFERENCE TO OPERATIVE\\nDENTISTRY. 1\\nBy Frederick B. Noyes, B. A., D. D. S.\\nThe development of our knowledge of the cell has had a most pro-\\nfound effect upon the entire practice of medicine in fact, the progress of\\nmodern medicine dates from the studies of cell biology, the germ theory of\\ndisease being only one of the phases of this development. In terms of the\\ncell theory the functions of the body are but the manifest expression of\\nthe activities of thousands or millions of more or less independent but\\ncorrelated centres of activity if these centres or cells perform their\\nfunctions correctly, the functions of the body are normal but if they\\nfail to perform their office, or work abnormally, the functions of the\\nbody are perverted. In the last analysis, then, all physiology is cell\\nphysiology all pathology cell pathology. To modern medicine his-\\ntology, or the cell structure of the organs and tissues of the body,\\ntogether with cell physiology, is the rational foundation of all practice.\\nThis is as true for the dentist as for the physician so far as regards all\\nof the soft tissues of the mouth and teeth that he is called upon to\\ntreat and handle. With caries of the teeth, the disease which most\\ndemands the attention of the dentist, the case is somewhat different.\\nCaries of the teeth is an active destruction, by outside agencies, of\\nformed materials which are the result of cell activity (the tissues them-\\nselves being passive). The cellular activities of organs and tissues of\\nthe body may have an influence, but this is only in producing those\\nconditions of environment which render the activities of the destructive\\nagents efficient in their action upon tooth tissues. Though the enamel\\nand dentin are passive, we can understand the phenomena of caries\\nonly as we understand the structure of the tissues and not only\\nmust the treatment of caries be based upon a knowledge of the\\nstructure of the tissues, but the mechanical execution of the treatment\\nis facilitated by that knowledge. In the preparation of cavities the\\narrangement of the enamel wall is determined by our knowledge of\\nthe direction of enamel prisms in that locality, and to a certain extent\\n1 In the preparation of this material I am indebted to Dr. G. V. Black for the use of\\nhis large and valuable collection of microscopic slides, and for much advice and many\\nsuggestions.\\n93", "height": "4548", "width": "2672", "jp2-path": "americantextboo00kirk_0101.jp2"}, "102": {"fulltext": "94\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nthe position of the cavity margins must be governed by our knowledge\\nof the structure of the enamel. In the execution of the work a minute\\nknowledge of the direction of enamel rods becomes the most important\\nelement in rapidity and success of operation.\\nFrom the standpoint of comparative anatomy, the teeth are found\\nto be not a part of the osseous system, but appendages of the skin,\\nand are to be compared with such structures in the body as the nails\\nand the hair. The teeth are a part of the exo-skeleton, and their rela-\\ntion to the bones of the endo-skeleton is entirely secondary, for the pur-\\npose of strength, the bone growing up around the tooth to support it.\\nIf we examine the skin of such an animal as the shark, we find\\nthe entire surface covered with small calcified bodies which are really\\nFig. 76.\\n^^^^^^1\\nkm\\nmML\\\\\\n\u00c2\u00a3\u00e2\u0080\u009ejJM\\n1\\n\u00e2\u0096\u00a0^-X\\n,^mmmm\\\\\\nShark s skull (Lamna cornubica), showing succession of teeth.\\nsmall simple cone-shaped teeth. The mouth cavity is to be regarded,\\nwhen viewed in the light of its development, as a part of the outside\\nsurface of the body which has been inclosed by the development of the\\nneighboring parts, and the dermal scales or rudimentary teeth which\\nwere found in the skin covering the arches which form the jaws have\\nundergone special development for the purposes of seizing and masti-\\ncating the food. In the simplest forms there is only a development\\nin size and shape of these scales, and they are supported only by the\\nconnective tissue which underlies the skin. These teeth are easily torn\\noif in the attempt to hold a resisting prey, and, as in the shark, they are\\nconstantly being replaced by new ones (Fig. 76). In the more highly de-\\nveloped forms there is a growth of the bone of the arch forming the jaw", "height": "4580", "width": "2768", "jp2-path": "americantextboo00kirk_0102.jp2"}, "103": {"fulltext": "DENTAL TISSUES.\\n95\\nupward around the bases of these scale-like teeth, to support them\\nmore firmly and render them more useful.\\nIf we compare the structure of the hair with that of the tooth, we\\nfind in the case of the hair a horny structure formed by epithelial\\ncells resting upon a papilla of connective tissue in the case of the\\ntooth, a calcified structure formed by epithelial cells resting upon a\\npapilla of connective tissue which is also partially calcified.\\nThe relation of the bones of the jaws to the teeth is entirely a secondary\\nand transient one. The bone grows up around the roots of the teeth to\\nFig. 77.\\ntym ^m\\nChanges in the mandible with age buccal and lingual view.\\nsupport them, and is destroyed and removed with the loss of the teeth\\nor the cessation of their function. In this way the development of the\\nalveolar process takes place around the temporary teeth all of this bone\\nsurrounding their roots is absorbed and removed with the loss of the\\ntemporary dentition, and a new alveolar process grows up around the\\nroots of the permanent teeth as they are formed. This development of\\nbone around the roots of the teeth leads to the changes in the shape of\\nthe body of the lower jaw, increasing the thickness above the mental\\nforamen and the inferior dental canal. When the teeth are finally lost\\nthis bone is again removed and the body of the jaw is reduced in thick-\\nness from above downward (Fig. 77). These phenomena are of im-\\nportance in their bearing upon the causes and treatment of diseased con-", "height": "4556", "width": "2676", "jp2-path": "americantextboo00kirk_0103.jp2"}, "104": {"fulltext": "96 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nditions of the teeth, particularly those which involve the supporting\\ntissues.\\nDental Tissues. The human teeth are made up of four tissues\\n(Fig. 78)\\n1. The enamel covers the exposed portion of the tooth, or crown,\\nand gives the detail of crown form. Its function is to protect the tooth\\nagainst the wear of friction.\\n2. The dentin forms the mass of the tooth and determines its class\\nform, the number of cusps and the number of roots being indicated by\\nthe dentin form.\\n3. Cementum covers the dentin beyond the border of the enamel,\\noverlapping it slightly at the gingival line and forming the surface of\\nthe root. Its function is to furnish the attachment of the fibers of the\\nperidental membrane, which fastens the tooth to the bone.\\n4. The pulp or soft tissue filling the central cavity in the dentin\\nis the remains of the formative organ which has given rise to the dentin.\\nIts functions are the formation of dentin and a sensory function.\\nIn describing the structure of the teeth and the arrangement of the\\nstructural elements of the tissues directions are described with reference\\nto three planes\\nThe mesio-disto-axial plane, a plane passing through the centre of the\\ncrown from mesial to distal and parallel with the long axis of the tooth.\\nThe bucco-linguo-axial plane, a plane passing through the centre of\\nthe crown from buccal to lingual and parallel with the long axis of the\\ntooth.\\nThe horizontal plane, at right angles to the axial planes.\\nThe Supporting Tissues. The human teeth are supported on the\\nmaxillary bones, their alveolar processes growing up around the roots of\\nthe teeth, so that the roots fit into the holes in the bone. The calcified\\nstructures of the tooth and the bone are not, however, united, but the\\nroots are surrounded by a fibrous membrane, the peridental membrane,\\nor pericementum, which fastens the tooth to the bone.\\nEnamel.\\nThe enamel differs from all other calcified tissues in the nature of\\nthe structural elements of which this tissue is made up, in the degree\\nof calcification, and in origin, being the only calcified tissue derived\\nfrom the epiblast.\\nThe enamel is formed from an epithelial organ derived from the\\nepithelium of the mouth cavity and indirectly from the epiblastic germ\\nlayer, while all other calcified tissues are products of the mesoblast.\\nIn the case of bone and dentin the formative tissue is persistent. It", "height": "4608", "width": "2728", "jp2-path": "americantextboo00kirk_0104.jp2"}, "105": {"fulltext": "97\\nGround section of a canine E, enamel Cm, cementum D, dentin Pc, pulp chamber De, dento-\\nenamel junction Ed, enamel defect G, junction of enamel and cementum at the gingival line\\nGt, granular layer of Tomes. (Reduced from photomicrograph made in three sections.)", "height": "4556", "width": "2680", "jp2-path": "americantextboo00kirk_0105.jp2"}, "106": {"fulltext": "98 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nis possible in the bone at least, therefore, to have degenerative and re-\\ngenerative changes, or the removal of part of the calcium salts and their\\nreplacement through the agency of the formative tissue while in the\\nenamel no such regenerative change is possible, as the formative tissue\\ndisappeared when the tissue was completed and before the eruption of\\nthe tooth.\\nThe enamel is the hardest of human tissues. Chemically it is com-\\nposed of the phosphates and carbonates of calcium and magnesium and\\na very small amount of the fluorids, water, also a very small amount\\nof organic matter if any. 1 The enamel in the natural condition, bathed\\nin the fluids of the mouth, contains a considerable amount of water.\\nIf dried at a little above the boiling-point of Avater, it gives up part\\nof it and shrinks considerably, so as to crack in fine checks. If heated\\nalmost to redness, it suddenly gives off from 3 to 5 per cent, (of the\\ndry weight) of water with almost explosive violence. These facts were\\ndemonstrated some years ago by Charles Tomes, 2 and account for most\\nof what was formerly recorded as organic matter in old analyses.\\nIf we observe under the microscope the action of acids upon thin\\nsections of enamel, when the inorganic salts are entirely removed, the\\nstructure of the tissue vanishes, there being no trace of organic matrix\\nleft as in the case of bone or dentin. In the growth of bone and\\ndentin the formative tissue produces first an organic matrix (see Chap.\\nII., p. 74) in the form of the tissue, and into this the inorganic salts are\\ndeposited, combining with the organic substances of the matrix. This\\nunion is comparatively weak, however, for by the action of acids the\\ncombination is broken up and the inorganic salts are dissolved or by\\nheat the organic matter is removed, and in either case the form of the\\ntissue will be maintained.\\nIn the case of the enamel, the formative organ produces organic\\nsubstances containing inorganic salts, and the substances are arranged\\nin the form of the tissue after the manner of a matrix but finally\\nunder the action of the formative organ all of the organic matter is\\nremoved and substituted by inorganic salts, whatever organic matter is\\n1 Von Bibra gives the following analysis of enamel\\nCalcium phosphate and fluorid 89.82\\nCalcium carbonate 4.37\\nMagnesium phosphate 1-34\\nOther salts 88\\nCartilage 3.39\\nFat 20\\nTotal organic 3.59\\ninorganic 96.41\\nJournal of Physiology, 1896.", "height": "4580", "width": "2736", "jp2-path": "americantextboo00kirk_0106.jp2"}, "107": {"fulltext": "ENAMEL.\\n99\\nfound in the fully formed tissue being the result of imperfect execution\\nof the plan.\\nThe enamel is composed of two structural elements, the enamel rods,\\nor prisms, sometimes called enamel fibers, and the interprismatic or\\ncementing substance, both of which are calcified. It is to the arrange-\\nment of these structural elements that the characteristics of the tissue\\nwith which we are most concerned in operative procedures are due.\\nWhile both the prisms and interprismatic substance of the enamel\\nare calcified, or, better, composed of inorganic salts, the two substances\\nthat is, the substance of the rods and the substance between the rods\\nshow markedly different properties both chemical and physical. If\\ntreated with acid, the interprismatic substance is acted upon more\\nrapidly than the rods, so that the latter become more conspicuous. By\\nthis means sections of the enamel may be etched to render it easier to\\nstudy the direction and arrangement of the rods. If the action of the\\nacid is carried far enough, the rods will fall apart before they are thern-\\nEnamel rods isolated by caries. (About 465 X.)\\nselves entirely dissolved. Fig. 79 is from the debris in a carious cavity,\\nand shows rods isolated by the action of the acids of caries.\\nThe interprismatic substance is not as strong as the rods, so that in\\nsplitting or breaking the enamel the tissue separates on the lines of the\\ncementing substance, occasionally breaking across a few rods but fol-\\nlowing their general direction, the lines running between rods, not at\\ntheir centres.\\nIn cleaving the enamel the chisel does not enter the tissue sepa-\\nrating rod from rod, but the edge engages with the surface, and the", "height": "4548", "width": "2672", "jp2-path": "americantextboo00kirk_0107.jp2"}, "108": {"fulltext": "100 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nforce applied at an acute angle with the direction of the rods fractures\\nthe tissue in the lines of least resistance. If the edge be keenly\\nsharp, it will enter the tissue slightly, and then the bevel acts as a\\nwedge in addition to the force applied to the shaft of the instrument\\nbut if the edge be dull, it will rest across the ends of many rods, will\\nnot engage with the surface, and the force applied will break and\\ncrumble the tissue but will not cleave it.\\nThe enamel rods, or prisms, are long, slender prismatic rods or\\nfibers, five- or six-sided, pointed at both ends and alternately expanded\\nand constricted throughout their length. They are from 3.4 to 4.5\\nmicrons 1 in diameter, some of them apparently reaching the entire\\ndistance from the surface of the dentin to the surface of the enamel\\nbut as the diameter of the rods is the same at their outer and inner\\nends, and as the crown surface is much greater than the surface of den-\\ntin covered by enamel, there are many rods which do not extend\\nthrough the entire thickness. These short rods end in tapering points\\nbetween the converging rods which extend the entire distance. To\\nexpress this in terms of development as the formation of enamel\\nbegins at the surface of the dentin, the increasing area of crown sur-\\nface requires more ameloblasts, and as new ameloblasts take their place\\nin the layer the formation of new enamel rods begins between the rods\\nwhich were previously forming. These short rods are most numerous\\nover the marginal ridges and at the points of the cusps, and will be\\nconsidered more fully in connection with those positions.\\nIn ground sections cut at right angles to the direction of the rods 2\\nthe tissue has the appearance of a mosaic floor, the outline of the rods\\nbeing more distinct if they have been marked out by treating the section\\nslightly with acid (Fig. 80). In longitudinal sections (Fig, 81) the sides\\nof the rods are not smooth and even like the sides of a lead pencil, but\\nare alternately expanded and constricted. They are well illustrated by\\ntaking balls of soft clay and sticking them together one above another\\nto form a rod, then putting a number of rods together so that by\\nmutual pressure they take hexagonal forms. This illustrates also the\\nmanner of growth of the tissue in formation. The expansions and\\nconstrictions can be seen in rods that have been scraped from a cleaved\\nsurface of enamel, but better by isolating rods by the slight action of\\ndilute acid (Fig. 82).\\nIn the construction of the tissue the rods are so arranged that the ex-\\n1 A micron is the unit of microscopic measurement, and is equal to one one-thousandth\\nof a millimeter.\\n2 In describing the direction of enamel rods they are always considered as extending\\nfrom the dentin to the surface, and the angle is formed at the surface of the dentin with\\nthe locating plane, either horizontal or axial.", "height": "4608", "width": "2704", "jp2-path": "americantextboo00kirk_0108.jp2"}, "109": {"fulltext": "ENAMEL.\\n101\\npansions of one rod come opposite to the expansions in the adjoining\\nrods, and do not interlock with their constrictions. This arrangement\\nFig, 80.\\nTransverse section of enamel rods. (About 80 X-)\\nleaves alternately a greater and a less amount of cementing substance\\nbetween them.\\nFig. 81.\\nVt\\nEnamel rods in thin etched sectic\\nWhen observed under the microscope, the enamel rods show a char-\\nacteristic appearance of light and dark lines running across them.\\nThese markings are similar to the striations of voluntary muscle fibers,", "height": "4544", "width": "2672", "jp2-path": "americantextboo00kirk_0109.jp2"}, "110": {"fulltext": "102\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nand are described as the striation of the enamel. It is seen not only in\\nisolated rods (Fig. 79), but also in sections ground in their direction (Fig.\\nFig. 82.\\nx3l\\nEnamel rods isolated by scraping. (About 800 X\\n83). This appearance of striation in the enamel is caused by the alter-\\nnate expansions and constrictions of the rods refracting the light like a\\nFig. 83.\\nEnamel showing striation. (About 1000 X.)\\nlens. In sections the expansions in adjoining rods are opposite to each\\nother, the diiference in the refracting power of the prismatic and inter-\\nprismatic substances producing the same effect.", "height": "4580", "width": "2844", "jp2-path": "americantextboo00kirk_0110.jp2"}, "111": {"fulltext": "ENAMEL. 103\\nThe appearance of striation is the record in the fully formed tissue\\nof the manner of growth, each dark stripe, or expansion, in a rod\\nrepresenting a globule of partially calcified material. The ameloblasts\\nbuild up the rods by the addition of globule after globule, surrounding\\nthem with a cementing substance and completing the calcification of\\nboth. In this sense the striation of the enamel may be said to record\\nthe growth of the individual rods.\\nWhile the enamel is a very hard substance when its structure is\\ncomplete and perfect, its most striking physical characteristic is a ten-\\ndency to split or crack in the direction of its structural elements when\\na break has been made in the tissue. While it is difficult to cut across\\nthe rods or make an opening on a perfect surface, if a break has been\\nFig. 84.\\nEnamel showing direction of cleavage. (About 70 X.)\\nestablished it is comparatively easy to split off the tissue from the sides\\nof the opening when the rods lie parallel with each other. Fig. 84\\nshows a field of enamel illustrating the w r ay in which the tissue splits\\nor cleaves in the direction of the rods.\\nUpon the axial surfaces the enamel rods are usually straight and\\nparallel with each other, except where there has been some flaw or\\ndisturbance in development but upon the occlusal surface, although\\nsometimes straight, they are very often much twisted and wound\\nround each other, especially at their inner ends. This difference in the\\narrangement of the rods causes the greatest difference in the feeling\\nof the tissue under cutting instruments. Such a specimen of enamel as\\nshown in Fig. 85 can be cut away easily, the tissue breaking through\\nto the dentin and splitting off in chunks while a specimen like Figs.\\n86 and 87 will not cleave if supported upon sound dentin. If the outer", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0111.jp2"}, "112": {"fulltext": "104 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 85.\\nStraight enamel rods. (About 80 X.)\\nFig. 86.\\nGnarled enamel. (About 8(", "height": "4580", "width": "2820", "jp2-path": "americantextboo00kirk_0112.jp2"}, "113": {"fulltext": "ENAMEL.\\n105\\nends of the rods are straight, they will split part way to the dentin (Fig.\\n87) but where they begin to twist round each other they will break\\nacross the rods. If the dentin is removed from under such enamel, it\\nwill break in an irregular way through the gnarled portion.\\nFrom a study of the arrangement of the enamel rods in the forma-\\ntion of the crown it is apparent that the plan is such as to give the\\nFig. 87.\\nGnarled enamel. (About 50 X.)\\ngreatest strength to the perfect structure, and may be likened to an arch.\\nAt the gingival border the rods are short and are inclined apically 6 to 10\\ncentigrades 1 (20\u00c2\u00b0 to 35\u00c2\u00b0) from the horizontal plane. These short rods\\n1 In the Centigrade division the circle\\nis divided into one hundred parts, each\\ncalled a centigrade. One centigrade is\\nequal to 3.6 degrees of the astronomical\\ncircle, 25 centigrades to 90 degrees, 12J\\ncentigrades to 45 degrees. The cut gives\\na comparison of the two systems of meas-\\nuring angles.\\n270\\n180\\nCentigrade division.", "height": "4560", "width": "2732", "jp2-path": "americantextboo00kirk_0113.jp2"}, "114": {"fulltext": "106\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nare overlapped for a short distance by the cementum. This inclination\\ngrows less and less, and at some place in the gingival half of the middle\\nthird of the surface they are in the horizontal plane. At this point they\\nare also usually perpendicular to the surface of the enamel. Passing\\nfrom this point they become inclined more and more occlusally from the\\nhorizontal plane, at the junction of the occlusal and middle thirds about 8\\nto 12 centigrades (28\u00c2\u00b0 to 40\u00c2\u00b0) in bicuspids and molars, and 8 to 18\\ncentigrades (28\u00c2\u00b0 to 65\u00c2\u00b0) in incisors and canines. In the occlusal third\\nthe inclination increases rapidly, and often the outer ends of the rods\\nFig. 88.\\nDiagram of enamel rod directions, from a photograph of a bucco-lingual section of a superior\\nbicuspid.\\nare inclined more than the inner ends. Over the point of the cusps\\nand the crest of the marginal ridges the rods reach the axial plane,\\nthough they are often very much twisted about each other in the inner\\nhalf of their length. This position does not always correspond with the\\nhighest point of the cusp, but is inclined slightly axially from that posi-\\ntion, and corresponds with the highest point of the dentin cusp.\\nPassing down the central slope of the cusp, or ridge, the rods\\nbecome again inclined away from the axial plane toward the groove, or\\npit, leaning toward each other where the two plates meet. The degree of\\ninclination of the rods on the central slope of the cusps depends upon the", "height": "4612", "width": "2820", "jp2-path": "americantextboo00kirk_0114.jp2"}, "115": {"fulltext": "ENAMEL.\\n107\\nheight of the cusps the higher the cusp the greater the inclination from\\nthe axial plane. Fig. 88, a diagram from a photograph of a bucco-\\nlingual section of a superior bicuspid, shows the plan of arrangement\\nand illustrates the arch principle in the construction.\\nFig. 89.\\nStratification of enamel the cusp of a bicuspid: Be, dento-enamel junction; Ed, enamel defect\\nshowing in the heavy stratification band; Ig, interglobular spaces in the dentin. (About\\n40X0\\nIn the study of longitudinal sections of the teeth, one of the most\\nconspicuous structural features is the stratification bands, or brown\\nbands of Retzius. These bands are not parallel with either the outer\\nsurface of the enamel or the dento-enamel junction. They begin at the\\ntip of the dentin cusps and sweep around in larger and larger zones.\\nThese stratification bands are better seen in comparatively thick sec-\\ntions, and are caused by the varying amount of pigment deposited with", "height": "4548", "width": "2788", "jp2-path": "americantextboo00kirk_0115.jp2"}, "116": {"fulltext": "108\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nthe calcium salts in the development of the tissue. They record the\\ngrowth of enamel of the crown as a whole, as each line was at one time\\nthe surface of the enamel cap. These stratifications, or, better, incre-\\nmental lines, are shown in Figs. 89-91.\\nAt the time the rod at A (Fig. 90) was completely formed the rod at\\nB was just beginning to form at its dentinal end. From this it would\\nFig. 90.\\nIncisor tip showing stratification or incremental lines. Rods at A were fully formed at the time\\nthe rods at B were beginning to form. (About 50 X.)\\nseem that any structural defect due to imperfect development would not\\nfollow the direction of the enamel rods from the surface to the dentin,\\nbut would follow the stratification lines and if these structural defects\\ninfluenced the penetration of caries, we should expect to have the direc-\\ntion of penetration modified. Fig. 89 shows a structural defect in the\\nenamel over a cusp following the stratification band, and it will be\\nnoticed also that there is a structural defect in the dentin at a corre-\\nsponding position.", "height": "4608", "width": "2808", "jp2-path": "americantextboo00kirk_0116.jp2"}, "117": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS.\\n109\\nHISTOLOGICAL REQUIREMENTS FOR STRENGTH IN ENAMEL\\nWALLS.\\n1. The enamel must be supported upon sound dentin.\\n2. The rods which form the cavo-surface angle must run uninter-\\nruptedly to the dentin and be supported by short rods, with their inner\\nends resting on the dentin and their outer ends abutting upon the cavity\\nwall, where they will be covered in by the filling material.\\n3. That the cavo-surface angle be cut in such a way as not to expose\\nthe ends of the rods to fracture in condensing the filling material against\\nthem.\\nThe first step, then, in the preparation of an enamel wall is to deter-\\nmine the direction of the enamel rods by cleavage with a chisel or hatchet.\\nFig. 91.\\nEnamel showing both striation and stratification\\nIn Figs. 92 and 93, No. 1 shows an enamel wall after cleaving the enamel\\nwith a hatchet. It will be noticed that the split has not followed the\\ndirection of the rods exactly, but has broken across them, slivering the\\nrods as wood slivers in splitting. This would cause in the cut surface\\na whitish, opaque appearance. The plane of the enamel wall should be\\nextended so as to form a small angle with the plane of the dentin wall,\\nby shaving the surface with a very sharp hand instrument. No. 2 shows\\nthe same wall after it has been extended somewhat but it will be seen\\nthat it has not been extended enough, for the rods forming the sur-\\nface at A do not reach the dentin, but run out at B on the cavity wall,\\nand that piece would chip out in packing against it or if force came upon\\nthe surface afterward. The angle should be extended so as to produce-", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0117.jp2"}, "118": {"fulltext": "110\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY", "height": "4616", "width": "2808", "jp2-path": "americantextboo00kirk_0118.jp2"}, "119": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS. Ill\\nb b\\nPreparation of enamel wall in gnarled enamel: 1. Enamel wallas cleaved, showing breaking\\nacross rods and slivering at a. 2. Wall as smoothed but not extended to remove short rods\\nwhose inner ends are cut off at b. 3. Wall extended and trimmed to a position of strength.\\nD, dentin De, dento-enamel junction c, cavo-surface angle b, point where inner ends of\\nrods are cut off; a, slivering of the tissue. (About 80 X.)", "height": "4564", "width": "2760", "jp2-path": "americantextboo00kirk_0119.jp2"}, "120": {"fulltext": "112\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nthe plane shown in No. 3 then the cavo-surface angle may or may not\\nbe bevelled as the position demands.\\nIn some positions, as on the axial surfaces, it is not possible to ex-\\ntend the plane of the entire enamel wall as described all that can be\\ndone is to shave the cut surface, leaving the wall in the direction of the\\nenamel rods, and then the margin is strengthened by bevelling the cavo-\\nFig. 94.\\nOcclusal fissure in a superior bicuspid, showing direction of rods. (About 80 X.)\\nsurface angle, so that the rods forming the margin are supported by at\\nleast a few rods which are covered by filling material.\\nIn cutting: out the fissures on the occlusal surfaces of molars and\\nbicuspids, the rods are inclined centrally from the axial plane, as seen\\nin Fig. 94. In opening a fissure the lines of cleavage will not be in\\nthe axial plane, but sloping inward toward the body of the cusp, in the", "height": "4616", "width": "2820", "jp2-path": "americantextboo00kirk_0120.jp2"}, "121": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS. 113\\ndirection indicated by the direction of the cracks in Fig. 94. The outer\\nends of the enamel rods must be shaved away, to bring the plane of\\nthe enamel wall parallel with the dentin wall or into the axial plane.\\nWhen this has been done a strong margin has been formed, for the\\nFig. 95.\\n?s:\\nr\\nv.\\n\u00e2\u0096\u00a0\\\\i\\nJ\\nX\\ny\\nt\\nPreparation of enamel Avails in occlusal fissure cavities (the same as Fig. 94).\\nrods which form the point of the cavo-surface angle are supported by\\nthe piece A, B, C (Fig. 95), made up of rods resting upon sound dentin\\nand covered by the filling material. Often the angle will be too sharp,\\nhowever, and the cavo-surface angle should usually be bevelled to pro-\\ntect the margin from accident. This illustration may be taken as typ-\\nical of occlusal cavities.\\n8", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0121.jp2"}, "122": {"fulltext": "114 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 96.\\nPreparation of enamel walls in a buccal cavity in a molar G, gingival wall 0, occlusal wall.\\n(About 70 X.)", "height": "4616", "width": "2888", "jp2-path": "americantextboo00kirk_0122.jp2"}, "123": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS.\\n115\\nFig. 96 shows a cavity prepared in the buccal surface of an upper\\nmolar. The occlusal margin is placed in the occlusal half of the middle\\nthird, and the gingival margin in the gingival half of the gingival third\\nFig. 97.\\n2. Wall as trimmed.\\nPreparation of occlusal wall of Fig. 96. (About 70 X.)\\nof the surface. In the occlusal wall the rods are inclined occlusally\\nabout 8 centigrades (28\u00c2\u00b0) from the horizontal plane. After cleaving,\\nthe broken and slivered rods should be shaved away, but the angle can-", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0123.jp2"}, "124": {"fulltext": "116\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nnot be increased without making the margin of filling material too thin\\nthe rods forming the margin should therefore be protected by bevel-\\nling the cavo-surface angle. At the gingival wall the rods are inclined\\napically from the horizontal plane about 6 centigrades (20\u00c2\u00b0). The\\nwall should be shaved in that plane, increasing the angle a little, and\\nthe cavo-surface angle should be bevelled. Fig. 97 shows the occlusal\\nenamel wall alone, after cleaving and trimming into form. Such\\nenamel walls may be taken as typical of axial surface cavities, the\\nFig. 98.\\nStructure of enamel about a fissure B, buccal side L, lingual side. (About 70 X.)\\nangle of the enamel with the dentin wall being determined by the\\ndirection of the enamel rods in the position where the margin is laid.\\nGrooves, fissures, and pits are always positions of weakness, and\\nwhen a cavity approaches a groove or pit a good margin, histologically,\\ncannot be prepared without cutting beyond it. Fig. 98 shows an\\nocclusal fissure in a bicuspid, which illustrates the conditions of struct-\\nure characteristic of these positions. The rods are inclined toward\\nthe fissure, and between the bottom of the fissure and the dentin are\\nvery irregular. If a cavity wall were made to approach this fissure from\\nthe lingual side, so as to come to the dotted line, the wall would have\\nto be inclined 6 to 8 centigrades (20\u00c2\u00b0 to 28\u00c2\u00b0) from the axial plane toward", "height": "4608", "width": "2916", "jp2-path": "americantextboo00kirk_0124.jp2"}, "125": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS. 117\\nthe fissure, and then the cavo-surface angle bevelled, when the condi-\\ntions would be similar to those in the wall of an axial surface cavity,\\nand not as strong as the location requires. Not only is this true, but\\nit also leaves a vulnerable point next to the margin of the filling a\\npoint of liability. Cutting just beyond the fissure, the wall may be\\nleft in the axial plane and have an ideally strong margin, and the\\npoint of liability is removed. To state the conditions in general\\nFig. 99.\\nTBucco-lingual section of upper bicuspid. Enamel is broken from grinding: A to B, area of weak-\\nness for enamel margins. (About 20 X.)\\nterms, a strong margin is more easily obtained where enamel rods are\\ninclined toward the cavity than where they are inclined away from the\\ncavity.\\nThe points of cusps and the crests of marginal ridges are positions of\\nstrength in the perfect tissue but when a cavity margin approaches\\nthem they become points of weakness, because it is impossible to sup-\\nport properly the rods Avhich form the margin. Over the marginal", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0125.jp2"}, "126": {"fulltext": "118\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nridges are many short rods which do not reach the dentin, and these\\nare usually very much twisted about each other, so as to form the\\nstrongest possible keystone in the perfect structure. In preparing a\\nFig. 100.\\nEnamel over tip of dentin cusp D, dentin cusp. (About 80 X.)\\nmargin in such a position it is impossible to have the rods which\\nform the margin reach the dentin with their inner ends, and these\\nshort rods are sure either to break in completing the operation or to", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0126.jp2"}, "127": {"fulltext": "HISTOLOGICAL REQUIREMENTS IN ENAMEL WALLS.\\n119\\nbreak out later. The arrangement of enamel rods in such positions is\\nto be borne in mind, especially when extending approximal cavities in\\nincisors toward the lingual side and in large pit cavities in incisors. A\\nsimilar condition is found over the points of the cusps. Fig. 99 shows\\na bucco-lingual section of an upper bicuspid. It will be noticed that\\nthe rods forming the point of the cusp are not in the axial plane, and\\nFig.\\n101.\\nto J\\n9.\\nf-J f\\n.j y\\n4\\nH\\ns\\n\\\\WM\\n\u00c2\u00a3t.\\n7\\nWl\\n3\\nHBb7*\\n3^\\nTip of an incisor. (About CO X.)\\ndo not reach the tip of the dentin cusp, but reach the dentin a little\\nway down on the outer slope. The enamel covering the tip of the\\ndentin contains many short rods, and they are very much twisted about\\neach other, so that the area from A and B to the point of the cusp is an\\narea of weakness for the cavity margins. If the margin reaches this\\narea, the cusp must be cut away and the enamel Avail carried out in the\\nhorizontal plane. Fig. 100 shows this area more highly magnified, and", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0127.jp2"}, "128": {"fulltext": "120\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nillustrates the structure. It will be noticed that, in grinding, some of\\nthe short twisted rods have broken out of the section.\\nFig. 101 shows the tip of an incisor in labio-lingual section, and is of\\ninterest in relation to the formation of margins in step cavities in in-\\ncisors. The tip of this tooth has been Avorn off in use. The illustration\\nshows that the great inclination of the rods toward the axial plane in\\nthe occlusal third of the incisors is such as to bring the wear almost at\\nright angles to the direction of the rods.\\nDentin.\\nThe structure of dentin is of comparatively little interest in the\\npresent consideration, as its histological forms do not directly influence\\nFig. 102.\\nL\\nDentin at dento-enamel junction, showing tubules cut longitudinally Dt, dentinal tubules D,\\ndentin matrix. (About 760 X\\nthe cutting of the tissue in the excavation of cavities. Its histological\\nforms have, however, much to do with the penetration of caries and\\nwith other considerations which are of importance to the intelligent\\npractice of operative dentistry.", "height": "4612", "width": "2888", "jp2-path": "americantextboo00kirk_0128.jp2"}, "129": {"fulltext": "DENTIN.\\n121\\nDentin belongs to the connective-tissue group, and is made up of\\na solid organic matrix impregnated with about 72 per cent, of inorganic\\nsalts 1 and pierced by minute canals or tubules, which radiate from a\\ncentral cavity which contains the remains of the formative organ, or\\npulp. The minute canals, or dentinal tubules, are occupied in life\\nby protoplasmic processes from the odontoblastic cells which form the\\nouter layer of the pulp. Dentin contains two kinds of organic matter,\\nthe contents of the tubules and the organic basis of the matrix. The\\ndentin matrix, after the removal of the calcium salts by acids, yields\\ngelatin on boiling and resembles the matrix of bone, reacting in a similar,\\nthough not identical, way with staining agents. The portion of the\\nmatrix immediately surrounding the tubules shows different chemical\\nFig. 103.\\nDentin showing tubules in cross-section Dt, dentinal tubules D, dentin matrix S, shadow of\\nsheaths of Neumann. (About 1150 X.)\\ncharacteristics from the rest of the matrix, resembling elastin, and re-\\nsisting the action of strong acids and alkalies after the rest of the\\ntissue has been destroyed. This portion of the matrix surrounding the\\ntubules and lying next to the fibrils is known as the sheaths of Neumann.\\nThe dentinal tubules are from 1.1 to 2.5 microns in diameter, and\\nare separated from each other by a thickness of about 10 microns of\\n1 Von Bibra gives the following analysis of dentin\\nOrganic matter 27.61\\nFat 40\\nCalcium phosphate and fiuorid 66.72\\nCalcium carbonate 3.36\\nMagnesium phosphate 1.08\\nOther salts 83", "height": "4552", "width": "2732", "jp2-path": "americantextboo00kirk_0129.jp2"}, "130": {"fulltext": "122\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\ndentin matrix. This is fairly uniform throughout the dentin. The\\ncharacter of the tubules is different in the crown and root portions.\\nIn the crown the tubules branch but little through most of their\\ncourse but in the outer part, close to the enamel, they branch and\\nanastomose with each other quite freely. Fig. 102 shows a field of\\ndentin just beneath the enamel, as seen with a high power, and shows\\nthe diameter of the tubules, their branching, and the amount of matrix\\nbetween one tubule and the next. The relation of one tubule to each\\nother is shown also in sections cut at right angles to their direction\\n(Fig. 103). In the crown portion the tubules pass from the pulp chamber\\nFig. 104.\\nA -x\\nB\\nV\\n1\\n~^**2j\\np^j\\nCrown of a molar, mesio-distal section, showing penetration of caries A, caries penetrating den-\\ntin B, line of abrasion P, pulp chamber. (About 20 x.)\\nto the dento-enamel junction in sweeping curves, so as to enter the pulp\\nchamber at right angles to the surface, and end next to the enamel at\\nright angles to that surface. This produces S- or F-shaped\\ncurves, which are known as the primary curves of the tubules. Through-\\nout their course the tubules are not straight, but show a great many\\nwavy curves, known as the secondary curves. These appear as waves\\nwhen seen in longitudinal sections, but are really the effect of an open\\nspiral direction, as is seen by changing the focus of the microscope in\\nstudying sections cut at right angles to the direction of the tubules.", "height": "4612", "width": "2888", "jp2-path": "americantextboo00kirk_0130.jp2"}, "131": {"fulltext": "DENTIN.\\nFig. 105.\\n123\\nDentin from the root, showing tubules cut longitudinally. (About 700 X.)\\nFig. 106\\nDento-enamel junction. (About 70 X", "height": "4560", "width": "2732", "jp2-path": "americantextboo00kirk_0131.jp2"}, "132": {"fulltext": "124\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nThe branches throughout their length are few and small, and are given\\noff at an acute angle to the direction of the tubule but just before the\\nenamel is reached the tubules fork and branch, producing an appearance\\nsimilar to the delta of a river. These branches are given off from the\\ntubules for some little distance back from the enamel, and they anasto-\\nmose with other tubules very freely. The branching of the tubules in\\ntheir outer portion causes the spreading of caries just beneath the\\nenamel, the micro-organisms growing through the branches from tube\\nFig. 107.\\nInterglobular spaces in dentin Ig, first line of interglobular spaces Ig second line of inter-\\nglobular spaces. (About 30 X.)\\nto tube, and so spreading sideways beneath the enamel plates, and then\\npenetrating the dentin in the direction of the tubules. Fig. 104 shows\\nthe penetration of caries in the dentin. It will be noticed that in decay\\nstarting at the contact point there has been more spreading under the\\nenamel than in that starting at the gingival line, but in both positions\\nthe penetration has followed the direction of the tubules.\\nIn the root portion the tubules pass out from the pulp canals at right\\nangles to the long axis of the tooth and pass directly out to the cemen-\\ntum, showing only the secondary curves. Throughout their course they", "height": "4612", "width": "2912", "jp2-path": "americantextboo00kirk_0132.jp2"}, "133": {"fulltext": "DENTIN.\\n125\\ngive off a great many fine branches passing through the matrix in all\\ndirections from tubule to tubule. These branches are so numerous that\\nin sections which have been mounted in such a way as to leave air in\\nthem, or if the tubules have been filled with coloring-matter, they give\\nthe impression of looking through a hazel bush or they may be likened\\nto the fine rootlets of a plant. These fine branches are shown in\\nFig. 105, and the character of the dentin in the root portion is to be\\ncompared with that in the crown portion as shown in Fig. 102. The\\nFig. 108.\\nGranular layer of Tomes L, lacunae of cementum Gt, granular layer of Tomes; Ig, interglobular\\nspaces. (About 200 X.)\\noutermost layer of the dentin next to the cementum contains many\\nsmall irregular spaces, which connect with the dentinal tubules and give\\nto the tissue when seen with low powers a granular appearance. This\\nlayer was first described by John Tomes as the granular layer, and has\\nsince been usually called the granular layer of Tomes. The spaces of\\nthe granular layer are probably filled by the enlarged ends of the den-\\ntinal fibrils. The same appearance is sometimes seen beneath the enamel,\\nbut is never as well marked as next to the cementum.\\nThe dentin at the dento-enamel junction seldom presents a smooth\\nsurface, but the inner surface of the enamel plate shows rounded pro-", "height": "4548", "width": "2728", "jp2-path": "americantextboo00kirk_0133.jp2"}, "134": {"fulltext": "126\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\njections, between which the dentin extends. In sections this gives to\\nthe dento-enamel junction a scalloped appearance, as shown in Fig. 106;\\nand often the deceptive appearance of the dentinal tubules penetrating\\nfor a short distance between the enamel rods.\\nIn many specimens made by grinding dried teeth large irregular\\nspaces are very conspicuous in the dentin. They usually occur in lines\\nor zones at about uniform depth from the surface. These have been\\ncalled the interglobular spaces. They are really not spaces at all, but\\nare areas of imperfect development in which the dentin matrix has not\\nFig. 109.\\nSecondary dentin A, margin of primary dentin, showing a few of the tubules continuing into the\\nsecondary dentin P, pulp chamber. (About 80 X.)\\nbeen calcified. The dentinal tubules pass through them without inter-\\nruption. In a dried specimen the organic matrix shrinks, and the\\nresulting space becomes filled with the debris of grinding, so as to give\\nthe appearance of black spaces. Fig. 107 shows two quite distinct layers\\nof interglobular spaces, the second much more marked than the first\\nand in the enamel at a position corresponding to the first is seen an im-\\nperfection of structure marked by the very dark stratification band.\\nThis is shown best in the region of the cusp (Fig. 89) from the same\\nsection. Interglobular spaces in the root portion of the dentin are\\nshown in Fig. 108, close to the granular layer of Tomes.", "height": "4604", "width": "2768", "jp2-path": "americantextboo00kirk_0134.jp2"}, "135": {"fulltext": "PULP. 127\\nThe formation of dentin is not complete at the time of eruption of\\nthe tooth, but continues for an indefinite period, thickening the layer of\\ndentin at the expense of the pulp. When the typical amount of den-\\ntin has been formed the growth ceases, and does not begin again unless\\nexcited by some irritation to the pulp or the pulp of some other tooth\\nof the same side, which leads to the formation of secondary dentin.\\nSecondary dentin is never as perfect in structure as primary dentin\\nthe tubules are smaller, fewer, and much more irregular. Often in\\nground sections several periods of formation can be determined by dif-\\nferences of structure, each deposit becoming successively more and more\\nimperfect in structure. This is shown in Fig. 109.\\nPulp.\\nThe dental pulp is the soft tissue occupying the central cavity of the\\ndentin. It is made up of embryonal connective tissue and contains a\\nlarge number of bloodvessels and nerves. Like all connective tissues,\\nthe intercellular substance is large in amount and the cells are widely\\nscattered in this soft, jelly-like tissue, which contains but few fibers.\\nWe recognize four kinds of cells in the pulp the odontoblasts, form-\\ning the outer surface of the pulp next to the dentin; and round, spindle-\\nshaped, and stellate connective-tissue cells.\\nARRANGEMENT OF CELLS.\\nThe odontoblasts are tall columnar cells, sometimes club-shaped, and\\nin older tissues, which have ceased to be functional, sometimes becoming\\nalmost spherical. They form a continuous layer over the entire surface\\nof the pulp, being everywhere in contact with the dentin. The layer\\nhas been called the membrana eboris, or the membrane of the ivory/\\nThe nuclei of the odontoblasts are large and oval, containing a large\\namount of chromatin, and are very different from the nuclei of ordinary\\nconnective-tissue cells.\\nThree kinds of processes have been described in connection with the\\nodontoblasts\\n1. The dentinal fibril processes, or fibers of Tomes. These are long,\\nslender protoplasmic processes projecting from the dentin end of the\\ncell into a dentinal tubule, and running through the tubule to the outer\\nsurface of the dentin. Usually there is but one fibril extending from\\neach odontoblast, but sometimes two can be seen, extending into two\\ntubules. These fibrils can be demonstrated in decalcified sections or\\nby removing the pulp from a recently extracted tooth by cracking the\\ntooth, and carefully lifting the pulp out of the pulp chamber, and then\\neither teasing or sectioning. Fig. 110 shows the fibrils projecting from", "height": "4560", "width": "2724", "jp2-path": "americantextboo00kirk_0135.jp2"}, "136": {"fulltext": "128 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nthe surface but in this section the cut was not in the direction of the\\nlong axis of the odontoblasts, but obliquely through them. Fig. Ill\\n(from a photograph by Rose) shows the form of the odontoblasts in a\\nFig. 110.\\nOdontoblasts. The section cuts obliquely through the odontoblasts F, fibrils N, nuclei\\nof odontoblasts N nuclei of connective-tissue cells W, layer of Weil, not well shown.\\n(About 80 X.)\\nyoung tooth in which formation of dentin is actively progressing, with\\nthe fibrils in the dentinal tubules.\\n2. Lateral processes projecting from the sides of the cells and unit-\\ning one with another in the formation of the layer.\\n3. Pulpal processes, projecting from the pulpal ends of the odonto-\\nblasts into the layer of Weil.\\nThe odontoblasts, as the name indicates, are the dentin-forming\\ncells. They superintend the formation and calcification of the dentin\\nmatrix, the fibril being left behind surrounded by the formed tissue.\\nWhether the fibrils have any share in the formation and calcification of\\nthe dentin matrix has been a matter of controversy.\\nThe relation of the fibrils to the transmission of sensation is also a\\nmatter of dispute but at present the weight of evidence is that they\\nin some way transmit impressions to the sensory nerves of the pulp.\\nJust beneath the layer of odontoblasts is a zone which contains very\\nfew connective-tissue cells, In thin sections, especially in the body of\\nthe pulp, this appears as a clear layer about half as thick as the layer\\nof odontoblasts. It is known as the layer of Weil. Just beneath the", "height": "4612", "width": "2764", "jp2-path": "americantextboo00kirk_0136.jp2"}, "137": {"fulltext": "PULP.\\n129\\nlayer of Weil the connective-tissue cells are especially numerous and\\nform a more or less distinct layer of closely placed cells. In the rest\\nof the body of the pulp the cells are about uniformly distributed through-\\nout the intercellular substance. These connective-tissue cells are of the\\ncharacteristic forms, rather small, containing a small but deep-staining\\nnucleus, the protoplasm stretching out into slender projections in two\\ndirections to form the spindle cells, or in more than two directions to\\nform the stellate cells. The stellate forms are more common in the\\nbody of the pulp, the spindle form in the canal portions. The round\\nFig. 111.\\nOdontoblasts and forming dentin: E, forming enamel; D, forming dentin; 0, odontoblasts;\\nDp, body of dental papilla. (From photomicrograph by Rose.)\\ncells are comparatively few in number, and are probably young cells\\nwhich have not yet acquired the adult form.\\nBLOODVESSELS OF THE PULP.\\nThe blood-supply of the pulp is extremely rich, several arterial ves-\\nsels entering in the region of the apex of the root, often through several\\nforamina. These large vessels extend occlusally through the central portion\\nof the tissue, giving off many branches which break up into a very close\\nand fine capillary plexus (Fig. 112). From the capillaries the blood is\\ncollected into the veins, which pass apically through the central portion\\nof the tissue. A very striking peculiarity of the bloodvessels of the pulp\\nis the thinness of their walls. Even the large arteries show scarcely any\\n9", "height": "4564", "width": "2720", "jp2-path": "americantextboo00kirk_0137.jp2"}, "138": {"fulltext": "130 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 112.\\nDiagram of the bloodvessels of the pulp. (Stowell.)\\ncondensation of fibrous tissue around them to form the usual adven-\\ntitious layer, and usually contain but a single involuntary muscle fiber\\nFig. 113.\\nA pulp bloodvessel, showing the thin wall C, blood corpuscles in the vessel Bl, bloodvessel wall\\nshowing nuclei of endothelial cells N, nuclei of connective-tissue cells in the body of the\\npulp I, intercellular substance, showing a few fibers. (About 200 X.)\\nrepresenting the media, while the walls of even the large veins are made\\nup of only the single layer of endothelial cells forming the intima, and", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0138.jp2"}, "139": {"fulltext": "PULP. 131\\nare in structure like large capillaries (Fig. 113). This peculiarity of the\\nbloodvessel walls is of great importance, as it renders the tissue specially\\nliable to such pathologic conditions as hyperemia and inflammation.\\nNERVE OF THE PULP.\\nSeveral comparatively large bundles of medullated nerve fibers, con-\\ntaining from six or eight to fifteen or twenty fibers, enter the pulp\\nin company with the bloodvessels and pass occlusally through the\\ncentral portion of the tissue. These bundles branch and anastomose\\nwith each other very freely. Most of the fibers lose their medullary\\nsheath before reaching the layer of Weil, in which position they form a\\nplexus of non-medullated fibers from these fibers free endings are given\\noff, which penetrate between the odontoblasts. In some cases these\\nhave been followed over on to the dentinal ends of the odontoblasts,\\nbut in no instance have they been followed into the dentinal tubules.\\nTHE FUNCTIONS OF THE PULP.\\nThe pulp performs two functions, a vital and a sensory.\\nThe vital function is the formation of dentin, and is performed\\nby the layer of odontoblasts. This is the principal function of the\\npulp, and it is first manifested in the development of the tooth before\\nthe dentinal papilla is converted into the dental pulp by being inclosed\\nin the formed dentin. After the tooth is fully formed the vital func-\\ntion is not manifested unless the pulp is stimulated by some excitation\\naffecting trophic centres and which causes the formation of secondary\\ndentin. There are some exceptions where the formation is entirely\\nlocal.\\nThe Sensory Function. In regard to sensation, the pulp resembles\\nan internal organ. It has no sense of touch or localization, and re-\\nsponds to stimuli only by sensations of pain. The pain is usually\\nlocalized correctly with reference to the median line, but, aside from\\nthat, is localized only as it is referred to some known lesion. If several\\npulps on the same side of the mouth and in teeth of both the upper\\nand lower arches were exposed so that they could be irritated without\\nimpressions reaching the peridental membrane, and the patient were\\nblindfolded, it would be impossible for him to tell which of the pulps\\nwas touched. The pain originating from a tooth pulp may be referred\\nto the wrong tooth or to almost any point on the same side supplied by\\nthe fifth cranial nerve.\\nThe pulp is especially sensitive to changes of temperature, but is\\nincapable of differentiating between heat and cold this fact is often\\nmade use of in differential diagnoses (see Chapter XYL). The pulp is", "height": "4564", "width": "2716", "jp2-path": "americantextboo00kirk_0139.jp2"}, "140": {"fulltext": "132\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nalso very sensitive to traumatic and chemical irritations, even when\\nthese are conveyed to it through the agency of the dentinal fibrils. Dr.\\nHuber has suggested l that this transmission may be accomplished by\\nthe traumatic or chemical action upon the fibrils setting up metabolic\\nchanges in the odontoblastic cells, which act as stimuli to the sensory\\nnerves ending between the cells of that layer.\\nCementum.\\nThe cementum covers the surface of the dentin apically from the\\nborder of the enamel, lapping slightly over the enamel at the gingival\\nmargin (Fig. 114). It forms a layer, thickest in the apical region and\\nFig. 11\\ni.\\nl~--\\nE\\ni\\n\\\\v- S\\\\\\nJl\\nQ\\nm\\n1 j__\\nf\\n4 V\\nGingival border of enamel, showing the cementum overlapping\\ndentin. (About 40 X.)\\nD.\\nit: E, enamel; C, cementum D,\\nbetween the roots of bicuspids and molars, and becoming thinner as the\\ngingival line is approached. The cementum resembles subperiosteal\\nbone in structure, but differs from it in the character and arrangement\\nof the lacunae and in the absence of Haversian systems the layers, or\\nlamellse, of the cementum also are less uniform in character than those\\nof bone.\\nThe function of the cementum is to furnish attachment for the\\nfibers of the peridental membrane which holds the tooth in its position.\\nThe surrounding tissues are never in physiologic connection with the\\nouter surface of the dentin, except to form cementum over it or to\\nremove its substance by absorption and when absorption of the dentin\\n1 Dental Cosmos, October, 1898.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0140.jp2"}, "141": {"fulltext": "CEMENTUM.\\n133\\nhas occurred on the surface of a root it is never repaired except by the\\nformation of cementum to fill up the cavity and reattach the membrane.\\nThe cementum is intermittently formed during the functioning of\\nthe tooth, being added layer after layer over the entire surface of the\\nroot, the difference in thickness of the tissue in the gingival and apical\\nportions being chiefly, though not entirely, due to the difference in\\nthickness of each layer in the two positions (Figs. 114, 115). The\\ncementum on the roots of newly erupted teeth is thin, and on the roots\\nof teeth of old persons is thick. This continued formation of cementum\\nFig. 115.\\nCementum near the apex of the root Gt, granular layer of Tomes L, lacunae b, point at which\\nfibers Avere cut off and reattached. (About 54 X.)\\nis due to the necessity for change and reattachment of the fibers of the\\nmembrane.\\nIn the gingival portions, where the cementum is thin, the tissue is\\nclear and apparently structureless, and usually contains no lacunae\\nwhile in the apical half and between the roots the lacunae are numerous.\\nIn general, wherever the lamellae are thin, the lacunae are absent; but\\nwhere the lamellae are thick they are found. The canaliculi which\\nradiate from the lacunae are not as regular as in the case of the lacunae\\nof bone. Sometimes they are numerous, sometimes few they may\\nextend from a lacuna in all directions, or they may be confined to one\\nside, usually the side toward the surface of the cementum (Fig. 116).", "height": "4564", "width": "2716", "jp2-path": "americantextboo00kirk_0141.jp2"}, "142": {"fulltext": "134 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 116.\\nH,\\nD.\\nThick lamellae of cementum with many lacunae, filling an absorption in dentin: L, lacunae; H,\\nHowship s lacunae filled; D, dentin. (About 250 X.)\\nFig. 117.\\nTwo fields of cementum showing penetrating fibers Gt, granular layer of Tomes C, cementum\\nnot showing fibers F, penetrating fibers. (About 54 X.)", "height": "4604", "width": "2804", "jp2-path": "americantextboo00kirk_0142.jp2"}, "143": {"fulltext": "PERIDENTAL MEMBRANE. 135\\nThe cementum is penetrated through all its layers by fibers of the\\nperidental membrane which have been imbedded in the matrix of the\\ntissue and calcified along with it. The first layer, that is, the one next\\nto the dentin, is usually structureless and shows no fibers in it, at\\nleast in its inner half. In ground sections the imbedded fibers often\\nappear in a number of layers, while they are not apparent in the rest\\nof the thickness. This is because just before and just after the forma-\\ntion of the layers in which they appear the fibers were cut off and\\nreattached, changing their direction, so that in the other layers the\\nfibers are cut transversely or obliquely. This is illustrated in Fig. 117.\\nThese imbedded fibers are very numerous in some places. If properly\\nstained, the tissue seems almost a solid mass of fibers. In ground sec-\\ntions these have sometimes been mistaken for minute canals from the\\nfact that they are not always as fully calcified as the cementum matrix,\\nand shrinkage causes the appearance of little open canals.\\nHypertrophies of the cementum (formerly often called exostoses, or\\nexcementoses) are very common. The increased thickness may be of\\none lamella or of several lamella? in the region of the hypertrophy, or\\nall of the layers from first to last may take part in it. Small local\\nthickenings of a single lamella are seen in connection with the peri-\\ndental membrane wherever a specially strong bundle of fibers is to be\\nattached to the root to support the tooth against some special strain.\\nPeridental Membrane.\\nThe peridental membrane may be defined as the tissue which fills\\nthe space between the root of the tooth and the bony wall of its\\nalveolus, surrounds the root occlusally from the border of the alveolus,\\nand supports the gingivus. It has been referred to under many names,\\nas pericementum, dental periosteum, alveolo-dental periosteum, etc.\\nWhile this tissue performs the functions of a periosteum for the bone\\nof the alveolus, it diifers in structure from the periosteum in any\\nposition, so that any name including the word periosteum or implying\\na double membrane should be avoided.\\nThe peridental membrane belongs to the class of fibrous membranes,\\nand is made up of the folloAving structural elements\\n1. Fibers. 2. Fibroblasts. 3. Cementoblasts. 4. Osteoblasts. 5.\\nOsteoclasts. 6. Epithelial structures which have been called the glands\\nof the peridental membrane. 7. Bloodvessels. 8. Nerves.\\nThe peridental membrane performs three functions a physical\\nfunction, maintaining the tooth in relation to the adjacent hard and\\nsoft tissues a vital function, the formation of bone on the alveolar\\nwall and of cementum on the surface of the root and a sensory", "height": "4548", "width": "2720", "jp2-path": "americantextboo00kirk_0143.jp2"}, "144": {"fulltext": "136\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nfunction, the sense of touch for the tooth being exclusively in this\\nmembrane.\\nThe fibrous tissue of the membrane is of the white variety, and\\nmay be divided into two classes, the principal fibers and the indifferent or\\nFig. 118.\\nDiagram of the fibers of the peridental membrane G, gingival portion Al, alveolar portion Ap,\\napical portion. (From a photograph of a section from incisor of sheep.)\\ninterfibrous tissue. The principal fibers may be defined as those which\\nspring from the cementum and are attached at their other end to the", "height": "4580", "width": "2804", "jp2-path": "americantextboo00kirk_0144.jp2"}, "145": {"fulltext": "PERIDENTAL MEMBRANE.\\n137\\nbone of the alveolar wall, to the outer layer of the periosteum covering\\nthe surface of the alveolar process, to the cementum of the approximating\\nFig. 119.\\nLongitudinal section of peridental membrane from young sheep, showing fibers penetrating\\ncementum: D, dentin; C, cementum, showing imbedded fibers; F, fibers running to outer\\nlayer of periosteum covering the alveolar process F fibers running to the bone at the border\\nof the process B, bone. (About 80 X.)\\ntooth, or become blended with the fibrous mat of the gum supporting\\nthe epithelium. They were so called by Dr. Black, not only because", "height": "4556", "width": "2712", "jp2-path": "americantextboo00kirk_0145.jp2"}, "146": {"fulltext": "138\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nthey form the principal bulk of the tissue, but they also perform the\\nprincipal function of the membrane, the support of the tooth and sur-\\nrounding tissues. The interfibrous tissue, also of the white variety but\\nmade up of smaller and more delicate fibers, is found filling spaces\\nbetween the principal fibers and surrounding and accompanying the\\nbloodvessels and nerves.\\nFor convenience of description and study, the peridental membrane\\nis divided into three portions the gingival, that portion which surrounds\\nthe root occlusally from the border of the alveolar process the alveolar,\\nthe portion from the border of the process to the apex of the root and\\nFig. 120.\\nD.\\nN.\\nF.\\na\\nF l\\n\u00e2\u0096\u00a0F*\\nB.\\nLongitudinal section of the peridental membrane in the gingival portion- D, dentin; N,\\nNasmyth s membrane C, cementum F, fibers supporting the gingivus F 1 fibers attached\\nto the outer layer of the periosteum over the alveolar process F 2 fibers attached to the bone\\nat the rim of the alveolus B, bone. (About 30 X.)\\nthe apical portion, surrounding the apex of the root and filling the\\napical region (Fig. 118).\\nThe principal fibers spring from the cementum, the cementoblasts\\nbuilding up the matrix around them and then calcifying both matrix\\nand fibers, in this way implanting their ends into the surface of\\nthe root. In Fig. 119 the fibers are seen passing through the last-\\nformed layer of cementum. In most positions the fibers as they spring\\nfrom the cementum appear as well-marked bundles of fine fibers. A\\nshort distance from the surface of the root they break up into smaller\\nbundles, which interlace and are reunited into larger bundles, to be", "height": "4612", "width": "2816", "jp2-path": "americantextboo00kirk_0146.jp2"}, "147": {"fulltext": "PERIDENTAL MEMBRANE.\\n139\\nattached at their other extremity to the bone, cementum, or fibrous\\ntissue.\\nTo arrive at an understanding of the arrangement of the fibers of\\nthe peridental membrane, they must be studied in both longitudinal and\\ntransverse sections. In longitudinal sections of the membrane, in the\\ngingival portion (Fig. 120), the fibers springing from the cementum at\\nthe gingival line pass out for a short distance at right angles to the\\nlong axis of the tooth and then bend sharply to the occlusal, 1 passing\\nFig. 121.\\nTransverse section of the peridental membrane in the gingival portion (from sheep) E, epi-\\nthelium F, fibrous tissue of gum B, point where peridental membrane fibers are lost in fibrous\\nmat of the gum P, pulp F fibers extending from tooth to tooth. (About 30 X.)\\ninto the gingivus to support it and hold it closely against the neck of\\nthe tooth. These fibers are most numerous on the lingual side, where\\nfood is brought against the gingivus with force in mastication and tends\\nto crush it down. In the middle of the gingival portion the fibers pass\\nout at right angles to the axis and are blended with the fibrous mat of\\nthe gum on the labial and lingual sides, or are attached to the cementum\\nof the adjoining teeth on the approximal sides. A little farther from the\\n1 In describing the direction and inclination of peridental membrane fibers they are\\nalways traced from the cementum to the bone, the angle with the horizontal plane being\\nformed at the surface of the cementum.", "height": "4552", "width": "2704", "jp2-path": "americantextboo00kirk_0147.jp2"}, "148": {"fulltext": "140\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\ngingival line the fibers are inclined slightly apically, passing over the\\nborder of the process to be attached to the outer layer of the periosteum.\\nThese fibers are specially large and strong. Just at the rim of the\\nalveolus the fibers are inclined slightly apically and are inserted into\\nthe bone, forming the edge of the process.\\nIn transverse sections of the membrane in the gingival portion (Fig.\\n121) the fibers spring from the cementum in large bundles at the centre\\nof the labial surface they extend directly outward, breaking up into\\nsmaller bundles, passing around bloodvessels and bundles of fibers, and\\nblending with the fibrous tissue supporting the epithelium. Passing\\nmesially and distally toward the corners of the root, the fibers swing\\naround laterally and pass to the cementum of the next tooth. On the\\nFig. 122.\\nFibers at the border of the alveolar process (from sheep): D, dentin C, cementum; F, fibers ex-\\ntending from cementum to bone Bl, bloodvessel; B, bone. (About 80 X.)\\napproximal sides the fibers suddenly divide into smaller bundles, which\\nwind in and out around bloodvessels, and bundles of fibers which pass\\ninto the gingivus and are reunited into large bundles to be inserted into\\nthe cementum of the next tooth. On the lingual side the arrangement\\nis like that of the labial, except that the distance to which the fibers of\\nthe membrane can be followed before they are lost in the fibrous mat of\\nthe gum is usually greater than on the labial.\\nIn the occlusal third of the alveolar portion of the membrane the\\nfibers pass, at right angles to the axis of the tooth, directly from the\\ncementum to the bone. In this position the fibers are large and do not\\nbreak up into smaller bundles, but the original fibers can be followed", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0148.jp2"}, "149": {"fulltext": "PERIDENTAL MEMBRANE.\\n141\\nFig. 123.\\nTransverse section of the peridental membrane in the occlusal third of the alveolar portion\\n(from sheep) M, muscle fibers; Per, periosteum .4/, bone of the alveolar process; Pd, peri-\\ndental membrane fibers P, pulp D, dentin Cm, cementum.", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0149.jp2"}, "150": {"fulltext": "142 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nuninterruptedly from the cementum to the bone (Figs. 119 and 122).\\nIn the middle third the fibers are inclined occlusally, and this inclina-\\ntion increases as the apical third is approached. In the apical third\\nthe inclination is greatest, and the fibers as they arise from the cemen-\\ntum are very large and break up into fan-shaped fasciculi as they pass\\nacross to the bone. In the apical portion the fibers radiate from the\\napex in all directions across the apical region and spread out in fan-\\nshaped bundles like those in the apical third of the alveolar portion.\\nIn a transverse section near the border of the alveolus (Fig. 123), at\\nthe centre of the labial surface of the root, the fibers are seen to extend\\ndirectly out from the surface of the root to the bone of the process, ex-\\ncepting where they are diverted to pass around bloodvessels. Passing\\naround distally at the corner of the root, the fibers swing laterally so as\\nto be almost at a tangent to the surface of the root, and are inserted\\nmuch farther to the distal on the wall of the alveolus. A similar ar-\\nrangement is noticed at the other corners of the root, though these\\ntangential fibers are usually more marked at the distal than at the\\nmesial corners.\\nStudying the arrangement of the fibers Avith reference to the physical\\nfunction of the membrane, it is seen to be the best that could be\\ndevised to support the teeth against the force of mastication and to\\nsupport the tissues about them. In the gingival portion the fibers\\npassing from tooth to tooth form the foundation for the gingiva? between\\nthe teeth filling the interproximal spaces so that if these fibers are\\ncut off from the cementum, by extending a crown band too far, or by\\nthe encroachment of calculary deposits beginning in the gingival space,\\nthe gingivus drops down and no longer fills the interproximal space. In\\nthe alveolar portion the fibers at the border of the process and those\\nat the apex of the root together support the tooth against lateral\\nstrain, while those in the rest of the alveolar portion are so arranged\\nas to swing the tooth in its socket and support it against the force\\nof occlusion (Fig. 118). As seen from the transverse section, the fibers\\nof the occlusal third of the alveolar portion are so arranged as to sup-\\nport the tooth against forces tending to rotate it in its socket.\\nCELLULAR ELEMENTS OF THE MEMBRANE.\\nThe fibroblasts are spindle-shaped or stellate connective-tissue cells\\nwhich are found between the fibers as they are arranged in bundles. In\\nsections stained with hematoxylin they take the stain deeply, and the\\nfibers, which are unstained, are differentiated by the cells lying in rows\\nbetween them. The number of fibroblasts in the membrane decreases\\nwith age. They are large and numerous in the membrane of a newly", "height": "4608", "width": "2816", "jp2-path": "americantextboo00kirk_0150.jp2"}, "151": {"fulltext": "PERIDENTAL MEMBRANE.\\n143\\nerupted tooth, and comparatively small and few in the membrane around\\nan old tooth. This is characteristic of fibroblasts in other positions.\\nThe fibroblasts are shown as they appear in a hematoxylin-stained\\nsection with low powers in Fig. 124, which gives part of the membrane\\nin the gingival portion between two teeth. The cells are seen as spindle-\\nshaped dots which mark out the fibers at F they are seen in a position\\nFig. 124.\\n^-F\\nFibers and fibroblasts from transverse section of membrane F, fibers cut transversely F 1 fibers\\ncut longitudinally, showing fibroblasts. (About 80 X.)\\nwhere the fibers are cut transversely. With higher powers these cells\\nappear as in Figs. 126 and 135.\\nThe cementoblasts are the cells which form the cementum, and are\\nfound everywhere covering the surface of the root between the fibers\\nFig. 125.\\nCementoblasts. (Drawing by Dr. Black.)\\nwhich are imbedded in the tissue. While these cells perform the same\\nfunction for the cementum as the osteoblasts do for bone, they are in\\nform very different from the osteoblasts. The cementoblasts are always\\nflattened cells, sometimes almost scale-like, and when seen from above", "height": "4556", "width": "2704", "jp2-path": "americantextboo00kirk_0151.jp2"}, "152": {"fulltext": "144 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nare very irregular in outline. This irregularity of outline is caused by\\nthe cells fitting around the attached fibers of the membrane so as to\\ncover the entire surface of the cementum between the fibers. Fig. 125,\\nfrom a drawing by Dr. Black/ shows several cementoblasts as seen\\nwhen isolated by teasing. The cementoblasts have a central mass of\\nprotoplasm containing an oval nucleus, and short irregular processes\\nwhich fit around the fibers as these spring from the surface of the\\ncementum. Fig. 126 shows them in section perpendicularly to the\\nFig. 126.\\nTransverse section, showing the cellular elements Fb, fibroblasts Ec, epithelial structures\\nCb, cementoblasts Cm, cementum D, dentin. (About 900 X-)\\nsurface of the root, where they are crowded between the fibers. The\\ncementoblasts often have processes projecting into the cementum like\\nthose from the osteoblast, but processes projecting into the membrane\\nhave never been demonstrated.\\nIn the formation of the cementum occasionally a cementoblast be-\\ncomes inclosed in the formed tissue filling one of the lacunae, in which\\nposition it becomes a cement corpuscle.\\n1 Periosteum and Peridental Membrane.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0152.jp2"}, "153": {"fulltext": "PERIDENTAL MEMBRANE.\\n145\\nFig. 127.\\nH.B.\\nPd.B,\\nBorder of growing process Cm, eementum Pd, peridental membrane Pd.B, solid subperidental\\nand subperiosteal bone with imbedded fibers Ms, medullary space formed by absorption of\\nthe solid bone; H.B, Haversian-system bone without fibers; Per, periosteum. (About 50 X.)\\n10", "height": "4564", "width": "2700", "jp2-path": "americantextboo00kirk_0153.jp2"}, "154": {"fulltext": "146\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nThe osteoblasts of the membrane cover the surface of the bone,\\nforming the wall of the alveolus, lying between the fibers which are\\nbuilt into the bone. In form and function they are like the osteoblasts\\nin attached portions of the periosteum. They form bone around the\\nends of the peridental-membrane fibers, building them into the sub-\\nstance of the bone. The bone thus formed over the wall of the\\nFig. 128.\\nPd.M\\nPd.B.\\nH.B.\\nr enetrating fibers in bone Pd.M, peridental membrane Ob 1 osteoblasts of peridental membrane\\nOb-, osteoblasts of medullary space; Pd.B, solid subperidental and subperiosteal bone with\\nimbedded fibers Ms, medullary space formed by absorption of the solid subperidental bone\\nwith imbedded fibers H.B, Haversian-system bone without fibers built around the medul-\\nlary space. (About 200 X-)\\nalveolus is like the solid subperiosteal bone, and is penetrated\\nthroughout its thickness by the imbedded fibers but, as with the\\nsubperiosteal bone, it is constantly being penetrated by perforating\\ncanals, the solid bone being removed by absorption and rebuilt in\\nbone with Haversian systems. This process is shown in Fig. 127,", "height": "4612", "width": "2832", "jp2-path": "americantextboo00kirk_0154.jp2"}, "155": {"fulltext": "PERIDENTAL MEMBRANE.\\nFig. 129.\\n147\\nOsteoclast absorption of bone over permanent tooth Oe, osteoclasts B, bone of crypt wal\\nF, fibrous tissue of follicle wall A, ameloblasts. (About 62 X.)\\nFig. 130.\\nOsteoclasts: Oc, osteoclasts B, bone. (About 66 X.)", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0155.jp2"}, "156": {"fulltext": "148\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\na section through a growing portion of the process around a per-\\nmanent tooth. A higher power (Fig. 128) shows the penetrating\\nfibers and the formation of Haversian-system bone without fibers, in\\nthe body of the process.\\nThe osteoclasts, or myeloplaques, are bone-destroying cells (Fig.\\n129); they act not only upon bone, but also upon cementum and dentin.\\nThey are oval cells, often as much as 30 microns in diameter, and con-\\ntain many nuclei, from two or three to fifteen or twenty. They are\\noften called giant cells. The osteoclasts are not constantly found in the\\nmembrane, but make their appearance whenever calcified tissues are to\\nbe destroyed. In order for them to act upon the tissues they must lie\\nin contact with its surface, and therefore the first step in absorption of\\nthe peridental membrane is the cutting off of the fibers imbedded in\\nthe bone or cementum. Where the osteoclasts act upon the surface of\\nFig. 131.\\nRecord in the calcified tissue of an absorption repaired D, dentin Cm, cementum filling absorp-\\ntion cavity. (About 40 X.)\\nthe tissue they produce bay-like excavations, in which they lie, and\\nwhich are known as Howship s lacunae. These excavations are shown\\nin Fig. 132, though the osteoclasts have disappeared. In Fig. 131,.\\nfrom a ground section, the basin-like excavations are shown filled with\\nnew-formed cementum, thus leaving in the tissue the record of an\\nabsorption repaired. In absorption of the roots of the temporary teeth\\nthe osteoclasts are found not only in the membrane and attacking the\\nsurface of the root, but all through the medullary spaces in the bone,\\nremoving the temporary alveolar process.\\nWhen absorption is going on at one place on the surface of a root\\na compensating formation of cementum is going on at another, so\\nthat not all of the fibers of the membrane are cut off. This is illus-", "height": "4580", "width": "2828", "jp2-path": "americantextboo00kirk_0156.jp2"}, "157": {"fulltext": "PERIDENTAL MEMBRANE.\\n149\\ntrated by sections of temporary teeth that are ready to be shed (Fig.\\n132).\\nFig. 132.\\nRoot of a temporary incisor, showing absorption and rebuilding of eementum (from sheep) G, gin-\\ngivus D, dentin Cm, eementum Ab, absorption cavity, showing Howship s lacunse CW, new-\\nformed eementum. (About 50 X.)\\nEPITHELIAL STRUCTURES OF THE MEMBRAXE.\\nThe peridental membrane contains cellular structures of epithelial\\ncharacter which are so conspicuous that they demand consideration,\\nthough their nature and origin are not as yet fully understood.\\nThese structures were first well illustrated and described by Dr.", "height": "4564", "width": "2704", "jp2-path": "americantextboo00kirk_0157.jp2"}, "158": {"fulltext": "150 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 133.\\nI u\\nDiagram of glands of peridental membrane. (G. V. Black.)\\nFig. 134.\\nFb.-\\nEc.\\n\u00e2\u0096\u00a0Ec.\\nEc.\\nOb.\\nCm.\\n-I).\\nEpithelial structures of the peridental membrane (from sheep): Fb, fibroblasts; Ec, epithelial\\nstructures; Cb, cementoblasts Cm, cementum D, dentin. (About 468 X.)", "height": "4608", "width": "2836", "jp2-path": "americantextboo00kirk_0158.jp2"}, "159": {"fulltext": "PERIDENTAL MEMBRANE.\\n151\\nBlack, in his work on the periosteum and peridental membrane, in 1887,\\nand were called by him the glands of the peridental membrane. About\\nthe same time von Brunn l described what are probably the same struct-\\nures, and which he regarded as embryonal remains of the inner layer\\nof the enamel organ, which he described as growing down oyer the sur-\\nface of the root. These structures appear as cords of epithelial cells\\nFig. 135.\\nEpithelial structures (from sheep) Fb, fibroblasts Ec, epithelial structures Cb, cemeutoblasts\\nCm, cementum D, dentin. (About 700 X.)\\narranged in the form of a network winding between the fibers of the\\nmembrane, very close to the cementum and surrouuding the root almost to\\nthe apex. Their arrangement is illustrated in Fig. 133, a diagram by Dr.\\nBlack. The meshes of the net are close in the gingival portion of the\\nmembrane, but grow more and more open in the alveolar portion. They\\nare not confined to the membranes of young teeth or the temporary den-\\ntition, as Dr. Black has shown them in the membrane of a tooth from\\na man seventy years old, though, like all of the cellular elements of the\\n1 Archiv f. mikros. Anat 1887.", "height": "4552", "width": "2704", "jp2-path": "americantextboo00kirk_0159.jp2"}, "160": {"fulltext": "152\\nDENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nmembrane, they become less numerous as age advances. These struct-\\nures are specially well shown in the membranes of the pig and sheep.\\nFig. 134 shows their appearance in a transverse section of the root of an\\nincisor of a sheep; here they swing out from the surface of the cemen-\\ntum and back again in loops, winding in and out among the fibers.\\nStudied with higher powers (Fig. 135), they are seen to be made up of\\nepithelial cells, with large oval nuclei and reacting to the characteristic\\nepithelial stains. They are arranged in cords, though sometimes what\\nseems to be a lumen of a gland tubule can be found (Fig. 136). The\\nFig. 136.\\n._\\nEg.\\nEpithelial structures Ec, epithelial cord, apparently showing a lumen Cb, cementoblasts\\nCm, cementum D, dentin. (About 500 X.)\\ncords are invested with a delicate basement membrane, but no special\\nrelation to bloodvessels has been demonstrated. The attempt to show\\ntheir connection with the surface epithelium has thus far failed. As the\\ngingivus is approached (Fig. 137), they seem to swing out from the sur-\\nface of the root and are lost between the projections of the epithelium\\nlining the gingival space. There is evidence that these structures are,\\nat least in some cases, of importance as the primary seat of pathological\\nconditions of the membrane.", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0160.jp2"}, "161": {"fulltext": "PERIDENTAL MEMBRANE.\\nFig. 137.\\n153\\nLongitudinal section: Ep, epithelium lining the gingival space; Gg, gingival gland, so called;\\nD, dentin N, Nasmyth s membrane Du, duct-like structure stretching away toward the gin-\\ngivus from the epithelial cord, seen at Ec Cm, cementum, separated from the dentin by\\ndecalcification. (About 50 X.)", "height": "4556", "width": "2720", "jp2-path": "americantextboo00kirk_0161.jp2"}, "162": {"fulltext": "154 DENTAL HISTOLOGY AND OPERATIVE DENTISTRY.\\nFig. 138.\\nB,\\nB.\\nCm.\\nPd.\\nOm 1\\nFig. 139.\\nB.\\nB.\\nPd.\\nCm.\\nD.\\nP.\\nYoung and old membranes (from sheep) D, dentin Cm, cementum Chi 1 thickening of cemen-\\ntum to attach fibers at the corner; Pd, peridental membrane B, bone forming the wall of the\\nalveolus P, pulp. (About 80 X", "height": "4612", "width": "2836", "jp2-path": "americantextboo00kirk_0162.jp2"}, "163": {"fulltext": "PERIDENTAL MEMBRANE. 155\\nBLOODVESSELS AND NERVES OF THE MEMBRANE.\\nBloodvessels. The blood-supply of the peridental membrane is\\nvery abundant. Several vessels enter the membrane from the bone in\\nthe apical region. These arteries branch and divide, forming a rich\\nnetwork, from which the capillary vessels are given off. The arterial\\nnetwork is constantly receiving vessels which enter the membrane\\nthrough Haversian canals opening on the wall of the alveolus, and in\\nthis way the size of the vessels passing occlusally is maintained. Ar-\\nterial vessels also enter the membrane over the border of the process.\\nThis double or triple supply of the membrane is important, as it main-\\ntains the health of the membrane when the supply entering through\\nthe apical region is entirely cut off by alveolar abscess. While the\\narterial supply of the membrane is very rich, the capillaries in the\\nmembrane are comparatively few. This is, however, a characteristic\\nof connective-tissue membranes.\\nThe nerves of the peridental membrane have not been sufficiently\\nstudied to be described in detail. Six to eight medullated nerve trunks\\nenter the apical region in company with the bloodvessels, and they re-\\nceive other trunks through the wall of the alveolus and over the border\\nof the process, but the manner of their distribution and the nature of\\ntheir endings are not known.\\nTHE CHANGES WHICH OCCUR IN THE MEMBRANE WTTH AGE.\\nWhen a tooth is erupted the roof of the bony crypt in which it was\\ninclosed in the body of the bone is removed by absorption and the\\ncrown advances through the opening. The diameter of the alveolus at\\nthat time is, therefore, greater than the greatest diameter of the crown,\\nand the peridental membrane which fills the space is very thick. By\\nthe formation of bone on the wall of the alveolus and the formation\\nof cementum on the surface of the root the thickness of the membrane\\nis reduced. In the young membrane most of the large bloodvessels are\\nfound in its outer half, forming a rather defined vascular layer near its\\ncentre. In the old membrane most of the bloodvessels are found very\\nclose to the surface of the bone, often lying in grooves in its surface.\\nBoth young and old membranes are illustrated in Figs. 138 and 139,\\nwhich are taken from the temporary teeth of a sheep, one just after\\neruption and the other shortly before the time of shedding.", "height": "4556", "width": "2732", "jp2-path": "americantextboo00kirk_0163.jp2"}, "164": {"fulltext": "", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0164.jp2"}, "165": {"fulltext": "CHAPTER IV.\\nANTISEPSIS IN DENTISTRY.\\nBy James Truman, D. D. S.\\nThe importance of antisepsis in dental operations has not been\\nrecognized as fully as the subject would seem to warrant. This has\\nbeen in part due to the fact that dentists have been accustomed to the\\nthought that cleanliness in the use of instruments would meet all the\\nrequirements of practice. This idea has been enforced by a general im-\\nmunity from unpleasant sequelae after operations, thus leading to a skep-\\nticism in regard to the value of antiseptic measures in the oral cavity.\\nThis immunity has been in part due to the fact that the fluids of the\\nmouth were supposed to have a direct influence in preventing in-\\nfection. This has never been proved through laboratory experiments,\\nbut clinical observation and long experience have demonstrated that\\ninjuries in the mouth ordinarily heal rapidly, even though these be made\\nby infected instruments. It seems unreasonable to suppose that a fluid\\npeculiarly subject to fermentation should have this effect, and this has\\nled some to ascribe it to a vital influence. Miller l says of this It\\nis a very fortunate provision that the gums in a healthy state offer so\\npowerful a resistance to the invasion of the germs of most infectious clis-\\neases. For this reason a wound in the gums may be followed by\\nscarcely any reaction whatever, while a similar wound on the hand\\nwith the same instrument may produce most disastrous results. It has\\nbeen attempted to account for this fact on the supposition that the\\nsaliva has an antiseptic action, in evidence of which we are often re-\\nminded that dogs lick their wounds, and that these heal rapidly.\\nI doubt if there is anyone who would wish us to believe that\\nthe dead saliva has even the slightest antiseptic properties, in consid-\\neration of the fact that saliva, especially when it contains much organic\\nmatter, readily putrefies. If the saliva possesses any such property, it\\nmust be sought for in its living histological elements, i. e., in the living\\nleucocytes or phagocytes. 2\\n1 Dental Cosinos, July, 1891.\\n2 For an elaborate study of this problem see Experimental Study of the Different\\nModes of Protection of the Oral Cavity Against Pathogenic Bacteria, by Arthur C.\\nHugenschmidt, M. D., Dental Cosmos, xxxviii., p. 797.\\n157", "height": "4556", "width": "2732", "jp2-path": "americantextboo00kirk_0165.jp2"}, "166": {"fulltext": "158 ANTISEPSIS IN DENTISTRY.\\nWhile it is true that there exists a degree of exemption from serious\\nresults, leading to indifference and careless management of cases, it is\\nequally true that infection has resulted in the experience of almost\\nevery operator in dentistry.\\nPrior to the period when Lister announced that all operations in\\nsurgery should be performed antiseptically, and made modern surgery\\npossible, this ignorance was excusable but at the present time, with the\\naccumulated knowledge in bacteriology, it should be impossible for any\\ndental operator to neglect the procedures under this head considered\\nabsolutely essential for the general surgeon.\\nThe difficulties attending antisepsis in dentistry far exceed those in\\nother branches of surgery. The dentist is necessarily obliged to meet\\nconditions hourly that seem to preclude absolute freedom from sources\\nof contamination. If he were to take the same precautionary measures\\nnow regarded as necessary for the surgeon, he would find practice almost\\nimpossible. While this is true, it does not follow that every effort\\nshould not be made to approach absolute surgical cleanliness.\\nThe usual methods employed to accomplish this, while valuable to\\na limited extent, are by no means equal to what could readily be secured\\nwithout consuming much time or patience. The dentist is usually sat-\\nisfied that he has fulfilled all antiseptic precautions when he has dipped\\nhis instrument in some antiseptic fluid, generally carbolic acid. Little\\nor no attention is paid to the possibility of infection from rubber-dam,\\ntowels, hands, and the variety of instruments that enter into dental\\noperations. Some of the latter, as, for instance, the separator, are more\\nliable to carry infection than the excavator, the one generally regarded\\nas most important.\\nThe appliances ordinarily in daily use are the rubber-dam, excava-\\ntors, broaches, pluggers, clamps, ligatures, separators, drills, hand-\\npieces, napkins, and forceps. It is safe to assume that but few of these\\nwill receive any attention beyond ordinary washing. The rubber-dam\\nis too often used as it is furnished by the manufacturer. If an attempt\\nat cleanliness is made, it consists in washing the dam in cold or warm\\nwater, this being regarded as sufficient. When it is remembered that\\nthis is passed between teeth and usually forced up under gingival\\nmargins with ligatures, or clamps, frequently lacerating the surface, it\\nbecomes evident that the possibility of infection is always present.\\nIf infection does not occur from the rubber, it is almost certain to pro-\\nduce a wound in a locality extremely favorable for the growth of patho-\\ngenic germs. The result is innumerable lesions that may extend to\\npericemental inflammations. The great increase in the past twenty-\\nfive years of gingival inflammations subsequent to operations in mouths\\nof more than ordinary health must be partly ascribed to this cause.", "height": "4604", "width": "2840", "jp2-path": "americantextboo00kirk_0166.jp2"}, "167": {"fulltext": "SOURCES OF INFECTION. 159\\nExcavators ordinarily receive the most attention, and yet, when their\\nuse is considered, they possibly require the least. It is rarely necessary\\nto use the excavator outside of a cavity, where infection, if at all pos-\\nsible, would do the least harm, for the continual washing of the cavity,\\nas the operator proceeds, reduces the danger to a minimum. Broaches,\\nand all instruments intended to enter the pulp canals, require the most\\ncareful attention, and this applies with equal force to drills yet it is\\nfeared that both of these, loaded though they are with septic matter,\\nreceive but indifferent care. When the dangerous possibilities which\\nmay result from this negligence are considered, it becomes a serious if\\nnot a criminal offence. The difficulty in making these instruments germ-\\nfree and in keeping them from becoming contaminated is fully appre-\\nciated yet the effort must be made, and it is not a difficult procedure,\\nnor does it require a large consumption of time an important item to\\nthe dental operator.\\nPluggers cannot be regarded as a source of infection. They are\\nused solely in connection with metal, and therefore strict cleanliness\\nis all that is absolutely required. It is fortunate that this is so, for\\n\u00e2\u0080\u00a2these instruments require unusual care to protect them from rust.\\nHence immersion in an antiseptic fluid is deleterious and not re-\\nquired.\\nSeparators and under this head are included metal with screw\\nattachments and wedges require special attention, but probably receive\\nthe least. They should be made as nearly sterile as possible before\\ntheir use upon a patient.\\nHand-pieces, of the various kinds in use, are probably the most\\ndifficult to keep thoroughly clean. While they do not come in direct\\ncontact with the tissues of the mouth, they may indirectly, by contam-\\ninating the hands, produce unpleasant results. Frequent taking apart\\nand boiling are essential, and should not be omitted.\\nNapkins from the ordinary wash have been and are used with con-\\nfidence that no bad results from use can follow. If the laundry is con-\\nfined to the home, this may ordinarily be true, but the indiscriminate\\nmingling of washes indulged in by the commercial laundryman is\\nalways a menace to health. Where napkins of the latter character are\\nto be used they should be subjected to the sterilizing process.\\nThe chair occupied by a variety of patients may be a source of\\ndisease, and should be carefully cleansed, especial care being taken with\\nthe head-piece. The latter should be covered with a clean napkin, to\\nbe changed for every patient.\\nThe cuspidor, where the fountain is not used, is ordinarily an abom-\\nination, for here, if anywhere, will carelessness be manifest. There can\\nbe no excuse for this, as thorough daily scalding with boiling water and", "height": "4564", "width": "2728", "jp2-path": "americantextboo00kirk_0167.jp2"}, "168": {"fulltext": "160\\nANTISEPSIS IN DENTISTRY.\\nthe\\nuse of antiseptics will keep it measurably free from unpleasant\\nconsequences.\\nFig\\nDownie steam sterilizer.\\nGlasses require to be thoroughly boiled\\nboth before and after use. Boiling should\\nnever be neglected with ejector tubes, either\\nmetal or glass, glass being generally used.\\nHard boiling in water for twenty minutes\\nshould be sufficient.\\nThe lancet is an instrument demanding\\nespecial care, as it may become a danger-\\nous source of infection. Before it is used\\nthe adjacent portions of the gum should be\\nwashed with an antiseptic.\\nThe forceps employed in extraction\\nshould be so constructed as to render the\\nblades readily separable at the joint, and\\nthey should be boiled in water and soda\\nsolution for an hour. The recorded cases\\nof infection from these instruments render\\nthis care imperative in all instances.\\nFig. 140 shows a convenient form of\\napparatus for sterilizing ordinary dental\\ninstruments by boiling soda solution.\\nOral Diseases and Their Transmission.\\nThe possibility of carrying disease from one person to another seems so\\nself-evident that it ought not to require more than a word of caution,\\nand yet it is clear that the attention given to this source of danger is by\\nno means commensurate with the risks assumed constantly in practice.\\nThe peculiarly transitory character of much of dental practice precludes\\nthe possibility of any previous history of patients, and therefore every\\none should be regarded as a possible source of infection.\\nDiseases the result of pathogenic bacteria independent of possible\\nexternal infection are now in the main well understood, but by no means\\nequally appreciated by medical practitioners, nor are they properly con-\\nsidered by dental operators. Miller 1 states that many facts favor the\\nsupposition that a considerable number of pathogenic micro-organisms\\nmay thrive in the juices of the mouth without showing in their vital\\nmanifestations any distinction from the common parasites of the oral\\ncavity as long as the mucous membrane remains intact. If, however,\\nthe soft tissues have been wounded, as in extraction, or if the resistance\\nof the mucous membrane has been impaired, these organisms may gain\\n1 The Micro-organisms of the Human Mouth, page 275.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0168.jp2"}, "169": {"fulltext": "ORAL DISEASES AND THEIR TRANSMISSION. 161\\na point of entrance and thus become able to manifest their special\\nactions. This fact, now well recognized, is being constantly demon-\\nstrated in the use of the various appliances that may, through careless\\nhandling, injure the mucous membrane. So much is this the case that\\na large proportion of gingival inflammations have undoubtedly had\\ntheir origin from this cause. It has come under the observation of the\\nwriter that injuries thus received, although apparently unnoticed by\\ni entist or patient, have resulted in the course of forty-eight hours in\\nvery disturbing pericementitis, confusing to the operator and very painful\\nto the patient. The necessity for such antiseptic precautions here as are\\ntaken in general surgery is almost entirely overlooked. Before placing\\nthe coffer-dam, the clamp, or ligature, that portion of the mouth should\\nbe thoroughly washed with an antiseptic solution and an effort made\\nto render the appliances equally sterile, or at least to inhibit develop-\\nment for a definite period. When the operation has been completed\\nthe same care should be extended to the tooth and contiguous structures.\\nThe evidence is abundant that many cases of pyorrhea alveolaris have\\nhad their origin from this careless indifference to accepted and necessary\\nprecautions.\\nThe mouth as a source of disease to the general system does not\\nproperly belong to this article to discuss, but its importance cannot be\\noverlooked. Dental writers have devoted much attention to this sub-\\nject. It is for the dentist to understand that he is, to a large degree,\\nresponsible for the general health of his patient as far as the mouth is\\nconcerned, and he should insist on prophylactic measures that will at\\nleast reduce this source of disease to a minimum. The constant danger\\nof what Miller aptly calls auto-infection from the collection and\\npropagation of pathogenic bacteria in the fluids of the mouth should\\nsuggest to the dentist constant efforts to effect the removal of all deposits\\non the enamel, gingival margins, tongue, and mucous membrane. This\\nline of study will bring about in the future an entirely different dentistry\\nas to hygiene and prophylaxis from that practised at the present time.\\nThe pulp of a tooth is not ordinarily regarded as a point of in-\\nfection, and yet it is well known to be a serious menace to the health\\nof an individual. Israel, quoted by Miller, 1 asserts that the root\\ncanal furnishes a point of entrance even for the ray-fungus, actinomyces,\\nand in one case the microscopic examination revealed the elements of\\nthis organism in the canal of a pulpless tooth. When it is considered\\nthat some individuals have decomposed pulps in a number of teeth at\\nthe same time, and frequently a score of dead and broken roots, sending\\nout their infectious material, it is not surprising that disease of a serious\\nnature may supervene. While there is no record of cases coming\\n1 The Micro-organisms of the Human Mouth, p. 285.\\nII", "height": "4560", "width": "2728", "jp2-path": "americantextboo00kirk_0169.jp2"}, "170": {"fulltext": "162 ANTISEPSIS IN DENTISTRY.\\nwithin the observation of the writer of pulps producing pyemia directly,\\nit is a well-known fact, supported by a long list of recorded cases,\\nthat alveolar abscess, with its concentration of putrid material, is liable\\nto be followed by blood-poisoning.\\nThere is no question that diseases of the digestive organs, of the\\nlungs in fact, of all the organs of the body may be produced by\\ninfected material germinated in the mouth, and indeed, through sputum\\nejected, may affect individuals remotely situated.\\nMiller, 1 in considering this portion of the subject, says We know\\nthat under certain circumstances saccharomycetes may directly colonize\\nin the mucous membrane of the mouth, and that in the mouths of\\nenfeebled individuals bacteria may occasionally obtain a foothold.\\nThe mucous membrane of the mouth and pharynx is especially sus-\\nceptible to the action of certain germs of infection (those of diphtheria,\\nsyphilis, etc.), and large portions of the mucous membrane and the sub-\\nmucous tissue may be wholly destroyed by parasitic influences.\\nThere is a phase of this subject that requires more extended in-\\nvestigation. Inflammations of the mouth are not infrequent where\\ngreat swelling is present. This may be observed around the lower\\nthird molars with no explainable cause in dead pulps, overlapping\\nmucous membrane, retarded eruption, or mal-presentation. It is evi-\\ndently produced by bacterial invasion, but has not always yielded to\\nantiseptic measures, and at times has resulted in abscess entirely inde-\\npendent of pulp devitalization.\\nA recent report of three cases by Dr. John A. McClain 2 in the\\nmedical practice of Dr. M. G. Tull is interesting as indicating possi-\\nbilities. The first case was an extensive swelling posterior to the lower\\nthird molar. He could not connect it with that tooth, and suspected\\nauto-infection. He had cultures made with negative results. His\\ntheory was that it was diphtheritic and, although laboratory evidence\\nwas wanting, he determined to inject antitoxin. This injection was\\nfollowed in twenty-four hours by an entire reduction of the swelling.\\nAll other efforts had previously failed to effect any result. Two other\\nsimilar cases yielded to the antitoxin treatment in the same speedy\\nmanner. If this can be regarded as something more than a coincidence\\nin practice, it may lead to an explanation of many similar anomalous\\npathological cases arising posterior to the third inferior molar, yet\\napparently not connected with it. Similar conditions have been the\\ncause of much uncertain diagnosis and still more empirical treatment.\\nThe more the writer has considered this subject the more important\\nit has appeared; and he is convinced that, when the proper prophy-\\n1 The Micro-organisms of the Human Mouth, p. 295.\\n2 International Dental Journal, October, 1900.", "height": "4608", "width": "2840", "jp2-path": "americantextboo00kirk_0170.jp2"}, "171": {"fulltext": "INFECTION FROM MOUTH TO MOUTH. 163\\nlactic measures come into use for the prevention of tuberculosis, in all its\\nprotean forms, antisepsis of the mouth will be given primary importance.\\nInfection from Mouth to Mouth.\\nInfection from mouth to mouth through instruments is a difficult\\nmatter to prove by cases, but theoretically there can be no cause for\\ndisputation. The question will always arise, Was the lesion occasioned\\nby auto-infection or by transmission The answer can rarely be given\\nwith the assurance desirable. In one instance, at least, in the writer s\\nexperience the origin was clearly traceable. This was in a patient of the\\nbetter class, presenting for treatment in the clinic of the Dental Depart-\\nment of the University of Pennsylvania. Her teeth were remarkable for\\nstructure, regularity, and cleanliness gums perfectly healthy. Necrosis\\nof the anterior alveolar plate was threatened when first seen, and\\nfinally resulted in the entire destruction of the alveolar border and all\\nthe anterior upper teeth, but did not involve the maxilla. The history\\nof the case as given was that a bicuspid had been extracted from the\\nright superior region by a dentist notorious for his uncleanly habits.\\nNot long thereafter the patient noticed a serious inflammation. These\\nsymptoms indicated a syphilitic infection, and the family physician was\\nconsulted, who insisted that no history of this disease existed and that\\ninfection must be the cause. The patient, through his treatment and\\nthat given locally, recovered, but was forced to wear an artificial sub-\\nstitute.\\nCases of infection through extraction, either by the forceps or after-\\ninfection from the mouth, might be quoted almost indefinitely. Miller\\nreports case upon case in fact, the accumulation of these has become\\nof serious moment and yet, in the face of undisputed facts, dentists\\nwill continue to extract teeth frequently without any precautions, or,\\nat most, relying on simple washing of the instrument. Some German\\nwriters contend that antisepsis after extraction is wholly unnecessary,\\nas the clot formed is a sufficient protection. This is certainly not true\\nin all cases. It is not always the fact that a clot is formed, or when\\nformed that it serves an antiseptic purpose. One of the most serious\\ncases that has fallen to the writer to treat was that of necrosis of the\\nsuperior maxilla involving destruction of the right side, taking in all\\nthe teeth from the third molar to the lateral, the floor of the antrum,\\na portion of the nasal bones, and half of the hard palate. This was the\\nresult of the extraction of the third molar by a specialist before the\\ndays of antisepsis; whether it was the result of infection is difficult\\nto determine. In the opinion of the writer, no extraction should be\\nattempted until the instruments used have been thoroughly sterilized by\\nboiling. Before the forceps are applied the parts surrounding the tooth", "height": "4560", "width": "2712", "jp2-path": "americantextboo00kirk_0171.jp2"}, "172": {"fulltext": "164 ANTISEPSIS IN DENTISTRY.\\nshould be well washed with an antiseptic solution. After the extraction\\nthe socket should be syringed with sterilized water, followed by\\nsome powerful disinfectant. In view of the serious results probable in\\nthis operation there is no longer any excuse for injuries resulting from\\ninfection, and a suit for malpractice could be well sustained against an\\nindividual who had failed to observe the well-understood methods of\\nantisepsis, while no intelligent practitioner could conscientiously appear\\non behalf of the defendant.\\nExternal Infection.\\nThe danger to the operator from external infection from instruments\\nis a constant menace; the constant use of these with general freedom\\nfrom serious results, however, leads to a degree of carelessness not war-\\nranted by the ever-present danger from wounds. There is more real\\ndanger to the operator from this source than to the patient. All the\\nexcavators, drills, and broaches are hourly in contact with infectious\\nmatter, and it requires but a slight wound to produce any of the possi-\\nbilities of blood-poisoning. The operator should be on constant guard\\nin this respect, upon the slightest abrasion immediately taking measures\\nto destroy all possibility of infection from germs that may have been\\nintroduced into the wound. This should at once be carefully washed\\nand an escharotic employed, burning the parts. For this purpose zinc\\nchlorid or carbolic acid is probably the best agent to use, followed by\\nan antiseptic. The latter should be frequently renewed. Experience\\nhas demonstrated the value of turpentine in the various mechanical\\nshops where this agent has been for many years in common use for\\nwounds from rusted iron, the possibility of trismus resulting from such\\ninjuries being well understood. The writer has used this agent, after\\nburning the wound, almost to the exclusion of other antiseptics.\\nAn illustration of the ever-present danger from wounds occurred\\nto a friend of the writer s, one of the many young women who have\\ngraduated in dentistry in this country. She accidentally wounded her\\nhand by a drill, and regarded it as of no moment. The result was severe\\nblood-poisoning that for two years kept her hovering between life and\\ndeath. After suffering from severe metastatic abscesses, she was finally\\nrestored to partial health, but with her constitution shattered and her\\npractice ruined for the time being.\\nImplantation and Transplantation.\\nPrevious to the recognition of the importance of antisepsis, the\\ndentists of that period had a very natural objection to reimplanting\\nteeth the practice of transplantation was then practically an unknown\\noperation. The danger of the operation was appreciated, but the reason", "height": "4616", "width": "2808", "jp2-path": "americantextboo00kirk_0172.jp2"}, "173": {"fulltext": "AGENTS USED FOR STERILIZATION. 165\\nwas not then comprehended. When the study of bacteriology had ad-\\nvanced to a science through the labors of Pasteur, Koch, and a host of\\ninvestigators, the reasons for this fear were explained, and the condi-\\ntions necessary to avoid unpleasant results being understood, the danger\\nfrom infection was changed to absolute security. It is, moreover, to be\\never borne in mind that but for this knowledge implantation and trans-\\nplantation could to-day not be practised without the probability of\\nserious results.\\nA case illustrating this point occurred prior to the knowledge of anti-\\nsepsis in the hands of a well-known dentist. He had removed three\\nteeth and successfully reimplanted them for the cure of a violent case of\\nneuralgia presumably due to calcific depositions in the pulp and about\\nthe external portions of the roots. Relief was so immediate that upon\\nreturn of the pain another tooth was attempted. Trismus followed,\\nresulting in the death of the patient. It is safe to assume that this\\nunfortunate result could not have happened under the antiseptic care\\nusual at the present time, even imperfect as it frequently is.\\nTo accomplish antisepsis in this operation the greatest care is neces-\\nsary. In transplantation, teeth being procured from other mouths,\\nthe danger is necessarily much increased. The method, adopted by\\nsome, of immersing these teeth in various antiseptic fluids cannot be\\ncommended. Miller says of this l It is generally accepted that\\nthe operator takes every possible precaution when he allows the tooth\\nto lie for one-half to one hour in a 1 per cent, solution of carbolic acid,\\nor in a 1 :1000 solution of bichloride of mercury. In order to\\nreach bacteria that may have penetrated into the lacunas or chance vas-\\ncular canals a much longer action of the antiseptic is necessary, and to\\nbe perfectly certain that we have accomplished our object we should\\nhave recourse to boiling water.\\nAgents used for Sterilization.\\nThe possibility of injuring instruments has deterred dentists from\\nusing many of the agents recommended for the purpose of sterilization.\\nMiller 2 made tests of various agents with indifferent results, with\\nthe exception of carbolic acid, trichlorphenol, and mercury bichlorid.\\nThe list tested included the following\\nCarbolic acid in 5 per cent aqueous solution and in pure form.\\nLysol in 5 per cent, aqueous solution.\\nTrichlorphenol in 5 per cent, aqueous solution.\\nSublimate in 5 per cent, aqueous solution also in the strength of\\n1 1000 of water.\\nBenzoic acid in the strength of 1 300 of water.\\n1 Dental Cosmos, July, 1891. 2 Ibid., page 520.", "height": "4556", "width": "2704", "jp2-path": "americantextboo00kirk_0173.jp2"}, "174": {"fulltext": "166 ANTISEPSIS IN DENTISTRY.\\nPotassium permanganate in 5 per cent, aqueous solution.\\nResorcin in 10 per cent, aqueous solution.\\nHydrogen peroxid in 10 per cent, aqueous solution.\\nSaccharin in concentrated alcoholic and aqueous solution.\\n/9-naphthol in 5 per cent, alcoholic solution.\\nPyoktanin in concentrated aqueous solution.\\nAbsolute alcohol.\\nAntiseptin in 5 per cent, aqueous solution.\\nZinc sulfate in concentrated aqueous solution.\\nThe essential oils in 5 per cent, emulsions and in pure form.\\nThe three previously named, carbolic acid, trichlorphenol, and\\nmercury bichlorid, were the only ones that gave any satisfactory\\nresults, and these only partially so. In regard to the rest, Prof. Miller\\nsays They all fall far short of those already mentioned. The 10 per\\ncent, solution of the peroxid of hydrogen came next to carbolic acid,\\nbut is considerably inferior to it. The essential oils, in emulsions as\\nwell as in pure form, utterly failed to produce the desired action.\\nThe results obtained by Miller are not wholly in accord with those\\nof some others. Charles B. Nancrede, M. D., in an article l gives a\\nlist of agents which have proved most reliable clinically, can be resorted\\nto in any emergency, or are peculiarly applicable to meet exceptional\\nindications\\nMarked Inhibition. Complete Inhibition.\\nMercuric chlorid 1 1,600,000 1 300,000\\nOil of mustard 1 333,000 1 33,000\\nThymol 1:86,000\\nOil of turpentine 1 75,000\\nIodin 1 5,000 1 1,000\\nSalicylic acid 1 3,300 1 1,500\\nEucalyptol 1 2,500 1 1,251\\nBorax 1:2,000 1:700\\nPotas. permanganate 1 1,400\\nBoric acid 1 1,250 1 800\\nCarbolic acid 1 1,250 1 850\\nQuinin 1 830 1 625\\nAlcohol 1 100 1 12.5\\nAt the time these tables were prepared one agent not mentioned was\\npractically unknown as an antiseptic, formaldehyd, or in solution\\nknown as formalin.\\nDr. Elmer G. Horton, B. S., assistant in bacteriology, Department\\nof Hygiene, University of Pennsylvania, undertook, at the request of\\nDr. Edward C. Kirk, a series of investigations with formaldehyd, 2 the\\nresults of which are given, omitting the details of experiments\\n1 Treatment of Wounds: Antisepsis and Asepsis, Surgery by American Authors,\\nPark, page 365.\\n2 Dental Cosmos, July, 1898.", "height": "4612", "width": "2768", "jp2-path": "americantextboo00kirk_0174.jp2"}, "175": {"fulltext": "AGENTS USED FOR STERILIZATION.\\n167\\nWe employed the gas generated by heating over an alcohol lamp\\na pastil which contained five grains of paraform. The lamp was placed\\nin a tin box of nearly one cubic foot capacity (Fig. 141). Among\\nthe instruments employed in the tests were various chisels, excavators,\\nand burs. These were boiled, shown by cultural method to be sterile,\\nthen either dipped into bouillon cultures or infected from selected cases\\nfound in the operative clinic of the Department of Dentistry, University\\nof Pennsylvania. After infection each instrument was placed in a sterile\\ntube and kept at incubator temperature (37.5\u00c2\u00b0 C.) for three hours.\\nIn a single test with moist instruments we found sterilization complete.\\nAfter the infection and subsequent drying the tubes containing the in-\\nfected instruments were separated into two lots, one to be subjected to\\nFig. 141.\\nSchering s formalin sterilizer\\nthe method of disinfection and the others to be kept as controls, by\\nwhich would be shown that no step other than the action of formalde-\\nhyd destroyed the vitality of the germs. After exactly ten or\\nfifteen minutes, according to the experiment, the door was opened and\\nthe instrument quickly removed. Each instrument (controls like-\\nwise) was placed in a considerable amount of sterile bouillon and these\\ncultures, together with the subcultures made from them, observed for\\nat least one week. In all experiments a free growth developed\\nfrom the controls. The disinfection of instruments purposely in-\\nfected in the clinics from cases of caries, pyorrhea, and gingivitis was\\nsatisfactorily accomplished in every case. AVe conclude that infected\\ndental instruments can be disinfected without injury in a closed space\\nof less than one cubic foot, by an exposure of fifteen minutes to the", "height": "4544", "width": "2700", "jp2-path": "americantextboo00kirk_0175.jp2"}, "176": {"fulltext": "168 ANTISEPSIS IN DENTISTRY.\\nformalclehyd gas generated from a pastil containing five grains of para-\\nform by heating the pastil over a proper alcohol lamp.\\nIn an article on the Uses and Limitations of Formaldehyd in\\nDentistry, by Dr. F. W. Low, Buffalo, N. Y., 1 the effect of formal-\\ndehyd gas is further given as shown by a series of experiments con-\\nducted by Dr. Thos. B. Carpenter, assistant bacteriologist to the Health\\nDepartment of the City of Buffalo. Without entering into detail, the\\nexperiments consisted of two series, one of infected instruments and the\\nother of clothing either of school-children, of nurses, or of the doctor\\nin the presence of contagion, to determine whether they could be thor-\\noughly sterilized by placing theni over night in a wardrobe exposed to\\nthe fumigation of the lamp used.\\nThe conclusion of Dr. Carpenter was that This apparatus can be\\nrelied upon, after an exposure of from ten to fifteen minutes, to destroy\\nthin layers of the common, non-sporulating pathogenic organisms.\\nIn regard to the second series of experiments with clothing, he says\\nIt is evident, therefore, that twelve hours exposure to the action of\\nthis lamp in a closet of 15.8 cubic feet capacity is sufficient for effec-\\ntive surface disinfection, the most resistant pathogenic bacteria being\\ndestroyed.\\nA third series of experiments was undertaken with scaling instru-\\nments taken from the instrument-cases from several operators, including\\nthat of Dr. Low. The result of this elaborate experimentation is thus\\nsummed up by the author Every set, except the one where the whole\\ncase was fumigated over night, produced some cultures but not one set\\ndeveloped a culture of pathogenic organisms.\\nThe Low lamp consists of an asbestos-lined tray, or box, sup-\\nported on legs (A), with an opening in the bottom to admit the chim-\\nney of the lamp, the purpose of which is to conduct the fumes of the\\nformaldehyd gas into the tray and upon the instruments it is desired\\nto sterilize.\\nThe working parts of the lamp are shown in the illustration. An\\nordinary alcohol wick is drawn into the wick tube. To place the lamp\\n(-B) in operation fill it with wood alcohol, grain alcohol being incapable\\nof generating formaldehyd. Adjust cone-shaped platinum coil so\\nthat it just touches the top of the wick. Light the latter; place on\\nchimney, and after a few seconds waiting blow out the flame. If the\\ncone be in proper adjustment to the wick, it will be observed that the\\ncoil glows like a live coal, but there is no flame or dangerous heat.\\nHaving the lamp in operation, as described, and the tray properly\\nadjusted to set over it, as in illustration, instruments may be placed\\nin the tray and allowed to remain for ten minutes, a sufficient time to\\n1 Dental Cosmos, February, 1900.", "height": "4580", "width": "2764", "jp2-path": "americantextboo00kirk_0176.jp2"}, "177": {"fulltext": "AGENTS USED FOB STERILIZATION.\\n169\\neffect sterilization. When taken out they should be wiped dry with a\\nsurgically clean napkin or towel.\\nTo stop the fumigation going on in the lamp, remove the chimney\\nand slide the cage high up on the tube, so that the platinum cone no\\nlonger touches the wick, then allow it to cool before replacing chimney.\\nFro. 142.\\nLow s formaldehyd lamp A, for dental use B, for household use C, locked cage for public places.\\nWhile it is not difficult for the average dentist to use formaldehyd\\nas a disinfectant, it will probably be considered a useless expenditure\\nof time, and, therefore, boiling in water and soda for at least twenty\\nminutes seems the more feasible and is equally certain in the results.\\nThe dentist who aims to keep only aseptic instruments should have", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0177.jp2"}, "178": {"fulltext": "170 ANTISEPSIS IN DENTISTRY.\\ntwo sets in daily use. When through with one patient the instruments\\nshould undergo the boiling process in preparation for the next. At\\nthe close of the day all instruments used should be thoroughly\\nboiled and dried upon aseptic napkins and placed in the case. The\\npossibility of infection from tne latter must not be overlooked. The\\nfirst and second set, therefore, used the next day for the first time should\\nbe either boiled again or each instrument dipped into an antiseptic fluid.\\nFor this purpose the writer prefers a strong solution of hydronaphthol\\n(8 grains to the ounce of alcohol) to the carbolic-acid solution ordinarily\\nused. With this care all danger of infection can be removed and the\\ndentist relieved of all legal responsibility.\\nThe preparation of the hands previous to operations is most per-\\nplexing to the conscientious operator, whether this be in surgery or\\ndental practice. In order that dental operators may be able to arrive\\nat definite conclusions in regard to what may be required of them in\\ntheir daily work, the following quotation is given from JNancrede s\\narticle l on the care required in hospital surgical practice\\nSterilized water as hot as can be borne should be employed. This\\nmust, of course, be never cooled by the addition of any but cold ster-\\nilized water. The nail-brush, best made of vegetable fiber, must\\nbe always carefully rinsed after use and sterilized by heat for each\\noperation. Although it is alleged that all soaps made by heat are\\nsterile indeed, that potash soap is an active germ-inhibitor in the pro-\\nportion of 1 5000 yet it is the part of prudence to combine with the\\nsoft soap 5 per cent, of hydronaphthol or thymol, to insure that the\\nsoap itself is free from germs. After thoroughly rubbing into the hands\\nand arms and under the nails abundance of soap, the nail-brush and\\nhot water must be vigorously used, especially beneath and around the\\nnails, for from two to five minutej. Next, carefully clean the nails and\\naround them with a nail-cleaner. Removal of all grease can now be\\neffected by ether or by immersion in alcohol, or best by alcohol contain-\\ning 5 per cent, of dilute acetic acid, which should be rinsed off thor-\\noughly with sterilized water, removing the last traces of soap. Finally,\\nthe hands should be immersed not merely dipped in a 1 2000 mer-\\ncuric chlorid solution for not less than three preferably five minutes.\\nInstead of corrosive sublimate solution, ordinary mustard flour mixed\\nin the hands into a thin paste with sterilized water, used with gentle\\nfriction for two or three minutes and then removed with sterilized\\nwater, will prove a most successful germicide.\\nWhile the foregoing may serve as a basis for comparison, it would\\nbe wholly impracticable in dental practice. It remains, however, that\\nthe hands of the dental operator should be the subject of constant care.\\n1 Loc. cit.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0178.jp2"}, "179": {"fulltext": "AGENTS USED FOB STERILIZATION. 171\\nNails should be kept short and scrupulously clean. It seems to the\\nwriter that the use of a good potash soap and nail-brush, with bathing the\\nhands in alcohol, will be amply sufficient unless working on a syphilitic\\npatient, when more effective methods must be resorted to, and there can\\nbe nothing better than the mode described by Dr. Nancrede.\\nThe conclusions to which the writer has arrived from experience and\\nstudy of the subject may be summed up briefly as follows\\n1. Dipping instruments in an antiseptic fluid previous to operating,\\nwhile beneficial, is not sterilization.\\n2. That boiling with soda is for the dentist the most convenient\\nmeans of sterilizing instruments without injury, while the more recently\\nintroduced method of formaldehyd antisepsis is a dry process that does\\nnot rust or injure steel instruments and is also promptly effective.\\n3. That the ordinary methods used to effect sterilization in surgical\\npractice are not possible in dentistry, but that every dentist is legally\\nand morally bound to live as near to the rules of antisepsis as is possi-\\nble with the demands of a daily practice.", "height": "4552", "width": "2692", "jp2-path": "americantextboo00kirk_0179.jp2"}, "180": {"fulltext": "", "height": "4616", "width": "2760", "jp2-path": "americantextboo00kirk_0180.jp2"}, "181": {"fulltext": "CHAPTER Y.\\nTHE EXAMINATION OF TEETH PRELIMINARY TO OPERA-\\nTION\u00e2\u0080\u0094METHODS, INSTRUMENTS, APPLIANCES\u00e2\u0080\u0094 RECORD-\\nING RESULTS, ETC.\\nBy Louis Jack, D. D. S.\\nThe Operator.\\nThe attitude of the body of the dental operator has considerable\\ninfluence upon the ease. with which the various positions required in\\noperating may be assumed, and also has some bearing upon the free-\\ndom of his hands.\\nThe erect position should be maintained as far as possible and the\\npreponderance of the weight should be sustained upon the balls of the\\nfeet. This secures equilibrium and enables movements to be made\\nwith little embarrassment. The shoulders should be held well back in\\norder that the arms may not be cramped, and to permit the respira-\\ntion to be carried on deeply and with quietness. For obvious reasons\\nthe breathing should be deep, slow, and always through the nose.\\nThe precise use of the fingers requires that in each application of the\\ninstrument a rest, as a fulcrum or base of action, should be used, and\\nwhen force is to be applied a guard in addition is necessary to give\\nsecurity to the movement of the hand. The positions of the rest and\\nthe nature of the guard required in operating are various, depend-\\ning upon the situation of the territory of operation and somewhat\\nupon the natural tact of the individual, so that a definition of\\nthem is scarcely required. Upon a careful application of the rests\\nand guards depends the graceful and comfortable use of the instru-\\nments, and by means of them the hand passes by quick and easy grada-\\ntion from the most delicate touch to the safe exhibition of considerable\\nforce. Each student should study and practice the use of the various\\nrests and guards until by repetition their employment becomes invol-\\nuntary and appropriate to the situation. 1\\nThe contact with the patient should be at as few points as possible\\nand should be generally made with the fingers.\\nExamination of the teeth and mouth in all their particulars is a\\n1 To aid in this study see American System of Dentistry, vol. ii. p. 44 et seq.\\n173", "height": "4552", "width": "2696", "jp2-path": "americantextboo00kirk_0181.jp2"}, "182": {"fulltext": "174 EXAMINATION OF TEETH.\\nnecessary preliminary to the treatment of any diseased or disturbed condi-\\ntion which may appear. The importance of this procedure cannot be\\noverestimated, as on it depends the formation of a correct diagnosis\\nof departures from the normal state and it becomes a basis for the\\nformulation of plans for the treatment required to restore the teeth and\\nthe related structures to a state of health, as well as to define the order\\nin which the several operations shall be taken up, since an orderly pre-\\ncedence in the treatment of individual teeth is frequently necessary.\\nIt is essential that the examination be most thorough, to prevent any\\nfailure to notice the least defect; since an unobserved slight lesion may\\nbecome a deeper injury in a few months, and the consequences of an\\noversight may prove serious.\\nAppliances used in Examination.\\nThe appliances required to effect thorough observation of every\\nportion of each tooth to ascertain the extent of any lesion are of several\\nkinds, viz, mirrors, magnifying glasses, explorers, floss silk, and wedges.\\nThe mierors should be both plane and concave. The plane mirror\\nis important as a means to assist by the reflected image in determining\\nthe position of defects the concave as an adjunct to effect illumination,\\nas it concentrates the rays of light and also may be used to produce an\\nenlarged image. The enlarged image, however, is less sharp in defini-\\ntion than the image of the plane mirror.\\nWorking to the Image. The plane mirror is an important adjunct in\\nall operative procedures connected with the teeth. Many situations in\\nthe mouth do not permit the direct reflection of the rays of light to the\\neye without assuming positions of the body and of the head of the\\noperator which are awkward and embarrassing to free movement of the\\nhand, as well as necessitating inconvenient and tiresome positions of the\\nhead of the patient. In addition, it frequently is impossible to secure\\ncorrect observation of the progress of various procedures by direct\\nvision. These difficulties may be overcome by the movements of\\nthe hand being directed by the image of the field of the pro-\\ncedure on the mirror. This method of working to the image is at first\\ndifficult to the novice, since the images are reversed but by continued\\neffort it becomes as easy to make correct application of movements by\\nthis method as by the direct rays of light. Further continued practice\\nin this way renders the movements so completely under reflex control\\nthat the operator passes from a direct movement to a reverse one, and\\nthe contrary, without an apparent effort of the brain. This is equally\\ntrue in all the various movements, even of those where the employment\\nof considerable force is required.", "height": "4608", "width": "2800", "jp2-path": "americantextboo00kirk_0182.jp2"}, "183": {"fulltext": "APPLIANCES USED IN EXAMINATION.\\n175\\nFig. 145.\\nh r\\na-\\nThe Quality of the Mirror. These appliances should constantly be\\nin good condition to insure clear definition in the image. The best\\nkind of glasses are those in which the surface is covered by a deposit of\\nF 144 pure silver. This furnishes a better reflect-\\ning surface and is more durable than is the\\nso-called silvering with tin and\\nFig. 146.\\nmercury.\\nMagnifying lenses of about 7^\\nfour diameters are useful to de- 7\\ntect minute defects either in the\\nteeth or in the condition of pre-\\nvious operations upon the teeth.\\nThey are used either directly to\\nmagnify the parts, or else to mag-\\nnify the image shown on the face\\nof the plane mirror when direct\\nrays of light cannot be caught.\\nThe latter method gives a clearer\\ndefinition than the magnified image\\nof the concave mirror.\\nThe magnifying glass may be\\nthe ordinary watchmaker s glass\\nheld before the eye by the muscles\\nof the brow and cheek\\nor the lens mounted\\nas shown in Fig. 144.\\nSuch glasses are indis-\\npensable to the careful\\npractitioner, since with\\ntheir aid defects of the\\nteeth and of operations\\nmay be detected which\\nwould escape obser-\\nvation by other means.\\nExplorers are, es- (j\\nsentially, prolongations\\nof the fingers they\\nconvey impressions by\\ntheir vibrations to the Explorer,\\ntactile nerves, and are principally intended to be\\napplied to parts where direct rays of light cannot reach. The forms\\nrequired are simple and few. Their points should be delicate, to enable\\nthe smaller apertures and spaces to be entered, and are best when made\\nMagnifying lens.\\nSelf-contained\\nsocket.", "height": "4560", "width": "2712", "jp2-path": "americantextboo00kirk_0183.jp2"}, "184": {"fulltext": "176\\nEXAMINATION OF TEETH.\\nof piano-wire, No. 18 B. S. gauge, filed to acuteness\\nand bent to a shape similar to that shown in Fig. 145.\\nThis form may be applied to all surfaces of the teeth,\\nand but slight modifications are needed to explore posi-\\ntions difficult of direct approach. At part a the size of\\nthe finer ones should be No. 25, and near the ultimate\\npoint, 6, No. 30. The temper of this kind of steel gives\\nsufficient stiffness and also permits slight bending to make\\nmodifications of the form to meet all requirements. The\\nultimate point may be sharpened and renewed at pleasure.\\nThe handles in which these instruments are inserted may\\nbe of wood, with metal sockets which should be of sufficient\\nlength to come into contact with the finger or they may\\nbe fixed in metal holders, in which case the latter should\\nbe tapered to avoid weight and to give balance. Either\\nform of handle should be round, to permit fractional\\nrotary change of direction. Fig. 145 shows an explorer,\\nwhich consists of a socket, into which the wire point is\\nsecured by means of powdered shellac or powdered sulfur.\\nThe points may be displaced and renewed when required.\\nThis socket fits into the usual cone-socket handles. Fig.\\n146 is a self-contained socket for the same purpose.\\nExplorers of this kind may be re-formed by straight-\\nening and then re-dressing between two emery-cloth disks\\nin the dental engine, when the points can be shaped at\\nwill.\\nFloss silk is used to pass between the approximal\\nsurfaces of the teeth at the places which are in too close\\ncontact to permit the ingress of fine explorers. In these\\npositions floss silk may detect the presence of superficial\\nsoftening of the enamel by the character of the friction\\nor by the fraying of its fibers. It\\nalso is of use in determining the con-\\ndition of fillings on approximal faces\\nor the presence of a deposit of sali-\\nvary calculus at similar parts. The\\nDow electric lamp for mouth illumination with reflectors. Reflector A is jointed to vary the angle\\nof reflection. Reflector B is for illumination of the fauces. Reflector Cis for lateral illumination.", "height": "4580", "width": "2764", "jp2-path": "americantextboo00kirk_0184.jp2"}, "185": {"fulltext": "THE EXAMINATION. 177\\nsilk should be slightly waxed in order to bind the fibers. Entire\\nreliance cannot be placed upon the use of silk, since it may in some\\ncases pass slightly carious spots without the fibers being displaced, but\\nit frequently furnishes indications for further procedures by which to\\nestablish certainty as to the state of approximal surfaces.\\nWedges are used when neither explorers nor silk give positive indi-\\ncations of carious action but have raised doubts of the integrity of any\\npart. They may be of wood where the teeth are not firmly fixed, when\\nthe space may be immediately made otherwise, where the fixation is\\nfirm, india-rubber or linen tape may be forced in.\\nTransillumination of the teeth and of the adjacent parts by the elec-\\ntric mouth lamp (Fig. 147) is extremely useful in cases where a question\\nhas arisen as to the condition of any approximal surface. Superficial\\nchanges of the enamel may frequently be detected by this means. It\\nis also of service in diagnosis of derangements of the antrum and to\\ntest the vitality of the pulp.\\nThe Examination.\\nThe parts of the teeth most liable to carious action are those\\nwhich most easily retain deposits of sedimentary matter composed of\\nfood debris, thickened mucus, and bacterial growths. These are the\\nlabial and buccal surfaces, where the mechanical relations of the lips\\nand cheeks tend to retain sediment the sulci, which by the direct\\nforce of mastication have food driven into them and the approx-\\nimal surfaces. The latter are the most important to consider.\\nThe interproximal space is a serious predisposing cause of caries, be-\\ncause the counteraction of the tongue and cheek in adapting the food\\nbetween the occlusal surfaces of the teeth forces the finer particles of\\nthe food into the interproximal spaces, where it is retained by capillary\\nattraction and by the apposition of the cheeks with the buccal surfaces\\nof the teeth. This space is usually triangular, the gum forming the\\nbase of the triangle. The point where caries usually begins is at the\\napex of this triangle, where there is the least movement and inter-\\nchange of the contents of the space, as here the capillary force is the\\ngreatest, so that the fermentative processes of food decomposition are\\nleast interfered with.\\nThe technique of examination is as follows After a cursory in-\\nspection of the denture with the mirror, the explorer is applied to the\\npreviously indicated surfaces, particular care being used in determining\\nthe condition of approximal surfaces, by introducing the instrument\\ninto the triangular space, the point being directed toward the acute\\nangle. It should be drawn back and forth with a slight rotary move-\\nment so as to impinge the point successively upon the whole approxi-\\n12", "height": "4556", "width": "2708", "jp2-path": "americantextboo00kirk_0185.jp2"}, "186": {"fulltext": "178 EXAMINATION OF TEETH.\\nmal surface of each tooth. This movement should be made from the\\ninner as well as from the outer aspect. In this manner the instrument\\nwill be brought into contact with every accessible portion of the inter-\\nproximal surfaces.\\nThen the sulci are explored and the buccal and lingual surfaces\\nexamined.\\nThe inspection is thus conducted from tooth to tooth. Next the lines\\nof apparent contact are critically tested with the mirror for evidence of\\nslow changes of structure as shown by discoloration or rapid alterations\\nshown by a milk -like appearance of the tooth surface.\\nFinally, all approximal surfaces which could not be explored are\\nsilked. To do this the floss is wrapped upon the index finger of the\\nleft hand, and with the right is drawn between the contact surfaces\\nwith a sliding lateral movement. Care should be exercised that no\\ninjury be done to the gingival margin of the interproximal space by\\nsuddenly and forcibly driving the floss into contact with it. This acci-\\ndent may be effectually avoided by a proper guarding and supporting\\nof the fingers by contact with the adjacent teeth. Practice gives\\nfacility in determining by means of the silk the state of the parts in\\ncontact with it.\\nIn the inspection of previous stoppings, all margins, particularly\\nthose beneath the gum, should be critically inspected.\\nLastly, doubtful situations should be noted for subsequent examina-\\ntion to be made after separation.\\n(The tests for pulp exposures are considered in Chapters VII. and\\nVIII.)\\nThe order of examination is best conducted by beginning at the\\nmedian line of each quarter of the denture, progressing posteriorly with\\none line of observation and returning to the place of beginning with\\nanother line of observation.\\nThe Chart Record. The chart record should at the same time be\\ncarried on by the principal, or better an assistant, with the view of\\nsecuring a complete record of each derangement, for guidance and for\\nreference. The details of the record are indicated in a simple manner\\nby symbols which are illustrated by Fig. 148, and explained by the glos-\\nsary. These symbols may be combined, where required, to give fuller\\nexpression.\\nFrom this temporary record important operations when executed\\nmay be transferred to a permanent record.\\nThe constitutional condition and the texture and apparent resistance\\nof the teeth to caries and attrition the inherited tendency to diseases of\\nthe teeth the chemical reaction of the mucous and salivary secretions the\\nstate of the general heath the condition of the mucous membrane of the", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0186.jp2"}, "187": {"fulltext": "THE CHART RECORD.\\n179\\nmouth and throat the indications presented by the tongue the dietary\\nhabits and other hygienic relations the tendency to catarrhal affections\\nthe presence of the rheumatic or gouty diathesis are all questions which\\nFig. 148.\\nS-EX\\nsignifies In the interproximal space.\\nAttention\u00e2\u0080\u0094 re-examine.\\nSuperficial softening.\\nA carious cavity.\\nAt the cervix.\\ns To separate.\\np To polish.\\nc signifies Salivary calculus.\\nex To examine.\\n1 A pulp nearly exposed.\\n1 A pulp probably exposed.\\n3 A pulp fully exposed.\\nD A devitalized pulp.\\nenter into the prognosis and frequently largely determine not only the\\nhygienic directions to be given to the patient, but also determine, in\\nconnection with the age and habits, the important question as to whether\\nthe restorative operations shall be of a permanent character or only of a\\ntemporary nature designed to preserve the teeth until restored normal\\nfunctions may make it judicious to perform more enduring operations.\\nThe foregoing considerations with respect to the examination of the\\nmouth and teeth sufficiently meet the requirements for beginning the\\nrational treatment of dental disorders.", "height": "4556", "width": "2696", "jp2-path": "americantextboo00kirk_0187.jp2"}, "188": {"fulltext": "", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0188.jp2"}, "189": {"fulltext": "CHAPTER VI.\\nPRELIMINARY PREPARATION OF THE TEETH\u00e2\u0080\u0094 REMOVAL OF\\nDEPOSITS AND CLEANING OF THE TEETH\u00e2\u0080\u0094 WEDGING\u00e2\u0080\u0094\\nOTHER METHODS OF SECURING SEPARATIONS\u00e2\u0080\u0094 EXPOS-\\nURE OF CERVICAL MARGINS BY SLOW PRESSURE, ETC.\\nBy Louis Jack, D. D. S.\\nCleansing the Teeth.\\nBefore restorative operations are commenced upon the teeth all\\ndeposits of salivary calculus upon them should be removed and they\\nshould be cleansed of the covering- of partially inspissated mucus\\nwhich even in persons of more than ordinary carefulness is liable to be\\nfound upon them. This film favors the admixture with it of sedi-\\nmentary matter from food substances and frequently has so much con-\\nsistence as to offer considerable resistance to its removal, and it pre-\\nvents to a degree the contact of the naked brush with the teeth. Its\\npresence is in every way detrimental to the preservation of the teeth,\\nsince it not only favors the adhesion of starchy matters, but also fur-\\nnishes, wherever situated in connection with these food products, a\\nfavorable habitat for the development of bacterial forms responsible\\nfor the formation of the acid products that are the active agents of\\nenamel solution. This deposit is most frequently formed on the inner\\nand outer surfaces of the posterior teeth, where it invades the inter-\\nspaces and in some cases covers all surfaces which are not directly sub-\\nject to the friction of mastication. It should be thoroughly removed\\nand all surfaces should then be carefully polished.\\nThe best means to effect this is to polish the parts with a mixture\\nof pulverized pumice with glycerin. The glycerin binds the particles of\\npumice and permits its retention upon the polishing instruments. The\\npersistence of the deposit is shown by the fact that when the pumice\\nis applied it is a moment before the polishing implement comes into\\nactual contact with the enamel. To be suitable for this purpose the\\npulverized pumice should have been elutriated or passed through a fine\\nbolting cloth to remove the coarse and irregular particles which if per-\\nmitted to remain might cause injury to the enamel surface. After the\\nremoval a vitreous surface should be given by quick friction with stan-\\n181", "height": "4564", "width": "2692", "jp2-path": "americantextboo00kirk_0189.jp2"}, "190": {"fulltext": "182\\nPRELIMINARY PREPARATION OF THE TEETH.\\nFig. 149.\\nnic oxid tutty powder which also is better applied when combined\\nwith glycerin or rubbed up with vaselin.\\nSalivary calculus is found precipitated at parts not subject to free\\nfriction, such as the buccal surfaces of the molars, the inner faces of\\nthe lower incisors, and it frequently invades the interstices. These\\ndeposits also should be displaced and the\\nsurfaces polished.\\nThe better appliances for the removal\\nof superficial calculus are sickle-shaped\\nscalers of various sizes and forms, which\\nare inserted beneath the free margin of\\nthe gum, when the direction of the move-\\nment should be obliquely toward the\\nocclusal aspect to avoid injury to the\\ngingival attachment with the tooth. The\\nconsideration of the removal of deeply\\nseated salivary calculus where some\\nserious injury has been caused by its presence is treated of in Chap.\\nXIX.\\nPolishing the Triangular Portion of the Interproximal Spaces.\\nWhen this is required an efficient means is to employ gilling twine\\nof sizes proportioned to the space. This is applied by looping one\\nor more strands with a piece of floss silk, when the silk is drawn up-\\nward into the triangle and then is used to pull the twine into the\\nspace, which being armed with suitable powders is drawn to and fro\\nuntil the absence of friction indicates that the surfaces have become\\nsmooth.\\nAbbott s scalers.\\nCARE BY THE PATIENT.\\nCoincident with the preparation above described the patient should\\nbe given such instruction as will tend to maintain the state of cleanli-\\nness. The importance of this should be impressed as a necessary\\nhygienic measure to preserve the teeth. This is to be accomplished by\\nthe use of suitable brushes and properly compounded powders. The\\ndetergent effect of powder is principally due to the particles becoming\\nmixed with the film of mucus. This action breaks up the continuity\\nof the film, which, with the accompanying sediments, is displaced by\\nthe friction of the brush.\\nThe correct use of the brush requires that it be placed with some\\ndegree of firmness upon the outer and inner faces of the teeth and then\\nslightly rotated. The pressure drives the bristles into the valleys, and\\nthe rotary movement being away from the gum avoids injury to that\\nstructure. The application of this procedure in combination with the", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0190.jp2"}, "191": {"fulltext": "TREATMENT OF THE MUCOUS SURFACES. 183\\nuse of j^ c s and floss silk should maintain a correct hygienic condition\\nof the teeth, upon which, in the light of the present knowledge of the\\ncauses of solution of the enamel, depends the preservation of the teeth\\nfrom that source of injury. It has been shown that when sound\\nenamel becomes attacked, the potent cause is the fermentation of\\nstarchy deposits permitted to remain in contact with it.\\nIt should be understood that the use of the pick removes deposits\\nfrom the cervical triangle, and that silk is intended to sweep the more\\ncontracted portion of the interstice.\\nFurther reason for care is found in the fact that the mouth in an\\nunclean condition becomes a favorable habitat for the development of germs\\nsome of which may have pathogenic properties capable of affecting the\\ngeneral health. It therefore becomes the duty of the dental adviser to\\nenforce correct hygienic conditions of the mouth.\\nMuch importance in this connection should be attached to the use of\\ncleansing preparations having inhibitive action toward bacterial life.\\nThose most serviceable contain hydronaphthol, which has considerable\\nefficiency without toxicity. Formalin as an ingredient of a wash is also\\napplicable, but must be prescribed with considerable caution.\\nTreatment op the Mucous Surfaces.\\nWhen the gums, the membrane of the mouth or of the throat are\\ninflamed, treatment preparatory to operations upon the teeth should be\\ndirected toward restoring these parts to a normal state. Where the\\ninflammatory condition is not expressive of derangement of the alimen-\\ntary functions and is the result of some simple local irritation, the\\ncondition will usually respond to the topical action of stimulant tonics.\\nIt is necessary here to discriminate as to whether or not the inflamed\\nsurface has been produced by neglected care of the mouth, which fre-\\nquently induces a lax condition of the gum from the absence of friction\\nor by the presence of bacteria. These may cause a deficiency of tone\\nor disorders in other portions of the mouth and of the throat. Should\\nthese conditions be present the employment of disinfectant gargles and\\nmouth-washes is indicated.\\nThe presence of salivary calculus may also induce inflammatory dis-\\nturbance of the gums, and from the points of deposit this may extend\\nby diffusion over a considerable area. In this connection deposits,\\neither of calculus or of sedimentary accumulations, posterior to the lower\\nthird molars may induce serious diffuse inflammation of the contigu-\\nous tissues, sometimes extending to the fauces. For this condition the\\nmechanical removal of the deposits combined with an antiseptic spray\\nwill usually be restorative.\\nFor diffuse redness and deficient tone of the mucous surfaces a wash", "height": "4560", "width": "2688", "jp2-path": "americantextboo00kirk_0191.jp2"}, "192": {"fulltext": "184 PRELIMINARY PREPARATION OF THE TEETH.\\ncomposed of potassium chlorate and quinin will prove sufficient in most\\ncases, as follows\\n]fy. Potassii chloras, 3ij\\nQuininse sulphas, gr. iij\\nSp. rectificatus, Ij\\nAquse, ^vj. M.\\nS. For use as a gargle. A dessertspoonful to a wineglass of\\nwater, or directly upon the gum in full strength by means of\\na soft tooth-brush.\\nConcurrently with the local therapeusis the employment of massage\\nof the gum with the finger, either naked or covered with a napkin, is\\nof considerable value.\\nWhen the conditions are catarrhal or are expressive of gastric\\nderangement only general treatment with concurrent attention to the\\ndiet and correct hygienic relations will meet the requirements of the\\ncase. Coincident with the general treatment above indicated, the\\nsimpler operations upon occlusal surfaces may be carried on.\\nIn all cases of initial treatment for children or nervous patients it\\nis important to begin with simple and, as nearly as may be, painless\\noperations, to accustom such patients to the more or less disagreeable\\nprocedures and to elicit their interest and co-operation in what is being\\ndone for their benefit.\\nCavities on Approximal Surfaces.\\nThe preliminary treatment of this class of cases, on account of the\\nlimitation of space and the necessity for somewhat indirect application\\nof the instruments and of the requisite force, necessitates the closest\\nattention to every detail. Upon the care here taken depends the\\ncomfort, and furthermore, indirectly in many instances, the health of\\nthe person.\\nThe procedure of first importance is to produce a sufficient enlarge-\\nment of the interproximal space. In all cases, whether the teeth are in\\napparent contact or whether they may, from loss of substance on the\\napproximal aspect, present sufficient room for the management of the\\nvarious procedures, spacing is equally necessary. It is done in order\\nthat when the stopping procedures shall have been completed the natural\\nrelations of the teeth with each other will be restored. This relation, as\\nbefore indicated, is one of apparent contact near the occlusal surface\\nwith a triangular space at the cervix. The mechanical basis of this\\narrangement is such that the function of comminution of food is better\\neffected if there is no breach in the continuity of the occlusal aspect of\\nthe denture.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0192.jp2"}, "193": {"fulltext": "SEPARATION OF THE TEETH. 185\\nThe consequences of breaches of continuity, especially in relation to\\nthe posterior teeth, are often of serious import. Not only may the food\\nbe driven into the space, to the discomfort of the patient, but serious\\ninjury of the gum may follow, as in many cases the tissue becomes\\ninflamed by the impaction of food in the enlarged interspace, which in-\\nduces peridental disturbances and may occasion the ultimate loss of the\\naffected tooth. It is also not unimportant to consider that the forms of\\nthe teeth have an esthetic value, and that the harmony of the features\\nforbids the mutilation of their natural forms.\\nSeparation of the Teeth.\\nSeparation of the teeth is a procedure requiring care to avoid injury\\nand to render the process comparatively painless.\\nWhen the teeth are mobile, as in the case of children, the movement\\nis more easily and more quickly made than when the alveolar walls are\\ncompact and when also the teeth are in close proximity. In the former\\ncase the arch easily expands and permits the teeth to yield in the other\\ncase the resistance requires more force to be used and the application\\nof it for a longer period. In all instances the force and the material\\nused should be adapted to the presented conditions and the movement\\nshould be sustained until the required space is gained, it being dele-\\nterious to make repeated attempts to separate the same pair of teeth.\\nWhen the proper precautions are taken there is no danger attending\\nthe process even the firmest structures of mature age permit sufficient\\nspacing if it be slowly and steadily done.\\nMETHODS OF MAKING SEPARATIONS.\\nThe means by which these are effected are various and the choice is\\ndetermined by the amount of space required, the time in which it must\\nbe accomplished, and the firmness of the supporting structures. Some\\nregard must also be had for the peculiar susceptibilities of the patient\\nto the pain which may be caused by the effort. These methods are\\nby immediate wedging, which may be made when the fixation of the\\nteeth is not firm by the swelling of firmly impacted pellets of cotton\\nor of tape, and by the resilience of strips of caoutchouc where the teeth\\nare in general contact and where they are firmly fixed.\\nImmediate -wedging is more applicable to the front teeth, where\\nusually only a small space is required, and is a valuable method of\\nsecuring a separation of the front teeth to determine their condition\\nand to permit polishing strips to be inserted for the removal of super-\\nficial discolorations and for the treatment of superficial softening. Here\\nthe procedure is to insert a wooden wedge between the incisors near the\\nincisive edge, when it is forced by pressure or by percussion until a suf-", "height": "4556", "width": "2688", "jp2-path": "americantextboo00kirk_0193.jp2"}, "194": {"fulltext": "186\\nPRELIMINARY PREPARATION OF THE TEETH,\\nficient opening is effected, the space then being secured by another wedge\\nof hard close-grained wood forced between the teeth at the cervix. This\\nprocess in some instances is repeated by forcing farther the first wedge\\nand again increasing the security by driving the cervical wedge. This\\nplan is not applicable when the interspace at the neck is quite angular,\\nsince the fixing wedge cannot be made secure, as it then is disposed\\nto advance against the gum. In this case one of the subsequent\\nmethods should be pursued.\\nIf the fixation of the teeth be not firm they yield by a slight enlarge-\\nment of the arch and by closing the neighboring slight spaces.\\nImmediate separations may be effected by mechanical separators,\\nnotably the William A. Woodward (see Fig. 150), for the front teeth and\\nFig. 150.\\nFig. 151.\\nBretTfE\\nWoodward s separator.\\n^ii;;Bi;;ii,;il|ininfi^^||p^\\nPerry s separator in conjoint use with matrix.\\nthe Perry (see Fig. 151) for the bicuspids and molars. It should be\\nstated that each of these is preferably to be used when some previous\\nspace has been made by other means, following which a considerable\\nincrease of space may be secured by these appliances.\\nSeparation by the Swelling- of Fibrous Materials. These act by\\nthe capillary force of water upon the fibrous structure of the material,\\nwhether pledgets of cotton or tape. This means is also more applica-\\nble when the fixation of the teeth is not firm, and has the advantage of\\nbeing painless and more readily tolerated by children and by persons\\nwho are impatient of pain or of any form of dental distress.\\nPledgets of cotton are more applicable where a partial preliminary\\nopening of a carious cavity has been made, and are more appropriate for\\nthe posterior teeth. Here, when there is no danger of pulp exposure,\\nthe pledgets may be packed with considerable firmness. In some\\ninstances it is advantageous to saturate the pledget with thin sandarac\\nvarnish, which attaches the fibers, but the time required is much in-\\ncreased, as the cotton yields to capillary attraction only as it loses the\\nresin.\\nTape is more useful for the incisors it should be of linen and may\\nor may not be waxed. Its entrance is facilitated by an immediate pre-\\nliminary application of a wooden wedge.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0194.jp2"}, "195": {"fulltext": "SEPARATION OF THE TEETH. 187\\nCaoutchouc India-rubber. When a strip of india-rubber is\\ndrawn into a close interspace the middle portion is constricted to great\\ntenuity. The action is by the resilience determining the two exposed\\nends toward the middle, with the result that at length the space attains\\nthe size of the thickness of the strip. It will be perceived that the\\nphysical force is that of two opposed wedges acting with constant\\npower. The effect is such that it overcomes the greatest resistance to\\nseparation of the parts and therefore is the most effective means which\\nwe have.\\nCaution is required in the use of this material both as to the thick-\\nness of the rubber and as to its parity. The pronounced resilience of\\npure rubber is generally painful, and in most instances greatly so.\\nThe resilience can be reduced by employing adulterated specimens\\nof the material. The white-rubber tubing of the shops cut longi-\\ntudinally into various widths effects the object with less rapidity but\\nsurely, and generally without pain. The strip is drawn into position\\nby a sliding motion, care being taken not to force the piece into contact\\nwith the gum. To prevent the rubber being conveyed to the gum as\\nthe space enlarges, a small portion should extend slightly beyond the\\nocclusal surface. As this kind of rubber is more difficult to introduce\\nwhen the contact is close and firm, a previous partial opening should be\\nmade with a piece of rubber dam. This method has the value of pain-\\nlessness, and also does not usually necessitate a period of rest after the\\nseparation has been effected.\\nRed Base-plate Gutta-percha. When it is desirable to gradually\\neffect considerable spacing between teeth, where the carious cavities are\\ndeep with well-defined boundaries but not involving the pulp, the method\\nof Dr. Bonwill, of packing the cavities and the existing space with a\\nsufficient mass of this form of gutta-percha, produces expansion by the\\ncontinued force of mastication driving the material upward. This\\nmethod also has value in some instances where it is desired to force\\nthe gum beyond the cervical margins, and may be an acceptable sub-\\nstitute for aseptic cotton for this purpose.\\nSecurement of the Space. Should soreness of the teeth have been\\ncaused by the separation, a period of rest should be given the parts until\\nthe distress has passed over. It is, however, important that large spaces\\nshould not be long retained, since in some instances alveolar resorption\\nmay be induced by the continuation of the changed position. An inter-\\nval of two days usually suffices for the pericementum to recover from\\nthe disturbance, when the restorative procedures may be conducted.\\nThe retention of the space may be effected with gutta-percha or with\\nthe plastic cements, the first being suitable when an open cavity\\nappears zinc phosphate when from the smallness of the cavity gutta-", "height": "4560", "width": "2684", "jp2-path": "americantextboo00kirk_0195.jp2"}, "196": {"fulltext": "188 PRELIMINARY PREPARATION OF THE TEETH.\\npercha may not be readily retained. Oxychlorid of zinc should be used\\nwhen the cavities are shallow but sensitive, the reason for which\\nwill appear later. It is generally advisable to introduce a thin wedge\\nof wood at the cervix and in contact with the gum to prevent the re-\\ntaining material from impinging upon this tissue and to give a base to\\nsupport the introducing force.\\nExposure of Cervical Margins. When cavities extend beneath\\nthe gum, which frequently is the case when caries has recurred above\\nthe cervical margins of fillings, it becomes necessary to force the gum\\nsomewhat above the carious border. This should be done quickly\\nrather than slowly, otherwise in adult subjects the continued pressure\\nmay arouse diffused inflammatory disturbance of the contiguous tissues.\\nGenerally it is preferable first to cut away the gum between the teeth\\nwith a straight, narrow bistoury, and gently force red gutta-percha\\nagainst the gum, gradually moulding it to the form of the depression.\\nCotton pellets for this purpose are not admissible unless they are anti-\\nseptically charged, for which purpose an admixture of aristol with the\\ncotton is the most suitable, since not being soluble in water it better\\nmaintains the asepsis. Cotton may be conveniently charged with aris-\\ntol by saturating it with a solution of aristol in chloroform and allow-\\ning the greater portion of the solvent to evaporate before introducing\\nthe pledget.\\nWhen hypersensitiveness of the gum tissues exists it is admissible to\\nparalyze the sensation with a suitable solution of cocain, previous to\\nintroducing the pellet of either gutta-percha or cotton fiber. A four\\nper cent, solution of cocain hydrochlorid applied upon cotton to the\\nsensitive tissues will speedily relieve the condition.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0196.jp2"}, "197": {"fulltext": "CHAPTER VII.\\nPRELIMINARY PREPARATION OF CAVITIES TREATMENT\\nOF HYPERSENSITIVE DENTIN BY SEDATIVES, OBTUND-\\nENTS, LOCAL AND GENERAL ANESTHETICS\u00e2\u0080\u0094 STERILIZA-\\nTION, WITH A BRIEF CONSIDERATION OF THE PHYSIO-\\nLOGICAL AND THERAPEUTIC ACTION OF THE MEDICA-\\nMENTS USED.\\nBy Louis Jack, D. D. S.\\nHypersensitive Dentin.\\nDentinal hypersensitiveness frequently presents the most serious\\nimpediment to the procedures connected with the treatment of dental\\ncaries. This condition must be considered an exaltation of the normal\\nsensitiveness of the dentin, and presents a wide range from slight pain\\non contact being made to so high a degree of sensitiveness as to be un-\\nendurable. In the latter instance persons of the greatest capacity for\\ntolerating pain will shrink from the most careful instrumentation. Im-\\nmediately upon the opening of a carious cavity there usually are indica-\\ntions of excitement of the vital elements of the dentin. This con-\\ndition may be so slight as to present no obstacle to further procedures,\\nor it may on the other hand be so excessive as to forbid all instru-\\nmentation until a reduction of the sensitiveness has been effected.\\nThis altered state of the dentin has been considered by some as one\\nof inflammation of the dentin. As the opportunity does not exist for\\nthe usual concomitants of inflammation as pathologically defined and\\nwhich are induced by the alterations of the circulation of the blood,\\nviz. heat, redness and swelling, with exaltation of nervous function\\ncaused by the additional supply of arterial blood, the term inflamma-\\ntion is a questionable one to apply to a hyperesthetic condition of\\ndentin. This manifestation is more logically explainable as a disturb-\\nance caused by changed relations of a tissue which is naturally pro-\\ntected by the enamel from irritating influences. The relation of the\\nenamel and the dentin is analogous to that of the epidermal coat of\\nthe skin and the rete mucosum. Pain caused by abrasion of the\\nepidermis is immediate and acute, and occurs before the increased\\nsupply of blood increases the intensity of it. It is hence induced by\\n189", "height": "4568", "width": "2688", "jp2-path": "americantextboo00kirk_0197.jp2"}, "198": {"fulltext": "190 PRELIMINARY PREPARATION\\nthe altered relation of the mucosum. The analogy is further borne out\\nby the fact that in each instance a protective covering affords salu-\\ntary relief.\\nThe normal sensitivity of dentin is not high, as is shown by an\\nimmediate examination of a surface exposed by accident, but after a\\nfew days the denuded surface manifests impatience of mechanical\\ncontact and of applications of cold, which proves that the altered rela-\\ntions induce a condition of the part similar to the condition of the\\nskin when the epidermis is broken. This appears to be the case in-\\ndependent of the influence of chemical agencies, as exaltation of sensi-\\ntiveness occurs when the fluids of the mouth are in a normal state.\\nThe same indications are presented when a non-sensitive cavity is pre-\\npared, as here, in case the cavity be not protected by a stopping, the\\nsame phenomenon subsequently appears.\\nGenerally also, in such cases, if a stopping is inserted without pre-\\nviously effecting a coagulation of the surface of the cavity, pain arises\\nupon reduction of temperature. This condition is designated as sec-\\nondary sensitivity, which is caused by the traumatism. In some cases\\nof this kind the pain becomes so great as to require the removal of the\\nstopping and the carbolization of the cavity. In extreme cases reflected\\npain in the other teeth may appear in consequence of the disturbed\\nrelations making an impression upon the nervous elements of the pulp.\\nWhen exposure of the dentin has been brought about by caries, the\\nsensitivity excited is liable to be much exalted above the normal, and is\\nonly prevented from giving constant indications of this condition by\\nthe presence of the carious matter, which, being a poor conductor of\\nheat, in a measure protects the pulp from thermal irritation. This\\naccounts for the fact that while there may sometimes be acute pain in\\nthe early stages of decay of dentin, the irritability and reaction of the\\npulp appear to become less as the caries advances.\\nWhen the teeth are undergoing rapid decay the dentin is more sen-\\nsitive than when the carious process is slow. As the color of the\\ncarious matter gives some indication of the rate of progress, we may\\nfrom this indication form an impression of the probable degree of\\nsensitiveness. When the carious matter is light, the action has been\\nrapid when it is yellow or light brown it is less active and when it\\nis dark brown or black, it has progressed very slowly. In some cases\\nof the last character, when the parts are subject to friction, spontaneous\\ncessation of decay takes place. The parts are then nearly devoid of\\nsensitiveness. The process by which the dentinal tubuli become oblit-\\nerated by calcific deposits is called ebumation. When the dentin be-\\ncomes exposed by attrition, that tissue is not as greatly irritated as it is\\nby the progress of caries, since by reason of the gradual loss of sub-", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0198.jp2"}, "199": {"fulltext": "HYPERSENSITIVE DENTIN. 191\\nstance changes take place within the tubules by which their capacity to\\nconvey sensation is diminished or obliterated as the case may be.\\nWlien the gum recedes, exposing the ceruentum, a very high degree of\\nsensitivity is often excited, which is prone to decline by spontaneous\\nchanges of structure. There is often here the added influence of acid\\nconditions of the mucous secretions where they flow out upon the teeth\\nat this point, and where, too, the parts are not easily cleansed. It is a\\nnotable fact in connection with cervical hypersensitiveness that while it\\npersists these parts are less liable to decay than when loss of sensitive-\\nness here takes place.\\nThe area of hypersensitivity usually is not evenly distributed\\nthroughout the carious cavity, but has its chief seat near the line of\\nunion of the dentin with the enamel, thus bearing out the law T that\\nsensitivity is greatest at the terminal end-organs of the sensory nerves,\\nwith the further qualification that the more minute the fibrillar the\\ngreater may be the acuteness of the sensitivity. This fact is illus-\\ntrated by the example of cavities in the occlusal surfaces of the molars,\\nwhich manifest pain only at the margins is only less evident in the\\ncavities of approximal surfaces, and is strongly shown in the shallow\\nbuccal and labial cavities, wdiich present their w T hole surfaces near the\\nline of juncture of enamel and dentin.\\nIn most cases of caries, the zone of highest sensitivity is immediately\\nbeneath the soft portion of the decay, and when this layer of dentin is\\ncut away the pain becomes less, in some instances approaching the nor-\\nmal. This statement, however, has force only in the milder manifesta-\\ntions of this condition.\\nThe Effect of Acid Conditions of the Oral Fluids. In the pre-\\nvious chapter some allusion was made to the fact that an acid state of\\nthe oral fluids is detrimental to the teeth as promoting carious action,\\nand that alkaline or even neutral states have a retarding influence.\\nHere it must be considered as an axiom that no cause is so active as a\\nprimary influence in inducing excessive dentinal sensitivity as a con-\\nstant slightly acid state of these fluids and, conversely, that a neutral\\nor slightly alkaline state is non-irritating. These conditions should be\\nkept in constant view in dealing with this subject.\\nThe degree of sensitivity of dentin is modified by a variety of\\nother general conditions. These are relative density of the structure,\\nrapidity of the carious action, and the constitutional peculiarities of the\\nperson which are connected most directly with nervous impressiona-\\nbility to disturbances of the tissues.\\nThe rate of progress of caries exerts considerable modifying influence\\nover dentinal sensitivity. When caries is of slow progress the amount\\nof organic tissue exposed to irritation is comparatively small, for the", "height": "4552", "width": "2684", "jp2-path": "americantextboo00kirk_0199.jp2"}, "200": {"fulltext": "192 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nreason that the well-known salutary and protective changes of structure\\ngo on coincidently with the slow inroad. The slight irritation of slowly\\nadvancing caries to some extent exerts a stimulating influence toward\\ninducing tubular deposits. On the other hand, when the carious pro-\\ncess progresses with rapidity, reparative efforts upon the part of the\\npulp are paralyzed, the organic elements of the tissue become denuded\\nto a greater extent, and therefore sensitivity is increased to a propor-\\ntionate degree.\\nAs these fibrillar elements are the means of extending the irritation\\nto the pulp of which they are the peripheral prolongations, it is evident\\nhow important a factor the active advance of caries is, and also to what\\nextent the rapidity of the process increases the morbid concomitants\\nof dental caries. It has been pointed out that the area of hypersensi-\\ntiveness generally pertains to a narrow line at the outer limit of the\\ndentin, but in rapid caries this line is a broader one.\\nThe anatomical element of the dentin concerned with its sensi-\\ntivity is contained within the tubuli. While the exact nature of the\\nmatter in these tubules has not yet been certainly determined, it has\\nbeen shown to have sufficient consistence to permit of extension, as\\nin separating sections under the microscope what appear to be fibers\\nhave been seen. Also the same appearance has been presented in fresh\\nspecimens when the pulp has been drawn away from the dentin. It\\nis not difficult in reviewing these facts in connection with the various\\nconditions and phases of dentinal sensitivity to conclude that the exalta-\\ntion is inseparably connected with an irritated state of the tubular con-\\ntents. The variation in the degree of sensitivity of different teeth of\\nthe same mouth of those which are side by side and in a similar\\ndegree of progress of carious action the profound fact, heretofore stated,\\nthat the dentin at a short distance beneath the decay is much less sen-\\nsitive that in some instances sedatives modify the degree of pain, and\\nthat coagulants produce a marked impression upon the capacity of the\\ntubular contents to convey sensation, force by inference the conclusion\\nthat in diseased conditions this anatomical element is largely concerned\\nin conveying impressions to the central organ of the tooth.\\nIt is also undoubted that unusually high sensitivity of dentin is an\\ninherent constitutional condition with some persons, and that it pertains\\nto some families apparently as an inheritance, but may be explained in\\nthese instances as the transmission of acute nervous impressionability.\\nIn connection with this subject should be considered the further\\nobservation that the temperature sense of the teeth is various that with\\nsome the application of ice makes no impression upon the teeth when\\nin normal condition, while with others in the same condition the least\\ncold induces pain. It would further appear that the degree of sensitivity", "height": "4608", "width": "2800", "jp2-path": "americantextboo00kirk_0200.jp2"}, "201": {"fulltext": "TREATMENT OF DENTINAL HYPERSENSITIVITY. 193\\nwhen caries occurs bears some relation to the relative tolerance of the\\nteeth to reduction of temperature.\\nOn these premises it is not difficult to account for the manifestation\\nof acute sensitivity, and to build thereon an hypothesis governing the\\nvarious conditions presented by dentin when it is subjected to the irri-\\ntation of the carious process. These views have steadily gained sup-\\nport with the advance of microscopic study of the tissues, and have\\nsupplanted the older view that the sensitivity of dentin is a result of\\nmechanical vibrations extending to the dental pulp.\\nTreatment op Hypersensitivity of the Dentin.\\nHaving considered the general principles governing hypersensitivity\\nof dentin, we are prepared to enter upon a study of the treatment.\\nThis is to be considered under the following general lines namely,\\nthe therapeutic, the chemical, the anesthetic, and the mechanical.\\nTreatment of Slight Hypersensitivity. The first requisites to be\\nobserved here are a calm manner and earnest sympathy, accompanied\\nwith the assurance that if severity of pain occurs, mitigating means will\\nbe resorted to. It is an important and laudable object to remove dread\\nand secure confidence, which is attained among other means by select-\\ning at first the simpler and less painful operations. When confidence\\nis secured, slight pain arouses the courage of the patient. The effect of\\nthe opposite course of indifference and harsh cutting alarms the patient,\\narouses apprehension, and greatly increases the nervous exaltation.\\nIn the simpler cases sharp instruments used with quick, light, and\\nrapid movements are called for. It should in this connection be noted\\nthat cutting in this manner stimulates somewhat the nervous force of\\nthe patient, and if the movements are in very quick succession they\\nappear to paralyze the part the pain is thus lessened in comparison\\nwith deliberate and slow instrumentation. The movements of the ex-\\ncavators should be in a direction away from the pulp rather than toward\\nit, and the cuts should be by drawing the points instead of pushing\\nthem this is for the reason that the pressure in the latter case is greater\\nthan in the former.\\nWhen the sensitiveness is so great as to interdict immediate excava-\\ntion and formation of the cavity, some method of treatment of the sur-\\nface is required to overcome or to confine it within a tolerable degree.\\nThe Therapeutic Treatment. Under this head the available reme-\\ndies are morphin, veratrin, and eocain, each of them being applied\\nwith glycerin as a menstruum. It should be stated that neither have\\nmuch immediate effect, and therefore they should be sealed in the cavity\\nafter the opening in the enamel has been prepared, and the softer caries\\nhas been lifted and peeled off. The closure should be effected by\\n13", "height": "4568", "width": "2664", "jp2-path": "americantextboo00kirk_0201.jp2"}, "202": {"fulltext": "194 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nmeans of gutta-percha, or with what is probably better, a thin paste of\\nphosphate of zinc laid over the dressing. After some days the pain will\\nbe found diminished in many instances. The therapeusis is effected by\\nthe absorption of these sedatives by the partially disorganized tissues.\\nAnother method of applying cocain is to secure the cavity from the\\nentrance of moisture, and after desiccating the surface a saturated\\npledget of vapocain, a solution of cocain in sulfuric ether, is introduced.\\nAs evaporation of the ether takes place cocain is forced by osmosis into\\nthe tissue. In cases of subacute sensitivity this means frequently is\\nefficacious, but is of little value in hypersensitive conditions. It is\\nadvantageous as preparatory to this line of treatment first to neutralize\\nthe acidity of the cavity with an alkaline solution, which may be either\\nammonia, sodium carbonate, or sodium dioxid, afterward removing the\\nexcess of alkali by thorough washing with warm water.\\nTreatment op Hypersensitivity of Dentin by Electrical\\nOsmosis.\\nWithin a recent period a means of treatment of this condition has\\nbecome prevalent which has been designated by the terms cata-\\nphoresis, electrical diffusion, and electrical osmosis. It\\nhas been demonstrated that the action of electrical currents conveys\\nfluids, with the substances held in solution, from the positive elec-\\ntrode toward the negative electrode. Further, that an electrical\\ncurrent passing through a membrane accelerates the natural process\\nof osmotic diffusion if the positive pole is applied on the side of a\\nmembrane or tissue from which the osmotic diffusion is taking place\\nin case the situation of the poles be reversed, the osmosis is retarded or\\nprevented from occurrence or is reversed. This action bears some\\nanalogy to that which takes place in electro-metallurgy when a metal\\nin solution is conveyed from the anode (positive pole), and is deposited\\nupon the cathode (negative pole). If the current be reversed the\\ndeposited metal is again taken up by the solution and is conveyed\\nback again to the other pole. This is a law connected with the\\npassage of electrical currents through fluids which are capable of con-\\nduction.\\nThe following will illustrate the action which takes place If two\\ncompartments separated by a membrane are filled with a fluid and in\\neach an electrode is placed, there is a streaming of the fluid through the\\nseptum from the positive to the negative pole, so that in time there is\\nan increase in the negative side. This osmotic action, as is well known,\\noccurs naturally between two fluids of unequal density from the lighter\\nto the denser liquid, but if the anode is placed in the denser liquid", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0202.jp2"}, "203": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 195\\nand the cathode in the lighter the natural osmotic current is not only\\novercome but is reversed.\\nIf a substance containing water, as a ball of wet clay or a piece of\\nmuscular tissue, have an anode connected with a current of sufficiently\\nhigh potential attached to one side, with a cathode attached to the oppo-\\nsite side, the watery contents of the substance are conveyed to and appear\\nin excess on the cathodal side at the same time the anodal side be-\\ncomes less damp also, if a capillary tube be filled with water and an\\nanode and a cathode be similarly arranged, the water flows toward the\\ncathode.\\nAs a membrane or tissue may be considered to be a series of tubes\\nin close contiguity, it is apparent that the movement of fluids must take\\nplace through them in the direction the current is passing.\\nThese examples are an expression of electrical force. The applica-\\ntion of this law of the passage of fluids from a higher to a lower elec-\\ntrical potential is the fundamental process which is employed in electrical\\ndiffusion of medicaments. The depth to which medicaments may be\\nconveyed depends upon the conductivity of the tissue and that of the\\nmedicament which is being applied.\\nThe cataphoric action of electricity has often been made use of\\nexperimentally to introduce drugs into the system through the skin.\\nIn man quinin and potassium iodid have been thus introduced and\\nsubsequently been detected in the urine.\\nAs early as 1859 Dr. B. W. Richardson used this process to pro-\\nduce local anesthesia, and completely demonstrated its power in this\\ndirection. It has also been clearly proven that when a solution of\\ncocain is applied to the skin, its characteristic action upon the mucous\\nmembrane will not here take place. But when the anode is wet with\\nthe solution and a galvanic current is passed through the epidermis\\nto the cathode, placed upon an indifferent surface, anesthesia is effected\\nover the surface covered by the anode and to an indefinite distance\\ninward.\\nThis effect is not produced by the current alone, which has been\\nabundantly proved by conclusive experiments, these having been fol-\\nlowed by demonstrations confirming the above statement. When the\\nmedicaments so applied have anesthetic or analgesic properties their\\ncharacteristic effects are produced.\\nWhen this principle is applied to the transfer of medicaments it is\\nfound that they pass for an indefinite distance into the contiguous tissue\\nalong with the current from the anode toward the cathode, but with\\nsome degree of diffusion the diffusion depending upon the resistance\\nof the tissue and upon the extent of the surface of the cathodal (nega-\\ntive) electrode.", "height": "4552", "width": "2712", "jp2-path": "americantextboo00kirk_0203.jp2"}, "204": {"fulltext": "196 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nGENERAL PRINCIPLES INVOLVED IN THE METHOD.\\nThe application of electricity requires the consideration of the\\ngeneral principles or laws governing its transmission.\\nThe source of this force is to be found in chemical transformation.\\nUnder the laws of the correlation of force it is capable of being con-\\nverted into heat, light, magnetism, and mechanical power, and may be\\nused to disorganize substances, when its action is called electrolysis. Its\\nmovements are constant in their direction, viz. from bodies of high to\\nthose of low potentiality.\\nIn perfectly conducting substances electricity moves with entire free-\\ndom under any electro-motive force however small.\\nIn perfectly non-conducting substances electricity will not move\\nunder any electro-motive force however great.\\nIn imperfectly conducting substances electricity moves only on the\\nexhibition of intense electro-motive force, the force varying according\\nas the substance is a more or less indifferent conductor.\\nElectricity has two elemental properties. These are defined as cur-\\nrent strength, designated by the term amperage; and electro-motive\\nforce, which is termed its voltage.\\nThe active energy of electricity depends upon the first property,\\nits distribution upon the latter. Since it must be assumed that few\\nbodies are perfect conductors, this force or pressure is of that degree\\nwhich may be required in any given case to move the active energy,\\nthe amperage, against the resistance it meets with.\\nThe unit of strength is the ampere.\\nThe unit of pressure is the volt.\\nThe unit of resistance is the ohm.\\nThe unit of power is the watt.\\nA volt represents the electro-motive force (E. M. F.) required to\\nimpel one ampere of current through one ohm of resistance.\\nAn ampere of current is so much as will deposit 0.00118 gram of\\nsilver per second when passing through a standard solution of nitrate\\nof silver or which will decompose 0.09326 milligram of water in one\\nsecond. Hence the ampere is the measure of rate of flow of an electri-\\ncal current, and in connection with the voltage measures the energy of\\nthe current.\\nThe unit of resistance (ohm) is that degree of resistance which\\nwill permit the passage of one ampere of current at one volt of\\npressure.\\nThe watt is the power exerted by one ampere of current at one volt\\nof pressure.\\nIn the economic application of electricity its transmission is effected", "height": "4580", "width": "2764", "jp2-path": "americantextboo00kirk_0204.jp2"}, "205": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 197\\nthrough metallic conductors. The resistance of these is varied by the\\ncharacter of the metal, the cross section, and the distance. For certain\\npurposes other substances are employed to effect greater resistance than\\nthe metals.\\nThe current strength flowing in a circuit is equal to the pressure\\ndivided by the resistance.\\nThe resistance equals the pressure divided by the strength.\\nThe pressure equals the strength multiplied by the resistance. In\\nelementary terms\\nAmperes volts -s- ohms.\\nOhms volts -s- amperes.\\nVolts amperes X ohms.\\nWatts volts X amperes.\\nIt follows from the formula that the amount of power and the cost\\nof producing it is the same whether the current is of large amperage at\\nlow voltage or of small amperage at high voltage. Thus an incandes-\\ncent lamp may be supplied by 100 volts at J ampere or by 50 volts at\\n1 ampere the result in each case being 50 watts.\\nComparative Illustration. Given a current of 100 volts at fifteen\\namperes, and we wish to use only ampere, the resistance to be put\\nin the circuit is found thus 100 v -^2^a 40 o.\\nIn case we have 2-| amperes under 7 ohms resistance, it requires\\n17 }j volts to move this degree of amperage through the given resistance,\\nthus 2J a X 7 r 17-J- v. If one has a current of 110 volts, and de-\\nsires to use a J-horse-power motor, the least amperage required is 1 t 9 q-,\\nwhich is found by dividing 186 watts by 110. These examples make\\nplain the means of determining the character of current required for\\nany given purpose.\\nElectrical force may be produced from its source in galvanic cells by\\narranging them in series or in multiple. If in series the voltage is\\nthe sum of the volts of the cells so arranged, and the amperage is that\\nof each of the cells. If joined in multiple, the strength in amperes\\nis the sum of the amperes of the cells, and the voltage is that of one\\ncell.\\nFig. 152 l represents the arranging of cells in series, the positive of\\none with the negative of the next. In case each cell has a voltage of\\n2 and an amperage of 1 the electro-motive force of 5 cells will be 10\\nvolts at 1 ampere.\\nFig. 153 2 represents the joining of cells in multiple. Here all the\\nx See Dental Cosmos, December 1896, p. 998. 2 Ibid.", "height": "4552", "width": "2704", "jp2-path": "americantextboo00kirk_0205.jp2"}, "206": {"fulltext": "198\\nPRELIMINARY PREPARATION OF CAVITIES, ETC.\\npositive elements are joined together and similarly all the negative to\\neach other. The voltage now is 2 and the amperage 5.\\nFig. 152.\\nm\\nThe former method of assembling the cells is designated as high\\ntension/ the latter method as low tension. When the source is the\\ndynamo, high and low tension are produced by the strength or weakness\\nof the magnetic field,\\nFor electrical osmosis the source should be from batteries in series,\\nfor the reason that in multiple the amperage would be too great when\\nthe voltage is of sufficient force to overcome the resistance.\\nThe degree of electrical energy tolerated by living dentin is exceed-\\ningly small, on account of the peculiar and intense pain excited by the\\ntransmission of electrical currents through the teeth. This is shown by\\nthe low initial voltage of the batteries used for the purpose, varying\\nfrom less than 5 to rarely more than 20. But the initial passage of a\\ncurrent of as high electro-motive force as these would not be tolerable,\\nand must therefore be reduced by suitable methods of effecting re-\\nsistance.\\nThe apparatus used for this purpose is the controller, the purpose of\\nwhich is through its resistance to diminish the energy of the current to\\nsufficient weakness to meet the requirements of any given case. All\\nforms are constructed on the principle of the use of materials which are\\nhighly resistant of the passage of electric currents. These substances", "height": "4612", "width": "2760", "jp2-path": "americantextboo00kirk_0206.jp2"}, "207": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 199\\nare water, carbon, graphite, and coils of wire of known high resistance,\\nthe most effective being of German silver. In the case of the latter the\\ndegree of resistance is regulated by the length and fineness of the wire,\\nthe cross section being reduced to the size which will conduct the cur-\\nrent without excessive heating, and to that end it is graded with refer-\\nence to the initial amperage of the current. In comparison with silver\\nas a unit German silver has a resistance of 13.92.\\nThe carbon and graphite controllers usually are constructed in the\\nform of a broken ring one pole of the battery being connected at one\\nend of the ring, the other pole being attached to an index which travels\\nover this annular disk. This method of construction gives a fine grada-\\ntion of current with high resistance. It may be used in connection with a\\nGerman-silver wire rheostat, where currents of great strength are used\\nfor reasons which will appear later. In the use of high-voltage cur-\\nrents, such as the 110-volt circuit, it may be switched through the\\ncoils to a nearly definite low voltage by means of a rheostat, when\\nthe adaptation to the case may be effected through the graphite con-\\ntroller.\\nIn the arrangement of the apparatus to effect electrical osmosis the\\nbattery, the controller, the instruments of observation, and the patient\\nare in series. In the analysis of the course of the current it appears that\\nthe patient is another element of resistance, and that dentin is more\\nhighly resistant than the other tissues. In other words, there are two\\nresistances in the circuit the controller and the tissues of the patient.\\nThe result of the resistance of the dentin, unless the initial voltage is\\nsmall and is reduced by the controller to an infinitesimal degree, is the\\noccurrence of pain, which takes place with different persons at various\\ndegrees of amperage. The approach to intolerance of the current is\\ndesignated the pain limit. This condition has been assumed by some\\nobservers to be caused by the evolution of heat in the dentin con-\\nsequent upon the resistance of this tissue. This view is not now con-\\nsidered to be conclusive, as the calculated elevation of temperature at\\n\u00e2\u0096\u00a0^q milliampere is not sufficient to account for the degree of irritation\\nwhich occurs on increasing the rate of flow. This determination\\nleaves two other hypotheses to account for the irritation a, the ten-\\ndency of the current to disorganize some of the anatomical elements of\\nthe canaliculi and 6, the osmotic pressure of the migration of the\\nmedicaments. Here the student is not confused with consideration of\\nthe complicated forces which are in action connected with the electroly-\\nsis of the cocain solution. 1\\nThe pain limit is variable with different persons, and in different\\n1 See The Foundation Principles of Dental Cataphoresis Items of Interest, vol. xx.\\np. 345 et seq.", "height": "4544", "width": "2716", "jp2-path": "americantextboo00kirk_0207.jp2"}, "208": {"fulltext": "200 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nteeth of the same person. With some it is reached with the first\\ninflux of the current at low voltage with a record of milliampere,\\nthis low record indicating high resistance of dentin and permitting but-\\nslow increase of the force until after cocain has diminished the sensitiv-\\nity of the irritated surface. With others the pain limit may not be\\nreached with a voltage of 20 and a recorded amperage of T 3 to milli-\\nampere. In respect of electrical irritation there must be taken into\\naccount also the high nervous sensitivity of some persons, as with these\\nthere usually appears greater susceptibility to electrical irritation.\\nThe following table of calculated resistances shows the resistance\\nin ohms, and the liability to the generation of heat in the dental tissues\\nin view of their density, or the tendency to disorganization as previously\\nstated, and it suggests that care be used in the application of electrical\\nforce for the purpose under consideration.\\nWith 15 volts initial pressure at t 4 q milliampere in circuit the ohms are 37,500.\\n15\\n10\\n10\\n5\\n5\\n150,000.\\n25,000.\\n100,000.\\n12,500.\\n50,000.\\nAs the resistance of the body including the dental tissues varies from\\n10,000 to almost 70,000 ohms, it would appear necessary that the con-\\ntroller should have at the highest point a resistance of not less than\\n400,000 ohms. This degree of resistance is required to obviate the\\neffect of impulse which may occur in closing the circuit. Occasionally\\nslight shock is felt at 600,000 ohms.\\nThe varying resistance of the current through the tissues depends\\nupon the density of the dentin, the distance traversed, the condition\\nof the surface of the skin, and the thickness of the adipose tissues.\\nThe average resistance of the patient as recorded by Dr. W. A. Price\\nis about 25,000 ohms from cavity to hand, and the difference of resistance\\nfrom tooth to hand and cheek to hand is from 3000 to 5000 ohms. He\\nreports one case where the resistance from cavity to hand with a 40 per\\ncent, solution of cocain was 28,500 ohms, which on placing the pad on\\nthe cheek was reduced to 23,000 ohms.\\nDr. Price further places the average resistance from hand to tongue\\nat 9000 ohms, and from cheek to tongue at from 3000 to 7000. This\\nwould make the resistance of the dentin nearly 20,000 ohms. An\\nexact determination of the resistance of the skin in any given case\\nwould enable a very close approximation for the dentin to be calculated.\\nThe condition of the cavity as to relative moisture and the degree\\nof saturation of the pledget of cotton containing the anesthetizing agent", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0208.jp2"}, "209": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 201\\nas well as the percentage of the medicament exert a considerable quali-\\nfying control of the resistance, as appears from the experiments of\\nDr. Price. When a section of dentin partially dry on the surface had\\na resistance of 30,000 ohms, after being dried and saturated with a 40\\nper cent, solution of cocain the resistance was reduced to 4500 ohms.\\nThe principles here stated and the facts presented apparently demon-\\nstrate the importance of careful selection of the degree of voltage at\\nthe battery of the use of a relatively low amperage to the voltage\\nof the necessity of controlling the current within the boundary of the\\npain limit of the importance of avoiding impulses of current by rapid\\nadvancement or by movements of or displacements of the anode and\\nof attention to the maintenance of a constantly moist state of the anodal\\nand cathodal contacts.\\nThese principles and facts have led to the application of galvanic\\ncurrents for the production of a state of anesthesia of hypersensitive\\ndentin and the results of experimentation in this direction have proven\\nthat the same effects have followed here as have occurred in the softer\\ntissues.\\nThe extreme sensitiveness of the teeth to electrical currents and their\\nresistance to the passage of electrical force were obstacles to the earlier\\napplication of this method of treatment in dentistry. The absence of\\nmeans to control the current strength (the amperage) and to reduce the\\npressure (the voltage) to the capacity of the teeth prevented experi-\\nmentation in this direction until within a comparatively recent period.\\nThe current strength that is tolerable at the commencement of the\\napplication is so small as to be scarcely measurable in many instances.\\nTo produce this small current, either the battery voltage must be low\\nor the resistance in the controller exceedingly high.\\nAny form of battery which is constant when the amperage of the\\nindividual cell is from one-fourth to one-half of an ampere will have\\nsufficient current strength. The E. M. F. may be from one to two\\nvolts per cell.\\nThe voltage required to produce the necessary electro-motive force in\\nan application to the teeth to produce dentinal anesthesia varies from\\nfive to thirty. For children and where the teeth are apparently not\\ndense, ten cells sometimes are sufficient, but generally fifteen to twenty\\nare needed. The cells should be arranged in series and connected in a\\nmanner which enables the selection of any number to produce the re-\\nquired E. M. F. for any given case and to permit an increase of cells\\nduring the administration.\\nThe most important condition of the electrical force for the purpose\\nis that the amperage shall be inconsiderable, since high amperage is intol-\\nerable to the teeth. As the most efficient results are produced when the", "height": "4560", "width": "2696", "jp2-path": "americantextboo00kirk_0209.jp2"}, "210": {"fulltext": "202 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nrecorded amperage is not over three-tenths of a milliampere, the use of a\\ncurrent of high amperage is unnecessary, and it is attended with distress.\\nHigh voltage is equally painful, as the endeavor to force the current\\nagainst the resistance of the dentin results in electrical irritation, as\\nalready described.\\nThe chlorid of silver cell is probably the one best suited for the\\npurpose, as its electro-motive force remains practically constant under\\nvarious conditions. The E. M. F. of each cell is about one volt the\\ninternal resistance eight ohms the strength one-fifth of an ampere.\\nThis battery on account of its constancy and durability is largely used\\nin electro-medical apparatus. It is now furnished dry, and is more\\nacceptable as being less troublesome on this account.\\nThe dry Leclanche battery is also one of the best forms, as it is an\\nopen-circuit battery. As long as the circuit is open there is no action\\nin the cell and consequently there is no loss.\\nAt present these two forms of galvanic battery cell appear to be the\\nkinds best adapted for the purpose of inducing electrical osmosis.\\nThe storage battery may also be used with advantage, but the plates\\nshould be small each cell should contain but three plates to give the\\nproper degree of current strength. When the plates are 3x3 inches\\nthe normal amperage at eight hours discharge is five-eighths of an\\nampere. The voltage of each cell is two. This when discharged under\\nthe resistance required for application to sensitive dentin in cataphoric\\nwork should have a capacity for 800 applications, providing waste of\\ncurrent strength does not occur from accidental short-circuiting.\\nThe life of a chlorid of silver dry cell battery is stated to be 700\\nhours of cataphoric work under a high resistance of tissue, but it must\\nbe remembered that the continuance of energy of all forms of battery is\\nvaried by the resistance and the conversion of electrical energy into heat\\nby the controller which regulates the amperage and the voltage. This\\nprinciple applies to all sources of electrical force.\\nThe controller which at present appears best adapted to be interposed\\nbetween the battery and the anode is the Willms controller, which, as\\nbefore stated, should be constructed with a resistance at the highest\\npoint of at least 400,000 ohms. The gradations of resistance decrease\\nfrom this through 112 contact points. These permit a very gradual\\nreduction of the resistance as the switch is conveyed from point to\\npoint in the circle. This controller also has the advantage of being\\nmoderate in cost and easily procurable.\\nAn important adjunct of any apparatus is a reliable milliampdremeter.\\nThis should have a scale to record divisions of fortieths of a milliampere,\\nfrom the fact that the amperage of the current through the dentin is fre-\\nquently efficient at less than two-tenths of a milliampere. The milli-", "height": "4608", "width": "2764", "jp2-path": "americantextboo00kirk_0210.jp2"}, "211": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 203\\namperemeter also aids in detecting leakage of current, as where the\\nindicated amperage exceeds five-tenths milliampere there is reason to\\nsuspect imperfection of the insulation of the tooth. In this case a\\nlonger period than usual will be required to effect the anesthetization,\\nand the degree of this effect may be less.\\nThe use of the direct current generated by the dynamo is of ques-\\ntionable utility as compared with the current from a battery. The\\ncurrent from the dynamo is subject to changes of voltage and the\\namperage is liable to fluctuations consequent upon alterations of the\\nload in the general circuit. This instability causes a series of pulsat-\\ning shocks upon sensitive dentin and the pulp, which react with the\\nexpression of pain. The possibility of the transmission of severe\\nshock through accidental grounding or defective apparatus where such\\nexcessive voltage is used is another and sufficient reason why the\\nsteady and low-voltage current of a battery is preferable for this class\\nof operations.\\nTECHNIQUE OF THE ADMINISTRATION.\\nAt the present period cocain has been found to be the most effective\\nanesthetic for obtunding dentinal sensitivity by electrical osmosis. It\\nis used in strength varying from 12 to 24 per cent., and by some as\\nhigh as 40 per cent, has been used 1^ grain of one of the salts of\\ncocain added to 5 minims of water procures a solution of 24 per cent.\\nto 1\\\\ minims, 18 per cent. to 10 minims, 12 per cent.\\nThe salts of cocain which have been used are the hydrochlorid and\\nthe citrate. Each is efficient in the strength stated. The resistance of\\ncocain citrate is for 12 percent, solution 234 ohms; for 24 percent.\\n153 ohms. The resistance of cocain hydrochlorid is for 12 per cent,\\nsolution 80.85; for 24 per cent, 61.25. These provings indicate that\\nthe hydrochlorid is the better salt of cocain for the purpose. 1\\nThe tooth to be operated upon is isolated by means of a rubber dam\\nand is ligated at the cervix to prevent leakage of current, If there are\\nmetallic fillings in the tooth, these should be covered with a coat of\\nvarnish carefully laid on and dried. This precaution does not always\\npossess the value claimed for it, as the dentin beneath a metal filling,\\nbecause of its density or lack of porosity, will not convey the current\\nas well as the carious matter and the softer dentin of the fresh cavity.\\nIn some cavities where caries has occurred at the cervix above gold\\nfillings, and which do not permit of complete isolation of the fillings,\\nthe cataphoric influence is not interfered with.\\nThe carious matter should not be completely removed and need only\\nbe partially dried. The cavity is loosely filled with a small pledget\\nx The writer is indebted for the determination of these resistances of cocain solutions,\\netc., to Mr. A. W. Schramm, of the University of Pennsylvania.", "height": "4548", "width": "2692", "jp2-path": "americantextboo00kirk_0211.jp2"}, "212": {"fulltext": "204 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nof lint saturated with the solution of cocain. The anode, the point of\\nwhich is of platinum, is covered with a thin stratum of lint which is\\ndipped in the solution and inserted in the cavity in contact with the\\npledget previously introduced. The cathode, which should be at least\\none and a half inches in diameter, is placed at a convenient place on\\nthe face or neck. The desired number of cells are placed in circuit\\nwith the controller at zero.\\nAll being ready, the switch is placed on the first contact point. At\\nthis moment, however great the resistance of the controller, a slight\\nsensation is sometimes experienced, but at once the switch may be\\npassed slowly over the contacts until some sign from the patient indi-\\ncates that the current is being felt. Here it is retained until subsidence\\nof the sensation occurs, when the resistance of the controller should\\nbe very gradually lessened. This process is continued, keeping con-\\nstantly within the limit of pain at length the switch may be more\\nrapidly advanced. When this can be done without thrill, the indication\\nis that anesthesia is complete. The switch is then carried back to the\\nzero point, when the excavation may be conducted.\\nWhere it is necessary to remove the rubber (as the solution of cocain\\nis strong) the preparation should be previously washed away to prevent\\nany of it from being swallowed.\\nThe period of administration varies from eight to fifteen minutes\\nin ordinary cases where the indicated amperage is from t 1 q to T 2 milli-\\nampere. When, however, the dentin is dense, as where denudation has\\ntaken place by attrition, a longer time is required to effect penetration\\nby the cocain. Also where from any condition the indicated amperage\\nat first is -^V milliampere or less, time and patience are demanded.\\nThe loss of time is more apparent than real, since there usually is a\\ndirect relation between the pain limit at very low amperage and high\\nsensitivity what is apparently lost in the time of the application is\\ngained in the after facility of instrumentation.\\nThe sphere of the action extends throughout the cavity, but to a\\nsomewhat less degree at the extreme lateral margins, and more particu-\\nlarly at the occlusal margin. Here usually no more than a normal\\ndegree of sensitivity is found, which appears to be due to the fact that\\nin making the retentive undercutting this procedure may extend beyond\\nthe sphere of the complete influence of the cocain. The effect is most\\npronounced when the application is made directly to the carious matter.\\nIn this case the diffusion is greater than when the caries is freely re-\\nmoved, for the reason that in the latter case the current seeks the line of\\nleast resistance toward the pulp. It follows from this that when all\\nparts of the cavity are equidistant from the pulp, the action should be\\nmore effective throughout upon the surface of the dentin. This is", "height": "4580", "width": "2764", "jp2-path": "americantextboo00kirk_0212.jp2"}, "213": {"fulltext": "DENTINAL ANESTHESIA BY ELECTRICAL OSMOSIS. 205\\nproven to be the case from the profound effect in cavities upon buccal\\nand labial surfaces and in shallow cavities of occlusal surfaces. Besides\\nthe less diffusion of the cocain when the carious matter is removed,\\na degree of electrical force which in the former case is easily tolerated\\nbecomes painful. These facts make conclusive the importance of retain-\\ning some of the carious contents of the cavity.\\nAn explanation of the influence of the current is found in the prin-\\nciples and examples given on page 194. As the anode is put in con-\\nnection with the lint saturated with the cocain solution the fluids of the\\ntooth advance toward the pulp through the canaliculi, their place being\\ntaken by the solution of cocain. At the same time it is observed\\nthat loss of fluid from the lint occurs, necessitating additions to\\nmaintain the proper wetness, some loss of water taking place by\\nevaporation.\\nConditions Influencing Tolerance of the Current. As already stated,\\nwhen the electrical force is brought into connection with the carious\\nmatter the irritation caused by the current is of trifling degree and\\nsoon subsides, indicating that the anesthetic effect has been produced\\nbut when the cavity is denuded of caries the above-stated degree of\\ncurrent force is not so tolerable, the irritation continues longer and\\ndoes not subside in the same manner, but the effect upon the tissue is\\nnearly if not quite as marked. The nearer the bottom of the cavity\\nis to the pulp, the greater the irritation. Hence in this condition it\\nbecomes necessary to begin with a low degree of voltage. While in\\nthe one case fifteen cells may be selected, in the other ten cells are\\nmore satisfactory.\\nTo avoid the removal of caries the condition of the dentin as regards\\nsensitivity should be tested at the line of its connection with the\\nenamel.\\nSome stress has been laid upon the necessity for rendering the solu-\\ntion of cocain more highly conductive. This claim is probably more\\ntheoretical than practical in its character, since experience with the\\nsolutions given indicates that the conductivity is sufficient, and that the\\nresistance is more to be looked for in the dentin than in the solution,\\nand that when the tooth has become tolerant of the current at a com-\\nparatively low voltage an increase of pressure of the current is suf-\\nficient to complete the anesthesia.\\nThe form of the platixum axode should be such as to permit its\\neasy entrance into the cavity when its point is covered with a layer of\\nabsorbent lint. For all cavities in the approxitnal surfaces and in most\\nocclusal positions an excellent form of anode is made by curling the\\nend of a fine platinum wire (No. 25) into a flat knot, or forming it in a\\nloop. On the loop a properly sized piece of lint may be gathered.", "height": "4556", "width": "2688", "jp2-path": "americantextboo00kirk_0213.jp2"}, "214": {"fulltext": "206\\nPRELIMINARY PREPARATION OF CAVITIES, ETC.\\nThis may be packed into the cavity and secured with additional lint\\nwhen required. This method is a self-sustaining one. The connection\\nbetween the free end of the anode and conducting cord is made with a\\nspring clip, as shown in Fig. 155.\\nFor labial and buccal surfaces two or more small points to screw\\ninto a common handle are sufficient (see Fig. 154). These have to be\\nFig. 154.\\nDental anodes for cataphoresis.\\nheld in situ. A form and arrangement to make these self-sustaining\\noffers an important field for inventive skill.\\nFig. 155.\\nSnap and wire electrode.\\nA convenient cathode electrode is shown in Fig. 156. In this\\nthe surface is recessed to receive a disk of amadou (spunk) or cottonoid,\\nFig. 156.\\nCathode for cataphoresis.\\none and a half to two inches in diameter, which retains an abundance\\nof a solution of sodium chlorid to maintain contact. The surface is\\nplatinized to prevent corrosion. The reverse side has the usual\\nsocket to receive the conducting cord, which is placed in a projection\\nintended to pass through an opening in the band which supports the\\nrobber dam.\\nIt is indifferent where this electrode is placed the objects to be\\nattained are to lessen the resistance as much as possible and to secure\\nconstant apposition with the surface with which it is connected. If the\\nperson be comparatively lean, the face before the ear is to be preferred.", "height": "4608", "width": "2792", "jp2-path": "americantextboo00kirk_0214.jp2"}, "215": {"fulltext": "DENTINAL ANESTHESIA BY CHEMICAL AGENTS. 207\\nWhen there is much adipose tissue on the face, the usual negative hand\\nelectrode, covered with a small wet napkin to maintain close contact,\\nmay be better than the application to the face but in general the nearer\\nthe cathode is placed to the angle of the jaw, the quicker and surer is\\nthe result of the administration.\\nThe action of cocain administered in this manner is profound. The\\neffect is primarily upon the contents of the canaliculi, as is shown in\\nthe cataphoric treatment of shallow cavities. After superficial anes-\\nthesia has been established much lateral cutting will later elicit a degree\\nof pain in deep cavities nearing the pulp, the effect extends to that\\norgan. The recurrence of sensitivity takes place within a few hours.\\nNo injury appears to follow.\\nThis method of treatment is little required where the degree of\\nhypersensitiveness is such as to yield to desiccation of the dentin or\\nthe application of carbolic acid combined with caustic potassa Eobin-\\nson s Remedy But when the pain attending excavation requires\\nactive treatment, such as the employment of zinc chlorid or general\\nanesthesia, the cataphoric method is far preferable to either, and is\\nnearly certain of giving relief. The results of successful cataphoresis\\nare marvellous, and it may be truly stated that no advance of\\nrecent years in the therapeutic treatment of the teeth is comparable\\nto this. 1\\nCautious excavation is required after cataphoric treatment, as in the\\nabsence of sensitivity indiscriminate cutting may needlessly encroach\\nupon the pulp. In case exposure really exists the action of cocain does\\nnot prejudice conservative treatment of the pulp. When devitalization\\nis determined upon, the anesthesia facilitates this procedure. As stated\\nin Chapter XVI. cocainization may be then continued either cata-\\nphorically or by instillation. Should arsenous acid be selected as the\\ndevitalizing agent, cocainization may be used as a preparatory measure\\nto avoid arsenical irritation.\\nThe Chemical Treatment.\\nUnder this head are included the application of warmed air, the use\\nof coagulants, notably carbolic acid or zinc chlorid, and, in combination\\nwith these, one of the essential oils, preferably oil of cloves, for reasons\\nstated below.\\nWarmed Air. This method is of great value in subacute cases.\\nIt is especially serviceable for the cavities of incisors and biscuspids and\\nothers of easy access. The effect here produced is due to the depriva-\\n1 For further study of this subject, see International System of Electro-Thera-\\npeutics, Section C, p. 1 et seq., Peterson; also, Foundation Principles of Dental\\nCataphoresis, by Dr. Price, Items of Interest, vol. xx. p. 345.", "height": "4552", "width": "2672", "jp2-path": "americantextboo00kirk_0215.jp2"}, "216": {"fulltext": "208\\nPRELIMINARY PREPARATION OF CAVITIES, ETC.\\ntion of the tissue, to a greater or less degree, of one of its elements, viz.\\nwater, and it is more effective in teeth of dense structure, since the sur-\\nface of these is more easily desiccated than the softer teeth. If it were\\npossible to remove all the water of the tissue from the surface to the\\ndepth of the irritated part all sensitivity would thereby be overcome, but\\ngenerally this can be only imperfectly done nevertheless, the benefit\\nis generally considerable. This means is easily and quickly applied,\\nand as it presents the simplest method in the cases where it is applicable\\nit forms therefore the easiest and most available procedure for this\\npurpose.\\nThe warmed air may be produced by heating the bulb of a warm-\\nair syringe (Fig. 157) over a lamp or Bunsen burner, when a continu-\\nFig. 157.\\nWarm-air syringe.\\nous stream of air is forced through the nozzle into the cavity. Some tact\\nis required to deliver the heated air in a manner to cause the least pain\\nby its impingement. If the nozzle be held too far away from the tooth\\nthe stream of air in passing through the atmosphere takes along with it\\nso much of the surrounding cool air as to cause pain, and if held too\\nclose the heat is equally painful. In all cases the abstraction of the\\nwater, even when the degree of heat is well balanced, produces some\\nElectric warm-air syringe.\\nunpleasant sensation, which soon passes away and after a few moments\\nthe case is reduced to a state of slight and simple sensitiveness. The", "height": "4580", "width": "2760", "jp2-path": "americantextboo00kirk_0216.jp2"}, "217": {"fulltext": "DENTINAL ANESTHESIA BY CHEMICAL AGENTS. 209\\nblast should be gently applied at first at intervals of a couple of sec-\\nonds when the pain induced by the abstraction of the water some-\\nwhat diminishes, the force should be increased and made continuous,\\nwhen in most cases the excavation may be continued. The air may\\nalso and preferably be heated by an electric warm-air syringe (Fig.\\n158), which has the advantage of maintaining an even degree of heat.\\nAs stated before, this means is of less use with soft teeth, and fre-\\nquently fails when the teeth have a high grade of sensitivity which\\nappears to be due to constitutional conditions, where the sensitivity is\\nnot confined to the surface of the tissues immediately beneath the caries\\nbut pertains to the whole of the dentin.\\nPreparatory to the use of heated air, the application to the cavity\\nof absolute alcohol is serviceable, on account of its high affinity for\\nwater.\\nCarbolic Acid. This substance, while of little efficiency in con-\\ntrolling acute sensitivity, is of benefit in moderating that condition.\\nIts efficacy is increased by adding to it a proportion of one-third of oil\\nof cloves, which latter has some anesthetic influence. When other\\nmore active means are not admissible and the effect is not immediately\\nsatisfactory, a better result is produced by placing this combination in\\nthe cavity and sealing it in with zinc phosphate until a subsequent\\nvisit, as before described. On account of the feeble affinity of carbolic\\nacid for water, the obtundent effect is facilitated by the previous partial\\ndesiccation of the surface of the cavity by warm-air blasts. Carbolic\\nacid in combination with caustic potassa, equal parts of each (Robin-\\nson s Remedy), is often of much service in subacute sensitivity. The\\npreparation should be laid in the cavity in contact with the denuded\\ndentin and should be allowed to remain until it deliquesces.\\nCarbolic acid in combination with tannic acid is also serviceable when\\nsealed in the cavity by an impermeable temporary stopping.\\nZinc Chlorid. Of all substances, when not interdicted by proximity\\nof the dental pulp, zinc chlorid is the most efficient of the topical\\nremedies for the condition under consideration. Its action is explained\\nby the double power of its affinity for water and its extreme coagulating\\neffect upon albumin. It is evident that if the tissue be deprived of two\\nof its elements the function of sensitivity must be impaired or destroyed.\\nIn the degree to which this action takes place the tissue loses its capacity\\nfor irritation.\\nAs zinc chlorid in concentrated solution is an active escharotic to\\norganic tissue, it must be employed with caution. After paralyzing the\\nvital resistance of the part its action is by combining in definite propor-\\ntions with the albuminous elements of the structure. It has the fur-\\nther property of an excessive affinity for water, which enables one to\\n14", "height": "4560", "width": "2680", "jp2-path": "americantextboo00kirk_0217.jp2"}, "218": {"fulltext": "210 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\narrest its action by sufficient irrigation to remove all traces of the salt\\nfrom the cavity. Its active coagulating power renders it a valuable\\nagent in excessive dentinal sensitivity where there is not close proximity\\nof the pulp, and its safety is ensured by the facility with which any re-\\nmains of the salt may be taken up with water.\\nUnless employed in excess and too long continued the action of the\\nzinc chlorid does not pass beyond the zone of the exalted tissue, which,\\nas we are aware, generally is of limited depth. The cessation of the\\npain produced by it indicates the time for its removal, when usually\\nthe dentin will be found to be insensitive. There are instances, how-\\never, when no apparent eifect is produced, which can only be satisfac-\\ntorily explained on the ground that the vital resistance of the tissue is\\nsufficient to overcome the coagulative power of the zinc salt.\\nIn general, zinc chlorid must be regarded as an entirely safe agent\\nif used with discretion. It is more applicable to shallow cavities which\\nare so situated, or are of such form, as to require much formative cutting\\nat the margins of the cavities, as in buccal and labial surfaces and in the\\nvery superficial cavities of incisors and bicuspids. A warning, however,\\nshould be presented that as the pulp cornua of incisors frequently pro-\\nject near the surface, particularly in the young subject, considerable care\\nis here required in any but shallow cavities of decay. If it were used\\nin excess and its action extended there would always be danger, as\\nits energies would not cease until the affinities of the whole amount\\nwere satisfied. In deep cavities the effect, particularly in soft teeth,\\nwould eventuate in the ultimate devitalization of the pulp. It fol-\\nlows, therefore, that it would be improper to seal up any quantity of\\nthis substance in a cavity.\\nThe action of zinc chlorid is terminated when the excess is removed\\nand the cavity irrigated with water. The affinity it has for water\\nquickly removes the excess and soon deprives the tissue of the remain-\\ning portion.\\nWhen cavities are deep and it is found necessary to resort to this\\nagent the surface of the deeper parts should be protected by an insoluble\\ncoating, after which the margins, where the sensitivity is acute, may be\\nacted upon without detriment. Here it is requisite to remove the deep\\ncaries, desiccate the surface and make a coating with a varnish. For\\nthis purpose red gutta-percha rubbed in chloroform is applicable, since\\nit may be deftly applied to any given part and when the chloroform has\\nescaped is protective.\\nTo properly apply zinc chlorid it is highly important to isolate the\\ntooth by means of rubber dam to protect the gum and to prevent the\\nentrance of moisture. Its affinities for water are so great that even\\nthe vapor of the mouth dilutes it so much as to lessen its power. The", "height": "4580", "width": "2820", "jp2-path": "americantextboo00kirk_0218.jp2"}, "219": {"fulltext": "DENTINAL ANESTHESIA BY CHEMICAL AGENTS. 211\\nform in which it is best to employ it is the saturated deliquesced salt,\\nwhich is taken from a bottle containing the salt in excess. The fluid\\nis introduced on a pledget of cotton and is permitted to remain until\\nthe pain occasioned by it has ceased. It will be found that there are\\ntwo periods of pain the first from its irritation of the fibrils in the\\nbottom layer of the caries, and then again when it has reached the\\nzone of exalted dentin a little beneath this ultimate layer of decay.\\nIt follows, if the caries has all been previously removed and the\\nsensitive tissue interdicts further cutting, that but one period of pain\\nis encountered. The cutting should therefore be deferred until after\\nthe second period of pain has passed. The disregard of this considera-\\ntion has sometimes cast discredit upon the efficiency of this sovereign\\nremedy.\\nIt is requisite that the chlorid be chemically pure, and the fused\\nform is preferable to the crystals of the shops.\\nThe paix attending the application is sometimes extreme for a mo-\\nment. This can be moderated by air-drying the cavity and dressing it\\nwith carbolic acid, which does not seem to prevent the action of the\\nchlorid.\\nTo avoid the loss of time which may be occasioned by the slow\\naction it is advisable, after securing the dam at the neck of the tooth\\nby a ligature, to very tightly tie the free portion of the rubber a short\\ndistance from the tooth w T ith a strong ligature, and after cutting away\\nthe excess of rubber some other service may be rendered. When the\\npain has ceased the case may be proceeded with, or the excess of chlorid\\nmay be thoroughly washed out and the cavity temporarily closed until\\na subsequent time.\\nAnother method of securing the action of zinc chlorid is to make a\\npaste of zinc oxychlorid and fill the cavity with it. Even after crys-\\ntallization of the paste takes place it contains a slight excess of the\\nchlorid, which slowly acts upon the hypersensitive tissue. This method,\\nhowever, is not adapted to deep cavities, and care must be exercised con-\\ncerning its use in teeth of inferior grade.\\nZinc chlorid is an extremely valuable remedy when the previously\\ndescribed agents prove insufficient or are not indicated.\\nConditions which render Zinc Chlorid inadmissible. It has been\\nstated that the chief danger of its use consists in the liability of the\\ncoagulant and escharotic action reaching the pulp in deep cavities.\\nThis danger is further enhanced when the teeth are soft, as in this con-\\ndition the penetration is liable to be greater than would be the case with\\ndense dentin. The same caution must be observed when the structure\\nis incomplete, as it is in the teeth of young subjects. Even here, as\\nextreme sensitiveness is always found at the peripheral limits of the", "height": "4552", "width": "2680", "jp2-path": "americantextboo00kirk_0219.jp2"}, "220": {"fulltext": "212 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\ntubules, it is not difficult to limit the action to this part by the means\\nabove pointed out if care be taken in the required procedures.\\nThe Acids. Chromic and nitric acids are of service in extremely\\nshallow cavities of very high sensitivity. The former acts by coagula-\\ntion of the organic elements of the dentin and the latter by decomposi-\\ntion and solution. To apply these the adjacent tissues require to be\\nprotected. Each should be carried in small quantity upon a gold\\nprobe.\\nNitrate of silver is applicable for reducing the sensitivity of dentin\\nafter the removal of superficial caries or when by abrasion or by erosion\\nthe exposed tissue is intolerably sensitive. It is, however, only to be\\nused in the back of the mouth on account of the discoloration which it\\nproduces.\\nChlorid of antimony is applicable only to cases of exposed cemen-\\ntum, where it is claimed that it is equally as efficient as silver nitrate,\\nand has not the objection of discoloring the tissue.\\nGeneral Anesthesia.\\nWhile some reluctance should exist as to the propriety of inducing\\ngeneral anesthesia, it sometimes becomes necessary to resort to this\\nmeans of alleviation. Necessity for this election arises where the sen-\\nsitivity is extreme, when the previous remedies have been inefficient,\\nand when from the nature of the case zinc chlorid is inadmissible.\\nThe subjects should generally be adult persons of intelligence, who\\npossess moral force and, having confidence in their adviser, are capable\\nof giving the requisite indications of the progress of the anesthetic\\ninfluences.\\nSulfuric ether is the most suitable anesthetic to be employed, and\\nthe operative procedures should be performed in the first stage, that\\nof peripheral anesthesia. At this period, which is before the stage\\nof excitement commences, dentin may be cut without the slightest\\npain being felt. This is an important consideration, since if the ad-\\nministration is continued into the period of excitement nothing can be\\ndone, and if it is conducted to a full degree the patient is not manage-\\nable. Also the subsequent depression is to be avoided. While general\\nanesthesia in the first stages is available for the relief of dentinal sensi-\\ntivity, it is found, on the contrary, when resorted to for the removal of\\nthe pulp, as may occasionally be required in the most severe cases of\\ncongestion, that nothing short of profound anesthesia will suffice.\\nWhen the first stage is reached, the patient being conscious and able\\nto reply to questions, the cutting is commenced as the pain returns a\\nfew more inhalations are given, when another part of the cutting may\\nbe proceeded with. This may be repeated until the cavity is formed.", "height": "4604", "width": "2760", "jp2-path": "americantextboo00kirk_0220.jp2"}, "221": {"fulltext": "GENERAL ANESTHESIA.\\n213\\nFig. 159.\\nThe cutting should be quickly and deftly conducted. The amount of\\nether administered is far less than is required to induce full anesthesia,\\nand the patient suffers far less depression than if the operation were\\nperformed without this means. There is also no danger of shock, since\\nthe patient is, or should be, intelligently concerned in the progress of the\\ncase. If the condition were carried into the second stage, when excite-\\nment exists and alarm is aroused in addition to the operative interfer-\\nence, there is liability to shock, which, being due to a profound impres-\\nsion on the nervous system, is not liable to occur when the patient\\nconcurs in all the steps of the procedure.\\nThe time required to bring about a sufficient degree of dentinal\\nanesthesia frequently is less than two minutes. The ether should be\\npure and should be given with a free supply of air mixed with the\\nvapor. The ordinary custom of using the towel to envelop the face is\\nquestionable, since this method does not permit enough air to accompany\\nthe ether vapor.\\nAn invaluable inhaler for this purpose is the one invented by Dr.\\nAllis (Fig. 159). This consists of an oval\\nframe composed of a series of wires through\\nwhich passes back and forth a continuous\\nband of muslin. The layers of muslin\\nare near each other, and still so far apart\\nas to permit the free passage of the at-\\nmosphere. The correct manner is to\\ncontinuously drop the ether in small\\nquantity upon the muslin to maintain it\\nat an even degree of saturation.\\nThis appliance is one of value to the\\ndental operator, as by it the anesthetic\\nstate can be more quietly brought about\\nwith less of the characteristic disturb-\\nances which attend the usual modes of applying sulfuric ether.\\nThe use of chloroform for the purpose under discussion is wholly\\ninadmissible.\\nThe mechanical means consist in the use of temporary fillings,\\nwhich may be either metallic or non-metallic. The metallic act by\\ninducing, in consequence of the slight irritation of thermal conductivity,\\na consolidation of the subjacent dentin, which in time obliterates the\\ntubules. The non-metallic act simply as a protective covering to the\\ndenuded dentin. Their action hence is more tardy than that which\\nfollows the use of the former.\\nThe metallic stoppings for this purpose may be composed of either\\ntin foil or amalgam. Each of these requires cavities of reasonably good\\nThe Allis inhaler.", "height": "4540", "width": "2672", "jp2-path": "americantextboo00kirk_0221.jp2"}, "222": {"fulltext": "214 PRELIMINARY PREPARATION OF CAVITIES, ETC.\\nretentiveness, therefore they are not applicable to shallow cavities of\\nunsuitable form.\\nThe non-metallic may be either gutta-percha, zinc phosphate, or zinc\\noxychlorid. The two latter are the most desirable, as they adhere\\nto any well-dried cavity, and having some irritating influence on\\nthe tissues tend to induce structural consolidation in addition to their\\nprotective action. They have, however, the disadvantage of suffering\\nloss by chemical solution, and unless kept under close observation are\\ndelusive and in many instances are a deceptive means of preventing the\\nrecurrence of decay. In the employment of these substances due care\\nshould be exercised concerning the proximity of the pulp, in which cases\\nthe previously indicated means of shielding the pulp walls should be\\npursued.\\nThe chief disqualification of gutta-percha is its lack of resistance to\\nattrition, and when in positions shielded from wear it may be attacked\\nby low forms of bacterial life, which disintegrate it.\\nMechanical protection of cavities is most applicable to teeth of a low\\ngrade of structure and for young children who may not have the ability\\nto tolerate the more active means needed to reduce dentinal sensitivity.\\nFor these cases gutta-percha stoppings when carefully introduced are a\\ngreat boon, since they protect the tissues during the period of completion\\nand consolidation of the teeth.", "height": "4580", "width": "2788", "jp2-path": "americantextboo00kirk_0222.jp2"}, "223": {"fulltext": "CHAPTER VIII.\\nPREPARATION OF CAVITIES\u00e2\u0080\u0094 OPENING THE CAVITY\u00e2\u0080\u0094 RE-\\nMOVING THE DECAY\u00e2\u0080\u0094 SHAPING THE CAVITY\u00e2\u0080\u0094 CLASSI-\\nFICATION OF CAVITIES.\\nBy S. H. Guilford, A. M., D. D. S., Ph. D.\\nGeneral Considerations. The importance of the proper preparation\\nof a cavity for the insertion of a filling can scarcely be overestimated.\\nUpon its being well done the success of the completed operation largely\\ndepends. As many fillings fail from lack of thoroughness in the pre-\\nparation of the cavity as from any other cause.\\nThe operator should not be actuated by haste, but should be deliber-\\nate, careful, and painstaking. Each stage of the operation should be\\nthoroughly performed in order that when completed the cavity may be\\nin the best possible condition for the reception and retention of the\\nfilling.\\nThe operation is naturally divided into three stages\\n1. Opening the Cavity.\\n2. Removing the Decay.\\n3. Shaping the Cavity.\\nOpening the Cavity.\\nEvery cavity to be excavated must first be opened, so that it may be\\napproached and operated upon at all points. The particular manner of\\ndoiug this will have to be determined by the extent of the decay and its\\nposition, but in all cases the opening must be as full and free as the\\nconditions will permit.\\nThe accessibility of the cavity will depend upon its location. Upon\\nthe three exposed surfaces of a tooth crown (occlusal, lingual, and labial\\nor buccal) access to a cavity is usually easy, but upon the unexposed\\nsurfaces (approximal) access can only be had after the teeth have been\\npressed apart. For methods of securing temporary separation of the\\nteeth see Chapter VI.\\nA cavity upon an exposed surface, if small, can usually best be\\nopened by the use of some form of engine bur. A few sizes each of\\nthe forms known as fissure, inverted-cone/ and round (or\\n215", "height": "4524", "width": "2708", "jp2-path": "americantextboo00kirk_0223.jp2"}, "224": {"fulltext": "216\\nPREPARATION OF CAVITIES.\\nrose-head are shown in Figs. 160-162. A spear-pointed drill\\nis sometimes used, but is less serviceable on account of its tendency\\nto be caught or broken in the irregularities of the cavity orifice. A\\nmodified form of fissure bur has found much favor in the opening of\\nsmall cavities on exposed surfaces. It is made from an ordinary bur\\nFig. 160.\\nFig. 161.\\nFig. 162.\\nFissure burs.\\nInverted-cone burs.\\nRound burs.\\nfrom which the head has been broken, by cutting spiral blades on the\\ntapering neck of the shank. Being pointed, round, and tapering it\\neasily effects an entrance into the cavity and enlarges the orifice grad-\\nually and symmetrically. It is shown in Fig. 163.\\nIn cavities of larger size, where decay has made more progress, the\\noverhanging walls of enamel can best be broken down by chisels of\\nsuitable size and form. Where a straight chisel can be employed it\\nwill be found most efficient, but in positions difficult of access one\\nhaving a slight curve or angle may need to be employed. Figs. 164 and\\n165 represent both forms as well as the sizes usually preferred. The\\nFig. 163.\\nFig. 164.\\nModified fissure bur with\\ntapering point.\\nStraight chisels.\\nCurved chisels.\\nwidth of the blade may vary from one-sixteenth to one-eighth of an inch,\\nbut wider ones than these Avill seldom be required.\\nA chisel may be used with either hand pressure or mallet force. If\\nthe former, great care must be exercised to prevent its slipping and\\ncausing pain or possible injury. The best safeguard in its use is to\\nplace the thumb of the right hand on the tooth being operated upon or\\nsome adjoining one and use it as a fulcrum or pivot upon which the", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0224.jp2"}, "225": {"fulltext": "REMOVING THE DECAY.\\n217\\ninstrument may move in a curve. By this means the motion of the\\nchisel is regulated and controlled and all danger of slipping avoided.\\nIt will sometimes be of advantage to roughly pack the interior of the\\ncavity with cotton or spunk to receive the impact of the instrument\\nshould the chisel accidentally be forced to the bottom of the cavity.\\nThe better plan, however, in most cases, is to employ mallet force\\nfor the cleavage of enamel unsupported by dentin. By holding the\\nchisel between the thumb and three fingers of the left hand and resting\\nthe little finger of the same hand on an adjacent tooth for steadiness, a\\nsmart but light blow of a mallet in the right hand upon the end of the\\nchisel will easily and painlessly cleave off portions of the enamel.\\nIn opening cavities of small extent or limited depth upon approxi-\\nmal surfaces a round or inverted-cone bur will best\\nserve the purpose, but where caries is more exten-\\nsive and the surrounding enamel is unsupported by\\ndentin the orifice of the cavity can be more advan-\\ntageously enlarged by means of a delicate chisel\\n(shown in Fig. 1 66) the blade of which is bent at a\\nslight angle to the shank and all three of the edges\\nof which are bevelled to convert them into cutting\\nedges. This instrument will be found especially\\nuseful in opening cavities of medium or larger size\\non the approximal surfaces of the incisors, the point\\ndoing the cleaving and the side edges being used to\\nsmooth the enamel margins.\\nAfter the orifice of the cavity has been sufficiently\\nenlarged to afford a full view of its interior the next\\nstage of the operation is entered upon\\nFig. 166.\\n8\\nDelicate three-sided\\nchisel, useful for\\nopening cavities on\\napproximal sur-\\nfaces.\\nRemoving the Decay.\\nThe character or consistence of the carious structure has much to\\ndo with the method and means employed for its removal. If it be of\\nthe semi-elastic or leathery variety so often found in the teeth of young\\npersons, it can be most easily removed by means of spoon-shaped or\\nround-bladed excavators, which being oval or circular in edge out-\\nline and free from marginal angles, will lift and separate the layers\\nwithout danger of injuring the underlying healthy dentin and with the\\ninfliction of a minimum amount of pain. Fig. 167 illustrates this kind\\nof instrument in some of its forms, selected from the Darby-Perry set.\\nIn the dark, hard variety of caries, as also in the white, chalky\\nvariety, the different forms of burs and excavators will be found best\\nsuited for the purpose.\\nIn the removal of caries care should be exercised to inflict as little", "height": "4552", "width": "2676", "jp2-path": "americantextboo00kirk_0225.jp2"}, "226": {"fulltext": "218\\nPREPARATION OF CAVITIES.\\npain upon the patient as possible. To this end, in cavities of con-\\nsiderable extent, it is best, after the orifice has been sufficiently enlarged,\\nto make a sweeping cut with an excavator around the cavity just below\\nFig. 167.\\nJ I M\\nExcavators.\\nthe enamel line, thus freeing the decayed portion at that point. Follow-\\ning this the remaining portion of carious dentin should be removed by\\nplacing the blade of the excavator near the bottom of the cavity and\\nmaking draw-cuts toward the orifice. To cut in the reverse direction\\nwould produce uncomfortable pressure upon the most tender portion of\\nthe cavity, and possibly, by inadvertence, expose and wound the pulp.\\nWhen burs are employed for the removal of caries it is safest to use\\nonly such as are more or less rounded on their circumference, such as\\nthe round or oval forms, for they more nearly conform to the natural\\noutline of the cavity, leave no angular grooves in the dentin difficult\\nor impossible to perfectly fill, and are not so likely to injure the healthy\\nsubjacent dentin.\\nThe varieties of bur known as the inverted-cone and wheel, while very\\nuseful for opening cavities, should not be used for the removal of caries\\nin deep cavities, because of the irregularities of surface which their\\nperipheral angles produce.\\nRapidly revolving bars in an engine handpiece are very apt to cause\\npain by the development of factional heat. This may largely be pre-\\nvented by lifting the bur at short intervals and allowing it to run free\\nfor a moment, which will prevent overheating the tooth and thus avoid\\nunnecessary pain.\\nThorough excavation of the cavity and the removal of all carious\\ndentin is absolutely essential to success. To allow any portion of it to\\nremain and trust to the employment of germicides for its sterilization\\nis running the risk of failure, for we can never be entirely sure of\\ndisinfection. Besides this, there is no good reason for allowing cari-\\nous dentin to remain.\\nBy carious dentin is meant the remains or debris of the action of", "height": "4580", "width": "2724", "jp2-path": "americantextboo00kirk_0226.jp2"}, "227": {"fulltext": "REMOVING THE DECAY. 219\\ncaries, a product resulting from this disintegrating action upon both\\nthe organic and inorganic constituents of dentin. In nearly all cavi-\\nties we find two varieties of altered tissue. That nearest the surface is\\na mass of thoroughly disorganized and usually decomposed matter filled\\nwith micro-organisms. Beneath this and lying next to the healthy den-\\ntin there is a zone or layer from which the calcium salts have been re-\\nmoved by the acid solvent, but which still retains its original form and\\nvitality. This layer of decalcified dentin may be allowed to remain,\\nespecially in the bottom of a cavity, as it serves to protect the subjacent\\ntissue from thermal shock and will in the great majority of cases be\\nagain converted into normal dentin by the re-deposition of calcium salts.\\nAs a precautionary measure, however, it should be treated to an applica-\\ntion of some germicide such as carbolic acid, mercury bichlorid, for-\\nmalin (10 per cent, aqueous solution), or oil of cinnamon, before the\\ninsertion of the filling.\\nOccasionally caries will be found to be self -limited. In such\\ncases, through some unexplained change of conditions, the progress\\nof caries has been checked and the layer of decalcified dentin re-\\nstored to its previous normal condition. Where this has taken place\\nthe restored tissue is usually of a darker color than ordinary dentin,\\nand on this account may be mistaken for carious dentin and removed.\\nIt is, however, easily distinguished from caries by its hardness, and\\nshould in no case be removed except from the sides of a cavity, and\\nthen only when its dark color showing through the walls would prevent\\nthe cavity, after being filled, from having that clear and clean appear-\\nance which it should possess.\\nWith some practitioners it is the custom to prepare a cavity dry,\\nbecause in this way the operation is more rapid and usually less painful.\\nIn such case the rubber dam is applied first of all and the operations of\\nopening, cleansing, and shaping the cavity are all performed without\\nthe presence of moisture. Repeated applications of warm air from a\\nsyringe, at intervals during the operation, desiccate the dentin and di-\\nminish its power of sensation. Others, in order to avoid the unpleasant-\\nness to the patient of having the dam in position for so long a time,\\nprepare the cavity roughly in the presence of moisture, then apply the\\ndam, dry the tooth thoroughly, and finish the operation.\\nWhichever plan is adopted it is absolutely necessary, in all cases, to\\nfinish the preparation with the dam on and the tooth dry, for it is only\\nafter a tooth has been deprived of its moisture that we are able to\\ndecide whether all the niceties of preparation have been successfully\\ncarried out. Certain marginal and structural defects that are not\\nnoticeable while the tooth is moist are plainly revealed after it has been\\ndried.", "height": "4548", "width": "2660", "jp2-path": "americantextboo00kirk_0227.jp2"}, "228": {"fulltext": "220 PREPARATION OF CAVITIES.\\nShaping the Oavity.\\nThis is one of the most important of all operations associated with\\nthe stopping of a cavity, for according as it is properly or improperly\\nperformed will success or failure result. Too much stress cannot be\\nlaid upon its importance, nor too great care be exercised in its accom-\\nplishment.\\nInasmuch as a filling is retained in place mechanically it follows that\\nthe cavity must be of such shape as to favor retention. To this end it\\nshould be larger within (at least at certain points) than at the orifice.\\nAn exception to this rule lies in such cavities as are of small diameter\\nand of more than moderate depth. In cavities of this character,\\nparallel walls will suffice, because lateral-surface contact is so great in\\nproportion to the mass to be held in place that displacement could not\\noccur. In larger cavities of moderate depth, however, the reverse is\\nthe case, and they will require the assistance of internal enlargement\\nfor the retention of the filling. To govern each of the conditions two\\nrules may be formulated\\n1. When the depth of the cavity is greater than the diameter of the\\norifice, parallel lateral walls will prove retentive.\\n2. When the diameter of the orifice is greater than the depth of the\\ncavity, the latter will have to be somewhat enlarged internally to retain\\nthe filling.\\nExamples of the first class are found in the narrow but rather deep\\ncavities which occur on the lingual surfaces of the upper incisors\\nnear the cervix in the pit cavities on the buccal surfaces of molars\\nand in the small cavities found on either side of the enamel ridge on\\nthe occlusal surfaces of the lower first bicuspids.\\nExamples of the second class are found in numberless places on any\\nof the crown surfaces.\\nIn some cases cavities will be found of such form that when the\\ndecay has been removed they will have a naturally retentive shape, but\\nin the great majority of cases more or less sound tissue will have to be\\nremoved in order to give them the required form. To give a cavity a\\nretentive form it is not necessary that its interior be enlarged throughout\\nits whole extent, but it must be larger at two or more points, and these\\npoints must be opposite one another. Frequently it will be easier to\\nenlarge the cavity at all points, and to this no objection can be urged\\nprovided too much sound tissue be not removed or the pulp be not too\\nnearly approached. Too great enlargement tends to weaken the cavity\\nwalls and therefore should be guarded against.\\nIn shaping the cavity internally instruments should be employed\\nthat will leave the surface free from angles, for the filling material can-", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0228.jp2"}, "229": {"fulltext": "SHAPING THE CAVITY.\\n221\\nnot be perfectly adapted to them. As in the removal of decay, excava-\\ntors for this purpose should have curved edges, and burs should be of\\na round or oval form.\\nIf grooves are required they should neither be made deep nor too\\nnear to the enamel, for fear of weakening the walls. At the cervical\\nmargins of cavities grooves and starting pits should be avoided when-\\never possible, for they weaken the portion of the cavity which is sub-\\njected to the greatest strain in the introduction of the filling, both\\nmechanically and by cutting off the nutrient supply to the cervical\\nmargin, which tends to alter the resistive character of that portion of\\nthe tooth structure by devitalizing it.\\nFor the same reasons deep grooves or undercuts should not be made\\nnear the incisal or occlusal surfaces, for the strain of mastication will be\\nliable to result in fracture of the wall if it is thus unduly weakened.\\nIn the process of shaping the cavity internally the enamel margins\\nwill naturally be assuming their proper form, but the final part of the\\npreparation should consist in giving these frail portals of the cavity\\nvery careful and minute attention.\\nThe value and permanency of a filling will largely depend upon the\\nstrength of the enamel walls and their proper preparation. The enamel\\ncap of a tooth when intact is exceedingly strong and capable of resist-\\ning great strain, but when its continuity has been broken by caries and\\nit is left unsupported by dentin it is very weak and brittle. This is\\nreadily understood when Ave remember that enamel is composed of an\\naggregation of enamel rods or prisms in close juxtaposition, slightly\\njoined together by a cementing substance, with their greater diameters\\nperpendicular to the plane of the surface of dentin upon which they\\nFig. 168.\\nShowing enamel structure.\\nrest. When continuous, these rods mutually support one another and are\\nthus capable of resisting great strain but when a lesion has occurred\\nthey lose support on the adjoining side and hence are easily separated\\nin the direction of their length. Fig. 168 (after Black 1 shows this\\n1 Dental Cosmos, vol. xxxiii. p. 441.", "height": "4564", "width": "2764", "jp2-path": "americantextboo00kirk_0229.jp2"}, "230": {"fulltext": "222 PREPARATION OF CAVITIES.\\ncondition perfectly. A detached section of enamel prisms is represented\\nat a, and at b is shown a portion about being separated by a chisel.\\nThis will explain why enamel unsupported by dentin should not be\\nallowed to form the margin of a cavity, for it will probably either be\\nfractured while the filling is being introduced or afterward in mastication.\\nOn all convex surfaces of a tooth the enamel rods radiate outwardly,\\nand by forming the margins of a cavity on these lines it will have a\\nslightly flaring or trumpet-shaped orifice, which will not only afford the\\ngreatest strength but will admit of a better finish being given to the edges\\nof the filling. In many cases it will be necessary to give the margins of\\na cavity more of an outward bevel than would be obtained by simply\\nfollowing the cleavage lines of the enamel rods. This can be secured\\nby cutting away the outer ends of the enamel rods in an oblique direc-\\ntion as shown at c in Fig. 168. No weakening of the border will result\\nin such cases, inasmuch as the shorter rods will still rest upon the\\ndentin. If, however, the rods were cut so as to leave only their outer\\nends in place, as shown at d, they would have no substantial support,\\nand would be liable to be crushed daring filling or afterward. All\\ncavity margins should have the outward bevel to a greater or less\\nextent in order to secure the best and most permanent results.\\nIn cavities upon depressed or concave surfaces of teeth it would not\\ndo to have the enamel margins formed on the lines\\nof enamel cleavage, for this would make the margin\\nof the orifice the most contracted portion and result\\nin frail marginal edges. Fig. 169, representing a\\ncross section of a bicuspid tooth with a cavity in the\\nbicus- SU J CUS wil1 illustrate this point A shows the cavity\\npid showing treat- orifice prepared on the lines of enamel cleavage,\\nment of enamel mar- i r\\\\ r\\\\ p 1\\ngins of cavity in the an( l B the dressing across the outer edges of enamel\\nsulcus, required to give the necessary strength.\\nIt may therefore be laid down as a rule that to secure the best results\\nthe line of a cavity wall from within outward should form with the surface\\nof the tooth at this point an obtuse angle.\\nBeside the proper shaping of a cavity margin it should also be made\\nas smooth as possible. In accessible cavities upon exposed surfaces of\\nteeth the final marginal smoothing or finish can best be effected by the\\nuse of a bur shaped somewhat like a fissure bur, but having a rounded\\nend and being simply file-cut upon its surface instead of being bladed.\\nSuch a one is shown in Fig. 170. Its sides being parallel, no rounding\\nof the cavity margins can occur when it is used with the end inside of\\nthe cavity. Any other form of bur with a short head would unavoidably\\ngive to the cavity margin either a concave or a convex surface, both of\\nwhich would be incorrect.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0230.jp2"}, "231": {"fulltext": "CLASSIFICATION OF CAVITIES.\\n223\\nThe buccal, lingual, and cervical margins of a compound approximal\\ncavity should never be finished with a bur, even of the plug-finishing\\nvariety, but should be smoothed with suitable chisels, broad-faced\\nexcavators, or approximal trimmers, the latter being shown in Fig. 171.\\nFig. 170. Fig. 171.\\nFile-cut enamel finishing bur. Approximal trimmer.\\nThe practice of finishing cavity margins with sand-paper disks,\\nHindostan-stone points, or wooden points charged with emery powder is\\nvery objectionable, as they are almost certain to give to the margins a\\nrounded edge which cannot be filled and finished without leaving a\\nfeather edge of the filling overlying the enamel, which will eventually\\nbe broken off or flared up, leaving an imperfect margin.\\nClassification of Cavities. 1\\nI. Simple Cavities on Exposed Surfaces.\\nBicuspids and Molars. Incisors and Canines.\\nA. Occlusal. D. Labial.\\nB. Buccal. E. Lingual.\\nC. Lingual. F. Incisal.\\nII. Simple Approximal Cavities.\\nIncisors and Canines. Bicuspids and Molars.\\nG. Mesial and distal. H. Mesial and distal.\\nIII.\\nCompound Cavities.\\nicisors and Canines.\\nBicuspids and Molars.\\nI. Mesio-labial.\\nP. Mesio-occlusal.\\nJ. Disto-labial.\\nQ. Disto-occlusal.\\nK. Mesio-lingual.\\nR. Occluso-buccal.\\nL. Disto-lingual.\\n8. Occluso-lingual.\\nM. Mesio-incisal.\\nT. Mesio-disto-occlusal\\nN. Disto-incisal.\\n0. Mesio-disto-incisal.\\n1 Following the suggestion of Dr. Black, in the above list the word lingual is used\\nfor the same surfaces in both the upper and lower teeth, doing away with the word", "height": "4564", "width": "2728", "jp2-path": "americantextboo00kirk_0231.jp2"}, "232": {"fulltext": "224 PREPARATION OF CAVITIES.\\nIn the foregoing classification the cavities have been arranged pro-\\ngressively from the simplest (A) to the most complicated (T).\\nI. Simple Cavities on Exposed Surfaces.\\nBICUSPIDS AND MOLAKS.\\nClass A. Cavities upon the occlusal surface are very accessible and\\nin full view, enabling the operator to see every part of the cavity and\\naffording him plenty of room in which to operate. Naturally those\\nnearest the front, as in the bicuspids, present the advantage of greater\\naccessibility, but none of them are difficult to prepare and fill except\\nunder unusual conditions.\\nUsually the first part of a bicuspid crown to become affected by\\ncaries is the fissure between the cusps. Sometimes it presents merely as\\na black line into which only the point of an explorer will penetrate\\nat a later stage the cavity is more fully defined by the greater pro-\\ngress of caries and the crumbling of the walls of its orifice. In the\\nfirst instance the cavity is most readily and comfortably opened by\\nmeans of the tapering fissure bur shown in Fig. 163. After passing it\\ninto one of the terminal pits of the cavity it may be drawn along toward\\nthe other, opening the fissure quite freely. Once open, the decay may\\nbe removed and the cavity shaped by a suitably sized round bur\\n(Fig. 162). As the decay has usually progressed farther in the region\\nof the terminations of the cavity than in\\nFig. 172. e S p ace between them, the cavity when\\nfully formed will be oblong in shape and\\ncontracted in the centre. In Fig. 172,\\nA shows this form, while B represents\\nthe same surface before being- operated\\nCavity in sulcus of a bicuspid. L\\nupon.\\nIn preparing the cavity no more sound tooth-structure should be\\nsacrificed than is absolutely necessary, but every portion of decay should\\nbe thoroughly removed and particular attention be given\\nto opening up the minor fissure terminations as shown at\\nA A, b b (Fig. 173).\\nWhen completed, the cavity should be very slightly\\nlarger within than without, the margins should present\\nno angles, but only a series of curves in outline, and the\\nThe fissure J\\nterminals. marginal edges should be slightly bevelled outwardly.\\nBicuspid cavities of this character vary in size according to the extent\\nof decay, but the essential features in each case are very similar. The\\npalatal. In the forming of compound terms, where the medal or distal surfaces are\\nincluded, these terms precede the others. Where they are not included and the word\\nocclusal is used, it is given first place.", "height": "4580", "width": "2784", "jp2-path": "americantextboo00kirk_0232.jp2"}, "233": {"fulltext": "SIMPLE CAVITIES ON EXPOSED SURFACES. 225\\nlower first bicuspid differs normally from all others of its kind in\\nhaving no sulcus and consequently no fissure between the cusps. In-\\nstead of the two cusps being separated by a sulcus they are united by\\na ridge of enamel. (See Chap. I., p. 35.) The only points, therefore,\\nthat invite decay upon the occlusal surface of this tooth are the two\\npits that are found one on each side of the ridge. These are to be\\nfilled separately. They probably represent the very simplest form of\\nsimple cavities to be found anywhere in teeth.\\nThe occlusal surface of an upper first or second molar presents two\\npoints liable to decay. One is a pit formed by the junction of two\\nsmall fissures near the mesial margin, and the other is a fissure which\\nruns between the disto-buccal, disto-lingual, and mesio-lingual cusps.\\nBoth are represented in Fig. 174. When limited in extent they should\\nbe opened in the same manner as a bicuspid fissure cavity, but when\\nlarger they may be opened by means of a chisel followed by a suitable\\nbur. In these, as in all cavities in sulci, the fissures must be followed\\nand opened up to their extremest limits in order to ensure success, while\\nthe margins and marginal edges must be so formed as to be strong,\\nsmooth, and bevelled.\\nThe general form of these cavities when prepared is shown in\\nFig. 175. It will frequently be found that these two occlusal cavities\\nFig. 174. Fig. 175. Fig. 176. Fig. 177.\\nMolar fissure cavities. Molar fissure cavities prepared for filling.\\nare joined underneath, while near the surface they are separated by a\\nridge of enamel and dentin. In such cases the ridge should be cut\\naway and the two cavities converted into a single larger one as illus-\\ntrated in Fig. 176.\\nIf the ridge were allowed to remain it would almost certainly be\\nfractured either in the operation of filling or subsequently by the force\\nof mastication.\\nThe upper third molar differs from those anterior to it in having\\nbut three cusps and consequently but one central pit with radiating\\nfissures. A cavity occurring here when properly prepared will pre-\\nsent a triangular outline with rounded angles, as in Fig. 177. The\\nterminals of fissures should always be finally finished with a round bur\\nto prevent any possible angles and opportunity for leakage at those points.\\nThe lower first molar, as well as the third, having five cusps with\\nintervening sulci, a cavity upon this surface will be pentagonal in out-\\nline, as represented in Fig. 178.\\n15", "height": "4560", "width": "2720", "jp2-path": "americantextboo00kirk_0233.jp2"}, "234": {"fulltext": "226 PREPARATION OF CAVITIES.\\nExtreme care should be exercised in preparing cavities of this\\ncharacter to insure that the fissures running between the buccal cusps\\nare fully opened and cleared of every particle of decay and discolora-\\ntion. Too often this is overlooked and caries supervenes.\\nThe lower second molar with its four cusps has two sulci inter-\\nsecting each other at a right angle. Decay usually begins at the inter-\\nsection and extends along the radiating arms of the fissures. If the\\ncavity were prepared by cutting out the fissures only it would yield a\\ncrucial-shaped cavity with four sharp or nearly sharp angles at the\\nintersection, as shown in Fig. 179. Owing to these angles of dentin\\nFig. 178. Fig. 179. Fig. 180.\\nLower first molar with stel- Lower second molar with Prepared cavity in lower\\nlate cavity. Prepared. crucial cavity. Not pro- second molar.\\nperly prepared.\\nand enamel the perfect filling of the cavity would be exceedingly\\ndifficult.\\nThe case may be simplified and better results in every way obtained\\nby rounding these angles and giving the cavity a form like the one\\nshown in Fig. 180.\\nClass B. Buccal cavities are seldom met with in the bicuspids\\nexcept at the cervix. In this location they possess the same features as\\nthe similar class of cavities occurring on the labial surfaces of the\\nincisors. Their treatment will be described under class D.\\nThe upper molars also are seldom found decayed on the buccal sur-\\nface except at the cervical border. Cavities occurring at this point are\\nusually narrow and long, following the outline of the gum. They can\\nbest be prepared with an engine bur of suitable form, and if occurring\\non the second and third molars a right-angle attachment may have to\\nbe employed to reach them conveniently. Decay at this point is often\\nof the white variety, and as it so nearly resembles the natural color\\nof the tooth extreme care will have to be exercised to include all of\\nthe decalcified portion within the limits of the cavity. A retentive\\nform is most conveniently given to these cavities by slightly undercut-\\nting them in the direction of their length. In the third molars it is\\nsometimes advisable to make an undercut or starting-pit at the distal\\nend for the beginning of the filling.\\nSometimes a small cavity will be found at about the centre of the\\nbuccal surface of the upper molars, but far more frequently a cavity\\nof greater extent will be found upon the same surface of the lower\\nsecond molar. It originates in a pit at the termination of the fissure", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0234.jp2"}, "235": {"fulltext": "SIMPLE CAVITIES ON EXPOSED SURFACES. 227\\nrunning over from the occlusal to the buccal surface between the two\\nbuccal cusps. Oftentimes the cavity is so large as to include the greater\\nportion of this surface of the tooth. Its usual form and appearance are\\nshown in Fig. 181.\\nNot infrequently this cavity is compounded with one on the occlusal\\nsurface. In opening and preparing it a slightly undercut\\nform is readily given to it.\\nClass C. Decay rarely occurs upon the Ungual sur-\\nfaces of molars on account of their smoothness and con-\\nvexity and because they are more or less constantly rubbed Buccal cav i t y\\nby the tongue in speech and mastication. The evenness of in lower sec-\\nthis surface is, however, broken in the upper first and sec-\\nond molars by a fissure extending over from the occlusal surface and\\npassing between the two lingual cusps. (See Chap. I., p. 39.) This fis-\\nsure is deeper and more pronounced in the first molar, but in each tooth\\nit is generally the seat of caries early or later in life. In the majority\\nof cases this fissure is decayed throughout its entire length, forming a\\ncompound cavity, but occasionally only the pit at its termination on\\nthe lingual surface is affected.\\nAnother point on the lingual surface liable to decay is on or near the\\nmesio-lingual angle of the upper first molar, about midway between the\\ncervical and occlusal margins. At this place is often found a supple-\\nmental cusp, diminutive in size, and where it joins the main surface of\\nthe tooth a small fissure exists which invites decay. This\\nadditional cusp, when it does exist, is found only upon the FlG# 182,\\nfirst molar. It is shown at A in Fig. 182. (See Chap.\\nI., p. 39.) Neither of these cavities presents any diffi-\\nculties in preparation except such as occur from their slight\\ndifficulty of access.\\nOccasionally, though very rarely, the lingual surface\\nof any of the molars may present a cavity of decay close\\nto the gingival line and partly beneath it. Such cavities are doubtless\\ncaused by the retention of food debris beneath the free margin of the\\ngum, and owing to their position they are difficult to treat. They\\nshould be opened and packed over-full with cotton and varnish or\\ngutta-percha for a day or two, to press the gum away, after which they\\nmay be prepared and filled in the usual manner.\\nINCISORS AND CANINES.\\nClass D. Cavities upon the labial surfaces of incisors and canines\\nare usually found along the gingival margin, and are the result of the\\ndirect action of acids probably formed at this point. In the beginning,\\nand when small, they are entirely exposed, but when of greater extent", "height": "4560", "width": "2724", "jp2-path": "americantextboo00kirk_0235.jp2"}, "236": {"fulltext": "228 PREPARATION OF CAVITIES.\\nthey frequently extend beneath the free margin of the gum. They are\\nnearly always elliptical in outline and may consist of simple decalcified\\nenamel still retaining the usual surface form, or they may possess the\\ncommon characteristics of cavities in general.\\nThe opening and preparation of this class of cavities are not attended\\nwith any marked difficulties except that when they extend beneath the\\ngum care will have to be exercised not to wound this tissue, as the\\nconsequent bleeding would obstruct the view and interfere with the\\nprogress of the work. This may be prevented by pressing and holding\\nthe gum away with a suitable instrument held in the left hand while the\\ncavity is being prepared. Particular attention should be paid to the care-\\nful preparation of the cervical margin of the cavity and to its terminal\\npoints. The former should be made smooth and even, and the latter\\nshould be extended far enough to include any enamel that shows the\\nleast sign of acid alteration. Slight grooves or enlargements at the\\nbase of the cavity along its upper and lower margins will give it a suf-\\nficiently retentive form.\\nA second locality on the labial surface where decay is frequently\\nfound is anywhere between the central portion and the incisal edge,\\nin pits and depressions that indicate imperfect development of the\\nenamel. These pits or grooves extend in a nearly straight line parallel\\nto the incisal edge, and are frequently the seat of decay.\\nWhen quite shallow they may be obliterated by grinding the surface\\nwith a small corundum wheel and polishing, converting the\\nsurface at this point into a distinct concavity. When the\\npits are deeper and isolated they may be filled separately,\\nthe result being a lesser degree of conspicuousness but\\nwhen they are connected by a groove, as they usually are,\\nPitted incisor, they will have to be converted into a single cavity and\\nfilled. A common type of this defect is shown in Fig. 1 83.\\nWhen these pits occur upon the incisal edge or in close proximity\\nto it the choice lies between an unsightly gold filling, a porcelain tip, or\\ntheir removal by grinding and the resultant shortening of the crown.\\nClass E. There is usually but one point upon the lingual surface\\nof incisors and canines that is liable to decay. It is in the pit at the\\njunction of the basilar ridge or cingulum with the adjacent tooth\\nsurface. The incipiency of caries at this point presents only as a mi-\\nnute cavity, the opening and shaping of which is readily accomplished\\nwith a round bur. Although the orifices of these cavities may be\\nsmall, the dark spot that marks their direction is often continued quite\\na distance toward the pulp chamber. This black point should in all\\ncases be followed to its termination and obliterated. It will never be\\nfound to reach the pulp or to approach dangerously near it. As the", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0236.jp2"}, "237": {"fulltext": "SIMPLE APPEOXIMAL CAVITIES. 229\\ndepth of these cavities is greater than the diameter of their orifices, no\\nspecial retentive shape need be given them.\\nThe orifice should always be bevelled and enlarged, if necessary, to\\ninclude any neighboring fissures.\\nWhen these cavities are of greater extent they are prepared and\\nfilled like others of similar size and form.\\nClass F. Cavities upon and confined to the incised edge of incisors\\nand canines are easily prepared on account of their accessibility. This\\nparticular surface should, and generally does, remain free from decay\\non account of the attrition to which it is constantly subjected but\\nwhen defects in the enamel exist, caries sometimes occurs in connection\\nwith it.\\nThis surface often needs covering with gold to check abrasion in\\ncases where, after middle life, the crowns (especially those\\nof the upper teeth) have been shortened by excessive\\nwear. Under these conditions the surface has to be so\\nprepared and shaped as to retain the gold that is to cover\\nand protect it just as though caries had originally injured\\nthe part. In forming the cavity in the exposed dentin\\nit is only necessary to cut deeply enough to afford a lodg-\\nment for the filling, but the orifice must be so enlarged and Cross\\nexcessively bevelled as to reach to the marginal edge of cavity on in-\\nenamel all around. This is done to protect the enamel\\nfrom chipping or fracture in mastication. To afford the greatest\\nsecurity to the filling the cavity should be undercut throughout its\\nwhole extent. When thus prepared, the cavity in cross section will\\nresemble a double dove-tail as shown in Fig. 184.\\nII. Simple Approximal Cavities.\\nINCISOKS AND CANINES\\nClass G. Cavities upon the mesial and elisted surfaces of the\\nanterior teeth present only the difficulty arising from inaccessibility.\\nTo reach and operate upon these cavities, the teeth, if in normal contact,\\nwill usually have to be pressed apart either by gradual wedging or by\\nimmediate separation with a separator. Even after this has been\\naccomplished the cavity cannot be operated upon in a direct way as are\\ncavities upon exposed surfaces, but will have to be approached from\\neither the labial or lingual aspect of the crown. To do this, if the\\ncavity be small, will generally necessitate an additional enlargement of\\nthe cavity toward the surface from which it is to be approached. As\\nthe lesser of two evils the enlargement is usually made toward the\\nlingual surface, for in this way the exposure of gold when the filling is", "height": "4544", "width": "2716", "jp2-path": "americantextboo00kirk_0237.jp2"}, "238": {"fulltext": "230\\nPREPARATION OF CAVITIES.\\nFig. 185.\\nDelicate three-sided\\nchisel, useful for\\nopening cavities on\\napproximal sur-\\nfaces.\\ncompleted will not be noticeable. When the cavity is of larger size and\\nthe enamel wall on the labial surface has been weakened by caries it will\\nhave to be removed, and access will thus unavoidably be afforded from\\nthat side. Whenever possible, however, undue enlargement of the\\ncavity and consequent exposure of gold should be avoided.\\nIn ordinary cavities upon the approximal surface the frail walls\\nbordering the orifice should be broken away with\\na small chisel, and after the decay has been removed\\nby means of burs or excavators and the proper form\\ngiven to the cavity, the margins should be carefully\\nsmoothed and bevelled with small plug-finishing burs\\nor with the side-cutting edge of the small chisel\\nshown in Fig. 166 and here reproduced (Fig. 185).\\nAnchorage is obtained in these cavities by slightly\\ndeepening the cavity at its cervical termination and\\nmaking a shallow undercut in the dentin near the\\nincisal border. Retaining grooves should never be\\nmade in the labial or lingual walls of the cavities,\\nas they would seriously weaken them. In approxi-\\nmal cavities of large size where they extend from\\nnear the incisal edge to or beyond the free margins\\nof the gum, the difficulties of producing a perfectly formed cavity\\nare greatly increased. While affording greater ease of approach on\\naccount of their size, the cervical border of this class of cavities is\\napt to be less perfectly prepared owing to its obscure location. When\\nthe cervical border extends beneath the free margin of the gum the latter\\nshould be pressed and held away during excavating, so that the cervical\\nwall may be plainly seen and operated upon throughout its whole\\nextent.\\nCutting of the wall should be sufficiently extended rootward to in-\\nclude any defects or checks in the enamel bordering it, and should be\\nmade entirely smooth and free from angles, for it is the most vulnerable\\nborder of the cavity after the filling has been completed. Should the\\ncavity extend to near the enamel termination at the cervix, it will be\\nbest to still further extend it so as to pass beyond this margin for if a\\nsmall portion of enamel be left there it will be liable to be broken\\naway in the process of filling and thus seriously impair the junction of\\nthe filling with the border.\\nSo, also, if the cavity on account of its size should approach very\\nnear to the incisal edge, it is best to remove this frail corner and con-\\nvert the cavity into a compound one. Where such a weak corner is\\nallowed to remain it is very frequently broken away in subsequent mas-\\ntication. Such a result is shown in Fig. 186. An accident like this is", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0238.jp2"}, "239": {"fulltext": "SIMPLE APPROXIMAL CAVITIES. 231\\nmore likely to occur in thin, fiat teeth where the plates of enamel meet-\\ning at the incisal edge have little or no dentin between them.\\nWhere doubt exists as to whether the corner should be F lg6\\nremoved or allowed to remain, it is well, after the cavity has\\nbeen prepared, to test the strength of the corner by strong pres-\\nsure upon it in the direction of the long axis of the tooth with\\na piece of orange-wood. If it resists this strain it will prob- straight\\nably resist the force of mastication, and if it break away under fracture\\nthe test it will demonstrate that it would have been unwise to allow it\\nto remain.\\nIf the corner be left as a border and support for the filling it should\\nnot be weakened by a deep retaining groove. Such groove or anchorage\\nshould be shallow, and as far removed from the incisal border as the\\nconditions will permit.\\nIn many cases, where the incisal wall would be seriously weakened\\nby any attempt to use it as an anchorage or support for the\\nfilling, and where it seems undesirable to remove it, an ex- r^-~*\\ncellent anchorage for the lower border of the filling may be *s|\\nobtained by cutting an extension upon the lingual surface in y^jK\\nthe form of an arm, as shown in Fig. 187. 1 Such extension, I 4\\nif made but little deeper than the enamel, will not materially Fjf\\nweaken the tooth and will secure the filling perfectly. Lingual ex-\\nIts position should be near the incisal edge, but not so tension an-\\nchorage.\\nclose to it as to weaken the part.\\nIn the anterior teeth the relative difficulties between mesial and distal\\ncavities are insignificant.\\nBICUSPIDS AND MOLARS.\\nClass H. The preparation of small cavities on the mesial and\\ndistal surfaces of the bicuspids and molars, though simple in character,\\nis usually most difficult of thorough performance. This is due entirely\\nto their inaccessibility when the teeth are closely approximated. How\\nto approach these cavities is often a matter of no small concern to the\\nstudent or young practitioner, and the preparation and filling of them\\nis generally more difficult than that of larger and more complicated\\ncavities in exposed situations. To lessen the difficulty of approach it is\\nimportant, whenever practicable, to create by wedging beforehand as\\ngreat a separation as possible between the teeth. The greater the space\\ngained the less the difficulty of approach.\\nWhen conditions will not warrant cuttinp; down to them from the\\nocclusal surface, and thus converting them into compound cavities,\\nbut two ways of approach are left open one is from the direction of\\n1 Dental Review, vol. ix. pp. 812 and 819.", "height": "4552", "width": "2712", "jp2-path": "americantextboo00kirk_0239.jp2"}, "240": {"fulltext": "232\\nPREPARATION OF CAVITIES.\\nthe occlusal surface, and the other from the buccal aspect. Usually the\\nformer is chosen, as it involves less sacrifice of tooth structure, although\\nby it the difficulties are increased owing to the limited space in which\\nwe are obliged to operate.\\nThese cavities can usually be best opened and mainly prepared with\\na round bur. After the decay has been removed and the walls defined\\nand prepared, the cavity may be made retentive in form by slight under-\\ncutting throughout its entire circumference, or it may be enlarged at\\ntwo opposite points only. The cervical wall can be inwardly deepened\\nby an obtuse-angle hatchet excavator as illustrated in Fig. 188, and the\\nlower or occlusal wall be slightly undercut by an acute-angle excavator\\nlike Fig. 189.\\nFig. 188.\\nFig. 189.\\nT\\nObtuse-angle hatchets.\\nAcute-angle hatchets.\\nThe sharp angles on the cutting edges of these excavators should\\nbe rounded before being used, so as to avoid the formation of angles in\\nthe cavity.\\nAs the enamel rods on this surface radiate outwardly at such an\\nangle as to give the proper bevel to the orifice of the cavity, a careful\\nfollowing of their lines in the preparation of the cavity margins will\\nbe all that is necessary to give them the desired form and strength.\\nOccasionally these cavities, instead of being round or nearly so, have\\na decided oval or oblong form, their greater diameter being in a bucco-\\nlingual direction, in which event the cavity may generally be best ap-\\nproached, for preparation and filling, from the buccal aspect.\\nWhen this seems desirable, the cavity should be extended so as to\\nopen at the approximo-buccal angle. A round bur is best suited for\\nthis purpose, and when the extension has thus been made the cervical\\nand occlusal walls of the cavity may be slightly grooved with a hoe\\nexcavator and the inner or lingual wall be made abrupt and also slightly\\nundercut.\\nIn all cases where sufficient space cannot be gained to operate satis-\\nfactorily from the direction of the occlusal surface, an extension of the\\ncavity to the buccal aspect is the only alternative.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0240.jp2"}, "241": {"fulltext": "COMPOUND CAVITIES. 233\\nWhere simple cavities upon the approximal surface are large they\\nmay extend so near to the occlusal surface as to weaken it. When this\\nis the case the enamel wall should be cut away and the cavity converted\\ninto a compound one of the approximo-occlusal type.\\nIII. Compound Cavities.\\nINCISOKS AND CANINES.\\nClasses I and J. Memo-labial and disto-labial cavities occur from\\nthe near approach or union of simple cavities upon their\\nrespective surfaces. Cavities of considerable length up-\\non the approximal and labial surfaces are very apt to L\\njoin one another by extension of caries. When they JT^I\\ndo not join they are usually separated by a narrow terri- (fl jf\\ntory of more or less impaired tooth tissue, and in such Mesio-iabiai cay-\\ncases must be united to obtain a satisfactory result. Each\\ncavity should be as nearly prepared as possible separately, after which\\nthe intervening tissue should be cut away and the lines of the channel\\nconnecting the two be made as strong and smooth as possible. This\\nchannel will usually be of less width than either of the cavities, but not\\nmore difficult to fill on this account. Fig. 190 shows a front view of\\nsuch a compound cavity.\\nWhether the cavity be a mesio-labial or a disto-labial one will not\\nmaterially affect the manner or difficulty of operating.\\nClasses K and L. Mesio-lingual and disto-lingual cavities are\\nformed in the same manner as those of classes I and J except that in\\nthese cases the lingual surface is involved instead of the labial. 1Q1\\nExtensive caries in the region of the basilar pit or of the\\nfissures connected with it often approaches so nearly to an\\napproximal cavity in the same tooth as to demand the union\\nof the two (see Fig. 191). The method of preparing and\\nuniting the two is substantially the same as that followed in\\nclasses I and J, just described.\\nA mesio-lingual cavity is perhaps more easily prepared and filled\\nthan a mesio-labial one, for in its preparation the free cutting away\\nof the intervening wall is permissible, which affords increased room for\\noperating.\\nFortunately, a lingual cavity rarely extends so far as to connect with\\nboth a mesial and a distal cavity. When it does, the joining of the\\nthree cavities very seriously weakens the crown at the point where the\\ngreatest strain occurs.\\nClasses M and N. These classes include cavities upon either the\\nmesial or distal surfaces connecting with a cavity upon the incisal edge.", "height": "4564", "width": "2712", "jp2-path": "americantextboo00kirk_0241.jp2"}, "242": {"fulltext": "234 PREPARATION OF CAVITIES.\\nThey usually occur in consequence of the wearing away of the latter\\nsurface through attrition or from the necessitated removal of the incisal\\ncorner on account of weakness. Both the approximal and incisal cavi-\\nties may be prepared separately as described in classes F and G, after\\nwhich they should be connected, the walls made strong and smooth and\\nproperly bevelled.\\nA typical cavity of this class is shown in Fig. 192. In all such\\ncases the labial plate of enamel should be preserved intact as\\nfar as possible for appearance sake, and if any cutting has to\\nLwilfl be done to increase the size or depth of the incisal portion of\\n1^ I the cavity, it should be done at the expense of the lingual wall.\\nwji;)) In order to protect the labial wall from possible fracture in\\nmastication the enamel should be bevelled outwardly (as men-\\nincisai cav- tioned under class F) so that when filled the gold alone will\\ncome in contact with the opposing teeth in mastication.\\nThe only anchorage needed for this class of cavities is a slight\\nundercut along the cervical wall and a dovetailed form of the incisal\\nportion of the cavity.\\nIn many cases there is no cavity upon the incisal edge, but where\\nopportunity offers for making one (as in the case of thick or worn teeth)\\nthis method of forming a compound cavity affords the greatest possible\\nsupport and security for a large approximal filling involving the ap-\\nproximo-incisal angle.\\nWhere the crown is thin and unworn upon the incisal surface a com-\\npound cavity of this character cannot be formed, but the same result as\\nto anchorage may be obtained by cutting an extension upon the lingual\\nsurface of suitable size, form, and depth, as described on\\np. 231. One form of such extension where the corner is\\ngone is shown in Fig. 187. 1 Another form, represented\\nin Fig. 193, 2 consists of giving the extension a curved or\\nhooked form. Both forms serve the same purpose, for\\n^anlnchorage 6 they a ff\u00c2\u00b0 r( l m these cases perfectly secure anchorage which\\ncould not be obtained so well in any other way.\\nClass 0. Mesio-disto-incisal Cavities. Cavities of this character\\ndiffer from the preceding ones principally in extent. The method of\\npreparation in each case is similar and the operation requires the\\nexercise of great skill and care in order to produce the best results.\\nIn both cases the following points will have to be observed\\nAs the operations are extensive in character, good strong walls are\\nneeded on all sides to withstand the force exerted in the introduction of\\nthe filling.\\n1 Dental Review, vol. ix. pp. 812 and 819.\\n2 I. C. St. John, D. D. S., Dental Cosmos, vol. xxxvi. p. 198.", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0242.jp2"}, "243": {"fulltext": "COMPOUND CAVITIES. 235\\nAll margins must be smooth and nicely bevelled.\\nNo angles or checked enamel must exist along the borders.\\nAll enamel should be supported by underlying dentin, although\\nto avoid the exposure of gold the labial plate (which is thicker than\\nthe lingual) may sometimes be left thus unsupported for a short distance\\nalong the approximal and incisal margins.\\nNo deep anchorages will be required. Only slight ones are needed\\nto start the filling at the cervical wall, for the form of the filling, when\\ncompleted, will be such as to afford the greatest possible security.\\nBICUSPIDS AND MOLARS.\\nClass P. Mesio-ocdusal cavities in bicuspids and molars represent\\na class not only frequently met with and difficult to fill, but one also in\\nwhich a large proportion of fillings fail. This is largely due to the\\nimproper shaping of the cavity and the imperfect placing and adaptation\\nof the filling. When these cavities are of moderate size, not extending\\nas far as the gingival margin on the mesial surface and without any\\ngreat width in a buccal or lingual direction, the preparation and filling\\nof them is not attended with any great difficulty but where they\\nextend beneath the gum margin and are much spread out laterally they\\npresent complications that are difficult to overcome.\\nThe cervical margin of such cavities as extend only to or near to\\nthe free margin of the gum has been aptly styled the vulnerable\\npoint/ because when failure occurs in these fillings it usually begins at\\nthis margin. When, however, the cavity Avail extends beneath the gum\\nmargin, although the difficulties of operating are increased, recurrence\\nof decay is seldom met with, because the conditions favorable to decay\\nare not present there.\\nIn the preparation of these cavities the teeth should have been pre-\\nviously wedged in order to afford light and room for excavating, as well\\nas for the. subsequent introduction and finishing of the filling. If the\\ncavity extend beneath the margin of the gum the latter should be\\npressed away by packing the cavity over-full with gutta-percha for a\\nday or two previously.\\nAfter opening and roughly preparing the cavity the rubber dam\\nshould be adjusted and the cavity thoroughly dried, after which the prep-\\naration can be completed more satisfactorily, as the dryness of the tooth\\nwill enable the operator to readily distinguish between sound and un-\\nsound tissue.\\nWhether the cavity be of large or moderate size, simple or difficult\\nin character, the niceties of preparation must receive due consideration.\\nThe cervical portion of the cavity should be dressed until a strong\\nsound wall is obtained. In it there must be no angles, and bordering", "height": "4556", "width": "2704", "jp2-path": "americantextboo00kirk_0243.jp2"}, "244": {"fulltext": "236\\nPREPARATION OF CAVITIES.\\nFig. 194\\nit there must be no decalcified tooth structure and no checks in the\\nenamel. Should either of the latter be found, further cutting of the\\nwall will be necessary until these defects are entirely obliterated.\\nIf the cavity should extend rootward to near the termination of\\nthe enamel, it will be necessary to deepen the cavity so as to include\\nthis portion, otherwise injury will be liable to result from the fracture\\nof this frail section of enamel during filling.\\nThe outline of the cervical wall may be either distinctly curved or\\nmore or less flattened the latter form, shown in\\nFig. 194, A, being preferred by many on account\\nof the assistance it renders in filling. The buc-\\ncal and lingual walls must be dressed to a smooth\\noutline and bevelled, and where the size of the\\ncavity warrants it should be extended so far\\ntoward the buccal and lingual surfaces as to free them from the danger\\nof future decay. In Fig. 195 the dark portion represents the buccal\\naspect of the completed filling. None of these walls should be deeply\\nundercut to assist in either the introduction or retention of the filling,\\nfor such undercutting is a source of weakness, but shallow grooves are\\nnot objectionable when needed.\\nStarting pits or grooves should not be made in the cervical wall\\nexcept in rare cases a slight dipping inward of the wall, as indicated\\nat a, Fig. 196, being sufficient to furnish all the retentive form needed\\nat this part of the cavity.\\nThat portion of the cavity in the sulcus on the occlusal surface may\\nFig. 196. Fig. 197.\\n(After Black.)\\nPrepared cavities and anchorages.\\nbe made retentive either by slightly enlarging it inwardly or by widen-\\ning it at its termination, as shown at A, Fig. 196. Where the occlusal\\nand approximal portions of the cavity meet, the angles should be re-\\nmoved and the cavity well opened so as to afford access and give\\nstrength to the filling (b, Fig. 197).\\nFig. 198 represents a compound cavity of this class, incorrectly\\nformed. In it moderately sharp angles are seen at the points\\nwhere the occlusal and approximal portions of the cavity join.\\nIn very exceptional cases, cavities upon the approximal sur-\\nfaces that involve a slight portion of the occlusal do not need\\nto be extended along and include the sulcus or sulci on this\\nsurface, owing to the fact that no fissures and no decay exist in them.\\nFig. 198.", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0244.jp2"}, "245": {"fulltext": "COMPOUND CAVITIES. 237\\nIn such instances the occlusal portion of the cavity should have a V\\nshape as shown in Fig. 199, and anchorage for the filling at this point\\nbe obtained by slightly undercutting the approximo-occlusal walls at A\\nand B.\\nFig. 200.\\n^B B X D\\nPrepared cavities and anchorages.\\nIn the diagram Fig. 200 the black portion represents the floor\\nof the cavity A and b indicate the points to which the buccal and lin-\\ngual walls should be cut c and d show the curved form of cavity\\nafter the occluso-approximal angles have been removed, while the\\ncurved line outside of the cavity indicates the approximal contour of\\nfilling, with contact point at h.\\nFig. 201 represents a compound cavity (mesio-occlusal) in a lower\\nsecond molar. These cavities differ from similar ones in _ _ A1\\nFig. 201.\\nbicuspids principally in having the occlusal portion of\\nthe cavity exteud in different directions along the sulci.\\nAll of the terminations should be well rounded and in\\nno portion of the cavity should distinct angles be allowed ^fesio-occiusai cav-\\nL J ity m lower sec-\\ntO remain. ond molar. Pre-\\nClass Q. Disto-occlusal cavities in either the bicus- pared\\npids or molars are not essentially different from mesio-occlusal cavities\\nin the same teeth. Owing to their position they are more difficult\\nof approach, but their manner of preparation and their form are vir-\\ntually the same.\\nClass R. Occluso-buccal cavities are more frequently met with\\nin the lower than in the upper molars. This is due to the general\\npresence of a pit upon the buccal surface in which decay by extension\\nreaches so near to the occlusal surface that the occluso-\\nbuccal wall is weakened and has to be removed. Coin-\\ncident with this there is usually a cavity of some size\\nupon the occlusal surface, and the union of the two\\ncavities becomes necessary to insure a satisfactory\\nresult in filling them. A common type of such cav-\\nity is Shown in Fig. 202. Occluso-bn17al cay-\\nThe channel connecting the two cavities is usually ity in lower molar.\\nnarrower than either of the latter, and also more shallow,\\nthus conserving the strength of the tooth. As, however, the strain\\nupon the walls bordering this channel is very great in mastication they", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0245.jp2"}, "246": {"fulltext": "238\\nPREPARATION OF CAVITIES.\\nFig. 203.\\nshould be trimmed until solidity is obtained, and also be considerably\\nbevelled for purposes of strength.\\nClass 8. Occluso-lingual cavities in the bicuspids and molars are\\nof rare occurrence except in the upper first and second molars, where\\nthey follow the line of the sulcus extending between the mesio-lingual\\nand disto-lingual lobes. Sometimes the cavity is nearly confined to the\\nocclusal surface, running over on to the lingual surface but slightly.\\nIn such cases the cavity is easily prepared by simply cutting the occlusal\\ncavity through to the lingual surface, giving the cavity a relatively uni-\\nform depth at all points.\\nAt other times the fissure on the lingual surface will extend farther\\ntoward the cervical margin, and the cavity when prepared\\nwill have the form of an L, the longer arm, A, represent-\\ning the occlusal, and the shorter one, B, the lingual por-\\ntion of the cavity (see Fig. 203). Where the extent of\\ndecay does not demand it, it would be a mistake to make\\nthe floor level of the two portions of the cavity uniform,\\nas the extensive removal of sound dentin would greatly\\nweaken the disto-occluso-lingual cusp.\\nWhere extensive decay has already weakened this cusp it is better to\\namputate it below the level of the occlusal plane and extend the filling\\nover it.\\nClass T. With the exception of those unusual cavities which\\ninvolve the greater portion of the crown of a tooth, the mesio-disto-\\nocclusal cavities in bicuspids and molars are the largest in extent of any\\nmet with. Being well exposed there is no lack of\\neither light or room in which to operate, and the only\\ndifficulty associated with their preparation and filling\\nJj lies in their size and extent.\\nTheir preparation is accomplished in the same man-\\nner as those of classes P and except that no special\\nretentive form need be given to the occlusal portion,\\nfor with the filling once in place its general form will\\nsecure it in position. Fig. 204 represents a typical cavity of this class\\nin a bicuspid tooth.\\nFig. 204.", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0246.jp2"}, "247": {"fulltext": "CHAPTER IX.\\nEXCLUSION OF MOISTURE\u00e2\u0080\u0094 EJECTION OF THE SALIVA-\\nAPPLICATION OF THE DAM IN SIMPLE CASES, AND\\nIN SPECIAL CASES PRESENTING DIFFICULT COMPLI-\\nCATIONS\u00e2\u0080\u0094NAPKINS AND OTHER METHODS FOR SECUR-\\nING DRYNESS.\\nBy Louis Jack, D. D.S.\\nThe interference of the secretions of the mouth offers a considerable\\nobstacle to the treatment of the teeth. In some in-\\nstances the flow is naturally excessive, and in all cases\\nit is stimulated by the operative procedures.\\nAn excessive flow of saliva is uncomfortable to the\\npatient its accumulation also impedes the operation,\\nand interferes with the view of parts by refracting\\nthe rays of light.\\nDuring the preparation of accessible cavities, par-\\nticularly those of the upper front teeth and the occlusal\\nsurfaces, the accumulation may be carried off by the use\\nof a saliva ejector, a simple form of which is shown\\nin Fig. 205, which form, or some modification of it, is\\nFig. 206.\\nFig. 205.\\nused where a connection can be\\nmade with the water supply, and\\nordinarily it is used in association\\nwith the fountain cuspidors. An-\\nother form, which is connected\\nwith a small reservoir of water,\\nis shown in Fig. 206. Either\\nof these forms has a further use\\nfor drawing off the saliva in con-\\nnection with the employment of\\nthe rubber dam to lessen the dis-\\ncomfort of the patient.\\nUse op Rubber Dam.\\nDuring the preparation of cavi-\\nties on the approximal surfaces of\\nthe bicuspids and molars where it is essential to have\\nunrestricted\\n239", "height": "4544", "width": "2704", "jp2-path": "americantextboo00kirk_0247.jp2"}, "248": {"fulltext": "240 EXCLUSION OF MOISTURE.\\nview and the exclusion of blood, the presence of which is inseparable\\nfrom thorough preparation of the cervical margins, it is necessary to\\nmake use of the rubber dam. When used for this purpose the\\nmaterial generally becomes impaired by the action of the instruments\\nin their free use at the cervix but the economy of time and the essen-\\ntials of thorough performance of this class of operations warrant the\\napplication during this portion of the treatment.\\nWhen the case is ready for the filling process a new piece of the dam\\nshould be prepared, and adjusted with great care to prevent the ingress\\nof the least moisture. Without this appliance the greatest skill is pow-\\nerless to secure sound results in large, difficult, or complicated cases.\\nThe introduction of this invention has made it possible to execute\\nwith gold, operations which previously were impossible not the least\\nadvantage resulting from its use is that the operator has free use of the\\nleft hand to assist the right.\\nQuality of the Rubber. The quality of the rubber greatly modi-\\nfies the facility of its application. It should be of medium thickness\\nand of light color, as it then absorbs less light. It should be freely\\nextensible and so elastic that when the thumb is forcibly pressed into it\\nit returns to its normal form on the removal of the force. If it re-\\nsponds to this test it will not tear if fairly applied.\\nThe size and form of the piece should be such as to avoid encum-\\nbering the face of the patient and to permit the lateral extension to be\\nfolded out of the way in such manner as to prevent obstruction of the\\nview. The form generally best suited is a triangle, which form also\\npermits of its most economical use.\\nFor the front teeth the piece should be moderately small for the\\nbicuspids and molars the size should be ample and is best adapted when\\ncut from strips about seven and a half inches in width.\\nThe selected piece should have holes cut in it of such size as to\\ncorrespond with the dimensions of the teeth over which it is to pass.\\nWhen more than one hole is required the holes should be at such dis-\\ntances apart as will present a sufficient amount of material to allow for\\nthe take-up in the application, so that the strait which passes between\\nthe teeth shall be sufficient to allow the edge to be carried upward to\\nform a valve at the cervices of both teeth and not be under such strain\\nas to interfere with the valvular action of the edges of the rubber. At\\nthe same time there should be no excess to hamper the view or inter-\\nfere with the placement of the filling material.\\nAttention to the valvular arrangement of the dam at the cervix will\\navoid subsequent difficulty and will prevent in many instances the\\ninfliction of pain in using ligatures except upon the tooth under treat-\\nment and the adjacent one. The appearance of this valve is shown in", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0248.jp2"}, "249": {"fulltext": "USE OF RUBBER DAM. 241\\nFig. 207. Fig. 209.\\nperspective by Fig. 208, a, b, c,\\nd. The holes iii the rubber may\\nFig. 208.\\na be\\nDiagrammatic drawing form of valve.\\nbe formed with a punch of suit-\\nable size, which should be forced\\nupon the end of a close-grained\\npiece of hard wood. They may\\nbe made Avith a little practice\\nby drawing the rubber over a\\nround-ended instrument with\\nsome force and pricking the\\nrubber at a suitable point with\\na sharp knife, when a round\\nsection escapes. The difference\\nin size of the holes is deter-\\nmined by the distance from the\\nend of the instrument at which\\nthe puncture is made. The deter-\\nmination, however, of size and\\ndistance is not easily made in\\nthis manner. The best appliance for the purpose is the Ainsworth\\npunch (see Fig. 209), with which complete control of size and distance\\nmay be easily effected.\\n16\\nThe Ainsworth punch.", "height": "4544", "width": "2728", "jp2-path": "americantextboo00kirk_0249.jp2"}, "250": {"fulltext": "242\\nEXCLUSION OF MOISTURE.\\nThe arrangement of the holes in the triangular piece should differ\\nfor each section of the mouth.\\nFig. 210 shows a piece for the central incisors. The figures repre-\\nsent inches.\\nFig. 211 shows the arrangement of holes for the upper bicuspids\\nand molars. It will be observed the line of holes is not parallel with\\nthe upper edge.\\nFig. 210.\\nFig. 211.\\nFig. 212.\\nFor central incisors.\\nFor upper bicuspids and\\nmolars.\\nFor lower bicuspids and\\nmolars.\\nFig. 213.\\nFor lower front teeth.\\nFig. 212 shows the arrangement for the lower bicuspids and molars.\\nHere, too, the line of holes is not parallel with the edge, to allow for\\nthe difference in distance from the commissure of the lips to the ante-\\nrior and posterior holes.\\nFig. 213 shows the arrangement when the lower incisors and canines\\nare included. Here the line of the apertures\\nis curved.\\nBy conforming to these arrangements of\\nthe openings in the rubber, and by extend-\\ning the line in conformity with it, as well as\\nby increasing the size of the piece, any num-\\nber of holes may be made, to include any\\nportion or all of the teeth of one quarter of\\nthe denture when that may be required.\\nThe number of apertures in the rubber should be such as to give\\neasy access to the operation and to permit the free entrance of light.\\nFor the anterior teeth five to six holes are necessary, and for the pos-\\nterior teeth from four to six as may be needed to secure the above-stated\\nobjects. In general, at least two teeth anterior to the one operated\\nupon, and when admissible the one posterior, should be included.\\nThe Placement of the Dam. When the teeth are not in firm con-\\ntact or when their attachments are flexible the adjustment of the dam\\nis simple. But when the teeth are rigid certain preliminary conditions\\nshould be secured. It has been pointed out in speaking of the prepara-\\ntion of the teeth for a series of operations that they should be well\\ncleaned of any deposits which may be upon them and be polished on\\ntheir approximal surfaces. This makes easier the insertion and the\\napplication of the rubber.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0250.jp2"}, "251": {"fulltext": "USE OF RUBBER DAM. 213\\nGenerally where the case under treatment is an approximal surface\\nthe necessary preparatory separation makes easy the immediate open-\\ning of any interstices near the operation. In cases of extreme fixa-\\ntion of the teeth a piece of rubber dam placed for a day or so in a\\ncouple of the neighboring spaces makes it easy to enter the margin of\\nthe interstices. The passage of a silver tape with a little benne oil or\\ncosmolin on it often answers as an equivalent means. In the front\\nteeth a thin wedge inserted just above a tight point permits an easy\\nentrance.\\nThe preliminary silking of the adjoining spaces, particularly if the\\nsilk be coated with cosmolin or its equivalent, also facilitates the\\npassage of the rubber, and for this purpose soaping the under surface\\nof the rubber adjacent to the holes is recommended.\\nAt first the novice finds difficulty in making application of the dam,\\nbut practice cultivates facility. In general it is better to commence\\nwith the anterior hole and proceed posteriorly until all the intended\\nteeth are included. Thus for the left lower teeth the rubber is taken\\nwith the index fingers applied to the upper surface, the other fingers to\\nthe under surface, and is grasped near the hole for the front bicuspid the\\nhole is extended the edge of the rubber is inserted in the mesial inter-\\nstice and is carried down to the gum. It is then drawn over the tooth\\nand passed into the next interstice in the same manner. This method\\nis pursued with each tooth until all are included. The passage of the\\nrubber is facilitated by helping it downward by the insertion of floss\\nsilk, which is held taut, and with a firm and gently sliding movement\\nthe rubber is conveyed toward the cervix.\\nWhen the most distant tooth is the lower third molar, it is generally\\nbest when the cavity is on either side of the last interstice to pass the\\njaws of a dam clamp through the posterior hole the clamp is then made\\nto grasp the tooth, the dam is conveyed to the gum by silking, and the\\nadjustment is then carried forward from tooth to tooth. The same pro-\\ncedure is sometimes applicable with short third molars in the upper\\ndenture, or in case any of the posterior teeth are so shaped as not to\\nretain the rubber.\\nWhen the rubber is adjusted over the teeth the purpose of the dam\\nis effected by directing the edge of the dam under the free margin of\\nthe gum. This is done by passing a silk thread around the tooth, and\\ncrossing the ends, when by a drawing movement of the thread it travels\\ndown the inclined surface of the cervix, carrying the dam with it, thus\\nmaking a more secure formation of the valve.\\nThis method avoids the needless paining of the patient caused by\\npushing the threads against the gum with instruments. Whenever\\nnecessary for securement the ligature should be tied. This should be", "height": "4568", "width": "2700", "jp2-path": "americantextboo00kirk_0251.jp2"}, "252": {"fulltext": "244 EXCLUSION OF MOISTURE.\\ndone to the teeth on both sides of an approximal cavity. It is neces-\\nsary here to place the cervical margin of the cavity in full view and to\\nmake certain the exclusion of moisture, which otherwise might pass the\\nvalve by capillary attraction.\\nThe ligature should usually be passed but once around the tooth and\\nthen be tied with a surgeon s knot, the place of the knot being on the\\noutside. When there is much strain the thread may be passed twice\\naround the tooth, but this should be avoided as being more painful and\\nas increasing the bulk of the ligature.\\nTo prevent the rubber from displacement by the movement of the\\ncheeks on the posterior teeth when they are long, if after drying the\\nsurface a little sandarac or damar varnish is applied at the last inter-\\nstice, the rubber becomes fixed.\\nIn cavities extending above the cervix where a ligature cannot be\\nplaced above the cervical border of the cavity, other means have to be\\nadopted to obstruct the entrance of fluids. Here the strait of rubber\\nbetween the holes should be much wider than usual the abundant fold\\nmay then be forced beyond this margin with a matrix, when, by drying\\nthe parts and by the deft introduction of alcohol varnish and suitable\\nwedges, dryness of the parts is attained. In the most extreme cases of\\nthis nature the part beneath the normal gum line may be filled with\\na permanent plastic substance, as described in the section on Lining\\nCavities (see Chapter X., p. 258).\\nThe Securement of the Dam from Displacement. When the\\nteeth are short from incomplete development or when their form is\\ntapering from the gum toward the occlusal aspect there is always ten-\\ndency of the rubber to escape, and the contraction of the commissure\\npf the lips tends to the displacement of the dam at the posterior teeth,\\nthe latter movement often being sufficient to overcome the friction of\\nthe ligatures. When these difficulties arise a clamp is required.\\nThe Clamp. This is an instrument of much value not only as a\\nmeans of securement of the rubber, but as an adjunct to prevent the\\nFig. 214. Fig. 215.\\nDr. Southwick s clamps. Dr. Huey s clamps.\\nrubber from obstructing the view. Clamps are more especially needed\\nto detain the rubber on the molars and are rarely required for the bicus-\\npids or the anterior teeth, since, if the foregoing directions are followed,,\\nthe necessity for their use will but seldom be presented.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0252.jp2"}, "253": {"fulltext": "USE OF RUBBER DAM.\\n245\\nForms of Clamps. For the molars various sizes and shapes of the\\nSouthwick and of the Huey wisdom-tooth clamp are sufficient\\nfor general use. In addition to these Palmer s set of eight/ after\\nthe sharp points of the jaws are rounded, will furnish the requisite\\nvariety.\\nFig. 216.\\nDr. Delos Palmer s set of eight clamps.\\nThe Application of the Clamp. The selected clamp is extended\\nby the clamp forceps to enable it to pass over the molar. It is con-\\nveyed to the middle portion of the tooth, when the inner beak\\nshould be brought against the tooth at the gum margin then with\\nthis point as a fulcrum the outer beak is carried to the cervix on the\\nbuccal surface. Much pain may be avoided in the employment of\\nthis appliance by deft and careful placement. Injury of the gum and\\nneedless pain has frequently been inflicted by careless use of force in\\nthe application of this appliance. Much of this may be avoided by\\nthe previous ligation of the tooth, which will prevent the tendency of\\nthe clamp to descend beneath the gum when the necks of the teeth\\nare much inclined inward.\\nWhen it is necessary to force the clamp against the soft tissues the\\nprevious application of a solution of cocain will obtund the tissue and\\nrender the application tolerable.\\nThe Arrangement of the Dam on the Face. This concerns the\\nconvenience of the operator and the comfort of the patient. To give\\neasy access and permit the entrance of light, the rubber is drawn aside\\nat each upper corner by dam-holders. The simpler forms of these are\\nsufficient and are more convenient than the more complicated ones when\\ntriangular pieces of rubber are employed. In addition a supporter,\\nshown at Fig. 218, passes over the head and engages at each end with\\nthe holder. The comfort of the patient is secured by including a nap-\\nkin along with the rubber in the clasps of the holder. The excess of\\nthe rubber at each side should be taken up in a fold and secured to the", "height": "4568", "width": "2712", "jp2-path": "americantextboo00kirk_0253.jp2"}, "254": {"fulltext": "246\\nEXCLUSION OF MOISTURE.\\nnapkin by dressing pins. The suspended part of the rubber is kept\\ntaut by pendent weights.\\nThe application and arrangement of the dam becomes Fig. 218.\\nby practice a very simple matter, and should not be the\\noccasion of discomfort or pain to the patient.\\nFig. 217.\\nDesign of Dr. Cogswell.\\nA supporter.\\nThe Use of Napkins. There are many instances of simple cases in\\naccessible positions not of approximal surfaces, when the general flow\\nof saliva can be kept under control by the saliva ejector, when it is not\\nnecessary to use a rubber dam. Also for children, when the teeth are\\ntoo short to permit the correct application of the dam, it is necessary to\\nfind other means to control the moisture. Here the reliance is upon\\nnapkins, and with them much skill may be displayed by deft operators.\\nFor this purpose the napkin should not be over eight inches square.\\nThe manner of folding is to carry two adjacent edges to the diagonal\\nof the napkin, and then fold again in like manner; by this plan the\\nfolds are held in place.\\nStrips of birdVeye linen of various lengths and widths are also\\nserviceable for simple cases and for children.\\nTo apply a napkin to the upper right side, the point is taken between\\nthe left index-finger and the thumb, the broad end being held at the\\nsame time by the right hand. The lip near the right commissure is\\neverted, the point is inserted here, and by the taut action of the left\\nhand the napkin is next laid between the gum and the lip. It is then\\ncarried backward until it reaches the duct of Steno, when the left index\\nfinger is applied to maintain the compression at this latter point. The\\nfree end of the napkin lies upon the lower lip. For the left side the\\naction is the same by the reversal of the hands.\\nFor the lower teeth the application differs by commencing for each\\nside at the upper canine of that side. When the duct of Steno is\\nreached a fold is made to effect the compression of the orifice of the\\nduct, then the napkin is laid between the cheek and the lower teeth", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0254.jp2"}, "255": {"fulltext": "USE OF RUBBER BAM.\\n247\\nand kept in position by the left index finger, a mirror, or a cheek-\\nholder.\\nAn important preliminary to the application of a napkin to these\\npositions is that the saliva ejector be first placed in action and that the\\nsurfaces of the gum and cheek be wiped to dryness, to cause the napkin\\nto cling to the surface. If the surfaces are covered with mucus and\\nat the same time are wetted with saliva, the napkin easily becomes\\ndisplaced.\\nFor the inner surface of the lower teeth a considerable fold of cot-\\ntonoid or similar substance laid beneath the tongue materially prevents\\naccess of saliva here, and also, by preventing the contact of the tongue\\nwith the teeth, lessens the opportunity for the access of moisture by\\ncapillary attraction between the tongue and the teeth under treatment.\\nIn instances where the form of the parts permits, the fold of cottonoid or\\nof linen may be retained in place by a dam\\nclamp upon any adjacent posterior tooth.\\nFor the medication of cavities where it is\\nimportant to confine the remedy to the\\ntooth in short operations, such as temporary\\nstoppings, and particularly for the simpler\\nFig. 219.\\nFig. 220.\\nThe Denham shield.\\nShield in use.\\ncases of children, the Denham coffer-dam shields shown in Fi^s. 219,\\n220 are of much advantage, more particularly for the lower teeth.\\nWith these the ejector forms a valuable aid.\\nNAUSEA.\\nThe contact of rubber dam with the tongue and the contiguous parts,\\nthe presence of napkins, and the touch of the fingers to the oral surfaces\\nfrequently excites nausea. With some persons this kind of distress is\\nextreme and produces simulation of faintness and nervousness. This\\ncondition may generally be relieved by the use of aqua camphora, a few\\ndrachms being used as a gargle to the mouth and the throat. When\\nindications of faintness appear a drachm may be swallowed with imme-\\ndiate benefit.\\nIn case excessive nausea is occasioned by the contact of the appli-", "height": "4544", "width": "2720", "jp2-path": "americantextboo00kirk_0255.jp2"}, "256": {"fulltext": "248 EXCLUSION OF MOISTURE.\\nances with the tongue or palate, these surfaces may be painted with\\ntincture of camphor. Spasmodic coughing, not infrequent with nervous\\npersons, yields to the same treatment. Camphor appears to relieve in\\nthese instances by its antispasmodic power, and it is stated to have also\\na specific action upon the eighth pair of nerves.\\nNervousness coming on during any of the operations upon the teeth\\nmay as easily and in the same manner be avoided. It will be observed\\nthat in neither of these conditions are the first signs of approaching\\nsyncope apparent, viz. sighing respiration, pallor, and clammy perspi-\\nration of the face.\\nA condition somewhat simulating approaching syncope sometimes\\nappears in connection with the use of the rubber dam, due to partially\\nsuspended respiration, which is caused not so much by the obstruction\\nof the mouth as by the unpleasant sensations occasioned by the appli-\\ncation and presence of the dam. This may at once be overcome by\\nrequesting the patient to breathe deeply through the nose.", "height": "4580", "width": "2820", "jp2-path": "americantextboo00kirk_0256.jp2"}, "257": {"fulltext": "CHAPTER X.\\nTHE SELECTION OF FILLING MATERIALS WITH REFER-\\nENCE TO CHARACTER OF TOOTH STRUCTURE, VARIOUS\\nORAL CONDITIONS AND LOCATION, DEPTH OF CAVITY\\nAND PROXIMITY OF THE PULP\u00e2\u0080\u0094 CAVITY LINING, WITH\\nITS PURPOSES.\\nBy Louis Jack, D. D. S.\\nThe general object in view in the filling of a prepared cavity is to\\nsecure the future preservation of the tooth at that part from the recur-\\nrence of caries. This involves a consideration of the character of the\\nmaterial to be used, in relation to its adaptability to the conditions of\\nage, the quality of the teeth, and the oral conditions which for the time\\nare an expression of the general state of the organism. The habits of\\nthe patient as to general care of the teeth also have some bearing upon\\nthe probability of permanence of the reparative operation. A material\\nadapted to preserve the teeth when they are of resistant quality and\\nwhen the general health is sound and the care good, may be out of\\nplace when the opposite conditions exist. Methods of procedure have\\nsome bearing upon the result, and the influence of these has also to be\\nkept in view.\\nThe general characteristics of the material to be used as a pre-\\nservative of tooth structure are of importance in the following order\\nResistance to chemical action\\nCapability of adaptation to the surface of the cavity\\nSufficient hardness to withstand the force of mastication and the con-\\nsequent attrition.\\nCapability of form and smoothness are also important in relation to\\ncleanliness, which more than any other indirect influence has the greatest\\nbearing upon the preservation of the margins from subsequent softening,\\nas will further appear.\\nThe Materials.\\nThe various accepted materials in use are gold, tin, amalgams, the\\nbasic oxid cements, gutta-percha.\\nThe first three named may be designated as permanent in their cha-\\n249", "height": "4564", "width": "2728", "jp2-path": "americantextboo00kirk_0257.jp2"}, "258": {"fulltext": "250 FILLING MATERIALS.\\nracter, and the others as of a temporary nature, which, after fulfilling-\\nimportant uses in this way, are often preparatory to later and permanent\\ntreatment.\\nGold. The properties of gold which adapt it for the restoration of\\ncarious teeth are its pliability and softness, which permit its adaptation\\nto the form of the cavity its tenacity, which gives facility of introduc-\\ntion and consolidation and its agreeableness of color, which, when the\\nsurface is solid, smooth, and unburnished, approaches more nearly the\\nshade of the teeth than any other metal.\\nNotwithstanding these appropriate qualities the packing of gold\\nrequires the employment of considerable force to overcome various\\nresistances to its adaptation and solid condensation. To effect the\\nrequisite degree of density percussive force frequently becomes necessary.\\nThe effect of percussive force, if employed throughout, is liable to be\\nexpended on the margin toward which it is directed, and while this may\\nnot inflict any injury upon the borders of cavities when the dentin and\\nenamel are dense, it often proves injurious to teeth when the anatomical\\nelements of the structure are not homogeneous and resistant.\\nWhile it may be stated with the strongest assurance that gold pos-\\nsesses the highest preservative qualities and promises greater durabil-\\nity and more satisfactory results than any other material, conditions\\nare often presented when to persist in its use would lead to unsatis-\\nfactory results thus, in the approximal cavities of the teeth of children,\\nwhen the calcifying process has not become complete and when by the\\nuse of the required force some impairment of the incomplete tissues is\\nalmost certain to ensue. The same maladaptability occurs later in life\\nwhen senile conditions have set in, when the teeth not only have lost\\ntheir density from the peculiar molecular changes which take place\\nin the dentin and enamel, but when usually also their resistance to\\nchemical influences is greatly impaired. These conditions, coupled with\\nthe usual inability to properly care for the teeth, render the use of gold\\nvery questionable.\\nSimilar states of the dental tissues take place in middle life in both\\nsexes, but more particularly in women during the pregnant state,\\nwhen the teeth lose their resistant power, which may later be restored.\\nWhile this condition lasts, materials requiring less force should be\\nselected until restoration of resistance has occurred.\\nThe mode of effecting percussion should be taken into account in\\nestimating the influences which bear against the use of gold. When\\npercussion is effected by the electro-magnetic instruments with proper\\nprecautions with respect to the placement of the first portions of gold,\\nthere is less danger of marginal injury than when percussion is made\\nwith the hand or the automatic mallet.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0258.jp2"}, "259": {"fulltext": "GOLD\u00e2\u0080\u0094 TIN. 251\\nFinally, the fact must also be recognized that in cases in which the\\ncharacter of the structure of the teeth raises a question as to the adapt-\\nability of gold, the physical and nervous resistance of the patient is\\ngenerally below that which would enable him to endure the ordeal\\nconnected with the thorough completion of the work in harmony with\\nthe high standard impressed by the continued advancement which has\\ntaken place in dentistry.\\nThe tendency to caries of the teeth is a general consideration to\\nbe held in view in determining the propriety of employing gold.\\nWhen the enamel is hard, the dentin solid, and the general tone of\\nthe health excellent, there can be no doubt that the inherent qualities\\nof gold constitute it the most nearly permanent material. When, on\\nthe contrary, the opposite conditions exist, gold becomes, in propor-\\ntion to the prominence of the unfavorable states present, the most\\nquestionable material.\\nNo correct conclusion, however, can be reached without consideration\\nof the state of the oral secretions and of the habits of the patient as\\nto the care taken of the mouth. The first stage of decay of the teeth\\nis the softening of the enamel, which is brought about as the conse-\\nquence of the presence of carbohydrates undergoing fermentation in\\nsecluded positions, which effects the solution of the enamel at these\\nplaces and prepares the way for the occurrence of caries of the dentin.\\nHence a correct hygienic condition of the mouth is the most important\\nrequirement for the protection of the margins of the tooth adjacent to\\nfillings intended to restore them.\\nThe reaction of the oral secretions in their bearing upon the permanence\\nof dental operations has also much weight, since, when these secretions\\nhave an acid reaction, as the consequence of the presence of fermenting\\nmaterial, this condition favors the continuance of the process. A con-\\ntinual acid state of the oral fluids, as a consequence of derangements of\\nhealth such as occur in impaired digestion or attend the rheumatic\\ndiathesis, should be taken into account. Only an appreciable degree\\nof alkalinity can inhibit enamel solution unless the general and local\\nhygienic conditions are favorable.\\nTin. This metal, in the form of foil, shavings, and rolled into\\nthin strips, while not in much use, should have a wider field than is\\naccorded it. It possesses great softness, when chemically pure, and\\nis readily adapted to the walls of cavities for the reason that it pre-\\nsents less resistance since it does not harden under the mechanical force\\nemployed. For the same reason, when the cavity is overfilled, the con-\\ndensing appliances effect by the lateral movement of the mass a better\\nand more easily procured adaptation with the cavity walls. For these\\nreasons it possesses excellent preservative qualities.", "height": "4556", "width": "2720", "jp2-path": "americantextboo00kirk_0259.jp2"}, "260": {"fulltext": "252 FILLING MATERIALS.\\nTin is also a poorer thermal conductor than gold, and this is an\\nimportant consideration when thermal irritation is to be avoided, and is\\nof great value in deep cavities approaching dangerously near to the pulp.\\nThe objections to this metal are its color when exposed to view and\\nits softness, which greatly lessens its value in positions where it may be\\nsubject to severe attrition.\\nIts most important use is for the temporary teeth of children, where\\nit may be easily inserted and readily condensed, and rapid progress in\\nits introduction may be made, producing good results.\\nExcept Avhen freshly prepared, tin is not cohesive, a quality which\\ncannot be restored by heat, as may be done with gold.\\nAMALGAMS.\\nTheir Composition. The essential metals which enter into the com-\\nposition of the dental amalgams are silver, tin, and mercury. To\\nthese are added various metals in varying proportions to modify the\\nsetting, the color, and the affinity for sulfur compounds. For these\\npurposes gold is used to influence the rate of chemical combination, and\\nit also affects the color. Zinc and copper are added in order to modify\\nthe shade and also to lessen the affinity for sulfur.\\nThe effect of various proportions of the metals entering into the\\nformulas upon the working qualities of an amalgam is extremely puz-\\nzling slight differences in proportions causing widely varying results.\\nThe order in which the metals are introduced into the crucible and\\nthe degree of heat to which the mass is subjected in the fusing process\\nalso affect the working qualities.\\nThe Proportion of the Ingredients. Valuable tables have been given\\nby Dr. Black which indicate that a nearly definite ratio between the\\nsilver and tin should be maintained. This ratio is found to be approxi-\\nmately as follows Silver 65, Tin 35 when only these two metals are\\nused to make the alloy. Whatever addition of a modifying metal is\\nintroduced should be of small quantity and at an equivalent reduction\\nof the percentage of the tin.\\nThe ingot of the alloy should be finely divided either by filing or by\\nthin shavings made by turning them off in a lathe. When the commi-\\nnution of the alloy is made immediately -before using, amalgamation is\\nmore easily effected than when the filings are kept for any considerable\\ntime, unless in the latter case there is a disproportion of tin or gold.\\nThis has been attributed to oxidation of the particles taking place, which\\nw T ould retard the amalgamation. Silver not being an oxidizable metal\\nunder ordinary conditions, the cause of the tardy combination with\\nmercury is to be found in the attachment of sulfids to the surface, and\\nalso to the influences of occluded gases, which also tend to retard", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0260.jp2"}, "261": {"fulltext": "AMALGAMS. 253\\namalgamation. It is a notable fact that while freshly comminuted alloy\\nwill more readily amalgamate, it requires more mercury than aged\\nalloy.\\nMore recent investigations by Dr. Black tend to the conclusion that\\nthe difference in capacity for mercury observed in freshly cut alloy and\\nthat which has been cut for some time is due to the difference in molec-\\nular arrangement of the alloy, brought about by the comminuting pro-\\ncess, which has the effect of hardening the grains and condensing their\\ntexture in the same manner that hammering the ingot would harden the\\nentire mass. By the application of sufficient heat the particles of alloy\\nmay be aged artificially, and this aging is presumed to be simply an\\nannealing process. The capacity of the aged alloy for mercury is\\nmarkedly different from that of the freshly cut alloy, as are also the\\nworking qualities of the resulting amalgam mass, the aged alloy form-\\ning a slower setting and much smoother working amalgam than that\\nmade from freshly cut alloy. For the further details of this subject\\nsee Chapter XIII., on Plastic Fillings.\\nIt is held by many that the proportion of mercury should be in some\\nexcess, to give decided plasticity to the mass for the purpose of securing\\ncomplete amalgamation of the particles of the alloy. When the amal-\\ngamation is complete the redundance is forced out through chamois\\nskin, or the mass is kneaded in a napkin or piece of China silk, which\\nforces through the meshes most of the excess. It is claimed that this\\nmethod of conducting the amalgamation effects an approximately cor-\\nrect atomic relation of the metals with each other; it being held that\\nthe freer proportion of mercury during the mixing process tends to this\\nresult, as the redundant metal is carried out with the excess of mercury\\nas it is expressed. On the other hand, it is maintained that the propor-\\ntions of any given alloy and mercury which will produce an amalgam\\nfulfilling every requirement should be established by experimentation,\\nand thereafter be weighed out in those proportions.\\nThe Distinguishing Features of a Good Amalgam. An amalgam (1)\\nShould be non-shrinking (2) Should have edge strength (3) Should\\nmaintain lightness of color under the varying oral conditions (4) Should\\ntend to assume a spheroidal surface. A further qualification is that the\\nsurfaces of the material may not undergo electrolysis.\\nIndisposition to shrinkage is secured by a close conformity of the\\nalloy with the proportions above given.\\nEdge strength is a term which has not as yet had a clear defini-\\ntion in respect to the causes which determine the deficiency of this\\nquality. The maintenance of unchangeability of the surface is directly\\nrelated to this important desideratum, as roughening and erosion of the\\nmargins is the result of molecular waste, which causes a ragged and", "height": "4560", "width": "2716", "jp2-path": "americantextboo00kirk_0261.jp2"}, "262": {"fulltext": "254 FILLING MATERIALS.\\nunclean appearance of the edges and an apparent separation of the fill-\\ning from the borders of the cavity. The causes which produce this\\ncondition are slowly progressive and are continuous.\\nThis kind of erosion is most marked when contraction takes place,\\nfrom incorrect preparation or improper ratio of the metals entering\\ninto the formula, or careless manipulation, when capillary defects are\\nliable to occur at the margins.\\nThe most probable hypothesis to account for these observed\\nchanges is that the presence of moisture having acid reaction, by\\ninducing electrolytic action between the metals, brings about the erosion\\nof the material immediately within the margins. In these cases the\\nexposed surfaces generally suffer little waste, for the reason that they\\nare subject to the continued movement of the oral fluids, but it is often\\nobserved that entire fillings undergo a similar gradual loss and disappear.\\nThis result is common where there is an excess of gold or mercury. In\\nsome instances the above described action takes place to a limited degree\\nupon the whole surface in proximity with the dentin, when a residue\\nis found upon the filling as well as on the surface of the dentin.\\nThe conclusion from these observed facts is that the securement of\\nedge strength depends upon an approximation to the chemical ratio of the\\nelements of the alloy. This would appear to be most nearly secured\\nwhen the material is subject neither to shrinkage nor expansion. Expan-\\nsion under some circumstances might produce marginal space and there-\\nfore lead to the same result for instance, if in approximal or buccal\\ncavities the depth were greater at one division than another the expan-\\nsion of the thicker part of the filling would tend to raise the edge sur-\\nrounding the shallow part of the cavity, and would then subject the\\nedge of the filling to electrolytic changes.\\nA related condition sometimes appears when an amalgam filling,\\nquite hard at completion, after some years becomes comparatively soft,\\nwhich apparently is due to molecular changes.\\nThe close conformity of the alloy to the proportions recently estab-\\nlished by Black, and foreshadowed by the much earlier experimentation\\nof Flagg, furnishes a result that is directly conducive to fixity of form\\nand edge strength when the margins of the cavity are overlapped.\\nThis formula is approximately silver, 68 tin, 26 copper, 5\\nzinc, 1.\\nThe maintenance of size, form, and strength depends largely, if\\nnot entirely, upon the influence of silver. When the proportion of\\nthis element becomes less than 60 per cent, of the formula, the tendency\\nto shrinkage appears and holds a nearly direct relation with the diminu-\\ntion. When the ratio of silver advances above 70 per cent, the expan-\\nsion becomes marked, and at 80 per cent, is excessive.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0262.jp2"}, "263": {"fulltext": "THE MINERAL CEMENTS. 255\\nLightness of Color. The means by which this property may be\\nsecured have not as yet been well determined and should be the sub-\\nject of extended experimentation. Some of the so-called white alloys\\napproximate stability in this respect, but the ratios of the modifying\\nmetal have not been accurately determined.\\nAmalgam as a filling material is adapted to large cavities in the pos-\\nterior teeth when the margins are too frail to permit gold to be con-\\ndensed for positions where mechanical force cannot be exerted with\\nefficiency, notably the cavities of the third molar distal cavities of the\\nsecond molar when of large size and the lingual cavities of the lower\\nmolars. When the teeth are of deficient resistance and when the con-\\ndition of the oral secretions favors the rapid progress of caries these\\nlimitations may be extended to cavities where otherwise gold would\\nappear to be a more suitable material.\\nAs a material for the filling of the deciduous teeth amalgam possesses\\nsuperiority over any other substance, for the reasons that it can be intro-\\nduced with less effort than tin and has greater durability than either\\nthe mineral cements or gutta-percha preparations the exception to its\\nuse here being when the conditions prevent retentive formation of the\\ncavity.\\nConcerning the form of the cavity adapted to amalgam, it is necessary\\nthat the retentive formation be equally exact as for gold, since many\\nof the formulas in use undergo slight movement for some time after\\ntheir introduction, during which there is liability of marginal displace-\\nment which may lead to the defects treated of under the section con-\\ncerning edge strength. Amalgam, while presenting in its appear-\\nance an unfavorable comparison with gold, is capable of rendering\\nimportant service when every consideration is given to the require-\\nments governing its successful employment.\\nTo attain the best results in the use of the amalgams requires\\nextreme exactness as to the ratios of the ingredients and great care in\\nall the procedures connected with the formation of the cavity, the form\\nof the filling, and the subsequent finishing process.\\nThe disqualifications of amalgam are its unsatisfactory color and the\\nunknown character of the composition of the formulas as furnished by\\nthe depots of supply.\\nTHE MINERAL CEMENTS.\\nOxychlorid of Zinc. This material, because of its lacking the\\nquality of indestructibility, is contraindicated in all exposed situa-\\ntions. It possesses, however, a considerable degree of antiseptic power,\\nand for this reason renders valuable service in deep cavities not nearly\\napproaching the pulp, or even here when the pulp wall of the cavity", "height": "4560", "width": "2720", "jp2-path": "americantextboo00kirk_0263.jp2"}, "264": {"fulltext": "256 FILLING MATERIALS.\\nhas been previously protected by a layer of gutta-percha or a disk of\\nasbestos paper. In such cases, particularly on occlusal aspects, the\\ncavity may be nearly filled, leaving a remainder the thickness of enamel\\nto be completed with gold.\\nFor the filling of root canals and pulp chambers it offers the best\\nsolution of the problem of preventing septic changes in the devitalized\\ndentin. After many years, fillings of root canals and pulp chambers\\nof this material remain unchanged and are found clean and without\\nodor on removal a result that is not presented by any other filling\\nmaterial which may be introduced in these situations. Here it is im-\\nportant that the material be not mixed very thin, especially on account\\nof the danger of forcing it through the apical foramen.\\nA further use of this substance is to influence the shade of devital-\\nized teeth by the color tone it imparts to the crown of the tooth on\\naccount of its whiteness. This is enhanced by the fact that it comes\\ninto exact contact and remains without change, a quality which cannot\\nbe given to gutta-percha or other cements.\\nAs a temporary filling to correct extreme sensitivity of dentin in\\nsituations or under conditions which forbid ordinary therapeutic treat-\\nment, oxychlorid of zinc has considerable value. Here when the pulp\\nis not closely approached it may be retained for several months with\\nconsiderable advantage. To secure the best results the proportion of\\nzinc chlorid should be slightly greater than in the formulas used for\\nordinary fillings.\\nZinc Phosphate. This material, because of its greater power to\\nwithstand the influence of the oral secretions, has a wider use than the\\npreviously described cement. It cannot, however, be depended upon\\n/or permanent uses. While in some instances it may remain for several\\nyears when the oral fluids are neutral and when every attention is given\\ntoward the attainment of cleanliness, it is nevertheless a deceptive sub-\\nstance, since it is liable under temporary changes of the secretions to\\nundergo solution, more particularly in situations near the gum. When\\nplaced in approximal cavities it is extremely liable to become fissured\\nat the cervical margin and then permit carious action insidiously to\\ntake place.\\nUnlike oxychlorid of zinc, the phosphate has no antiseptic influence,\\nhence it does not inhibit decay of the dentin in its proximity. Its chief\\nuse is as a temporary expedient for filling cavities on labial and buccal\\nsurfaces, where, being under easy observation, it may be used with\\nbenefit. On account of its chemical solution by the oral secretions,\\nhowever slow this may be, it requires frequent renewal.\\nZinc phosphate is also of value for filling the principal portion of\\nlarge compound cavities where the teeth would be injured by the force", "height": "4608", "width": "2820", "jp2-path": "americantextboo00kirk_0264.jp2"}, "265": {"fulltext": "CAVITY LINING IN RESPECT TO PROXIMITY OF THE PULP. 257\\nemployed in the condensation of gold, and as a desideratum to avoid\\nthe great amount of time required to fill large cavities with this metal.\\nIt also here imparts in some instances much strength to frail margins.\\nIn the cavities which early form upon the occlusal surfaces of the\\npermanent molar teeth of children it is of great value, as here it is kept\\nclean by the friction of mastication, and being under easy observation\\ncan be renewed when this is required. When the child reaches the age\\nto have permanent operations the margins may be shaped for the reten-\\ntion of gold, and in this case the principal part of the cement should\\nbe allowed to remain.\\nZinc phosphate is of questionable use in pulp chambers as not hav-\\ning antiseptic properties, and being porous it becomes after several\\nyears quite offensive. For the same reason it is inadmissible for canal\\nfillings. Furthermore, for this purpose it is questionable, on account\\nof its adhesiveness, whether it is capable of being thoroughly introduced\\ninto root canals. All things considered, it is for these purposes greatly\\ninferior to oxychlorid of zinc.\\nGutta-percha. Compounds of gutta-percha with oxid of zinc form\\na useful substance for temporary fillings, acceptable for teeth of low\\ngrade at points not subject to attrition. Its preservative properties are\\nvery considerable, and were it not subject to surface degeneration would\\nin the situations noted be a nearly permanent material.\\nThe requirements for its successful use are that it be not heated\\nhigher than 212\u00c2\u00b0 F., that the cavity be quite dry, that it be intro-\\nduced in small pieces, and be kept under continual condensation until\\ncooled to prevent shrinkage. (See Chapter XIII.)\\nCavity Lining in Respect to Proximity of the Pulp.\\nAs caries approaches the pulp it reaches a period when the proximity\\nof this organ is so close as to require much care to avoid irritation and\\nprobable congestion. Under these circumstances it is necessary to\\navoid thermal conduction and to exclude chemical influences. After\\ndisinfection of the dentin some substance the ingrediency of which\\nis non-irritating and non-conducting should be selected to overlay the\\npulp wall of the cavity. Here choice must be made between gutta-\\npercha and either of the classes of mineral cements.\\nWhen the use of gold is preferable for the external portion of the\\nfilling, it is required that the foundation be sufficiently solid to with-\\nstand the force to be applied to the gold. Hence one of the cements is\\nhere necessary. Previous to the placement of the cement, should the\\npulp be near, the surface should be covered with a thin solution of one\\nof the resins to prevent the influence of the fluid element of the cement\\nfrom producing irritation. Copal ether varnish, a solution of hard", "height": "4564", "width": "2712", "jp2-path": "americantextboo00kirk_0265.jp2"}, "266": {"fulltext": "258 FILLING MATERIALS.\\nCanada balsam in chloroform, or the solution of nitro-cellulose in\\namyl acetate sold as kristaline or cavitine are effective\\nmaterials for this purpose. When the cavity is deep the layer of\\ncement should be brought to the inner line of the retentive grooves.\\nAs soon as hardening takes place the metallic covering may be given.\\nWhen the shallowness of the cavity will not permit a considerable\\nlayer of the cement, a metal cap covering the pulp wall of the cavity\\nfilled with the cement may be laid in place, the metal of the cap thus\\nsustaining the force.\\nThese forms of cavity lining are of great utility, and should be\\nregarded as of importance.\\nMarginal Cavity Lining. When cavities are situated on approxi-\\nmal surfaces of the teeth and extend high up on the cervical aspect so\\nas to place them beyond the probability of efficient service with metal\\nfoils, and when the lateral walls of cavities are weak either by their\\nthinness or by instability from defects of structure, some form of\\nlining is necessary. In the one case, to ensure certainty of per-\\nformance at the cervix in the other, to prevent injury.\\nFor the cervical part the choice is between (1) tin, (2) a combination\\nof tin and gold, and (3) amalgam.\\nTin has the objection when superimposed above gold that it suffers\\nwaste, in most instances by electrolysis, to which the mixture of tin and\\ngold is not liable. This latter combination made by folding a layer\\nof the tin within the gold foil appears to give the tin protection. This\\ncombination is more plastic and more yielding than gold alone, and\\npermits adaptation and consolidation in places difficult of approach.\\nWhen used in connection with a matrix thorough consolidation may\\nbe effected without injury to the cervical margin when the tissues are\\nnot dense.\\nWhen the color of a lining at the cervix will not be objectionable,\\na quick-setting amalgam answers extremely well, and may at the same\\nsitting be followed by the completion of the operation with gold. In this\\nsituation, whatever the lining material, close conformity with the lines\\nof the cervical form of the tooth must be assured. In many instances\\nthe lining and the completion of this portion of the filling should be\\neffected before the rubber dam is placed, when the lining portion is for\\nthe time being considered in its relations as a part of the tooth.\\nWhen it is necessary to use the mineral cements on approximal sur-\\nfaces of the posterior teeth for temporary purposes, the cervical border\\nshould be covered with a line of gutta-percha stopping, to protect this\\nvulnerable part of such fillings from the exposure of this border by\\nthe solution to which they are there liable.\\nLining Lateral Walls. For this purpose choice should be made of", "height": "4580", "width": "2820", "jp2-path": "americantextboo00kirk_0266.jp2"}, "267": {"fulltext": "CAVITY LINING IN RESPECT TO PROXIMITY OF THE PULP. 259\\nzinc phosphate, since it has the required strength and enters into the\\nnecessary adhesive union with the margins to give the required secur-\\nity. The layer should be kept within the extreme outer border of the\\ncavity, to permit the metal filling to overlay the margin of the enamel.\\nWhen the cavity is deep the retaining groove may be formed in the\\ncement.\\nA general summary of cavity lining is, that this procedure is required\\nin proportion to the difficulty of effective approach, and for the safe\\ntreatment of teeth below the average of structural quality.", "height": "4552", "width": "2720", "jp2-path": "americantextboo00kirk_0267.jp2"}, "268": {"fulltext": "", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0268.jp2"}, "269": {"fulltext": "CHAPTER XI.\\nTREATMENT OF FILLINGS WITH RESPECT TO CONTOUR,\\nAND THE RELATION OF CONTOUR TO PRESERVATION\\nOF THE INTEGRITY OF APPROXIMAL SURFACES.\\nBy S. H. Guilford, D. D. S., Ph. D.\\nThe treatment of a cavity of decay by filling must have a twofold\\nobject in order to subserve its best purposes first, the restoration of\\nthe affected part to a healthy condition and second, the prevention as\\nfar as possible of a recurrence of the lesion.\\nThe first is accomplished by the removal of all disintegrated tissue\\nand the perfect filling of the cavity with a suitable and durable material.\\nThe second demands for its success a proper understanding of the cha-\\nracter of the surfaces operated upon and their mechanical and physio-\\nlogical relations. While the simple filling of a cavity, if properly\\ndone, will generally prevent the extension of decay on exposed surfaces,\\nthe same operation on surfaces less favorably situated may utterly fail\\nto subserve the desired end.\\nThe contiguity of the approximal surfaces of teeth greatly favors\\nthe retention of food and the harboring of micro-organisms, while at\\nthe same time it prevents the free cleansing movement of saliva be-\\ntween them. For these reasons such surfaces, though originally per-\\nfect in their continuity, are attacked by caries more frequently than any\\nothers, except the occlusal surfaces where continuity is broken by fis-\\nsures and pits. When once affected by caries, their restoration by fill-\\ning is difficult owing to their inaccessibility, and while the operations\\non this account often lack the perfection that would otherwise be secured\\nand the fillings consequently fail, the recurrence of decay is more largely\\ndue to the same influences that brought about the initial lesion.\\nThis being the case it is obvious that the original conditions must be\\nchanged if immunity from future decay is to be expected. This\\nprinciple was early recognized and the first attempt to alter the con-\\nditions was by filing or cutting the approximal surfaces so as to free\\nthem from contact, on the principle of no contact, no decay. Where\\nall of the teeth were thus separated immunity from decay was generally\\nsecured, although at the cost of great loss of masticating surface, much\\n261", "height": "4552", "width": "2712", "jp2-path": "americantextboo00kirk_0269.jp2"}, "270": {"fulltext": "262 THE SELF-CLEANSING SPACE.\\ndisfigurement, and subsequent serious injury to the gum and peri-\\ncementum.\\nWhere only an occasional space of this character was made, the\\noperation proved a failure because in a short time, through the pressure\\nof adjoining teeth and altered occlusion, the mutilated teeth would again\\nbe brought into contact and the opportunity for decay be increased a\\nhundredfold. With the recurrence of decay, cutting or filing would\\nagain have to be resorted to until but little of the teeth remained, and\\nthey were eventually lost. On account of its unfortunate results the\\nmethod was for a time abandoned, but in 1870 it was revived in a\\nmodified form through the teachings and writings of Dr. Robert\\nArthur. His method consisted in altering the form of the approximal\\nsurfaces of teeth by filing or grinding so as to change the point of ap-\\nproximal contact from near the occlusal surface to near the cervical\\nmargin. This not only changed the normally convex approximal sur-\\nface into a flat or plane one, but was also supposed to free it from further\\nliability to decay by preventing the retention of food debris and render-\\ning the surfaces and spaces self-cleansing. The method was measur-\\nably adopted by numbers of conscientious practitioners as a means of\\nobviating a difficulty hitherto unsuccessfully combated. In a short\\ntime, however, it was discovered that its promise of success was not\\nbeing realized, and it was also gradually abandoned. Its failure was\\ndue to its being wrong in principle, for, while it seemed to offer tem-\\nporary relief, its after results were most disastrous.\\nBy leaving a shoulder near the cervical margin the point of contact\\nwas simply transferred from one point to another with the result that\\nthe latter point was far more liable to caries than the former one, owing\\nto its position. More than this, the exposed dentin on the cut surfaces,\\nlacking the natural protection of the enamel covering, was apt to be\\nsensitive, and the food crowding into the space and pressing upon the\\ngum rendered it hypersensitive and eventually caused its recession.\\nThe discomfort following this unnatural operation, together with the\\nincreased liability to decay resulting from it, were sufficient to condemn\\nthe method and cause its abandonment.\\nThese failures to secure freedom from decay by an unnatural altera-\\ntion of the forms of approximal surfaces led to a more careful investi-\\ngation of the causes responsible for its recurrence on these surfaces, and\\nthe gradual adoption of more rational and scientific methods for its pre-\\nvention. It was apparent to even the most casual student of compara-\\ntive dental anatomy that the number and kinds of teeth found in the\\njaws of man, their arrangement in the arches, and their general form\\nwere all such as to best subserve the wants and needs of the individual,\\nbut the more minute points of their external anatomy, their inter-", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0270.jp2"}, "271": {"fulltext": "NORMAL CONTOUR IN RELATION TO CARIES. 263\\ndependence and relation to one another, and the part played by the fluids\\nof the mouth in the causation of caries under both original and changed\\nconditions, had not previously been carefully inquired into. Under the old\\nbelief that contact caused decay it was thought that decay upon approxi-\\nmal surfaces always began at the point of contact and that this was due\\nto the fermentative changes occurring in food debris retained at this\\npoint. Investigation proved, however, that the points of contact be-\\ntween teeth were not only free from decay, but more or less polished\\nfrom slight motion of the teeth in their sockets, and that approximal\\ndecay always began just above the contact point, that is, slightly nearer\\nthe gum also that it could occur nearly as readily without the presence\\nof food as with it.\\nIt was further noted that the normal contact of teeth on their\\napproximal surfaces, which was formerly supposed to be essential only\\nfor mutual support, was equally necessary for the protection of the\\ntender gum tissue from injurious pressure of food in mastication.\\nFinally it was observed that those portions of the crown of a tooth\\nthat were beneath the gum margin or those above it that were constantly\\ncovered by saliva (as on the approximal surfaces near the gum) were\\nalways free from the beginnings of decay, and that the approximal and\\nbuccal or lingual surfaces, when faultless in structure, were first attacked\\nby caries on a line corresponding with the point to which the fluids of\\nthe mouth usually rose. An explanation of this peculiarity was soon\\nfound in the fact that the saliva is usually alkaline and consequently\\nprotective of the parts covered by it, but at its surface, in a state of\\nrest (as in sleep), this condition of alkalinity is changed to one of\\nacidity the calcium salts are dissolved and decay is begun.\\nAs a result of the foregoing observations and investigations it\\nbecame apparent to the mass of conscientious workers in the field of\\noperative dentistry 1st. That the natural form or outline of each tooth\\nwas the best for its particular function, and that to materially alter it was\\nto lessen its usefulness and hasten its loss. 2d. That contact of ad-\\njoining teeth was essential both to the comfort of the individual and\\nthe durability of the organs. 3d. That inasmuch as the teeth originally\\ndecay in spite of their natural form and contact, some plan would have\\nto be devised by which, in their repair after decay, liability to a recur-\\nrence of caries Avould be greatly lessened if not entirely prevented.\\nTo fulfill these requirements there was but one course left to pursue,\\nnamely, to fill approximal cavities in such a way as to restore the\\noriginal contour of the surface, and, in all cases where the extent of\\ndecay was sufficient to warrant it, to extend the cavities so far over upon\\nthe buccal and lingual surfaces as to bring the enamel margins within\\nthe range of protective influences.", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0271.jp2"}, "272": {"fulltext": "264\\nCAPILLARITY OF APPROXIMAL SURFACES.\\nThe rationale of original and recurring decay upon approximal\\nsurfaces is readily made apparent by considering certain facts and prin-\\nciples of physics.\\nWhen a tube is inserted in a liquid capable of wetting its surface\\nthe liquid will rise to a higher level within the tube than the surface\\nlevel of the surrounding liquid. This phenomenon is known as capil-\\nlary attraction, and is explained upon the principle of surface tension\\nof liquids. If, instead of a tube, two rounded or flat plates are im-\\nmersed in the liquid, the same rising of the fluid between them will\\nbe noticed. The smaller the tube, or the nearer the two plates are\\ntogether, the higher will the liquid rise.\\nApplying the principles governing these facts to the teeth and con-\\nsidering them as bodies immersed in a liquid (saliva), it will readily be\\nseen that if the approximal surfaces of the teeth were parallel and\\nclose together the saliva would rise to a higher level between them and\\ncover more tooth surface than if they stood farther apart, and being re-\\ntained in this narrow space with little opportunity for motion the saliva\\nwould soon assume an acid character and destruction of the tooth tissue\\nbegin. This is exactly what takes place upon approximal surfaces\\nmade flat by filing, and will occur whether fillings have been placed\\nin such surfaces or not.\\nNormally, however, the crowns of the human teeth are more or less\\nconvex upon their approximal surfaces and touch each other only at the\\npoint of their greatest transverse diameters, which is near to and just\\nabove the occlusal surface. From this point their diameters gradually\\nbecome less until they reach the cervical border, where they are smallest.\\nThis leaves a triangular interdental space with the base of the tri-\\nangle at the gum, as shown in Fig. 221, in which the saliva will rise but\\na short distance owing to the separation near the\\ngum and the consequent lessening of the capil-\\nlary attraction. For this reason teeth preserving\\ntheir normal forms are less liable to approximal\\ndecay than they could possibly be under any\\nother conditions.\\nThe earliest treatment of approximal sur-\\nfaces with a view to the prevention of caries consists in gaining access\\nto them by wedging, and if found to be superficially affected by caries\\nthe removal of the injured structure and the perfect polishing of the\\nsurfaces.\\nWhen cavities of moderate size are discovered they should be care-\\nfully prepared and filled, preserving the original contour as far as\\npossible. Decay may recur, but it is less likely to do so with advan-\\ncing age, increased density of tissue, and proper prophylactic treatment.\\nFig. 221.\\nShowing normal contact of\\nteeth.", "height": "4608", "width": "2824", "jp2-path": "americantextboo00kirk_0272.jp2"}, "273": {"fulltext": "CONTOURING AS A PROTECTIVE MEASURE. 265\\nWhere the decay is of larger extent, however, we have it in our power\\nto make such physical change in the parts affected as to render future\\nimmunity from decay reasonably certain.\\nFirst, it is necessary to separate the teeth well by wedging, to so\\nenlarge the cavities as to bring their lateral margins well out upon the\\nlingual and buccal surfaces, and to extend the cervical margins of the\\ncavities down to or beneath the free margin of the gum.\\nNext, the fillings must be carefully inserted, built out to fully\\nrestore the original contour, and most perfectly finished. When this\\nhas been done and the teeth have returned to their former positions\\nthe approximal surfaces will be in a better condition to resist the influ-\\nences of decay than they originally were, for any changes in the char-\\nacter of the saliva cannot affect the gold, and while the cervical border\\nof the filling is protected by being constantly covered by saliva the\\nlateral borders are so far out upon their respective surfaces as to be sub-\\nject to the cleansing influences of the lips and tongue.\\nIn addition to this, and scarcely less important, the restoration of\\ncontour on the approximal surfaces affords normal protection to the\\ntender gingivae by preventing the lodgment and pressure of food upon\\nthem.\\nThe contour method of filling, based as it is upon physiological,\\nanatomical, and mechanical principles, has become the accepted method\\nof operating. Experience has proved it to be the only rational method\\nof treatment of approximal surfaces, for by it we secure all the desir-\\nable conditions of preservation of the natural outline of the teeth,\\nnecessary contact, immunity from future decay, and protection of the\\ngum margins. Its practice involves some sacrifice of healthy tooth\\nstructure along the buccal and lingual aspects, as well as greater ex-\\npenditure of time in filling and finishing, but the results compensate\\nfor both of these.\\nTo properly perform the operation of filling and restoration of\\napproximal contour requires not only manipulative skill of a high\\norder, but also an artistically trained eye in order that the restoration\\nmay in all respects correspond both in extent and form to the original\\noutline of the tooth both of these requisites will be acquired through\\nfrequent repetition. In certain cases, as where the teeth originally were\\nnot quite in contact, the contour may be advantageously exaggerated in\\norder to close the space, but it should never be less than normal or the\\nresult will not be satisfactory.\\nIn the filling of an approximal surface next to a space, as where a\\ntooth has been lost, the necessity for full restoration of contour does\\nnot exist and is not absolutely demanded, although a more artistic result\\nis secured by its performance in all cases.", "height": "4548", "width": "2708", "jp2-path": "americantextboo00kirk_0273.jp2"}, "274": {"fulltext": "", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0274.jp2"}, "275": {"fulltext": "CHAPTER XII.\\nTHE OPERATION OF FILLING CAVITIES WITH METALLIC\\nFOILS AND THEIR SEVERAL MODIFICATIONS.\\nBy Edwin T. Darby, D. D. S., M. D.\\nIn the selection of a filling material the operator should consider the\\ncharacter of the secretions of the oral cavity, the position of the tooth\\nto be filled, the extent of the diseased area, the physical structure of the\\ntooth, and the strength of the cavity walls. A filling material must\\npossess certain inherent qualifications, the most important of which are\\nadaptability, indestructibility, non-conductivity, hardness, absence of\\nshrinkage, harmony of color, and ease of manipulation. All of these\\nare not to be realized in any one material, and yet some of the more\\nimportant are to be found in a single metal or in a combination of\\nmetals.\\nLead possesses the quality of softness and is easy of adaptation but\\nis readily oxidized when exposed to the air or the secretions of the\\nmouth. Likewise tin possesses characteristics, such for instance as duc-\\ntility and softness, low conducting power, and the ease with which it\\nmay be manipulated, which place it in the front rank as a preservative\\nof carious teeth, but it is inharmonious in color, and its very softness,\\nwhich is so desirable in manipulation, is an obstacle to its use upon\\nsurfaces where there is much attrition. The zinc phosphates, which are\\ncomposed of zinc oxid and phosphoric acid in solution, form a com-\\nbination which at first attracted the favorable attention of the dental\\nsurgeon as possible substitutes for metallic foil fillings. They possess,\\nowing to their plasticity, ease of manipulation, harmony of color, com-\\nparative non-conductivity, and absence of shrinkage, many desirable\\nqualities, but are lacking in one essential qualification, namely, inde-\\nstructibility.\\nGold.\\nGold, which has been used for about a century, has fulfilled in a\\nmore marked degree than any other material or combination of materials\\nthe requirements sought for in a filling for carious teeth. It has one or\\ntwo objectionable features, such as high conductivity of heat and inhar-\\nmonious color.\\n267", "height": "4552", "width": "2704", "jp2-path": "americantextboo00kirk_0275.jp2"}, "276": {"fulltext": "268 THE OPERATION OF FILLING CAVITIES.\\nToo much stress cannot be laid upon the question of its purity if the\\nbest results are to be obtained from its use. While it is claimed by\\nmanufacturers of dental gold foil that their products are absolutely free\\nfrom alloy, it is nevertheless true that but few specimens of dental foil\\nshow a fineness above 999. If this standard were always attained the\\noperator would have little cause for complaint. So small a percentage\\nof alloy as 1 in 1000 would not materially affect the working qualities\\nof the product, but when this is increased to 4 or 6 parts per 1000 it\\nmanifests itself by harshness and intractability under the instrument.\\nGreat care should be exercised in the preparation of the foil, since\\nso much depends upon its purity and cleanliness. For a detailed\\ndescription of the process of manufacture, from the ingot to the beaten\\nand annealed foil, the reader is referred to an article by a practical foil-\\nmaker. 1\\nIn former times the dental surgeon was restricted to one form\\nof gold for filling. This was foil ranging in thickness from 4 to 10\\ngrains to the leaf, but as the requirements of the operator broadened\\nthe art of manufacture increased, and new preparations were offered,\\nuntil to-day the most fastidious can find such as will please his fancy\\nfoils ranging in weight from 4 to 120 grains to the leaf; cylinders of\\nvarious sizes and composed of non-cohesive and semi-cohesive foil cohe-\\nsive blocks prepared for use rolled gold, varying in thickness from No.\\n30 to 120, and crystal gold possessing great cohesive properties. These\\nare the more important forms in which gold is offered the operator at\\nthe present time.\\nBefore entering upon a description of the classes of cases where each\\nof these seems best adapted, it may be well to describe somewhat in\\ndetail the peculiar qualities which each form of gold presents when\\nsubjected to clinical use.\\nSoft or Non-cohesive Foil. Prior to 1854, when Dr. Robert\\nArthur discovered and promulgated the desirability of cohesive foil in\\ncertain cases, the operator used gold which possessed very low cohesive\\nproperties. Used as it then was, in the form of large rope, tape, or as\\ncylinders, the property of cohesion would have been a serious objection,\\nsince there would be constant danger of the mass clogging and bridging\\nin the cavity, and the cause of many unfilled places along the cavity\\nwalls.\\nThe terms soft and hard, when used to designate the kind of gold, are\\nmisleading, since all gold foil prepared from pure gold or gold that is\\nnearly pure possesses great softness under the instrument. The distin-\\nguishing characteristics between the two kinds of gold are the inability\\nto make a certain kind of foil cohesive when exposed to a reasonable\\n1 American System of Dentistry, vol. iii. p. 839.", "height": "4580", "width": "2844", "jp2-path": "americantextboo00kirk_0276.jp2"}, "277": {"fulltext": "GOLD. 269\\ndegree of heat, and the ability to render another make of equal purity\\ncohesive by the application of a similar degree of heat. It has been\\nclaimed by some manufacturers of dental gold foils that they are able\\nto procure from the same ingot samples of non-cohesive, semi-cohesive,\\nand extra-cohesive gold, attaining these physical properties of the mate-\\nrial without alloying with other metals. This has led to the belief\\nthat, since absolutely pure gold possesses inherent cohesive properties,\\nsome metallic salt or other foreign substance has been deposited upon\\nthe surface of the leaf of non-cohesive foil which has the power of pre-\\nventing the union of the surfaces of the foil when contact is sought.\\nIt has been surmised that a thin film of iron has been deposited upon\\nthe surfaces of the leaf of non-cohesive foil, for the reason that if a\\nleaf of such foil be melted into a globule, it presents a reddish brown\\nappearance, which is not true of the leaf of cohesive foil when melted\\nas above.\\nMuch of the so-called non-cohesive foil offered for sale is not,\\nstrictly speaking, of this variety, as the application of moderate heat\\nwill render it quite cohesive. It possesses the softness peculiar to pure\\ngold foil, but it should not be classed with the variety which does not\\nweld with other particles of the same metal except when subjected to\\ngreat heat.\\nIt has been claimed by some that non-cohesive foil has no place in\\ndental practice that any tooth which can be filled with gold may be\\nfilled with cohesive foil. This statement may be true in the main, but\\nit is also true that many teeth having strong cavity walls can be just as\\nwell filled where a large portion of the filling is made with non-cohe-\\nsive foil, and with a great saving of time. Adaptation, not hardness,\\nconstitutes the saving quality in cavity filling.\\nAs most non-cohesive foil is prepared in the form of sheets and\\nis placed in books containing one-eighth of an ounce, the operator is\\ncompelled to prepare it in some form suitable for introduction to the\\ncavity. The size and shape of the cavity will be some guide as to the\\nbest method of preparing the gold. The narrow tape, the mat, the\\ntightly rolled cylinder, and the roll or rope are the forms best adapted\\nfor the use of non-cohesive gold foil.\\nThe tape is best made by taking one-half or one-third of a leaf of\\nNo. 4 or No. 5 foil, laying it upon a table napkin of medium size folded\\nsquare as it comes from the laundry the napkin is then taken in the\\npalm of the left hand, and the foil spatula is placed in the middle of\\nthe piece of foil the hand is then closed tightly, thus folding the nap-\\nkin, likewise the foil, upon the sides of the spatula. This process is\\nrepeated until the tape is one-eighth or one-sixteenth inch in width\\n(Fig. 222).", "height": "4548", "width": "2712", "jp2-path": "americantextboo00kirk_0277.jp2"}, "278": {"fulltext": "270\\nTHE OPERATION OF FILLING CAVITIES.\\nIf mats are required, the foil may be folded twice or three times and\\nthen folded lengthwise upon itself until mats of any thickness are pro-\\nduced, as shown in Fig. 223.\\nWhen non-cohesive cylinders are desired, it is better for the operator\\nto make them rather than depend upon the ready-made ones as prepared\\nby the manufacturer, since these are usually loosely rolled and more or\\nless cohesive. The tape is quickly made into the cylinder by rolling it\\nFig. 222.\\nFig. 223.\\nTapes of gold foil.\\nMats of gold foil.\\nupon a five-sided broach to the desired size. The depth of the cavity\\nis a guide to the width of the tape, and the width of the tape determines\\nthe length of the cylinder. These should be somewhat longer than the\\ndepth of the cavity. The manner of introducing and condensing will\\nbe described later when special cases are under consideration.\\nThe roll, or rope as it was formerly called, is made in the following\\nway A leaf or half leaf or a third of a leaf of foil is rolled between the\\nFig. 224.\\nDevice for rolling gold foil.\\nthumb and finger until a roll of moderate density is obtained. As foil\\nis contaminated by contact with the moisture and surface impurities of\\nthe hands, it is better to avoid such contact as much as possible. This\\ncan be completely attained by rolling it upon the little device shown in\\nFig. 224. Any operator can make one of these by taking two pieces of\\nthin board, such for instance as the lid of a cigar box, and fastening\\nto the two pieces with glue a piece of white kid about eight inches in", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0278.jp2"}, "279": {"fulltext": "GOLD. 271\\nlength, and in width equal to the sheet of foil. Two little drawer-\\nknobs of ebony should be inserted into the centre of each of the pieces\\nof board. These act the part of handles for holding the appliance.\\nThe gold is then placed upon the kid strip between the two pieces of\\nboard, and by bringing the two surfaces of the kid in contact the foil is\\nrolled between them. The undressed surface of the kid should be the\\none upon which the gold is rolled. Ropes thus made may be cut in\\nlengths to suit the size of the cavity to be filled, and, as gold thus pre-\\npared has great softness and ease of adaptation, it may be inserted in\\nquite large pieces if plenty of condensing force be applied to it.\\nCohesive Gold Foil. All gold which has been refined by any of\\nthe ordinary methods and is in a pure state may be said to be cohesive.\\nNor is absolute freedom from alloy an absolute necessity. It has been\\nshown that softness is dependent upon purity, but a foil may contain\\nquite a percentage of silver, copper, palladium, or zinc, and yet its\\ncohesion may not be impaired. It may also be alloyed or combined\\nwith platinum and not lose its cohesive properties. It is, however,\\ndesirable that cohesive gold be pure, since the smallest percentage of\\nalloy destroys its softness.\\nWhen two sheets or lamina? of freshly annealed foil are brought into\\ncontact and slight pressure is applied, they form a permanent union and\\nare practically inseparable. It is this property in gold to which the\\nterm cohesive has been applied. But this property is soon lost by the\\nocclusion of gases or impurities of any kind which may be deposited\\nupon the surface of the gold. 1\\nExperiments have demonstrated the fact that if the gold be sub-\\njected to the fumes of ammonia, hydrogen, hydrogen carbid, hydrogen\\nphosphid, or sulfurous acid gas its cohesive property is quickly de-\\nstroyed, but this property may be restored by heat except in the case\\nof sulfur or phosphorus fumes. Hence the importance of excluding\\nthe gold as much as possible from the atmosphere, especially during the\\nwinter months when gases arising from the combustion of coal are most\\nliable to be present in the operating room.\\nDr. Black has shown that ammoniacal gas has the power to prevent\\nthe deleterious influence of other gases, and recommends that the foil\\nbe subjected to the influence of carbonate of ammonia by keeping it in\\na drawer with a bottle of that salt.\\nThe advantages of cohesive foil cannot be overestimated. With its\\nintroduction in 1855 began a new era in the possibilities of saving cari-\\nous teeth. Operations which were deemed impossible by the use of\\nnon-cohesive foil were made comparatively easy by the intelligent use\\nof cohesive foil. The restoration of broken-down or badly decayed\\n1 G. V. Black, Dental Cosmos, vol. xvii. p. 138.", "height": "4556", "width": "2704", "jp2-path": "americantextboo00kirk_0279.jp2"}, "280": {"fulltext": "272\\nTHE OPERATION OF FILLING CAVITIES.\\nteeth became the common practice in the hands of the skillful, and mod-\\nern methods of practice coupled with intelligent use of this form of\\ngold have made it possible for the operator of modern times to do that\\nwhich the earlier practitioner deemed impossible.\\nThe beginner, however, must not lose sight of the fact that cohesive\\nfoil cannot be worked after the same methods as non-cohesive foil. To\\nuse cohesive foil in the form of mats or cylinders or in tightly rolled\\nropes would mean inevitable failure in adaptation. The very property\\nwhich renders it valuable in the restoration of broken-down teeth and in\\nsurfacing is the one which would condemn it if used carelessly in the\\ninterior of inaccessible cavities. Non-cohesive gold may be introduced\\ninto a well-shaped cavity in large masses, and because of its softness\\nand ease of adaptation may be made to touch all points of the cavity\\nwalls if persistent pressure be applied. On the contrary, cohesive foil\\nshould be introduced in small pieces, the first of which should be well\\nanchored in a retaining pit or groove and each subsequent piece welded\\nthereto.\\nThere are several modes of preparing the beaten cohesive gold foil\\nfor the cavity, and good results are obtained by either of the following\\nmethods.\\nA loosely rolled rope made of a quarter sheet of No. 4 or 5 foil\\nmay be cut into lengths varying from one-eighth to one-quarter of\\nFig. 225.\\nRibbons and strips.\\nan inch, and after annealing carried to the cavity upon the point of\\nthe plugging instrument. Or a leaf may be folded with a spatula four", "height": "4608", "width": "2844", "jp2-path": "americantextboo00kirk_0280.jp2"}, "281": {"fulltext": "GOLD. 273\\ntimes, making a broad ribbon, which may be cut either lengthwise or\\ncrosswise of the ribbon in pieces one-sixteenth or one-eighth of an inch\\nin width (see Fig. 225). This is a very convenient manner of working\\ncohesive gold. Or the heavier foil up to No. 20 or No. 30 in thickness\\nmay be cut in strips of a single thickness and of the widths above indi-\\ncated, and after annealing may be packed into the cavity the essential\\nidea being ever in mind, that but a small quantity of the gold shall be\\nunder the instrument at a given time. Cohesive gold which has been\\nrolled instead of beaten to the desired thickness is much prized by some.\\nIt has been asserted that greater softness is obtained when gold has been\\nthus prepared. Such gold should not be more than No. 20 or No. 30\\nin thickness to insure the best results. It should be cut in narrow\\nstrips and after annealing be folded back and forth as rapidly only as\\neach previous fold has been well condensed. Good results are only\\nattainable if each lamina be thoroughly welded.\\nThe loosely rolled cylinders and blocks which are prepared by some\\ndealers and offered as cohesive gold are usually but slightly cohesive,\\nand if used in this form, without re-annealing, may be packed in the\\ninterior of cavities without danger of clogging, but if freshly annealed\\nthey are contraindicated, since there is more or less danger of imper-\\nfect union of all particles of the gold. It is questionable whether the\\nlarger sizes are admissible when the filling extends beyond the cavity\\nwalls and great solidity is an essential factor.\\nCrystal Gold. This form of gold was introduced by Mr. A. J.\\nWatts in 1853, and as prepared at the present time is one of the best\\npreparations of cohesive gold. When first brought out the method of\\nmanufacture was faulty, since it was difficult or impossible to rid the\\nspongy mass of nitric acid which was used in its preparation, but since\\nMr. Watts adopted electrolysis instead of chemical precipitation the\\nobjectionable features no longer exist. Gold thus prepared manifests\\ngreat cohesive properties, and when used with care as beautiful opera-\\ntions can be made with this gold as with any form of cohesive foil. The\\noperator should not lose sight of the fact that the gold is to be intro-\\nduced into the cavity in small quantities. Should failure attend its\\nuse, it would doubtless be from the attempt to introduce it too rapidly.\\nGold of this variety comes in bricks containing one-eighth of an ounce\\neach, and is either torn apart in irregular-shaped pieces or cut by means\\nof a razor into small cubes. This gold should be excluded as much as\\npossible from the atmosphere and when used should be well annealed,\\nalthough when recently made it is quite cohesive. There is no prepara-\\ntion of gold better adapted for starting fillings in shallow or irregular\\ncavities, or for surfacing fillings. Many operators make use of it\\nalways for starting and for finishing fillings,\\nis", "height": "4560", "width": "2724", "jp2-path": "americantextboo00kirk_0281.jp2"}, "282": {"fulltext": "274 THE OPERATION OF FILLING CAVITIES.\\nCrystal Mat Gold. This is another form of crystal gold, and\\ndiffers from that previously described in that it presents a more compact\\nform, the crystals appearing smaller and matted together. It breaks\\nand crumbles under the instrument to a greater degree than the other,\\nand possesses no desirable qualities which the other has not. If it has\\nany merit it is for finishing the fillings upon occlusal surfaces, or such\\nsurfaces as are easy of access, or it may be used in conjunction with\\namalgam.\\nGold and Platinum. This form of gold has found much favor\\nwith many practitioners for the restoration of incisal edges, or where\\nfor any reason great hardness of surface is desired.\\nAn ingot or bar of pure gold and one of platinum are sweated\\ntogether and then rolled to the desired thinness, usually about that of\\nNo. 20 or No. 30 foil. It is then cut into narrow strips, freshly an-\\nnealed and used after the same manner as heavy foil. The commingling\\nof the platinum with the gold gives the filling a tint more nearly the\\nshade of the tooth, and for this reason it is much used upon labial sur-\\nfaces and in mouths where the teeth are much exposed.\\nGold thus combined with platinum is much more rigid than gold\\nalone, and is contraindicated for making the bulk of most fillings. The\\nbest results are obtained from it when the mallet is used for its con-\\ndensation throughout.\\nAnnealing Gold.\\nAfter the manufacturer has reduced the gold to the desired thinness\\nby beating, his last act before booking it is to heat it this is termed\\nannealing. The object of this is to remove any harshness which has\\nbeen given to it by the process of beating. All metals become more or\\nless stiff or rigid by hammering, but become soft again by the applica-\\ntion of considerable heat. Gold foil which has been recently made and\\nexcluded from the atmosphere or certain gases, as previously men-\\ntioned, may present sufficient cohesive properties to weld satisfactorily,\\nbut this property is soon lost, and reheating becomes necessary if it is\\ndesirable to get union of the various layers.\\nMost operators make use of an alcohol flame for annealing gold\\nothers a small Bunsen gas burner. Some hold the piece of gold to be\\nannealed in the direct flame or a little above it others place the gold\\nupon a tray of Russia iron, mica, or platinum and hold this in the flame\\nof the lamp or gas jet. This latter method is safest, since there are apt\\nto be impurities in the flame dependent upon a charred wick, a particle\\nof phosphorus dropping into the wick from the burning match, or, in\\nthe case of the gas jet, imperfect combustion which might give either", "height": "4608", "width": "2824", "jp2-path": "americantextboo00kirk_0282.jp2"}, "283": {"fulltext": "INTRODUCTION OF THE GOLD. 275\\ncarbon or sulfur deposits upon the surface of the gold. All or any\\nof these accidents would impair the working qualities of the gold.\\nThe most satisfactory method of annealing gold is by the use of the\\nElectric Annealing Tray. Such a device has been invented by Dr. L.\\nE. Custer, and is shown in Fig. 226. By this method the gold can be\\nFig. 226.\\nCuster s electric annealing tray.\\nheated to any desired degree and with a uniformity not easily attained\\nby the methods generally used. The working qualities of foil whether\\nnon-cohesive or cohesive are greatly enhanced by the application of\\nheat at the time of using. Gold that is absolutely non-cohesive is made\\ntougher by annealing and yet its softness is not impaired, while cohesive\\ngold may be made either slightly or decidedly cohesive according as\\nmuch or little heat may be applied to it. It is the practice of many\\noperators to use the gold but slightly cohesive when filling cavities sur-\\nrounded by strong walls, and the gold known as semi-cohesive, in the\\nform of loosely rolled cylinders, is much used. As the filling approaches\\ncompletion the cylinders are heated and additional cohesive property\\nimparted to them. But when the object is the restoration of contour or\\nbuilding up of teeth which have been broken, the gold should be heated\\nbut little short of redness in order that the greatest cohesive property\\nmay be realized.\\nIntroduction of the Gold, and Manner of Adapting It to\\nthe Walls of the Cavity.\\nIt has been shown in Chapter VIII. that few cavities are of proper\\nshape for retaining the filling when the decay alone has been removed.\\nMost cavities require to be given a retentive shape so that the filling\\nshall not be dislodged during its introduction or by mastication or\\notherwise after its completion. In former times, when the operator was\\nrestricted to one form of gold and that the non-cohesive variety, he was\\ncompelled to prepare his cavities accordingly but at the present time,\\nwhen the variety is almost endless, he can shape his cavity with a view", "height": "4560", "width": "2736", "jp2-path": "americantextboo00kirk_0283.jp2"}, "284": {"fulltext": "276 THE OPERATION OF FILLING CAVITIES.\\nto conserving tooth structure, and when he has given it a shape to please\\nhim he can select, from the many, a special form of gold that will meet\\nhis requirements.\\nThere are certain principles involved in the packing of gold which\\nmust be borne in mind, and the operator should study these before\\nintroducing his filling. The first of these is force, and the direction and\\nrelation of that force to the object to be attained. If a given cavity is\\nto be filled with non-cohesive gold the operator must take into consid-\\neration the strength of the cavity walls, and must determine whether by\\nthe wedging process which he will exercise in the effort to adapt the\\ngold to the walls of the cavity he will run the risk of breaking them.\\nNon-cohesive gold is usually introduced by what is known as hand\\npressure. Each layer of gold is carried to the floor and the walls of\\nthe cavity by a process of wedging, and the mechanical arrangement of\\neach piece of gold should be such that no portion of the gold can es-\\ncape when the filling is completed. It will be shown later on, when\\nconsidering the various types of cavities to be filled, that in small cav-\\nities of simple shape the gold prepared in the form of tape is best\\nsuited, whereas in compound cavities or those of greater size the gold\\nmay be introduced in the form of compact cylinders or blocks.\\nWhen it is desirable to use a combination of non-cohesive and cohe-\\nsive gold, the former is generally introduced first and the cohesive is in-\\ncorporated with it by driving or forcing layers of cohesive into the non-\\ncohesive. This is best effected by using single layers of heavy foil or\\nrolled gold of a thickness equal to 20, 30, or 40 grains to the leaf. If\\nthe filling is to be made of but one kind of gold and that the cohesive\\nvariety, both hand pressure and percussion by means of the mallet\\nmay advantageously be employed. The operator who has learned .to\\ncombine the two forms of gold and is not restricted to either method\\nof packing is best qualified for the requirements which are presented in\\ngeneral practice. Perfect adaptation to the walls may be effected by\\neither method, but greater celerity and the attainment of equal excel-\\nlence may be reached by combining the two.\\nPlugging- Instruments. In the selection of instruments for pack-\\ning gold the operator should have a sufficient number to meet his every\\nneed. They should be of such a variety of patterns that every part of\\nevery cavity, however remote, can be reached with ease. It is a mis-\\ntaken notion that a large number of instruments (if well selected) is\\nconfusing. The operator should study his instruments and know their\\nuses as thoroughly as he knows the letters of the alphabet, and if this\\nbe done and they be arranged in an orderly manner in his case, the\\nconfusion will be manifest in their absence, not in the possession of\\nthem.", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0284.jp2"}, "285": {"fulltext": "INTRODUCTION OF THE GOLD.\\n277\\nFor packing non-cohesive foil none are better adapted than the set\\nshown in Fig. 227, made from patterns furnished by Dr. B. J. Bing.\\nFig. 227.\\n14 15 16 17\\nDr. Bing s set of pluggers.\\nThis set should be supplemented by a small and a medium\\nsized foot-shaped condenser (Fig. 228), for packing FlG 2 28.\\ncylinders, mats, or blocks against the cervical wall.\\nThe handles of instruments used for packing\\nnon-cohesive foil should be of such size that they\\ncan be grasped firmly in the hand. When made\\nof wood they are light in weight and agreeable to\\ntouch. Plugging instruments should have as few\\ncurves and angles as is consistent with the ability\\nto reach all points in the cavity. As these are\\nmultiplied, direct force is sacrificed. The point of\\nthe instrument should be as nearly as possible in a\\nline with the shaft. Deviations from this rule are sometimes necessary\\nin order to reach all points in the cavity. Most plugging instruments\\nhave serrated points and are used for all forms of gold. As a rule these\\nserrations should be shallow, and when cohesive gold is to be employed\\nthey should be only sufficient to prevent slipping, as gold that is quite\\ncohesive packs as readily with smooth points as with rough ones.", "height": "4560", "width": "2728", "jp2-path": "americantextboo00kirk_0285.jp2"}, "286": {"fulltext": "278\\nTHE OPERATION OF FILLING CAVITIES.\\nFig. 230.\\nFig. 231.\\nFig. 229.\\nil\\nSnow and Lewis auto- The Abbott mallet\\nmatic mallet.\\nS. S. White electric mallet No. 2.\\nFounded on the Bonwill.", "height": "4608", "width": "2824", "jp2-path": "americantextboo00kirk_0286.jp2"}, "287": {"fulltext": "INTRODUCTION OF THE GOLD. 279\\nIt is not definitely known when packing gold by percussion was first\\nsuggested, but the idea is quite generally accorded to Dr. E. Merrit of\\nPittsburg, who as early as 1838 used the hand mallet for condensing\\nthe surface of fillings which had been introduced by hand pressure.\\nThe first mallets used were of light weight and were made of wood or\\nivory. As the method became more general, heavier mallets were em-\\nployed, and those made of lead, tin, various alloys, and steel found much\\nfavor. Before the introduction of rubber dam for excluding moisture\\none hand of the operator was employed in holding the napkin, and it\\nbecame necessary to have an assistant at hand to do the malleting.\\nThis led ingenious minds to discover some means of percussion besides\\nthe hand mallet, and several spring instruments known as automatic\\npluggers were introduced. The Snow and Lewis, the Foote, and the\\nSalmon found greatest favor, and all of them were good of their kind.\\nThe accompanying cut (Fig. 229) shows the Snow and Lewis Automatic\\nMallet as made at the present time. When pressure is applied to the\\npoint of the instrument a spring is liberated which throws a plunger\\nforward with great force, which is expended upon the gold beneath the\\npoint. The impacting quality of this blow is not excelled by any of\\nthe mechanical devices in use. It is so constructed that a light or a\\nheavy blow can be given at will. The operator will do well to adjust\\nthe instrument for light blows when using it in close proximity to frail\\nor delicate walls, as there is more or less danger of fracturing them.\\nInstruments of this class are not well adapted to packing gold in\\nthe posterior teeth of the lower jaw, as the blow is delivered at a more\\nor less acute angle, and unless care be exercised when the operation is\\nnearing completion the plugger point will slip from the surface of the\\nfilling and wound the soft tissues.\\nAnother instrument of this type devised by Dr. Frank Abbott (see\\nFig. 230) has a socket at either end of the hand-piece, the one giving a\\npushing and the other a pulling blow. The latter is serviceable for\\ncondensing gold upon distal surfaces.\\nThe electric mallet is one of the most ingenious devices em-\\nployed in dentistry. The first practical application of electro-magnetic\\nforce for dental malleting was made by the late Dr. W. G. A. Bon will.\\nIts latest development is shown in Fig. 231. This instrument has\\nfound great favor among dentists for packing cohesive gold. Its blows\\nare delivered with great rapidity and with such force that great solidity\\nis attainable. A pair of electro-magnets transforms the electric current\\ninto electro-magnetic force, which is transmitted to the hammer. The\\nelectric current is furnished by a Bunsen or Partz battery, or the con-\\ntrolled current from a dynamo or storage battery can be used as the\\nmotive power. In the hands of a skilful operator there could be nothing", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0287.jp2"}, "288": {"fulltext": "280\\nTHE OPERATION OF FILLING CAVITIES.\\nbetter for packing cohesive\\ngold. The best results are\\nobtained by its use when the\\ngold is prepared in thin lam-\\ninae or where a single thick-\\nness of heavy foil or rolled\\ngold is employed.\\nConsiderable experience is necessary to\\nenable the operator to use this instrument\\nwith satisfaction to himself and his patient.\\nIf the plugger point be pressed hard against\\nthe filling, the blows, which are delivered with\\ngreat rapidity and force, become painful and dis-\\ntressing and there is also danger of chipping the\\ncavity walls. The better plan is to hold the point\\nslightly away from the surface of the filling and\\nallow the momentum which is given the instru-\\nment by the falling armature to complete the\\nunion of the various pieces of gold.\\nThe engine mallet (see Fig. 232) is intended\\nfor use upon the dental engine. It is made with\\na slip joint and can be applied in place of the\\nhand-piece to nearly all of the dental engines in\\nuse, although it is best adapted to one of the\\ncord engines because of the greater freedom\\nof action. The instrument shown in the illus-\\ntration embodies many improvements in con-\\nstruction which have been suggested by various\\noperators since the Bonwill mechanical mallet\\non which it is based, was introduced, and a point\\nof relative perfection has been reached where are\\ncombined great efficiency with compactness and\\nlightness in handling. It will be seen by the\\nillustration that the essential feature of this in-\\nstrument is a revolving wheel having inserted in\\nits periphery a hollow cylindrical steel roller.\\nThis constitutes the hammer. It gives a spring,\\nnot a dead blow, as it is held to its position by\\na stiff steel spring. The roller revolves slightly\\nin its socket at each contact Avith the plunger.\\nWhen the engine is run at ordinary speed the\\nsmall wheel revolves with great velocity, deliver-\\ning upon the head of the plunger as many as fif-\\nFig. 232.\\nEngine Mallet.", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0288.jp2"}, "289": {"fulltext": "INTRODUCTION OF THE GOLD.\\n281\\nteen blows per second. The force of the blow can be modified at will\\nby an extremely simple contrivance, as follows The interdigitations\\nseen around the upper end of the sleeve are held together by means of\\na spring attached to the sleeve. Pulling the sleeve away from the head\\nagainst the spring, and revolving it to the right or left, raises or lowers\\nthe head of the plunger. Upon releasing the sleeve the spring at once\\nthrows it back to engage with the head, and the blow is heavier or\\nlighter, according to the direction in which the sleeve has been revolved.\\nThe impacting power of the blow from this is great, and in the\\nhands of an experienced operator a large quantity of gold can be con-\\nFig. 233.\\n1\\nVarney s set.\\niff if 1 1\\nChappell s set.\\ndensed in a short space of time. When cohesive gold foil is employed\\nsmooth oval points may be used with most satisfactory results. The\\npoint should not be pressed hard against the filling, but a skimming or\\nsmoothing motion given to the instrument. The surface of the filling\\nwhen thus packed has a polished or planished appearance as if done\\nwith a hand burnisher. Such fillings are usually of great density.\\nThere are other mechanical mallets intended for use on the engine\\nwhich have what is known as a cam movement. They are not,", "height": "4556", "width": "2720", "jp2-path": "americantextboo00kirk_0289.jp2"}, "290": {"fulltext": "282 THE OPERATION OF FILLING CAVITIES.\\nstrictly speaking, mallets, for the instrument is pushed rather than\\ndriven forward by an eccentric. The Buckingham and the Holmes\\nmallets belong to this class. They have not the same steadiness of\\nmotion as the ones previously described, and for this reason, among\\nothers, have not been in general use.\\nIn the selection of plugger points for power mallets the operator will\\ndo well to confine himself to those having more than one row of serra-\\ntions and those which are smooth-faced. The serrations, if any, should\\nbe extremely shallow, and the corners of the instrument slightly\\nrounded. Those of the foot-shaped variety are admirably adapted to\\npower mallets, and as there is a great variety of patterns and sizes he\\nwill have little difficulty in meeting his every wish in this particular.\\nA few points selected from the Webb, the Varney, and the Chappell\\nsets will fill all requirements. The accompanying cut (Fig. 233) shows\\na good working set which has been selected from the three mentioned.\\nFilling by Classes.\\n(As arranged in Chapter VIII.)\\nI. Simple Cavities on Exposed Surfaces.\\nBicuspids and Molars.\\nClass A. The small cavities upon the occlusal surfaces of the\\nbicuspids and molars are among the simplest in form. They are shown\\nin Chapter VIII., Fig. 173. Cavities of this kind are quickly filled\\nby means of non-cohesive foil in the form of tape as shown in Fig.\\n222. Such cavities are usually of regular shape and of a form re-\\nquiring little if any additional shaping to make them retentive. A\\nlength of tape varying from an inch to two inches should be taken\\nupon a wedge-shaped plugger point and carried to the bottom of\\nthe cavity, where it may be held for an instant with a point in the\\nleft hand the instrument in the right hand makes a fold of the gold\\nand carries it into and against the walls of the cavity by a lateral mo-\\ntion fold after fold is then carried into the cavity and pressed firmly\\nin every direction. As it is always best to finish such fill-\\nFig 234.\\nings with cohesive gold, a strip of No. 20 cohesive foil\\nshould be wedged into the mass already in the cavity, and\\nthen all subsequent pieces malleted, to give the occlusal\\nsurface as great hardness as possible. A completed filling\\nof this class is shown in Fig. 234. Perfect adaptation to\\nthe walls of the cavity is obtained by the use of the non-\\ncohesive foil, and great solidity is only essential upon the surface.\\nCavities of this character, though of greater size, are found in the\\nmolars, as shown in Figs. 235-237, and may be filled in the same gen-", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0290.jp2"}, "291": {"fulltext": "SIMPLE CAVITIES ON EXPOSED SURFACES.\\n283\\neral way. Mats of foil may be substituted for tape, and where the decay\\nhas progressed to such an extent as to involve a large portion of the\\nocclusal surface, making, as is frequently found, large round and quite\\ndeep cavities, the gold may be introduced in the form of cylinders.\\nIn former times, when the dentist s only means of excluding moisture\\nFig. 235.\\nFig. 236.\\nFig. 237.\\nFig. 238.\\nFillings in molar fissure cavities.\\nwas the napkin, and when his ability to keep cavities free from saliva\\nwas for a limited time only, the use of cylinders was much more com-\\nmon than at the present time when the rubber dam is generally em-\\nployed.\\nCylinders for such cavities should be hand-made and of No. 4 non-\\ncohesive foil (Fig. 238). They should be long enough to extend above\\nthe margins of the cavity as shown in Fig. 238 and arranged\\naround its walls. The first one is usually carried to that\\npoint in the cavity farthest away, and should be pressed with\\na foot-shaped instrument against the wall. Others are then\\nput in place and wedged laterally until room is made in the\\ncentre of the mass for another cylinder, this in turn being\\nwedged toward the outer walls, and the operation continued\\nuntil no more cylinders can be introduced. The cylinders\\nshould then be condensed with great force upon their pro-\\ntruding ends, and finished with cohesive foil in the same\\nmanner as previously described. This mode of filling is best suited to\\ndeep cavities in which the walls are nearly parallel and yet sufficiently\\nstrong to endure great lateral pressure.\\nIn a cavity of unequal depth, where the central portion is quite deep\\nand the sulci radiating from it quite shallow (see Fig. 239), it is well to\\nuse semi-cohesive foil in the central portion and cohesive\\nfoil in the radiating sulci. Such fillings require to be well\\nanchored at the extremities of the fissures lest they be dis-\\nlodged by sticky candy, which often adheres with great\\ntenacity to the surface of the gold. The operator will do\\nwell in filling such cavities to confine himself to gold that\\nis quite cohesive, except in the central portion as above\\nindicated.\\nClass B. Cavities situated upon the buccal surfaces of the bicus-\\npids and molars are rather more difficult to fill because of the difficulty\\nin getting the rubber dam beyond the cervical border of the cavity.\\nFig. 239.\\nFilled stellate\\ncavity in\\nlower first\\nmolar.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0291.jp2"}, "292": {"fulltext": "284\\nTHE OPERATION OF FILLING CAVITIES.\\nFig. 240.\\nBuccal cavity\\nin lower sec-\\nond molar.\\nWhen this has been done and perfect dryness effected these cavities may\\nbe classed as simple ones.\\nIn small or non-elastic months it is often difficult to reach the second\\nor third molars, hence the view of the cavity is somewhat impaired.\\nIn selecting the gold for such cavities the operator must\\ntake into consideration the depth of the cavity. If it be\\nshallow he will do better to start his filling in a retaining\\npit and fill throughout with cohesive foil. If, on the con-\\ntrary, the cavity be of considerable depth, he may fill the\\nbulk of the cavity with mats or tape made of non -cohesive\\nfoil, and, as he approaches the surface of the filling, incor-\\nporate with it cohesive gold and finish his operation with\\nthe last-named variety. Such cavities are often advantageously filled\\nthroughout with Watts crystal gold. This form of gold is easily seated\\nand it has no tendency to rock or move in the cavity. A slight under-\\ncut along the upper and lower border of the cavity is sufficient to hold\\nthe filling in place (Fig. 240).\\nWhen these cavities assume larger proportions, as they frequently do\\nin the lower molars, and become confluent with cavities on the occlusal\\nsurface, they should be filled after the following method A mat or\\nblock of non-cohesive foil should be placed at the border nearest the\\ngum this may be held for a moment with an instrument in the left\\nhand. One or two other blocks may be laid against this, and, when\\nthey have been well fixed in the undercut, should be malleted thoroughly\\nagainst the cervical border the remainder of the cavity may then be\\nfilled with semi-cohesive or cohesive gold. The surfacing of all fillings\\nshould be done with gold which has been made cohesive by recent\\nannealing.\\nClass C. Cavities do not often occur on the lingual surfaces of the\\nbicuspids or molars except in teeth of very poor structure and in teeth\\nfrom which the gum has receded to a point below the enamel border.\\nSuch cavities because of their inaccessible position are difficult to fill\\nwith gold, and, as a rule, some of the plastics are indicated. When the\\nfissures on the upper molars become the seat of caries they may be\\nfilled with gold in the same manner as those in class B. It is usually\\nnecessary to pack the gold in these cases almost entirely by hand pres-\\nsure because of the inaccessible situation of the cavity.\\nIncisors and Canines.\\nClass D. Cavities upon the labial surfaces of the incisors and canines\\nsituated at or near the gingival border of the gum were formerly the\\nsource of much annoyance to the dentist when gold was the material\\nselected for filling. The principal difficulty was occasioned by mois-", "height": "4580", "width": "2920", "jp2-path": "americantextboo00kirk_0292.jp2"}, "293": {"fulltext": "SIMPLE CAVITIES ON EXPOSED SURFACES. 285\\nture, either in the form of blood or serum from the wounded gum or\\nmucus from the follicles situated along the mucous surface. Since the\\nintroduction of the rubber dam this difficulty has been greatly modified.\\nBut when the cavity extends somewhat above the nor-\\nmal gum line there is more or less difficulty in keeping\\nthe rubber above the gingival border of the cavity. This\\nis best done by taking a straight instrument the point\\nof which has been made very sharp by rubbing it upon\\nan Arkansas hone. The dam is then raised well above\\nthe cavity border and the point pressed firmly into the\\ndentin and held with the left hand throughout the ope-\\n\u00c2\u00ab-it a Till Woodward clamp.\\nration oi tilling the cavity. A very neat and valuable\\ndevice in the form of a clamp has been introduced by Dr. W. A. Wood-\\nward for this purpose. It is shown in Fig. 241.\\nThe dam should include not only the tooth to be filled, but several on\\neach side of it. With the left hand it is stretched above the margin\\nof the cavity, while with the right hand the two little points on the\\nbow of the clamp are pressed firmly into the cementum above the cavity.\\nThe clamp is then made secure by turning the set-screw. This clamp\\nwhen well seated rarely fails, and the operator feels that this difficult\\noperation has become a simple one.\\nThere are cases, however, where the decay has followed the receding\\ngum or extended beneath it to such an extent that the clamp cannot be\\nused. To overcome this difficulty the gum should be slit and a\\nMack screw inserted to the depth of two or three threads into the\\ndentin. The rubber dam is then drawn above this and held securely\\nabove the cavity. When the operation is completed the screw should\\nbe cut off with the wedge-cutters and nicely smoothed. When the slit\\nin the gum has healed, the portion of the screw remaining will be\\nconcealed.\\nMost cavities upon the labial surfaces are shallow and are best filled\\nwith cohesive foil or Watts crystal gold. It is well to fix the first piece\\nsecurely in a small retaining pit and build each piece\\nFig. 242. upon a sure foundation, As fillings upon the labial\\nsurfaces of teeth are usually conspicuous (Fig. 242),\\nit is often desirable to fill such cavities with plat-\\ninous gold, because the tint of the two metals in\\nLabial fillings. combination is more nearly the shade of the tooth.\\nEspecially is this true in teeth of yellowish hue.\\nClass E. As cavities upon the lingual surface of the incisors are\\nusually confined to the laterals and most frequently are the result of\\nimperfect development of the enamel in relation to the cingulum (see\\nChapter I., p. 25) they are small in size and easily filled. A tape of", "height": "4556", "width": "2764", "jp2-path": "americantextboo00kirk_0293.jp2"}, "294": {"fulltext": "286 THE OPERATION OF FILLING CAVITIES.\\nnon -cohesive foil, or a small mat of the same material, may be inserted\\ninto the cavity first, and the filling completed with cohesive gold as in\\nother cavities surrounded by strong walls.\\nClass F. As caries rarely attacks the incisal edge of the anterior\\nteeth the operation of filling with gold is usually confined to artificially\\nmade cavities, with the view of arresting waste of tooth substance\\ncaused by attrition, or where for any reason it is deemed best to open\\nthe bite. Great strain is often brought to bear upon fillings in this\\nposition, and too great care cannot be exercised in the shaping of the\\ncavity and the subsequent packing of the gold.\\nCohesive gold is best suited to cavities of this description, and each\\npiece should be freshly annealed, that there may be no doubt about the\\nperfect union of each piece. It is well to start the first\\npiece in a small retaining or starting pit and then fill all\\nof the undercut before attempting to build the gold above\\nthe walls. As fillings in this position are subjected to\\ngreat wear, the greatest hardness of surface attainable\\nshould be sought for, otherwise there will be battering\\nof the edges and possibly flaking of the gold. Platinous\\ngold is well adapted for this kind of fillings. Narrow strips of No. 20\\nor No. 30, well annealed and condensed with mallet force, will answer\\na better purpose than lighter foil (Fig. 243).\\nII. Simple Approximal Cavities.\\nIncisors and Canines.\\nClass G. In selecting the kind of gold and the form in which it\\nshould be prepared for fillings upon the approximal surfaces of the\\nincisors and canines, the operator must consider the size of the cavity\\nto be filled and the retaining hold which he is able to secure without\\nsacrificing too much of the tooth structure.\\nIf the cavity be a small one, situated midway between the labial and\\npalatal walls, and the surrounding borders be strong, a rapid and easy\\nway of filling such cavities is to prepare the non-cohesive foil in the\\nform of narrow tape. A leaf of foil cut into four pieces and folded\\nwith a spatula upon a napkin to the width of one-sixteenth of an inch,\\nand then cut into lengths of three-quarters or one inch, is a good way\\nof preparing it.\\nAn excavator of an angle of forty-five degrees, with the extreme\\npoint broken off, makes a very good instrument for packing such\\nfillings. Space should previously be obtained, either by the slow pro-\\ncess of wedging with rubber or linen tape or by means .of the Perry\\nseparator.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0294.jp2"}, "295": {"fulltext": "COMPOUND CAVITIES. 287\\nWhen the cavity is two-thirds filled it is well to use a few pieces of\\nXo. 20 cohesive foil, so that a dense surface may be given to the filling.\\nSuch cavities may be classed among the simple ones, and Fig. 244.\\npresent no difficulties except their inaccessibility (Fig. 244).\\nThe operator should ever strive to conceal as much as pos-\\nsible the gold in the anterior part of the mouth, and when it\\nis possible he should preserve the labial wall intact. This Mesio-ap-\\ncan often be done by cutting away a portion of the palatal P roximal\\nJ incisor\\nwall and by packing the filling almost entirely from the under filling.\\nside of the tooth. Where a large portion of the approximal surface is\\ninvolved, the retaining hold for the filling must be had at the cervical\\nborder and at the cutting edge. The first pieces of gold should be an-\\nchored in a groove or retaining pit near the cervix and the cervical\\nborder made secure before any other portion of the cavity is filled.\\nThe beginner will ordinarily do better to start such fillings Avith cohesive\\nfoil or Watts crystal gold. If the latter, he may then complete his\\nfilling with cohesive foil. Non-cohesive gold is rarely indicated in cav-\\nities of this description.\\nThe electro-magnetic mallet or the Bonwill mechanical mallet is well\\nadapted for packing such fillings.\\nBicuspids and Molars.\\nClass H. Cavities of medium size situated upon the mesial or dis-\\ntal surfaces of the bicuspids and molars and not involving the occlusal\\nFig 245 surface may be filled after the same manner as small cav-\\nities in the incisors or canines. Operators who are not in\\nthe habit of using non-cohesive foil prefer starting such fill-\\nings in a small undercut or retaining pit and filling through-\\nout with cohesive gold prepared either in narrow ribbons\\nApproximal x\\nbicuspid or loosely rolled cylinders (Fig. 245).\\nfilling. Such fillings, because of their position, must be packed\\nlargely by hand pressure, although the mallet may be used as the\\nfilling approaches completion.\\nIII. Compound Cavities.\\nIncisors and Canines.\\nClasses I and J. Mesio-labial and disto-labial cavities in the incisors\\nand canines are usually best filled throughout with cohesive gold. Each\\ncavity independent of the others should have retentive shape, so that in\\nthe event of one filling being displaced the other will remain intact.\\nAs a rule it is better to fill the cavity on the labial surface first,\\nbecause the first pieces of gold are more easily anchored in an accessible", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0295.jp2"}, "296": {"fulltext": "288 THE OPERATION OF FILLING CAVITIES.\\ncavity, and because also of the danger of displacing the gold in the\\napproximal cavity when filling the channel connecting the two fillings.\\nEvery possible care should be exercised in packing the gold\\nFig. 246. i n cavities of this description. The gold should be made\\nthoroughly cohesive by recent annealing, and be used in pieces\\nsufficiently small to prevent clogging. Such operations are\\nmore or less exposed to view, and the greatest degree of\\nartistic skill should be bestowed upon them to render them\\nas pleasing as possible to the eye. The original outline of\\nthe tooth should be restored with the gold, because it pre-\\nsents a better appearance than a space between it and the adjoining\\ntooth (Fig. 246).\\nClasses K and L. Cavities upon the mesio-lingual or disto-lingual\\nsurfaces of the teeth are filled in precisely the same way as those\\ndescribed under classes I and J. If the cavity be of con-\\nsiderable depth, non-cohesive gold may be used as part of Fig. 247.\\nthe filling, but in any event the bulk of the filling should\\nbe made of cohesive foil (Fig. 247).\\nClasses M and N. Mesio-incisal Disto-indsal. Cav-\\nities situated upon the approximal surfaces of the incisors\\nand becoming confluent with one on the incisal edge require guai filling.\\ngreat care in the matter of packing gold. It is often an\\nadvantage to have the cavity on the approximal surface unite with\\na natural or an artificially made one upon the incisal edge, because\\nmuch better anchorage can be obtained in such cavities. Cohesive\\ngold prepared in the form of ribbon or in pellets or cohesive cylin-\\nders, if loosely rolled, may be used. The better method is to fill\\nthe undercut at the cervical border of the cavity first, and then bring\\nthe gold toward the incisal edge as squarely as possible, keeping the\\nmass on a line with the labial and palatal walls. The\\noperator feels a sense of security when he is able to an-\\nchor such fillings in an undercut or retaining pit on the\\nincisal edge. In teeth with broad incisal edges there is\\nample opportunity to make a strong retaining hold, but\\nwhere the edge is narrow a lateral cut into the palatal Mesio-incisai _\\nfilling.\\nwall one-third back from the incisal edge affords a strong\\nand secure hold for that portion of the filling. Operations of this class\\nrequire great thoroughness in the packing of the gold. It should be\\nvery cohesive and when possible condensed with some form of mallet\\n(Fig. 248).\\nClass 0. Mesio-disto-incisal Where both approximal surfaces\\nand the incisal edge are united in one cavity, the better plan is to begin\\nthe filling at the undercut near the cervical border of the distal cavity,", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0296.jp2"}, "297": {"fulltext": "COMPOVND CAVITIES. 289\\nand build the gold squarely down as in classes M and N until the in-\\ncisal edge is reached, thence across the incisal edge, then fill the mesial\\ncavity after the same manner, uniting the three fillings at the mesio-\\nincisal corner. It is better to insert such fillings with an\\nelectric or a mechanical mallet, as there is always dan-\\nger, when packing across the incisal edge by hand pres-\\nsure, of pushing one or the other of the fillings out of\\nthe approximal surfaces.\\nIf no accident occurs in the packing of the gold a Mesio-disto-incisai\\nfilling thus made is very secure, for its form is like a\\nstaple and each portion helps to bind the others securely in the triple\\ncavity. Non-cohesive gold should form no part of such fillings (Fig.\\n249).\\nBicuspids and Molars.\\nClass P. Mesio-occlusal. The filling of this class of cavities offers\\nno serious difficulties provided sufficient space has previously been ob-\\ntained. As it is desirable to restore with gold the original outline of\\nthe tooth, sufficient space to do this in is a necessity, and the operator\\nwill soon learn that he can only accomplish good results in proportion\\nas he recognizes the importance of this preliminary.\\nThe cervical border is the vulnerable point for recurrence of decay,\\nand imperfection here in the matter of packing the gold means speedy\\nfailure of the filling, hence the importance of a perfect joint between\\ngold and tooth. This may be obtained by either non-cohesive or cohe-\\nsive gold if due care be exercised in its use. Where the cavity has not\\ngreat depth and the retaining grooves are also shalloAV, no better method\\nof laying the cervical foundation can be adopted than by the use of\\nWatts crystal gold or the Velvet cylinders, which possess great soft-\\nness and some slight cohesive properties. If the operator has had\\nsome experience in working non-cohesive foil he will do well to use a\\nmat of non-cohesive foil at this point, allowing the mat to extend some-\\nwhat beyond the cervical border of the cavity. This may be followed\\nby another mat or two, after which they should be malleted to place, a\\nfoot-shaped plugger point being used. The upper third or even one-\\nhalf of the cavity may be filled after this method. He should then\\nbegin the use of cohesive gold. The two kinds can be incorporated as\\npreviously described and the filling completed with gold which has been\\nfreshly annealed.\\nIt is always better to insert too much rather than too little gold, as\\nthe operator can shape the contour according to his fancy or to the\\nnecessities of the case.\\nThe occlusal portion of the filling should be thoroughly condensed,\\n19", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0297.jp2"}, "298": {"fulltext": "290\\nTHE OPERATION OF FILLING CAVITIES.\\nFig. 250.\\nas much depends upon this for holding the filling in place. Great hard-\\nness is also essential to prevent battering in the\\nact of mastication (Fig. 250).\\nClass Q. Disbo-occlusal cavities may be filled\\nin precisely the same manner as those situated\\nupon the mesio-occlusal surface. The difficulties\\nare slightly greater because these cavities are not\\nso accessible. Cavities of this description can be\\ngreatly simplified by the use of the matrix. This little device converts\\ncompound cavities into simple ones, and when used with care and judg-\\nment facilitates the operation of filling to a wonderful degree. It will\\nbe observed in the Jack matrices (as shown in Fig. 251) that provision\\nFig. 251.\\nApproximo-occlusal\\ncavities.\\nODDDDD\\nThe matrices of Dr. Louis Jack.\\nhas been made for contouring the filling. If this style be employed the\\noperator must study the outline which he desires his filling to assume\\nand select his matrix accordingly. He must have previously obtained\\nample space between the teeth for the placement of the matrix.\\nWhen put in place the matrix should be thoroughly fixed against the\\ntooth to be filled, with wedges of orange wood previously dipped in\\nFig 252.\\nLoop matrices.\\nmoderately thick sandarac varnish. This will keep the wedges from\\nslipping. A very good way of fixing the matrix is to pack between it\\nand the adjoining tooth some quick-setting oxyphosphate of zinc. If\\nthe part be thoroughly dry the cement will become adherent to the\\nmatrix and the adjoining tooth and the matrix will thus be made secure.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0298.jp2"}, "299": {"fulltext": "COMPOUND CAVITIES.\\n291\\nWhenever the matrix is to be employed it must be understood that an\\nimportant feature is absolute fixation of the device, otherwise the ope-\\nrator will suffer continual annoyance throughout the operation.\\nWhere there is sufficient space between the adjoining teeth for a\\nband matrix the operator will find great satisfaction in their use (they\\nFig. 253.\\nBrophy s band matrices.\\nare show^n in Figs. 253, 254), but as most teeth are smaller at the neck\\nthan at the occlusal surface, there is often difficulty in adjusting the\\nFig. 254.\\nc ,o\\nf\u00c2\u00a3\\\\\\npi\\nfZ\\\\\\nra\\nf^\\nm\\nN^ ^J. Vifc v **o^\\nI\\n\\\\kjj v*.^ v__y w*\\nGuilford s band matrices and clamps.\\nmatrix to that portion of the tooth a wedge used as previously described\\nw T ill often overcome this difficulty.\\nA modification of the band matrix has been devised by Dr. Guilford,\\nand is shown in Figs. 254, 255. It will be seen that space upon both\\nsides of the tooth to be filled is unnecessary, as the little clamp binds the\\nmatrix to the tooth. Another style of matrix, and one admirably\\nadapted to many cavities in the bicuspids and molars, has been intro-\\nduced by Dr. W. A. Woodward, and is shown in Fig. 256. It will be\\nseen that this matrix has two screws which are driven against the", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0299.jp2"}, "300": {"fulltext": "292\\nTHE OPERATION OF FILLING CAVITIES.\\nadjoining tooth and keep the matrix firmly in place and at the same\\ntime act as a separator. If the operator feels that he has insufficient\\nspace, as his filling progresses he can occasionally tighten the screws\\nand gradually gain space between the teeth, which is of value when he\\nis ready to dress down and polish his filling. Several sizes of these\\nshould be at hand to meet the exigencies of individual cases.\\nIt has been said that the matrix converts a compound cavity into a\\nsimple one. This is accomplished by making of metal a temporary\\nfourth wall to the cavity. It must be borne in mind, however, that\\nFig. 255.\\nExamples showing uses of matrices.\\nthe use of the matrix does not lessen the care which should at all times\\nbe exercised in the packing of the filling. Direct pressure against the\\ndisto-buccal and disto-lingual borders of the cavity cannot be as well\\nobtained when the matrix is used as when it is not, hence the importance\\nof having the matrix so adjusted that these walls may be accessible.\\nCavities of this variety seldom require retaining pits. The cavity is\\nsupposed to be of a retentive form. If the matrix has been made to\\nfit the cervical border of the cavity and is thoroughly wedged against\\nit, the filling may be started with mats of non-cohesive foil or with loosely\\nFig. 256.\\nrolled cylinders. Two, three, or even more may be pressed thoroughly\\nagainst the cervical wall and condensed with a hand mallet or with the\\nautomatic mallet. Similar pieces are then inserted and malleted to place\\nuntil the upper third of the cavity has been filled. Cohesive gold may\\nthen be substituted for the non-cohesive and each piece packed with\\nhand pressure or mallet force as preferred. The instruments shown in\\nFig. 257 are well adapted to fillings of this description.\\nAs there is sometimes difficulty in adjusting the matrix to the cer-\\nvical bordej^of the cavity, it is well at times to insert a cylinder or two", "height": "4608", "width": "2824", "jp2-path": "americantextboo00kirk_0300.jp2"}, "301": {"fulltext": "COMPOUND CAVITIES.\\n293\\nbefore putting the matrix in position, letting the ends of the cylinder\\nextend beyond the walls and into the space between the teeth. The\\nmatrix is then put in place and rests upon the protruding ends of the\\ncylinders. These are condensed against the cervical border and the\\noperation is completed as previously described. The introduction of the\\ncylinders as stated, previous to the adjustment of the matrix, contributes\\nlargely to the successful formation of a tight joint of the gold and the\\ncervical border. Or the same object may be accomplished with perhaps\\ngreater certainty by adjusting a band matrix and screwing it tightly\\ninto close contact with the tooth surfaces. When this is done there will\\nusually be found a slight space between the matrix and the tooth at the\\ncervical border, caused by the band standing away from the tooth at\\nthat margin. In filling this Cavity the first pieces of gold, preferably\\nloosely rolled cylinders or mats, are grasped singly by the foil tweezers\\nnear the end and passed endwise into the space between the matrix and\\nnmu urns\\nMatrix pluggers.\\nthe cervical margin of the cavity. The end projecting into the cavity\\nis then bent inward and over the cervical margin and pressed firmly\\ndown upon the cervical wall. Other pieces of gold are then similarly\\nintroduced and condensed. This forms the foundation of the filling,\\nafter which the operation is completed with cohesive foil as before de-\\nscribed. The advantages of this method are that the first pieces of\\ngold by being wedged between the matrix and the neck of the tooth\\nare immovably held, thus rendering the usual starting anchorages un-\\nnecessary. This method also gives positive assurance that the cervical\\nborder is perfectly filled. The same perfection of joint at the lateral\\nmargins of the filling may be attained where a band matrix of the Guil-\\nford type is employed by slightly loosening the set-screw of the matrix\\nclamp as the operation proceeds, so that the band may be moved from\\ncontact with the lateral margins of the cavity and the gold carried over\\nthem as was done at the cervical margin. Moreover, when excessive\\ncontour is desired it is easily accomplished by a gradual loosening of", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0301.jp2"}, "302": {"fulltext": "294 THE OPERATION OF FILLING CAVITIES.\\nthe clamp screw as the operation proceeds and the additional space is\\nneeded.\\nThe matrix is best suited to disto-occlusal cavities. It is sometimes\\nemployed upon mesio-occlusal cavities, but as a rule obstructs the light\\nand adds little to the convenience of the operator.\\nExperience has demonstrated that the only satisfactory method of\\nfilling cavities upon the approximal surfaces of the bicuspids and molars\\nis to restore by means of filling material, the original outline of the\\ntooth. This is termed restoration of contour. To do this success-\\nfully requires artistic sense and mechanical skill of a high order, and\\nan accurate knowledge of the topographical anatomy of the teeth. To\\nthe man who has these the operation is easy, but otherwise persistent\\neffort alone will enable him to acquire the ability. The inexperienced\\noperator will often do better if he confine himself in the beginning to\\nbut one kind of gold, and that of the cohesive variety. If this be done\\nhe should start the filling in a well-defined groove at the cervical border\\nof the cavity, and then add, piece by piece, well-annealed foil until the\\nfilling is completed. Such a procedure is of necessity slow, but excel-\\nlent operations can be made by this method. The beautiful and lasting\\noperations of Varney and Webb and others were made in this way.\\nClass R. Occluso-buccal cavities are usually confined to the lower\\nmolars. If they be shallow it is better to fill throughout with cohe-\\nsive gold. If, on the other hand, the cavity upon the occlusal surface\\nbe deep, non-cohesive gold may be used in part and then cohesive gold\\nused to fill the channel connecting the two cavities. Such fillings are\\nsubjected to great wear and should be solid (Fig. 258).\\nClass 8. Occluso-lingual. These cavities are nearly always con-\\nfined to the first and second upper molars, and as a rule are best filled\\nFig. 258. Fig. 259. Fig. 260.\\nOccluso-buccal tilling. Occluso-lingual filling. Mesio-occluso-distal filling.\\nwith cohesive gold. The channel running into the lingual aspect of\\nthe tooth is not often deep, and non-cohesive gold is contra-indicated\\n(Fig. 259).\\nClass T. Cavities upon the mesial and distal surfaces of the\\nbicuspids often become confluent with those upon the occlusal sur-\\nface, and it becomes necessary to fill them as one cavity. Such ope-", "height": "4612", "width": "2824", "jp2-path": "americantextboo00kirk_0302.jp2"}, "303": {"fulltext": "FILLING WITH TIN. 295\\nrations are simplified by the use of a matrix upon the distal surface.\\nA band matrix could be employed, but it obstructs the light somewhat\\nand the operator will more frequently confine himself to a matrix upon\\nbut one side of the tooth. The filling should be commenced at the\\ndisto-cervical border, and after inserting a few mats or cylinders of\\nnon-cohesive foil proceed as in cavities described under class Q\\n(Fig. 250).\\nIf these cavities be of considerable size the buccal and lingual walls\\nare weakened and there is danger of their being broken away in the act\\nof mastication. It is often well to truncate the cusps somewhat and\\nbuild the gold well across the occlusal surface, allowing the strain to\\ncome directly upon the gold instead of upon the tooth structure.\\nPilling with Tin.\\nIt is not definitely known when tin was first employed for filling\\ncarious teeth, but it has been used for at least a century and has found\\ngreat favor with many. Prior to the improvement in the formulas of\\ndental amalgams, tin was used more generally than at the present time.\\nTin possesses certain inherent characteristics which make it valuable\\nas a filling material. Among these are great malleability, non-conduc-\\ntivity, and it is thought by many to possess antiseptic properties. But\\nwhile it has desirable qualities it has also some undesirable ones, such\\nas softness, and when exposed to the secretions of the mouth it discolors,\\nwhich facts render it unfit for surfaces exposed to great wear in the\\nact of mastication and upon surfaces exposed to view. The discolora-\\ntion, however, is confined to the surface, and teeth filled with tin are not\\ndiscolored in consequence of its presence.\\nThere are various methods of preparing tin for dental purposes.\\nThat which has found greatest favor in the past is in the form of foil.\\nThe tin used should be chemically pure. An ingot of the metal is\\nrolled into ribbon and then beaten, after the same manner as gold foil,\\ninto sheets of the desired thickness. As a rule it is not beaten as thin\\nas the former. The foil best suited for most fillings is No. 10.\\nPure tin, like pure gold, is cohesive, and fillings of great solidity\\ncan be made if the operator will exercise care in packing it. The best\\nresults are obtained by taking a third of a leaf of No. 10 foil and roll-\\ning it into a loose rope, then cutting it into lengths of half an inch or\\nless and packing each piece with a view of making each part of the\\nfilling solid. Some prefer folding the sheet with a spatula after the\\nsame manner as gold foil, and then cutting into narrow tape. Equally\\ngood results are obtainable by either method.\\nA more rapid but less satisfactory manner of introducing the fillings\\nis to use the tin in the form of cylinders, not relying so much upon the", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0303.jp2"}, "304": {"fulltext": "296 THE OPERATION OF FILLING CAVITIES.\\ncohesive properties of the metal. The directions for using gold in the\\nform of cylinders will apply equally well for inserting tin foil.\\nFelt Tin. This form of tin was introduced by Dr. Slayton some\\nyears ago, and at one time found favor with many operators. Tin thus\\nprepared resembles coarse felt, and comes in sheets of various thick-\\nnesses, usually about that of billiard cloth. This is cut into squares\\nor strips of various widths and packed into the cavity after the same\\nmanner as tin foil. It appears to possess no advantages over ordinary\\nfoil prepared as above.\\nShredded Tin. This form of tin, as its name implies, presents a\\nshredded appearance, and it is said to contain a small percentage of\\nplatinum. It is quite cohesive, and works with a degree of softness\\nthat is pleasing to the operator. It is claimed for it that cohesive gold\\nfoil will adhere to it much more readily than to pure tin in the form of\\nfoil. If this claim be valid the advantages are apparent when the\\noperator desires for any reason to use the two metals in combination.\\nShavings of Tin. The cohesive property of tin is best illustrated\\nwhen it is used in the form of freshly cut shavings from a revolving\\ningot of the metal. Any operator can prepare his own shavings and\\nhave them fresh daily or hourly, if necessary, after the following\\nmethod Take an ordinary corundum wheel two inches in diameter\\nand one-half inch in thickness, such as is used in the laboratory. Make\\na mould of this in sand or marble dust, then melt in a crucible or ladle\\nenough pure tin to fill the mould. When it has cooled mount accurately\\nupon the mandrel of the laboratory lathe, and from it, with a sharp car-\\npenter s chisel, turn shavings of great tenuity. When freshly cut, and\\nbefore oxidation of the surface has taken place by exposure to the atmo-\\nsphere, it will be found that the tin coheres with the same readiness that\\npure gold does. Broken-down teeth can be built up by this method, or\\nby means of it surfaces may be contoured as with gold.\\nThe plugging instruments best adapted for tin filling are those hav-\\ning shallow but well-defined serrations and points not too broad. As\\nthe marginal surface is approached broader points and condensers\\nmay be used, and the surface should be well burnished. The ope-\\nrator must not lose sight of the fact that while tin possesses many\\ndesirable qualities and is easily manipulated, it lacks hardness and is\\nnot adapted to surfaces where great attrition occurs. Its chief value\\nis found in its use upon surfaces concealed from view and shielded\\nfrom wear, and in the temporary teeth, where its greatest value is\\nmanifest.\\nTin fillings should be finished with the same care as gold ones, and\\nthe same directions will apply in all particulars.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0304.jp2"}, "305": {"fulltext": "FINISHING FILLINGS.\\n297\\nFinishing Fillings.\\nMuch of the beauty and utility of a filling is imparted to it in the\\nfinishing. It is not enough that it be well made, it must also be well\\nfinished if the best results are to be attained.\\nAll fillings should contain rather more gold than it is intended shall\\nremain, and this for the purpose of dressing down to such lines as will\\nbe artistic and practical.\\nFillings that are not well condensed cannot be given a fine finish.\\nSolidity of the surface is an essential quality. After the last piece of\\ngold has been well condensed it is well to give the surface a thorough\\nburnishing for the purpose of getting a compact surface as well as to\\ninsure perfect contact with the margins of the cavity.\\nThe simple fillings upon the occlusal surface of the bicuspids and\\nmolars are best dressed down with small finishing burs, as shoAvn in\\nFig. 261. These are fine cut and leave\\nthe gold with a better surface than when\\ncavity burs are used for this purpose.\\nThe gold should be cut away until\\nthe margin of the cavity has been\\nreached and until all overlapping of\\ngold has been removed. The occlusion\\nof the tooth of the opposite jaw should\\nbe noted, and, if it occludes unduly with\\nthe filling, enough should be taken from the surface of the gold to pre-\\nvent it. When a uniform surface has been given to the gold, a suitable\\nFig. 262.\\nFig. 261.\\nPlug finishing burs.\\nWood polishing points.\\nwood point as shown in Fig. 262 should be mounted in an engine man-\\ndrel and dipped first in water and then in fine pumice powder and the\\nsurface nicely smoothed. A round-end burnisher may be used if the\\noperator desires a polished surface, although it adds nothing to either\\nthe beauty or the utility of the filling.\\nWhen fillings cover a larger portion of the occlusal surface the dress-\\ning down may be done with corundum points, which if kept wet will\\ncut more rapidly than burs and cause less heating. These are shown in\\nFig. 263, and are of many patterns and admirably adapted to all parts", "height": "4536", "width": "2764", "jp2-path": "americantextboo00kirk_0305.jp2"}, "306": {"fulltext": "298\\nTHE OPERATION OF FILLING CAVITIES.\\nof the filling. Those made of fine corundum and shellac, or corundum\\nand vulcanized rubber, are more desirable than the coarse ones, which\\nFig, 263.\\nCorundum points.\\nare liable to grind away the cavity margins because of the rapidity with\\nwhich they cut.\\nFig. 264.\\nFig. 265.\\nFelt polishing wheels.\\nFig. 266.\\nHindostan points.\\nFillings upon labial and buccal surfaces should be dressed down\\nwith fine corundum points or the Hindostan\\nstones shown in Fig. 264 until the outline of\\nthe cavity has been reached. Any overlap-\\nping of the gold upon these surfaces gives a\\nragged appearance to the filling and detracts\\nmuch from its beauty. Care should also be\\nexercised in giving the filling the same degree\\nof convexity that the tooth formerly had in\\nother words, the filling should accurately re-\\nstore the lost anatomical contour of the tooth.\\nWhen sufficient gold has been removed the\\nSurface should be nicely smoothed with re-\\nvolving wood points charged with pumice\\npowder and water, or a paste made of pumice\\nand glycerin, after which the final finish may\\nbe made with flour of pumice, chalk, or oxid\\nof tin, used by means of a revolving disk or\\nwheel of felt or soft rubber (Fig. 265). The\\nsoft rubber polishing cup of Dr. John B.\\nWood is a valuable aid in polishing the con-\\nvex surfaces of approximal fillings or those\\nupon the cervical portion of labial cavities.\\nIt is shown in Fig. 266. As fillings upon the\\nlabial surface are more or less conspicuous at best, it is better not to\\ngive them a burnished surface. The dead or satin-like finish which is\\nleft by the flour of pumice is usually preferred.\\nDr. Wood s polishing cup.", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0306.jp2"}, "307": {"fulltext": "FINISHING FILLINGS.\\n299\\nFillings upon approximal surfaces are more difficult to finish, and too\\ngreat care cannot be bestowed upon them. An operator is often judged\\nby the finish which he gives his approximal fillings, and justly so, as\\nno class of fillings requires a higher degree of skill in the finishing.\\nThere is of necessity more or less overlapping of the gold in the\\ninsertion of a filling, and the removal of all excess is as important as\\nany other part of the operation. For this purpose a great variety of\\ninstruments is supplied. Files and gold trimmers, as shown in Figs.\\nFig. 267.\\nIll\\nPlug finishing files.\\n267 and 268, are best adapted. The cervical border is one which\\nshould receive most careful attention. The gold should be filed and\\ndressed down until the finest excavator or probe will not catch when\\ndrawn from the cervix toward the cutting edge. In addition to the\\nFig. 268.\\nCurved finishing files.\\nfile and gold trimmer, strips of emery tape or sandpaper should be used\\nuntil all margins are well defined. The operator should have at hand\\na great variety of these strips, some of extreme thinness and of various\\ngrits, of emery, of silex, and of buckhorn.\\nWhen the filling has assumed the desired shape and all overlapping\\ngold has been removed, the final finish should be given with linen or", "height": "4536", "width": "2768", "jp2-path": "americantextboo00kirk_0307.jp2"}, "308": {"fulltext": "300\\nTHE OPERATION OF FILLING CAVITIES.\\ncotton tape charged with pumice of exceeding fineness. If there are\\nplaces where the tape cannot be made to reach, a soft-rubber wheel in\\nFig. 269.\\n8\\nApproxirnal trimmers.\\nthe handpiece of the engine and charged with the same powder may\\nbe used (Fig. 270).\\nFillings in the bicuspids and molars because of their inaccessible\\nposition are often most difficult to finish, and for this reason should\\nreceive unusual care. If a matrix has been used at the cervical border,\\nand has been made to fit the tooth perfectly at or near the gum, it\\nwill be found that the finishing process has been simplified in a great\\nmeasure, because there is less overlapping of the gold at this point.\\nFig. 270.\\nSoft-rubber disks.\\nThe pointed files, right and left, as shown in Fig. 268, are admirably\\nadapted to dressing away any overlapping of gold at the cervical border.\\nFig. 271.\\nSandpaper disks.\\nWith these and the trimmers shown in Fig. 269 the general outline\\nof the filling may be obtained, after which the emery and corundum\\ntape may be used and the filling polished after the same manner as", "height": "4580", "width": "2828", "jp2-path": "americantextboo00kirk_0308.jp2"}, "309": {"fulltext": "REPAIRING FILLINGS. 301\\ndescribed above. Disks of sandpaper and emery cloth and finer ones\\ncharged with cuttlefish powder (Fig. 271) are exceedingly useful in\\nshaping, and polishing the filling. Fig. 272 shows two forms of disk\\nmandrels which may be satisfactorily used in carrying disks.\\nFig. 272.\\nMorean-Maxfield disk mandrel.\\nMany approximal fillings in the bicuspids and molars extend to the\\nocclusal surface. When this is the case the operator should pay special\\nheed to the occlusion of the opposing teeth. If left too full the con-\\nstant touching of an opposing cusp may batter the filling, or, if not\\nsecurely anchored, dislodge it. Overlapping gold is the rock of offence,\\nand is the cause of many failures. A filling is not well finished until\\na delicate instrument can be passed from enamel surface to filling with-\\nout catching. When this can be done, and dental floss is not frayed at\\nthe cervical margin, the inference is justified that no gold has been left\\noverlapping.\\nRepairing Fillings.\\nFillings somewhat defective are often susceptible of repair. The\\ndefect may sometimes be apparent in the finishing at other times it\\nis the result of subsequent caries, and at still other times the result of a\\nfracture of the tooth enamel alone: the border of the filling:.\\nThe nature of the defect and the condition of the remaining filling\\nmust be taken into consideration before an effort to repair is undertaken.\\nWhen the defect is due to insufficient gold at any point in the filling\\nmore gold may be added. It is well to first cut out a portion of the\\nfilling, making a distinct cavity of retentive shape. Cohesive gold is\\nusually best suited to the purpose crystal gold often serves well in\\nthe repair of such defects.\\nIf the filling has been thoroughly condensed and the mass is solid\\nthere is little difficulty in adding more gold to it, provided the surface\\nbe clean. If it has been wetted with saliva, the surface of the gold\\nmust be made not only dry but clean. It is well to wipe it with a\\npellet of cotton or paper saturated with alcohol or ether, after which\\nthe filling should be scraped with a suitable instrument. If the fill-\\ning be of considerable size and well anchored, shallow retaining pits", "height": "4556", "width": "2768", "jp2-path": "americantextboo00kirk_0309.jp2"}, "310": {"fulltext": "302 THE OPERATION OF FILLING CAVITIES.\\nmay be drilled into it, which will make an additional hold for the\\ngold which is to be added. Defects which arise from subsequent caries\\nare perhaps more frequent in approximal surfaces at or near the cervical\\nmargin. These borders are vulnerable points for the recurrence of\\ncaries, and imperfect adaptation is not infrequently the determining\\ncause of the beginning of such decay.\\nTo eifect a successful repair in such localities ample space should be\\nobtained, especially so if the repair is to be made with gold.\\nIf the decay has not extended beneath the filling, and sufficient\\nspace has been obtained, there is no greater difficulty in making a suc-\\ncessful repair than in filling a simple cavity similarly located. If the\\noperator is skilled in the use of non-cohesive gold, he will do well to\\nprepare his foil in the form of narrow tape, and work it into the cavity\\nfold after fold, allowing the loops to extend somewhat above the walls\\nof the cavity. When the cavity has been completely filled the protru-\\nding folds may be well condensed and the filling finished in the usual\\nway or the repair may be made with cohesive gold, the first piece\\nhaving been made fast in a groove or retaining pit.\\nSuch repairs are often required in the bicuspids and molars, and\\nlarge fillings otherwise good are saved by a successful repair at the\\ncervix. The plastics are sometimes indicated in this class of cases,\\nprovided they be not so near the anterior part of the mouth as to be\\nunsightly. Gutta-percha often serves a good purpose here, but in some\\nmouths undergoes decomposition and is less reliable than gold. The\\noxyphosphates are contraindicated because of their liability to wash\\naway after a few months. Amalgams are more frequently used, and\\nnearly always serve well when thus employed but unfortunately the\\ncontact with gold insures discoloration, and an unsightly filling is the\\nresult. Whenever gold and amalgam are brought in contact in the\\nsame tooth, if the surface of each is exposed to the fluids of the mouth,\\nthe amalgam is almost sure to turn quite black. The discoloration of\\nthe surface of the alloy does not lessen its value as a preserver of the\\ntooth, but its unsightliness is often too great to be tolerated nevertheless,\\nutility enters so largely into the equation that the operator feels justified\\nin using the alloy, because with it he feels sure of making a better repair.\\nAfter the alloy has hardened it should be nicely dressed down and all\\noverlapping of the material at the gum margin removed, when it should\\nbe smoothed and polished with the same care that other fillings receive.\\nFracture of one or more of the cavity walls is a common accident,\\nand one which may be repaired if the filling has been securely anchored\\nin portions of the tooth not involved in the fracture. Such accidents\\nsometimes befall bicuspids and molars, especially the bicuspids, where\\nfillings have been inserted in each approximal surface, the two meeting", "height": "4580", "width": "2836", "jp2-path": "americantextboo00kirk_0310.jp2"}, "311": {"fulltext": "REPAIRING FILLINGS. 303\\nin the fissure upon the occlusal surface. The buccal wall is sometimes\\nthe one broken away, sometimes the lingual. In either case the ability\\nto successfully repair depends upon the stability of the approximal\\nfillings and the anchorage which can be obtained at the cervical wall\\nand in the exposed fillings. To restore with gold a buccal cusp or the\\nentire buccal surface of a bicuspid might necessitate a show of gold\\nwhich would be objectionable and a better plan would be to engraft a\\nporcelain facing or an entire porcelain crown whereas such a restora-\\ntion on the lingual surface would not be open to the same objections.\\nCohesive gold alone is indicated for repairs of this kind. Watts crystal\\ngold when used in cases of this description has been most satisfactory.\\nIf the fracture extends above the margin of the gum the operation\\nis much more difficult because of the danger from a flow of blood, and\\nthe additional difficulty of getting the rubber dam above the border\\nof the fractured surface. This may be accomplished by filling for a\\nfew weeks with gutta-percha, when there will be recession of the gum\\ncaused by the pressure of the gutta-percha upon it. When a similar\\nfracture occurs in a molar, if the fractured surface does not encroach\\nupon the pulp, and will admit of drilling retaining pits without danger\\nto the pulp, there is no difficulty in restoring the broken portion with\\ncohesive gold. Mack s screws are sometimes indicated in cases of this\\nkind, since strong anchorage can be secured in this way without much\\nloss of tooth substance.\\nFracture of the incisal edge of the anterior teeth is often a serious\\naccident, because of the difficulty of repair and the unsightly display\\nof gold when it has been accomplished.\\nLarge fillings situated upon the approximal surfaces of the incisors\\nbut not extending to the cutting edge, yet near enough to weaken the\\nenamel overhanging, are especially liable to need repairs. The corner\\nof the tooth breaks away, leaving the surface of the gold exposed, and\\nthe only hold the filling has is at the cervical border and the slight\\nundercut along the labial and lingual walls of the cavity. In order to\\nsecure retaining hold for additional gold the operator must be careful not\\nto displace the original filling. Sometimes a retaining pit can be made\\nlaterally into the sound dentin, or, by cutting a little channel through to\\nthe lingual surface and then deepening the channel at its extremity with\\na round bur, a secure anchorage may be had for the fresh gold.\\nGreat care should be exercised in packing the gold lest by inadvert-\\nence the instrument should slip and push the original filling from its\\nposition. Fractured surfaces should receive prompt attention, for if left\\nfor a period of time disintegration of the dentin will set in and the\\ncaries may extend beneath the filling and thus jeopardize or ruin the\\nmost thorough work.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0311.jp2"}, "312": {"fulltext": "304 THE OPERATION OF FILLING CAVITIES.\\nEroded Areas.\\nThere is a class of cavities which has not been specifically treated in\\nthe foregoing chapter, partly because the lesions under consideration\\ncannot, strictly speaking, be classed under the head of carious cavities,\\nand they are of such a peculiar formation that no definite rule can be\\nlaid down as to the best mode of treatment. If the eroded area be\\nnarrow and confined to the cervical border of the labial surface, and\\nin a mouth in which the teeth are not conspicuous, a filling of gold\\nmay be employed but not infrequently the eroded area extends over\\na considerable portion of the labial surface, and in such cases a filling\\nof gold would be so inharmonious that it should be avoided if possible.\\nHitherto the operator has had little choice of filling materials, and has\\noften been compelled, against his better judgment, to employ gold in\\nthese cases.\\nThe zinc phosphates have been almost as inharmonious in color as\\nthe gold, and their durability has been so variable that they could not\\nbe regarded as permanent in character. The same may be said of gutta-\\npercha.\\nHappily, the progress which is being made in porcelain inlay ivork\\npromises something both artistic and durable. It is quite possible, with\\nthe great variety of shades of porcelain now being furnished, to match\\nthe tint of the natural tooth, and if care be exercised in the selection of\\nshades and the contour given to the inlay these eroded areas may be\\ncovered and the tooth made to assume almost as natural an appearance\\nas before the disease had attacked the surface. (For a detailed descrip-\\ntion of porcelain inlays the reader is referred to Chapter XV.)", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0312.jp2"}, "313": {"fulltext": "CHAPTER XIII.\\nPLASTIC FILLING MATERIALS\u00e2\u0080\u0094 THEIR PROPERTIES, USES,\\nAND MANIPULATION.\\nBy Henry H. Burchard, M. D., D. D. S.\\nThe materials included in the heading of this chapter are (1)\\nAmalgam (2) Gutta-percha and its preparations (3) The basic zinc\\ncements.\\nHistory. The introduction of the first member of the group was\\nnot prompted by any specific merit that it had been demonstrated to\\npossess, but was due solely to its properties of easy introduction, com-\\nparatively perfect sealing and prompt hardening, qualities which appar-\\nently recommended its wide and general use to those not possessing the\\nrequisite degree of skill for the successful manipulation of gold foil.\\nApplied upon a basis of glaring empiricism, with an absence of\\ntechnical skill, the material received the prompt and sustained con-\\ndemnation which its abuse had warranted. The steps and phases of\\nthis opposition of the trained and skilled against untrained and un-\\nskilled operators may be read in the dental journals of from 1846 to\\n1878 and even after. It was commonly known as the amalgam war.\\nThe first dental amalgam was that of Taveau, called Silver Paste.\\nIt was made of filings of coin silver (silver 9, copper 1), combined\\nwith sufficient mercury to make a plastic mass. It was presumably this\\nalloy which was introduced into America by two charlatans named\\nCrawcour, under the glittering title of Royal Mineral Succedaneum.\\nThe discovery of the nature of the paste followed soon after its intro-\\nduction, which was clearly prompted by the motives above stated.\\nThereupon followed a persistent and virulent attack upon the material\\nand all who used it. Upon less than the merest shreds of evidence\\nalleged cases of salivation and mercurial necrosis were recorded as due\\nto the use of amalgam.\\nThat amalgam was still employed by the practitioners of France is\\nevidenced by the presentation in 1849 of a formula for an amalgam\\nalloy of pure tin and cadmium by Dr. Thomas Evans, an American\\ndentist practising in Paris. An amalgam made from this alloy was\\nfound to shrink, and also to stain the dentin of teeth into whichlit had\\nbeen introduced, owing to the formation of cadmium sulfid. It is note-\\n20 305", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0313.jp2"}, "314": {"fulltext": "306 PLASTIC FILLING MATERIALS.\\nworthy that Dr. Evans himself was the first to discover and make\\npublic the deficiencies of his amalgam.\\nIn America amalgam remained under a ban until Dr. Elisha Towns-\\nend of Philadelphia, a practitioner of such great skill as to be safe from\\nany imputation of lack of manipulative ability, introduced in 1855 an\\nalloy of 44^ silver, 55 tin. The amalgam of this alloy received an\\nendorsement and application based more upon the eminence of its\\nauthor than upon the results of actual clinical tests, and a reaction\\noccurred which brought amalgam again under general condemnation.\\nWhat was known as the new-departure corps had its birth shortly\\nafter this time. This was composed of a limited number of practi-\\ntioners and metallurgists, who were impressed by the fact that gold as a\\nfilling material was not the panacea of dental caries, and that by inves-\\ntigation alone could the proper place of amalgam be found in the dental\\narmamentarium. It is due to this group of investigators to state that\\nthe history of the rational employment of plastics is the history of the\\nnew-departure corps. It was undoubtedly due to it that plastics\\nhave come to be regarded as substances having definite physical and\\nchemical properties which fit them for application as restorative and\\ntherapeutic agents for the relief of clearly defined physical and patho-\\nlogical states. As the properties of these agents become better under-\\nstood, their employment more closely follows what is known as rational\\ntherapeutics.\\nThe use of any or of all of these several materials is founded so\\nentirely upon their individual properties that a discussion of these\\nproperties must precede and govern that of their methods of manipula-\\ntion.\\nNature and Properties of Amalgam.\\nAn amalgam is a combination of one or more metals with mercury it\\nis therefore any alloy into which mercury enters as a constituent. The\\nword amalgam (Fr. amalgame) is derived from Gr. dpa, together, yajuecu,\\nI marry or from d/ia and /m^ay/jta, from tmXdoaco, I soften because\\nof the softness and fusibility which mercury confers upon alloys.\\nIt is to be understood that amalgams are classified as alloys, and may\\nbe therefore members of any of Matthiesseir s groups as follows A chemi-\\ncal compound in which the affinities are exactly satisfied one in which\\nthere is unstable chemical equilibrium a sub-chemical compound, or\\na mechanical mixture although this latter is rare, as mercury exhibits\\nsome degree of affinity for all metals.\\nThere are two possible ways in which mercury brings about the\\nsolution of other metals First, by a chemical affinity for the metals\\nsecond, by lowering the melting-point of the solid metal, forming an", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0314.jp2"}, "315": {"fulltext": "NATURE AND PROPERTIES OF AMALGAM. 307\\nalloy whose melting-point is higher than that of a mean of its constitu-\\nents. The former is the explanation more in accord with the observed\\nphenomena relative to the combination.\\nPhysical Properties of Amalgams. As a class amalgams have defi-\\nnite physical properties. First, that of hardening from a previous\\nplastic condition; and nearly all of them for some time subsequent to\\napparent hardening undergo change of volume and of form. The\\nchange of volume may be either contraction or expansion.\\nContraction and Expansion. In contraction the mass tends to\\nassume the form shown in Fig. 273.\\nIt has been shown by Dr. Black 1 that FlG 273\\nthe extent of this contraction is due to\\nseveral factors\\n1. To the composition of the pri-\\nmary alloy. All other things being\\nequal, an alloy of 65 per cent, silver,\\n35 per cent, tin, represents about the\\nfixed point where there is a minimum _. ~L\\nt^ v. Diagram of amalgam shrinkage.\\nof shrinkage. As a class, alloys con-\\ntaining less than 65 per cent, silver make amalgams which contract\\nthose containing more than 65 per cent, silver make expanding\\namalgams.\\n2. To the amount of mercury used in amalgamation. There appears to\\nbe a definite percentage of mercury which produces the greatest strength\\nof an amalgam mass moreover, the percentage which produces the\\nmaximum strength increases the shrinkage of the shrinking alloys and\\nincreases the expansion of the expanding alloys. Surplus mercury in\\nthe amalgam mass can reduce neither the expansion nor contraction\\nof the amalgam mass. While an excess or deficiency of mercury in-\\ncreases the shrinkage or expansion of an amalgam (according as the\\npercentage of silver is 65 or 65 these volume changes cannot be\\novercome by the percentage of mercury. An excess or deficiency of\\nmercury weakens an amalgam. It would appear that the conditions\\nwhich bring about the most perfect union of the metals produce the\\ngreatest changes of bulk in those alloys in which changes of bulk occur.\\nAn alloy the amalgam of which neither shrinks nor expands cannot be\\nmade to do so by changes in the amount of mercury employed.\\n3. A strong controlling factor has been found to be the evenness\\nof distribution of mercury and alloy throughout the amalgam mass.\\nAn increase of the ratio of silver above 70 per cent, is followed by an\\nenormous expansion of the hardening mass. It had always been noted\\nthat the amalgam made of a coin-silver alloy bulged from the walls of\\n1 Dental Cosmos, 1895, vol. xxvii. p. 637.", "height": "4556", "width": "2784", "jp2-path": "americantextboo00kirk_0315.jp2"}, "316": {"fulltext": "308 PLASTIC FILLING MATERIALS.\\na cavity inclosing it. This alloy contains, as stated, 90 per cent, of sil-\\nver. The appearance of an expanded amalgam is similar to that of ice\\nat the mouth of an iron tube in which the water has been frozen.\\nCopper amalgam is the only alloy tested by Dr. Black which under-\\nwent no change of form in hardening.\\nFlow of Amalgam. A property attributed to certain amalgams,\\nthat of spheroiding, has been shown by Dr. Black to be without exist-\\nence. The bulging of amalgams from the orifices of cavities was held\\nto be due to the tendency of the mass to assume a spheroidal form, hence\\nthe term spheroiding. Tests showed the appearance to be delusive, the\\nphenomenon being due to expansion and not to a spheroidal tendency.\\nIn addition to the properties of contraction and expansion the same\\ninvestigator has discovered the property, hitherto unsuspected in amal-\\ngams, that of flow. The property of flow i. e. change of mass form, from\\nmolecular motion under stress\u00e2\u0080\u0094 had been observed in the majority of\\nmetals, but as found in amalgams it has a unique expression. Instead\\nof being limited to a definite degree, proportioned by the stress applied,\\nit has been found that amalgams yield repeatedly to the same amount of\\nstress when applied at intervals, as in mastication, or yield continuously\\nwhen the stress is constant. The process appears to be without limita-\\ntions. It is at zero in copper amalgams next less in amount with alloys\\ncontaining 55-60 per cent, of silver with 5 per cent, copper and the\\nremainder tin. It will be readily seen that this property exercises a\\ngreat influence upon the integrity and adaptation of an amalgam filling.\\nThe notes quoted from Dr. Black were compiled from studies made\\nof amalgams whose exact chemical composition had not been actually\\ntested by the investigator. Later experiments made with alloys pre-\\npared with the utmost care and exactitude by the investigator himself,\\ngave widely different results (particularly as to the effect of adding a\\nthird or fourth metal to the basal alloy) in the direction of both flow\\nand shrinkage. The first series of experiments which appeared to show\\nan enormous increase of shrinkage and flow together with a lessening of\\nedge strength, by the addition of a third or fourth metal (except copper,\\nwhich the latest experiments still show to lessen flow and increase\\nrigidity) were not confirmed when Dr. Black experimented with alloys\\nmade by himself, and an additional and unsuspected factor was taken\\ninto consideration, viz. the influence of heat upon the alloy.\\nIt has been noted by Dr. J. Foster Flagg 2 that alloys which were\\nfreshly cut possessed working properties different from the same alloys\\nwhen old cut, or when aged. Dr. Black s observations appeared\\nto confirm this, and his later experiments were directed toward deter-\\nmining the cause underlying the change. Motion, which was said to\\n1 Dental Cosmos, December, 1896. 2 Plastics and Plastic Fillings.", "height": "4612", "width": "2832", "jp2-path": "americantextboo00kirk_0316.jp2"}, "317": {"fulltext": "NATURE AND PROPERTIES OF AMALGAM.\\n309\\nbring about the change, was found to have no influence. After exhaus-\\ntive and conclusive experiments it was ascertained that the change was\\ndue to a molecular alteration of the cut alloy, through a process of an-\\nnealing or tempering i. e. heat was the agent producing the change.\\nThe degrees of heat applied ranged from 130\u00c2\u00b0 to 212\u00c2\u00b0 F.\\nIt was found that the amount of time during which an alloy was\\nsubjected to the action of heat governed the extent of tempering for\\nexample, alloy subjected to a temperature of 130\u00c2\u00b0 for a given period,\\nhad the amount of amalgam expansion reduced a given amount; if\\nthe heat were maintained for a longer period the expansion was corre-\\nspondingly decreased. Each formula has its zero point beyond which\\ntempering has no effect.\\nIn general terms, it was found that alloys in amalgams which\\nexpanded in hardening had the extent of expansion reduced by anneal-\\ning those which contracted had the contraction increased.\\nAlloys which were without alteration of volume unannealed, shrank\\nwhen annealed.\\nThe following tables will show the extent of change produced by\\nannealing. It will be noted that the alloy of 72.5 silver, 27.5 tin, ex-\\nhibits the minimum contraction after annealing. It will also be observed\\nthat less mercury is required to effect amalgamation in the annealed\\nalloy. 1 Amalgams made from annealed alloys have both their flow and\\ncrushing stress slightly increased.\\nI. Exhibit of Unmodified Silver-Tin Alloys. 2\\nFormula.\\nHow prepared.\\nPer cent, of\\nmercury.\\nShrinkage.\\nExpansion.\\nFlow.\\nCrushing\\nstress.\\nSilver.\\nTin.\\n40\\n60\\nFresh -cut.\\n45.78\\n6\\n7\\n40.15\\n178\\n40\\n60\\nAnnealed.\\n34.14\\n9\\n3\\n44.60\\n186\\n45\\n55\\nFresh-cut.\\n49.52\\n4\\n8\\n25.46\\n188\\n45\\n55\\nAnnealed.\\n32.13\\n11\\n1\\n28.57\\n222\\n50\\n50\\nFresh-cut.\\n51.18\\n2\\n2\\n22.16\\n232\\n50\\n50\\nAnnealed.\\n37.58\\n17\\n1\\n21.03\\n245\\n55\\n45\\nFresh-cut.\\n51.62\\n2\\n2\\n19.66\\n245\\n55\\n45\\nAnnealed.\\n40.11\\n18\\n17.53\\n276\\n60\\n40\\nFresh-cut.\\n52.00\\n1\\n9.06\\n239\\n60\\n40\\nAnnealed.\\n39.80\\n17\\n14.10\\n297\\n65\\n35\\nFresh-cut.\\n52.00\\n1\\n3.67\\n290\\n65\\n35\\nAnnealed.\\n33.00\\n10\\n5.00\\n335\\n70\\n30\\nFresh-cut.\\n55.00\\n14\\n3.45\\n316\\n70\\n30\\nAnnealed.\\n40.00\\n7\\n4.67\\n375\\n72.5\\n27.5\\nFresh-cut.\\n55.00\\n42\\n3.92\\n275\\n72.5\\n27.5\\nAnnealed.\\n45.00\\n3\\n3.76\\n362\\n75\\n25\\nFresh -cut.\\n55.00\\n60\\n5.64\\n258\\n75\\n25\\nAnnealed.\\n50.00\\n6\\n5.40\\n300\\n2 For a full exhibit of this stupendous work of Dr. Black s, the reader is referred\\nto his contributions in the Dental Cosmos for 1895 and 1896.\\n2 Black, Dental Cosmos, 1896, p. 982.", "height": "4556", "width": "2768", "jp2-path": "americantextboo00kirk_0317.jp2"}, "318": {"fulltext": "310\\nPLASTIC FILLING MATERIALS.\\nII\\nExhibit of Modified Silver- Tin\\nAlloys. 1\\nFormula.\\nHow pre-\\npared.\\nFresh-cut.\\nPer cent,\\nofmercury.\\nShrinkage.\\nExpansion.\\nFlow.\\nCrushing\\nstress.\\nModifying\\nmetal.\\nSilver.\\nTin.\\n65\\n35\\n52.33\\n1\\n3.67\\n290\\n65\\n35\\nAnnealed.\\n33.00\\n10\\n5.00\\n335\\n66.75\\n33.25\\nFresh-cut.\\n51.52\\n4\\n3.35\\n329\\n66.75\\n33.25\\nAnnealed.\\n33.53\\n7\\n5.06\\n380\\nGold 5.\\n61.75\\n33.25\\nFresh -cut.\\n47.56\\n1\\n4.62\\n330\\nGold 5.\\n61.75\\n33.25\\nAnnealed.\\n30.35\\n7\\n6.07\\n395\\nPlatinum 5.\\n61.75\\n33.25\\nFresh-cut.\\n51.87\\n9\\n9.68\\n273\\nPlatinum 5.\\n61.75\\n33.25\\nAnnealed.\\n37.33\\n7\\n8.20\\n352\\nCopper 5.\\n61.75\\n33.25\\nFresh-cut.\\n53.65\\n23\\n2.38\\n343\\nCopper 5.\\n61.75\\n33.25\\nAnnealed.\\n35.60\\n5\\n3.50\\n416\\nZinc 5.\\n61.75\\n33.25\\nFresh-cut.\\n56.65\\n68\\n1.83\\n290\\nZinc 5.\\n61.75\\n33.25\\nAnnealed.\\n40.65\\n9\\n2.07\\n345\\nBismuth 5.\\n61.75\\n33.25\\nFresh-cut.\\n46.26\\n4.78\\n288\\nBismuth 5.\\n61.75\\n33.25\\nAnnealed.\\n23.67\\n6\\n5.58\\n308\\nCadmium 5.\\n61.75\\n33.25\\nFresh-cut.\\n57.57\\n100\\n6.40\\n225\\nCadmium 5.\\n61.75\\n33.25\\nAnnealed.\\n47.25\\n5\\n3.54\\n290\\nLead 5.\\n61.75\\n33.25\\nFresh-cut.\\n44.17\\n1\\n4.88\\n290\\nLead 5.\\n61.75\\n33.25\\nAnnealed.\\n32.76\\n10\\n7.18\\n276\\nAluminum 5.\\n61.75\\n33.25\\nFresh-cut.\\n65.00\\n445\\nAluminum 1.\\n64.5\\n34.5\\nFresh-cut.\\n46.98\\n166\\n12.60\\n198\\nAluminum 1.\\n64.5\\n34.5\\nAnnealed.\\n38.26\\n48\\n17.90\\n213\\nEdge Strength. What is termed the edge strength of an amal-\\ngam is the degree of resistance an edge or angle of an amalgam mass\\noffers to force which tends to fracture it.\\nAmalgams have heretofore been regarded as rigid crystalline masses,\\nutterly devoid of malleability. The discovery of the existence of flow\\nat once modifies all previous conceptions and data regarding edge\\nstrength, for it is evident that a corner or angle might not fracture and\\nyet might flow under the stress of the impact of mastication, whereupon\\nedge strength might be said to be great, and in reality be but slight.\\nIn view of the existence of the property of flow, edge strength must be\\nmeasured as rigidity, the antithesis of flow, and a high crushing stress.\\nIt has been shown that contraction or expansion, and flow, are the\\ninfluences which would disturb the maintenance of size and form of\\nan amalgam filling therefore, a minimum of shrinkage and flow are\\nthe primary considerations in a satisfactory dental amalgam.\\nColor. One of the serious drawbacks to the wide employment of\\namalgam has been its objectionable color, both in its original state and\\nfurthermore when it has suffered discoloration through the formation of\\nox ids or sulfids upon its surface. The silvery white of amalgam in its\\nmost acceptable condition is not so harmonious a color as the yellow of\\ngold, which fact has led first to the restriction of the use of amalgams\\nto such spaces as are not readily visible, where its original and subse-\\nquently its altered color could not be a strong objection and, next,\\n1 Black, Dental Cosmos, 1896, p. 987.", "height": "4580", "width": "2852", "jp2-path": "americantextboo00kirk_0318.jp2"}, "319": {"fulltext": "NATURE AND PROPERTIES OF AMALGAM.\\n311\\nhas prompted a modification of the silver-tin formulae with the object\\nof maintaining their original color.\\nThe discolorations are not alone upon the external surfaces of fill-\\nings, but frequently (and most frequently in improperly prepared and\\nfilled cavities) the discoloration affects the dentinal walls bounding the\\ncavity (see Fig. 274).\\nFig. 274.\\nStaining of tooth structure with amalgam (Bodecker) e, enamel D, D, dentin B, border of cav-\\nity s, solidified dentin along the border of the cavity k, reticulum brought forth by the\\namalgam, (x 500.)\\nAs shown in the illustration the discoloration may be deep. This\\ndanger is increased by leakage, when putrefaction of the protoplasmic\\ncontents of the dentinal tubuli or decomposing albuminous substances\\ngenerate H 2 S, and metallic sulfids are formed in marked quantities.", "height": "4552", "width": "2764", "jp2-path": "americantextboo00kirk_0319.jp2"}, "320": {"fulltext": "312 PLASTIC FILLING MATERIALS.\\nThis danger of dentinal discoloration is guarded against by interposing\\na barrier between the cavity walls and the amalgam prior to the inser-\\ntion of the latter. The influence of individual metals upon color will\\nbe discussed later.\\nThermal and Chemical Relations. As a conductor of thermal in-\\nfluence, amalgam is midway between gold and the basic zinc cements.\\nAs to the actual effects upon the vital tissues of dentin, it has\\nnever been demonstrated that amalgam exercises any specific influence,\\nexcept that cadmium appears to cause, through the cadmium sulfid\\nformed, a degenerative influence (Flagg), and copper has antiseptic\\nproperties (Miller, Fletcher).\\nChemically the dental amalgams are, to all intents and purposes,\\ninsoluble in the fluids of the mouth, the common solvent found in the\\noral cavity, lactic acid, affecting them but little.\\nClassification of Amalgams. Amalgams are divided into binary,\\nternary, quaternary, and so on, according to the number of constituent\\nmetals. The only binary amalgams employed in dentistry are those of\\ncopper and of palladium.\\nBinary Amalgams. Copper amalgam is made by adding freshly\\nprecipitated and washed metallic copper to an excess of mercury when\\nsolution is complete the surplus mercury is expressed through chamois.\\nThe plastic residuum is then packed into moulds to make small tablets\\nof the usual form in which it is dispensed.\\nA better method, which yields a product of greater purity, is to pre-\\ncipitate the copper directly into the mercury by electrolytic process.\\nThis may be done conveniently by pouring a quantity of mercury into\\na suitable glass vessel a small battery jar, for example and suspend-\\ning a thick plate of copper, by means of a wooden support, some dis-\\ntance above the surface of the mercury. A saturated solution of\\ncupric sulfate is then poured into the jar until the copper plate is com-\\npletely submerged. The cathode pole of a battery or other source of\\nelectrical current is then connected with the layer of mercury, and the\\nanode with the copper plate. All that portion of the cathode electrode\\nin contact with the cupric sulfate solution should be insulated with gutta-\\npercha, and only the point which is in contact with the mercury left\\nexposed. The passage of the current causes solution of the copper\\nfrom the anode and deposits it in the mercury continuously as long as\\nthe foregoing conditions are maintained. The precipitation should be\\ncontinued until the mercury is saturated, which will be evidenced by\\nthe appearance of the characteristic red color of the excess of copper at\\nthe cathode pole. When the saturation point has been fully reached\\nthe mass should be washed, first in dilute hydrochloric acid and then in\\nwater, dried and compressed as is usual with this amalgam when pre-", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0320.jp2"}, "321": {"fulltext": "NATURE AND PROPERTIES OF AMALGAM. 313\\npared by the ordinary processes. This method was suggested to the\\nwriter by Dr. E. C. Kirk.\\nIn its typical form and condition, copper amalgam, when made\\nplastic by heat, may be packed into matrices, such as cavities in\\nteeth, where it sets quickly, undergoes no change of volume or form,\\nand is devoid of flow. Therefore a cavity which has been sealed by\\nit remains sealed. Upon its outer surface a coating of black sulfid\\nquickly forms, which remains but does not penetrate the tooth struc-\\nture. The dentinal walls are commonly stained green through the\\nabsorption of the metallic salts.\\nIn improperly prepared specimens there is not a perfect chemical\\nunion between the metallic mercury and the copper. The presence in a\\nfilling mass of oxids of either of these metals establishes local electrolytic\\nconditions which prevent the formation of the black sulfid coating and\\nbring about the gradual dissolution of the amalgam mass. To recapitu-\\nlate Copper amalgam is physically unchangeable as a filling material\\nit brings about very offensive discoloration both of the dentin and of\\nits own surface it is antiseptic.\\nThe second binary amalgam is that of palladium. Palladium is\\nprecipitated from a solution of its chlorid by iron or zinc, washed in\\nnitric acid, and dried. To the precipitated metal, mercury is added,\\nthe combination being attended by the evolution of much heat (i. e. is\\nan active chemical union). If an excess of mercury has not been used\\nthe amalgam sets quickly, does not alter in form, 1 and becomes black\\nupon the surface, 2 but does not discolor the dentin. The addition of\\nan excess of mercury retards the setting, and produces an inferior filling.\\nTernary Amalgams. The base of all ternary amalgams is the\\nalloy of silver and tin. The first of these was the alloy of Townsend,\\n44^ per cent, silver, 55-j per cent. tin. From this point the investi-\\ngations and experiments radiated it being found after many years of\\nclinical testing that those alloys containing more than 50 per cent, of\\nsilver gave the best results.\\nThe formula given by Dr. J. Foster Flagg as affording the most\\nstable alloy for amalgam 60 silver, 35 tin, and 5 copper Avas found\\nby Dr. Black to be that giving the highest degrees of resistance to\\nchange of form, to flow, and to crushing. In view of Dr. Black s\\nresearches into the effects of annealing alloys it is evident that the\\nternary amalgam of the future will have a composition closely approxi-\\nmating 72.5 per cent, silver, 27.5 per cent. tin.\\nThe binary alloys of tin and silver form the basis of all of the\\nquaternary amalgams used in dentistry.\\n1 Tomes, Trans. Odontological Society of Great Britain, 1872.\\n2 Bogue, Dental Cosmos, 1884.", "height": "4544", "width": "2776", "jp2-path": "americantextboo00kirk_0321.jp2"}, "322": {"fulltext": "314 PLASTIC FILLING MATERIALS.\\nQuaternary Amalgams. The metal additional to the basal alloy\\nis added for the purpose of modifying the color or increasing the edge\\nstrength of the amalgam. The addition of copper 5 per cent, to an\\nalloy containing over 60 per cent, silver increases the crushing stress\\nand lessens both flow and contraction. The alloy is white when fresh,\\nbut in the presence of sulfur compounds discolors.\\nThe addition of gold (5 per cent.), as clinical records testify, aids in\\nmaintaining the color of the filling. It lessens shrinkage slightly (com-\\npare this and following statements with table No. II.), and appears to\\nhave little or no influence upon flow and crushing stress. The addition\\nof platinum causes dark fillings and notably increases the flow the\\nsetting is slowed.\\nThe addition of zinc increases rigidity the amalgams expand for\\nlong periods after apparent hardening the crushing stress is moderately\\nhigh a direct contradiction of statements of several previous ob-\\nservers. 1\\nAdditions of bismuth, cadmium, lead and aluminum were made to\\nthe basal alloy, but all of them exhibited properties which exclude\\nthem from introduction into dental amalgam.\\nDr. Black 2 states that alloys containing 5 per cent, of aluminum\\nhave their setting attended by the evolution of much heat an enormous\\nexpansion of the mass occurs the instruments used in packing are oxi-\\ndized, and a distinct crackling of gas-disengagement is heard. The\\nformation of aluminum amalgam is characterized by an exhibition of\\nthe affinity of aluminum for oxygen. Aluminum oxid is doubtless\\nformed, which increases the volume of the amalgam mass.\\nWashing of Amalgams.- Alloys which have been cut for some\\ntime, and mercury the purity of which is questionable, are found to be\\ncoated with oxids of the metals in the case of mercury, with the oxids\\nof contaminating metals. The advisability of washing the amalgam\\nmass in some solvent which will remove the oxids is a mooted question.\\nIt has been stated that the washing of an amalgam mass increases its\\nshrinkage (Flagg). On the other hand it has been observed that\\nwashed amalgams retain their color better. It is difficult to see how\\nthe washing could affect the integrity of the set mass unless oxidizing\\nsubstances were left in it and this is clearly contraindicated by the\\nmaintenance of color in washed amalgam. The writer prefers wash-\\ning the plastic mass in chloroform prior to expressing the surplus of\\nmercury.\\n1 It is to be recalled in this connection that Dr. Black s measurements are made with\\ninstruments of unequalled accuracy, those of previous observers with comparatively crude\\ninstruments.\\n2 Private communication.", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0322.jp2"}, "323": {"fulltext": "USE OF AMALGAM. 315\\nUse of Amalgam.\\nIt is to be understood that amalgam is to be employed only in those\\nconditions and situations which clearly indicate it as the proper mate-\\nrial. As a general rule, it is excluded from the ten anterior teeth of\\neach jaw, although this rule is open to exceptions. Its anterior limit\\nof application is usually regarded as the distal surface of the first bicus-\\npid. Its more general employment has been greatly reduced in many\\nplaces since the introduction of what are known as combination fillings\\n(see Chapter XIV.), and by improvement in the forms and character of\\nartificial crowns.\\nThe first class of cavities to which amalgam is applied are those\\nwhich extend beneath the gum margin the second, buccal cavities the\\nthird, compound cavities the fourth, approximal cavities the fifth,\\ncavities upon the masticating faces of the teeth. These are the classes\\nin which gold is most difficult of introduction and of proper shaping\\nand finishing, in the order named. Amalgam should rarely or never be\\npacked against dentinal or enamel walls without the interposition of a\\nlayer which will prevent either the discoloration of the dentin or the\\nbluish appearance noted when amalgam underlies enamel.\\nThe shaping of cavities for the reception of amalgam fillings (see\\nChapter VIII.) should be done with such care as will give assurance\\nof the permanent retention of the filling and the perfect sterilization of\\nthe dentin before and during its introduction.\\nThe separation of the teeth, removal of gum overhanging cavity\\nmargins, and breaking down of frail enamel walls by means of chisels,\\nprecede the filling.\\nThe rubber dam is to be adjusted where and when possible, with such\\ncare that an exclusion of the fluids of the mouth is assured during the\\nshaping, sterilizing, and filling of the cavity. As Dr. Black has shown, 1\\nmuch of the permanency of form of an amalgam mass depends upon\\nthe even distribution of the constituents it is evident that every aid to\\nthis end should be utilized, an important one being that the mass should\\nbe packed into a cavity having but one orifice, that for the introduction\\nof the filling.\\nWith the data relative to dental amalgams which have been given,\\nit is evident that a dental amalgam mass is by no means simple, but is\\na very complex body. If sufficient mercury has been used to effect\\nsolution of the alloy particles the mass will consist, first, of a quantity\\nof a chemical amalgam i. e. one in which the metals are united in\\natomic ratios this being surrounded by one or more other distinct\\n1 Dental Cosmos, 1895, vol. xxxvii. p. 553.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0323.jp2"}, "324": {"fulltext": "316\\nPLASTIC FILLING MATERIALS.\\namalgams, each having its own time of setting and rate of contraction.\\nIf only enough mercury has been used to make a creaky mass the sur-\\nfaces of each alloy particle are covered by an amalgam of indefinite\\ncomposition which acts as a cement binding the particles together. In\\nthis line the same experimenter has shown that mixing the alloy and\\nmercury in a mortar by means of a pestle, wringing the surplus mer-\\ncurial solvent from the mass by means of heavy pliers, and packing the\\nfilling with steel burnishers are all influences which lessen the strength\\nof the completed filling.\\nThe conditions are now a prepared and sterilized cavity any miss-\\ning wall required to give four sides has been replaced by a properly\\nadjusted matrix (see Figs. 255, 256, Chapter XII.).\\nFig. 275.\\nDr. Herbst s matrix.\\nMatrices. Matrices may be readily and quickly formed by cut-\\nting strips from a sheet of very thin steel which has been annealed\\nFig. 276.\\nFig. 277.\\nHerbst pliers.\\nand polished. By means of contouring pliers the matrix is given\\nthe correct contour, then wedged or tied into place. They must", "height": "4580", "width": "2788", "jp2-path": "americantextboo00kirk_0324.jp2"}, "325": {"fulltext": "USE OF AMALGAM.\\n317\\nbe so adjusted that they are immovably held during the filling ope-\\nration.\\nA rapid method of forming a matrix is that of Dr. AVilhelm Herbst\\nA strip of German silver No. 33, wide enough to extend from the\\ncervical margin of a cavity to its mouth, and long enough to more than\\nembrace the tooth, is passed around the tooth (see Fig. 275) the strip\\nis caught near its extremities by a pair of Herbst pliers (Figs. 276,\\n277) and drawn taut; the pliers pinch the metal into close adaptation\\nto the tooth walls. Held by the pliers the matrix is withdrawn, the\\nline of junction touched with zinc chlorid solution, and soldered over\\nan alcohol or Bunsen flame with soft solder. The matrix is replaced\\nupon the tooth, the rubber dam applied, and the matrix pressed\\nagainst the cervical margin of the cavity by means of a wooden\\nwedge.\\nThe matrices of Guilford and those of Brophy (Figs. 253, 254,\\nChapter XII.) are operated upon a common principle the band which\\nmost nearly fits the periphery of the tooth is adapted, then drawn\\ninto close apposition with the tooth by means of the screw appli-\\nances.\\nThe matrix of Woodward is one of the most convenient. Its mode\\nof application is shown in Fig. 256, Chapter XII.\\nThe Miller matrix (Fig. 278) is useful and adapted for the class\\nof cavities shown in Fig. 279, as held in contact with cervical mar-\\nFig. 278.\\nThe Miller matrices.\\ngins through the action of the duplex spring leaflets. Fig. 279.\\nWhen necessary a wooden wedge is forced between\\nthe leaflets.\\n(For other forms and applications of matrices see\\nChapter XII.)\\nMixing the Amalgam. It is usually recom- Oilier matrix adjusted.\\nmended that the proportion of mercury and alloy be determined by\\nweight. An amount of alloy is first weighed, then weighed additions\\nof mercury are added to it sufficient to make a plastic mass, when the\\ntwo are to be mixed together; the relative amounts of mercury and\\nalloy are to be gauged and recorded for each formula of alloy. With\\nthe submarine alloy of Flagg\u00e2\u0080\u0094 60 silver, 35 tin, and 5 copper\u00e2\u0080\u0094 the", "height": "4548", "width": "2768", "jp2-path": "americantextboo00kirk_0325.jp2"}, "326": {"fulltext": "318\\nPLASTIC FILLING MATERIALS.\\nratio is equal parts by weight of filings and mer-\\ncury. When a mortar is used for making the amal-\\ngam, one of glass and having a glass pestle (see\\nFigs. 280, 281) is to be preferred. Mixing in the\\npalm of the hand is a dirty process, the hand and\\nfingers becoming much discolored by the metallic\\noxids.\\nFig, 280.\\nFig. 281.\\nGlass mortar.\\nGlass pestle.\\nA rubber mortar (Fig. 282) to be received in the palm of the hand\\nhas been devised by Dr. Genese. In view of deductions from Dr.\\nFig. 282.\\nDr. Genese s rubber mortar.\\nBlack s experiments this latter method of mixing is regarded as usually\\nthe preferable one.\\nThe filings are placed in the receptacle, the mercury is added, and\\nthe mass is triturated if in a mortar, by the pestle, if in the rubber\\nbasin, by the forefinger guarded by a rubber finger-stall. When the", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0326.jp2"}, "327": {"fulltext": "USE OF AMALGAM.\\n319\\namalgamation appears to be complete the mass is transferred to the\\nhand and kneaded, then pressed into a ball. It is next enclosed in\\nstout muslin, or China silk as recommended by Dr. C. E. Kells, Jr.,\\nand the surplus mercury expressed by wringing when no more mer-\\ncurv appears through the muslin, the button is removed it should break\\nwith a clean, white fracture surface.\\nAnother method of mixing the filings and mercury is that of Fletcher.\\nFilings and mercury are placed in a long glass tube which is shaken vio-\\nlently until amalgamation is complete.\\nThe Packing- Operation. Several devices have been invented for\\nthe purpose of carrying the amalgam to the tooth cavity, one of the\\nFig. 283.\\nmost simple being shown in Fig. 283, and another in Fig. 284. An-\\nother excellent instrument is shown in Fig. 285, one end having ser-\\nFig. 284.\\nrated points which engage the soft amalgam, the other a plugger\\nhead.\\nNumerous methods have been advanced and advocated for the pack-\\ning operation. The one commonly followed is that of burnishing the\\namalgam. This has been shown by Dr. Black to weaken the mass. A\\nsmall piece, rarely more than a cube of in. side, is carried to the deep-\\nest and most inaccessible recess of the cavity and pressed against its\\nwalls by tapping, burnishing, or uniform pressure. Dr. Flagg s method\\nis by tapping. Each successive piece of amalgam is tapped upon by the\\npacking instruments until it combines with its predecessor and is per-\\nfectly adapted to the cavity walls. The set of instruments shown in\\nFig. 286 are those by which this process is accomplished Nos. 30-34\\nbeing packing instruments, while the others are shapers.", "height": "4552", "width": "2764", "jp2-path": "americantextboo00kirk_0327.jp2"}, "328": {"fulltext": "320\\nPLASTIC FILLING MATERIALS.\\nA convenient and effective set of instruments for accomplishing the\\npacking are shown in Figs. 287-289.\\n30 31 32 33 34 35 36 37 38 39 40\\nDr. J. Foster Flagg s amalgam and zinc filling instruments.\\nDr. W. G. A. Bon will has advised a method which accomplishes the\\nremoval of surplus mercury and the even distribution of the mass,\\nFig. 287.\\nFig. 288.\\nWoodson s double-end amalgam instruments\\nduring the progress of the filling. Small squares of folded bibulous\\npaper are caught in the jaws of pliers and laid upon the amalgam,\\nwhen the exertion of pressure by means of amalgam pluggers or\\npliers forces out the surplus solvent and it is wiped away with the\\npaper. The same end is also accomplished by the use of bulbous\\npoints of soft rubber.\\nWhen through either method the cavity is more than half full, the\\nremainder of the amalgam mass is wrung out to express more mercury,\\nand the packing is resumed until the cavity is more than full.\\nAt the later stages of the filling the process of wafering is usually", "height": "4616", "width": "2776", "jp2-path": "americantextboo00kirk_0328.jp2"}, "329": {"fulltext": "USE OF AMALGAM.\\n321\\nFig. 290.\\nfollowed. By means of chamois and heavy pliers (Figs. 290, 291) the\\namalgam mass remaining is compressed into\\na wafer, driving the surplus mercury through\\nthe pores of the chamois. The amalgam is\\nput in a piece of chamois, and the chamois\\nsack A is entered between the beaks b and\\nc (the latter a roller) closing the handles\\nof the instrument progressively squeezes out\\nthe mercury till any desired degree of dryness\\nis attained. When the amalgam is squeezed\\nto the requirements of the operator, the han-\\ndles are released, and the spring opens the ap-\\npliance. The action is analogous to the finger\\nand thumb movement in common use, but is\\nmuch more powerful, and therefore more cer-\\ntain and more uniform. Small sections of the\\nwafer are laid upon the half-completed filling\\nand tapped into a union with it. The cavity\\nis more than filled, and at the completion of\\nthe packing the amalgam should cut as though\\nnearly set.\\nAnother and excellent method where applicable is to shape small\\npieces of half-vulcanized rubber and cement them upon broken excava-\\nMercury expresser.\\nFig. 291.\\nFlagg s wafering pliers.\\ntors, and use them as pluggers during the later stages of the filling.\\nThe fluid cementing amalgam will have its surplus mercury expressed\\nabout the sides of the plugger.\\nStill another method is to fill the cavity more than half full, then\\ncut away the softened portion, and complete the filling with drier amal-\\ngam. Fillings the initial portions of which have been introduced com-\\nparatively dry are more homogeneous and are less likely to discolor\\nand crevice than when more fluid amalgam has been used to begin the", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0329.jp2"}, "330": {"fulltext": "322 PLASTIC FILLING MATERIALS.\\nfilling. An examination of an amalgam filling immediately after com-\\npletion will show the marginal portions to contain the softer amalgam,\\nthe harder being in the more central parts.\\nThe too common practice of placing in the prepared cavity sufficient\\namalgam in one mass to nearly or quite half fill it, is faulty. By no\\nmeans can this method secure the accuracy of adaptation of filling\\nmaterial to cavity walls which is demanded of a correct filling.\\nAt the completion of the packing operation, unless the filling has\\nbeen finished by wafering, the surface will be found still soft. It has\\nbeen recommended l that small pieces of annealed No. 1 gold foil be\\nburnished over the surface of the amalgam, until no more gold can be\\namalgamated by this means, when the filling will be found quite hard.\\nThe indefinite cementing amalgam has combined with the gold, for\\nwhich mercury has a strong affinity, and formed a distinct amalgam\\nupon the surface of the filling proper. As amalgams of gold are com-\\nparatively soft, it is advisable to first fill the cavity more than full, apply\\nthe gold foil, then scrape the filling down to the cavity margins. Dr.\\nRhein s procedure is to fill the cavity with plastic amalgam and rub on\\nthe pieces of gold until no more gold is amalgamated. This gold amal-\\ngam is permitted to remain. The surplus of mercury may also be con-\\nveniently removed by absorbing it from the surface of the filling by\\npieces of sponge or crystal mat gold.\\nAn amalgam filling should be hard enough to resist cutting before\\nthe rubber dam is removed.\\nIn those situations where the rubber dam cannot be successfully\\nemployed, it is the accepted practice to prepare the cavity, sterilize it,\\nwhen access is difficult sealing a germicide in the cavity for a day; next\\nadjust a napkin, and having mixed a submarine amalgam (one contain-\\ning copper and a high percentage of silver), the cavity is dried as well\\nas possible a piece of the amalgam is then carried to the deepest recess\\nof the cavity and quickly and forcibly compressed with a mass of\\nbibulous paper. Another piece of amalgam is added and compressed,\\ndriving the surplus mercury from the amalgam. While the napkin is\\nin position, a mass of temporary stopping (which see) is softened and\\nplaced in the remainder of the cavity. A knife blade passed over the\\nedges of the amalgam will remove overhanging portions. At a subse-\\nquent visit, the rubber dam is adjusted, the temporary stopping is\\nremoved, and the filling completed with amalgam.\\nIf the operator prefer, the rubber dam may be adjusted at once and\\nthe filling completed at one sitting the former method is, however, pre-\\nferable, as the cervical portion of the filling may be perfectly finished,\\nand not be in danger of displacement, while the second section is packed.\\n1 Ottolengui s Methods of Filling Teeth, Method of M. L. Rhein.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0330.jp2"}, "331": {"fulltext": "USE OF AMALGAM. 323\\nIn cavities extending beneath the gum, and opening broadly upon a\\nsurface of a tooth where discoloration would be highly objectionable,\\nthe cervical half of the filling is made of a submarine amalgam and is\\ncompleted with an amalgam containing gold, which will retain a better\\ncolor. Should the external face of the filling be readily visible and not\\nsubjected to the stress of mastication, its outer surface is made of a\\nwafer of an amalgam containing zinc, known as a facing amalgam.\\nCopper amalgam is used, when used at all (and that is but seldom),\\nupon the distal and buccal walls of third molars, in cavities extending\\nunder the gum line, which are difficult of access and to sterilize, and\\nwhich cannot be properly dried.\\nA cavity is prepared which need be but slightly undercut. A pellet\\nof the copper amalgam is placed in an iron spoon (Fig. 292) held above\\nFig. 292.\\nHeating spoon for copper amalgam.\\na Bunsen flame until globules of mercury appear upon its surface, when\\nit is quickly crushed in a mortar and pounded until made into a paste.\\nThere can be no objection to washing the soft mass in aqua ammonia to\\ndissolve and remove oxids which later form discoloring salts, and thus\\npermit a chemical union of the metals which would be prevented by\\ntheir presence. A napkin, or always when possible the rubber dam,\\nis adjusted, and the filling inserted in sections. At the end of the oper-\\nation the filling should be firmly compressed with a broad -bladed spatula.\\nIn by far the greater number of cases in which amalgam was at one\\ntime used alone, it is now the accepted practice to place a lining of a\\nzinc cement, and add the amalgam as a resistant and insoluble covering.\\nIn cavities which approach the pulp the same precautions are taken\\nfor the prevention of thermal shock as with gold.\\nThe most difficult class of cases in which to obtain satisfactory results\\nwith amalgam are those opening alone upon the approximal surfaces of\\nbicuspids and molars. While it is true that amalgam may be manip-\\nulated in spaces impossible with gold foil even in soft cylinders, it is\\nessential that sufficient room be obtained for the perfect introduction of\\nthe material and its subsequent trimming and polishing for polishing\\nis quite as necessary an operation with amalgam as with gold. This\\nspace is obtained either through wedging or by cutting through the\\nocclusal face of the tooth into the cavity.\\nSpace is to be obtained and amalgam packed in such a manner\\nthat the amalgam at the completion of the operation shall exhibit no", "height": "4544", "width": "2752", "jp2-path": "americantextboo00kirk_0331.jp2"}, "332": {"fulltext": "324 PLASTIC FILLING MATERIALS.\\nevidence of pastiness. To insure the removal of the excess of the sol-\\nvent, gold foil may be burnished over it as already described until it\\nrequires some effort to cut the mass with a lancet blade. Amalgam\\nwhen set is more difficult to cut and polish than gold the greater por-\\ntion of the carving is therefore done at the same sitting as the filling,\\nbut should never be undertaken while the filling is soft. It should be\\nin such a condition that it is necessary to carve, not smear, it into shape.\\nA suitable cutting instrument of the form of Nos. 37 to 40 of Flagg s\\nset (see Fig. 286) is passed first across the cervical border of the filling,\\nremoving any excess due to imperfect contact of the matrix with the\\ncervical margin of the cavity next the lateral borders are carved, and\\nthen the masticating surface. The body of the filling is left full, so that\\nafter two days, when the filling receives its final dressing and polishing\\nwith cuttlefish disks, strips, pumice, etc., the filling will be reduced to\\ncorrect contour. A polished amalgam filling will retain an untarnished\\nsurface when an unpolished one will discolor very objectionably.\\nMany of the cases in which it was at one time the usual prac-\\ntice to fill or restore almost entire tooth crowns with amalgam,\\nFig. 293. are trimmed down, shaped, and artificial\\nt crowns applied. One class of cases is fre-\\nj*^^^^ quently seen in which the indication is for\\nIWl|jj|pl\\\\ an enormous amalgam filling rather than an\\nk^^^B| artificial crown this is, the loss of the dis-\\nWp^ilP^ tn\\\\ na \u00c2\u00b0f the crown of a molar. As a\\nrule the teeth are pulpless, or it is necessary\\nRestoration of lower molar with to Revitalize the pulp. The appearance of\\namalgam. the crown after the removal of carious den-\\ntin and cutting away frail enamel walls is seen in Fig. 293.\\nA Herbst matrix is fitted, closely embracing all the margins of the\\ncavity. The rubber dam is adjusted. It is of course understood that\\nthe root canals have been properly sterilized and filled. The posterior\\ncanal is drilled out for about J in. and screw-tapped. A thin solution\\nof zinc phosphate is mixed and the tip of a screw to fit the tapped\\nroot has its point dipped into the cement, and then quickly screwed\\ninto place. The amalgam is packed in larger masses than usual, using\\nbibulous paper to compress it about the screw and into such scant\\nundercuts as may be secured in the anterior portion of the tooth. The\\nfilling is completed with amalgam wafers.\\nSuch a filling should be well set before the rubber dam is removed.\\nThe upper surface is carved into cusps and sulci to occlude properly\\nwith the antagonizing teeth. The matrix should remain for twenty-\\nfour hours, when it may be split and removed. If the matrix has been\\nexactly adjusted there should be no trimming of the margins required,", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0332.jp2"}, "333": {"fulltext": "USE OF AMALGAM. 325\\nno carving of contour, and no smoothing, the amalgam being ready for\\npolishing strips. The occlusal surface is smoothed and polished with\\nmoosehide points and pumice, using a stiff brush to polish the sulci.\\nFinishing The process of finishing hard amalgam fillings is simi-\\nlar to that of finishing gold. For example a compound cavity occu-\\npying the approximal and occlusal faces of a molar. A fine saw is\\nplaced in a frame as in Fig. 294, but set to draw-cut with its teeth\\nFig. 294.\\nThe Kaeber saw frame.\\npointing toward the frame. The blade is passed above the cervical\\nmargin of the filling, engaging any projecting amalgam, which is then\\nsawn off. It is just as essential with an amalgam as with a gold filling\\nthat the cervical edge should be exactly flush.\\nThe lateral margins of the filling are next carved smooth strips of\\nemery cloth are passed into the interdental space and the filling smoothed\\nand rounded, completing this portion of the operation with emery strips\\nof the finest grit.\\nLinen tapes or metal polishing strips are next charged with pumice\\nand passed over the surfaces until they are smooth and the margins are\\nperfect. The occlusal portion is polished by means of rubber or moose-\\nhide points and pumice.\\nShould it be a plain approximal filling, not a contour, the saw is\\nused to cut away surplus amalgam, and the polishing accomplished by\\nmeans of disks and powders.\\nFillings upon the buccal surfaces of teeth are smoothed by means\\nof disks and polished with rubber cups or disks and pumice.\\nGutta-percha.\\nOrigin. The gutta-percha of commerce is the coagulated juice of\\nthe Isonandra gutta, a tree of the order of Sapotacece. The juice is\\nfound in all trees of this order, but some specimens are of much higher\\nvalue than others. That from Borneo is regarded by manufacturers as\\nbeing inferior it is the variety from which the name is derived Malay,\\ngatah or gittah, gum, and pertja, a tree. The gutta Tuban from Singa-\\npore is regarded as a superior variety.", "height": "4556", "width": "2764", "jp2-path": "americantextboo00kirk_0333.jp2"}, "334": {"fulltext": "326 PLASTIC FILLING MATERIALS.\\nThe mode of securing the juice is by tapping the cambium layer of\\nthe tree and catching the juice as it exudes. From this stage to its\\nformation into sheets it undergoes several processes (see works on gutta-\\npercha) it is possible that in some of these operations it may have its\\ntexture injured by overheating.\\nThe purified gutta-percha probably consists of a hydrocarbon (pure\\ngutta) having the formula C 10 H 16 albane, C 10 H 16 O fluavile, C 40 H 64 O 3\\nand a variable compound named guttane. Pure gutta possesses all the\\ngood qualities of gutta-percha in a much enhanced degree, becoming\\nsoft and plastic on heating and hard and tenacious on cooling without\\nbeing in the least brittle. The resins appear to be simply accessory\\ncomponents which have a decidedly detrimental effect when they pre-\\nponderate. Water, wood, fibers, bark, sand, etc., occur as mechanical\\nimpurities of gutta-percha. (Obach.)\\nHistory. Gutta-percha was introduced into dental practice as a fill-\\ning material about the year 1847. Soon after this a.secret preparation\\nwas introduced by a Dr. Hill, which received his name. Numerous\\nalleged analyses of Hill s stopping have been given, all of which are\\nuntrustworthy. It was found to subserve so useful a purpose that it\\nreceived the tribute of wide imitation in fact, the white gutta-percha\\npreparations of the present day had their foundation in this imitation.\\nThere is no entirely trustworthy evidence that the original was superior\\nto the best of contemporary preparations.\\nAs at present employed as a filling material gutta-percha is in two\\nforms, the first the well-known pink gutta-percha base plate, which is\\ncolored by the insoluble sulfid of mercury, the second the white prep-\\narations, made firmer in texture by additions of the soluble zinc oxid.\\nThe specimens of crude gum differ as to the amount of heat required\\nto soften them to an equal degree. Dr. Flagg l states that the speci-\\nmens requiring the greatest degrees of heat for softening, prior to the\\naddition of the zinc oxid, afford the best dental gutta-perchas. The\\nmethod of making the gutta-percha of dentistry is by softening a mass\\nof the brownish-yellow gum on a slab which has been heated over boil-\\ning water, and driving zinc oxid into the softened mass by a process\\nof kneading, using a w r edge-shaped steel instrument as the kneader. It\\nrequires infinite patience and much time to distribute the powder evenly\\nthroughout the mass. Overheating the material at any stage of its\\nmanufacture or manipulation is ruinous to its texture.\\nClasses. Gutta-perchas are divided into three classes according to\\nthe temperature of softening Loto heat, softening below 200\u00c2\u00b0 F. Me-\\ndium heat, becomes plastic at 200\u00c2\u00b0 to 210\u00c2\u00b0 F. High heat, 210\u00c2\u00b0 to 218\u00c2\u00b0 F.\\nThe low-heat specimens contain 1 part by weight of gutta-percha to 4\\n1 Plastics and Plastic Filling.", "height": "4580", "width": "2788", "jp2-path": "americantextboo00kirk_0334.jp2"}, "335": {"fulltext": "GUTTA-PERCHA. 327\\nof zinc oxid in medium-heat the ratio is 1 to 6 or 7 and in the high-\\nheat specimens the gutta-percha is almost saturated with zinc oxid.\\nPhysical Properties. Gutta-percha is an almost perfect non-con-\\nductor both of heat and electricity. It is less hard and rigid than any\\nother filling material. It contracts in hardening, i. e. cooling. Softened\\nmasses of it are coherent when dry, but not when wet. Its color may\\nbe made to resemble that of the teeth. To vital tissues it is the most\\nbland, unirritating filling material known.\\nAfter it has served as a filling for a greater or less period it is found\\nto have increased in hardness and difficulty of softening, and its surface,\\nand perhaps its substance, has become porous in variable degree. The\\nincreased hardness is observed in such situations as those in which\\nputrefactive decomposition occurs that is, in places where there is an\\nevolution of hydrogen sulfid the gutta-percha apparently undergoes a\\nspecies of vulcanization. It becomes somewhat porous in those situa-\\ntions where the formation of a solvent is active (lactic acid), which\\nabstracts the soluble zinc oxid from the mass. The pink variety con-\\ntaining the insoluble mercury sulfid does not become porous, but wears\\nwith a comparatively smooth surface when subjected to attrition.\\nExamining in detail these several physical properties it will be noted\\nthat gutta-percha has but one property in common with gold its insol-\\nubility. Its rational employment is therefore in such situations and\\nconditions as those in which the use of gold is contraindicated.\\nIndications for its Employment. First, in its several forms it is\\nemployed as a temporary filling material for both the temporary and\\npermanent teeth. Owing to its non-conductivity it is employed near\\nthe pulp its insolubility recommends its use at the cervical margins of\\ncavities, particularly in the buccal cavities of molars which do not\\nextend to the masticating surface, where the non-resistance of the\\nmaterial would cause its rapid wasting.\\nThis is the most common of the situations in which gutta-percha is\\napplied very deep cavities upon the buccal surfaces of molars, extend-\\ning beneath the gum, and having ragged enamel margins, the orifice\\nof the cavity being much smaller than its body. Owing to its non-\\nirritating quality, the condition of the gum in contact with a gutta-\\npercha filling remains normal.\\nIt is used in approximal cavities of the anterior teeth which have a\\nsimilar form to those just described also in labial cavities, particularly\\nwhen these teeth are in any degree loose. For example in a cavity\\nopening alone upon the distal wall of a canine tooth the carious process\\nhas almost invaded the pulp, the enamel walls unsupported by dentin\\nstill retain their form and have a good texture.\\nPink base plate is invaluable for the temporary filling of spaces after", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0335.jp2"}, "336": {"fulltext": "328\\nPLASTIC FILLING MATERIALS.\\nwedging and also the cavities to be subsequently filled with metal. A\\nmass of the material may be packed into such spaces and be permitted\\nto remain for months if desired, the gum in contact with it after its\\nprolonged presence exhibiting no indications of irritation. Masses of\\ngutta-percha may be packed in interdental spaces where there is not\\nsufficient space for the introduction of contour fillings, with the purpose\\nof having the teeth gradually separated by the impact of mastication\\nthe gutta-percha acts as a persistent and very gradual wedge.\\nWhen it has been determined that an excavated cavity is unfit for\\nthe reception of a permanent filling, gutta-percha is the filling material\\npar excellence.\\nAlthough it is stated that gutta-percha shrinks markedly in harden\\nFig. 295.\\nFlagg s gutta-percha softener and tool-heater.\\ning, cavities in which it has been properly placed exhibit no evidences\\nof softening after the material has been worn for months, or it may be", "height": "4612", "width": "2816", "jp2-path": "americantextboo00kirk_0336.jp2"}, "337": {"fulltext": "GUTTA-PERCHA.\\n329\\nfor years. Particularly is this true when the pink variety has been\\nemployed and the method of introduction is correct.\\nMode of Softening-. Gutta-percha should never\\nbe heated beyond a point which permits of accurate\\nadaptation to undercuts and frail walls. The soften-\\ning should be gradual. Any heat in excess of this is\\nnot only harmful but ruinous.\\nFor its proper softening some device is necessary\\nwhich shall permit of this type and degree of heating\\n(see Figs. 295-297, 306).\\nFig. 295 illustrates the heater of Dr. Flagg. There\\nare three metallic shelves, the highest of which receives\\nthe least amount of heat, and is designed for softening\\nlow-heat gutta-percha. The second shelf is for the\\nsoftening of high-heat specimens. The lowest shelf\\nand rack support the packing instruments, which are\\nkept at a higher temperature than the filling material.\\nFig. 296 illustrates a device of Dr. L. A. Faught\\nfor the packing of gutta-percha. The heating wires\\nconnect at the bases of the instrument points, which\\nare of aluminum, and sufficient heat is conveyed to the\\ngutta-percha to maintain it in a plastic state during the\\npacking operation.\\nInstruments. As a rule the instruments used in\\npacking gutta-percha are too large and the material\\nitself is used in too large pieces. If the cavity is of\\nconsiderable extent, and usually it is, the filling should\\nbe introduced in four or more pieces. It is preferable\\nto warm all the packing instruments so that the gutta-\\npercha will remain plastic until perfectly adapted.\\nManipulation. The rubber dam having been ad-\\njusted, the cavity excavated and sterilized, the frail\\nenamel edges broken away, without\\nany particular object of margin form-\\ning, but to gain space, the cavity is\\ndried for the reception of the gutta-\\npercha. The field of operation should\\nbe dry, in order that each additional\\npiece of gutta-percha shall adhere to\\nits predecessor, which it avouIc! not do\\nif wet. A softened pellet is taken upon the point of a\\nprobe and placed in the most inaccessible portion of\\nthe cavity and tapped into accurate contact with the tooth walls (by\\nOrder of placing\\ngutta-percha pellets.\\nDr. Faught s electric\\nheater.", "height": "4544", "width": "2776", "jp2-path": "americantextboo00kirk_0337.jp2"}, "338": {"fulltext": "330 PLASTIC FILLING MATERIALS.\\nmeans of the corkscrew plugger No. 32 or No. 33), as shown in\\nNo. 1 of Fig. 297. A second pellet is added (No. 2) and similarly\\nmanipulated. The Nos. 3, 4 pellets are packed in the order shown in\\nthe figure. In adding the last piece broad-faced instruments are used,\\nadapting the gutta-percha accurately to the margins of the cavity. The\\nsoftened gutta-percha may be made to adhere better to the walls of the\\ncavity if these be first coated with one of the lining varnishes.\\nAnother method of manipulation is to line the walls of the cavity\\nwith pellets until a cylindrical cavity remains. A cylinder of gutta-\\npercha of that size is nearly softened and pressed firmly into the cavity\\nby means of a broad spatula.\\nShould the cavity be very deep, the pulp almost exposed, the por-\\ntion of dentin overlying the pulp is to be covered by a thin pellet of low-\\nheat gutta-percha softened sufficiently to permit of adaptation. A disk\\nof pink gutta-percha base plate answers admirably for this purpose.\\nThe use of one of the lining varnishes, noted at page 257, especially\\nthe cellulose solution known as kristaline, previous to placing the pellets,\\nwill insure their adhesion to the cavity walls and prevent rocking or\\ntipping of the mass of gutta-percha during the operation of its insertion.\\nIn order to secure the best results the kristaline solution should be thin\\nwhen applied, and the solvent completely evaporated by blasts of warm\\nair before any attempt is made to introduce the gutta-percha, for unless\\nthe varnish lining is fully hardened the pellets will not strongly adhere\\nto the surface so treated.\\nDr. How s Improved Gutta-percha Fillings. Dr. W. Storer How 1\\nhas published a method of packing gutta-percha which is as excellent\\nas rational, when the directions given are closely followed\\nMany approximal cavities like C, Figs. 298, 299, may well be\\nFig. 298. Fig. 299. Fig. 300.\\nApproximal cavities.\\nfilled with gutta-percha, and such as C, Fig. 299, where a gold filling\\nwould show through the thin enamel front, can better be filled with\\nsuitable gutta-percha. The section, Fig. 300, shows the angles A, A\\nwhich should be given the enamel-edges when practicable, and in any\\ncase the enamel-margin should have a squarely defined angle at its\\nsurface border.\\nCervico-labial or buccal cavities, as shown in Figs. 301-305,\\n1 Dental Cosmos, 1892, vol. xxxiv. p. 281.", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0338.jp2"}, "339": {"fulltext": "G UTTA-PERCHA 331\\nadmit of permanent gutta-percha fillings. Of course due attention\\nFig. 301.\\nFig. 302.\\nFig. 303.\\nFig. 304.\\nFig. 305.\\nCervico-labial and buccal cavities.\\nmust be given to the retention of the fillings by enlarging the interior\\nwalls of the cavities when they have not already such expansions.\\nAfter suitably preparing the cavity, it should be made as dry as possible\\nand so kept. The problem of conveniently and properly softening\\npellets of gutta-percha has been solved by the production of the ther-\\nmoscopic heater shown in Fig. 306, which approximates the exact size\\nFig. 306.\\nThermoscopic heater for gutta-percha.\\nof the device. The heater is in this instance made of steatite, because\\nof its heat-retaining property and the desirable physical qualities of its\\nsurface. The handle is of wood, at the opposite end from which, in\\nthe centre of the circular recess, is a small disk (A) of metal, fusible at\\nabout 212\u00c2\u00b0 F. On the heater near the metal a suitable number of\\ngutta-percha pellets, as 1,1, are placed, and the heater held over the\\nflame of the annealing lamp or burner (as in the illustration) until the\\nfusible metal melts, when the heater is placed on a piece of cardboard\\n(or an empty foil-book), and the gutta-percha will be found to be prop-\\nerly softened. The steatite plaque retains the heat long enough for an\\nordinary operation, but if the metal meantime loses its fluidity and so", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0339.jp2"}, "340": {"fulltext": "332 PLASTIC FILLING MATERIALS.\\nindicates a lowering of the standard heat, it may be quickly restored\\nby a moment s holding of the heater over the flame, which will again\\nfuse the metal.\\nWhen the flame is applied directly under the metal, as in the illus-\\ntration, the material placed at 1 will, when the metal is seen to be fused,\\nbe at the heat of near 208\u00c2\u00b0 F., while the pellets at 2 will be heated to\\nabout 200\u00c2\u00b0, those at 3 and 4 to near 194\u00c2\u00b0 and 180\u00c2\u00b0 respectively. Of\\ncourse the location of the heat-source will produce corresponding varia-\\ntions in the relative temperatures of the materials as severally situated\\nbut with a visibly definite standard such as the metal A, having a known\\nfusing-point, the desired degree of heat may repeatedly be produced at\\nany place on the receiving surface of the heater. A few seconds contin-\\nuance of the heater over the flame, after the metal has melted, will raise\\nthe surface heat to 212\u00c2\u00b0 or 215\u00c2\u00b0, as the case may be but as a suitable\\nindicator for a high-heat stopping, a button (B) of metal fusing at 230\u00c2\u00b0\\nis provided as a substitute for A, which is first melted and poured out\\non a piece of clean paper, the heater cavity being undercut so that\\nwhen cold the metal cannot be shaken out. The boiling of a few\\ndrops of water in the heater cavity will likewise serve to indicate\\nthe proper temperature, but the fusible metal is in every way pref-\\nerable. The best plan is to hold the heater over the flame until the\\n-p o 07 metal melts, set down the heater, blow hot air\\ninto the previously prepared and dry cavity until\\nthe tooth is sensibly warm, hold the heater again\\nover the flame to melt the metal, and then with a\\nsuitable broad and cold instrument pick from the\\nheater a pellet or group of pellets sufficient to a little\\nmore than fill the cavity, and by a quick, firm, rock-\\nTrimming margins of ing pressure force the mass into the cavity as if it\\ngutta-percha filling. were sought impresgion of the game#\\nThen dip the instrument into ice-water, wipe dry, and hold it firmly\\nagainst the filling for one or more minutes, after which with a keen-\\nedged thin blade pare off the surplus, cutting from the centre obliquely\\ntoward the margin, as in Fig. 307, taking great care that the filling B\\nshall be flush with the cavity margin at every point, as at A, A Figs.\\n308 and 309.\\nAccess to approximal cavities, as C, C, Figs. 298 and 299, will\\nseldom permit the instantaneous mass-method just described, but in\\nmany such cases a warm, broad, flat blade, as stiff as the space will\\nadmit, can by repeated quick pressures be made to squeeze the soft mass\\ninto the cavity of the warmed tooth, and be instantly followed by a very\\nthin strip of metal held tightly in both hands and wrapped with hard\\npressure over the filling around that side of the tooth, to both condense", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0340.jp2"}, "341": {"fulltext": "G UTTA-PERCHA.\\n333\\nand contour the plastic and produce the closest adaptation of the\\nmaterial to all parts of the cavity walls.\\nThere is good reason for the belief that the common mode of suc-\\ncessively introducing small pieces of imperfectly softened gutta-percha\\ninto a comparatively cold cavity, and employing instrument points more\\nor less heated for packing the cooled plastic against one side of the\\ncavity after the other, must in the nature of the case result in a leaky\\nfilling, such as gutta-percha is commonly said to make, whereas the\\ndefect is due not to the material, but to its inconsiderate manipulator.\\nIn order to definitely determine whether or not suitably softened\\ngutta-percha inserted by the mass-method will make a moisture-tight\\nfilling, some porcelain teeth of natural sizes and forms were made, hav-\\nFig. 308.\\nFig. 309.\\nFig. 310.\\nFig. 311.\\nFig. 312. Fig. 313.\\nA\\nA -4\\ning cut in them, prior to baking, cavities of the class shown in Figs.\\n298-305. These cavities have been filled with gutta-percha, leaving\\na surplus over the margins as at a, a Fig. 310, and when quite cool\\nparing them flush as at A, A Figs. 308 and 309, and after several days\\nimmersion in dilute aniline ink, the fillings have been removed without\\na trace of color showing on the walls of either the fillings or the cavi-\\nties. The only exceptions have been where the margins were rounded,\\nas at a, a f Fig. 310, and the fillings not cut below them as shown, but\\nleft feather-edged as at d, d Fig. 312. In these few instances discolor-\\nations were found under the laps, but in no case extending farther than\\nto A\\\\ A Fig. 313. The tests prove that under conditions as nearly\\npractically parallel as extra-oral tests can well be, gutta-percha fillings\\nproperly made will exclude external moisture. Obviously, it is better\\nto pare the filling below the enamel-slopes, as in Figs. 311 and 313,\\nthan to leave it overlapping, as in Figs. 310 and 312. For a final finish\\nuse a rapidly revolved, lightly touching cuttlefish-paper disk, followed\\nby a wisp of bibulous paper or piece of tape wet with chloro-percha,\\napplied for but an instant, to glaze the surface of the filling.\\nIn the case of a very thin enamel front like that of Fig. 299, that\\npart of the cavity O may be varnished with thin chloro-percha and dried\\nwith hot air just prior to filling it as before said. It might first be\\nthinly coated with a tinted oxyphosphate or oxychlorid of zinc, which", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0341.jp2"}, "342": {"fulltext": "334 PLASTIC FILLING MATERIALS.\\nshould be given ample time to harden before placing the gutta-percha.\\nIndeed, it is a fundamental feature of good gutta-percha\\nwork that while one cannot operate too rapidly when\\nthe plastic is at its proper temperature, the preparatory\\nand completing processes should be given as much time,\\ncare, and close scrutiny as more elaborate and often less\\nenduring gold operations. There is furthermore room\\nfor the exercise of the artistic faculty in having at hand chloro-percha,\\nor cellulose varnish of varied colors, with which, by means of a small\\nbrush, a gutta-percha filling as B, Fig. 301, and one in the like cavity\\n(7, may be given an inconspicuous shade, and the painting be renewed\\nfrom time to time, if that be necessary by reason of wear. Fig. 314 is\\na sectional view of fillings like B, C, Fig. 301\\nFinishing Gutta-percha Fillings. If a gutta-percha filling has\\nbeen packed with the proper amount of care and skill, it should require\\nbut little trimming. It should be undisturbed until cold. Its harden-\\ning may be hastened and intensified by holding ice-water in contact\\nwith it for a few moments.\\nThe portions overlying the margins are to be trimmed with extremely\\nsharp lancets or by warm blades. Every cut should remove a little of\\nthe surplus material, never a mass of it, and should be made toward the\\ncavity margins, never away from them. The filling should have been\\nmade so that no fulness is present to require reducing.\\nIt is a general practice to give a smooth face to a gutta-percha filling\\nby wiping it with a tape slightly moistened, not wet, with chloroform.\\nThe surface produced by this means, although smooth, does not retain its\\nintegrity so well as when the surface is formed by cutting.\\nThe use of gutta-percha as a canal filling is discussed in Chap. XVII.\\nBasic Zinc Cements.\\nZinc Oxychlorid. The basic zinc cements employed in dentistry are\\nthe oxychlorid and the phosphate the oxysulfate should also be included.\\nThe oxychlorid is formed by the combination of calcined and pul-\\nverized zinc oxid with a solution of zinc chlorid\\nZnO ZnCl 2 H 2 2ZnClHO.\\nThis compound was introduced as a dental filling material about 1850,\\nits hardness, whiteness, and apparent insolubility recommending it for\\nthat purpose. It required no lengthy period of time to demonstrate\\nthat as a filling material per se it was unfit for use. It disintegrated\\nrapidly and was not free from shrinkage.\\nProperties. Freshly mixed, this material is irritating to vital\\ntissues with which it is brought in contact applied close to or upon an\\nexposed pulp it may be productive of a transient or a persistent irritation,", "height": "4580", "width": "2760", "jp2-path": "americantextboo00kirk_0342.jp2"}, "343": {"fulltext": "BASIC ZINC CEMENTS. 335\\nor even inflammation. The extent of the irritation is largely governed\\nby the fluidity of the cement paste, i. e. the amount of zinc chlorid present.\\nIt sets in fifteen minutes sufficiently to permit the packing upon it\\nof an amalgam, and in half an hour a gold filling. After setting it is\\nwhiter though less hard than the zinc phosphate; it shrinks, particularly\\nwhen used in large masses. It is a poor thermal conductor, and, like\\nall bodies containing zinc oxid, is soluble in lactic acid the usual sol-\\nvent in the oral cavity. These several features are at present regarded\\nas limiting the application of oxychlorid to first, a lining material for\\ncarious cavities over which the insoluble filling proper is to be placed\\nsecond, as a root-filling material (its use in this connection is discussed\\nin Chapter XVII.). It is to be noted that the cement retains after\\nsetting an antiseptic power for a greater or less period.\\nUse. Zinc oxychlorid is usually employed as a lining material in\\nteeth having what is known as poor structure those in which caries\\nproceeds to great depths without external evidence of the extent of\\ninvasion. After these cavities have been partially excavated it is found\\nthat further excavation and the removal of the deepest layers of the\\nleathery dentin which appear to have retained sensitivity would prob-\\nably uncover the pulp it may be that the pulp has given subjective\\nevidence of a mild attack of active hyperemia.\\nIn such cases the deepest layer of the partially disorganized dentin\\nis permitted to remain and is subjected to the prolonged fifteen minutes\\nor longer contact of hydrogen peroxid in the 25 per cent, ethereal\\nsolution (caustic pyrozone), 5 per cent, aqueous solution of formalin,\\nor preferably a saturated solution of thymol in alcohol. The cavity\\nwalls are well dried with bibulous paper and the warm-air blast.\\nUpon a mixing slab (see Fig. 315), a drop or two of the zinc chlorid\\nis placed, and beside it a quantity of the zinc oxid powder. The\\npowder is gradually incorporated with the fluid by means of a spatula\\nuntil a creamy paste is made. A number of balls of bibulous paper\\nare to be at hand. A portion of the paste is taken upon the end of\\nan instrument and placed in the cavity, where it is quickly pressed into\\na layer against the cavity walls by means of the balls of bibulous paper.\\nThe walls are to be covered to a uniform depth of about one-sixteenth\\nof an inch. The prompt application of the bibulous paper usually pre-\\nvents any irritation due to the contact of the oxychlorid with the dentin\\noverlying the pulp. Should the cavity be very deep it is advisable to\\nprotect the pulp by interposing a film of ethereal varnish between the\\noxychlorid and the dentin over the pulp.\\nAt the completion of the lining operation, the margins of the cavities\\nare to be cleansed of the oxychlorid and the filling completed with the\\nmaterial indicated.", "height": "4548", "width": "2728", "jp2-path": "americantextboo00kirk_0343.jp2"}, "344": {"fulltext": "336 PLASTIC FILLING MATERIALS.\\nZinc oxychlorid as an obtunding agent in the treatment of hyper-\\nsensitive dentin is of considerable value, and its use for that purpose is\\ndescribed in Chapter VII.\\nThe use of zinc oxychlorid as a canal filling, and the mode of using\\nit, are discussed in Chapter XVII.\\nThe powder of this cement is made of zinc oxid calcined and pow-\\ndered, to which have been added substances (borax, silica, etc.) which\\naffect its properties but little if at all.\\nThe fluid is made by dissolving pure zinc or its oxid in hydrochloric\\nacid to the point of saturation or, by making a solution of zinc chlorid\\n4 parts, water 3 parts, and filtering the solution.\\nThe use and effects of zinc oxychlorid as a pulp capping are dis-\\ncussed in Chapter XVI.\\nZinc Phosphate. These cements are nominally a combination of\\ncalcined zinc oxid with a syrupy solution of orthophosphoric acid\\n3ZnO 2H 3 P0 4 Zn 3 (P0 4 2 3H 2 0,\\nalthough their actual composition is more variable than that of any other\\nfilling material. Both base and solvent commonly contain impurities\\nthose of the base owing to lack of discrimination, or worse, in the source\\nof the oxid. Many of the impurities of the phosphoric acid are due\\nprimarily to the well-known inconstancy of the acid itself, and others to\\nthe mode of its manufacture.\\nMany of the specimens of powder are prepared from commercial\\nmetallic zinc, and therefore contain the impurities of that metal.\\nAmong the latter is arsenic, so that the presence of arsenic compounds\\nin inferior cement powders is by no means impossible, which may pos-\\nsibly explain in some cases the death of non-exposed pulps in teeth\\nwhich have been filled with zinc phosphate but as recent chemical in-\\nvestigation has shown that the arsenic when present in cement powders\\nis in the form of an insoluble zincarsenite, the danger of arsenical irrita-\\ntion of the pulp from that source would seem to be a remote one.\\nA common source of the glacial phosphoric (metaphosphoric) acid of\\ncommerce is from sodium phosphate, variable quantities of which are\\nretained in the acid solution as acid sodium phosphate (dihydrogen\\nsodium phosphate). This substance is soluble in water, and must there-\\nfore greatly increase the solubility of any cement containing it.\\nTo properly make pure specimens of zinc oxid and phosphoric acid\\nis a comparatively expensive operation which will serve to explain the\\nseemingly high cost of fine specimens of cement, and incidentally serve\\nas a warning against the indiscriminate use of cheap cements.\\nMaking the Powder. A quantity of pure zinc oxid is luted in a", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0344.jp2"}, "345": {"fulltext": "BASIC ZINC CEMENTS. 337\\nsand crucible and kept at the highest forge-heat for hours. When cool\\nthe crucible is broken away and the vitreous inass of yellowish zinc oxid\\nis reduced to a powder which will pass through a fine bolting cloth.\\nThis powder is placed in tightly stoppered bottles, for if exposed to the\\nair it absorbs carbon dioxid and a portion of it is converted into the\\nhydrated carbonate of zinc. This change may be noted in old powders\\nby the effervescence due to the disengagement of carbonic oxid when\\nphosphoric acid is added to them. Numerous substances have been\\nadded to the basal powder with the object of lessening the disintegra-\\ntion, i. e. chemical solution, when used as a dental cement. Usually\\nthese additions are the oxids of other metals. The oxid of magnesium\\nadded to the powders causes the cement to set more rapidly the oxid of\\naluminum increases the rapidity of setting and makes a finer-grained\\ncement, the central texture of which is, however, inferior. Cements of\\nzinc oxid and phosphoric acid alone are apparently less soluble in lactic\\nacid than when the oxids of aluminum and magnesium are added.\\nVarious other substances have been added which do not enter into\\nchemical combination with the phosphoric acid, in the hope of confer-\\nring greater durability on the cement, but as yet but few of them have\\nbeen shown to possess any value.\\nThe Fluid. Phosphoric acid in its pure state is formed by hydrating\\nphosphorus pentoxid\\nP 2 5 3H 2 2H 3 P0 4\\nMuch of the phosphoric acid used for cements is made by hydrating\\nthe glacial (metaphosphoric) acid, HPO s The acid dissolves readily\\nin water, being deliquescent when pure. Difficulty of solution is\\ntherefore an indication of impurity of the glacial acid. It requires a\\ndefinite degree of heat to bring about the chemical hydration of the\\nacid. At a temperature of 210\u00c2\u00b0 F. the union occurs, which is attended\\nby the evolution of heat, the glacial acid being transformed into ortho-\\nphosphoric acid. These acids are all hygroscopic. They will even ab-\\nstract water from sulfuric acid.\\nImpurities. The commercial glacial acid is commonly, or as a rule,\\nimpure, containing variable amounts of sodium and magnesium phos-\\nphates. These salts, particularly the dihydrogen (acid) sodium phos-\\nphate, are permanently soluble in the phosphoric acid, and therefore\\ngive no evidence of their presence by the formation of precipitates.\\nThey are also soluble in water, which fact has a direct bearing upon the\\ndurability of cements made with the impure acid.\\nIt has been stated by writers that the acids of cement were occasion-\\nally the meta- and pyrophosphoric. A test of some of them said to be,\\n22", "height": "4548", "width": "2728", "jp2-path": "americantextboo00kirk_0345.jp2"}, "346": {"fulltext": "338 PLASTIC FILLING MATERIALS.\\nof these varieties showed none of them to give the reaction of the pyro-\\nacid a few giving traces of the meta- acid.\\nPrecipitates which form in cement fluids are probably metallic phos-\\nphates. The instability of cement fluids is notorious. Aside from the\\nknown or probable contaminations which they may contain this insta-\\nbility is to be regarded as a distinctive feature of phosphoric acid.\\nThe Cement. To make the cement, successive portions of the oxid\\nare mechanically incorporated with the fluid until a stiff paste results.\\nIn five minutes a ball made of the paste glazes, and rebounds when\\ndropped upon a hard surface. It breaks with a granular surface in\\nfifteen minutes it is cut with some difficulty. If the cement fluid con-\\ntain the acid sodium phosphate, an acid reaction may remain for hours\\nor days. The atmospheric conditions markedly modify the properties.\\nIn warm, or hot and moist weather, the setting is more rapid and it\\nmay be sudden. In cold weather it is delayed. The greater the dilu-\\ntion (the thinner the fluid), the more rapid the setting.\\nIn its freshly mixed state zinc phosphate is adhesive, losing this\\nproperty in a great degree when set, if surrounded by moisture. It has\\na higher rate of heat conductivity than zinc oxychlorid.\\nUses. Its legitimate field of usefulness is in situations and under\\nconditions where its advantageous properties may be utilized and its\\ndisadvantages minimized. One of the principal facts to be borne in\\nmind is the solubility of the cement in lactic acid, which is present\\nalmost always about the necks of the teeth, in approximal spaces, and\\nalong gingival margins. Its clinical use is therefore attended by the\\ngreatest measure of success when placed at a distance from such situa-\\ntions as, for example, in cavities opening upon the masticating sur-\\nfaces of teeth, where its great hardness is an element of advantage.\\nGood specimens have been known to last for periods varying from\\nthree to eight years. Dr. Henry Weston has cited cases where an un-\\nusually good zinc phosphate filling has lasted for ten years.\\nAs a filling material per se y zinc phosphate has but limited employ-\\nment except for the teeth of children, and as a temporary filling in the\\nteeth of adults. Times and occasions will suggest themselves to every\\noperator where gold, amalgam, and gutta-percha are contraindicated as\\nfilling materials in such cases zinc phosphate performs a useful ser-\\nvice. Its great field of usefulness where, indeed, there is no substi-\\ntute for it is in the filling of the greater portion of extensive cavities,\\nwhich are then filled and sealed with gold or amalgam, by an inlay, or it\\nmay be by a partial crown. It is invaluable, and in most cases indispen-\\nsable, as the retaining medium of fixed bridge work and of many forms\\nof artificial crowns.\\nPrior to placing the zinc phosphate filling in a cavity, it is a wise", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0346.jp2"}, "347": {"fulltext": "BASIC ZINC CEMENTS.\\n339\\nFig. 316.\\nDropper.\\nFig. 317.\\nScoop.\\nFig. 31:\\nprecaution to line the latter with one of the quick-drying ethereal var-\\nnishes, to protect the dentinal walls from contact with acid sodium\\nphosphate which may be present in the cement. In some cases the\\nplacing of the cement in proximity to a non-exposed pulp is productive\\nof marked suffering. Should the cavity\\nbe very deep it is the usual practice to\\nplace a softened disk of gutta-percha\\nover the wall nearest the pulp. The\\nrubber dam should always be adjusted\\nbefore the insertion of a phosphate fill-\\ning, to insure dryness not only during\\nthe insertion, but during the period of\\nhardening, at least fifteen minutes.\\nMixing of Cement. This is an\\noperation of equal, if not greater, im-\\nportance than any other in the manipu-\\nlation of zinc phosphate. Dr. Henry\\nWeston has demonstrated how, almost\\nentirely, the mixing of cement gov-\\nerns its stability. Specimens of the\\nsame powder and fluid mixed after dif-\\nferent methods gave entirely different\\nresults, not only in the appearance but\\nalso in the hardness, texture, and solu-\\nbility. The method of mixing set forth\\nis that of the same experimenter. As-\\nsuming for illustration that an approx-\\nimal cavity is to receive a contour filling,\\nor a large occlusal cavity is to be filled,\\nFig. 315.\\nGlass mixing tablet, with rubber feet.\\nor an extensive cavity is to be three-\\nfourths filled with cement\\nA drop, or, where a large mass of\\ncement is required, two drops of fluid are placed upon a scrupulously\\nclean glass (Fig. 315) by means of the dropper shown in Fig. 316, and\\nSpatula.", "height": "4548", "width": "2744", "jp2-path": "americantextboo00kirk_0347.jp2"}, "348": {"fulltext": "340\\nPLASTIC FILLING MATERIALS.\\na mass of powder, in great apparent excess of that required, is heaped\\nat a distance from it, taken from the bottle by the scoop (Fig. 317). A\\nportion of the powder is drawn into the fluid by means of a stout spatula\\n(Fig. 318), and stirred with a rotary movement until a thin paste is\\nmade another portion of powder is then added and is slowly and thor-\\noughly incorporated more powder is added until the mass is as thick as\\nputty and difficult to smear with the heavy spatula the mass is scraped\\ntogether, taken from the spatula, and rolled between the forefinger and\\nthumb, which have been well scrubbed. The mass is now kneaded,\\nthen rolled into an oblong pellet.\\nIf for an occlusal cavity a piece about one-fourth the size of the cavity\\nis set in the deepest portion and tapped into perfect apposition with the\\ncavity walls by means of a burnisher. Other pellets are added, and the\\nprocess is repeated until the cavity is exactly full, the burnisher form-\\ning the surface of the filling and outlining clearly every margin of the\\ncavity. The filling should remain under rubber dam for at least fifteen\\nminutes longer when possible. A coating of ethereal varnish, a solu-\\ntion of gutta-percha in chloroform, or melted paraffin as suggested by\\nDr. Bonwill, is applied to the surface and the grinding of the filling\\ndeferred for a day or two. Should the cavity be upon an approximal\\nside of a tooth, a matrix is to be employed the most satisfactory and\\nquickly adapted instrument for this purpose is one of the composition\\nsilver strips used for carrying polishing powders (Fig. 319). A strip\\nFig. 319.\\nPolishing strip.\\nas wide as the length of the tooth is to have one end rolled upon itself\\nuntil it forms a cylinder more than one-sixteenth of an inch thick (Fig.\\n320, .4). The strip is passed into the next interdental space and drawn\\nFig. 320.\\nthrough until the cylinder (A) rests firmly upon the teeth; the free end\\nis now passed through the space into which the cavity opens where it", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0348.jp2"}, "349": {"fulltext": "BASIC ZINC CEMENTS.\\n341\\nFig. 321.\\nrests upon the lingual surface of the tooth it is burnished into contact\\nwith the edges of the cavity, forming walls to the latter (320, B). The\\ncement is introduced as in the preceding case, and when the cavity is\\nfull the free end of the strip is drawn upon, compressing and round-\\ning the filling. Should the cement be an adhesive specimen or mixed\\nthinner than described, the surface of the flexible mat-\\nrix is to be faintly oiled by means of olive oil.\\nAt the completion of the operation the cement should\\nbe exactly flush with the margins except at the labial\\naspect, and the surface of the cement should have such\\nsmoothness that polishing is not necessary. Cement\\nfillings are polished dry with the finest of cuttlefish\\ndisks.\\nThe process of filling the body of any cavity is the\\nsame, except when the enamel walls are thin and frail.\\nIn the latter case, where space permits, it is preferable\\nto line the walls with the oxychlorid of zinc, over which\\nthe phosphate is placed. Before inserting a veneer fill-\\ning of gold or amalgam, each cavity margin must be\\nscraped free from cement.\\nWhen orthodontia appliances such as rings or caps,\\nor prosthetic appliances, crowns and bridges, are to be\\nset it is preferable to use a cement prepared for that\\npurpose, although it is the general practice to use the\\ncement to which the operator is accustomed, mixing it\\nthinner than for filling purposes. Wherever possible,\\nit is advisable to operate under rubber dam, even while\\nsetting orthodontia appliances.\\nThe tooth is cleansed with chloroform as, for ex-\\nample, when a ring or cap is set to remove fatty mat-\\nters, and a layer of shellac varnish applied, which is\\nthen dried by the air blast (chip blower). Cement\\npaste is formed, of such consistence that it will flow\\nreadily and yet not be watery the inside of the band\\nor cap is filled with cement by means of an appropriate\\nspatula (Fig. 321) a layer of cement is placed on the\\ntooth where it is to be embraced by the band, which is\\nthen pressed into position and is to remain without\\ndisturbance until it is hard. The application of bands\\nor ligatures should be deferred until the following day.\\nAs soon as the cement is hard the surplus is cut away\\nand the dam removed.\\nPointed spatula.", "height": "4556", "width": "2736", "jp2-path": "americantextboo00kirk_0349.jp2"}, "350": {"fulltext": "342 PLASTIC FILLING MATERIALS.\\nTemporary Stopping.\\nPreparations of this name are compounds of gutta-percha with\\nvarious substances added to lessen the temperature of softening.\\nAs procured from the manufacturer they are of two varieties, the\\nadhesive and the non-adhesive or, to be more precise, the less adhesive.\\nThe former preparations, the adhesive, are usually made of gutta-percha\\n(generally the pink base plate), Burgundy pitch, white wax, and chalk\\nor zinc oxid. In the non-adhesive varieties the Burgundy pitch is omitted.\\nThe latter varieties are usually made of a pink color, to furnish a safe-\\nguard against mistaking a filling of temporary stopping for one of gutta-\\npercha.\\nAs the name implies, they are designed for temporary use, retaining\\ndressings in teeth, to maintain space between teeth which have been\\nwedged apart, until the attendant pericementitis subsides to press away\\ngum tissue overhanging the margins of a cavity to fill excavated cav-\\nities for a few days.\\nUnlike gutta-percha, most of these preparations cannot be permitted\\nto remain for a prolonged period they usually become offensive, par-\\nticularly so when the hygiene of the mouth does not receive proper\\nattention. To maintain space and press away gum tissue they are used\\nas gutta-percha their lower heat of softening permits their application\\nclose to the pulp of a tooth without the painful response associated with\\nplacing hot gutta-percha in the same position. A prominent use of the\\nmaterial is the sealing of arsenical applications in teeth.\\nAs with any other material, it is necessary, in order to have the\\nminimum of pain, to make the application and manipulate the stopping\\nso that no pressure shall be exerted upon the pulp. Temporary stop-\\nping is inferior to zinc phosphate for this purpose, as the latter may be\\nflowed into a cavity and over an arsenical application without causing\\nthe slightest pressure.\\nShould the cavity of decay extend to or beyond the gum, a small\\nconical piece of the temporary stopping should be softened and packed\\ncarefully against the cervical margin and gum, to act as a guard to the\\nlatter against contact with the virulent irritant arsenic trioxid. The\\narsenical paste on a minute pledget of cotton is laid upon the exposed\\npulp if the latter be hypersensitive, beside it and the remainder of\\nthe cavity and interdental space are filled with one very soft piece of\\ntemporary stopping.\\nTemporary stopping, in cones, has been used as a canal filling (see\\nChapter XVII.) and as a filling for the bulbous portion of pulp\\nchambers.\\nAnother important use of the material is the sealing of the occlusal\\ncavities of teeth which are under treatment for septic pericementitis.", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0350.jp2"}, "351": {"fulltext": "OXYSULFATE OF ZINC. 343\\nPlugs of softened temporary stopping have been used for the arrest\\nof alveolar hemorrhage also for the temporary setting of artificial\\ncrowns.\\nLining Varnishes.\\nThese are solutions of various gums and resins in alcohol, chloro-\\nform, and ether, which are employed to furnish a non-conducting and\\nimpermeable film to cover the dentinal walls of excavated cavities.\\nThe first, sandarac varnish, is a thin solution of sandarac in alcohol.\\nThe second, a solution of virgin rubber in chloroform.\\nThe third a solution of hard Canada balsam, copal, or damar in\\nether.\\nAnother is the preparation known as kristaline, a solution of trinitro-\\ncellulose in anhydrous amyl acetate.\\nBefore lining a cavity with zinc oxychlorid, a film of one of these\\nvarnishes, the quick-drying ones preferred, is applied, and when this is\\ndry the cement may be inserted without causing pain. Varnishes have\\nbeen used to furnish an adhesive surface upon which to pack gutta-\\npercha fillings. It is always advisable to varnish the walls of a cavity\\nwhich is to receive a filling of zinc phosphate, to prevent the action of\\nany free acid or acid salt upon the dentinal walls.\\nSome of these varnishes are admirable non-conductors, and serve\\nin that capacity under gold or amalgam fillings in a most satisfactory\\nmanner.\\nThey may be used to prevent the tooth discoloration due to the pres-\\nence of amalgam, particularly of copper amalgam.\\nOXYSULFATE OP ZlNC.\\nWhat is known as the oxy sulfate of zinc in dental parlance is\\nmerely a thin zinc oxychlorid containing zinc sulfate. A true zinc\\noxysulfate is made by mixing a saturated solution of zinc sulfate with\\nuncalcined zinc oxid. It forms a white paste which sets quickly and\\nattains about the hardness of an inferior plaster-of-Paris.\\nIt is bland and unirritating to exposed pulps is a non-conductor\\nis faintly and persistently astringent. 1\\nIts principal use is as a pulp capping or protective. A thin paste is\\nmade, in which a disk of paper is dipped, then quickly and accurately\\nlaid upon the area of exposure. When hard (in a few seconds) a drop\\nof fresh thin paste is flow T ed over the capping. The cavity may then be\\nlined with zinc phosphate.\\nAs a pulp protector from thermal shock it is applied in a thin layer,\\nand over it a lining of zinc phosphate is packed.\\n1 J. Foster Flagg.", "height": "4556", "width": "2760", "jp2-path": "americantextboo00kirk_0351.jp2"}, "352": {"fulltext": "", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0352.jp2"}, "353": {"fulltext": "CHAPTER XIV.\\nCOMBINATION 1 FILLINGS.\\nBy Dwight M. Clapp, D. M. D.\\nThe use of more than one material for filling a single cavity was\\nsuggested by the observation of the condition of fillings composed of\\nbut one material and noting the effects of time and use thereon.\\nIf a large number of amalgam fillings in crown cavities are exam-\\nined, many will be found to have imperfect edges. One cause of this\\nimperfection is, undoubtedly, the brittle character of amalgam, in con-\\nsequence of which the edges have become broken. In other words,\\namalgam as a filling material lacks edge strength. Its dark, sometimes\\nalmost black, color also renders it very objectionable, especially if used\\nin conspicuous positions.\\nIf the same number of gold fillings in occlusal cavities are examined,\\nthe edges will be found in better condition than was the case with the\\namalgam. One reason for this is, undoubtedly, because gold is not\\nbrittle, but possesses sufficient edge strength to withstand the force\\nof mastication. Its color is also less unsightly than that of amalgam.\\nFor occlusal cavities, therefore, gold is regarded as the better filling\\nmaterial.\\nIf a series of occluso-approximal cavities filled with gold be studied,\\nit will be found that the teeth are in much better condition on the oc-\\nclusal surface than at the cervical borders of the fillings. Compare gold\\nfillings with a series of amalgam fillings in the same class of cavities,\\nand the condition of the teeth will be reversed at least a much larger\\npercentage of the teeth will be found in good condition around the ap-\\nproximal portion of the fillings than was the case with the gold. Hence,\\nthe deduction is inevitable that, of these two materials, amalgam is the\\nbetter to fill the cervical portion of approximal cavities.\\n1 The term combination is adopted for the various fillings here described, in which\\nmore than one material is used, because it seems to be the most comprehensive. The\\nputting together of different materials in filling teeth makes in no sense a chemical combi-\\nnation, in which any part of the compound is the same as any other part of it.\\nStrictly speaking, the fillings are more mixtures than combinations. According to\\nthe best authorities, however, the meaning given to combination makes its use here quite\\nadmissible.\\n345", "height": "4556", "width": "2760", "jp2-path": "americantextboo00kirk_0353.jp2"}, "354": {"fulltext": "346 COMBINATION FILLINGS.\\nZinc phosphate cement has many admirable qualities and is one of\\nthe most valuable filling materials known. It is easily worked, its color\\nis good, its adhesiveness serves to bind tooth and filling together as the\\nstonemason s cement unites the blocks of granite that he piles one on\\nthe other into one solid piece of masonry. As a tooth-saver it has no\\nequal but its one great defect, its solubility in the fluids of the mouth,,\\nrestricts, in a great degree, its usefulness when exposed to these fluids.\\nFrom this it will be easily understood why it is often desirable to\\ncombine in one filling two or more different materials and it may be\\nsaid with truth that the operator who selects his filling materials with\\nthe best judgment, and combines and uses them with the most skill,,\\nwill save the greatest number of teeth. There would be just as much\\ncommon sense and scientific reason for an electrician to make a dynamo\\nentirely of copper, or a watchmaker to use nothing but gold in making\\na watch, as for a dentist to fill many of the cavities that come to him\\nwith but one material.\\nIt is an error to think that combination fillings are resorted to\\nbecause more easily made than fillings of but one material, or that it\\nindicates a lack of skill on the part of the operator who makes and\\nrecommends them. On the contrary, it is often much more difficult to\\nmake a suitable combination filling than one of any single material and\\nthe student will find that combination work will give ample opportunity\\nfor the employment of all the skill and ingenuity he may possess.\\nEvery operation must be made with the greatest amount of care and\\nattention to minute details, or the object sought will be unattained, and\\nthe result be an inferior piece of work which will sooner or later cause\\ngrief to the patient and chagrin to the operator.\\nIt is impossible to describe all the combination fillings that have\\nbeen found advantageous and useful, therefore only some of the most\\nimportant will be considered in detail. The list is limited only by the\\nperverse manner in which teeth decay, and by the ingenuity of the ope-\\nrator to devise scientific and practical combinations to meet the cases\\npresenting.\\nIt is to be understood in every instance in this chapter that the teeth\\nare in proper condition to be filled without further treatment. If pulp-\\nless, the roots are supposed to have been put in a healthy condition and\\nfilled. In cases of exposed, or nearly exposed, pulps, they are supposed\\nto have been properly protected, and the teeth ready in every respect\\nfor the mechanical operation of inserting the fillings.\\nCement (Zinc Phosphate) and Amalgam.\\nIn Simple Cavities. This combination is of the greatest service in\\nsaving badly decayed teeth that otherwise might have to be cut off and", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0354.jp2"}, "355": {"fulltext": "CEMENT AND AMALGAM.\\n347\\nFig. 322.\\ncrowned, or perhaps lost altogether. The simplest cases where it may\\njudiciously be employed are occlusal cavities. Many such cases are\\nseen where there is little left but the enamel, which, however, is thick\\naround the orifice of the cavity, and, if properly supported, will have\\nsufficient strength to withstand the ordinary strain of mastication.\\nGreat care should be taken to remove the decay from every part of the\\ncavity, being sure that none is left under the cusps or any part of the\\noverhanging enamel.\\nThe edges of the cavity must be carefully trimmed, so that the filling\\ncan be finished flush with the external surface, in order not to leave any\\noverhanging portion of amalgam to be broken off, as it certainly will be\\nif so left, to the great injury of the filling.\\nThere are but few cases, even in occlusal cavities, where the rubber\\ndam should not be used, at least for the final excava-\\ntion and for putting in the filling for it is almost im-\\npossible to be sure that all decay has been removed\\nfrom a cavity unless it is dry. No filling should be\\nallowed to get wet before it is all in place if it can\\npossibly be avoided. It is much better to err by\\nusing the rubber dam too often than not often enough.\\nFig. 322 shows a cavity such as described.\\nThe cavity being ready, sufficient amalgam to fill\\none-third of it is prepared. Before introducing the amalgam, however,\\nthe cavity is filled two-thirds or three-fourths with rather soft cement,\\ninto which pieces of the prepared amalgam are crowded, forcing the\\ncement into every portion of the cavity. The cement\\nwhich has oozed out around the edges is then removed\\nwith an excavator, and the operation will have the ap-\\npearance shown in Fig. 323. The filling is then com-\\npleted in the same manner as an ordinary filling of\\namalgam in an occlusal cavity.\\nThe advantages of this kind of filling are many The\\nbulk of it is of cement, which does not change its shape\\nperceptibly and is the best of materials when not ex-\\nposed to the fluids of the mouth. The cement firmly\\nunites the tooth to the filling, thus making a support to\\nthe frail walls as well as a stopping to the cavity. The\\namount of metal is reduced to just enough for a cover-\\ning of sufficient strength to guard the cement, and the tooth will not be\\ndiscolored by the amalgam, as is often the case in teeth of not very\\ndense structure, and especially in the mouths of young patients, when\\nnot thus protected.\\nThe combination of cement and amalgam, as described above for\\nLarge occlusal\\ncavity.\\nFig. 323.\\nSection showing\\namalgam and.\\ncement. (Sur-\\nplus cement\\nmust now be\\nremoved; then\\nfinish with\\namalgam.)", "height": "4552", "width": "2768", "jp2-path": "americantextboo00kirk_0355.jp2"}, "356": {"fulltext": "348 COMBINATION FILLINGS.\\nocclusal cavities, may be used in the same manner in simple approximal\\ncavities in the molars and bicuspids, and even in the six front teeth,\\nwhen the cavities are so situated that the amalgam does not show.\\nWhen used in the front teeth the cement should be allowed to remain\\nvery near to the edges of the cavity. The amalgam need not be\\nmore in amount at this point than the thickness of an ordinary\\nFig. 324.\\nCement and amalgam filling in an incisor. The surplus cement has heen removed and the fill-\\ning is now ready for the finishing portions of amalgam a, enamel b, cement c, amalgam.\\nvisiting card (see Fig. 324). For the front teeth very light colored\\namalgam should be selected, as color is of more importance than\\nstrength.\\nIn the temporary molars this combination can be used, frequently,\\nwith the greatest satisfaction, especially in those shallow approximal\\ncavities where but little undercut can be obtained without exposing the\\npulp. The cement should be used quite thin, and the amalgam worked\\ninto it with a burnisher, or rounded instrument, forcing the cement to\\na feather edge at the margins of the cavity. In cases of this kind resto-\\nration of contour should not be attempted, as the force of mastication\\nmight serve to fracture the cement and dislodge the filling. In this\\nmanner many troublesome and difficult cavities can be successfully\\ntreated, and teeth made to last their allotted time that would otherwise\\nbe prematurely lost.\\nIn Compound Cavities. A more extended description will be\\nnecessary for the treatment of compound cavities in the bicuspids and\\nmolars, especially where it is desirable to restore contour. In these\\ncases a matrix is often a necessity. There are many matrices that may\\nbe used successfully, but, as they are described in other parts of this\\nwork, only one need be mentioned here. This is selected on account of\\nbeing almost universal in its application. It can be made from any\\nmetal not acted on by the mercury contained in amalgam. German\\nsilver is inexpensive and seems to meet every requirement, and is,\\ntherefore, recommended. For ordinary use it should be from No. 35 to\\nNo. 38 gauge. If stiff it should be annealed, so as to be readily bent to\\nthe form of the tooth. It can be easily polished so as to reflect light", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0356.jp2"}, "357": {"fulltext": "CEMENT AND AMALGAM.\\n349\\ninto the cavity, by drawing a narrow strip of it between two pieces of\\nstationer s rubber (ink erasers). Place one piece of the rubber on a\\ntable, then the strip of metal held with pliers in one hand is placed on\\nthe cake of rubber, while with the other hand another piece of rubber\\nis held firmly down on the metal, which is drawn between the two until\\nsufficiently bright.\\nFor ordinary cases, a piece is cut from the German silver, as shown\\nin Fig. 325, A, wide enough to extend from the top of the tooth to a\\nlittle beyond the cervical wall of the cavity, and long enough to a little\\nmore than cover the cavity laterally when tied in place. Sometimes it\\nis necessary to make the matrix with a lip to extend under the gum, as\\nshown in Fig. 325, B, or in some other irregular form, so that it can be\\nFig. 325.\\nA, Matrix and ligature; B, lipped matrix.\\nmade to properly fit the cavity. Special cases may require a very wide\\nor a very narrow one. The operator s ingenuity must devise the right\\nshape.\\nFor tying the matrix to the tooth, coarse, well-waxed floss silk is the\\nbest. It is passed through the holes punched in the metal, as shown\\nin Fig. 325, A and B. When these holes are made, the edges must be\\nfinished smooth, or the silk will be cut when drawn tightly around the\\ntooth. The operator must use tact as to\\nFig. 326. how and where to make his knots in\\ntying on the matrix. Usually, a good\\nway is to place one end of the ligature, a,\\nbetween the teeth, then to make a sur-\\ngeon s knot, as shown in Fig. 326. The\\nother end of the ligature, b, is then forced\\nbetween the teeth, and the knot tightened.\\nThis will bring the knot between the\\nteeth and opposite the matrix and will hold the latter until it can be\\nshaped and bent into place with a burnisher or other suitable instru-\\nment. The knot is again tightened, and the two ends of the ligature\\ncarried to the back of the matrix and a similar knot tied there. The\\nsecond knot, when drawn tightly against the back of the matrix, forces\\nit closely up to the cervical border of the cavity, and makes a firm\\nresistance when the filling is being condensed. The silk is then wound\\nManner of ligating the matrix.", "height": "4556", "width": "2760", "jp2-path": "americantextboo00kirk_0357.jp2"}, "358": {"fulltext": "350 COMBINATION FILLINGS.\\nround and round the tooth and matrix until it nearly covers both, or at\\nleast sufficiently to insure its remaining in place during the operation.\\nA knot may be tied each time the silk is wound around the tooth, or\\nnot, as appears to be necessary. Sometimes, when the sides of the\\ntooth are sloping, the ligature has a tendency to slip off. This can\\nusually be overcome by turning back, with tweezers, the two upper\\ncorners, as shown in Fig. 331. To saturate the ligature with sandarac\\nor other sticky varnish will sometimes be sufficient to prevent the same\\ntendency.\\nFig. 327 illustrates a simple and delicate, but very powerful, little\\n-p IG 3 27 slip matrix which is of great efficiency\\nin the treatment of occluso-approximal\\n^p^ ^gg- jgg a_, cav ities. They were conceived originally\\n%-J 1|L\u00e2\u0084\u00a2J (CU iETI f\u00c2\u00b0 r ne plastics, in which case they are\\nleft in place over night (the plastics thus\\nsetting under pressure), slipping out easily the next day away from the\\nthen hardened and perfectly contoured surface of the filling.\\nThey are most easily made, even for each case (though in practice\\nthis is not necessary, as they may be employed over and over again),\\nas follows: Suitable-shaped pieces, of a size to a little more than over-\\nlap the cavity margins, are cut from thin steel, all corners\\n:and burred edges smoothly finished a tiny hole is punched close to\\nthe middle of both the buccal and lingual edges, and it is then laid\\nupon a piece of lead and swaged (not merely bent, be it remarked) into\\nperfect concavity, greater or less as the individual case shall require,\\nby tapping with a hammer a convex rod of hardened steel laid upon it\\nmy own instrument being a round-headed picture nail, case-hardened,\\npolished, and with twisted wire attached at right angles to a handle.\\nAny amount or shape of concavity required for each case can thus be\\nproduced in a moment, either newly from blanks kept ready or changes\\nmade in those used for other cases to fit the one in hand, about a\\ndozen of different sizes and degrees of convexity being sufficient to\\nselect from, with little or no changes for all ordinary cases. The\\ntapping having re-stiffened the steel somewhat, taken in connection\\nwith the impingement of the convex face against the approximal\\nsurface of the adjoining tooth, gives firmness and strength to these\\ndelicate little strips and a perfect hugging fit to the surfaces of the\\ntooth being filled, especially at its cervical margin, that is most\\nsatisfactory/ l\\nWhen the cavity involves a large portion of the crown, or the mesial\\n-and distal surfaces, the matrix should be long enough to almost encircle\\n1 Dental Cosmos, June 1898, vol. xl. No. 6, p. 452.", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0358.jp2"}, "359": {"fulltext": "CEMENT AND AMALGAM. 351\\nthe tooth, the ends nearly joining against the sound remaining wall (see\\nFig. 328). In such cases it may be desirable to slit it one or more\\ntimes, in order that it may be made to take the form of\\nthe tooth more easily (Fig. 329).\\nAfter the tying is completed, a suitably shaped bur-\\nnisher is used to form the matrix, by pressing it outward,\\nto a proper contour.\\nOne of the desirable features of the matrix here de-\\nscribed is the ease with which it is made to give just the\\nright shape and contour to the filling. When used for\\ngold fillings it yields enough so that with a little care in\\npacking the gold can be forced beyond the margin of the cavity suf-\\nficiently to insure a flush filling when burnished, after removing the\\nmatrix.\\nA matrix put on as described will have sufficient resistance for a gold\\nfilling; for amalgam, cement, or gutta-percha it\\nmay not be necessary to tie it quite so securely.\\nFor compound fillings of cement and amalgam\\ntwo methods, A and B, are here given.\\n7 -I -i -ii Matrix with marginal slits.\\nA. Those cavities which, although large and\\ninvolving much of the tooth, may have but small or comparatively small\\nopenings, especially if a matrix be used and there are but few cases\\nwhere the matrix is not advisable. If, after putting on the matrix, in\\nthis class of cavities, cement is introduced, and pieces of amalgam\\nthrust into it, the cement will most likely be carried to the margin of\\nthe cavity at the cervical wall, and it Avill be found, after removing the\\nmatrix and finishing the filling, that a part of the external portion is\\nof cement, and not being protected by the amalgam, would be washed out.\\nTo avoid this, a portion of the filling is made before the\\nmatrix is pat on. Cement is put in, followed immediately\\nby the amalgam as described for occlusal cavities\\nwith the added complication of the missing approximal\\nwall. After sufficient amalgam has been put into the\\ncement the portion of the latter which may have oozed\\nout must be carefully cut away, so as to expose the entire\\nouter edge of the cavity, including the cervical tvall (see Cement lining and\\nfe J 7 V amalgam.\\nFig. 330).\\nAfter this has been done, the matrix may be tied on and the filling\\ncompleted as though it were but a simple cavity. Sometimes it is well\\nto leave the matrix in place until the amalgam is fully set. If this be\\ndone, care must be taken that no sharp edge or corner of it be left to\\nwound the tongue or cheek.", "height": "4556", "width": "2760", "jp2-path": "americantextboo00kirk_0359.jp2"}, "360": {"fulltext": "352\\nCOMBINATION FILLINGS.\\nFig. 331.\\na, Matrix b, amalgam packed\\nagainst the matrix c, por-\\ntion of cavity to be nearly\\nfilled with cement and fin-,\\nished with amalgam.\\nB. Cavities with large openings. The rubber dam and matrix\\nhaving been adjusted, enough amalgam is packed\\nagainst the matrix to form a shell of sufficient\\nstrength to make the approximal wall of the\\nfilling (see Fig. 331).\\nThis will leave a large portion of the cavity\\nunfilled as shown in the figure in this space is\\nplaced cement, which is gently worked into the\\nsoft amalgam, but with care not to carry it\\nthrough to the matrix. Before the cement be-\\ncomes hard more amalgam is put in, the sur-\\nplus cement is removed, and the whole finished\\nto look like an entire amalgam filling, while in reality it is only a shell\\nof amalgam, perfectly fitting the outside of the cavity, cemented into\\nplace. If the walls of the tooth are frail, the cement will serve to\\ngreatly strengthen them. If, as some claim, large metal fillings alter\\nsufficiently under changes of temperature to fracture frail walls, the\\ndanger is by this method reduced to a minimum, as the amount of metal\\nis only just sufficient to give requisite strength.\\nThere is another class of cavities which may be described in this\\nconnection, presenting great difficulties in themselves,\\nyet, with this simple matrix, they are often easily\\nfilled. It is those cases where decay has reached the\\nalveolar border approximally, and extended on either\\nthe buccal or lingual portion of the tooth, or both, in\\nsuch a manner that the dam cannot be made to stay\\nbeyond the cervical border of the cavity. If a liga-\\nture is used, it will draw into the lateral grooves of\\ndecay and be of no use (Fig. 332).\\nThe mode of treatment is as already described,\\nwith the exception that the matrix is adjusted before the rubber is put on.\\nAfter the matrix is in place, it is but the work of a moment to put a\\nPalmer clamp on to the tooth, and slip the rubber\\ndam over clamp, matrix, and tooth. If the matrix\\nhas been carefully fitted there will be no trouble in\\nkeeping the cavity dry long enough for any ordinary\\noperation.\\nThere are certain buccal cavities, also, below\\nwhich it is difficult to retain the rubber dam. A\\nvery narrow matrix, adjusted with ligature and\\nMatrix and clamp clam P Fi g- 333), over which the rubber is placed,\\nadjusted, ready for w iH often greatly simplify the operation. Modifica-\\ndam tions of this method may also be applied to the\\nFig. 332.\\na, Alveolar line be-\\nyond which the liga-\\nture cannot be made-\\nto stay.\\nFig. 333.", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0360.jp2"}, "361": {"fulltext": "CEMENT AND GOLD. 353\\nbicuspids, and sometimes even to marginal cavities in the incisors and\\ncanines, with good results.\\nCement and Gold.\\nThis combination may be used, with but slight modification, in the\\nsame manner and in the same class of cases that have been mentioned\\nfor the use of amalgam and cement, cases under B excepted. The\\ncement is placed in the cavity, and, while soft, pieces of some of the\\nso-called plastic golds are put into it, in the same manner as has\\nbeen described for cement and amalgam the surplus cement is carefully\\ncut away, and, after waiting for that in the cavity to become\\nso hard as not to break or crumble under pressure, the pieces of gold\\nplaced in the soft cement are thoroughly condensed. For this pur-\\npose, de Trey s Solila Gold, Steurer s Plastic Gold, White s Crystal\\nMat Gold, and Watts Crystal Gold are recommended. The filling\\ncan then be completed with the same or any kind of cohesive gold.\\nCare must be taken to place a sufficient amount of the plastic\\ngold into the cement to make, when condensed, a solid foundation\\nupon which to build the rest of the filling. If too little gold has\\nbeen used, it will chop up and not make a secure union with the\\ncement.\\nIn some large cavities it may be found more convenient, after having\\nfilled the approximal portion with the cement and gold, to make a second\\nmix of cement for the rest of the cavity, into which the gold is put as\\nbefore.\\nIn some special cases it may be well to use foil in this manner, but,\\nas a rule, the plastic golds will be found preferable.\\nToo much stress cannot be laid on the desirability of this method\\nfor frail teeth, remembering always that the cement is the strengthening\\nand supporting medium. The mason would not build a bridge pier of\\ngranite alone, or a house of bricks without mortar. However nicely\\nthe blocks of granite or the bricks might fit each other, it is the cement\\nand the mortar that hold them together as in one piece.\\nEspecial attention is called to this combination of gold and cement\\nfor the six front teeth. In the teeth of young patients and teeth\\nof low-grade structure there are often found large cavities which,\\nif filled with gold alone, will in a few years, sometimes months, show\\ndiscoloration around the fillings. Filled as above described, every\\nvestige of decay having first been removed, a combination results which\\nis the ideal preservative filling as far as present knowledge and facilities\\ngo. Pulpless front teeth that are much decayed can be improved in\\nappearance and greatly strengthened by this method. Fig. 334 shows\\n23", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0361.jp2"}, "362": {"fulltext": "354 COMBINATION FILLINGS.\\na cavity in a central incisor that can be filled to advantage with cement\\nand gold. Fig. 335 shows a cavity in a central\\nFig. 334. Fig. 335. incisor with the pulp removed and but little of\\nthe -crown remaining but the enamel. The greater\\npart of the cavity has been filled with cement into\\nwhich plastic gold has been put and condensed.\\nThe filling can be completed with any cohesive\\ngold.\\nIn compound cavities in molars and bicuspids,\\na, Frail enamel walls; after the cement and gold have been put in, as\\n6, gold surface made by described for cement and amalgam J., and the\\nplastic gold condensed t i r r -i i -t i\\ninto cement. matrix adjusted, sojtjoiL can be used to great ad-\\nvantage at the cervical portion of the cavities, as\\nelsewhere described for using soft and cohesive golds.\\nAmalgam and Gold.\\nGold may be used in combination with amalgam A, by allowing\\nthe amalgam to become hard before adding the gold B, by adding\\nthe gold while the amalgam is soft and finishing the filling at one sitting.\\nA. Allowing the amalgam to harden and then adding* gold at a\\nsubsequent sitting will usually be done in compound cavities in bicus-\\npids and molars, for the purpose, principally, of overcoming the dark\\nappearance of the amalgam. For instance, a filling involving the occlu-\\nsal and mesial surfaces of an upper first molar will, in many mouths,\\nshow more or less, and, if of amalgam, be dark and unsightly. To\\navoid this, the cavity may be nearly filled with amalgam, leaving a\\nportion of the occlusal surface and along the buccal wall (this being the\\npart of the filling most likely to show) for completion with gold later.\\nThe matrix should be used as described for cement and amalgam\\nfillings. It is a good plan to leave it in place, when convenient, until\\nthe amalgam is hard. Before adding the gold, it should be ascertained\\nwhat part of the filling will show, and the amalgam trimmed and shaped\\nso that the gold may form that portion of the filling that will be in\\nsight. Fig. 336 shows a compound cavity in a molar partially filled with\\namalgam. The amalgam has been left until hard and the filling is now\\nready to be finished with gold. The figure also shows the cement\\nlining under the amalgam.\\nSuitable retaining places must be made in the amalgam to hold the\\ngold in position, as there is no union between the two in this case, as\\nthere is when gold is added to unset amalgam. The gold being added\\nmakes a filling much superior in appearance to one entirely of amalgam.\\nThe gold will also make a better wearing material for the masticating\\nsurface, having better edge strength than the amalgam, and therefore", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0362.jp2"}, "363": {"fulltext": "AMALGAM AND GOLD.\\n355\\nbeing less liable to be broken away from the walls of the cavity by the\\nforce of mastication, as spoken of elsewhere.\\nLarge amalgam fillings, when it is not necessary to have gold added\\non account of color, will be greatly improved if a channel is made with\\na small fissure bur between the amalgam and the enamel, and this care-\\nfully filled with gold (Fig. 337).\\nFig. 336.\\nFig. 337.\\nFig. 338.\\nOccluso-approximal cavity\\npartly filled with amal-\\ngam ready for completion\\nwith gold: a, a, amal-\\ngam b, cement lining.\\nAmalgam and cement com-\\nbination with channel cut\\nin occlusal margin for re-\\nception of gold a, amal-\\ngam; b, gold; c, channel\\nburred out ready for gold,\\nshows also cement lining.\\nGold and amalgam com-\\nbination in incisor: a,\\namalgam b, gold.\\nAll amalgam fillings when gold is intended to be added, should be\\nput in with soft cement, whenever possible, as described for Cement\\nand Amalgam fillings. This will prevent much of the discoloration\\nfrom the amalgam, as well as strengthen the teeth. Many front teeth\\ncan be saved and made to look well by filling with cement and amal-\\ngam, as before described, and, after the amalgam becomes hard, cutting\\naway that portion which is in sight, and filling with gold (Fig. 338).\\nB. Amalgam and gold fillings, the gold being added while the\\namalgam is soft. These fillings will be indicated, usually, in com-\\npound cavities of the molars, and in the occluso-distal and sometimes\\neven the mesial surfaces of the bicuspids. The amalgam will occupy\\nnot more than one-quarter or one-third of the approximal portion of\\nthe cavity, but sometimes in distal cavities of molars it may be good\\njudgment to have as much as three-fourths of that* portion of the fill-\\ning, amalgam.\\nNo operation requires greater attention to detail, or more neatness\\nof execution, than w 7 here gold is used in conjunction with soft amalgam.\\nIf chips of the unset amalgam are left around the matrix, or in the folds\\nof the rubber, or in any place where they may be caught up on the disk\\nor finishing strip and rubbed over the surface of the gold while the\\nfilling is being finished, they will give it a coating of mercury and injure\\nthe appearance of the work. On the other hand, if the method given is\\nfollowed carefully, no detail left out of account, no slovenly manipula-\\ntion allowed to pass for neatness and tact in handling the materials, the.", "height": "4556", "width": "2764", "jp2-path": "americantextboo00kirk_0363.jp2"}, "364": {"fulltext": "356 COMBINATION FILLINGS.\\nfillings can be finished as soon as the last piece of gold is consolidated,\\nwithout the least danger of mercury coating.\\nIn preparing the cavity for a filling of this kind, almost no tooth\\nsubstance has to be cut away simply to get access to the cavity, to prop-\\nerly start and pack the filling, as is often necessary if an entire gold\\nfilling is to be made. As a consequence, much valuable tooth substance\\nis saved, for, so long as the decay is removed and frail edge walls are\\ncut away, the amalgam can be perfectly packed, no matter how irregular\\nthe surface to which it is to be adapted. Of course, the excavation\\nmust be planned so that a filling of proper contour can be made, and\\nwalls cut back when by so doing future decay can be better guarded\\nagainst. There will be many cases encountered, however, where, by\\nthis method, much of a tooth structure can be left, whereas if gold\\nwere to be used it would be necessary to cut, often causing severe\\npain, in order that the part might be properly filled.\\nFor the purpose of describing a simple combination filling of this\\nkind, a cavity involving the occlusal and distal surface of an upper sec-\\nond bicuspid is selected as an example. In the first place, sufficient\\nspace must be secured for a filling of the right contour, and to allow\\nfor passing in a very thin strip for finishing the filling. It is best to\\nsecure this room by previous wedging. Space having been secured, the\\ncavity is prepared with proper undercuts, and the walls of the approxi-\\nmal part, to be filled with gold, made at as nearly a right angle to the\\nmatrix as possible. This is in order to facilitate packing the gold, it\\nbeing very difficult to obtain a satisfactory margin if the walls form a\\nvery acute angle with the matrix.\\nA matrix so adjusted that it will stand the pressure of putting in\\nthe filling without moving is an absolute necessity for this combination.\\nIt having been put on as described under the head of Cement and\\nAmalgam fillings (page 349), enough amalgam is carefully packed at\\nthe cervical wall to fill one-fourth or one-third of that portion of the\\ncavity. It should be thoroughly consolidated by using properly shaped\\ninstruments and sufficient force to drive it into every part of the cav-\\nity. It is a good plan to use small pellets of bibulous paper, forcing\\nthem against the amalgam with medium-sized instruments. The free\\nmercury which rises to the surface should be carefully removed. It is\\nwell to put in considerably more amalgam than is to be left, cutting\\nout the surplus, which method leaves a good surface upon which to\\nbegin with the gold. Before the gold is added, however, care should\\nbe taken to remove every chip of soft amalgam from the folds of the\\ndam, or any that may be clinging to the matrix, or in any position\\nwhere it might be brought in contact with the gold when finishing the\\nfilling. These chips will remain for a long time soft enough to coat", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0364.jp2"}, "365": {"fulltext": "AMALGAM AND GOLD.\\n357\\nthe gold with mercury if rubbed against it, Fig. 339.\\ntherefore they must be disposed of or an\\nunsatisfactory filling will be the result.\\nThe proper amount of amalgam having\\nbeen packed in the cavity, medium-sized\\npieces of some of the plastic golds before\\nreferred to are immediately added. The\\ninstruments used first on the gold should be as large as the\\ncavity will accommodate, as they will break it up less and\\nmore readily carry the piece where it is wanted, after which\\neach piece of gold should be thoroughly condensed with\\nsmaller instruments.\\nAs soon as the gold touches the amalgam it will absorb\\nmercury, and sometimes several pieces of the gold will be\\nentirely amalgamated. The surface of the filling will be-\\ncome very granular, and chop up to a certain degree as\\nthe first pieces of gold are used, and the instrument will\\ncause a peculiar squeaky sound as it is pressed against the\\nfilling. The condensation must be very thorough at this\\npoint of the work, or the filling will be porous and the union\\nbetween the amalgam and gold unsatisfactory. If the work\\nis thoroughly done, however, the filling will be just as strong\\nat this point as any other. As piece after piece of the plastic\\ngold is added, the mercury will soon cease to penetrate it,\\nand the surface become entirely gold. As soon as this stage\\nis reached, and no more mercury is visible, any kind of cohe-\\nsive gold can be used for the remaining portion of the filling.\\nFig. 339 presents some instruments that have been found\\nespecially useful in this work. The gold may be packed\\nwith hand or mallet pressure, or both.\\nAfter the gold is all packed the matrix is removed, and\\nthe filling finished with sandpaper disks, strips, burs, and\\nstones, in the ordinary manner. For finishing the amalgam\\nportion of the filling only fine disks or strips should be used.\\nThe amalgam being yet in a granular condition, and not\\nthoroughly hard, will be dragged from the edges somewhat\\nand made slightly imperfect if a coarse grade of sand or\\nemery paper be used.\\nThe gold will not break away from a filling made in\\nthis manner, even if there be no undercut in the tooth for\\nholding it the union with the amalgam will be quite suf-\\nficient to retain it. The cavity must have the proper shape,\\nGold-pack-\\ning instru-\\nments.", "height": "4548", "width": "2732", "jp2-path": "americantextboo00kirk_0365.jp2"}, "366": {"fulltext": "358 COMBINATION FILLINGS.\\nhowever, for holding in the filling as a whole, the same as if it were\\nentirely of gold or amalgam.\\nCases may occur where it does not matter whether the amalgam\\nand gold are firmly united or not then, instead of putting the plastic\\ngold into the amalgam, soft foil may be used against it in the manner\\ndescribed for the combination of Ci soft and cohesive golds (page 361).\\nHaving become familiar with the simplest form of fillings of amalgam\\nand gold, it will be well now to go a step farther, and take up some of\\nthe complications that constantly occur. Even the small amount of\\namalgam that is used will sometimes discolor a tooth slightly, especially\\nif the buccal wall is thin or if the tooth is not of very dense structure.\\nWhen there is danger of this discoloration taking place, it can be largely\\nprevented by placing a medium-sized pellet or fold of\\nFig. 340. foil, known as gilded platinum, against the buccal\\nwall of the cavity before putting in the amalgam. This\\nfoil being faced with platinum, which has but very slight\\naffinity for mercury, the amalgam can be consolidated\\nagainst it with little danger of discoloration following.\\nOn the mesial surface of bicuspids and molars it will\\na, Amalgam; b, not be enough, always, to put the gold and platinum foil\\ngold extend- gignmst the buccal wall more or less of the proximo-\\nmg on the x\\nbuccal side buccal surface of the filling being exposed to view i. e.\\nnearly to the t bidden by the tooth anterior to it\u00e2\u0080\u0094 it would look badly\\ngum margin. J J\\nif made of amalgam consequently, in these cases the\\ngold must be carried to the cervical wall, as shown in Fig. 340, the\\namalgam occupying a triangular space.\\nCement, Amalgam, and Gold.\\nThere are many teeth with very large cavities and frail walls, that\\ncan be rendered serviceable for years and made to look surprisingly\\nwell by the use of this triple combination. For instance, a molar or\\nbicuspid having lost its pulp and a large portion of its crown, and\\noccupying a conspicuous position, presents to the conscientious dentist a\\nserious problem. He knows that if filled with amalgam it will be an\\neyesore to every one by its unsightliness. If filled with gold it would\\ntake hours, and exhaust both patient and operator, and there would be\\nevery probability of the walls soon breaking away and the filling com-\\ning out, testifying to the poor judgment of the operator in recommend-\\ning such a filling under such circumstances. If filled with cement it\\nwill have to be refilled often, and with each refilling would more than\\nlikely be somewhat weakened. The loss of contour by the wasting away\\nof the cement will allow the tooth to change position, and its usefulness", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0366.jp2"}, "367": {"fulltext": "GUTTA-PERCHA AND CEMENT.\\n359\\nwill gradually be lost, and the tooth sacrificed because the dentist did\\nnot bring the requisite amount of knowledge and skill to his aid to\\nmeet the opportunity offered. It is in saving such teeth as these that\\nthe reputation of the dental profession for skill and usefulness is in-\\ncreased, and honor and gratitude are accorded to the men who can\\naccomplish it.\\nThe method of procedure will vary according to the size, shape, and\\nposition of the cavity. If small, a little amalgam can be put into the\\nsoft cement before putting on the matrix, as described for Cement and\\nAmalgam A, the surplus cement removed from the entire edge of the\\ncavity, the matrix adjusted, more amalgam put in, and gold added, as\\ndescribed for Amalgam and Gold.\\nIn larger cavities, involving more of the crown, after having filled\\nthe approximal portion of the cavity with the cement, amalgam, and\\ngold, cement should be put in a second time, into which plastic gold is\\ncarried, and the filling completed by building gold on to that which was\\nadded to the amalgam, and joining it to that which was put into the\\nsecond mix of cement.\\nIn still larger cavities, the matrix can be put on first, amalgam\\npacked against it to form the outer\\nshell of the approximal side, as\\ndescribed for Cement and\\nAmalgam B; cement is then\\nput into the body of the tooth,\\nand into this gold is pressed (not\\namalgam) and afterward added\\nto until it joins the amalgam,\\nthus completing the metallic\\nshell. From the specimen\\nshown in Fig. 341 the matrix has been removed\\nto better show the partially completed filling.\\nIt will be seen that the cement plays a very important part in this\\noperation. It will preserve the color of the tooth though it may have\\nbeen necessary to use a little of the gilded platinum, or to have the\\ngold extend to the cervical border of the buccal corner of the cavity\\nto support and bind firmly together the tooth and filling, yet it is pro-\\ntected from external influences which would destroy it. Fig. 342 shows\\nsection of a filling of cement, amalgam, and gold.\\nFig\\nFig. 342.\\na, Amalgam and gold to\\nform approximal shell\\nof filling; b, cement\\nand gold to which is\\nto be added gold to\\ncomplete the filling.\\nCement b, amal-\\ngam c, gold.\\nGutta-Percha and Cement.\\nThis combination is extensively used for what may be termed tem-\\nporary work, in the teeth of young patients, in teeth of poor quality,\\nand in badly decayed and frail teeth.", "height": "4552", "width": "2764", "jp2-path": "americantextboo00kirk_0367.jp2"}, "368": {"fulltext": "360 COMBINATION FILLINGS.\\nIt is generally believed that zinc phosphate will not last as well at,\\nor just under, the gum margin in approximal cavities as will gutta-\\npercha although exceptions might be taken to such a general rule. It\\nis the common custom to combine these materials, placing the gutta-\\npercha at cervical margins, using the cement for the occlusal and con-\\ntour portions of the filling.\\nThere is no doubt that fillings of these materials last much better\\nwhen inserted with considerable pressure, thereby condensing well and\\nmaking them solid. In accomplishing this, the matrix is of great\\nassistance. It not only allows force to be used on the material while\\nin a plastic state, but prevents its being crowded out of the cavity and\\nup into the gum, and leaves the filling in such condition that but little\\nshaping and finishing are necessary.\\nAny suitable matrix the one previously described in this chapter\\nis recommended having been adjusted, gutta-percha sufficient to fill\\nthe cavity a little below the gum margin is carefully packed into place\\nwith warm instruments. Sufficient heat must be used to make it\\nthoroughly plastic, but great care must be taken not to burn or overheat\\nthe material. If the gutta-percha is overheated its physical properties\\nand durability are very much impaired.\\nAll cavities where gutta-percha is used should be varnished with a\\nthin coating of white resin or Canada balsam dissolved in chloroform.\\nThis will prevent the dragging away of the gutta-percha from the walls\\nof the cavity in finishing, and will make the filling water-tight.\\nSufficient gutta-percha having been put in, the rest of the cavity is\\nfilled with cement. The matrix being in place and properly shaped, the\\noperation is reduced, practically, to that of filling an occlusal cavity.\\nIt is of great importance that the cavities be kept dry, consequently\\nthe, rubber dam should be used wherever it is possible to do so. The\\ncement should be kept dry for at least fifteen minutes after it is put in,\\nand then covered with varnish or vaselin to prevent the disagreeable\\ntaste due to its acid reaction, also to keep the filling for a still longer\\ntime from the saliva after the dam is removed.\\nCement will wear better if smooth and well polished. A fine glossy\\nsurface can be obtained with an oiled burnisher when the cement is at\\njust the right degree of hardness, i. e. when but slightly plastic.\\nA convenient method of oiling burnishers and other instruments for\\nplastic fillings is to place on the back of the third joint of the forefinger\\nof the left hand a bit of vaselin, half the size of a drop of water, just\\nbefore beginning to put in the filling. The instrument can be readily\\ntouched to this, and it quite does away with the necessity for an oil\\npad.\\nAn excellent lubricant for instruments used to manipulate gutta-", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0368.jp2"}, "369": {"fulltext": "GUTTA-PERCHA AND GOLD\u00e2\u0080\u0094VARIOVS KINDS OF GOLD. 361\\npercha or cement is cocoa butter. A small porcelain druggist s jar\\ninto which it has been melted is convenient to have on the operating\\ntable. Plastic fillings will rarely stick to instruments that have been\\nrubbed on cocoa butter. If a shaving of it is placed on a completed\\ncement filling it will instantly melt and flow over the entire surface,\\npreventing the disagreeable taste when the dam is removed, and will\\nkeep it from contact with the saliva for some time.\\nGutta-percha and Gold.\\nFor many years it has been the habit of some good operators to fill\\nthe interior of large cavities with gutta-percha, covering it with gold.\\nAlthough this may not be objectionable practice in some cases, it cer-\\ntainly cannot be recommended for general use. The principal objection\\nto it is the danger of frail walls being fractured by the subsequent\\nexpansion of the gutta-percha. So many instances have been noticed\\nwhere fracture has followed this combination that the fact seems well\\ndemonstrated that this danger exists. Again, there is no need of com-\\nbining these two materials when zinc phosphate, which is so much\\nbetter than gutta-percha for this purpose, is available and does not pos-\\nsess the dangerous quality of expansion attributed to gutta-percha.\\nGutta-percha and Amalgam.\\nWhat has been said in regard to gutta-percha and gold will apply\\nequally well to gutta-percha and amalgam. Rarely, if ever, can this\\ncombination be used to so good advantage as can zinc phosphate and\\namalgam.\\nVarious Kinds of Gold in Combination.\\n(A) The So-called Plastic or Crystal Mat Gold, with Other\\nForms of Gold. Within a few years, preparations of gold other\\nthan that known as foil, or foil made into cylinders, ropes, and so\\nforth, have been introduced and have become of great value in the\\nfilling of teeth.\\nThese golds are commonly known as plastic gold. The term is,\\nhowever, misapplied. The granular quality of these gold preparations,\\ni. e. lack of fiber, is what gives them their peculiar and, for certain\\npurposes, very valuable working qualities. To understand this charac-\\nteristic, take a piece of White s crystal mat gold and place it upon\\na piece of blotting paper, then press the point of a medium-sized gold\\npacker upon the centre. It will be observed that when the pressure is\\napplied the gold is not inclined to curl up, but rests in its flat posi-\\ntion, and the instrument has cut a clean track in the gold, condensing\\nonly that which is directly under the point. The gold being without", "height": "4568", "width": "2784", "jp2-path": "americantextboo00kirk_0369.jp2"}, "370": {"fulltext": "362\\nCOMBINATION FILLINGS.\\nFig. 344.\\nfiber/ so to speak, the particles not directly under the point are not\\ndrawn down as the pressure is applied. This is why this preparation\\nof gold is so useful for starting fillings.\\nNow take a cylinder made of gold foil, place it on blotting paper as\\nbefore, and with the same instrument press on the centre of it. It will\\nbe noticed that the instrument does not make a clean cut through the\\ncylinder, as was the case with the piece of mat gold, and, instead of\\nremaining flat on the blotting paper, it is inclined to curl up. The\\nfibrous quality of the foil is an advantage when a corner is to be built\\non to a tooth, or in any place where toughness of the material assists in\\nits manipulation.\\nBy using these golds for starting cavities, the peculiar qualities just\\nreferred to will be exhibited. For illustration, we will take an extreme\\ncase that of a shallow circular cavity in the buccal surface of a lower\\nmolar. This cavity is entirely without angles or undercuts, its walls\\nflaring outward, the bottom being flat,\\nor as nearly so as it can be made with\\na large bur (see Fig. 343). A piece of\\nplastic gold a little larger than the\\ncavity is placed in position, then with\\nFig. 343.\\na-i\\nRoyce plugging instruments.\\na flat, very slightly serrated instrument Fig. 339) it is carefully and\\ngently worked into place. When it is condensed about even with the\\nouter edge of the cavity, a smaller instrument is used to condense\\naround the edge. As only the portion of gold under the point is dis-\\nturbed, this can be done quite readily without dislodging the whole piece.\\nSoon sufficient force can be used to thoroughly condense the whole.\\nCare must be used in selecting a first piece that it be not too large, but\\nlarge enough, so that it will not chop up as it is being manipulated.\\nAfter getting the first piece in place, the filling can be finished with the\\nsame or any other preparation of gold. If of the same, it is well to\\nuse oval points (Fig. 344) and work the gold toward the sides of the\\ncavity with a sort of rotary motion, keeping the edges of the filling\\nhigher than the centre.\\nThis gold is very soft and takes a very sharp impression of the sur-", "height": "4604", "width": "2896", "jp2-path": "americantextboo00kirk_0370.jp2"}, "371": {"fulltext": "VARIOUS KINDS OF GOLD IN COMBINATION. 363\\nface on which it is packed, as shown by the cross lines on the filling, a,\\nFig. 343, which are reproduced from those made in the cavity shown\\nat b in Fig. 343. The lines across the bottom of the cavity were made\\nwith the sharp point of a hatchet excavator.\\nThis form of gold can be used to advantage, sometimes, at the cervi-\\ncal wall of compound cavities, provided a matrix has been tightly ad-\\njusted. For starting fillings in approximal cavities in the front teeth it\\nis sometimes invaluable, and it can be used in conjunction with any other\\nform of gold, or interchangeably. If at any point in a filling the oper-\\nator sees a place w T here he thinks he can put a piece of plastic gold\\nbetter than any other, there is no reason why he should not use it.\\nSometimes it is particularly useful to thrust into soft foil to make a sur-\\nface upon which to build cohesive foil.- It can be packed with either\\nhand or mallet force, and with smooth or serrated instruments.\\n(B) Non-cohesive and Cohesive Gold. Strictly speaking, non-\\ncohesive gold cannot be made cohesive by annealing, and can be used\\nonly on what is known as the wedge principle. Soft gold, as the\\nterm is generally understood, is non-cohesive when used without anneal-\\ning, but when annealed it becomes cohesive.\\nSoftness and toughness are the qualities necessary to make tight joints\\nbetween fillings and cavity walls, and good preparations of non-cohesive\\nand soft golds have these qualities. Consequently, a method that will\\nadmit the use of these golds against cavity walls with a sufficient amount\\nof cohesive gold added to insure strength and hardness, when strength\\nand hardness are necessary, is desirable.\\nAn exaggerated illustration of stopping a cavity watertight with soft\\nor cohesive gold is that of stopping a bottle tightly by using a velvet\\ncork or a piece of hickory. It can be done with the hickory, but the\\ntime required to do it perfectly, as compared with doing it with the\\nvelvet cork, is not unlike the difference between making a filling of soft\\nand one of cohesive gold.\\nSimple cavities, whether in occlusal or approximal surfaces, can often\\nt e half or two-thirds filled with soft gold in a very few minutes, and\\nthe rest of the cavity filled with cohesive gold. A filling made in this\\nmanner is as good as, or even better than, one made entirely of cohesive\\nfoil, and the time required to do it is much less, as the soft gold can, on\\naccount of its softness, be used much faster than can the cohesive. In\\ncavities of easy access the soft gold can be so manipulated as to be\\nagainst the walls of the cavity at every point. Small cylinders, or any\\nother form of soft gold, can be set around the edges, and the central\\nportion of the cavity filled with cohesive gold. Care must be taken to\\ncarry the cohesive gold into the soft with instruments not too large, so\\nthat a mechanical union between the two golds is effected, as but little", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0371.jp2"}, "372": {"fulltext": "364 COMBINATION FILLINGS.\\ncohesion can be had between soft and cohesive gold. In large cavities,\\nafter the first pieces of soft gold have been put in place and cohesive\\ngold worked in, the two kinds of gold can be used interchangeably. A\\npiece of soft gold can be placed against a portion of the Avail of the cav-\\nity, followed by a piece of cohesive, which is first attached to the cohe-\\nsive portion of the filling and then used to force the piece of soft gold\\nto its place. Dexterity and tact in using these two golds together can\\nonly be obtained by experience, and carefully noting the characteristics\\nexhibited under manipulation.\\nIn compound cavities soft gold pla} T s a most important part. Fill-\\nings in these cavities fail, usually, at the cervical wall, and too much\\ncare cannot be taken in making them at this place as nearly perfect as\\npossible. For this purpose it is now generally conceded that soft gold\\nis much better than cohesive.\\nA suitable matrix will greatly facilitate the operation and assist in\\nobtaining the proper contour. The thorough packing of the gold will\\nalso be much simplified if the cavity is so prepared that the walls form\\nno acute angles with the matrix, therefore attention to this point is\\nimportant.\\nA matrix having been properly adjusted the one described under\\nAmalgam and Gold fillings is recommended one-half or two-thirds\\nof the approximal portion of the cavity is filled with soft gold. For this\\npurpose soft cylinders, ropes, pellets, or mats can be used. Great care\\nmust be taken in condensing the gold that it does not tilt under the\\ninstrument. The pressure should force the matrix away from the tooth\\nenough to allow the gold to be condensed just a little over the edge of\\nthe cavity, so that when the burnisher is applied there will be sufficient\\ngold to make a flush filling.\\nWhen all the soft gold has been put in that the case will allow, the\\ncohesive gold should first be added in very small pieces in order to\\nfacilitate the driving of it into the soft gold, so as to make a strong\\nunion between the two. For this purpose very small cohesive cylin-\\nders or No. 3 or No. 4 foil will generally be used, but sometimes No*\\n30 or No. 60 foil or some of the plastic or crystal gold can be used.\\nThe filling can be finished with any cohesive gold, that kind being\\nselected which the operator has found by experience he can best manipu-\\nlate under the existing conditions. He will also remember, as the\\nwork goes on, that a piece of soft gold laid against an exposed wall,,\\nand backed up with cohesive, as before described, will do much toward\\nsecuring a good filling.\\n(C) Soft, or Cohesive Gold, and Heavy Gold. Fillings of soft\\nor cohesive gold, or a combination of the two, should sometimes be\\nfinished with heavy gold. Nos. 30, 40, 60, and sometimes No. 120,", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0372.jp2"}, "373": {"fulltext": "GOLD AND TIN\u00e2\u0080\u0094 TIN-GOLD. 365\\ncan be used to advantage. These heavy golds which are usually\\nrolled, not beaten make a very dense filling, and, when great strength\\nand hardness are required, they are preferable to lighter grades.\\nWhen a filling that is to be finished with heavy gold has been\\nbrought to the point where the thick gold is to be added, the surface\\nshould be as nearly level as possible, as it is difficult to adapt the heavy\\ngold to indentations and irregularities. The instruments used should\\nhave the very finest serrations, if any at all. The gold can be put on\\nby hand or mallet pressure, or by burnishing with oval points having\\nvery slight serrations, or with an ordinary burnisher. When done in\\nthis way the burnisher is apt to become gold plated, and the instrument\\nwill stick to and drag away the gold. When this happens the gold\\nplating can be removed from the steel by rubbing on a piece of ink\\neraser, or on flour-of-emery paper.\\nIn using heavy gold great care is necessary that no portion of the\\npiece added be left, uncondensed. Hard pressure must be applied to\\nevery part of the gold, or it will flake off and destroy the good appear-\\nance, if not the utility, of the filling.\\nGold and Tin.\\nCompound cavities are sometimes partially filled with tin and then\\nfinished with gold.\\nAt the present time it is a disputed question whether tin, if used as\\nabove suggested, will not be dissolved out, after a time, by the action\\nupon it of the fluids of the mouth, leaving a cavity.\\nIt can be used exactly as described for soft and cohesive golds, sub-\\nstituting the tin for the soft gold, or for a portion of it for, as a rule,\\nmuch less tin would be used than soft gold.\\nIf desired enough tin can be used to cover the cervical wall, followed\\nby sufficient soft gold to complete one-half or two-thirds of the filling,\\nthe final finish being of cohesive gold.\\nThe matrix will be found of the same service as in the case of soft\\nand cohesive gold.\\nTin-Gold.\\nThe term tin-gold has been applied to the combination of tin and\\ngold when a sheet of tin and a sheet of gold have been laid one upon\\nthe other, and rolled, folded, or crimped together, being then used in\\nthe same manner as non-cohesive foil, depending on the wedge prin-\\nciple for holding in the filling. Various authorities recommend differ-\\nent proportions of the tin and gold to be used in this manner. All the\\nway from one-quarter of tin to three-quarters of gold, i. e. the propor-\\ntion of one-quarter of a sheet of tin and three-quarters of a sheet of", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0373.jp2"}, "374": {"fulltext": "366\\nCOMBINATION FILLINGS.\\ngold to be folded or crimped together, to three-quarters of tin and one-\\nquarter of gold. A convenient way of preparing tin-gold for use\\nFig. 345.\\nFoil crimpers.\\nFig. 346.\\nCrimped tin-gold.\\nin medium-sized cavities is to take one-third of a sheet of No. 4\\ntin foil, upon which one-third of a sheet of No. 4 non-cohesive foil\\nis laid. It is then placed upon\\ncrimpers (Fig. 345) and drawn into\\nan evenly folded mass (Fig. 346).\\nThis is to be cut into lengths\\nsuitable to be used for the cavity in\\nhand. These pieces can be doubled\\nto make blocks, or rolled around a broach into cylinders, if desired.\\nFor larger cavities one-half, two-thirds, or even a whole sheet each\\nof the tin and gold foils can be used. For very small cavities, one-\\nquarter sheet of each may be sufficient.\\nIf it be a fact, as often claimed, that tin has peculiar preservative\\nqualities as a filling material, it will be best to so crimp or fold the\\ntin-gold that the tin will be on the outside, in order that it may be\\nplaced against the cavity walls.\\nTo obtain good results with this combination, it must be used with\\nthe same care and accuracy that are required for working gold. It is\\nvery tough and soft, and can be worked with great rapidity by an\\nexpert. For method of using see chapter on Non-cohesive Gold, and\\nwork tin-gold as there described for non-cohesive gold.\\nAfter a filling of tin-gold has been in for some time it will often\\nbe found to have changed in character, and instead of being a mass of\\nmalleable metal, as it was when put in, to have become hard and brittle,\\nclosely resembling amalgam, but, unlike it, will not stain or discolor\\nthe teeth.\\nTin-gold is recommended for use in the temporary teeth, in\\nocclusal and buccal cavities of molars, especially in teeth of poor qual-\\nity, and in the mouths of young patients. Small approximal cavities", "height": "4608", "width": "2896", "jp2-path": "americantextboo00kirk_0374.jp2"}, "375": {"fulltext": "AMALGAMS OF DIFFERENT QUALITY\u00e2\u0080\u0094 CEMENT AND ALLOY. 367\\nin all the teeth may be filled with it to good advantage, when located\\nwhere its dark color will not be objectionable.\\nTin-gold and Gold. Tin-gold can be used in connection\\nwith gold in the same manner as has been described for the use of tin\\nand gold, or soft and cohesive golds.\\nAmalgams of Different Quality in Combination.\\nFor certain amalgams is claimed a greater preservative character\\nthan is possessed by others. But on account of very dark color or\\nlittle edge strength l they may be undesirable for the surface of fillings,\\nespecially when contour is necessary, or when prominently exposed to\\nview.\\nIn simple cavities it is very easy to fill nearly full with the amalgam\\ndeemed best for its preservative qualities, and to finish with that having\\nsuperior color or edge strength as the case may require.\\nFor compound cavities fill about two-thirds with the first-mentioned\\namalgam, cutting away the surfaces and exposing the entire outer rim\\nof the cavity, as shown in Fig. 336. The matrix is then adjusted and\\nthe remaining portion of the cavity filled with amalgam having the\\nrequisite edge strength for contour work.\\nCement and Alloy.\\nMixing alloys (such as used for amalgam) with cement has been\\nrecommended to a certain extent. This can be done by adding from\\n25 to 50 per cent, of the alloy filings to the cement powder and then\\nmixing with the liquid, or the alloy may be worked into a thin mix of\\ncement.\\nThe object of the alloy is to protect the cement, in a measure, from\\nthe fluids of the mouth, thereby making the filling more lasting.\\nAnother combination of cement and alloy which has proved of con-\\nsiderable worth, especially where it is impossible to secure proper re-\\ntention for an ordinary amalgam filling, the combination having a very\\nstrong adhesive quality, is thus described by a well-known writer\\nOrdinary alloy should be used, and not the recently introduced\\nquick-setting varieties. On the mixing slab should be placed a quantity\\nof zinc oxid powder and a sufficient quantity of the liquid. Now mix\\nthe alloy in the usual way, but do not express the mercury, unless in\\nconsiderable excess, as a very dry mix is difficult to incorporate with\\nthe cement. Mix the cement as usual for use as a filling, and immedi-\\nately mix in about an equal quantity of amalgam, using a stiff steel\\nspatula. The white metal or bronze spatula should not be used, as it is\\nacted upon by the mercury. Now you have a stiff plastic mass, which.\\n1 See Chapter XIII. also writings of Dr. J. Foster Flagg.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0375.jp2"}, "376": {"fulltext": "368 COMBINATION FILLINGS.\\nmay be rolled between the thumb and finger into a convenient pellet\\nand placed entire in the cavity, pressing carefully to place with smooth\\nburnishers. A perfect contour may be built up without the aid of a\\nmatrix.\\nThe mixture is extremely adhesive to the dry cavity walls, and no\\ndefinite retaining shape is needed. Some of the amalgam may be saved\\nunmixed with the cement, and can now be burnished over the surface\\nof the combination filling, to which it adheres almost greedily, and thus\\na pure metallic surface, like a veneer, is given it which is as durable as\\nan amalgam filling. Or a quick-setting amalgam may be employed\\nfor the veneering.\\nIn color this combination is like amalgam, but is more granular in\\nappearance, and in its working properties resembles stiff cement. When\\nhard it takes on a metallic luster under the burnisher if sawed through\\nit shows a metallic surface. It is less soluble in the oral fluids than\\noxyphosphate cement, but less durable than amalgam alone, except when\\nveneered with amalgam as described.\\nIts advantages over amalgam are, first, its adhesiveness, which\\nproperty makes it applicable to cavities in which, for any reason, a re-\\ntentive form cannot be obtained secondly, the rapidity with which a\\nlarge cavity can be filled, a valuable item where dryness cannot be long\\nmaintained, and making it unnecessary to employ the rubber dam in\\nmany cases thirdly, the ease with which large contours may be made\\nwithout using a matrix.\\nIts advantages over cement are its greater hardness and durability,\\nbut it is less agreeable in color, hence should be employed only in the\\nposterior teeth.", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0376.jp2"}, "377": {"fulltext": "CHAPTEE XV.\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nBy Joseph Head, D. D. S., M. D.\\nStrictly speaking, the term inlay may be applied to any substance\\nplaced in a tooth cavity, but custom has restricted this term to fillings\\ninserted as one piece.\\nIn primitive times teeth were filled by driving a solid piece of lead\\ninto the cavity gum mastic was also used in the same way and the\\ngreen stone inlays in the central incisors of a human skull discovered\\nat Copan, Honduras, probably antedate all historical record.\\nBefore describing the construction of inlays it may be well to con-\\nsider their advantages and disadvantages for if they have no superi-\\nority over other fillings to counterbalance their inherent defects, inlays\\nare without excuse for existence.\\nLet us, therefore, first consider the main characteristics of the per-\\nfect filling and then by a comparative table of other filling materials\\nthe good and bad points of each may be justly examined.\\nThe characteristics of an ideal filling may be stated as follows\\n1. Resistance to wear of mastication.\\n2. Resistance to action of oral fluids.\\n3. Harmony of color.\\n4. Exclusion of bacteria, and preclusion from growth of those that\\nenter the margin.\\n5. Non-conductivity of heat.\\n6. Manipulation easy to patient.\\n7. Manipulation easy to operator.\\n8. Manipulation not destructive of healthy tooth structure.\\nBy a study of the table on page 370 cohesive gold will be seen to pos-\\nsess over all other materials the sole, though important, superiority of\\ngreatest edge strength and resistance to the crushing force of mastication.\\nTrue, it excludes bacteria from the cavity but experience proves that\\nif the edges of a cohesive gold filling begin to leak and admit micro-\\norganisms, the gold seems to be almost entirely lacking in the antiseptic\\npower possessed by tin, amalgam, gutta-percha, and the cements. And\\n24 369", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0377.jp2"}, "378": {"fulltext": "370\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nco\\nM\\nM\\nW\\nEh\\no\\nCO\\np\\nO\\nM\\no\\nCO\\nO\\ni\u00e2\u0080\u0094 i\\nH\\nCO\\nS\\nGO\\nw\\nhH 1\\nS3\\nChips at\\nedges crush-\\ning resistance\\nexcellent.\\n3\\ncp\\nOP\\nCP\\n03\\na\\nO^cS\\nsi\\n(XT\\ncu\\n3 o3\\n03\\nco\\nCP\\n-d\\nPh O\\nCP\\no\\n1\\na g\\nGO-C\\n0P.U\\nX O\\n03 fl\\nCP\\n.d\\nII\\nu\\nCO OP\\ndS\\nCD 03\\nft^\\nSoS\\n^3\\ne\\na,\\n1\\nto oS\\nS\u00c2\u00ab5\\nCO\\nCP\\nd\\nd\\n03\\n6\\nCP\\nC3\\nC3\\nSh\\nOS\\nCO\\nSi\\n^osd\\no\\no\\ncp\\na\\no\\no5\\nPh O\\ngbD\\nf3\\nO\\no\\nGO\\nCO\\n03\\nol\\ntH O\\nQJ-rH\\nSol\\nCP GO\\nGO\\nCP\\nCP\\nCP\\n3\\np\\nd\\n4H\\nO\\nS\\nd o\\nSPSS\\n\u00c2\u00a7g\\nsi\\n,d os\\nS- -H\\nco o\\nSh\\no\\no\\nft\\n,d\\nCO\\ncS\\nPh\\nd\\no\\no\\nbo\\nco\\n1\\n.2\\nCP\\no\\nCP\\no\\nti\\nCO\\nCP\\nd\\nd\\nCP\\n,s\\nr-H CP\\n83^2\\nPh\\nC3\\no\\na\\no\\nB\\ncu\\np C\\ngo-^2\\nO C\\np\\n^d\\n3 OP\\nS lo\\nPh\\nGO\\nOP\\na\\nd\\no\\nCO\\nCP\\n^3\\nd\\nCO\\nS\\nCP\\nFh\\nO\\n03\\nGO\\nGO\\nCU\\no\\nCP\\nC\\nSh\\noS\\nGO\\nCP\\nCP\\nCP\\n3\\n3\\nP\\n4o\\ne\\ncp\\nd\\nd\\nX\\ncp\\nCP\\no\\ns\\nCO OP\\n\u00c2\u00a7a\\n03\\nO\\nOJ\\n1\\nd\\nCP\\nFh\\n0)\\nd\\n5\\no\\nO\\n-OJh\\nS\\nS\\noj d\\n4h\\no\\np,\\nd\\nI\\nS\\nd\\nd+\\ncS oS\\nco co co\\nO) Q.CP\\nbJ0-r7bX3\\n3\u00c2\u00ab\\ns\\nto\\nco\\nD\\nd\\no\\nSh\\nSh\\no\\nO\\n_bo\\nP\\n03 T3\\nCP ca\\nC3\\n03\\n^3\\nSH\\nc\\no\\nO\\no\\no\\n03\\nCrQ\\nC n 0\\ncp CJO\\no\\n5?!\\nS 53\\nGO\\n03\\no\\nGO\\nd\\n03\\no\\nGO\\n4-9 Sh\\np oS\\n|1\\nc CI\\noS\\nCO\\nOP\\nCP\\ns\\np\\n8\\n11\\nbeg\\nO CP\\n-oil\\nbp\\nCP\\nd\\no\\n5\\nPh\\np\\nco\\nCP\\nrQ\\no\\nCP\\nC3\\n03\\n^3\\nd\\no\\n6\\nd\\no\\nco\\nCP\\nd\\n03\\nO\\nGO\\nd\\nCP\\ncu\\ncl\\nE3 go\\nftCP\\nCP CP\\nCP \u00c2\u00a3H\\nSh\\noS\\nGO\\nGO\\nOP\\n8\\nJ\\nP\\nl-H\\nbo\\nGO\\n03\\n^3\\nX\\ncp O\\nco o\\n3\\nft\\nfc\\no\\n1\\n1\\nt3 ap\\no\\n\u00c2\u00a38\\nJo\\nco\\no\\nCP\\n+3\\nS^\\nCP\\no\\nCP\\n5\\nfa\\n\u00c2\u00abP2\\nO^ o\\n^5 be\\n03 1\\nO o co\\n+J CP\\nGO CP i- 1\\n3\\nCP\\nd\\no\\nCP\\nd\\n42 Sh\\nB OS\\nd ap\\noS\\nCO\\nco\\nOP\\no\\n+3\\no\\ncu i 3 o\\no\\nc d\\nJ\\noS\\na\\n=*H\\no\\nOP\\npq\\nPh\\ne^\\n-o\\nO o\\nH^\\np\\nP\\nfc\\n1\\na\\n,4*\\n2 be\\n*\u00c2\u00a3.d\\no^ f\\ncS 33\\nCO Sh\\ncp cp 43\\npq-w CO\\nSh\\no\\nO\\nPh\\nCP\\n3\\nCP\\nCP\\ntn\\ncc*x3\\n.s|\\n^o\\n03 CP\\nP3\\n03\\nga\\n03 ^h\\nO C CP\\nII\\ncp c\\n3\\ngo\\nOP\\n,C\\n03\\nO\\ngo\\nd\\no\\nCP\\nr- 03\\n3 CO\\nftcu\\nOP CP\\nCP B\\nSh\\nOS\\nGO\\nOP\\nCP\\nCP\\n6\\n1\\n6\\n03\\n^2\\no\\nCP\\nCP\\n3\\n5 bx\\n08 r^\\nQ\\nCO\\ncS\\nS\\nO\\nCS\\ncp\\n3?\\nO\\no\\ncp\\nCP\\nO\\no\\nco\\nCP\\n8*g\\nCO CU jh\\ncp*? S\\n^*H S3\\ng C P\\nPh\\nol\\nOP\\nA\\no\\n_0P\\nft\\no\\nGO\\n03\\n03\\nOP\\nft\\no\\no\\nt\\nCO\\n03\\n03\\nO\\nO\\no\\nco i2\\nuS\\n^3 03\\nT3\\n3\\n3\\n3\\nCP\\nGO, Sh\\n?^3 cS\\nCV O GO\\nCP GO\\n2 ^O\\n83 \u00c2\u00abCP\\nCP^g\\n2^3\\nfe\\no\\ncp\\na\\ne\\niS\\nC3\\nC3\\np CP\\nPh\\nH\\nP\\nn\\nCP\\no\\nCP\\n3\\n.2\\nO\\ne\\nrO\\n5\\ns\\ncS\\nCO-rt\\ncp-*\\nd\\n.2 3\\nC3\\no\\na\\nCO\\nd\\no\\n03\\n.S 4\\nd\\nft\\n-JDt\\nan\\n3*3\\nOS\\nti d\\nc\\n03\\n03\\nAu^\\nIt 8LIJO\\n)AT\\nPh\\nP3\\nPh\\nS\\n-lor\\njjssp\\njBindxu\\nOil\\nT-l\\ntN\\noo\\nlO\\nGO\\nt\\nUOI\\nBK 8", "height": "4580", "width": "2904", "jp2-path": "americantextboo00kirk_0378.jp2"}, "379": {"fulltext": "INLAYS COMPARED WITH OTHER FILLINGS. 371\\nwhile it resists perfectly the action of the oral fluids, it so utterly lacks\\nthe other ideal attributes, as already enumerated, that with front teeth,\\nsoft teeth, and teeth of nervous patients its manifest disadvantages\\nmore than counterbalance its advantages.\\nSoft gold is open to the same objections, but it has the advantages\\nof resistance to wear, resistance to oral fluids, and, to a less degree,\\nexclusion of bacteria.\\nTin has to a marked degree the good and bad attributes of soft gold,\\nbut it turns black.\\nAmalgam bulges under mastication, chips on the edges, rusts, and\\nleaks; it prevents decay, however, through antiseptic action. When\\nrusty it is a moderately poor conductor of heat, it is easy of adap-\\ntation both for operator and patient, and calls for a manner of manipu-\\nlation that is conservative of healthy tooth structure. It is therefore\\noften available where gold is not.\\nOxyphosphate of zinc has all the advantages lacking in cohesive gold\\nwith the exception of color, and lacks all the advantages that cohesive\\ngold possesses. Its edge strength is solely due to its great adhesion.\\nIt wears under mastication, dissolves in the fluids of the mouth, and\\nusually absorbs bacteria but, on the other hand, it prevents the growth\\nof germs, is a non-conductor of heat, has better color than gold, is\\neasy of insertion for patient and operator, preserves weak walls, and\\ndoes not require undercuts.\\nThe same may be said of oxychlorid of zinc, except that it causes\\npain to sensitive dentin and exposed gums.\\nGutta-percha, in a similar way, with the exception of color, possesses\\nthe good points lacking in cohesive gold, and lacks the good points pos-\\nsessed by cohesive gold. It loses shape and wears under mastication,\\nhas feeble resistance to fluids of the mouth, has poor color, and leaks\\nmicro-organisms but, on the other hand, it inhibits from further growth\\nthe germs that enter, is a non-conductor of heat, is easy of insertion for\\nboth patient and dentist, and has a manipulation that tends to conserve\\nfrail though healthy walls.\\nWhen we come to inlays we have a filling in which the good points\\nof the cement are combined with those of amalgam, gold, or porcelain\\nin such a way as to insure the advantages of both in the largest degree,\\nand to reduce to a minimum the disadvantages of each.\\nWhen a cavity is lined with a thin zinc cement squeezed out by the\\ninsertion of soft amalgam, this amalgam afterward having as much as\\npossible of its mercury removed and the edges of the metal burnished\\nto the cavity margins, an inlay of amalgam is to all intents and purposes\\nmade. This treatment takes away from the amalgam three of its objec-\\ntionable features, conductivity of heat, lack of adhesion to the cavity,", "height": "4560", "width": "2804", "jp2-path": "americantextboo00kirk_0379.jp2"}, "380": {"fulltext": "372 RESTORATION OF TEETH BY CEMENTED INLAYS.\\nand discoloration of adjacent tooth structure, while the adaptation of\\nthe plastic metal to the tooth margins can be quite as perfect as though\\nno cement were used. So in using the principle of the inlay with\\namalgam three distinct advantages are gained without any counteracting\\ndisadvantages, all of which would seem to indicate that whenever possi-\\nble zinc cement should be used under amalgam.\\nWhen an inlay of gold is cemented into a cavity with oxyphosphate\\nof zinc all the advantages of cohesive gold and oxyphosphate of zinc are\\nobtained, excepting that a fine line of cement remaining at the margins\\nmay in time prove a source of weakness. Except in the fine line above\\nmentioned, such a filling compared with the ideal filling possesses ex-\\ncellent resistance to mastication and to the action of oral fluids, it has\\npower to restrain the growth of bacteria that may enter, it is a non-\\nconductor of heat, and is easy for the patient, while the manipulation\\ninvolves no greater labor or loss of tooth structure than is entailed in\\nthe use of cohesive gold. The two objections that can be raised against\\nthe filling are bad color and an edge protected by a soluble cement.\\nHence given a firm tooth structure that can bear the mallet without\\ndanger of being crushed, a dentin not sensitive to thermal changes,\\nand a patient not too severely prostrated by the necessary malleting a\\ncohesive gold filling is superior to a gold inlay, inasmuch as the cohe-\\nsive filling may have edges that perfectly exclude bacteria, even though\\nit has no antiseptic action. Though the inlay largely inhibits from\\ngrowth the germs that enter its margins, it nevertheless does allow\\nthem to enter and the filling that keeps out the germs entirely must\\nbe held superior to the filling that admits germs and then inhibits or\\ndestroys them. Unfortunately, in the soft, sensitive teeth of nervous\\npatients the manipulation of cohesive gold does not result in the exclusion\\nof decay germs. The tooth margins are powdered or weakened in some\\nway by the manipulation or apposition of the gold, and the entering\\ngerms cause rapid decay, the cohesive gold not having the antiseptic\\npower of restraining them. The thermal shocks, and the overwrought\\ncondition of the patient that sometimes lasts longer than can be avoided,\\nboth tend to produce unhealthy conditions of the mouth and consequent\\ntooth dissolution. In such a mouth the inlay is indicated, as the patient\\nshould not be made to undergo the malleting and since the germs of\\ndecay will probably enter under any circumstances, it is necessary to use\\na filling the action of which will inhibit or prevent their growth.\\nIn approximal cavities where the filling does not show, and where\\ngreat resistance to the percussive force of mastication is necessary, the\\ngold inlay is usually to be preferred. Its sole objection is .the fine line\\nof cement that connects it with the cavity walls but if the gold inlay\\nbe properly prepared, burnished, and finished as hereafter described,", "height": "4580", "width": "2904", "jp2-path": "americantextboo00kirk_0380.jp2"}, "381": {"fulltext": "PORCELAIN COMPARED WITH OTHER MATERIALS. 373\\nthis line of cement may be rendered so microscopic as to become prac-\\ntically no longer a source of danger. In other respects the gold inlay,\\nwhen not visible, approaches very nearly the requirements of the ideal\\nfilling, having the advantages of perfect resistance to mastication, pre-\\nclusion from growth of bacteria, non-conductivity of variations in tem-\\nperature, easy manipulation, firm adherence to cavity walls, and an\\nadaptation not usually so expensive to tooth structure as is the ordinary\\ninsertion of a gold filling.\\nWe shall now speak of the porcelain inlay, which in labial and buccal\\ncavities fulfills more nearly than any other the characteristics of the ideal\\nfilling. Such a filling may possess color that really matches the tooth.\\nIt may be set with a cellulose cement that almost absolutely resists the\\noral fluids. It excludes germs of decay and precludes from growth\\nthose that enter. A porcelain inlay is a non-conductor of heat, it\\nadheres to cavity walls, its manipulation is easy to the patient, and is con-\\nservative of tooth structure. The only real objection to labial porcelain\\nfillings is in the fact that great skill and patience are required in their\\ninsertion. Where, however, porcelain inlays have to withstand heavy\\nstrain in mastication, as in Figs. 370, 375, and 376, they are liable to chip\\non the edges, and thus to demand the use of oxyphosphate of zinc as a\\ncement. This objection, therefore, renders them somewhat less service-\\nable than gold inlays for non-visible approximal cavities in molars and\\nbicuspids. For while the porcelain is sufficiently strong to withstand\\nthe crushing force of mastication, the chipping of the margin tends to\\naccentuate the weakness already found in the solubility of the cement,\\nwhich is its sole defence against bacteria. If such chipping occurs on\\nthe masticating surface of the molars or bicuspids, the fractured mar-\\ngins can be readily filled with gold in such a way that edge strength\\nequal to gold is obtained. Also, if the edges of the inlays are painted\\nwith insoluble cellulose 1 before the filling is cemented into place, all the\\nstrength and adhesibility of oxyphosphate of zinc can be combined.\\nThus with care and patience the porcelain inlay acquires the advantages\\nof gold, cement, and porcelain, while it has none of the usual disad-\\nvantages. The porcelain filling properly guarded may have the natural\\ncolor possessed by no other filling material, strength to withstand masti-\\ncation, resistance to the fluids of the mouth, power to exclude bacteria\\nand to inhibit the growth of those that enter, non-conductivity of heat,\\nadaptation, and conservatism of tooth structure. And if at times the\\nmanipulation for the dentist is of necessity so deft and artistic that the\\nhighest skill and judgment are required, it is but further evidence that\\nthe finest work is usually the most difficult.\\nx The Doyle cement, a cellulose cement, is claimed to be permanent, and seems\\npromising, but only years of experience can prove its value.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0381.jp2"}, "382": {"fulltext": "374\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nThe Porcelain Inlay. The work of manufacturing and manipu-\\nlating porcelain inlays remains to be considered.\\nPieces of porcelain matching the natural tooth have, in times past,\\nbeen ground to fit the cavities and then held in position with cement.\\nThis class of work, however, is hardly feasible except in labial cavities\\non the surfaces of the front teeth. An excellent method for obtaining\\nFig. 347.\\na b c d e\\na, Defect at gingival margin b, cavity prepared c, mark of edge on tin foil d, tin foil cut out\\nand glued to artificial tooth e, piece of porcelain ground and cemented into the cavity.\\ngood adaptation is to proceed as follows A piece of tin-foil should be\\nlightly burnished over the prepared cavity, as in Fig. 347, b, and the\\nedges thoroughly outlined either with a burnisher or a plug of cotton\\nlightly pressed into the cavity, making the foil appear as in Fig. 347, c.\\nFig. 348.\\ne@99\\n0000\\nlOOOOOOOOoo\\nPOOOODOOIC8I0\\nPorcelain cavity stoppers.\\nThe foil within the line of demarkation is then cut out and glued to\\nthe surface of a piece of porcelain that matches the tooth, as in Fig.\\n347, d, the porcelain is ground away up to the edges of the tin on all\\nsides, and a moderately good fit is thus secured (Fig. 347, e). This\\nmethod, however, is superseded by recent discoveries but for those\\nwho are interested historically Fig. 347, illustrating the steps of the\\noperation, may prove of value. Ready-made porcelain inlays have been\\nkept in stock for years at the dental depots. These stoppings are of\\ndifferent shapes and sizes, and are intended to be ground to fit the cav-", "height": "4580", "width": "2920", "jp2-path": "americantextboo00kirk_0382.jp2"}, "383": {"fulltext": "THE PORCELAIN INLAY.\\n375\\nities and finally to be cemented in place (Fig. 348). Some, however,\\ninstead of being ground to fit the cavity, require the cavity to be\\nground to fit them. Dr. George H. AVeagant has devised a set of\\ninstruments suitable for this purpose (Fig. 349), consisting of five tre-\\nphines of consecutive sizes made of copper charged with diamond\\ndust. These instruments are intended to cut pieces of porcelain out of\\nan artificial tooth that matches the color of the natural tooth, and the\\ncavity in the natural tooth is prepared with one of Dr. How s inlay\\nFig. 349.\\nFig. 350.\\nm\\nDr. Weagant s diamond trephines.\\nDr. How s inlay burs.\\nFig. 351.\\nburs (Fig. 350) corresponding in size to the trephine. This method has\\nseveral serious objections, one of the principal being that in order to\\ngive the cavity a circular shape much sound tooth structure is usually\\nsacrificed. Take for example the decayed spot shown in Fig. 351, a.\\nThis would have to be enlarged as in Fig. 351, b,\\na very serious objection.\\nAs early as 1882 Dr. Herbst advocated glass\\nfillings. These were made by taking impressions\\nof the cavity in wax and making two moulds in\\nsome such material as plaster or asbestos. The\\nground glass was then flowed into the first mould,\\nin which most of the shrinkage occurred. The\\npartly formed filling was then removed and placed in the second\\nmould, when more glass was added until the filling was complete.\\nEven with this crude method the results were fairly satisfactory, although\\nthe margins were far from perfect and the glass was permeable to such\\nan extent as to blacken nevertheless, fillings were made that preserved\\nthe teeth for years.\\nIn 1887 Dr. C. H. Land made mechanically perfect edges possible\\nby devising the metal matrix. He used both gold and platinum, but\\nfound the latter preferable, as platinum could be adapted with a facility\\nequal to gold, and allowed the use of a high-fusing tooth body much\\nstronger and less likely to deteriorate than bodies capable of being fused", "height": "4556", "width": "2808", "jp2-path": "americantextboo00kirk_0383.jp2"}, "384": {"fulltext": "376\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\non gold, these of necessity requiring so large a percentage of glass that\\nthey, like the fillings of Herbst, lacked permanence of gloss and color.\\nFrom this discovery of Land dates all effective porcelain filling. Before\\nthis, pieces of porcelain had been ground to fit labial cavities, with\\nfairly good results, and pieces of enamel from extracted teeth had been\\ninserted in a similar fashion, but the accurate adaptation of porcelain to\\napproximal cavities as far back as the molars was impossible until the\\nmetal matrix was evolved.\\nAt present the advocates of porcelain fillings are represented by two\\ndistinct parties those who advocate a low-fusing porcelain that can be\\nmelted in a gold matrix, and those who advocate a porcelain of a fusing-\\npoint and resistance at least equal to Close s continuous-gum body,\\nFig. 352.\\n12 3\\nDiamond points, Nos. 1 to\\n4 5 6\\na, copper disk charged with diamond dust.\\nnecessitating the use of platinum for the matrix. It is claimed by the\\nadvocates of low-fusing porcelains that gold can be more perfectly\\nadapted as a matrix than platinum. This, if true, is a very important\\nadvantage. But, on the other hand, those advocating high-fusing\\nporcelains believe that they can get as perfect an adaptation with\\nplatinum as with gold, and that their porcelains have a better color,\\nare stronger, more durable, and more easily manipulated, thus giving to\\nthe work a far wider range than seems possible with any low-fusing\\nbodies yet devised, for porcelains seem to have strength and durability\\nin direct proportion to their fusing-points. In this connection we should\\nremember that when brilliant men of the past, through long series of\\nexperiments, were perfecting the process of continuous-gum work, they\\nwould undoubtedly have adopted the low-fusing bodies had they found\\nany that would melt on gold and remain permanent. That they\\nfinally resorted to platinum and made durable porcelain bodies at their\\npresent fusing-points would seem to indicate that low-fusing porcelains", "height": "4580", "width": "2904", "jp2-path": "americantextboo00kirk_0384.jp2"}, "385": {"fulltext": "THE PORCELAIN INLAY.\\n377\\nare unable to withstand the solvent action of saliva and the force of\\nmastication.\\nThe preparation of the cavity for either high-fusing or low-fusing\\nporcelains is identical. The cavities should be free from undercuts. If\\nFig. 353. Fig. 354. Fig. 355. Fig. 356. Fig. 357. Fig. 358.\\nthese are unavoidable through extensive decay, the cavity should first\\nbe filled with oxyphosphate of zinc. The edges should be sharp and", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0385.jp2"}, "386": {"fulltext": "378\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nsmooth, and where they are approximal there must be sufficient separa-\\ntion to allow the metallic matrix, or mould, to be withdrawn without\\nFig. 359.\\nA, Outline of labial cavity B, platinum foil large enough to be readily held immovable by the\\nfirst and second fingers during the formation of the matrix.\\ndistortion, as success is impossible with a distorted matrix. The final\\npolishing can be best accomplished with a set of diamond points (Fig. 352).\\nFig. 360.\\nA, Outline of cavity in distal aspect of lateral incisor B, platinum folded over cutting edge to\\ninsure immobility and to give outlines of tooth so that a perfect contour of porcelain may be\\nobtained.\\nThe separation may be obtained with rubber, cotton, or tape. Approx-\\nimal cavities between front teeth may be sometimes advantageously cut", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0386.jp2"}, "387": {"fulltext": "THE PORCELAIN INLAY.\\n379\\nfreely away from the back, as in Fig. 374, a, b, c, d. When the\\nfillings are between bicuspids the palatal or lingual walls should be cut\\nunsparingly whenever it is necessary. Where the filling is to stand the\\nforce of mastication the edges of the cavity should be at least at right\\nangles to the grinding surface, as in Figs. 370 and 375. The prepara-\\ntion of the cavity being completed, if high-fusing porcelain is to be\\nused the matrix must be made with rolled platinum one one-thousandth\\nof an inch in thickness. If found desirable, thinner platinum may be\\nused for small cavities but the firm burnishing required usually re-\\nduces the foil of one one-thousandth of an inch to one three-thousandth\\nFig. 361.\\nA, Cavity in anterior approximal surface of first molar.\\nor one four-thousandth of an inch on the margins, where excessive\\nthickness of the metal is objectionable. Foil thinner than one one-\\nthousandth of an inch seems to lack sufficient body to stretch properly\\nwithout tearing. This platinum, if annealed in a Bunsen burner or\\nblowpipe, will be harsh and unfit for use, but when annealed in a muffle\\nor electric furnace it becomes soft and tough. The platinum is placed im-\\nmovably over the cavity and spun into all parts with a ball burnisher\\n(Figs. 353 and 354), great care being taken to define the edges sharply\\nand smoothly. The edges that wrinkle may be flattened and smoothed\\nwith the broad surfaces of the spatula shown in Fig. 356. Should the\\nbottom tear, it is of little moment as long as the edges are smooth and\\nintact. Sometimes it is useful to form the matrix by driving the metal", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0387.jp2"}, "388": {"fulltext": "380\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\ninto all the recesses with cotton but while this is undoubtedly of\\nadvantage in some instances, the careful spinning of a piece of foil\\nfrom the edges to the cavity floor will generally give the best results.\\nThe soft, unburnished platinum takes a beautiful impression, but when\\nthe metal has been burnished it becomes elastic if therefore the matrix\\nbe moved during its formation, an accurate impression is impossible,\\nfor the elastic platinum when distorted cannot be forced back accurately\\ninto position until it has been reannealed. When complaint is made\\nFig. 362.\\nJ, Posterior\\nipproximal cavity in second bicuspid B, edge of platinum extending over first\\nbicuspid to insure mobility.\\nagainst platinum by the advocates of gold matrices it probably arises\\nfrom the fact that they try to work the platinum in the same manner\\nas gold.\\nThe matrix when finished should be carefully removed and heated\\nto redness in order to destroy all organic material, as such material will\\ntend to destroy the true shade of the porcelain.\\nIn labial cavities the piece of platinum should be cut sufficiently\\nlarge to extend beyond the two adjacent teeth, and the metal should be\\nmoulded to the three teeth by pressure with cotton and bibulous paper.\\nThe metal is then held firmly upon the two adjacent teeth by the first\\nand second fingers, as in Fig. 359, when the general directions for adjust-\\ning the matrix to the cavity may be readily carried out. The large\\npiece of platinum has two great advantages it conduces to immobility", "height": "4612", "width": "2900", "jp2-path": "americantextboo00kirk_0388.jp2"}, "389": {"fulltext": "THE PORCELAIN INLAY.\\n381\\nof the metal during the formation of the matrix, and it gives the entire\\nlabial form of the tooth, so that an accurate idea may be obtained of\\nthe desired contour of the filling.\\nIn corners of centrals, as in Fig. 360, the platinum should be folded\\nwell over the labial and palatal surfaces of the tooth then it should\\nFig. 363.\\nA, Outline of approximal cavity B, flap of platinum that had been cut away and turned back to\\nfacilitate the removal of the matrix.\\nalso be bent over the cutting edge, forming a sort of cap, beneath which\\nshows the entire contour of the tooth, and by means of which entire\\nFig. 364.\\nA, Outline of cavity as formed in platinum matrix B, clamp holding platinum immovable while\\nthe matrix is being burnished into place.\\nimmobility may be obtained while the cavity margins are being defined\\nand the matrix formed.\\nThe same principle applies in forming a half cap from a large piece\\nof platinum for the approximal cavities of bicuspids and molars. The\\nplatinum should extend, as in Figs. 361 and 362, from grinding edge to\\ncervical margin, and along the sides of the adjacent tooth. This can be", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0389.jp2"}, "390": {"fulltext": "382\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nfirmly held with the index and middle fingers of the left hand, while\\nthe right hand presses the metal with cotton partly into the cavity. The\\nmargins and floor of the matrix may then be defined with a burnisher.\\nIn mesial cavities the metal must be pushed away from the operator\\nand the work accomplished by means of the index and middle fingers,\\nas in Fig. 361. In distal cavities the metal is pulled toward the oper-\\nator, who works around and beyond the hand, holding the platinum as\\nin Fig. 362.\\nWhen, as sometimes occurs, the adapted platinum is dovetailed\\naround the teeth, so as to render its removal difficult or impossible with-\\nFig. 365.\\nPosition of fingers left lower bicuspid.\\nout distortion, the outer edge of the platinum cap may be split with a\\nsharp knife from the gum line, just beyond the cavity margins, as is\\nshown in Fig. 363. Fig. 364 shows a method of obtaining immobility\\nof the matrix by a clamp that sometimes proves useful. Figs. 365\\nand 366 show the position of the fingers when manipulating the\\nmatrix on the lower teeth. This, of course, should be done while the\\nmatrix is held motionless in the cavity. It is sometimes advisable, in\\norder that perfect immobility may be obtained, first to pack the matrix\\nfull of bibulous paper or cotton. When this is done and the packing", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0390.jp2"}, "391": {"fulltext": "THE PORCELAIN INLAY.\\n383\\nremoved there will be no difficulty in teasing out an undistorted matrix\\nfrom the cavity.\\nThe color of the filling must next be decided by means of a shade\\nring. The basal color of nine-tenths of all porcelain fillings is light\\nyellow, and white added according to necessity will in a large number\\nof cases be all that is required to obtain a perfect match. Whatever tint\\nis desired, the basal color should be first ascertained, when the correct\\ntoning material may be added with comparative ease. The thoroughly\\nmixed body, being wet with distilled w r ater and dried with blotting-paper\\nto the consistence of dough, is placed in the matrix on the point of the\\nbrush or spatula (Figs. 357 and 358), and settled to the bottom with a\\nfew taps on the pliers that hold the platinum. The porcelain should not\\nFig. 366.\\nPosition of fingers right lower bicuspid.\\nbe allowed to come quite to the edge. After it has been carefully dried by\\nturning it face downward on a piece of soft muslin, the filling is placed\\nin an electric or gas furnace, as the case may be, and baked until a gloss\\nappears. It is then removed, cooled, and placed again accurately in the\\ncavity, and the edges once more burnished down.\\nThis second burnishing is the most important part of the operation,\\nfor however perfect the first adaptation may have been, the edges must\\nof necessity be warped in the furnace by the unequal expansion and\\ncontraction of the porcelain and platinum. This contraction having for\\nthe most part occurred, a second burnishing makes an adaptation that\\nmay be practically perfect. The partially filled matrix must then be\\nremoved, filled up to the edges with porcelain paste, and finally baked.", "height": "4556", "width": "2804", "jp2-path": "americantextboo00kirk_0391.jp2"}, "392": {"fulltext": "384 RESTORATION OF TEETH BY CEMENTED INLAYS.\\nA third addition of porcelain may be needed, but this is usually unnec-\\nessary. After baking, the filling may be taken from the furnace almost\\nimmediately, as practically only very large pieces need to be cooled\\nslowly, although theoretically a gradual cooling will make the porcelain\\ntougher. The platinum should now be stripped off, care being taken\\nto pull it away from the edge. Should it be pulled off toward the edge,\\nchipping is likely to occur. If small portions of platinum stick to the\\nporcelain, they can be peeled off with a sharp, tempered, pointed\\ninstrument.\\nThe filling is now ready for insertion. Undercuts may be carefully\\nmade in the cavity and grooves made in the porcelain, by using a thin\\ncopper disk (Fig. 352, a) charged with diamond dust, so as not to mar\\nthe edges. This is usually, if the proper method is employed, a safe and\\neasy procedure with the smallest fillings. The disk and porcelain must\\nbe kept thoroughly wet during the cutting of the grooves. The inlay\\nshould be so held that the edge adjacent to the intended groove may be\\nburied in the skin of the finger the groove can then be fearlessly made\\nby the swiftly revolving disk that cuts only the hard porcelain and\\npushes back the yielding tissue of the finger without inflicting injury.\\nIf the porcelain is blackened by the powdered copper, the discoloration\\nmay be readily removed by a strong jet of water thrown upon it. If,\\nhowever, the undercuts are not deemed feasible or sufficient, the gloss\\nfrom the under side should be removed with a sandpaper disk or with\\nhydrofluoric acid. For etching with the hydrofluoric acid the following\\nmethod should be pursued The face of the filling should be imbedded\\nin a piece of soft base-plate wax, leaving free the porcelain that is to\\nenter the cavity. A drop of hydrofluoric acid is then placed upon the\\nporcelain and left there for about five minutes, when wax and porce-\\nlain may be washed in water and the filling removed from the base\\nplate. The under side will be frosted and the cement will adhere to it\\nfairly well, but not so well as though efficient grooves had been obtained.\\nThe filling and the cavity should next be washed in alcohol and\\nthoroughly dried. The rubber dam may often be put on with advan-\\ntage just before the filling is inserted, although the thorough dryness\\nof the tooth thus obtained will at first tend to make the filling appear\\ntoo dark.\\nIn a buccal or labial cavity, where no force of mastication is to\\nbe withstood, the transparent cellulose cement may be advantageously\\nused. If this cement proves to be durable and sufficiently adhesive it\\nwill be a great desideratum, for a translucent insoluble cement is the\\none thing lacking to make porcelain fillings practically perfect; but\\ngreat care should be observed in its use. The dried cavity, well under-\\ncut, should be filled with the cement. The cement should then be", "height": "4580", "width": "2820", "jp2-path": "americantextboo00kirk_0392.jp2"}, "393": {"fulltext": "THE PORCELAIN INLAY. 385\\npainted all over the under side of the porcelain filling, so that the under-\\ncuts may be well filled. These coatings should then be allowed to dry\\nto the consistence of a thick jelly, when the filling is put into the cavity\\nand ironed into place with a hot instrument. The cement sets hard\\nonly through evaporation of the solvent, and if the filling is too soon\\ninserted it will act as a stopper, preventing the hardening of the cement.\\nWhere great strain is brought to bear upon the filling, or where the\\ncavity is not deep enough to warrant the use of any but the most\\nadhesive cement, oxy phosphate of zinc should be used. The rubber\\ndam should be applied wherever practicable. The filling and cavity\\nshould be carefully undercut and dried in alcohol. Creamy, slow-set-\\nting oxyphosphate of zinc, corresponding in color as nearly as possible\\nto the tooth, should then be placed in the cavity, and the filling, picked\\nup by means of a little cement on the spatula, be pressed home. The\\nporcelain should be held in position for a minute or two until the oxy-\\nphosphate has lost its elasticity for, however perfectly the porcelain\\nfilling may have been fitted, if it does not go accurately into place the\\nedges will be as imperfect as though an ill-adapted matrix had been\\nused. As before mentioned, a creamy, slow-setting cement is essential,\\nand up to the present time the Harvard cement seems best to satisfy\\nthese requirements. When the filling is finally in position the setting\\nof the cement may be hastened by a blast of hot air or a hot instru-\\nment applied to the porcelain. When the cement is wiped away and\\nthe tooth cleaned, paraffin or varnish should be flowed over the filling,\\nin order that the cement may set for six hours before it is exposed to\\nthe action of the saliva. On the following day the edges may be\\nground with an Arkansas stone or polished with sandpaper. It is\\nbetter for finishing that the edges should be a little too low than too\\nhigh. If, however, the porcelain is too high it can be ground down\\nand still give good results but the original gloss is in most cases to be\\npreferred. Having described the general operation of putting in a\\nporcelain filling, a few cautions may not be out of place before describ-\\ning the special operations.\\nA filling smaller than a pinhead should not be attempted, as good\\nedges can hardly be obtained. Simple circular cavities without com-\\npound curves in the margin frequently require only one burnish,\\nespecially if they be small, as the contraction of the fused porcelain is\\noften less than the probable personal error of the operator.\\nLabial cavities should be made deep if good color and adhesion are\\ndesired. A bar of porcelain running into the tooth makes a much\\nstronger anchorage than a platinum pin, as the platinum may stretch\\nand it always tends to weaken the substance of the body.\\nIn large contours excessive contraction may be avoided by adding one\\n25", "height": "4564", "width": "2792", "jp2-path": "americantextboo00kirk_0393.jp2"}, "394": {"fulltext": "38 6 RESTORATION OF TEETH BY CEMENTED INLAYS.\\npart in four of a colorless high-fusing powder to that part of the mixed\\nenamel which is to be used for the first baking. The unfused particles\\nextend across the matrix in every direction, making what is practically\\nan internal investment. The slight lightening thus occasioned is\\nentirely overcome by the second coat, and the proper contour is obtained\\nin fewer bakings. When handling small fillings, the pliers and cavity\\nmay be advantageously kept wet up to the time of insertion, as capillary\\nattraction will prevent the filling being dropped and lost. To place a\\ntiny filling on the operating-case in the same relative position that it\\nwill take in the tooth prevents mistakes as to which side should go in\\nfirst.\\nIn addition to the classification labial, buccal, approximal, contour,\\netc. porcelain fillings are to be considered in regard to their position\\nin the mouth, viz. fillings that keep their color when cemented into\\nplace, and those that will be darkened by the consequent shadow. Unless\\nthese classifications are understood, many a well-matched porcelain inlay\\nwill end by appearing dark and unsightly in the mouth. Color varia-\\ntions are met similar to those that are seen upon examining a piece\\nof window-glass. The surface may be nearly colorless while the edge is\\ndark green. The color of porcelain fillings is dependent upon the per-\\nfection with which the light is reflected to the eye of the observer. For\\ninstance, in a perfect light, yellow porcelain is yellow, because all of the\\nother rays that make up light are absorbed and only the yellow are\\nreflected to the eye. If the light be gradually decreased, fewer yellow\\nrays will be reflected, and the color will become darker when there is\\nno light reflected the porcelain will appear black. The more perfect the\\nfront and side lights in porcelain fillings the less will be the shadow\\nvariations in color. Take, for example, a simple labial cavity, as illus-\\ntrated in Fig. 367. If this extend into the dentin sufficiently deep to\\nprevent the color of the oxyphosphate of zinc or of any other cement\\nshining through it, the correct color of the porcelain will be given.\\nIf, however, we place this well-matched material on the approximal\\nsurface of the tooth, as in Fig. 368, with an adjacent tooth shutting\\noff direct reflection, and thus allowing only indirect rays to meet the\\neye of the observer, the color will be lost in shadow, and from having\\nbeen a perfect match, or nearly so, the shade will assume a dull lead\\ncolor. Also, if in Fig. 367 the labial cavity should penetrate entirely\\nthrough the tooth, through the palatal enamel, the inlay would present\\na problem of almost insurmountable difficulty for nearly all of the\\ndirect rays would pass through it and would be lost in the shadows\\nof the mouth, while the side lights would be shut off by the non-\\ntransparent but necessary zinc cement. This difficulty may be over-\\ncome by placing two fillings, one on the palatal and one on the labial", "height": "4612", "width": "2840", "jp2-path": "americantextboo00kirk_0394.jp2"}, "395": {"fulltext": "THE PORCELAIN INLAY. 387\\nsurface. The oval inlay running through the entire tooth substance is\\nmentioned only as an illustration of the greatest amount of color varia-\\ntion to be met with and the nearer that a porcelain inlay approximates\\nto this condition the greater will become the tendency of the color to\\nbe lost in shadow.\\nTake, for further example, the two fillings shown in Fig. 369. In\\neach illustration the fillings go evenly through the labial and pal-\\natal walls of the enamel, and yet if both fillings are made of material\\nthat matches the tooth substance the corner inlay will look well, while\\nthe halfmoon-shaped filling will be dark. If, however, b does not go\\nthrough the palatal wall and the cement extends entirely behind it, its\\ncolor will be nearly, if not quite, as good as that of the corner, it\\nhaving almost assumed the classification of the simple labial cavity\\nbefore mentioned. The difference in the shades of these two fillings\\nmay be explained as follows The corner (a) is illuminated by side\\nlight from the cutting edge, while the halfmoon-shaped filling (b) is\\nshut in on four sides, on three by cement and on the fourth by the adja-\\ncent tooth. It must be further noted with reference to the corner (a),\\nFig. 367. Fig. 36S Fig. 369.\\nY\u00c2\u00bb r\\nthat if it is looked at from directly in front, or from the direction of\\nthe arrow X toward the cement, the color will be good if, however,\\nit is looked at away from the cement, as indicated by the arrow Y, the\\ncolor will be lighter or darker according to the intensity of the light\\nbut the true color will not be seen. This, however, is not a serious\\nobjection, as the filling is usually seen from directly in front, and the\\noccasional side views are equally divided between good and bad lights.\\nWe may, therefore, feel that a corner inlay which does not include\\nmore than a third of the tooth s cutting edge is an inlay favorable to\\nthe obtaining of a good match. Buccal fillings in bicuspids and molars\\nare as easily matched as the simple labial cavities, for they come under\\nthe same conditions of light reflection but all approximal inlays, from\\nthe posterior surface of the canines back to the molars, show the same\\nfalling off in color, and unless allowance be made for this falling off\\ndisheartening results will be the outcome of otherwise careful work.\\nThe greater the slope of the cavity floor into the mouth the greater\\nwill be the shadow variations, as in Fig. 374 the greater the slope out-\\nward the less will be the shadow variations.", "height": "4568", "width": "2788", "jp2-path": "americantextboo00kirk_0395.jp2"}, "396": {"fulltext": "388 RESTORATION OF TEETH BY CEMENTED INLAYS.\\nThose not affected are simple labial cavities, corners of centrals and\\nlaterals, cusps of canines, bicuspids, and molars.\\nThose most affected are tips of centrals and of lateral incisors, and\\napproximal and halfmoon-shaped cavities running through the palatal\\nenamel. The broader the adjacent teeth the greater will be the shutting\\nout of light and the consequent darkening of color. Tips of central and\\nlateral incisors running entirely across the tooth are so subject to the\\nshadow variations from cross light, side light, top light, and bottom\\nlight, that the restoration of more than a third is not advisable. When\\nhalf of a tooth has been carefully matched and cemented into place, the\\ntip may look very well in good daylight, but at night it may turn\\ndark also in an artificial light shining from above the tooth and\\ncement line show very dark while the porcelain seems snow-white. In\\nall such cases, whenever possible, a portion of the tooth should be\\nallowed to run down to the cutting edge.\\nAnd now let us consider how we may partly conquer these shadow\\nvariations. Halfmoon-shaped cavities, as in Figs. 368 and 369, may be\\nfilled on the palatal wall with gold, an absolute match thus being made\\npossible. A porcelain tip may be built up as two corners, to avoid the\\nside lights but generally all attempts to antagonize shadow variations\\nwill result in an effort to lighten the fillings, so that the shadows\\nwill be overcome. This lightening is now quite possible, for experi-\\nments indicate that an addition of from one-tenth to one-fifth of oxid\\nof tin to the ordinary white enamel gives a white so dense as to be\\npractically the reverse of shadow. If, therefore, we have a filling half-\\nmoon-shaped or approximal, we should first match the porcelain tooth\\nas though it were a simple labial cavity then by adding to this paste\\none-fourth to one-third of the dense white powder mentioned above\\nwe shall find that, if the colors have been properly mixed, the filling\\nwhen cemented into place will darken to the original color of the tooth.\\nAnd now having described the process of using high-fusing porce-\\nlain for inlays, the next consideration will be the modifications necessary\\nwhen the low-fusing porcelain is melted in a gold matrix. The best\\nof the low- fusing bodies are said to keep their color and texture in the\\nmouth indefinitely, to be strong enough for all necessary wear, and to\\nretain their color in fusing, which would indicate that the low-fusing\\nmaterials have greatly improved during the last eight or ten years.\\nPorcelains capable of being melted in a gold matrix are of two classes\\nthose that are sufficiently low r fusing to be melted in a bare matrix, and\\nthose that melt so near the fusing-point of gold as to render necessary\\nthe investment of the gold matrix in order to prevent its being warped\\nby the fire. In porcelains of the first class the method of procedure is\\nvery similar to that in which the high-fusing porcelains are fused in a", "height": "4608", "width": "2864", "jp2-path": "americantextboo00kirk_0396.jp2"}, "397": {"fulltext": "THE PORCELAIN INLAY. 389\\nplatinum matrix. The No. 30 gold foil is placed over the cavity mar-\\ngins in a manner similar to that prescribed for the use of platinum and\\nthen, instead of burnishing or spinning it in place, it is pressed into\\nall parts of the cavity by means of spunk or cotton. The metal is so\\nsoft and ductile that this can be accomplished in a manner impossible\\nwith platinum and it is this easy manipulation of the gold that makes\\nthe sole advantage of the low-fusing over the high-fusing porcelain\\nbodies. The gold matrix is then teased out of the cavity. This must\\nbe carefully done, as, being more easily adapted, it is also more easily\\ndistorted than the platinum. The proper mixture of porcelain is placed\\nin it, and the baking is performed exactly as with the high-fusing\\nmaterials, the only marked difference in the working of the low-fusing\\nFig. 370. Fig. 371.\\nLarge cavity in molar tooth involving approximal and Showing restoration of broken lateral\\ngrinding surfaces. Restored by porcelain inlay. incisor by porcelain tip.\\nand the high-fusing materials being that low-fusing bodies tend to\\nspheroid and lose contour. This can be remedied by mixing with the\\npaste a small quantity of similarly colored high-fusing porcelain.\\nWhen such porcelains are used as require the gold matrix to be\\ninvested, the following additional points should be carefully observed\\nThe matrix must not be torn on the bottom at all, as in such event the\\nporcelain will tend to run through into the investment instead of- draw-\\ning away from the crack, as it does from a platinum matrix where no\\ninvestment is used. The gold matrix must be dropped bottom side\\ndown into a paste of asbestos and alcohol, which is allowed to evaporate.\\nThen the porcelain may be flowed into the matrix little by little, to\\nminimize warping.\\nThe method described by Dr. J. Leon Williams 1 is as follows\\nThe thinner the gold can be used, the more perfect the fit of the\\nfinished inlay. A proper set of instruments for shaping the gold form\\nand for manipulating the porcelain paste is an important matter. I\\nhave devised for these purposes the set of instruments shown in Fig.\\n372. They are all double-end instruments. Nos. 1, 2, 3, and 4 are\\ndesigned for fitting the gold form to the cavity, while Nos. 5 and 6 are\\nfor manipulating the porcelain paste. The gold should be cut out to\\nrepresent roughly the shape of the orifice of the cavity, but consider-\\n1 Dental Cosmos, November 1899, vol. xli. p. 1087.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0397.jp2"}, "398": {"fulltext": "390 RESTORATION OF TEETH BY CEMENTED INLAYS.\\nably larger. Fig. 373 shows the proper shape for such a cavity as is\\nshown in Fig. 374 at a. It will greatly facilitate the shaping of the gold\\nFig. 372.\\nf%\\nform if a notch be cut out of the gold as shown in Fig.\\n373, and at the same time decrease the chances of break-\\ning through the gold in forcing it into the shape of the\\ncavity. It should first be introduced into the cavity with-\\nout annealing. The cut edges will then slide over each\\nother as the centre of the gold is forced to the bottom of the\\ncavity. Then, with the cotton or spunk tightly packed\\nin the cavity, take instrument No. 2 and most carefully\\nburnish the gold around the entire edge of the cavity. This,", "height": "4580", "width": "2852", "jp2-path": "americantextboo00kirk_0398.jp2"}, "399": {"fulltext": "THE PORCELAIN INLAY.\\n391\\ninstrument will be found well adapted to reach every part of the margin.\\nIt will generally be found best to hold the cotton-wool back a little\\nfrom the margin of the cavity when one is burnishing, with an instru-\\nment held in the left hand, and with this instrument (preferably a ball\\nburnisher) also press the cotton-wool well into the cavity. This holds\\nthe gold form well in place and prevents rocking while the edges are\\nbeing burnished.\\nMost operators have found the removal and imbedding of the gold\\nform to require the most delicate manipulation, and by the methods\\nheretofore described one is never quite certain whether or not this part\\nof the operation has been successfully performed until the inlay has\\nbeen completed and tried in place. All of this uncertainty may be\\navoided by the following procedure Slightly warm and roll up in the\\nfingers a small ball or pledget of hard white wax, such as is supplied\\nfor crown- and bridge-work. The ball of wax should be just a little\\nlarger than is necessary to fill the cavity completely; that is to say, it\\nshould slightly project over the margin of the cavity all round. The\\nwax should be quite stiff when introduced into the gold form as it lies\\nin the cavity of the tooth. Now take the broad, thin burnisher, shown\\nFig. 373.\\nFig. 374.\\nSheet of gold or plat-\\ninum, notched and\\nready for adaptation\\nto cavity.\\nRight superior central, showing two large approximal cavities\\nto which access is obtained by cutting freely from the lin-\\ngual walls a, tooth with cavities prepared b, porcelain\\ninlays for same c, tooth showing lingual surface and d,\\nlabial surface after cementing of inlays.\\nin No. 4, Fig. 372, and press the ball of wax firmly into place. To pre-\\nvent the burnisher from sticking to the wax, it should first be dipped\\ninto French chalk or pulverized soapstone. In such cavities as are\\nshown in Fig. 374, at a, broad polishing tape, dusted with French\\nchalk, may be used for pressing the wax ball into place but great care\\nshould be exercised not to pull the tape the least in one direction or the\\nother, as one would do in polishing a filling. This would rock the gold\\nform and mar the fit. The pull should be steadily and equably from\\nboth ends of the tape, the object being to press the wax everywhere\\nfirmly over the edges of the cavity. A stream of cold water should\\nnow be thrown on the wax, and then the wax and gold form should\\nbe quickly removed. If this part of the operation is done with ordinary", "height": "4564", "width": "2800", "jp2-path": "americantextboo00kirk_0399.jp2"}, "400": {"fulltext": "392 RESTORATION OF TEETH BY CEMENTED INLAYS.\\ncare, the finished inlay will always be found to fit perfectly. To facili-\\ntate the quick removal of the form, care should be taken to prevent\\nthe wax overlapping the gold much at any point outside the margin of\\nthe cavity. To prevent this and also to assist in securing proper imbed-\\nding of the gold matrix it is well to let the margin of the gold project\\nas much as possible beyond the edges of the cavity.\\nThe matrix may now be imbedded without the slightest fear that\\nits shape will be changed. For imbedding material I use plaster and\\nmarble-dust. When the investment is sufficiently hard the wax is thor-\\noughly melted out with a stream of boiling waters The investment is\\nthen dried and brought to a full red heat with the blowpipe. It\\nis then allowed to cool, and is ready for packing. Now, the first step\\nin the packing of the porcelain paste is the all-important one to prevent\\nthe porcelain shrinking away from the walls of the matrix. This may\\nalways be accomplished easily with porcelain of any make if the follow-\\ning instructions are carefully observed Mix the porcelain paste to the\\nconsistence of soft putty, and with the upper point shown in No. 6, Fig.\\n372, place a ring of this putty around the entire circumference of the cavity,\\nFig. 375. Fig. 376.\\na b c\\nShowing bicuspid with cavity involving approxi- Canine tooth showing at o, large cavity, and\\nmal and grinding surfaces a, tooth with at b and c, large porcelain inlay restor-\\ncavity prepared b, porcelain inlay c, inlay ing contour of tooth,\\ncemented in place.\\nleaving the centre quite free or empty. In melting a porcelain paste it\\nnaturally shrinks toward the largest mass of its own body, or toward\\nthe centre of the mass. If, then, this centre be removed we should\\nnaturally expect the mass to shrink toward the circumference, and this is\\nprecisely what happens when manipulated as directed. The matrix\\nalways comes out from the first baking with the porcelain everywhere\\nfirmly melted to the walls of the matrix. Nor will it start from this\\nposition at any subsequent baking unless it is very much overheated.\\nAfter each packing of the porcelain paste, a small camel Vhair brush\\nwith a fine point should be moistened (this is best done by drawing it\\nbetween the lips after the manner of water-color artists) and drawn\\naround the margin of the matrix to remove all overhanging particles of\\nthe paste. If this be not done, the margins of the inlay will often be\\nfound ragged, and a perfect margin is the most essential feature of a", "height": "4616", "width": "2864", "jp2-path": "americantextboo00kirk_0400.jp2"}, "401": {"fulltext": "THE PORCELAIN INLAY. 393\\nporcelain inlay. If gum-water be used for mixing the paste, it will be\\nfound necessary to remove these overhanging particles with great care,\\nas the tendency naturally is for the gum-water to cause the particles of\\npowdered porcelain to stick to the gold or platinum margin of the ma-\\ntrix. In building up the inlay for restoring lost corners of teeth and for\\ngeneral contours the work will be much facilitated if, after the first\\nbaking has been carried through as above described, to secure perfect\\nunion with the walls of the matrix, a small piece of solid porcelain be\\nplaced at the point representing the highest point of the contour of the\\ninlay. These pieces of porcelain may be made by crushing old porce-\\nlain teeth in an iron mortar. Care should be taken to use a piece small\\nenough so that the outer edge will not show through when the inlay is\\ncompleted. Corners like the one shown in Fig. 376 may be produced\\nin this manner without much difficulty.\\nDr. Williams s method of separating the gold matrix from the porce-\\nlain, and grooving the inlay and cementing it into the cavity, need not\\nbe dwelt upon, the subject having already been fully discussed.\\nIn summing up the advantages and disadvantages of the high-fusing\\nand low-fusing bodies it will be seen that the advocates of the low-fusing\\nmaterials claim the sole point that gold is more easily adapted as a\\nmatrix than platinum while the others claim that porcelains of high-\\nfusing bodies are known to be permanent, to keep their color under\\nfiring, to contour without spheroidal tendency, to dispense with the\\nuse and consequent restrictions of an investment, and to furnish a\\nprocess so simple and reliable that fillings may be constructed with\\ngreater certainty of good results and with more rapidity.\\nFurnaces suitable for fusing the porcelains used in inlays are of\\ntwo classes gas and electric. The gas furnace is usually noisy, odor-\\nous, and dirty but it seldom, if ever, gets out of order. On the other\\nhand, the electric furnace is clean, silent, and beautiful but it has only\\na limited life. Even in experienced hands its wires will burn out\\nand need mending once or twice a year, and with the inexperienced it\\nmay easily be rendered useless in a few seconds. Nevertheless, in\\nspite of these drawbacks, the electric furnace is to be preferred to the\\ngas, as with a little practice it can be easily mended, while the gas furnace\\nis suitable only for the laboratory. The only feasible gas furnaces for\\nhigh-fusing bodies are those which have a platinum muffle, in which the\\nfusing porcelain can be thoroughly protected from the gas, for no fusing\\nporcelain can keep its color if subjected to the products of combustion\\nof carbon. The two most practicable gas furnaces are the Downie\\n(Fig. 377) and the Midget Land. Either of these properly manipu-\\nlated will fuse continuous-gum body within three minutes. They\\nwork on the blowpipe principle, and necessitate either a pressure-", "height": "4544", "width": "2764", "jp2-path": "americantextboo00kirk_0401.jp2"}, "402": {"fulltext": "394\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nreservoir or labor with the foot-bellows. The electric furnaces are based\\non the principle that platinum wire submerged in fire-clay will become\\nred-hot when a current is passed through it. The fire-clay stores up\\nthis heat indefinitely, so that any degree of temperature below the fusing-\\npoint of platinum may be obtained. This fusing-point is said to be\\nabout 4500\u00c2\u00b0 Fahrenheit. The best of these furnaces for the high-fusing\\nbodies that require a temperature of from 2500\u00c2\u00b0 to 3000\u00c2\u00b0 F. are the\\nTimme (Fig. 379), the Custer crown (Fig. 378), and the McBriar crown.\\nFig. 377.\\nDownie gas crown furnace.\\nAny one of these will give satisfactory results, but the Timme furnace\\nhas the important advantage of being made in sections which can be\\nreadily taken apart, thus rendering a burn-out easy to locate and mend.\\nWith the other furnaces it is difficult at times to find and twist together\\nthe fused or broken wires and when the break is located, it has to\\nbe reached by cutting down through fused fire-clay that is sometimes\\nso dense as to require the use of a hammer. Should electric furnaces\\nbe used, it is well to have two, so that if a burn-out occur the opera-\\ntion need not be delayed while the defect is being located and repaired.", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0402.jp2"}, "403": {"fulltext": "THE PORCELAIN INLAY.\\nFig. 378.\\n395\\nCuster electric oven No. 1.\\nFig. 379.\\nTimme furnace.\\nFor baking the low-fusing bodies the gas outfit of Dr. Jenkins is\\nneat and effective in fact, as a gas outfit it is almost ideal. The little", "height": "4548", "width": "2768", "jp2-path": "americantextboo00kirk_0403.jp2"}, "404": {"fulltext": "396\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nelectric oven made by Ash (Fig. 380) is perfect for low-fusing bodies,\\nand wherever a current can be secured and low-fusing bodies are used\\nthis little furnace is to be strongly recommended. Its only drawback\\nis that it cannot be mended, and that if a burn-out occur it must be\\nFig. 380.\\nAsh electric oven.\\nsent to the manufacturer for a new coil of wire. It has not sufficient\\npower to melt the high-fusing bodies quickly and well.\\nThe Gold Inlay. As previously said, the gold inlay has practi-\\ncally perfect edge strength, and therefore is to be preferred to the\\nporcelain inlay in the back of the mouth, where its color is no objection\\nand where its power of resisting mastication is of prime importance.\\nThe following method of making gold inlays is the one advocated by\\nDr. W. V. B. Ames, of Chicago\\na The gold inlay is especially useful in compound approximal cavities\\nof bicuspids and molars. There must be ample separation. As in the\\ncase of porcelain, there should be excavation, both to prevent decay and\\nto permit the easy removal of the matrix.\\nTaking, for example, an occluso-approximal cavity of a soft molar\\nor bicuspid where a gold or amalgam filling has failed in such a case\\ndecay has usually extended laterally, one side or both, necessitating\\nthe cutting away of the side walls to such an extent as to leave very", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0404.jp2"}, "405": {"fulltext": "GOLD INLAYS.\\n397\\nlittle support for the filling at the cervical margin. The fissure of\\nthe occlusal surface must then be opened thoroughly to the end for\\nanchorage, and the entire margins of the cavity be excavated until they\\nare strong, smooth, and sharp. When practicable, an impression of\\nthe cavity may be taken in modeling compound and run out in plaster\\nor oxyphosphate of zinc. To this the matrix, made of pure gold No.\\n36 B. S. gauge, can be approximately fitted and trimmed, avoiding\\nmuch laceration to the gum. The matrix should be, however, finally\\nburnished to fit the tooth cavity. Then 22-carat gold solder should\\nFig. 381.\\nFig. 382.\\nFig. 383.\\nFig. 384.\\nbe flowed into the hollows of the occlusal surface, running off into\\nthe fissure. A coating of whiting placed on the outside of the matrix\\nwill prevent the solder from running over the edge and destroying the\\nfit. Then it must be cooled, washed, and replaced in the cavity for\\nfurther burnishing. When the occlusal groove is nearly full of solder,\\na small globule of pure gold should be placed, as in Fig. 381, a, to serve\\nas a guide for the contour, which must be shaped up about the pellet\\nwith crystal gold or foil, into the interstices of which 22-carat solder\\nis to be again flowed.\\nIn the efforts to obtain anchorage on the occlusal surface punctures\\nor tears frequently occur. Gold foil can be inserted into these, which\\nwhen filled with solder afford excellent retain-\\ning pins (see c, Figs. 383 and 385). F\\nWhere sufficient anchorage is easily ob-\\ntained, as in pulpless bicuspids and molars, a\\ndowel or small gold bead may be soldered to\\nthe gold foil, and adjusted to the pulp cavity, when the first start in the\\nformation of the matrix is made, as in d, Figs. 384 and 385.\\nSome dentists restore the tips of abraded frt nt teeth by burnishing\\npure gold over the surface, running little dowels up on each side, so as\\nto avoid the pulp chamber, and finally moulding the contour with 22-\\ncarat solder, gold foil, and spongy platinum.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0405.jp2"}, "406": {"fulltext": "398\\nRESTORATION OF TEETH BY CEMENTED INLAYS.\\nDr. C. L. Alexander s method 1 is described by its author as fol-\\nlows My method consists in detail of burnishing platinum over the\\nsurface to be restored; the holes for retaining posts having already been\\nmade, can easily be located and the posts adjusted therein. Then by\\nFig. 386.\\nShowing details of the process for making cast rilling for incisor: a, pest with plate adapted;\\nb, restored contour in wax c, the contour invested d, cast contour detached e, e, the\\nfinished restoration.\\nheating a little modeling compound over a spirit lamp, and pressing it\\nfirmly down over the surface and allowing it to cool, we can remove the\\nplatinum sheet and posts in correct relation to each other. We now\\ninvest and solder the posts with pure gold. The piece is again placed\\nupon the tooth in the mouth, and after carefully trimming and rebur-\\nnishing an impression is taken, and when an occlusion is needed it\\nFig. 387.\\nFig. 388.\\nRestoration of bicuspid\\nby cast filling.\\nFront and back view of an incisor restoration, and cast\\nfilling for molar.\\nis made at the same time by the patient closing the teeth together\\nbefore the impression material has become hard. The metal founda-\\ntion will be drawn out by the impression compound when it is removed\\nfrom the mouth. Each side of the impression thus secured is filled\\nwith any good investing material and placed in an articulator. After\\nheating and removing the impression material, the contour of the tooth\\nmay be restored by building up with wax. Over the wax surface thus\\n1 Dental Cosmos, October 1896, vol. xxxviii. p. 850.", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0406.jp2"}, "407": {"fulltext": "GOLD INLAY\u00e2\u0080\u0094 A HARD-RUBBER INLAY.\\n399\\nformed gold or platinum foil is burnished; if the former, it should be\\nvery heavy, say No. 60. A suitable portion of the wax being left\\nuncovered, the work is cut away from the model and invested, with the\\nexception of that part of the wax left uncovered by the metal. Through\\nthis opening the wax is boiled out, leaving a matrix lined with metal,\\nwhich acts as a carrier for the fused gold 20- or 22-carat gold solder\\nshould be used for this purpose. When pure gold is used, of course\\nthe matrix must be lined with platinum throughout. When removed\\nfrom the investment, the casting is finished and cemented to its position\\nin the tooth.\\nIn bicuspids and molars it will frequently be found more con-\\nvenient to stamp up the cusps, using pure gold, 35 gauge.\\nThe pieces made as described by Dr. Alexander may be used as\\nabutments for bridge- work. The gold inlays are, of course, to be\\nFig. 389.\\nFoil matrix invested. Cast filling for molar.\\n\u00e2\u0080\u00a2cemented into place with great care as regards asepsis, dryness, and\\napposition. They have a great advantage over the porcelain inlays in\\nthat their edges may be burnished into place while the cement is soft\\nand therefore when they are being given their final polish with the\\nsandpapar disk the disk should always be run toward the margins, so\\nthat a feather edge may be formed, which, with the burnishing men-\\ntioned, may make an almost absolute joint possible.\\nA Hard-Rubber Inlay. Some dentists advocate making cemented\\ninlays of hard rubber approximating the tooth in color. These inlays\\nare feasible only where a perfect impression can be readily taken of the\\noavity, the filling being then made by the method usually followed in\\nvulcanite work. The rubber inlay is noted only as a curious fact, and\\nis not enlarged upon or recommended, as its color is not equal to porce-\\nlain, nor is its edge strength equal to that of gold. As we have not\\nonly other materials that will produce better results, but also materials\\nthat can be manipulated in the time required merely for the vulcanizing\\nof the rubber, it does not seem advisable to enlarge upon a process that\\nappears to have no practical value.", "height": "4564", "width": "2784", "jp2-path": "americantextboo00kirk_0407.jp2"}, "408": {"fulltext": "400 RESTORATION OF TEETH BY CEMENTED INLAYS.\\nMAKING MATRICES UPON MODELS FOR PORCELAIN INLAYS.\\nThere are many who take impressions of the cavities intended for\\nporcelain inlays, which impressions are run out in plaster or oxyphos-\\nphate of zinc. On the models thus obtained the matrices are formed,\\nand the porcelain fillings finished according to shades selected when the\\nimpression was taken. This has the advantage of saving much time for\\nthe operator, as the work of construction may be done by an assistant\\nin the laboratory. As good results are claimed, the process should be\\ngiven a fair trial but on theoretical grounds the expansion of the\\nplaster, or the contraction of the oxyphosphate of zinc 1 used for the\\nmould would tend to cause inaccuracy in adaptation of the edge.\\nMost inlay workers find it sufficiently difficult to get perfect adaptation\\nwhen the matrix is burnished to sharp enamel edges, and, except in\\nlabial cavities, to get the exact contour. Also, the colors often require\\nsuch nice calculation that an assistant, not having seen the mouth,\\ncould hardly mix them satisfactorily. While good results have been\\nobtained by giving the matrices for filling to an assistant especially\\ntrained in the art of fusing and mixing the porcelains, thus proving\\nthat such time-saving methods are practicable, the average dentist\\nshould not attempt the art of inlays with the idea of saving time\\nprobably there will always be sufficient factors for failure if he works\\ndirectly from the tooth cavity and gives his entire personal skill to\\nthe completion of the filling. With porcelain inlays the question of\\nartistic color effect is paramount, and only through the most subtle\\ndiscrimination can the best results be obtained.\\n1 Wet oxyphosphate of zinc usually expands dry oxyphosphate usually contracts.", "height": "4612", "width": "2804", "jp2-path": "americantextboo00kirk_0408.jp2"}, "409": {"fulltext": "CHAPTER XYI.\\nTHE CONSERVATIVE TREATMENT OF THE DENTAL PULP-\\nDEVITALIZATION AND EXTIRPATION OF THE PULP.\\nBy Louis Jack, D. D. S.\\nAs the dental pulp by its supply of nutritive pabulum maintains\\nthe vitality of the dentin and increases the resisting power of the tooth,\\nit is important when this organ becomes exposed to agencies which\\nthreaten its destruction, to attempt its preservation when the condi-\\ntions are favorable to that object. A further reason for maintaining\\nthe vitality of the dentin is that when the pulp becomes devitalized the\\nloss of cohesive force which occurs as a consequence leads sooner or\\nlater to the fracture and early loss of the tooth this final result being\\ndelaved in proportion to the inherent strength of the tooth and the\\nperiod of life at which devitalization takes place.\\nThe treatment of teeth when the pulp has been approximately\\nreached by the invasion of dental caries has been previously consid-\\nered (Chapter VII.). Here will be set forth a rational line of treatment\\nwhen the carious action has encroached upon that organ.\\nNormal Characteristics and Pathological Tendencies of\\nthe Dental Pulp.\\nThe minute anatomical elements of the dental pulp are given in\\nChapters II. and III. The salient features of these elements which\\nhave to be kept in view in connection with treatment are\\n(1) The minuteness of the apical foramina, which restricts the efferent\\ncirculation when the vascular phenomenon known as determination\\noccurs.\\n(2) The ultimate nervous distribution immediately beneath the odon-\\ntoblastic layer, forming a plexus which renders the whole surface of the\\norgan highly sensitive when the blood supply is increased as the effect\\nof irritation.\\n(3) The arrangement of the capillary circulation in loops which arise\\nfrom the vertical vessels. This relation of the vessels lessens the tend-\\nency to inflammatory diffusion.\\n2fi 401", "height": "4560", "width": "2808", "jp2-path": "americantextboo00kirk_0409.jp2"}, "410": {"fulltext": "402 CONSERVATIVE TREATMENT OF THE PULP.\\n(4) The absence of lymphatics, which deprives the pulp of the power\\nto remove inflammatory effusions or to convey insoluble medicaments.\\nIt should be noted that the pulp in a normal state is not a highly\\nsensitive organ, but is rendered exquisitely so by the irritation from\\nexternal chemical and infectious influences incident to its exposure.\\nAnd it is under all conditions so extremely impatient of compression\\nthat a severe shock of that kind renders recuperation nearly impossible.\\nThis is probably due to the liability of disconnection of the pulp with\\nits walls at some point on account of its feeble attachment to them.\\nThe pathological tendencies of the pulp under irritation are\\n(1) To hyperesthesia.\\n(2) To circumscribed hyperemia under slight irritation.\\n(3) To congestion or mechanical hyperemia under increased irrita-\\ntion which terminates at length in stasis by the restriction of the\\ncirculation.\\n(4) To proliferation of the deeper tissues as the result of latent con-\\ngestion attended by fatty degeneration of cells and the development of\\ndentinal nodules pulp stones.\\nAn important consideration connected with the treatment of the\\npulp is the indication presented by a state of the teeth designated as\\nthe temperature sense. This is a variable condition with different\\nindividuals, some being able to apply the coldest water in the mouth\\nand to crunch ice without pain, whilst others whose teeth are sound are\\ndisturbed if cool water is brought into direct contact Avith these organs.\\nWhen irritation of the pulp occurs the temperature sense is exaggerated\\nin the individual tooth. This variation from the normal, as determined\\nby a comparative test of the sound teeth, becomes an important diag-\\nnostic indication, as will appear later.\\nA further pertinent consideration bearing upon the various condi-\\ntions of the exposed pulp, as shown by the symptomatology, is here in\\nplace. It has already been indicated that when the exposure of the pulp\\nto irritation has been slight that is, where this organ has been measur-\\nably protected from exterior influences by the covering layer of incom-\\npletely decalcified dentin the pulp is ordinarily but slightly affected.\\nWhen the denudation has become complete and the amount of pulp\\nsurface in contact with the carious matter has become considerable,\\nand further, when by the solution and displacement of the carious\\nmatter the influence of the contents of the mouth is direct, the disturb-\\nances of the pulp become progressively increased. In the light of pres-\\nent knowledge of these injurious influences the causes of their operation\\nmust be attributed to infection of the pulp by the various minute organ-\\nisms which have their habitat in the mouth. The pulp tissue becomes\\ninfected in the degree to which it is exposed and in proportion to its", "height": "4604", "width": "2820", "jp2-path": "americantextboo00kirk_0410.jp2"}, "411": {"fulltext": "PATHOLOGICAL TENDENCIES OF THE PULP.\\n403\\nFig. 390.\\npower of resistance to the pathogenic character of these forms of life.\\nIt is axiomatic that the activity of inflammatory processes is usually in\\nproportion to the degree and the kind of infection. Therefore it must be\\nheld here as elsewhere in surgical procedures that the existence of infec-\\ntive influences and their control have to be kept clearly in view.\\nThis consideration enables us to understand the causes which render\\nconservative treatment inoperative, in cases in which there has existed\\nfor a considerable period the opportunity for active invasion of the pulp\\nby micro-organisms. When these deleterious influences have long con-\\ntinued, the deeper tissues of the pulp, as before stated, become involved\\nthe chief factors producing the disturbed state eventuate in a suppura-\\ntive condition. This state of the organ clearly indicates invasion by pyo-\\ngenic germs, the inflammatory processes attending this condition being\\nsuperinduced by the peculiar irritation caused by the infection. This\\nresults in some instances in stasis followed by gangrene in other cases,\\nwhere the arterial tension has not been great, in suppuration. The cha-\\nracter of the suppurative process, rarely, is a circumscribed abscess of\\nthe pulp, the more common form being by\\nprogressive and destructive ulceration of\\nthe organ.\\nFig. 390 (after Arkovy) shows the\\nphenomenon of invasion of the pulp by\\nmicrococci. 1\\nIn the treatment of an organ which\\ncannot be brought under ocular inspec-\\ntion, the chief guides to determine its state\\nare the apparent conditions viewed in con-\\nnection with the symptomatology of the\\ncase under treatment.\\nThe above-stated anatomical relations,\\nphysiological qualities, and pathological tendencies have an interesting\\nbearing upon conservative treatment of the pulp.\\nExposure of the Pulp. As an indication of the tolerance of the\\npulp to the approach of caries it is a common experience that after\\nsolution of the enamel has taken place, caries of the dentin proceeds\\nuntil the pulp is nearly reached by the destructive process with little or\\nno signs of irritation, as evinced by pain, appearing. It is the excep-\\ntion that even persons of high nervous sensibility are cognizant of the\\ninfluence of the carious process upon the pulp previous to actual\\nencroachment.\\nIn the earlier stages of exposure the elements of the organ involved\\n1 In this connection see Micro-organisms of the Human Mouth, by W. D. Miller, pp..\\n293-295.\\nInvasion of pulp by micrococci..", "height": "4564", "width": "2792", "jp2-path": "americantextboo00kirk_0411.jp2"}, "412": {"fulltext": "404 CONSERVATIVE TREATMENT OF THE PULP.\\nare its peripheral nerve filaments, which are hyperesthetic from the\\nhyperemic state of the organ immediately adjacent to the point of\\nencroachment. At this stage the pulp becomes impatient of cold, and\\nmay indicate the nature of the lesion by reflex pain in other branches\\nof the trigeminus. Later on, unless these conditions are subdued by\\ntreatment congestion of the organ takes place, when objective symp-\\ntoms in the organ itself may be elicited. This is shown by some sore-\\nness upon percussion, accompanied by much pain on the application of\\nheat.\\nThese indications point to a greatly increased blood supply. Dila-\\ntation of the arterial vessels of the apical region occurs, and the blood\\nbeing unable to enter at the foramen is distributed to the peridental\\nmembrane. These manifestations indicate that the point of danger\\nhas approached. Soon thereafter congestion becomes so far estab-\\nlished that prospect of successful conservative treatment vanishes.\\nWhen patients are under frequent observation and have regular and\\nperiodical care taken of the teeth the pulp exposures which occur should\\nbe found in the hyperemic state, and if placed under treatment early\\nafter the carious action has approached the pulp, the prognosis should\\nbe favorable. But when neglected cases appear the history of which\\nis obscure, and where the patient is forced to seek relief by the occur-\\nrence of objective symptoms as narrated above, accompanied by local\\npain and pulsation, the indications point to devitalization and extirpa-\\ntion as the suitable recourse.\\nThe exposure of the pulp is often discovered in the treatment of\\nordinary cavities in a somewhat unexpected manner, no indications\\nappearing until the part is uncovered or a variety of subjective or\\npossibly objective indications may be elicited which plainly point to\\nthis condition.\\nAt the commencement of the treatment to restore the lost tissue\\nin any given carious tooth, except in very small cavities, the proba-\\nbility of encroachment upon the pulp should be a supposition, and each\\nstep should be made with reference to this probability. The destruc-\\ntion of the dentin is frequently surprisingly deep, or the cornua of the\\npulp may be acutely pointed and liable to be unexpectedly encountered.\\nTherefore, in what may seem simple cases, cautious approach should be\\nmade toward the bottom of the cavity.\\nMethod op Opening the Cavity.\\nThe opening of the cavity should be effected by instruments\\nwhich will not easily enter it, and the softer caries removed in a\\nmanner which will not induce pressure of the carious matter upon the\\npulp. For this reason, in the removal of the caries the excavation", "height": "4612", "width": "2828", "jp2-path": "americantextboo00kirk_0412.jp2"}, "413": {"fulltext": "METHOD OF OPENING THE CAVITY. 405\\nshould be first carried on at the sides of the cavity, and also along the\\nmargin of the cervical wall in approximal cases. Then the carious\\nmatter nearest the pulp should be carefully peeled off without pres-\\nsure and without irritation. In this manner a pulp may be uncov-\\nered and the cavity cleansed of carious matter without contact being\\nmade with the pulp. To do this is the acme of skilful preparation.\\nThe instruments for removing caries should be of thin edge, very\\nsharp, and always having cutting surfaces which are rounded, since\\nangular or square-ended excavators are liable to make exposures un-\\nnecessarily. It is important that the direction of movement of the ex-\\ncavators should be from the cervix toward the occlusal part in other\\nwords, by drawing cuts instead of pushing ones. The diiference in the\\nexcitement of pain between these two methods of cutting is surprising,\\nand can only be appreciated by those who have experienced the com-\\nparison upon their own teeth. The probable reason for this is that the force\\nof the pushing cut is necessarily greater, and this may induce com-\\npression of the caries or of fluids against the pulp. It causes more\\npain at the moment, and cleansing in this manner is followed by greater\\nafter-irritation. Patients will at the time complain of reflected pain\\nbeing caused by incorrect manipulation.\\nIt is obvious that every mode of procedure which increases the local\\nirritation in the preliminary procedures of a pulp treatment must be\\ndeleterious in its results. The danger of making accidental exposures\\nand of forcing the instruments upon the pulp are increased under push\\ncutting. It is also clear that the use of burring instruments upon the\\npulp wall of cavities is questionable, since the infliction of some com-\\npression by excavating in this manner is nearly unavoidable.\\nHere an interesting question appears A cavity may be sufficiently\\ndeep to cause an exposure it has been carefully cleansed of caries, and\\nthe cornua are not apparent. It is then necessary to determine whether\\nthere is a real but minute exposure or whether there is a safe amount\\nof healthy dentin to protect the pulp beneath the stopping material.\\nOne method is to cross-hatch the cavity by a very fine explorer.\\nThis is effected by holding the instrument very lightly and passing\\nit gently over the surface in parallel lines in two directions. If the\\npulp has been reached, the instrument at the point of encroachment\\nwill lose its resistance or will drag the point of the cornu, as the case\\nmay be.\\nWhile there may be no visual evidence of exposure, the certainty of\\nit is frequently shown during the preparation of the cavity or the test-\\ning by a peculiar expression of the face of the patient, different from\\nthat manifested by the cutting of the most exquisitely sensitive dentin.\\nThis change of the countenance, accompanied by a slight start of the", "height": "4564", "width": "2760", "jp2-path": "americantextboo00kirk_0413.jp2"}, "414": {"fulltext": "406 CONSERVATIVE TREATMENT OF THE PULP.\\nfeatures, may occur without the recognition of pain. This indication\\nsometimes appears previous to the removal of all the caries it is then\\nprobably caused by some tension of the apex of the cornu produced\\nby the disturbance of the carious dentin.\\nThe Diagnostic Value op the Reaction of the Pulp to\\nThermal Tests.\\nAllusion has been made to the eifects caused by reducing the tem-\\nperature of the teeth. To make this subject clear it is necessary to con-\\nsider the reaction of the dental pulp to thermal changes in its states of\\nhealth and of disease.\\nThe normal rate at which the pulp of sound teeth reacts to cold\\napplications varies with different persons from 22 to 66 degrees F. below\\nthe blood heat, the reaction to heat varying from 20 to over 55 degrees\\nF. above the blood temperature, these tests being the extremes of the\\nwriter s observations.\\nThe degree of heat reaction may be designated by the -f sign and\\nthe cold rate by the symbol. These ascertained extremes may be\\ntaken as representing the range of tolerance, in any individual case.\\nThe significance of ascertaining the normal rate of thermal irritation\\nof the teeth is important in connection with the treatment of any case.\\nWhen a healthy rate of 144\u00c2\u00b0 32\u00c2\u00b0 F. is compared with one of 124\u00c2\u00b0\\n76\u00c2\u00b0 F. this at once is apparent. In the one case, the range of tolerance\\nis 112 degrees in the other, 48 degrees. Hence it is obvious that the\\ndetermination of the normal rate is essential as a basis from which to\\nconsider the value of the thermal reaction of any given disturbed pulp.\\nIt is also evident that where the range of tolerance is considerable the\\nprobability of favorable treatment is greater than when this is small.\\nWhere the normal range is found to be below 50 degrees F., unless the\\nother conditions are very favorable, conservative treatment of the pulp\\nbecomes questionable.\\nThe normal rate is easiest found by exposing the lower incisors to a\\ncontinued discharge of water from a small-aperture syringe. The most\\nsuitable kind of syringe is that having a large aperture for charging\\nand a small one for discharging. 1\\nThe tests are begun at a temperature of 80\u00c2\u00b0 F., reduced succes-\\nsively by diminutions of ten degrees until slight pain follows the tests.\\nThe continuation of the stream of cold water is necessary to enable\\nthe effect to reach the pulp through the dentin. With some per-\\nsons the response is so quickly shown as to indicate that the dentin\\nis responsive.\\n1 The best for the purpose is a modified form of the Laskey syringe.\\ni", "height": "4612", "width": "2828", "jp2-path": "americantextboo00kirk_0414.jp2"}, "415": {"fulltext": "REACTION OF THE PULP TO THERMAL TESTS. 407\\nA large proportion of persons manifest distress between 40\u00c2\u00b0 and\\n60\u00c2\u00b0 F.\\nIntolerance of heat is determined in the same manner, except that\\nit is frequently necessary to isolate the tooth by applying rubber dam,\\nsince the gum usually begins to be pained at 130\u00c2\u00b0 F. In all cases in\\nwhich the cementum is exposed isolation is required, since the cemen-\\ntum may react at slight variations from blood heat. To secure exact-\\nness in any case isolation is better than an open test.\\nAVhen disturbance of the pulp occurs from the extended progress\\nof caries the reaction of the pulp to changes of temperature is usually\\nmarked, and the variation from the normal rate is indicative of the\\ndegree of disorder of this organ. The response occurs to temperatures\\nboth below and above the normal rate. When the irritation of the\\npulp consequent upon its exposure is slight, the reaction is principally\\nto cold, the degree apparently depending upon the extent of the hyper-\\nemia. AVhen the reaction to heat is marked, congestion of the organ\\nis threatening.\\nDisorders of the pulp appear to excite other anatomical elements of\\nthe teeth, as is indicated by reaction to cold and heat being more\\nimmediate than is the case with the sound teeth. A more exact\\ndegree of temperature reaction may also be secured when this condi-\\ntion exists.\\nIt is essential in making tests that a carious cavity be closed by a\\npledget of wet cotton. This is sufficient to exclude the disturbing effect\\nof the hypersensitive dentin, since water is a nearly absolute non-con-\\nductor.\\nExamples from practice to illustrate 1. Cavity rate, 110\u00c2\u00b0 \u00e2\u0080\u009480\u00c2\u00b0,\\nwhen protected as above 130\u00c2\u00b0 60\u00c2\u00b0. Here the normal rate was\\n131\u00c2\u00b0 58\u00c2\u00b0. 2. Cavity rate, 108\u00c2\u00b0 90\u00c2\u00b0 normal rate, 134\u00c2\u00b0\\n-65\u00c2\u00b0. 3. Cavity, 120\u00c2\u00b0 50\u00c2\u00b0 normal, 128\u00c2\u00b0 -48\u00c2\u00b0.\\nThe following table of normal rates shows the relation between the\\npoint of heat reaction of the pulp and the degree of its reaction upon\\nthe abstraction of heat\\n152\u00c2\u00b0 41\u00c2\u00b0\\n150\u00c2\u00b0 40\u00c2\u00b0\\n144\u00c2\u00b0 48\u00c2\u00b0\\n144\u00c2\u00b0 32\u00c2\u00b0\\n-f- 140\u00c2\u00b0 48\u00c2\u00b0\\nj- 140\u00c2\u00b0 _ 46\u00c2\u00b0\\n140\u00c2\u00b0 46\u00c2\u00b0\\n140\u00c2\u00b0 32\u00c2\u00b0\\n4- 140\u00c2\u00b0 56\u00c2\u00b0\\n134\u00c2\u00b0 58\u00c2\u00b0\\n4- 134\u00c2\u00b0 65\u00c2\u00b0\\n134\u00c2\u00b0 60\u00c2\u00b0\\n133\u00c2\u00b0 66\u00c2\u00b0\\n131\u00c2\u00b0 63\u00c2\u00b0\\n130\u00c2\u00b0 55\u00c2\u00b0\\n130\u00c2\u00b0 72\u00c2\u00b0\\n128\u00c2\u00b0 48\u00c2\u00b0\\n-f- 126\u00c2\u00b0 64\u00c2\u00b0\\n124\u00c2\u00b0 76\u00c2\u00b0\\n124\u00c2\u00b0 60\u00c2\u00b0\\n122\u00c2\u00b0 75\u00c2\u00b0\\n120\u00c2\u00b0 72\u00c2\u00b0", "height": "4564", "width": "2796", "jp2-path": "americantextboo00kirk_0415.jp2"}, "416": {"fulltext": "408 CONSERVATIVE TREATMENT OF THE PULP.\\nThe normal averages of table\\n9 cases from 152\u00c2\u00b0 to 140\u00c2\u00b0\\naverage 143.3\u00c2\u00b0 43.2\u00c2\u00b0 100\u00c2\u00b0 range of tolerance\\n7 cases from 140\u00c2\u00b0 to -f 130\u00c2\u00b0\\naverage -f 132.3\u00c2\u00b0 62.7\u00c2\u00b0 69.6\u00c2\u00b0 range of tolerance\\n7 cases from 130\u00c2\u00b0 to 118\u00c2\u00b0\\naverage 123\u00c2\u00b0 67\u00c2\u00b0 56\u00c2\u00b0 range of tolerance.\\nOccult Oases of Reflected Pain.\\nCases difficult of diagnosis sometimes appear in which the question\\narises whether the pain is caused by a hyperesthetic pulp, by the influ-\\nence of malarial poisoning, or by a gouty condition. When the origin\\ndepends upon the two causes last named the teeth are not subject to\\nthermal irritation also from these causes the occurrences of pain are\\nnot confined to the evening, as usually is the case with teeth in the\\nearly stages of disturbance.\\nThe stages of pulp exposure are divisible into three periods (1) of\\nquiescence (2) of subjective symptoms, and (3) of objective manifestations,\\n(1) Quiescence may continue in many instances for a considerable\\nperiod after caries has reached the pulp where the situation is such\\nthat the force of mastication cannot cause compression of the contents\\nof the cavity. Notwithstanding constant saturation of the gelatinous\\ncovering, and the presence of the micrococci concerned in producing\\nthe caries of the dentin, excitement of the pulp may not occur. The\\nfact should not be overlooked that some persons escape odontalgic\\nsymptoms notwithstanding such progressive alteration of the pulp tissue\\ntakes place as to result in gangrene of the organ.\\n(2) Usually, however, after a period of quiescence of a longer or shorter\\nduration there arises a train of subjective disturbances brought on by\\nthe continuance of chemical irritation and by the presence of fluids in\\nthe cavity, these influences becoming accelerated as the area of exposure\\nbecomes increased. The pain which occurs in this stage is reflected to\\none or more branches of the fifth pair of nerves. Flashes of pain\\noccur to the teeth of the other maxilla, to the eye, or the supraorbital\\nregion, the most common region affected being the nerves of the ear,\\npain in this organ being probably the most general form of reflection\\nwhich occurs. The exacerbations take place usually in the evening and\\nat first entirely remit in the daytime. The pain in this stage will fre-\\nquently pass away as the pulp is relieved from pressure and chemical\\nirritation.\\nIn this stage the surface of the pulp does not present indications of\\nbeing inflamed. From the lack of continuity of the symptoms it is\\na reasonable inference that the hyperesthesia observed in this condition\\nis due to impressions made upon the point of encroachment and is con-", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0416.jp2"}, "417": {"fulltext": "TECHNICAL TREATMENT OF THE UNCOVERED PULP. 40D\\nfined to the nerve fibrils distributed about the capillary loops involved,\\nand thereby induces the reflected manifestations, the nerve fibrils being\\nin this stage the anatomical element chiefly implicated.\\n(3) Objective symptoms comprise those manifestations which, after\\nthe subjective ones have continued for some time, become localized in\\nand about the affected tooth. These are some soreness of the peri-\\ndental membrane; extreme sensitiveness to heat, accompanied through-\\nout with dull, heavy pain in the tooth, and at length pulsative\\nthrobs.\\nThis order of statement is the usual sequence in which these indica-\\ntions appear. They are the result of the extension of the disturbance\\nto the deeper circulatory elements of the tissue. When this condition\\nappears on the presentation of a case, or when in the course of the\\ntreatment it becomes apparent, the prognosis usually is rendered\\nunfavorable to recuperation.\\nThe Technical Treatment of the Uncovered Pulp.\\nAccidental Exposures. These, which happen in the preparation\\nof cavities, if produced by clean (aseptic) instruments where compres-\\nsion has been avoided, require but simple treatment. The pain is\\nrelieved by the application of tincture of calendula one part, to four of\\nwater. When the bleeding ceases, the point of exposure should be\\nantiseptically dressed and capped in the manner to be described.\\nIf the injury has been slight, the cavity may be at once filled w r ith\\na metal, having regard to the strength, the placement, and the fixation\\nof the cap used to defend the part from compression. Here the fixa-\\ntion may be made by covering the cap with a broad block of gold foil\\nafter adapting this to the margins of the pulp wall of the cavity the\\nfilling may be proceeded with. In case of doubt a metal of less con-\\nductivity may be used, such as tin or amalgam. A metal filling is\\nbetter in these cases, since the slight thermal irritation tends to the\\nultimate recovery. (See Chapter VII.)\\nTreatment of Recent Exposures. When the pulp has been fully\\nuncovered, as previously described, the cavity should be washed clean\\nwith tepid water, be securely protected from the fluids of the mouth\\nwith rubber dam, dried, and lightly filled with a pledget of lint sat-\\nurated with a mild disinfectant. On account of the invasion of the\\nzone of dentin immediately beneath the caries by bacteria and micro-\\ncocci, it is recognized that some means of sterilization must be adopted.\\nThis being necessary in the treatment of ordinary cavities, it is evidently\\nhere more demanded. On account of the impatience of the pulp to\\nmedication it. is important to be careful in the selection of the sterilizing\\nagent. The choice should be between hydronaphthol, acetanilid, and", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0417.jp2"}, "418": {"fulltext": "410 CONSERVATIVE TREATMENT OF THE PULP.\\nformalin the first in the strength of 1 to 300 parts water the second,\\n1 to 200 parts the third, not stronger than 3 per cent.\\nThe saturated pledget of cotton may remain in the cavity during the\\nprocedures of the preparation of the dressing paste, the selection of the\\ncap, etc.\\nWhen these preparations are complete the cavity should be again\\ndried, the drying being finished by a few puffs of warmed air. The\\npoint of exposure and the adjacent dentin are now touched with lint,\\nfilled with carbolic acid and oil of cloves, equal parts. The effect\\nof this is to coagulate to a superficial degree the point of exposure.\\nThis practice is largely empirical. It may be avoided in cases where\\nno disturbance has previously existed but where there are evidences\\nof irritation it seems indispensable.\\nThe application of carbolic acid in this manner should be for a\\nmoment only. As carbolic acid has a very feeble affinity for water and\\nas the topical touch is but momentary, it probably does not invade the\\ntissue to an appreciable degree. It will also be observed that the com-\\nbination possesses anesthetic properties.\\nThe student will not fail to hold in view that the treatment is appli-\\ncable to cases in which it is evident the pulp tissue is not under much\\nirritation. The condition should be one of hyperemia of the organ and\\ngives indications of- this by the existing hyperesthesia. Congestion\\nshould not have taken place, neither should inflammatory indications\\nexist. Therefore the inference is that after the carious matter is removed\\nthe surface of the dentin and the point of exposure may be sterilized\\nand the vital force of the pulp be given the opportunity to overcome\\nwhatever slight bacterial invasion may have reached that organ. Here\\nthe case must rest upon the well-established fact that the tissues have\\nconsiderable power of mastering the influence of non-pathogenic germs\\nas a factor in the process of recuperation.\\nTreatment of Old Exposures. In the conditions which exist\\nwhere denudation has taken place to a considerable degree and where\\nirritation has long continued, the disturbances which have arisen in\\nconsequence of the extension of the disorder to the larger bloodvessels\\nand the attendant alteration of most of the anatomical elements of the\\npulp, the chances of establishing quiescence are slight.\\nIn the earliest stages of objective disturbances when the constitu-\\ntional conditions are favorable an attempt may be made at conservative\\ntreatment after the inflammatory conditions are subdued by antiseptic\\ntreatment, accompanied by the use of resorbents and counter-irritation\\nupon the gum.", "height": "4616", "width": "2836", "jp2-path": "americantextboo00kirk_0418.jp2"}, "419": {"fulltext": "CAPPING THE PULP. 411\\nCapping the Pulp.\\nA prominent feature in the conservative treatment of the pulp is the\\nmeans to protect it from pressure, in agreement with the established\\nfact that there is no irritation so fatal to the normal functions of the\\npulp as compression, and no condition from which it recovers with so\\nmuch difficulty as this. Therefore all means directed toward its con-\\nservation must conform to the necessity of preventing the least degree\\nof compression. The means employed to prevent this form of disturb-\\nance have given this method of treatment the common appellation of\\ncapping the pulp.\\nAnother principle of equal importance connected with the foregoing\\nis that the capping material should be brought into immediate apposi-\\ntion with the pulp. This is for the reason that if the least space be\\npermitted to exist between the capping and the exposed point this space\\nwill fill with effused fluids, and the putrefactive changes which take\\nplace in these fluids induce the formation of gases with consequent\\ncompression.\\nMETHOD OF CAPPING.\\nVarious methods of capping are practised, such as laying on the part\\n\u00e2\u0096\u00a0disks of paper or asbestos rendered antiseptic in various ways using\\ndisks of paper coated on the side to be placed next the pulp with\\nchloro-percha or other plastic matter flowing over the exposed\\npoint a coating of oxysulfate or oxychlorid of zinc, being careful with\\nthe latter to use a formula of the fluid element in which the zinc\\nchlorid is only in sufficient proportion in relation with the water that\\nthe union Avith the zinc oxid is not active. In connection with this\\nmethod it has been common to mistakenly employ the strength of the\\nfluid which is used when the formula is adapted for temporary fillings.\\nWhen this method is used the coating is flowed over or laid in a cap on\\nthe pulp, and when somewhat set the cavity is temporarily filled\\nwith a more resistant material laid upon it with great care.\\nWith all the precautions which may be taken these dressings\\nare somewhat complicated and are not applicable to small cavities or\\nthose difficult of access. In these cases the\\nwriter has generally depended upon the use Fig. 391.\\nof a dressing composed of carbolic acid and\\noil of cloves equal parts combined with zinc lyP |\u00c2\u00a7P 1\\nOxid to form a plastic paste of Such Consist- Weston s dental cavity caps.\\nence that when it is laid upon the pulp it will\\nyield as it is adapted to the part, without producing pressure, and will\\nflow out around the margins of the metal cap when this is used to con-\\nvey the dressing.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0419.jp2"}, "420": {"fulltext": "412 CONSERVATIVE TREATMENT OF THE PULP.\\nThe composition of the dressing is based npon the considerations\\nthat the menstruum is antiseptic, and possesses some anesthetic value.\\nIt also remains unchanged within the space and in time becomes, from\\nthe dissipation of the menstruum, somewhat firm in its character. The\\ntherapeutic action of the menstruum when combined with the zinc oxid\\nis mild, and is employed for the reason that it is slowly given up by the\\noxid, and therefore makes an acceptable dressing.\\nThe Cap. In all cases where metal fillings are selected it is essential\\nto use a metal cap. The methods where this is used are simpler and\\nbetter under control than when dressings are made without this appli-\\nance. The reason for this is that the avoidance of compression is more\\ncertain.\\nThe caps are best when made of platinum, for the reasons that this\\nmetal is a resistant material and the caps are easily formed.\\nWhen the outer filling is to be of gutta-percha or of the mineral\\ncements, caps may be formed of concave disks of pure tin. The tin\\nand platinum caps are stamped from the plate by the hollow punches\\nof the hardware shops, by which means various sizes of round and\\nelliptical ones may be made. The effect of punching them upon the\\nend of a block of wood gives the suitable concavity to meet the require-\\nments. For ordinary purposes they should be quite thin, but when\\ngold fillings are made over them the thickness and the concavity should\\nbe such as to enable them to sustain the force applied. In cases where\\nthere are indications of approaching congestion, or where it is probable\\nthat the exposure is not recent, the dressing should have added to it a\\nportion of guaiacocain.\\nPlacing the Cap in Position. Placing the cap in position is a step\\nin the treatment requiring care. It should be assured that it is of suf-\\nficient size to pass well beyond the borders of the ex-\\nposed organ, and in the approximal cavities it should\\ncover the pulp wall of the cavity without intruding\\nupon the marginal walls. If there is a single exposure\\nit should be round if two cornua are exposed, either\\ntwo caps should be laid or one oval one employed, as\\nmay best suit the case. In molars, usually, where two\\npoints are exposed, two caps are generally best; in the\\nbicuspid, one oval one under the same circumstances.\\nThe cap should be inserted edgewise in such manner\\nthat as it is laid in place the excess of dressing may flow\\nout at the margin toward the operator. This is to prevent undue\\npressure, and to avoid air being included beneath the dressing, which\\nwould prevent complete apposition of the dressing with the pulp.\\nIn cases of easy access the cap may be laid in place with fine-pointed", "height": "4616", "width": "2840", "jp2-path": "americantextboo00kirk_0420.jp2"}, "421": {"fulltext": "CAPPING THE PULP. 413\\npliers notably the Bogue pliers but in the majority of instances it is\\npreferable to previously coat the convex side of the metal with wax,\\nwhen, with an instrument adapted to the case, it may be carried into\\nposition and then placed in the manner described. It should next\\nbe pressed into position with sufficient force to bring the margins in\\ncontact with the dentin. Any excess of dressing should be taken away\\nby light touches of an excavator, and when the cavity is to be filled\\ntemporarily it is better to fix the cap in place by flowing over it a little\\nchloro-percha, which, when dried, prevents disturbance of its position\\nin the filling procedure.\\nCare should be taken that when the pulp is found exposed in a de-\\npression, as occurs sometimes in the molars, this depression should be\\nfilled nearly or quite to a level with the floor of the cavity by taking a\\nlittle of the dressing upon a suitable instrument and carefully filling\\nthis point otherwise, when the cap is placed, the paste may not find its\\nway into contact with the pulp.\\nAt the moment of placing the cap, as the paste is yielding under the\\ngentle pressure of forcing the edges of the cap into contact with the\\ndentin, a little pain will sometimes be observed but\\nunless the paste is too stiff no compression of the pulp G- 393-\\nshould be caused.\\nFilling the Cavity. Whether the cavity shall be\\nfilled temporarily or permanently depends upon the\\nprognosis. This, as will be perceived, is based upon\\nthe constitutional conditions and the state of the pulp\\nF Cap in position.\\nat the time of treatment.\\nFor those of small experience in this line of treatment it would not\\nbe safe to attempt the permanent stopping of the cavity, except in acci-\\ndental exposures and in cases where the history of no previous dis-\\nturbance can be elicited and where the thermal reaction is slight. Even\\nin the latter class it is generally best to delay permanent closure by a\\nconductor of heat until after an experience of a year or more with a\\nnon-conducting stopping. At the end of this time the filling may be\\nnearly all removed, care being taken not to disturb the cap, when with\\nsuitable precaution a metallic filling may be inserted.\\nIn the majority of instances it is safest to fill the cervical part with\\ngutta-percha stopping, carrying the material over the cap, and then to\\ncomplete the filling with zinc phosphate. In this way, with an occa-\\nsional renewal of this temporary work, cases may be carried forward\\nfrom ten to fifteen years.\\nThey may, however, be closed permanently and safely after an\\nexperimental trial of five years where no irritation has appeared.\\nIn many instances recovery takes place by secondary deposits of", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0421.jp2"}, "422": {"fulltext": "414 CONSERVATIVE TREATMENT OF THE PULP.\\ndentinal tissue the exact character of which has not been made out.\\nThe writer has observed a multitude of cases in practice when the open-\\ning at the point of exposure has become occluded by bony tissue. In\\nsome instances this has occurred in two years, in others after longer\\nperiods. In one instance a lateral incisor became protected by this\\nformation, but in consequence of mistaken diagnosis of another condi-\\ntion causing pericementitis, a drill was passed through the new tissue\\nto the living pulp. This new opening healed again. In the same mouth\\nanother incisor also recuperated in the same manner.\\nIn some cases when entire quiescence has been maintained for many\\nyears the pulp will be found not to have undergone any protective\\nchanges.\\nIt is not remarkable, however, that pulps may remain in a state of\\nquiescence for a long period, when it is considered that in slowly-\\nadvancing caries the pulp will often be exposed for a long time without\\nthe occurrence of any signs of irritation, unless, by the position of the\\nmouth of the cavity, the pulp has been subjected to the pressure of\\nfood.\\nIt may be concluded that, whether the pulp becomes protected by\\nsecondary deposits or acquires complete quiescence, conservative treat-\\nment in these cases has considerable advantage over immediate devital-\\nization. Still, in this connection in order to avoid embarrassments the\\nnecessity exists for careful selection of subjects to be treated in this\\nmanner, and also for proper analysis of the apparent condition of the\\npulp itself. To aid in this discrimination the following summary of\\nconditions should be held in mind\\n(a) Where no previous observable disturbances can be elicited.\\n(b) Where the tooth has been impressed only by the application of\\nlow temperature.\\n(c) Where, in addition, reflected pain in related parts has been\\nobserved.\\n(d) Where the tooth has become much subject to impressions by\\nheat.\\n(e) Where continued objective disturbances appear, such as soreness\\nto touch, or local pain of spontaneous character accompanied by pulsa-\\ntion.\\nClasses a, b, and c may be considered as amenable to treatment, and\\nalso, problematically, class d if taken early. Class e must, in view of\\nthe principles stated in this section, be eliminated from the field of con-\\nservative treatment and where cases in the other divisions apparently\\namenable subsequently take on disorders coming within this classi-\\nfication they usually have passed beyond the reach of palliative treat-\\nment.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0422.jp2"}, "423": {"fulltext": "CAPPING THE PULP. 415\\nIt is important here to consider the influence of the physical endow-\\nments of the patient upon the conservative treatment of the pulp. For\\nsome persons this treatment is followed by the happiest results no\\nintolerance of the operation appearing, and even cases somewhat un-\\npromising doing well. Again, with others, any case, however simple,,\\ngoes down the scale to class e in spite of every care.\\nThe first constitutional condition favorable to success is that of\\nsoundness. As to what are called temperamental indications, when the\\nsubject is of good health, the lymphatic should alone be excluded and\\nmore particularly the bilio-lymphatic. These latter do not respond to-\\npulp treatment in any conditions which occur to them and in reference\\nto their exposed pulps the probabilities are that in the sluggish condi-\\ntion of the parts involved the organ is early invaded by bacteria, and\\nsuch changes have quickly taken place in the anatomical elements of\\nthe pulp as to render all chances of successful treatment valueless. The\\nmost promising cases are those for persons of active temperaments, Avith\\ngood circulation, thin skins, healthy gums, and limpid oral secretions.\\nAfter-treatment. It is not unusual for classes a, b, and c to require\\nafter-treatment. For this reason close observation for some time should\\nbe maintained. It is presumed that the judicious operator has made\\ncareful selection of the cases to be conservatively treated and that he\\nwill early decide from an analysis of the evident conditions whether the\\nprognosis is promising or not. As previously indicated, some of the\\napparently favorable cases will not yield to treatment for the reason\\nthat the actual condition of the pulp may not be made out. Part of\\nthe difficulty here is occasioned by the indefinite character of the state-\\nments of the patient, who should in all cases be instructed to return for\\nconsultation if painful response to cold appears or if reflected pain\\nshould occur. If these conditions supervene, it is a sign of needed care\\nto avert increasing disturbance.\\nA most marked form of reflected pain is felt in the ear, and this\\nfrequently occurs previous to the aggravation of the temperature reac-\\ntions. So much importance should be attached to this symptom of\\npulp disturbance that the first question asked a patient appearing with\\npain, or on approaching a suspected pulp, is, Have you had any pain\\nin the ear of that side? As reflection to the ear often occurs in advance\\nof similar pain in other branches of the fifth pair, it becomes important\\nto maintain close observation of this indication. In this state, sedation\\ncombined with counter-irritation is required.\\nIn any case where the tooth has been impressed by cold, either before\\nthe treatment or afterward, an application should be made to the gum\\nover the tooth, of tincture of aconite root two parts, chloroform one\\npart. The mode of application is important. A pledget of cotton or", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0423.jp2"}, "424": {"fulltext": "416 CONSERVATIVE TREATMENT OF THE PULP.\\nmuslin to cover an area of one-half by three-fourths of an inch should\\nbe filled with the prescription, then squeezed out nearly to dryness between\\nfolds of a napkin to prevent an excess flowing over the mouth and with\\nthe saliva entering the fauces, to which it is extremely irritating as well\\nas unnecessarily medicating the patient. Before the pledget is applied\\nthe surface of the gum should be cleansed of the coat of mucus cover-\\ning it, otherwise the remedy will fail to come in contact with the mem-\\nbrane. It is equally important that dryness of the surface be secured.\\nThis application should be maintained for from twelve to fifteen seconds.\\nIf allowed to remain too long upon the part, vesication takes place.\\nThe general after-treatment consists in the repeated application of aco-\\nnitum as above directed, the repetitions not being made at the same point\\nmore frequently than at intervals of forty-eight hours. When it is\\ndesired to increase the counter-irritation, the gum may be scarified very\\nsuperficially by quick, light movements of a small scalpel. The patient\\nshould be instructed to avoid subjecting the tooth to extremes of tem-\\nperature in either direction. The control period of conservatively\\ntreated cases is usually within the first fortnight after the capping.\\nIt is important that treatment be given at the beginning of the dis-\\nturbance, when a few applications may suffice. Neglected cases, from\\nthe tendency to pulp disorders, are liable to pass beyond the curative\\nstage.\\nThe interesting phenomenon is frequently observed that when the\\nheat rate rises the pulp at first becomes more intolerant of cold. In\\ncase the pulp continues to respond to the remedy the range of tolera-\\ntion should increase in both directions.\\nExamples: No. 1, W. H. J., 108\u00c2\u00b0-73\u00c2\u00b0 112\u00c2\u00b0- 76\u00c2\u00b0; +120\u00c2\u00b0\\n-74\u00c2\u00b0; 124\u00c2\u00b0 -74\u00c2\u00b0; 128\u00c2\u00b0 -67\u00c2\u00b0; 130\u00c2\u00b0 66\u00c2\u00b0. No. 2, I. A. W.,\\n120\u00c2\u00b0 84\u00c2\u00b0 120\u00c2\u00b0 86\u00c2\u00b0 128\u00c2\u00b0 86\u00c2\u00b0 124\u00c2\u00b0-76\u00c2\u00b0 134\u00c2\u00b0-70\u00c2\u00b0\\n140\u00c2\u00b0 -67\u00c2\u00b0; +142\u00c2\u00b0 -66\u00c2\u00b0; +142\u00c2\u00b0 -64\u00c2\u00b0.\\nIt sometimes becomes necessary to open the cases and recap. This\\nusually occurs when in reviewing the case it is considered that some\\noversight has befallen. There may have been two exposures. The\\ncap may not have completely covered the exposed part. There may\\nhave been some compression from forcing the cap, or it may have been\\ndisplaced during the after-procedures.\\nMost careful records of all cases should be kept, with a relation of\\nthe condition and of the controlling symptoms. These records should\\nbe methodically preserved in a book kept for this purpose. Should sub-\\nsequent irritation occur, a new diagnosis may be formed from the recorded\\nfacts and the new conditions. The record of conservatively treated pulps\\nshould be carried forward to the examination chart at each recurring\\nperiodic examination of the teeth. It is better that they be marked in", "height": "4608", "width": "2840", "jp2-path": "americantextboo00kirk_0424.jp2"}, "425": {"fulltext": "CALCIFIC CHANGES IN THE PULP.\\n417\\nsymbol with red ink, to prevent the unnecessary removal of temporary\\nfillings and to explain the reason for their presence and thus avoid the\\naccident of unnecessarily uncovering the pulp in such cases.\\nCalcific Changes in the Pulp as related to the Operation\\nof Pulp Capping.\\nWhen loss of substance takes place slowly, either by carious action\\nor by attrition, a notable calcific growth takes place in the pulp cham-\\nber opposite to the point of waste in the direction of the radiant course\\nFig. 394.\\nSecondary dentin, resulting from irritation of the dentinal fibrils by caries (Black). A, Diagram\\nof an incisor having a decay in the labial surface, a, and a deposit of secondary dentin at b.\\nThe point from which the illustration B is taken is shown by c. B, Illustration of the tissue\\nof the secondary deposit in A a, primary dentin b, secondary dentin c, seems to be a blood-\\nvessel that has become calcified d, an irregular fault having some resemblance to the lacunae\\nof bone e, pulp chamber. It will be noted that there are irregular deposits of granular matter\\nin the substance of the secondary dentin, and that the tubules wind about them.\\nof the tubules (see Fig. 394). If the loss of substance from the ex-\\nterior progresses with sufficient slowness encroachment upon the pulp\\ndoes not take place. The pulp chamber may become obliterated by the\\nprogressive deposition of calcific matter, which has the designation of\\nsecondary dentin.\\nThe morphological character of the secondary deposit is histologically\\nirregular, being frequently of mixed character, presenting some of the\\ncharacteristics of dentin and also containing cemental cells with radiant\\nand anastomosing canal iculi. For this reason deposits have been\\ndesignated as osteo-dentin.\\nIn the earlier years of life opportunity does not offer to study these\\nchanges of structure, as the usual progress of caries is too rapid, but in\\nadvanced life they are common, it being not infrequent to find complete\\n27", "height": "4568", "width": "2816", "jp2-path": "americantextboo00kirk_0425.jp2"}, "426": {"fulltext": "418\\nCONSERVATIVE TREATMENT OF THE PULP.\\nobliteration of the pulp cavity as well as of the canal of the root (see\\nFig. 395). In some instances nodules of calcific material appear un-\\nFig, 395.\\nCalcification of the dental pulp (Black). At A is shown the outline of a lower molar with a cavity\\nat b. The pulp chamber is much reduced in size and filled with calcific material, as shown in\\nB. a, a large granular mass of calcific material, which is very transparent but finely granular.\\nA very few irregular lines are seen in the centre, which slightly resemble dentinal tubes b,\\nan erratic growth of irregularly formed and unusually transparent dentin c, line of the\\ngrowth of dentin from the floor of the pulp chamber the growth from other directions is so\\nperfectly regular as to leave no markings d, margin of the cavity of decay e, a bundle of\\ncylindrical forms of calcific material extending down into the root canal. These extended to\\nthe apex of the root.\\nattached to the walls of the pulp cavity (Fig. 396). These increase\\nsometimes by external development and in other cases by the coalescence\\nFig. 396.\\nA\\nr\\nA, Outline of a lower molar, with a large carious cavity at a; b, pulp chamber. The shaded por-\\ntion, c, was occupied by cylindrical calcifications. B, Illustration of the cylindrical calcifica-\\ntions. X 100. (Black.)\\nof several contiguous nodules. Again, several nodules inhabiting the\\npulp chamber may increase in size without becoming fused, and, accom-\\ni", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0426.jp2"}, "427": {"fulltext": "CALCIFIC CHANGES IN THE PULP. 419\\nmodating themselves to each other as development progresses, they at\\nlength completely fill the cavity, from which they are severally removed\\nwith great difficulty.\\nIt is remarkable that while in some instances pulp nodules become\\nthe cause of producing violent pain by their pressure upon the nerves\\nof the pulp, in the majority of cases substitution of the normal tissue\\ntakes place until nearly complete occlusion of the pulp cavity is affected\\nwithout the occurrence of pain.\\nSmall pulp nodules are not infrequently found in pulps otherwise\\nperfectly normal, but generally they are evidence of continued irritation\\nof a mild form usually attending the progressive slow advancement of\\ncaries of the tooth. But this is not necessarily the case, since some of\\nthe most violent attacks of dental neuralgia have arisen from the pres-\\nence of nodules in perfectly sound teeth.\\nThe diagnosis of the existence of pulp nodules as the cause of pulp\\nirritation is not easily made out. The determination of the condition\\nusually can be reached only by the process of exclusion. As they do\\nnot occur early in life while the teeth are undergoing ordinary develop-\\nment, they may be looked for only after middle life. The pain is dull\\nand reflected, and the paroxysms are frequent. There is sensibility to\\ncold, and rarely pain appears on percussion. When the teeth are\\nsound, the disturbing one will usually be determined by the tem-\\nperature tests.\\nAn important differentiation from the usual irritation of ordinary\\npulp disturbance from exposure or the thermal irritation caused by the\\napproximation to the pulp of large metal fillings, is that the disturbance\\nfrom nodular irritation is not rapidly progressive and that the irritation\\nmay continue without marked exacerbations or subsidence for consider-\\nable periods.\\nTreatment is useless which does not include drilling to the pulp and\\ndevitalizing it. The difficulties involved in treatment by devitalization\\nare liable to be attended by great pain, since when the pulp chamber is\\nmuch occupied by nodules the action of the devitalizing agent has not\\nfree course. In these cases the remains of the pulp between the nodules\\nand the walls of the chamber are attenuated, and when irritated by the\\narsenous acid give expression to an excessive degree of pain. 1\\nThe Influence of Pulp Exposure, and the Effect of Conservative Treat-\\nment of the Pulp upon Calcific Depositions. Allusion has been made\\nto calcific deposits occurring on the walls of the pulp chamber as the\\nresult of peripheral irritation. Here, as stated, these accretions only\\noccur when the degree of irritation is slight and of long continuance.\\nThe examples of this which have been given in dental literature are\\n1 For the form and extent of nodular calcification see American System of Dentistry.", "height": "4568", "width": "2812", "jp2-path": "americantextboo00kirk_0427.jp2"}, "428": {"fulltext": "420 CONSERVATIVE TREATMENT OF THE PULP.\\nconclusive as to the ability of the pulp at all stages of its existence to\\ntake on this action when the conditions are as stated. On the contrary,\\nwhen the disturbances are active the formation of calcific deposits on\\nthe walls of the pulp chamber do not take place, or if in the earlier\\nprogress of decay they have commenced, as the progress of the destruc-\\ntive action approaches the pulp this change is suspended, and in some\\ninstances resorption of the secondary deposit takes place.\\nIt is apparently in this manner that the pulp becomes denuded under\\nthe influence of thermal or traumatic irritation in cases in which there\\nwas no evidence of exposure at the time of the preparation and filling\\nof the cavity. This result Avould appear to be related to the principle\\nthat secondary structures and tissue of repair are liable to resorption as\\nthe result of irritation or disturbances of nutrition.\\nThe frequent occurrence of secondary dentin following the conserva-\\ntive treatment of the pulp and in some instances occurring spontaneously\\nover exposed pulps, raises important considerations connected with the\\nsubject. The writer has had many instances come under his observation\\nin which secondary dentin has obliterated exposures, both in his own\\ncases and in those of others.\\nThe influence of the tendency to nodular deposits upon the results\\nof conservative treatment does not appear to be detrimental unless the\\npulp chamber becomes largely filled with them. The pulp at the period\\nof life when calcific deposits usually take place is not so sensitive as it\\nis at an earlier age, and therefore, unless senile conditions appear to be\\npresent or imminent, the existence of such deposits should not be inim-\\nical to the preservation of the pulp. The writer, who has had frequent\\ncases of pulp devitalization after conservative treatment, has rarely ob-\\nserved pulp stones in these cases.\\nIt is an important consideration that when calcific deposits take\\nplace beneath fillings where the pulp has been nearly exposed, or where\\nthey have followed conservative treatment of the pulp, they are liable\\nto resorption on the occurrence of irritation of the pulp from any cause\\nwhich brings on an increased blood supply. This is more remarkable\\nsince there are no lymphatic vessels in the pulp. This change can occur\\nonly by the development of osteoclasts on the surface of the pulp.\\nOf this development there have been several recorded instances\\nwhere the dentin has suffered resorption until the enamel has been\\nencroached upon by the process of denudation, and when favorable\\nconditions were established a deposition or formation of secondary\\ndentin has occurred.", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0428.jp2"}, "429": {"fulltext": "DEVITALIZATION AND EXTIRPATION OF THE PULP. 421\\nDevitalization and Extirpation of the Dental Pulp.\\nWhen the existing conditions are such as to require the devitalization\\nof the pulp there are several requirements essential to secure a satis-\\nfactory result\\n(1) That little pain be inflicted.\\n(2) That the destruction be quickly effected.\\n(3) That precaution be taken to prevent discoloration of the dentin.\\nThe first requirement is the most important, since, if the means used\\nto effect the devitalization are painless or nearly so, the pulp promptly\\nyields to the devitalizing agent and there is little danger of discoloration\\nof the dentin.\\nAt present there are three general methods of procedure by chemi-\\ncal means, by extirpation with suitable instruments, and by narcotization\\nof the tissue.\\nReliance has usually been placed upon chemical agents, these being\\n1. Zinc chlorid 2. Caustic potassa 3. Chromic acid 4. Arsenous\\nacid 5. Arsenical ore (cobalt).\\nThe agents 1, 2, 3 are usually painful, of slow progress, difficult of\\napplication, and uncertain. Hence arsenous acid has usually been\\ndepended on. This substance, notwithstanding certain objections, is the\\nmost available and most reliable of the substances above named. It\\nhas generally been combined with acetate of morphin in variable pro-\\nportions, to which has been added in the formation of this paste a suf-\\nficient quantity of creosote, carbolic acid, or one of the essential oils, to\\ngive the combination the consistence of cream. 1\\nIn making this formula it is important that the ingredients be\\nthoroughly ground together to effect the comminution of the arsenic\\nand the morphin as well as to intimately mix the components. The\\nmorphin is used as a sedative to counteract the excessive irritation fre-\\nquently caused by the action of the arsenous acid, which is also modified\\nby the anesthetic influence of the creosote. Carbolic acid has been fre-\\nquently substituted for creosote as being of less disagreeable odor, and\\nas, from its coagulative action upon the surface of the pulp, it prepares\\nthe tissue to absorb the arsenic and markedly lessens the time of absorp-\\ntion. It is a well-known fact that with great frequency the application\\nof arsenous acid to the pulp is so greatly irritating to it that much pain\\n1 Of late cocain has largely superseded the morphin salt as an ingredient of these pre-\\nscriptions. As\\nR Acid, arsenosi,\\nCocainse hydrochl., da, pars seq.\\n01. caryophylli, q. s.\\nM. et ft. pasta.", "height": "4556", "width": "2824", "jp2-path": "americantextboo00kirk_0429.jp2"}, "430": {"fulltext": "422 CONSERVATIVE TREATMENT OF THE PULP.\\nis excited, which brings about congestion of the surface of the pulp to\\nsuch a degree as to delay absorption of this agent.\\nWhen the above-stated combination is applied to a living pulp which\\nhas not been in a state of disturbance, and therefore is in the condition\\nof quiescence considered in the section on conservative treatment of the\\npulp, little or no excitement of the organ takes place. If the paste be\\ncarefully applied in such a manner as to avoid pressure the pulp does\\nnot usually become excited and promptly succumbs to the chemical force\\nof the arsenic. When on the contrary the pulp is in a condition of\\nactive congestion, such as is presented by cases of prolonged exposure,\\nand where congestion has supervened as the consequence of futile\\nattempts at conservation, violent further excitement of the pulp is\\nnearly certain. In this condition the pulp resists the absorption of the\\narsenic and repeated applications are likely to produce no better results.\\nThe failure to discriminate between the different conditions of the pulp\\naccounts largely for the variation in the action of the same formula\\nupon the exposed pulp.\\nIt becomes important, therefore, to reduce the state of hyperesthesia\\nof the pulp and to relieve the congestion in many instances before\\ncommencing the devitalization.\\nThe relief of congestion requires, first, the disinfection of the surface\\nof the pulp and of the dentin contiguous to it. The most efficient\\nagent for this purpose, generally, is formalin, which after the first slight\\npain produced by it is almost immediately soothing. Formalin owes\\nits value as a disinfectant to its extreme diffusibilityand in the strength\\napplicable does not appear to be coagulative in its action. The strength\\nshould for this purpose not be greater than 2|- per cent. As formalin is\\ncomposed of 40 volumes of formaldehyd with 60 of water, the above-\\nstated percentage of formaldehyd is produced by adding 1 volume of\\nformalin to 14 volumes of water.\\nWhen violent congestion is manifest and when the pain attending\\nthe removal of the carious matter forbids the complete baring of the\\npulp, a paste composed of tannic acid and oil of cloves sealed in the\\ncavity will so far subdue the conditions as to permit complete removal\\nof the caries. This application should be allowed to remain for several\\ndays. This paste should be contained in a large concave cap and\\nsecured with one of the plastic cements.\\nFor the relief of ordinary congestion of the pulp cocain offers the\\nbest means, since it has direct and positive action over the capillaries,\\nwhich has generally been adduced to account in part for its anesthetic\\ninfluence, as by lessening the supply of blood in the capillaries it there-\\nby reduces the stimulation of the nerve fibrils. In cases of known con-\\ngestion as determined by the symptomatology when there is no effusion", "height": "4608", "width": "2864", "jp2-path": "americantextboo00kirk_0430.jp2"}, "431": {"fulltext": "DEVITALIZATION AND EXTIRPATION OF THE PULP. 423\\nof lymph or pus from the exposed surface, the pulp is bathed with a\\nstrong solution of cocain and is then covered with a deep cap filled with\\na paste of cocain and oil of cloves hermetically sealed in for several\\ndays, when usually the arsenical paste may be used with much-lessened\\ndanger of irritation.\\nIn these cases, and indeed in all cases, an excellent formula for de-\\nvitalization will be found in the combination of 10 grams of arsenous\\nacid ground well with 20 grams of cocain. This is taken upon a minute\\npledget of cotton previously charged with oil of cloves or carbolic acid,\\nwhich is laid upon the exposed point and then sealed in hermetically,\\ncare being taken to avoid compression by arching over the dressing a\\nsuitable cap, or by flowing over the dressing a soft paste of one of the\\nmineral cements. Too much care cannot be taken concerning the\\nprotection of the gum from escape of the arsenical preparation, since\\nserious destruction of the gum and alveolus may be produced by the\\nexuding of the arsenic.\\nWhen there is evidence of the exudation of pus, this is checked by\\nthe application of deliquescent zinc chlorid or by washing with pyrozone.\\nUsually in such cases the surface of the pulp has become necrotic by\\nthe suppurative process and will not be so repel lant of the arsenic as in\\nordinary cases.\\nThe time usually required for the action of the arsenic to reach well\\ntoward the apex of the roots is from four to six days. This, however,\\ndepends upon the quantity of the preparation applied and the resistance\\nof the pulp tissue. As the aim should be to procure the nearly com-\\nplete death of the pulp by one application, the longer period is preferable\\nas entailing less difficulty and the expenditure of less time than when\\nshorter intervals are allowed.\\nWhen the application is made to an entirely quiescent pulp it will\\noften be found that at the end of one or two days a broach may be\\npassed to the end of single-rooted teeth, when the pulp may sometimes\\nbe removed. In these cases, if the pulp be not then extracted, it will\\nbe found in some instances that at a subsequent period the organ has\\napparently recovered its sensitivity. The explanation of this is that the\\narsenic apparently paralyzes the nerves of the pulp without having acted\\ndeeper than the surface. In this case the application should be repeated\\nfor a lengthened period without disturbing the tissue. On removing\\nthe dressings if the broach cannot be passed to the end of the canal\\neither of two courses may be pursued the application may be repeated\\nwithout removing the devitalized portion, or a strong solution of cocain\\nmay be carefully instillated until it is conveyed to the apex of the canal\\nby means of a broach. This procedure is best effected by isolating the\\ntooth with rubber dam and then filling the pulp chamber with the solu-", "height": "4556", "width": "2796", "jp2-path": "americantextboo00kirk_0431.jp2"}, "432": {"fulltext": "424 CONSERVATIVE TREATMENT OF THE PULP.\\ntion of cocain, which may be conveniently conveyed forward by gentle\\nadvancements and withdrawals of this instrument. The best form of\\ninstrument for this purpose is the Swiss broach tempered a little beyond\\na spring temper.\\nA matter of considerable importance in connection with the instru-\\nments used in these manipulations is that they be either such as have\\nnot been previously used or that they be thoroughly disinfected previous\\nto use. If an instrument of this kind is indiscriminately used, having\\nprobably been infected by some purulent case, septic disturbance of the\\ntissues at the apex is brought about. The safest course is to use a new\\nbroach suited in size and stiffness to the case in hand.\\nSince cataphoresis has been employed in dentistry it has been fre-\\nquently used to effect the anesthetization of the pulp by cocain. This\\nmethod has certain advantages. The time expended in the procedure\\nis from ten to thirty minutes. The requirements are that insulation be\\nperfectly secured that the selected voltage be low at the commence-\\nment in most instances from 5 to 10 volts and be gradually increased\\nas the pain limit will permit.\\nThe impediments are the usual small size of the foramina and the\\ndensity of the pulp walls. When the foramen is large the resistance is\\nless and the action prompt.\\nCocain may be employed in this manner to obtund the parietes of the\\ncavity and the surface of the pulp, when after the removal of the carious\\nmatter the pulp may be uncovered. The application can then be\\nrenewed to complete the anesthetization of the pulp.\\nThis procedure saves much time and discomfort and also avoids\\npain as compared with devitalization by chemical means. It is indi-\\ncated in cases of severe congestion of the pulp, in which arsenic usually\\nproduces great pain and often is without satisfactory result.\\nIn some instances complete obtundation is not effected throughout\\nthe extent of the pulp. Here, after removal of the part anesthetized\\nthe remainder may be devitalized easily by White s fiber, which is\\nthe safest arsenical preparation to use under these conditions.\\nInstillation of cocain by means of a broach may also be efficacious.\\nA further advantage in this method of treatment is that when the\\nanesthesia is completed the pulp may be entirely removed and the\\ncanal be filled at the same sitting.\\nIt is sometimes observed, as the result of forcing the current beyond\\nreasonable limits, that soreness of the peridental membrane follows.\\nWhat effect has been produced in this instance is not clearly apparent.\\nWhether it is a result of undue pressure of the current upon the apical\\ntissues or is caused by the interference of cocain with the nutrition of\\nthe parts has not been determined. This effect is mentioned to induce", "height": "4612", "width": "2864", "jp2-path": "americantextboo00kirk_0432.jp2"}, "433": {"fulltext": "PRECAUTIONS TO PREVENT DENTINAL DISCOLORATION. 425\\nthe degree of caution which is the accompaniment of an intelligent use\\nof a force of signal service when carefully applied, but which recklessly\\npushed may do injury. 1\\nThe Pressure Method of Obtunding the Pulp.\\nA method of applying cocain to the pulp under pressure has recently\\ncome into use. It consists of laying over the exposed surface, after\\nthe pulp is carefully and broadly uncovered, a small piece of amadou\\n(punk) filled with a saturated solution of cocain in absolute alcohol or\\nchloroform. The cavity is then filled with a piece of unvulcanized\\ncaoutchouc. Pressure is effected directly upon the rubber with a broad\\nrounded instrument, so adapted in size that it will not meet with\\nimpediment and yet not small enough to exert force directly upon the\\npoint of exposure. The degree of pressure should at first be slight, and\\nbe gradually increased as the cocain exerts its effect upon the pulp.\\nThe force is exerted by successive steps, terminating when pain follows,\\nbut maintained until the sensation ceases. At length when no pain is\\nproduced by excessive pressure the rubber and punk are removed, when\\nthe pulp is immediately removed by the usual means. This operation\\nis done quickly, to avoid the return of sensitivity.\\nThose who pursue this plan state that it produces nearly uniform\\nresults and enables the canal and pulp chamber to be filled immediately.\\nThe indications are that the cocain overcomes the sensitivity of the\\nsurface of the pulp, and that pressure paralyzes the tissue by the com-\\npression to which it is subjected. Were the cocain conveyed to the\\napex, as when it is instillated, pain would not so soon return.\\nPrecautions required to Prevent Discoloration of the\\nDentin.\\nIt sometimes occurs where arsenous acid produces much irritation\\nof the pulp that the violent congestion occasions disorganization of the\\nblood corpuscles, resulting in the distribution of the hematin throughout\\nthe dentin. This most unfortunate result is liable to follow the applica-\\ntion to an already congested pulp when the application is made without\\nfirst subduing this condition. It is also more liable to happen when\\nunder these circumstances the pulp has not been completely denuded of\\nthe carious matter.\\nThe removal of the ultimate layers of carious matter is important to\\npermit the pulp to bleed and thus to deplete the engorged vessels. It\\nis also necessary to avoid making an arsenical application until the\\n1 The student will find much instruction in Price s Foundation Principles of Den-\\ntal Cataphoresis, Items of Interest, vol. xx. p. 345 et seg.", "height": "4552", "width": "2796", "jp2-path": "americantextboo00kirk_0433.jp2"}, "434": {"fulltext": "426 CONSERVATIVE TREATMENT OF THE PULP.\\nassurance is reached that the bleeding has completely ceased, else subse-\\nquent bleeding may induce discoloration. In addition the bleeding or\\nany other kind of effusion prevents direct contact between the pulp and\\nthe arsenical paste.\\nThese general directions apply also to the employment of pow-\\ndered cobalt as a devitalizer. The difference between the action of\\ncobalt and arsenous acid is due to the variations in their respective\\nsolubility in the fluids of the pulp cobalt having a low rate of solu-\\nbility. For this reason this substance requires a longer interval, at\\nleast a week being necessary for its action to extend into the canals. In\\nanterior teeth a shorter period should be chosen. With this substance\\nit is of extreme importance that the application be made directly to the\\npulp. The method is as follows\\nA pellet of cotton the size of a pinhead is saturated with any of the\\nessential oils it is then dipped in the powder and laid upon the pulp.\\nThe previously stated precautions are taken to prevent pressure of the\\npellet of cotton upon the pulp and to protect the cavity from the ingress\\nof moisture.\\nIn these procedures connected with the removal of the pulp the use\\nof alcohol is an important aid, since on account of its affinity for water\\nit much aids, in addition to its cleansing properties, in the procurement\\nof dryness of the parts. Desiccation of the pulp chamber materially\\nassists in all the delicate procedures connected with the treatment of\\nthis class of cases. It lessens the pain of the remaining living portion\\nof the pulp, and by giving firmness to the devitalized part makes more\\neasy the removal of the dead tissue. It also facilitates the action of the\\ndisinfectants which may be employed to prevent rapid changes in the\\norganic contents of the canal. The process of desiccation may be much\\nfacilitated by the concurrent injection of warmed air.\\nIt should be emphasized that in all procedures connected with\\nthe treatment of pulps undergoing devitalization the teeth should be\\nisolated by the use of rubber dam. This is necessary not only to\\nfacilitate observation and secure dryness but to protect from mouth\\ninfection.\\nThe removal of the dead pulp tissue is effected by small barbed\\nbroaches which are passed between the pulp and the walls of the canal.\\nWhen these reach the apex the pulp may in most instances be wound\\nupon the instruments by a gentle rotation. When this does not take\\nplace because of the loss of consistence of the tissue, it is broken up by\\nconstant rotation of the instrument and removed piecemeal. The dis-\\nplacement of the shreds is best effected by wrapping the broach w T ith a\\nfew fibers of cotton dipped in alcohol.\\nPreviously to this, free communication must be established between", "height": "4608", "width": "2856", "jp2-path": "americantextboo00kirk_0434.jp2"}, "435": {"fulltext": "PRECAUTIONS TO PREVENT DENTINAL DISCOLORATION. 427\\nthe cavity and the pulp chamber, as well as such a formation of the\\nlines of approach to the canals of the root as will give free access, not\\nonly for the removal of the dead tissue, but as well to facilitate the\\ncomplete closure of the root canals to the apices to prevent the ingress\\nof organic matter from the adjacent tissues.\\nMinute directions for the form of approach to the various canals and\\nthe related procedures will be found in the next chapter.", "height": "4536", "width": "2776", "jp2-path": "americantextboo00kirk_0435.jp2"}, "436": {"fulltext": "", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0436.jp2"}, "437": {"fulltext": "CHAPTER XVII.\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nBy Henry H. Burchard, M. D., D. D. S..\\nPathological Conditions.\\nThe modes of treatment of the pulp chambers and canals of teeth\\ncontaining non-vital pulps, or those in which the pulp is absent, are\\ndetermined and governed by the pathological conditions present. These\\nconditions may be broadly divided into aseptic and septic i. e. those\\nwhich have not been invaded by micro-organisms, the others those in\\nwhich the pulp or its remnants furnish the soil in which the develop-\\nment of micro-organisms has taken place.\\nThe first class includes those cases in which the pulp has been inten-\\ntionally devitalized en masse, and also those in which the organ has\\nundergone a process known as mummification, or dry gangrene. This\\nlatter condition is occasionally found as a consequence of traumatic\\ndeath of the pulp without exposure, and sometimes as a sequel of\\nattempts at conservation of exposed pulps by capping them with zinc\\noxychlorid.\\nThe septic cases may be divided into classes according to the depth\\nof invasion of septic organisms they range from superficial ulceration\\nof the pulp, to its disorganization through the agency of putrefaction,\\nand the infection of the tissues beyond the apex of the root.\\nImmediately upon or even before exposure of the dental pulp,\\nits surface, and subsequently its substance, is invaded by several\\nof the many forms of organisms which find a habitat in the human\\nmouth.\\nThe first of the septic cases are those in which organisms have\\ninvaded the coronal portion of the pulp and destroyed part of its sub-\\nstance through a process of ulceration. Such cases become aseptic\\nthrough the removal of the pulp en masse, provided no organisms be\\ncarried into the canal during or subsequent to the removal of the\\npulp.\\nThe second class of cases comprises those in which septic organisms\\nhave invaded the pulp along the direction of its veins and destroyed\\nthe mass of the organ through a process of suppuration. In these cases\\n429", "height": "4548", "width": "2788", "jp2-path": "americantextboo00kirk_0437.jp2"}, "438": {"fulltext": "430\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nit is not uncommon to find the tissues of the apical region affected in\\nsome degree presumably by infection with the waste products of the\\norganisms, a transitory pericementitis occurring which ceases when the\\ndead pulp sloughs from its vital connection at the apex. The succeed-\\ning stages of the infection are those of moist gangrene and putrefactive\\ndecomposition of the pulp tissues, and later of the contents of the\\ntubules. Following upon these conditions are affections of the cemen-\\ntum and the pericementum in the apical region, resulting in an inflam-\\nmatory process in these parts.\\nAll of these stages of infection and decomposition may be found in\\nthe pulp at one time, the suppurative process preceding that of putre-\\nfaction. Cultures made from a gangrenous pulp (see Fig. 397) 1 showed\\nFig. 397.\\nc\\n4 5\\nMicro-organisms found in cultures from a gangrenous pulp.\\nthe smaller cocci and diplococci (5) nearest the apex of the root (c, Fig.\\n397, 1) where suppuration was in progress the larger forms and more\\nvarieties were found in the necrosed and decomposing portions of the\\n1 Miller, Dental Cosmos, July, 1894.", "height": "4604", "width": "2860", "jp2-path": "americantextboo00kirk_0438.jp2"}, "439": {"fulltext": "PATHOLOGICAL CONDITIONS. 431\\npulp (4, 3, 2). The cases of gangrenous pulps exhibit a mixed infec-\\ntion, several varieties of cocci, bacilli, and spirochetes being found. 1\\nCases are occasionally seen in which the pulp of a non-carious tooth\\nhas been devitalized in consequence of a blow, injuring the vessels as\\nthey enter the apex of the root the same effect is not rare as a conse-\\nquence of too rapid or extensive movement of teeth in regulating. The\\npulps in such cases are probably destroyed by thrombosis of the vessels\\nat the root apex. The death of the pulp may not be detected for years\\nwhen evidences of albuminous decomposition are discovered, a growing\\nopacity and changing color of the tooth may be detected. In other\\ncases alveolar abscesses may form and discharge at some point near the\\ntooth, or it may be at some distance from it. It is presumed that the\\norganisms which have effected this decomposition of the pulp resulting\\nin the suppurative process have found their way to it via the blood\\ncurrent.\\nIt is within the experience of every dentist that the products of\\ndecomposition occurring under these conditions afford a suitable soil for\\nthe development of virulent micro-organisms as soon as the tooth is\\nopened to the air.\\nThe several conditions described are to be regarded, for purposes of\\ntreatment, as definite pathological states. The treatment is to be\\ndirected to the attaining of such conditions as shall insure the retention\\nof the tooth with an entire absence of pathological manifestations.\\nRational therapeutics should govern each procedure.\\nCases in which the Pulp has been Intentionally Destroyed and Re-\\nmoved en masse. As this procedure usually has been determined upon\\nin consequence of suppuration or inflammation of the pulp, the septic\\norganisms, the staphylococci, streptococci, and bacilli, have followed\\nthe course of the inflammation, i. e. along the veins. The organisms of\\nputrefaction, if present, have affected but in very limited degree the\\nmost external portions of the pulp, so that the color of the dentin is\\nunaltered except to a very slight depth. After the removal of the pulp\\nthe contents of the tubules are chemically unchanged, and the canals\\ncontain no organic matter, except the blood which may have escaped in\\nconsequence of tearing away the pulp. There may also remain odonto-\\nblasts which have become mechanically detached during the operation.\\nProvided no organisms have been introduced during or subsequent to\\nthe operation of extirpation, the canals are aseptic. If proper anti-\\nseptic precautions have been taken, sterilizing and isolating the tooth to\\nbe operated on and also the instruments employed, no infection occurs.\\nThese are the cases in which immediate root filling has been recom-\\nmended and practised with success.\\n1 See Fig. 397.", "height": "4564", "width": "2804", "jp2-path": "americantextboo00kirk_0439.jp2"}, "440": {"fulltext": "432\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nFig. 398.\\nPigment. S hemoglobin\\nC0 2 ,NH 3\\nHoO and H 2 S\\nfatty\\nucts.\\nIf the septic process has invaded the pulp extensively the pulp\\ntissue, as its destruction progresses, be-\\ncomes the seat and soil of putrefactive\\ndecomposition involving also to a vari-\\nable extent the contents of the dentinal\\ntubules, and the color of the dentin un-\\ndergoes a series of changes. 1 The ap-\\npended figure (Fig. 398) gives a graphic\\ndiagrammatic representation of the serial\\ndecomposition of an infected pulp. The\\nalbuminous constituents of the pulp un-\\ndergo fatty transformation next putre-\\nfactive decomposition attended by the\\nevolution of hydrogen sulfid, ammonia,\\nand other end products. According to the\\nAromatic and extent of invasion and its variety, waste\\nprod- products are formed (ptomains and al-\\nlied substances) by the organisms which\\nact as irritants to the vital tissues, until,\\nwhen the apical but still vital portions\\nof the pulp become the soil for the de-\\nvelopment of pyogenic organisms, the\\ntissues of the apical region are affected.\\nUsually in the later stages of pulp sup-\\npuration the tooth becomes sensitive upon percussion. Succeeding this\\nstate of affairs is a period of delusive quiet, during which the apical\\ntissues, although doubtless affected by the toxic substances present,\\nexhibit but slight subjective symptoms. The remnants of the pulp are\\nundergoing progressive decomposition, as are also the contents of the\\ndentinal tubules. After a variable period, governed by the virulence\\nof the organisms present and the inherent resistance of the vital tissues\\nof the apical region, these latter succumb, poisoned by the toxic sub-\\nstances formed in contact with them, and an inflammatory action arises\\nthis may be subacute, evidenced by sensitiveness upon percussion and a\\ndeepening of the gum color overlying the apex of the root, constituting\\na condition known as subacute pericementitis or, if the attack be more\\nsevere, or the resistance lessened, the symptoms are more violent there\\nis a pronounced hyperemia, quickly succeeded by the evidences of\\nmarked inflammatory action. The tooth, owing to the effusions in the\\npericementum, becomes elevated and exquisitely sensitive to touch\\nthe color of the gum deepens, and heavy throbbing pain is complained\\nof; acute pericementitis is in progress. In more severe cases marked\\n1 See Chapter XX. on Bleaching.\\nPtomains.\\nPeptones,\\nPus.", "height": "4608", "width": "2872", "jp2-path": "americantextboo00kirk_0440.jp2"}, "441": {"fulltext": "THERAPEUTIC AGENTS. 433\\noedema of the gum and it may be of the face arises the pulse increases\\nin volume, tension and frequency febrile action, with a temperature as\\nhigh as 103\u00c2\u00b0 or 104\u00c2\u00b0 may occur; in other cases distinct evidences of\\nseptic intoxication may appear, and indeed even septicemia or pyemia\\nmay result at a later stage.\\nThe severity of the inflammatory action is no doubt governed in part\\nby the variety of the infecting organisms, and again by the physical\\ncondition of the individual attacked. Judging from the mode of prog-\\nress and attack, the staphylococci are the offenders where the inflam-\\nmatory action is circumscribed, and the streptococci in cases which\\nexhibit a tendency to spread along the course of the fascia and produce\\nphlegmonous inflammation. 2 Schreier has found the almost invariable\\npresence of a diplococcus in this condition, probably the diplococcus\\npneumonice.\\nIndividuals presenting any of the several manifestations of struma,\\ninherited or acquired, suffer from a debility of general vital processes,\\nand may have the inflammatory action run a riotous course (see\\nAlveolar Abscess, Chapter XVIII.). As a rule, when a tooth has been\\nthe seat of subacute pericementitis for a lengthened period, or of acute\\nseptic pericementitis for from twenty-four to forty-eight hours, there is\\nmore or less death of cellular elements in the inflammatory effusion,,\\npus forms, and alveolar abscess is established (see Chapter XVIII.).\\nIn cases of subacute pericementitis, even those in which pus forma-\\ntion is not evident, the tissues of the apical region are assailed by the\\nproducts of putrefactive decomposition, which latter process may prove\\ndifficult to overcome, the tissues rebelling at each attempt to close the\\noutlet to the escape of gases which irritate them.\\nEach phenomenon mentioned as accompanying the stages of septic\\ninfection and albuminous decomposition forms an item for consideration\\nin the therapeutic measures to be applied.\\nTherapeutic Agents.\\nThe natural and true inference from what has been stated is that the\\nclass of therapeutic agents to be locally employed in any of these condi-\\ntions are all included under the general order of germicides, antiseptics,\\nand disinfectants.\\nThe one distinguishing feature that all of these substances have in\\ncommon is the power differing in degree in each of destroying patho-\\ngenic organisms or rendering innocuous their waste products their\\nother properties differ widely, so that the agent for application to spe-\\n1 See case of Dr. E. T. Darby, Proc. Odontological Society of Pennsylvania, 1892.\\n2 See case reported by Dr. E. C. Kirk, Proc. Odontological Society of Pennsylvania,\\n1892.\\n28", "height": "4564", "width": "2816", "jp2-path": "americantextboo00kirk_0441.jp2"}, "442": {"fulltext": "434 THE TREATMENT AND FILLING OF BOOT CANALS.\\ncific disease conditions is selected with a regard to which shall best and\\nmost completely attain a definite end. According to the effects produced\\nupon albumin the agents under consideration may be placed in two\\nclasses, coagulants and non-coagulants. In the former class are in-\\ncluded salts of the metals and alcohols in the latter, many of the\\nessential oils.\\nMineral acids and the alkalies act by chemically destroying the\\nalbumin. The metallic salts which have been employed or tested as\\ngermicides in pulp canals are the chlorids of zinc and of aluminum, the\\nbichlorid of mercury, the bichlorid of gold and sodium, the sulfate of\\ncopper, and the nitrate of silver. The salts of copper, silver, and gold\\nare not adapted on account of the discolorations produced by them.\\nMercuric chlorid is open to the same objection thus the only metallic\\nsalt having general application is zinc chlorid.\\nThe alcohols employed are the ethylic (commercial) alcohol phenylic\\nalcohol, i. e. carbolic acid, and creosote, with the coal-tar derivatives,\\nthe cresols. In this connection formalin a 40 per cent, solution of the\\ngas formaldehyd in water should be mentioned very favorably in\\ndental practice it is reduced to a strength of 3 to 5 per cent.\\nPreparations of iodin, bromin, and chlorin are all powerful anti-\\nseptics and disinfectants. Bromin is inapplicable owing to its irritat-\\ning effects and offensive odor chlorin is employed in the form of\\nhypochlorites usually in the solutions called electrozone and meditrina,\\nelectrolytic products of sea-water. Labarraque s solution of sodium\\nhypochlorite appears to have fallen into general disuse, as have also the\\nhyposulfites. The usual form in which iodin is applied is as the\\ntincture. Iodin trichlorid is said 1 to be five times as strong as mercuric\\nchlorid as an antiseptic.\\nThe essential oils recommended as antiseptics for employment in\\ncanal and dentin sterilization are those of thyme, cinnamon, cassia,\\nmyrtle, and eucalyptus.\\nThe alkalies employed as sterilizing agents are Schreier s alloy of po-\\ntassium and sodium, called Kalium-natrium sodium carbonate and so-\\ndium dioxid. The mineral acids which have been recommended are hydro-\\nchloric and sulfuric, the latter by the method described by Dr. Callahan. 2\\nThe gases oxygen and chlorin, in statu nascendi, are employed as\\nsterilizing agents, the former extensively. When these are applied as\\nbleaching agents, the sterilization is coincidently accomplished, as\\npointed out in the chapter on Bleaching.\\nOxygen is liberated from aqueous and ethereal solutions of hydrogen\\ndioxid and solutions of sodium dioxid.\\n1 Langenbach, quoted by Miller, Dental Cosmos, vol. xxxiii. p. 342.\\n2 Proc. Ohio State Dental Society, 1894.", "height": "4612", "width": "2788", "jp2-path": "americantextboo00kirk_0442.jp2"}, "443": {"fulltext": "THERAPEUTIC AGENTS. 435\\nIodol, iodoform, and kindred substances are not employed as germi-\\ncides per. se, but for other therapeutic properties possessed by them, e. g.\\ntheir supposed capability of maintaining sterilization after the more\\npowerful antiseptics have been employed as germicides.\\nAristol, dithymol binioclid, is another member of this group, which\\nowing to its chemical composition is theoretically preferable to the\\nothers. It contains twice the quantity of iodin in loose combination,\\nand in addition has as its base a powerful antiseptic, thymol.\\nThese agents are supposed to act as antiseptics in consequence\\nof setting free iodin when brought in contact with albuminous\\nsubstances.\\nIt has been demonstrated that iodoform is not a germicide (organ-\\nisms growing about it), but it appears to lessen or destroy the effects\\nof toxic substances generated about it as the result of albuminous de-\\ncomposition.\\nThe final antiseptic to be mentioned is the mechanical removal of\\ninfected tissues.\\nZinc chlorid forms, when brought in contact with albumin, a dense\\nand almost colorless coagulum of zinc albuminate. Placed at one end\\nof a capillary tube containing albumin, it diffuses rapidly through the\\nsolution, coagulating it throughout. l\\nCarbolic acid forms less dense coagula, and creosote still less.\\nMercuric chlorid and silver nitrate form complete coagula also. It may\\nbe AA r ell in this connection to call attention to an observation made by\\nDr. Kirk, in an essay read before the First District Dental Society of\\nNew York, that coagulation is a chemical process, as illustrated in the\\nunion of mercuric chlorid with albumin. The metallic salt does not\\nact by catalysis, but there is a distinct quantitative relation between the\\ncoagulant and the coagulable material, the process ceasing when the\\nquantitative relation of these bodies is chemically satisfied if an excess of\\nHgCl 2 be employed, a definite amount of the salt combines with albumin\\nto form an albuminate of mercury suspended in a solution of the chemical\\nexcess of HgCl 2 If an excess of the albumin be employed, an albumin-\\nate of mercury is formed suspended in a solution of albumin. The albu-\\nminate of mercury when brought in contact with an easily decomposable\\nsulfur compound may be reduced by the formation of mercury sulfid\\nand the albumin be restored to its primary condition, 2 which would\\nseem to indicate that HgCl 2 is an unreliable germicide where putrefac-\\ntive decomposition is in progress giving rise to H 2 S.\\nFormalin readily and quickly affects both albumin and gelatin, con-\\nverting them into a tough coagulum which maintains its form and\\n1 Prof. James Truman, Proc. Academy of Stomatology of Philadelphia, Dec. 1894.\\n2 Abbott, Principles of Bacteriology, 3d ed., 1896.", "height": "4560", "width": "2820", "jp2-path": "americantextboo00kirk_0443.jp2"}, "444": {"fulltext": "436 THE TREATMENT AND FILLING OF BOOT CANALS.\\nappears to be persistently antiseptic for certain varieties of micro-\\norganisms.\\nThe essential oils act as antiseptics without coagulation, having\\nmarkedly less germicidal action than the agents above mentioned.\\nPlaced in root canals they diffuse through the dentin, maintaining a\\nprolonged antiseptic influence their absorption into the dentin pro-\\nduces some degree of discoloration in that tissue. These oils differ in\\nantiseptic power. Oil of thyme and oil of cinnamon stand at the head\\nof the list, oil of cloves and eucalyptus being far below them in the\\nantiseptic scale.\\nThe alkalies employed as antiseptics saponify the fatty matters formed\\nin the course of albuminous decomposition, and dissolve albuminous\\nsubstances with which they are brought in contact. The first of these,\\nthe alloy of potassium and sodium, when placed in contact with decom-\\nposing pulp tissue, abstracts the elements of water from it, and sodium\\nand potassium hydroxids are formed, which have the power of saponi-\\nfying fats and dissolving albumins. Sodium carbonate has similar\\nproperties, but acts less energetically. Sodium dioxid under the same\\nconditions forms sodium hydroxid, nascent oxygen being set free, which\\nacts as a germicide and also decomposes the coloring substances in the\\ndentinal tubules, acting as a bleaching agent to the dentin. Solutions\\nof hydrogen dioxid are decomposed into water and nascent oxygen in\\ncontact with the putrescent canal contents the liberated oxygen acting\\nas an oxidizer.\\nThe mineral acids when employed subserve a double office. Sul-\\nfuric acid placed at the mouth of fine canals unites with and decom-\\nposes the calcium salts of the dentin, forming calcium sulfate, easily\\nremovable with the fine canal scrapers its second office is that of an\\neffective germicide, destroying all organisms with which it is brought\\nin contact.\\nMaterials for Filling the Root Canal.\\nThe materials employed to hermetically seal the apical foramina of\\nsterilized canals are in the condition of solids inserted en masse or in\\nsuccessive portions or they are pastes applied alone, or upon some\\nmedium which acts as a vehicle. Another class are ordinarily solid, but\\nare brought to a condition of fluidity before inserting them.\\nThe properties which should be possessed by a satisfactory canal filling\\nare as follows Impermeability it should hermetically seal the apical\\nforamen, effectually preventing the egress of pathogenic organisms or\\ntheir waste products from the canals to the tissues of the apical region\\nand vice versa, and.it should prevent transudations from the apical\\ntissues into the pulp canals. It should be unchanged by the influences", "height": "4612", "width": "2820", "jp2-path": "americantextboo00kirk_0444.jp2"}, "445": {"fulltext": "MATERIALS FOR FILLING THE ROOT CANAL. 437\\nabout it be un irritating to the soft tissues and possess sufficient\\nplasticity to permit of its ready adaptation to the walls of the space it is\\ndesigned to fill. It should be at least aseptic when applied, and pref-\\nerably antiseptic it is to be esteemed in the degree that it maintains\\nthis latter quality in combination with the other desiderata stated.\\nThe solid materials which have been employed for this purpose are\\ngold foil, shredded tin foil, gold, copper and lead points wood points\\ndipped in creosote have been used for this purpose. The readily oxi-\\ndizable metals have not found favor owing to the possibility of dentinal\\nstaining following their employment. The plastic materials employed\\nare softened gutta-percha cones and the zinc oxychlorid cement. The\\nlatter and also other pastes are frequently employed to fill the meshes\\nof a wisp of crude cotton wool or asbestos fiber, these latter being the\\nvehicle for carrying the paste into position. It is to be remembered\\nthat when cotton fiber is kept in prolonged contact with zinc chlorid,\\nthe cellulose undergoes a chemical change it is converted into a pectous\\nsubstance called amyloid, which is a colorless colloid, unchangeable in\\nthe conditions existing at the apex of a pulp canal.\\nCotton itself may be included among the plastic root fillings.\\nThe fluid substances employed are solutions of red gutta-percha\\nbase plate in chloroform, the solution called chloro-percha, which con-\\ntains in this case vermilion if made of white gutta-percha it contains\\nzinc oxid and a variable amount of other mineral substances. The\\nother members of this class are salol and paraffin, made fluid by heat\\nbefore insertion and becoming hard when cool.\\nGold was the first material adopted for the purpose of canal filling,\\nbeing introduced in this connection by Dr. Maynard over fifty years\\nago. Properly adapted it may be made to hermetically seal the apical\\nforamen. It is difficult to manipulate, and its removal after the type of\\nadaptation required is wellnigh impossible. Tin has the same virtues\\nand is open to the same objection, which in fact obtains when any metal\\nis forcibly driven into the apical portion of the canal. It is held, how-\\never, and with a measure of good reason, by those who advocate the\\nemployment of metal for this purpose, that when a pulp canal has been\\nthoroughly sterilized and filled, the necessity for the removal of the root\\nfilling will never arise. The degree of confidence expressed in this opinion\\nhas not yet seryed to override the caution of the conservative operator,\\nso that metals have an extremely limited employment in this connection.\\nThe plastic materials most frequently recommended and which sta-\\ntistics and general experience demonstrate to serve most acceptably as\\ncanal fillings, are the oxychlorid of zinc and gutta-percha.\\nThe zinc cement when in paste form may be readily adapted to any\\naccessible canals, and it maintains during and for some time after set-", "height": "4560", "width": "2816", "jp2-path": "americantextboo00kirk_0445.jp2"}, "446": {"fulltext": "438 THE TREATMENT AND FILLING OF ROOT CANALS.\\nting an antiseptic action. The peculiar and specific influence exerted\\nby this material upon the albuminous constituents of the tooth may be\\nseen as a not infrequent sequel to its employment as a pulp capping.\\nMany of such teeth whose pulp chambers have been opened some years\\nafter the capping operation are found to have had their pulps changed\\nto a dry tough mass which has not been the seat of septic invasion\\nmoreover, the normal color of the dentin of such teeth has been main-\\ntained, showing that no extensive chemical decomposition has occurred\\nin the contents of the tubules. As a canal filling it becomes very hard,\\nremains white, and when freshly mixed is markedly irritating to vital\\ntissue with which it is brought in contact. Its removal when indicated\\nmay be accomplished by repeated applications of sulfuric acid after the\\nCallahan method of opening canals.\\nWhen the meshes of cotton are filled with the paste made thin, the\\nzinc chlorid acts upon the cotton, converting it into amyloid so that\\nif a pellet of cotton moistened with a sedative antiseptic be placed in\\nthe apical portion of a root canal and the thin paste placed over it, the\\nfilling of the apex after the chemical action noted consists of the un-\\nchangeable impervious amyloid and not of cotton.\\nLong thin gutta-percha cones are readily made plastic, but the\\nadaptation of the material to the walls of the canal is less intimate than\\nis that of the oxychlorid of zinc. It is unchangeable in the conditions\\nunder which it is placed, and is the most bland and unirritating of\\nfilling materials. Its removal after proper placement is difficult but by\\nno means impossible. The gutta-percha compound known as temporary\\nstopping has similar properties, but is less tough in texture.\\nThe last of the plasties introduced is a resinous substance called the\\nbalsamo del deserto. It is probably an exudation from one of the\\nvarieties of pine or fir, Its virtues and employment were first described\\nby Dr. W. H. White of Silver City, N. M. His experiments indicate\\nthat the resin has a pronounced antiseptic action it adheres to wet\\nsurfaces, and is perfectly non-irritating to soft tissues with which it is\\nbrought in contact. It remains unchanged when employed as a canal\\ndressing. He finds that the roots of temporary teeth which have been\\nfilled with the material suffer no interference with the resorption process\\nbecause of its presence.\\nThin solutions of gutta-percha in chloroform (chloro-percha) have\\nwide employment as fillings for fine and tortuous root canals. These\\nsolutions may be carried into any canal which will admit the finest\\nbroach. They shrink in hardening, so that a canal filling of such a\\nsolution does not hermetically seal the cavity when the material is\\nhardened.\\nThe solution is usually employed in combination with the gutta-", "height": "4612", "width": "2820", "jp2-path": "americantextboo00kirk_0446.jp2"}, "447": {"fulltext": "MUMMIFICATION OF THE PULP. 439\\npercha cones. Dr. R. Ottolengui L recommends a method which may\\nbe followed with advantage A number of pieces of floss silk about an\\ninch long are saturated with chloro-percha and dried these are then\\nthrust in a chloro-percha canal filling while it is fluid. Should it ever\\nbecome necessary to remove the filling, the projecting end of one of the\\npieces of silk is caught, and the entire filling may be withdrawn.\\nThe use of salol in this connection was first described and advocated\\nbv Dr. Mascort of Paris. 2 Salol, the salicylate of pheuol, is mildly\\nantiseptic. When brought into contact with alkalies it is decomposed\\ninto carbolic and salicylic acids, two powerful antiseptics. It melts at\\n40\u00c2\u00b0C. (104\u00c2\u00b0F.), and if fused at or but little above this heat it crys-\\ntallizes in a few minutes if the heat be raised to a higher point crystal-\\nlization is delayed for some time after the mass has cooled far below its\\nnormal melting-point. The melted salol may be readily carried into any\\ncanal which will admit the finest broach. Portions of the material which\\nmav be carried beyond the apical foramen appear to be unirritating.\\nReports as to the permanence and value of this material vary from\\nenthusiastic endorsement to unqualified condemnation. Many of those\\nwho have used salol have found, upon reopening canals which have\\nbeen filled with it, an absence of the salol however, where the practice\\nhas been to employ a central canal filling of gutta-percha, a cone of\\nwhich material is thrust into the melted salol, in such cases its absence\\nhas not been observed. Salol has been found to suffer rapid decomposi-\\ntion in canals which have been treated with one of the fixed alkalies\\njust before the salol was inserted.\\nParaffin has been employed for a caual filling, made fluid by heat and\\ncarried into the canals it is bland, unirritating, unchangeable, and easily\\nremovable. 3 It may be used, mixed with aristol, in sterilized canals. 4\\nBefore discussing the cleansing of pulp canals, certain means and\\nmethods suggested for avoiding the necessity for the toil and care\\nnecessary to mechanically cleanse the more inaccessible canals require\\nconsideration. These agents are preservative pastes.\\nMummification of the Pulp. As early as the introduction of\\narsenous oxid as a devitalizing agent it was noted that a certain per-\\ncentage or rather, an uncertain percentage of cases gave evidence of\\nlittle or no disease after the application of arsenic and its sealing in a\\ncavity by a filling. Later, it was found that applications of powerful\\nantiseptics to exposed pulps not infrequently were followed by a long-\\ncontinued quiet of that organ still later, when more definite knowledge\\nwas possessed of the pathological results which might follow the leaving\\nof portions of pulp substance in the canals of teeth after devitalization\\n1 Methods of Filling Teeth. 2 Dental Cosmos, 1894, p. 352.\\n3 Ibid. i Ibid., June 1897.", "height": "4548", "width": "2788", "jp2-path": "americantextboo00kirk_0447.jp2"}, "448": {"fulltext": "440 THE TREATMENT AND FILLING OF ROOT CANALS.\\nby arsenic, it was observed that after saturating the canals with creosote\\nor zinc chlorid solutions, many cases gave little or no evidence of peri-\\ncemental disturbance thereafter.\\nWhile it is unquestionably preferable to always thoroughly remove\\nthe last vestige of devitalized pulps, the time, care, skill, and expense\\ninvolved in perfect cleansing are detriments to its universal practice.\\nThe only other possible solution of the difficulty is to so alter the tissue\\nnot removed that it shall remain permanently aseptic, and, if possible\\nto make it so, antiseptic.\\nObservations derived from clinical experience, although undoubtedly\\nof great and permanent value, are indeterminate, and our truly scientific\\nknowledge of this matter dates from Dr. W. D. Miller s experiments. 1\\nHe credits Dr. Witzel with the first systematic observations in this\\ndirection. Dr. Witzel in 1874, devitalized the crown portion of pulps\\nby means of arsenic, extirpated that portion leaving the pulp in the\\ncanals undisturbed, their exposed ends being treated as freshly exposed\\npulps. This is the method followed by Herbst, who employs cobalt\\n(which is native arsenic sulfid or metallic arsenic) instead of arsenic\\ntrioxid.\\nDr. Miller s experiments have shown that none but the most power-\\nful and penetrating antiseptics have value as permanent sterilizers.\\nThese are The cyanid, bichlorid, and salicylate of mercury, sulfate\\nof copper, and oil of cinnamon. Orthocresol, carbolic acid, trichlor-\\nphenol, and zinc chlorid penetrate the pulp tissue rapidly, but are too\\ndiffusible, disappearing in a few weeks.\\nHe classifies salicylic acid, eugenol, campho-phenique, hydronaphthol,\\na- and /3-naphthol, acetico-tartrate of aluminum, and some essential oils,\\nresorcin, thallin, sulpho-carbolate of zinc, etc., as being of doubtful\\nvalue.\\nThose nearly or quite worthless are iodoform, basic anilin coloring\\nmatters, borax, boric acid, dermatol, europhen, calcium chlorid, hydro-\\ngen dioxid, sozoiodol salts, tincture of iodin, spirit of camphor, and\\nnaphthalin.\\nThe preparation giving the best results consisted of Mercuric chlo-\\nrid, 0.0075 gram thymol, 0.0075 gram, in tablet form.\\nThe pulp is devitalized the crown portion and all the root portion\\nreadily accessible is removed one of the tablets is placed in the pulp\\nchamber, crushed by means of an amalgam plugger, and covered with\\ngold foil. The mercury salt tends to discolor the crown of the tooth,\\nso that its employment should be restricted to the posterior teeth\\nindeed, the necessity for its use would be, as a rule, found with these\\nteeth, being those from which it is most difficult to extract pulp rem-\\n1 Proc. Columbian Dental Congress, 1893.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0448.jp2"}, "449": {"fulltext": "MUMMIFICATION OF THE PULP.\\n441\\nnants. Dr. Miller expresses faith in the power of oil of cinnamon to\\npermanently sterilize pulp fragments. He suggests the experimental\\napplication of the sterilizing tablets to such teeth as are readily sal-\\nvable yet which are for various reasons consigned to the forceps.\\nDr. Theodore Soderberg of Sydney, IS S. W., reports excellent\\nresults from a continuous practice of this variety of pulp sterilization.\\nHe employs a paste composed of\u00e2\u0080\u0094\\nAlum exsic,\\nThymol,\\nGlycerol,\\nZinc oxid,\\nda. 3j\\nq. s. to make stiff paste. M.\\nIt will be noted that he substitutes dried alum for tannin, originally\\nused by him as the hardening agent his experiments showed the\\ntannin to be productive of discoloration. Mercuric chlorid is set aside\\nfor the same reason. Oil of cassia employed in the paste also caused\\ndiscoloration. At present Dr. Soderberg adds a small quantity of\\ncocain to the paste to prevent the pain arising from the action of the\\ndried alum. He states (Nov. 1895) that he has in a year applied the\\npaste in 97 cases and has had no untoward results. The method of\\nplacing the material is shown in Figs. 399, 400.\\nFig. 399.\\nFig. 400.\\na, Caries exposing a horn of the pulp.\\na, Root portion of pulp; b, mummifying paste\\nc, zinc phosphate d, gold or amalgam.\\nC. A. Firth of Queenleyan, N. S. W., 1 advises the omission of\\nzinc oxid from the paste, to avoid the formation of the brown tannate\\nof zinc. He suggests the use of a mixture of tannic acid and thymol\\nequal parts, made into a paste with glycerol and applied with ivory\\ninstruments, to avoid discolorations. He expresses himself as gratified\\nat the results obtained. Another formula suggested by the same gentle-\\nman is\\n1 Dental Cosmos, May, 1896.", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0449.jp2"}, "450": {"fulltext": "442 THE TREATMENT AND FILLING OF ROOT CANALS.\\nDESCRIPTION OF FIGS. 401, 402, AND 403. 1\\nFig. 401. Fig. 3 gives in contrast a sectional view of deciduous and permanent upper teeth\\ndivided through their lateral diameters.\\nFig. 4, a sectional view of the corresponding lower teeth divided through their antero-posterior\\ndiameters, a, b, c represent, respectively, the deciduous and permanent front incisors in con-\\ntrast: d, e,f, the lateral incisors; g, h, i, the canines; k, deciduous molars, upper and lower; and\\nI, m, the successors to the deciduous molars, the bicuspids n, o represent permanent molars.\\nc,f, i, m, o have dotted lines indicating the thickness of enamel removed by wear, atrophy of the\\ncementum, and reduction in the size of the pulp due to progressive calcification, these changes\\nbeing incident to old age.\\nFig. 402 represents in Fig. 1, letters a to h and a toh, the longitudinal or vertical sections of\\nthe sixteen upper teeth, showing the labio-palatal diameter of the pulp chamber and canal in\\ncrown and roots, the section of the molars being through the anterior buccal and palatal roots,\\nwhile the bicuspids d e and d_e illustrate the result of such a compression of the root as to\\ndivide the pulp chamber into two canals\u00e2\u0080\u0094 a condition which so frequently exists in these flattened\\nroots. The double-lettered series, d d to h h and d d to hh, represent in the molars a section\\nthrough the posterior buccal and the palatal roots, from which is quite readily recognized the\\nslightly greater lateral diameter of the pulp chamber in the crown and the larger canal in the poste-\\nrior buccal root over that in the anterior buccal root, while the bicuspids lettered eedd and ddee\\nillustrate a modified pulp chamber and canal, with bifurcation of the root in one, these being cut\\nthrough a different axis or plane from the single-lettered series.\\nFig. 2, letters a to h and a to h, represent the sixteen lower teeth with the section through\\ntheir long diameters, as in the upper series. These incisors illustrate the compressed or flat-\\ntened condition of their roots in contrast with the cylindrical character of the roots of the upper\\nincisors, while the bicuspids d e and d_e illustrate the singleness of their pulp chamber and the\\ncylindrical condition of their roots as in contrast with the flattened or compressed condition of\\nthe roots of the upper bicuspids. The molars g, h and f, g, h represent sections through the\\nanterior root, illustrating its compressed condition and divided pulp chamber in the first and\\nsecond molar, and a somewhat flattened one in the anterior root of the third molar ff,g g ,hh\\nand g g, h h represent the single and cylindrical pulp chamber in the posterior root of the\\nlower molars, while bb, cc and aa,bb represent the incisors and canines of the same series, with\\nmodified pulp chambers arising from modified development.\\nFig. 403.\u00e2\u0080\u0094 Fig. 1, from o to h and_a to_A, represents the upper teeth, with transverse or horizon-\\ntal section through the base of the pulp chamber in the crown, viewing the entrance to the canals\\nof the several roots, while the same letters in Fig. 2 represent the lower series in the same\\nmanner.\\nFig. 3 represents the upper teeth, with the transverse or horizontal section made below the\\nlargest diameter of the pulp chamber and through the canals after they have diverged from the\\ncentral chamber, but before the roots into which they run have in the molars bifurcated.\\nFig. 4 in like manner represents the lower series, well illustrating the flattened or compressed\\ncondition of the canal in anterior roots of the molars and the division of the chamber, as is fre-\\nquently found in the roots of the lower incisors.\\nThe letters aa,bb,cc,d d,ff, d_d and_ee (Fig. 3) represent the relative shapes, whether circu-\\nlar, oval, or flattened, of the pulp canal in the roots of the upper central and lateral incisors,\\nthe canines, the first and second bicuspids, and the first, second, and third molars, while the\\nsame letters in Fig. 4 represent the relative shapes of the pulp canal in similar teeth in the\\nlower series.\\n1 These figures are taken from v. Carabelli s Anatomie des Mundes.", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0450.jp2"}, "451": {"fulltext": "Fig. 401.\\n(For description, see page 442.\\n05*\\n^ff^..\\n443", "height": "4540", "width": "2800", "jp2-path": "americantextboo00kirk_0451.jp2"}, "452": {"fulltext": "Fig. 402.\\n(For description, see page 442.)\\n444", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0452.jp2"}, "453": {"fulltext": "Fig. 403.\\n(For description, see page 442.)\\nik\\nCO\\n^b\\nM\\nr\\nfcX)\\n^P\\n6\\n*L\\n*/i\\nV\\nfcb\\n445", "height": "4548", "width": "2764", "jp2-path": "americantextboo00kirk_0453.jp2"}, "454": {"fulltext": "446\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\n1^. Mercuric chlorid,\\nThymol,\\nAcid, carbolic,\\nAcid, tannic,\\nMorph. mur.,\\n01. menth.,\\nOl. cassise,\\nda. 2.0 grams\\nad. 1.5 gram\\nda. q. s. to make stiff paste. M.\\nA tannate of mercury is formed it is insoluble, and but little pain\\nis caused by its absorption.\\nIt is to be understood that these preparations and this method of\\npulp preservation are only to be utilized when reasons exist which\\nwould preclude the perfect cleansing and filling of canals. These\\nreasons may be economic or the impracticability of thoroughly extir-\\npating all pulp remnants. Failing in perfect extirpation, the paste is\\nto be packed into parts where the irremovable pulp remnants exist.\\nQuite recently formalin and its isomeric modification paraform\\nhave been suggested for use as mummifying agents, with* some promise\\nof satisfactory results, but these substances are still in the stage of ex-\\nperimental study. The irritating nature of formalin suggests caution in\\nits permanent application to pulps or pulp canals, as several cases of\\nchemical necrosis of tissues about the teeth have been reported from the\\ninjudicious use of the drug in question.\\nTopographical Anatomy of the Pulp Chambers and Canals.\\nA familiarity with the topographical anatomy of pulp chambers and\\ncanals is an essential preliminary to their proper opening and cleansing.\\nFigs. 401, 402, and 403 (see pp. 443-445) illustrate the average pulp-\\nchamber forms.\\nThe following outline figures (Figs. 404-439) are exact reproductions\\nFig. 404.\\nFig. 405.\\nUpper central incisor.\\nUpper lateral incisor.\\nof sections made of typical teeth which have been shown by comparison\\nwith numerous other sections to be about the average anatomical forms.\\nThe Upper Central Incisor. The pulp chamber (Fig. 404) approxi-", "height": "4608", "width": "2840", "jp2-path": "americantextboo00kirk_0454.jp2"}, "455": {"fulltext": "FORMS OF PULP CHAMBERS AND CANALS.\\n447\\nmates in form that of the tooth itself. The opening of the canal is\\nseen to be almost circular, and in the central axis of the tooth.\\nUpper Lateral Incisor. The chamber of the lateral incisor (Fig. 405)\\nhas a similar form the canal exhibits a tendency to diverge from the\\nFig. 406.\\nFig. 40/\\nFig. 408.\\nUpper lateral incisors (Ottolengui).\\nstraight line toward the apical end (see Figs. 406-408). The entrance\\nto the canal is nearly oval.\\nUpper Canine. The chamber of the upper canine is large and open\\nand has an elliptical canal entrance (Fig. 409). The root of this tooth\\nFig. 409.\\nFig. 410.\\nFig. 411.\\nUpper canines.\\nmay also deflect from the line of the general axis.\\nbifurcation of the root is seen (Figs. 410, 411).\\nIn\\nrare cases a\\nFig. 412.\\nFig. 413.\\nFig. 414.\\nUpper first bicuspids.\\nThe upper first bicuspid very commonly exhibits a bifurcation of\\nthe roots which may extend to any distance toward the crown (Fig. 412).\\nAt its entrance the pulp canal has a dumb-bell form, the handle of the\\ndumb-bell being much attenuated. The distinct canals may begin\\nalmost at the base of the chamber, or be evident only near the apices", "height": "4548", "width": "2764", "jp2-path": "americantextboo00kirk_0455.jp2"}, "456": {"fulltext": "448\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nof the roots. Two distinct canals may be present even in the absence\\nof bifurcation of the root. The roots of this tooth may be much curved.\\nFig. 413 presents a condition occasionally seen a trifurcation of the\\nroot of a bicuspid. Fig. 414 represents a section through the buccal\\nroots; Fig. 414 also shows the neck section of the tooth. In the same\\nmouth were found three bicuspids exhibiting the same condition. The\\nbifurcated cuspid, Fig. 411, was from the same denture.\\nUpper Second Bicuspid. Sections of two typical forms of upper\\nsecond bicuspid are shown in Fig. 415, a and b. In such a case as b\\nfar from uncommon it will readily be seen what dangers exist as to\\nthe difficulty of perfectly filling the flat general canal beyond the ellip-\\ntical obstruction. The neck section in both types is almost alike.\\nUpper First Molar. The neck section of the upper first molar\\nFig. 415.\\nFig. 416.\\nb a\\nUpper second bicuspid.\\nb a\\nUpper first molar.\\n(Fig. 416, a) shows a free entrance to the palatal root; the anterior\\nbuccal root has a triangular entrance, near the mesio-buccal angle of\\nthe tooth. The entrance to the disto-buccal root is very small; b, Fig.\\n41 6, shows a section through the buccal roots of the tooth. Cases are\\noccasionally seen where a short crown is associated with very long and\\ndivergent roots (Fig. 417).\\nFig. 41\\nFig. 418.\\nFig. 419.\\nUpper molar.\\nUpper second molars.\\nUpper Second Molar. The arrangement of canals in the second\\nupper molar (Fig. 418, a) is much like that in the first; except that\\nthe tooth has a compressed form which brings the canal entrances closer\\ntogether. A section through the buccal roots is seen in Fig. 418, b.\\nThis tooth occasionally presents marked aberrations in the location and", "height": "4612", "width": "2788", "jp2-path": "americantextboo00kirk_0456.jp2"}, "457": {"fulltext": "FORMS OF PULP CHAMBERS AND CANALS.\\n449\\ndistribution of pulp canals. Fig. 419 illustrates a case in which there\\nwas a trifurcation of the palatal root. Other abnormalities of the canals\\nof upper molars are shown in Figs. 420-425 (Ottolengui x\\nFig. 420.\\nFig. 421.\\nFig. 422.\\nFig. 423.\\nFig. 424.\\nFig. 425.\\nUpper molars (Ottolengui).\\nUpper Third Molar. The three roots of the upper third molar are\\nfrequently compressed together, giving the external appearance of a\\nFig. 426.\\nUpper third molars.\\nsingle round conical root. In many instances there will be found but\\na single large canal, as in Fig. 426, a. The rule is three canals, as\\nFig. 427.\\nFig. 428.\\nFig. 429.\\nLower incisors and canine.\\nshown in Fig. 426, 6, which shows also a section through the buccal\\nroots. The root is generally curved backward more or less.\\n1 Methods of Filling Teeth.\\n29", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0457.jp2"}, "458": {"fulltext": "450\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nLower Anterior Teeth. The forms of the canals and canal entrances\\nto the lower anterior teeth are shown in Figs. 427-429. The form\\nof partial canal bifurcation shown in Figs. 428 and 429 is noted\\nfrequently in longitudinal sections of typical teeth.\\nLower Bicuspids. The forms of the canals in the lower bicuspids\\nare much alike; the canal of the first, however, exhibits a tendency to\\nthe dumb-bell form of entrance (Figs. 430, 431). Tortuosities of the\\nFig. 430.\\nFig. 431.\\nLower first bicuspid.\\nLower second bicuspid.\\ncanal are far from uncommon, many of them of such nature as to ren-\\nder full and complete entrance to their ends next to impossible in\\nFig. 432.\\nFig. 433.\\nFig. 434.\\nLower bicuspids.\\nFig. 432 the root was of corkscrew form, in Fig. 433 bent at right\\nangles, and in Fig. 434 a short crown is associated with an extremely\\nlong and bent root.\\nFig. 435.\\nLower first molars.\\nLower First Molar. The lower first molar usually presents two\\ncanals a large open canal for the posterior root, as seen in Fig. 435,\\na and 6, while the anterior root presents a flat ribbon-like canal very", "height": "4608", "width": "2800", "jp2-path": "americantextboo00kirk_0458.jp2"}, "459": {"fulltext": "FORMS OF PULP CHAMBERS AND CANALS.\\n451\\ndifficult of entrance. A transverse longitudinal section of the ante-\\nrior root is shown in Fig. 435, c. In order to effect an entrance to\\nthe majority of these canals it is absolutely essential that the rubber\\ndam be applied and the tooth well dried. A section through both roots\\nis shown in Fig. 435, b. Not uncommonly two distinct anterior canals\\nare found, and in rare instances two distal roots may be present, as\\nshown in Fig. 435, d. The roots of this tooth, as those of the other\\nlower molars, as a rule, bend backward. Fig. 436 (from Ottolengui)\\nshows an exaggeration of this bending.\\nThis tooth not infrequently requires canal treatment before the roots\\nare fully formed. A section through the anterior half of an immature\\nFig. 436.\\nFig. 437.\\nLower first molar.\\na b\\nLower first molar, immature.\\ntooth is shown in Fig. 437, a; through the posterior half, Fig. 437, 6.\\nLower Second Molar. A section of the lower second molar resem-\\nbles that of the first, but distinct double canals in the anterior root are\\nmore frequently seen, as shown in the section of the anterior half in\\nFig. 438, b.\\nLower Third Molar. In the lower third molar the roots are fre-\\nquently compressed together, exhibiting bifurcation toward their apices\\n(Fig. 439).\\nFig. 438.\\nFig. 439.\\na b\\nLower second molar.\\nLower third molar.\\nThe canals of any tooth may exhibit constrictions or flexions at any\\npoints of their lengths. Although there is no absolute indication as to\\nthe presence of flexions or abnormal lengths, an examination of the\\noverlying gum should always be made, when lengths and irregularities\\nmay possibly be determined if the gum tissue and alveolar wall be very", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0459.jp2"}, "460": {"fulltext": "452 THE TREATMENT AND FILLING OF ROOT CANALS.\\nthin. If any of these irregularities be present it is important that they\\nbe discovered and additional care be taken to effect a complete entrance\\nto the canals.\\nInstruments for Canal Treatment.\\nThe description thus far has included the territory to be operated\\nupon and its condition as regards sepsis, the agents commonly employed\\nto produce asepsis and antisepsis, and those applied to maintain these\\nconditions. The first, the condition of the root canals and dentin the\\nsecond, the various antiseptics employed therein the third, the several\\nmaterials used as canal fillings. The next study includes the instru-\\nments employed and their specific applications.\\nThe first are enamel chisels. These are employed to cut down weak\\nunsupported enamel walls and those portions of enamel removable by\\nsuch instruments, which interfere with direct access to the pulp canals.\\nThe next, burs, of several forms the first, that known as the dentate\\nfissure bur, for cutting enamel next rose, inverted cone, and oval forms\\nfor enlarging cavities and removing infected dentin. Next, several\\nforms of broaches, canal cleansers, and probes, Gates-Grlidden reamers\\nfor enlarging canals syringes, pluggers, and finally rubber dam and the\\nappropriate selection of clamps.\\nIn relation with this latter device, it is to be recalled that demon-\\nstrations have shown the saliva to be a highly infective fluid, for the\\nreason that it contains a variety of pathogenic organisms which must be\\nexcluded from pulp canals if asepsis of these passages is hoped for. No\\nother single means serves so effectively as isolation by the rubber dam.\\nA variety of syringes will be required, a large instrument for irriga-\\ntion (Fig. 440), to wash away loose debris which may be present in the\\ncavities smaller syringes will be required to accurately place definite\\nquantities of medicaments in canals (Figs. 441, 442, and 443).\\nDentate fissure burs are invaluable instruments for removing por-\\ntions of sound enamel walls which interfere with direct access to the\\nroot canals. Cutting from within outward, giving the bur a sawing\\nmotion, a groove may in a few minutes be extended across the occlusal\\nface of a molar from a distal cavity to a point directly over the ante-\\nrior root.\\nLarge rose, inverted cone, and oval burs are employed to remove\\nthe dentin which may obstruct direct entrance to the canals these are\\nas a rule to be used with a draw-cut, placed first in the deepest portion\\nof the cavity, and while revolving drawn toward the operator. Care is\\nto be exercised that no more than necessary of the walls, particularly\\nthe floor of the pulp chamber, is to be burred away, to avoid mechan-\\nically weakening the tooth.", "height": "4612", "width": "2796", "jp2-path": "americantextboo00kirk_0460.jp2"}, "461": {"fulltext": "INSTRUMENTS FOB CANAL TREATMENT.\\n453\\nThe broaches employed are of several forms. A broach is, accurately\\nspeaking, an instrument designed to enlarge openings; so that the\\nFig. 440.\\nFig. 441.\\nFig. 442.\\nDental syringe.\\nMinim syringe.\\nJ. X. Farrar s alveolar abscess syringe.\\nbarbed nerve broach is not employed as a broach but as a pulp-extrac-\\ntor (Fig. 444). They and other forms of extractors (Fig. 445) are used\\nto loosen and remove debris from canals.", "height": "4548", "width": "2768", "jp2-path": "americantextboo00kirk_0461.jp2"}, "462": {"fulltext": "454\\nTHE TREATMENT AND FILLING OF BOOT CANALS.\\nFig. 443.\\nBulb syringe.\\nThe toughness of these instruments is remarkable. They are so tem-\\npered that they can be bent in any desired direction and when properly\\nmanipulated will readily follow a small and crooked canal to the apex\\nwithout danger of breaking off. Two forms with sharp hooks, for\\nFig. 444.\\nBarbed pulp-extractors and holder.\\nremoving the pulp and straight, with the ends slightly roughened,\\nfor carrying a shred of cotton in cleansing out the canal or treat-\\ning alveolar abscess.\\nThe next instruments employed in this connection are what are\\nknown as Donaldson s pulp-canal cleansers (Fig. 446). The points of\\nthese palp-canal cleansers are reduced so as to enter the canal readily,\\nand the barbs, which are cut of just sufficient depth to accomplish\\ntheir work, are arranged spirally around the shaft, in effect forming a\\nscrew, so that no two cuts are exactly opposite each other (see enlarged\\nview, a, Fig. 446). With ordinarily careful usage these cleansers will\\nremove the pulp substance perfectly, without liability to be broken or\\nto become fastened in the canal. If at any time the instrument does\\nnot withdraw readily from the root, a turn or two to the left (unscrew-\\ning) will at once release it.\\nMade of tough steel piano-wire, with polished rubber handles also\\nwithout handles, to be used in broach-holder.\\nThe enlarged view of the Gates-Glidden nerve-canal drill (Fig.\\n447) shows the peculiarity of the safety Glidden point, which will not", "height": "4580", "width": "2792", "jp2-path": "americantextboo00kirk_0462.jp2"}, "463": {"fulltext": "INSTRUMENTS FOR CANAL TREATMENT.\\nFig. 445. Fig. 446.\\n455\\nu\\nDr. Donaldson s pulp-canal cleansers.\\nDr. Donaldson s spring-\\ntempered nerve-bristles.\\nenlarge the canal, but will merely guide\\nthe drill into a canal no wider than itself,\\nuntil it reaches the root-apex, through\\nwhich only the sharp point will pass, and\\nproduce a sensation of pain that gives\\nnotice of its protrusion yet, unless the\\nforamen is wider than the base of the\\nguide, the Gates drill will not cut\\nthrough the end of the root a danger\\nthat the improved drill is specially\\ndesigned to avoid. The reamers are\\nmade with their thinnest part near the\\njunction of shaft and stem, so that\\nshould fracture of the tool occur, a long\\npiece will be left protruding from the\\ntooth and may be readily withdrawn.\\nUsing the series, one after the other, with care and judgment, even\\na tortuous canal may be suitably enlarged but it should be kept in\\nmind that many roots are thin at their\\napical portions, and their canals, if much\\nenlarged, may be cut through laterally\\nhence the advisability of employing usu-\\nally the smaller sizes of drills, and always\\nthe smallest first when the canal is narrow.\\nThere is a diversity of opinion as to the\\nwisdom and propriety of using reamers of\\nany kind in pulp canals. They are con-\\ndemned in toto by some operators others advise their employment\\nin all cases.\\nFig. 447.\\nImproved Gates-Glidden nerve-\\ncanal drill for engine work.", "height": "4548", "width": "2768", "jp2-path": "americantextboo00kirk_0463.jp2"}, "464": {"fulltext": "456 THE TREATMENT AND FILLING OF BOOT CANALS.\\nThe Cleansing of Canals.\\nThe student has been made familiar with the pathological conditions\\nhe is called upon to treat, and with his armamentarium, including the\\nmedicinal agents employed in their correction, and is now prepared to\\napply the one to the other.\\nIt is most apropos at this juncture that the arguments for and against\\nthe reaming of root canals should be reviewed. The valid objections\\nurged against reaming as a routine practice are, first, the danger of\\nencroachment upon the cementum by the reamer second, the breaking\\nof the delicate reamers in the canal and the difficulty and often impos-\\nsibility of removing the fragment when such accident occurs third, the\\nliability of forming false canals by inability to confine the drill to the\\nanatomical canal. The argument advanced in support of the practice is\\nthe direct and ready access attained by it to the length of the canal.\\nOwing to the fineness and tortuosity of many canals it is impossible for\\nthe operator to assure himself that he has thoroughly cleansed and filled\\nthem by accurately and properly reaming the canals directly accessible\\nto fine reamers they are given such form that a filling may be placed\\nwith a reasonable assurance that the apex is hermetically sealed. It is\\nurged that as many roots notably the anterior roots of lower molars,\\nthe anterior buccal roots of upper molars, the roots of upper bicuspids\\nand of lower incisors have a flattened form, their pulp canals have a\\nribbon form. In reaming such canals there is danger of the reamer\\nimpinging upon the cementum at the thin portion of the root. The\\nadvocate of root reaming, therefore, advises in such cases the employ-\\nment of Donaldson s canal cleansers to scrape away the canal walls,\\nenlarging them uniformly.\\nThe danger of breaking reamers is always an imminent one, al-\\nthough such accidents are commonly due either to poorly made or\\nimperfectly tempered instruments, or to carelessness upon the part of\\nthe operator. Even the most skilful must be ever on the alert to detect\\nany unusual resistance offered to the advance of the reamer. This\\ndanger increases if the direction of the canal diverges from a straight\\nline. It is obvious that with any instrument which is being rotated, its\\npoint must be kept in line with its shaft to minimize the strain on the\\npart immediately above the cutting portion.\\nThe employment of reamers is therefore advised only in nearly straight\\nand rounded roots the central idea to keep in mind is that reamers are\\nemployed merely to uniformly enlarge canals which already exist, never\\nto form new ones. Root canals which have a flattened form are en-\\nlarged by means of the cleansers, using progressively increasing sizes,\\nand supplementing their action where and when necessary with sulfuric", "height": "4580", "width": "2836", "jp2-path": "americantextboo00kirk_0464.jp2"}, "465": {"fulltext": "THE CLEANSING OF CANALS.\\n457\\nFig. 448.\\nacid, as advised by Dr. J. R. Callahan. 1 This method is of great value\\nit furnishes a means for entering and thoroughly cleansing and enlarg-\\ning canals which before its introduction were regarded as impossible of\\nentry.\\nIt has no doubt been observed by every operator, how seldom roots\\nwhich have been well prepared for artificial crowns of the post variety\\nbecome the seat of pericementitis. This fact sug-\\ngests that the mechanical removal of the existing\\nboundary walls of the root canals, by removing\\nthose portions of dentin invaded by septic organ-\\nisms may lessen the opportunity of sepsis. Miller\\nhas shown 2 that this infection of dentin about\\ncanals is, as a rule, superficial (Fig. 448). The\\nobservations made in the essay of Dr. Miller\\nshow also that any danger to the lateral peri-\\ncementum by invasion of the dentinal tubules\\nleading from the root canal is remote in the\\nextreme. Infection to some depth does occur,\\nhowever (Fig. 449). It is undisputed that the\\nsource of septic infection of the pericementum\\nis from the canals by way of the apical foramen,\\nFig. 449.\\nMi; ii\\\\\\nm\\nm\\nHi\\nFig. 448.\u00e2\u0080\u0094 Sector of a cross section from a diseased root a, cement b, stratum granulosum\\nc, very narrow and finely branched tubules d, infected district. (X 150.)\\nFig. 449.\u00e2\u0080\u0094 Dentin from the root of an abscessed tooth, showing the penetration of cocci to e\\ndepth of about mm. ff in.). The side a-b bordered upon the canal. (X 1000.)\\n1 Proc. Ohio State Dental Society, 1894.\\nDental Cosmos, 1890, p. 353.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0465.jp2"}, "466": {"fulltext": "458 THE TREATMENT AND FILLING OF BOOT CANALS.\\nand if the tract there represented be made aseptic no trouble need b\\nfeared.\\nAs the object in all succeeding operations is to remove and not to\\ninstitute a septic condition, care must be exercised that no septic organ-\\nisms be introduced by the operator into the field of operation. The\\nfirst step is therefore the rendering aseptic of this field. The teeth\\nshould be cleansed first with a brush and soap, then the mouth be rinsed\\nwith an antiseptic, as 3 per cent, pyrozone, 10 per cent, solution of\\nmeditrina, or a lilac-colored solution of potassium permanganate. The\\ninstruments are to be sterilized, and to effect this object an excellent\\nmeans is by dipping the mechanically cleansed instruments in strong\\nammonia water. 1 If any food or pulp debris occupy the pulp chamber it\\nis to be washed away with the antiseptic employed to sterilize the mouth.\\nThe rubber dam is adjusted, and direct sterilization of the canals, and,\\nwhen indicated, of the tissues at the apex of the root, is to be attained.\\nMethod of Entrance to Canals. The first step or stage of the\\noperation is the gaining of direct and free access to every canal of the\\ntooth. This may at times appear to involve the removal of an undue\\namount of the crown of the tooth. Unfortunately this is true, but\\nefforts at the conservation of too much of the crown structures and\\nform are frequently followed by incomplete cleansing and filling of the\\ncanals. This latter is the greater evil of the two, so the cutting away\\nof the crown is always to be done when necessary to accomplish the\\nend in view.\\nIn the vast majority of cases in which it is necessary to remove a\\nputrescent or septic pulp the carious process has invaded the crown of\\nthe tooth extensively the cavity of decay is therefore excavated until\\nperfectly free from carious dentin weak enamel walls are dressed\\naway by means of enamel chisels, and usually direct access to the pulp\\nchamber is gained. This is still insufficient the cavity must be\\nopened so that the finest size of canal bristle can be carried directly to\\nthe apex of the root without danger of fracturing the instrument.\\nIn central incisors, as the carious cavities usually open upon the\\napproximal surfaces, entrance is gained to the pulp chamber by extend-\\ning at the palatal aspect of the cavity a groove from the cavity to\\nover the entrance of the pulp chamber (a, Fig. 450).\\nThe same rule is observed with the lateral incisors and canines.\\nShould the pulp have died subsequently to the insertion of fillings,\\nwhich are mechanically faultless, entrance to the pulp canal is made in\\nthe basilar pit (b, Fig. 451). For canines the opening is made at a\\nhigher point, about one-third the way toward the cutting edge. These\\nopenings, while they should be large enough to afford free access to the\\n1 See also Chapter IV.", "height": "4612", "width": "2832", "jp2-path": "americantextboo00kirk_0466.jp2"}, "467": {"fulltext": "THE CLEANSING OF CANALS. 459\\ncanals, should not be made so large as to weaken the crown, or there is\\ndanger of fracturing it when in physiological use.\\nCavities in bicuspids invading the pulp are usually upon the ap-\\nproximal surfaces they are to be extended over the occlusal face of\\nthe tooth until access to the canals may be had (see Fig. 452).\\nFig. 450. Fig. 451.\\nFig. 452.\\nCavity in bicuspid.\\nFig. 453.\\na c\\nThe same procedures are to be followed in molar teeth. In lower\\nmolars if the .carious cavity be upon the distal wall, it is to be artificially\\nlengthened across the occlusal face until the probe may be carried\\ndirectly into each canal (Fig. 453, a) the same method is pursued if\\nfor a mesial cavity. In upper molars, especial care is required to gain\\nprimary access to the anterior buccal root, and tooth structure must be\\ncut away until this access is secured (Fig. 453, b). Should the carious\\ncavities open upon the buccal faces of the posterior or lingual faces of\\nthe anterior teeth, the upper cavity edge, that farthest from the gum,,\\nmust be extended toward the cutting edge of the tooth until a bent\\nprobe may be readily passed to the apex of each root (Fig. 453, c). In\\noperating upon many, or most, of the canals of the posterior teeth it is\\nnecessary to bend the pulp extractor or canal cleanser until it is almost\\nor quite at a right angle with the instrument carrier.\\nIn the six anterior lower teeth where openings are to be made in\\nthem in the absence of large cavities of decay, entrance is effected\\nthrough the lingual wall.\\nThe advice of Dr. J. Foster Flagg is appended, as to the position\\nof tap openings to be made in the several teeth, when the teeth if\\ncarious have not the carious cavity in such position as to afford access\\nto the pulp chamber\\nBy means of a diamond drill or an inverted cone bur, a rougk\\nspot is made in the centre of the face to be perforated this prevents\\nslipping of the spear-pointed drill which is then employed to enter the\\npulp chamber. The outlines of the chamber are to be obliterated with\\nburs. The dentate bur is a most effective means of enlarging such\\nopenings. The opening is to be enlarged until a fine probe may be", "height": "4560", "width": "2792", "jp2-path": "americantextboo00kirk_0467.jp2"}, "468": {"fulltext": "460 THE TREATMENT AND FILLING OF ROOT CANALS.\\npassed into each canal the teeth are tapped in the following sit-\\nuations\\nUpper Teeth. Centrals and laterals On the lingual face.\\nCanines On the tuberosity, or disto-labially.\\nFirst or second bicuspids On occlusal or buccal face.\\nFirst molars On occlusal, or, as a second choice, on buccal face.\\nSecond molars On occlusal, mesio-occlusal, or buccal face.\\nThird molars On mesio-occlusal face.\\nLower Teeth. Centrals and laterals On lingual face just posterior\\nto cutting edge.\\nCanines On disto-labial portion near the gum.\\nBicuspids On mesio-buccal face.\\nFirst, second, and third molars On mesial, buccal, or mesio-occlu-\\nsal face.\\nTreatment of Canals.\\nThe tooth and adjacent teeth being isolated by the rubber dam,\\ndirect access to each canal having been gained, the tooth having its\\nwalls sterilized and each instrument which has been or is to be used\\nbeing sterilized, the subsequent procedures depend entirely upon the\\ncondition of the pulp chamber, canals, and dentin (and perhaps the peri-\\ncementum), as regards sepsis. One of the several conditions described\\nin the opening of the chapter is present which of these it is, governs\\nthe therapeusis.\\nFirst A ease in which the pulp has been intentionally devitalized and\\nextirpated. The pulp having been removed en masse it has carried with\\nit, provided of course no organisms have been introduced during or subse-\\nquent to its extirpation, all of the sources of infection. The remote\\ndanger is now the existence of small fragments of pulp tissue which\\nif unremoved might form a soil for the development of organisms ob-\\ntaining entrance to them or blood may have escaped into the canals\\nwhere the dead pulp was torn from its connection at the apex. These\\nmust both be removed.\\nHydrogen dioxid, being the agent which will most quickly and\\neffectively disorganize the blood corpuscles, is carried into the canals\\nand permitted to act for a few minutes, when it is absorbed by means of\\ncotton, or taper twists of bibulous paper then canal cleansers, beginning\\nwith the smaller sizes, are employed to scrape the walls of the canals free\\nof any adherent pulp shreds or odontoblasts which may have been torn\\noff when the pulp was removed. Larger sizes are to succeed these\\nuntil the caliber of the canal is made larger and smooth. If it be a\\nround root and there be any interference with the passage of these\\ninstruments to the apex of the root, it is evident that the same difficulty\\nwould be found in carrying filling material to its apex. A judicious", "height": "4612", "width": "2792", "jp2-path": "americantextboo00kirk_0468.jp2"}, "469": {"fulltext": "TREATMENT OF CANALS.\\n461\\nFig. 454.\\nreaming of the root removes this difficulty and is therefore done. That\\nsize of the Gates-Glidden reamer which will enter the canal readily is\\nrevolved by hand, or, if in the engine, is revolved very slowly, stopping\\nthe moment any resistance is felt. The reamer is frequently withdrawn\\nto remove the de bris which collects behind it. As soon as resistance\\nis felt, a fine canal cleanser is passed beyond the point and the walls\\nscraped, when the reamer is reapplied this alternation of instruments\\nis continued until sensitivity shows that the point of the reamer has\\nreached the pericementum. The next size of reamer is then employed\\nto enlarge the canal uniformly. As soon as a canal is reamed a tem-\\nporary dressing of alcohol on cotton is placed in it to prevent the ingress\\nof debris from other canals that is, if it be a tooth having two or more\\nroots. In upper molars, the palatal, and in lower molars the distal,\\nroot is to be first cleansed and dressed. If the subject of operation be\\na single-rooted tooth, preparation is now made for hermetically sealing\\nthe apex and filling the canal if a multi-rooted tooth, the canal next in\\nsize is entered if the root be round as evidenced\\nby the general shape of the canal. For example,\\nthe anterior roots of lower molars, the buccal roots\\nof upper molars or of bicuspids, which exhibit a\\nround opening, have usually but not always a\\nrounded body those showing a ribbon-like out-\\nline are likely to have a corresponding outward\\nform. Any efforts at reaming such canals should\\nbe confined to that portion showing a rounded\\nopening thus, if a lower molar, the finest reamer,\\nrotated by hand, the device of Dr. W. W. Walker\\n(Fig. 454), is employed to enter and enlarge the\\nbuccal and lingual extremities of the ribbon-like canals. Any further\\nenlarging should be done with the canal cleansers. The same rule\\napplies to the buccal roots of upper molars and to bicuspids. When\\nany doubt exists, the enlarging should always be done with the cleansers\\ninstead of the reamers.\\nNot infrequently cases are found in which the root canals, or one\\nof them, may have such contracted caliber as to refuse entrance to the\\nfinest canal cleansers. As a rule, such canals will be found in the buc-\\ncal roots of upper molars and the anterior root or roots of lower molars\\noccasionally the bicuspids, particularly the upper first bicuspids, will\\nexhibit this condition. It is in such cases that the method of cleansing\\nand enlarging introduced by Dr. Callahan will be found effective. A\\nrose bur is employed to form a small pit of which the entrance of the\\npulp canal is the centre. In this pit a drop of sulfuric acid, 50 per\\ncent, solution, is placed immediately upon the contact of the acid the\\nWalker pulp-canal\\nreamers.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0469.jp2"}, "470": {"fulltext": "462 THE TREATMENT AND FILLING OF BOOT CANALS.\\nfinest size of Donaldson canal cleanser is passed as far as it will go into\\nthe canal, the cleanser is inserted and partially withdrawn, scraping\\naway the calcium sulfate formed by the action of the acid upon the cal-\\ncium salts of the tooth. The acid is quickly neutralized and fresh\\napplications are made drop by drop, the scraping and pumping with the\\ncleanser being continued until the point of the instrument is felt to\\nreach or pass the apical foramen. Any organic matter, such as filaments\\nor minute fragments of pulp tissue, which may have been present in the\\ncanal is destroyed. This applies also to organic matter undergoing de-\\ncomposition or to organisms which may be present. As there is no\\nmarked degree of force required in the operation it may be pursued\\neven in cases of pericementitis or acute abscess, to gain direct and free\\nentrance to the seat of morbid action, the focus of germ development.\\nIn the event of the operator being unable to detect through instru-\\nmental means the openings of minute canals, Dr. Callahan advises that\\na pellet of cotton containing a minute portion of acid be placed over the\\nprobable situation of each canal and sealed in over night. The follow-\\ning day, when the rubber dam is applied and the cavity dried, the spot\\nof application of acid will be represented by a small white area, in\\nwhich, if a canal entrance exist, it will be represented by a black dot.\\nA pit is made at this point and acid is applied, when entrance by cleansers\\nis attempted should failure to gain entrance result, it is most probable\\nthat the canal is almost or quite obliterated with secondary deposits\\nformed by a receding pulp, hence no future sepsis is probable. As\\nsoon as the cleanser is felt to touch or pass the apical foramen the\\ncanals are syringed out with a saturated solution of sodium bicarbonate.\\nCarbon dioxid is disengaged, which drives the debris left in the canals\\ninto the pulp chamber, and the acid is neutralized.\\nThus far has been described the entrance to and thorough cleansing\\nand uniform enlarging of canals of a tooth from which the intentionally\\ndevitalized pulp has been extracted the immediate question is, What\\ntreatment shall now be pursued Owing to the method of pulp with-\\ndrawal, the contents of the dentinal tubules are as yet chemically un-\\nchanged and it scarcely requires argument to demonstrate that, can\\nthey be kept in a stable condition, they constitute the best material for\\noccupancy of the tubules. Examining the list of medicaments applica-\\nble as preservatives zinc chlorid is the agent fixed upon as the one\\nwhich will best procure an unchangeable condition of the contents of\\nthe tubules. The experiments of Prof. Jas. Truman l have shown that\\nthis agent quickly diffuses through a capillary tube containing albumin,\\nconverting it into a whitish coagulum, an albuminate of zinc, which\\nevery anatomist knows to be one of the most efficient of all preserva-\\n1 Proc. Academy of Stomatology, Philadelphia, 1894.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0470.jp2"}, "471": {"fulltext": "THE ROOT-CANAL FILLING. 463\\nlives. Anatomical specimens of parts injected with a zinc chloric!\\nsolution, and which have been subjected to all the conditions known to\\nfavor the development of putrefaction, remained unchanged after the\\nlapse of years. It is advised, therefore advice endorsed by a majority\\npercentage of operators that a solution of zinc chlorid be now placed\\nin each canal. A twist of absorbent cotton is dipped in a solution of\\nthe salt. Should the apical foramen be large, a weak solution, about\\n10 per cent., is employed; if fine,. the strength of the solution may be\\n40 per cent. Unless carelessly manipulated or too great an excess of\\nthe coagulant be employed there is but little danger of forcing the solu-\\ntion beyond the apex of the root. After about ten or fifteen minutes\\nthe application is withdrawn and cotton or paper cones passed in the\\ncanal to absorb any excess of the chlorid which may be present, and the\\ncanals are now ready for filling.\\nThe Root-canal Filling.\\nWhen oxy chlorid of zinc has been determined upon as the perma-\\nnent canal filling, the preliminary treatment of the canal with zinc\\nchlorid solution is superfluous, as the coagulating and antiseptic action\\nof the zinc chlorid used in making the oxychlorid cement fully answers\\nthe purpose in the short period of time elapsing before chemical com-\\nbination of the fluid and powder results in a hardened body.\\nExamining the available statistics regarding the several materials\\nwhich have been employed for canal filling in such cases, there is found\\na greater percentage of success that is, a fewer number of cases pres-\\nent subsequent evidences of sepsis when zinc oxychlorid has been used.\\nThis is quite in accord with rational therapeusis the material is capable\\nof hermetically sealing the apex and is unchangeable in the conditions\\nsurrounding it. Its antiseptic action probably plays little or no con-\\ntinued part, disappearing shortly after the material sets it is, however,\\nindisputable that when this material has been employed as a pulp cap-\\nping it has not infrequently converted the entire pulp into a hyaline\\ncoagulum which has remained permanently aseptic.\\nThis material is mentioned first on account of the ease, readiness, and\\ncertainty with which it may be placed.\\nGidta-percha ranks second in point of favor as a canal filling; this\\nnot on account of any deficiency of specific properties contraindicating\\nits use, but there is not the same certainty of accurate placement and\\nhermetic sealing as with the oxychlorid. Gold and tin, the remain-\\ning materials which have found any extensive employment in such\\ncases, are open to the same common objection, viz. difficulty of manipu-\\nlation.", "height": "4568", "width": "2796", "jp2-path": "americantextboo00kirk_0471.jp2"}, "472": {"fulltext": "464 THE TREATMENT ANH FILLING OF ROOT CANALS.\\nThese are the practically irremovable materials. The removable\\nmaterials which have been recommended are, first\\nCotton. It is due to Prof. J. Foster Flagg that this substance has\\nbeen extensively employed, not as a filling material per se, but as a\\nmedium holding an antiseptic. The variety of cotton employed is the\\ncrude uncarded cotton wool. Dr. Flagg cites as a proof of the imper-\\nmeability of this material when properly packed, that bales of cotton\\nwhich have floated in sea-water for long periods, when opened show no-\\nevidences of moisture in their interior.\\nEvidence regarding the value and danger of this material is con-\\nflicting. It is asserted by the advocates of cotton canal fillings that,\\nproperly inserted, they remain unchanged for long periods, are readily\\npacked into position, and if necessity demand may be readily removed.\\nThose who oppose the use of cotton assert that it soon becomes filled\\nwith products of decomposition, and that after some years the texture\\nof the material is destroyed, rendering its removal very difficult. In\\nconsequence of these conflicting opinions, the weight of evidence being\\nwith those who oppose its use, cotton has found but limited endorsement.\\nThe other removable materials, salol and paraffin, are innovations\\ntoo recent to determine their value and position as canal fillings. The\\nreports regarding salol are sufficiently conflicting to warrant advising\\nits use only in conjunction with a central mass of gutta-percha or tin\\npoints the salol filling the space between the gutta-percha or metal\\npoint and the walls of the canal.\\nThese are the arguments for and against the several materials the\\nweight of evidence being largely in favor of, first, the oxychlorid of\\nzinc and second, gutta-percha.\\nThe question is, now, When shall the canals be filled Shall it be\\ndone immediately, or shall a period be permitted to elapse for assurance\\nthat no inflammatory action shall arise and the filling be a bar to its\\nprompt reduction There are two causes which might be productive\\nof inflammatory action First, the dental manipulations of removing-\\nthe pulp and cleansing the canals might be productive of sufficient\\nirritation to give rise to inflammatory reaction in that event the open\\ncanal would afford an escape for inflammatory effusions. The second-\\ndanger would depend upon whether septic organisms had been intro-\\nduced or had not been thoroughly destroyed their sealing in the canals\\nmight be productive of septic inflammation. If the foregoing meas-\\nures of cleansing have been followed it is scarcely possible that any\\norganisms could survive. General experience demonstrates that in but\\na small percentage of cases does the pericementum suffer markedly from\\ntraumatism during the cleansing and sterilizing of canals, so that the", "height": "4612", "width": "2796", "jp2-path": "americantextboo00kirk_0472.jp2"}, "473": {"fulltext": "THE BOOT-CANAL FILLING. 465\\nweight of evidence clearly teaches that such canals may be filled at\\nonce, and little or no reaction occur.\\nFreshly mixed zinc oxychlorid being markedly irritating to vital\\ntissues, it is usual to place between the paste and the tissues of the\\napical region a barrier to the former. This may be of gutta-percha. A\\nvery fine cone of gutta-percha about one-quarter inch long is dipped in\\noil of eucalyptus or oil of cajuput to soften it it is then carried to the\\napex of the root upon a fine probe and pressed into position. Or, a\\nsmall pellet of cotton is dipped in a strong solution of thymol or aristol.\\nIt is extremely probable that when the freshly mixed oxychlorid is\\nplaced over it, the cotton becomes converted into amyloid which her-\\nmetically and permanently seals the apical foramen the same change\\noccurs in the cotton upon which the oxychlorid is carried into position.\\nSlender wisps of cotton are rolled thin enough to pass readily into the\\ncanals. A thin paste of oxychlorid is mixed, the cotton wisps are\\nrolled in it until the meshes are full, when the extremity of a wisp is\\ncaught upon the end of a long, smooth, and slender canal plugger and\\ncarried up the canal to contact with the guard at the apex the plugger\\nis withdrawn about one-eighth of an inch, and that length of the cotton\\nis crimped upon itself; the remainder of the canal is plugged in the\\nsame manner until it is full, when the surplus length of the cotton is\\ncut off and bibulous paper is pressed against the canal filling to absorb\\nthe surplus zinc chlorid. The floor of the pulp chamber may be covered\\nwith the stiffening paste from the mixing slab.\\nA method by which cotton fiber loaded with the oxychlorid may be\\ncarried to the root apex with great accuracy and precision is as follows\\nThe smallest size Donaldson bristle with smooth sides has its hooked\\nend cut off with the scissors and the cut end made flat by rubbing\\nlightly upon a fine Arkansas stone. This may be readily done by\\ngrasping the bristle very near to its point between the thumb and index\\nfinger and lightly rubbing it back and forth upon the surface of the\\nstone. The bristle is then laid flat upon a glass slab and burnished\\nfrom heel to point until the surface is perfectly smooth and any burr\\nturned upon the point by the action of the burnisher is fully re-\\nmoved. A few fibers of cotton wool are then held between the thumb\\nand index finger of the left hand, the direction of the fibers being in\\nthe line of the long axis of the index finger. The point of the prepared\\nbroach is then laid upon the cotton fibers, and both broach and cotton\\nare rolled together between the finger and thumb. The rolling action\\nof the finger and thumb serves to felt the cotton fiber on to the broach,\\nand should be continued until the cotton is evenly felted over the\\nsquared end of the broach. The whole operation is done by the left\\nhand. The broach is not twirled into the cotton with the right hand as\\n30", "height": "4560", "width": "2804", "jp2-path": "americantextboo00kirk_0473.jp2"}, "474": {"fulltext": "466\\nTHE TREATMENT AND FILLING OF ROOT CANALS.\\nFig. 455.\\nis ordinarily clone where a roughened cotton-carrying probe is used.\\nWith a smooth broach and the cotton fiber felted on as described the\\nbroach may be pushed forward with considerable force into a canal\\nwithout puncturing the cotton, which is securely carried as\\nfar as the broach will go. On account of the smoothness\\nof the sides of the broach it may be easily withdrawn for\\na slight distance, and then engaging in the surrounding\\ncotton it is used as a plugger to pack the cotton ahead of\\nit, and the plugging action continues until the material is\\nall packed in place. The adjustment of the cotton to the\\nbroach as described really forms a tube-like arrangement\\nof the cotton with the instrument in its central lumen\\nan arrangement greatly favoring the operation of carrying\\nthe cotton into place and enabling the operator to use the\\ncotton or any suitable fiber as a vehicle for canal dressings\\nor for permanent filling in connection with the oxychlorid\\nof zinc cement.\\nIf gutta-percha be the material selected for filling the\\ncanal, a careful examination is made to determine whether\\nthe apical foramen be comparatively large or very small\\nin the latter case chloro-percha may be first pumped into\\nthe canals in the former it is wiser to omit the fluid,\\nowing to the possibility of passing it through the apical\\nforamen. In all cases where a canal filling is to be made\\nof gutta-percha cones it is advisable to first lubricate the\\nwalls of the canal with one of the antiseptic oils, cinnamon,\\neucalyptus, or cajuput these will facilitate the passage of\\nthe point to the apex, and as solvents of gutta-percha will\\nsoften its surface and permit a more close adaptation to\\nthe canal walls. Should the apical foramen be found large\\nenough to admit the pointed extremity of one of the gutta-\\npercha cones, the end of the latter is cut off. The canal is\\nlubricated with the oil, the cone itself dipped in the same\\nmedium, its base caught upon the end of a canal plugger,\\nand it is passed carefully into the canal as far as it will go,\\nwhen the plugger is withdrawn blasts of hot air from a\\nhot-air syringe are directed against the exposed end of the\\ncone until it is softened, and it is then pressed firmly into\\nposition by means of fine pluggers. A sufficient number\\nof cones are added, softened and packed in position, filling\\nthe canal flush with the pulp chamber.\\nIn fine tortuous canals it is the usual practice to first pump them\\nfull of thin chloro-percha. A portion of the solution is caught be-\\nFlagg s dress-\\ning pliers.", "height": "4612", "width": "2792", "jp2-path": "americantextboo00kirk_0474.jp2"}, "475": {"fulltext": "THE ROOT-CANAL FILLING.\\n467\\ntween the points of a pair of Flagg s dressing pliers (Fig. 455) and car-\\nried to the opening of the canal, when, if the points are opened, the\\ndrop of fluid is deposited there it is then pumped into the canal by\\nmeans of a fine smooth broach. To minimize the leakage due to the\\nshrinkage of the chloro-percha in hardening, it is advised to thrust into\\nthe fluid material in the canal as large a gutta-percha cone as the canal\\nwill admit. Dr. Ottolengui advises that the pieces of silk described in\\nthe beginning of the chapter be used and an end left projecting into\\nthe pulp chamber, when, should removal of the filling ever become\\nnecessary, this end may be caught and the entire filling withdrawn.\\nShould it be designed to fill the canal with gold, its exact length is\\nmeasured by placing a small disk of rubber dam over a canal plugger,\\nwhich may be carried to the apex, and inserting the plugger in the\\ncanal. The floor of the pulp chamber engages the rubber dam, and\\nwhen the plugger point has reached the end of the canal the little gauge\\npiece of rubber dam marks its exact length. Minute pieces of soft gold\\nfoil are cut, and one by one are carried to the end of the canal, the rubber\\nupon the plugger being the guide to completeness of access to the root\\napex. This method is to-day rarely followed. Dr. W. S. How advises\\nthe use of shredded tin for sealing the apex of canals. By a series of\\nfine probes the canal length is measured (as shown in Figs. 456-460),\\nFig. 456.\\nFig. 457.\\nFig. 458.\\nand particles of shredded tin foil are carried to the apex and impacted\\nby means of measured probes.\\nSalol and paraffin are both manipulated after one manner. A very\\nfine probe is passed into the canal to its apex a portion of the ma-\\nterial is caught between the beaks of a pair of dressing pliers (Fig. 455)\\nand held above an alcohol flame until it is melted, when the closed\\nbeaks are placed in the canal beside the probe, and opened, and the fluid", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0475.jp2"}, "476": {"fulltext": "468\\nTHE TREATMENT AND FILLING OF BOOT CANALS.\\nmaterial runs into the canal. Slowly withdrawing the probe, the fluid\\nruns into the space occupied by the probe, filling the canal to the apex\\nit is advisable, however, to warm a broach, and by a pumping motion\\nFig. 459.\\nFig. 460.\\ninsure the carrying of the filling to all parts of the canal. If salol be\\nemployed a cone of gutta-percha of such size as may be readily carried\\nto the apex should be thrust into the fluid material, virtually filling the\\ngreater portion of the canal with gutta-percha. Several trustworthy\\nobservers have noted a disappearance of salol from canals in which it\\nhas been placed the gutta-percha minimizes the risk attendant upon\\nsuch disappearance. The gutta-percha subserves another purpose\\nshould it ever be necessary to remove the canal filling, blasts of warm\\nair directed against the end of the gutta-percha may be made to melt\\nthe salol about it, when the cone may be readily withdrawn. This\\nmelting and withdrawal are more quickly accomplished if the central\\nmass be of metal.\\nParaffin is unchangeable in the conditions under which it is placed.\\nTreatment op Root Canals with Mummified Pulps.\\nThe remaining member of the aseptic cases is that of mummified\\npulp. So long as these cases remain perfectly aseptic they give rise to\\nno symptoms and are, as a rule, uncovered by accident, rarely by design.\\nTheir usual history is as follows At some time (perhaps years)\\nbefore, an exposed or almost exposed pulp has been covered with a cap\\nor cavity lining of the oxychlorid of zinc. They have remained com-\\nfortable thereafter. At some subsequent time it may be necessary to\\nopen the tooth, usually on account of recurring caries the total\\nabsence of dentinal sensitivity is noted, the tooth has changed color but", "height": "4616", "width": "2792", "jp2-path": "americantextboo00kirk_0476.jp2"}, "477": {"fulltext": "SEPTIC CASES. 469\\nlittle, if at all, and the operator burs carefully toward the pulp to\\ndetermine its condition. (It should be remarked here that absence\\nof dentinal sensitivity in a tooth having normal color and which con-\\ntains a very large filling is an indication of aseptic death of the pulp,\\nand the operator should renew all of his antiseptic precautions as to\\nisolation of the tooth by the rubber dam and complete sterilization of\\nall instruments and of the territory of operation.) The burring is con-\\ntinued without any evidence of sensitivity, and the instrument is finally\\nfelt to pass into the pulp chamber. There is no odor, no escape of\\nfluid, the pulp being found dry and shrivelled. If sterilized pulp\\nextractors are passed into the canals, the remnants of the pulp may be\\nwithdrawn, exhibiting none of the usual signs of decomposition such as\\nodor and confluent softening.\\nIt is highly improbable that any organisms are present, unless they\\nshould have been introduced by the operator from the exterior. The\\npossibility of this occurring should prompt caution, for it is the expe-\\nrience of many that although organisms have not been present in the\\ncanals, when introduced from without they find a fruitful soil for devel-\\nopment. Reaction indicating infection may occur within a few hours or\\nmay be delayed for perhaps two days. This condition may arise even\\nin connection with teeth whose pulps have died under a capping of\\nzinc oxychlorid, from the fact that the quantity of zinc chlorid used in\\nthe capping material was insufficient to completely saturate the pulp\\ntissue and render it permanently antiseptic. It is advisable, therefore,\\nto cleanse the canals with some powerful and penetrating antiseptic to\\ndestroy any chance organisms and to insert a probationary though per-\\nfect root filling until the time of danger has passed. The antiseptic\\nwhich meets the indications is the ethereal 25 per cent, solution of\\nhydrogen dioxid known as pyrozone, permitted to remain in the canals\\nfor several minutes. The canals are then dried, and for the temporary\\nfilling salol is the rational indication. At the expiration of three days\\nif no evidences of pericementitis are present the operator may remove\\nthe salol, reapply the antiseptic, and fill the canals with oxychlorid or\\nwith gutta-percha.\\nThe use of formalin (40 per cent, aqueous solution of formic alde-\\nhyde) should be mentioned in this connection. A 5 per cent, solution\\nplaced in the canals is a coagulant antiseptic which quickly and cer-\\ntainly penetrates into and sterilizes the finest recesses.\\nSeptic Oases.\\nThe second great class of cases, the septic, comprises those in\\nwhich the pulp has undergone some extent of decomposition. As a\\nrule, the first organisms which invade pulp tissue are the staphylo-", "height": "4560", "width": "2784", "jp2-path": "americantextboo00kirk_0477.jp2"}, "478": {"fulltext": "470 THE TREATMENT AND FILLING OF ROOT CANALS.\\ncocci and streptococci, which find a suitable habitat in the live pulp.\\nAdvancing first along the lines of the veins, their toxic waste prod-\\nucts causing inflammation, the organisms invade, peptonize, and liquefy\\nthe inflammatory effusions. As these cocci advance toward the apex\\nof the root, the necrotic and altered tissues which are left behind\\nbecome the breeding-ground of other organisms, particularly the bacteria\\nof putrefaction. The altered portions of pulp tissue are decomposed\\ninto products of progressively simpler chemical composition, until all\\nof the albuminous substances have been transformed first peptones are\\nformed, further decomposition produces ptomains, next such bases as\\nleucin, ty rosin, and the amines, together with fatty acids x finally the\\nend products are hydrogen sulfid, ammonia, carbon dioxid, and water\\n(see Fig. 398). Fermentation and putrefaction can only occur where the\\nfungi concerned live, and the extent of decomposition is conditioned by the\\nnumber of fungi (Ziegler).\\nAs there are several distinct types of decomposition, so is there a cor-\\nresponding number of varieties of organisms. The septic cases may be\\ndivided into two classes First Those in which septic invasion has not\\npassed beyond the apical foramen and given evidence of pericemental\\nirritation or inflammation, these tissues being threatened though not\\ninvaded. Second Those in which the pericementum has become the\\nseat of septic invasion. This latter class is subdivided according to the\\nnature and extent of the septic processes the first subdivision comprises\\ncases of acute pericementitis non-purulent the second, of chronic peri-\\ncementitis without evident pus formation the third, of purulent peri-\\ncementitis, which may be either acute or chronic.\\n1. In the first of the first class of these cases those in which the\\nsuppurative process has invaded the pulp to near its end the necrotic\\nportions of the pulp are undergoing putrefactive decomposition. To-\\nward the end of the process, when the apical portion of the pulp is\\ninvaded, it is not uncommon to find evidences of pericemental irritation;\\nthis frequently ceases spontaneously, as though the irritation had caused\\nthe formation of a barrier between the tissues of the apical region\\nand the suppurating pulp. An increasing discoloration of the dentin\\nshows the contents of the dentinal tubules to be also undergoing de-\\ncomposition. It is necessary to remove this mass, destroying the\\nproducts, the causes, and the soil of decomposition this without cariy-\\ning infection to the vital tissues beyond the apex. When the odor of\\nhydrogen sulfid may be detected, it is evidence that the ultimate de-\\ncomposition of albuminous matter is in progress. As it is quite prob-\\nable and an imminent danger that organisms might, upon a broach\\ninjudiciously employed, be carried from the body of the putrescent\\n1 Ziegler, General Pathology, 1895, p. 437,", "height": "4608", "width": "2804", "jp2-path": "americantextboo00kirk_0478.jp2"}, "479": {"fulltext": "SEPTIC CASES. 471\\nmass to the apex of the root, it is the part of wisdom and prudence to\\ndestroy the organisms as a primary measure. There is no quicker or\\neffective means of destroying H 2 S, and probably the causes leading to\\nits production, than applications of iodin. The reaction involved in\\nthe decomposition of H 2 S by iodin was pointed out by Dr. W. F.\\nLitch l In passing a stream of hydrogen sulfid through tincture of\\niodin, the latter element seizes upon the hydrogen, forming hydriodic\\nacid, which remains in solution, the sulfur falls as a precipitate the\\nsolution is decolorized. Any excess of iodin which remains may be\\nreadily removed by an application of ammonia water, a solution of\\nammonium iodid being formed which may be readily washed away.\\nA penetrating antiseptic is now indicated, to sterilize to as great a\\ndepth as practicable. A 10 per cent, solution of formalin fulfils this\\nindication. It is permitted to act for some time. The contents of the\\ncanal are scraped away, never pushing the broach by which the scraping\\nis done, for fear of carrying organisms deeper into the canal. As the\\nend of the canal is approached 5 per cent, formalin is substituted.\\nAs stated, septic canals contain certain fatty bodies and derivatives\\nof albumin, together with more or less partially disorganized pulp tissue\\nand a mixed bacterial infection. Examining the list of therapeutic\\nagents it is seen that one of them, sodium dioxid, possesses properties\\ncapable of neutralizing each of the offending elements. This material\\nmay be employed either in the solid form or in solution. Solutions of\\nsodium dioxid must be made with great care to prevent escape of the\\noxygen. A tumbler of distilled water is set in a vessel containing ice-\\nwater into the distilled water the sodium dioxid is dusted very slowly\\nin small amounts. Each addition is attended by the evolution of heat. 2\\nThe sodium dioxid is added to the point of saturation, and reduced to\\nthe desired percentage strength by additions of distilled water. 3\\nA drop of the saturated solution is placed upon a wisp of asbestos\\nfiber (as it destroys cottou fiber) and is carried into the canal in a few\\nmoments the cavity may be syringed, and a deeper application of the\\ndioxid solution made this time of 50 per cent, solution. Each time\\nthe asbestos is removed it is seen that the discolored dentin surrounding\\nthe canal becomes whiter; the discoloring matter in the tubules has been\\ndestroyed.\\nWhen a broach may be passed freely to the apex of the root, and\\nthe solution comes away clear from the root, sterilization is presumably\\n1 Dental Cosmos, 1882.\\n2 Dr. Win. Trueman advises that the soldered lid of the can containing the oxid be\\nperforated as a pepper caster, and the sodium dioxid shaken into the distilled water\\nthrough the perforations.\\n3 E. C. Kirk, Denial Cosmos, vol. xxxv. p. 195; F. T. Van AVoert, ibid., vol. xxxvi.\\np. 499.", "height": "4544", "width": "2768", "jp2-path": "americantextboo00kirk_0479.jp2"}, "480": {"fulltext": "472 THE TREATMENT AND FILLING OF ROOT CANALS.\\ncomplete. A 10 per cent, solution of sulfuric acid is pumped into the\\ncanals by means of iridium broaches this neutralizes any free alkali\\nwhich may be present. The canal or canals are next washed out with\\nhot distilled water, dried with cotton, filled with alcohol, and well dried\\nby blasts of warm air.\\nMany operators immediately and permanently fill such canals\\nhowever, as there is the possibility that sterilization may not be abso-\\nlute, it is the usual practice to fill the canals tentatively yet perfectly.\\nSalol and a metallic point make an excellent canal filling in such\\ncases. When the canals and dentinal walls are dried by means of the\\nalcohol and warm blast they are filled with salol made very fluid, and\\nthe metallic point thrust into the canal containing it. Some slight\\npericemental disturbance may follow, but quickly subsides under the\\ninfluence of a counter-irritant applied to the gum over the root (tr.\\niodin., tr. aconit. et chloroform, da. pars wq. The crown cavity is sealed\\nwith sticky temporary stopping for a few days, when if the condition\\nof the pericementum is found normal, the salol filling is removed (if\\nthe operator desires) by heating a pair of tweezers and grasping the\\nprotruding end of the metal cone. It is the general practice to then\\nfill the canal with oxychlorid or gutta-percha.\\nShould the case present evidences of profound change in the contents\\nof the tubules, i. e. much discoloration, the 50 per cent, solution of\\nsodium dioxid may be sealed in the canal for a day the next day the\\ncanals are syringed freely with an acid solution of hydrogen dioxid.\\nDr. Kirk advises that the dentin be saturated with the sodium dioxid\\nsolution, then upon the addition of hydrochloric acid, hydrogen dioxid\\nis formed wherever the sodium has penetrated, and drives out the soapy\\nmatters formed by the action of sodium hydroxid upon the products of\\ndecomposition.\\nPreliminary to filling the canals it is the usual practice to fill them\\nfor a few minutes with an antiseptic, which will exercise an influence\\nover a considerable period of time. Of all antiseptics, oil of cinnamon\\ngives evidence of the most prolonged presence when so placed.\\nOases in which Pericementitis is Present.\\nThe next class for consideration includes the cases in which the\\ntissues of the apical region are invaded. The first evidence of such\\ninvasion is tenderness of the tooth upon pressure. The cause of this is,\\nno doubt, the inflammatory reaction of these tissues consequent upon con-\\ntact and absorption of the waste products of organisms which are\\ndeveloping in the pulp canal. In the milder cases the tooth is sore to\\nthe touch, is slightly loose and extruded, and the gum over the affected\\nroot is redder than normal. Here, as in all grades of this disturbance,", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0480.jp2"}, "481": {"fulltext": "CASES IN WHICH PERICEMENTITIS IS PRESENT 473\\nthe aim is to get rid, first, of the causes of the inflammation second,\\nwhen necessary to treat the inflammation itself. In entering the canals\\nof such teeth and of course they should be opened and cleansed as\\nquickly and as thoroughly as possible The tooth should receive\\nlateral support against the pressure of the burs used in excavating if\\nthe cavity be approximal the tip of a finger is placed against the face\\nof the tooth on the opposite side to the bur. Should the direction\\nof entrance be in a perpendicular line a ligature of linen twine having\\nlong ends may be tied tightly about the neck of the tooth, and traction\\nexerted as a counter-pressure. l\\nIf the conditions permit, the cleansing and sterilizing are to be well\\ndone at once. Should the tooth be too tender to permit the usual\\nmanipulations, the gross mass is removed by treatment with sodium\\ndioxid solution or by syringing with meditrina and stirring with\\nbroaches then a pellet of cotton saturated with lysol, a stronglv alka-\\nline and penetrating cresol, is placed against the putrescent mass the\\ngum is painted with iodin at a little distance from the site of the inflam-\\nmation. When quiet is secured, the cleansing and sterilization of the\\ncanals should be thoroughly done and a dressing of a sedative anti-\\nseptic introduced. Campho-phenique or cinnamon oil answers well in\\nthis particular.\\nIn more pronounced cases the tenderness, extrusion, and looseness\\nof the tooth are more marked in case the tooth should contain a filling\\nbeneath which a pulp has died and this is a common history of such\\ncases- the release of the imprisoned mephitic gases is imperative. Ex-\\nercising counter-pressure, a very sharp and small spear-pointed drill is\\npassed into the pulp chamber it may be necessary in cases of extreme\\nsoreness to effect this entrance at the neck of the tooth as the shortest\\npath. After a few minutes the opening is syringed out with meditrina,\\nand a blister is applied over the gum at a distance from the tooth, about\\ntwo teeth posterior to it. The patient is directed to immediately take\\na hot mustard foot-bath, and to use frequently a 3 per cent, solution of\\npyrozone or other strong antiseptic solution as a mouth-wash. When\\nthe tooth is much extruded and is kept irritated by striking upon the\\noccluding tooth, it is advisable to place a cap over the tooth posterior\\nto the one affected. A cap may be readily made in a few minutes, by\\ntaking an impression in moldine or in plaster of the tooth to be capped,\\npouring a small die of fusible metal drive this into a block of soft\\nlead, and then swage a piece of silver or German silver, !NTo. 26, to fit\\nthe die. This cap, covering the occlusal face and about half the walls\\nof the tooth, is attached by means of zinc phosphate, thus securing\\nsurgical rest for the affected tooth. It was at one time a general prac-\\n1 J. Foster Flagg s Lectures.", "height": "4560", "width": "2784", "jp2-path": "americantextboo00kirk_0481.jp2"}, "482": {"fulltext": "474 THE TREATMENT AND FILLING OF BOOT CANALS.\\ntice to permit the vent hole drilled at the neck of a tooth to remain\\nopen for the escape of the gases of decomposition, consequently the\\ncases were in a constant state of sepsis. The practice is obsolete and\\nis to be unqualifiedly condemned.\\nIn cases where the inflammatory action runs high, the tooth is ex-\\ntremely tender, much extruded, and loose, the gum over the tooth be-\\ncomes livid, the pulse increases, there is some, and it may be marked,\\nfebrile action, the tongue is coated and the breath offensive. Energetic\\nmeasures are necessary to avert necrotic action in the apical tissues.\\nIn this, as indeed in all cases without exception, the promptness and\\nthoroughness of relief depends primarily upon the thoroughness with\\nwhich the exciting cause of the inflammation is removed, i. e. the septic\\ncontents of the pulp chamber. In any case where direct access may be\\nhad to the canals, and this is very frequently the case, every effort short\\nof that producing great suffering to the patient should be employed to\\nwash away and broach away the putrescent material, using, where ne-\\ncessary, sulfuric acid to enter the canals, powerful antiseptics always\\npreceding the broach. Lysol is an excellent medicament in this con-\\nnection, and campho-phenique another. The canal is syringed freely\\nand repeatedly with 3 per cent, pyrozone, which should also be used as\\nan antiseptic mouth-wash. Local bloodletting, as advised by Dr. G. V.\\nBlack, 1 is frequently an effective means for securing relief. Make a\\ndeep cut in the gum, clear to the process, the incision to be about one-\\nquarter inch from the margin of the gum and encircling the neck of the\\ntooth this will tend toward unloading the engorged vessels of the apical\\nregion. Dry cups over the face and to the neck, and always hot mus-\\ntard foot-baths, are valuable adjuncts.\\nShould the inflammatory disturbance run high, and a full, bounding\\npulse, coated tongue, marked fever, constipation, headache, and other\\nfebrile symptoms appear, attempts should still be made to abort the\\ninflammatory action. After as thorough a cleansing of canals and anti-\\nseptic washing as possible under the circumstances, local bloodletting\\nas described and advised by Dr. Litch 2 is efficient, by means of Swedish\\nleeches, washing the gum, touching it with sugar, then applying the\\nleech, which should be first placed in a test-tube, the mouth of the tube\\nthen being placed over the gum when the leech is gorged, it drops back\\ninto the tube. The mouth is then rinsed with warm water, to continue\\nthe bleeding. Quinin in doses never less than gr. vj is given in the hope\\nof limiting the exudation into the inflamed area. As one of the best and\\nmost effective means of derivation is the induction of watery alvine dis-\\ncharges, the patient may be directed to take a saline cathartic or a rectal\\n1 American System of Dentistry, vol. i. p. 927.\\n2 Ibid., vol. i. p. 928.", "height": "4612", "width": "2796", "jp2-path": "americantextboo00kirk_0482.jp2"}, "483": {"fulltext": "CASES IN WHICH PERICEMENTITIS IS PRESENT. 475\\ninjection of half an ounce of pure glycerin. If the pulse remain full and\\nbounding, and headache persist, tr. aconiti or tr. veratri viridis is to\\nbe used as an arterial sedative, gtt. j of the tr. aconiti rad., or gtt. ij of\\nthe tr. veratri viridis, repeated every hour, until the pulse slows and\\nlessens in volume and tension. At bedtime, if the inflammation be not\\nmarkedly lessened, a sedative diaphoretic is administered, Dover s pow-\\nder in full dose, gr. x, given in hot lemonade while the patient is drink-\\ning the latter he or she is to be well wrapped in hot blankets and the\\nfeet and legs immersed in a hot mustard foot-bath. The following\\nmorning a saline cathartic magnesise sulph. 3ss is given in a goblet\\nof water. These directions (substantially those given by Dr. Litch,\\nibid.), may be followed with gratifying results in many cases even\\nwhen the inflammation is not aborted, its violence is almost invariably\\nlessened.\\nShould the inflammation remain at its height for more than twenty-\\nfour hours, it is almost certain that pus has formed, and the indication\\nis to give it exit. A spear-pointed bistoury is thrust through the gum\\nover the apex of the affected root with such decided force as to pene-\\ntrate the process if possible. In the event of not accomplishing this\\nend, the point of a spear-head drill revolving very rapidly is passed\\nthrough the process to the apical region. Although this operation may\\nbe performed very quickly it may be necessary to administer nitrous\\noxid to quiet the patient and render the drilling painless. Anesthesia\\nmay be secured by means of the injection of a drop of a 15 per cent,\\nsolution of cocain. Dr. Black has described a painless method of effect-\\ning an entrance to the apical region. 1 A napkin is placed about the\\nparts, the gum dried and touched at the point of election with a drop of\\n95 per cent, solution of carbolic acid (trichloracetic acid full strength\\nmay be used). The necrosed membrane is scraped away by means of a\\ncoarsely serrated plugger until sensation is felt, when another drop of\\nacid is applied, and the scratching is resumed until the bone is laid\\nbare a sharp chisel is then used to open the apical region. No blood\\nshould be drawn during the operation except at the last step.\\nThe case in its present stage belongs to and is described in the suc-\\nceeding chapter, upon Alveolar Abscess. In any case presenting in\\nwhich there is reason to believe the patient is the victim of syphilis\\nand alveolar periostitis is an occasional accompaniment of tertiary syphi-\\nlis 2 the use of large doses of potassium iodid is imperatively indicated.\\nUnless decided measures are taken to abort such cases and the usual\\nantiphlogistic measures are of little avail dangerous involvement of\\nthe general periosteum may occur, leading to necrosis. Not less than\\n1 American System of Dentistry, vol. i. p. 928.\\n2 See case Heath, Injuries and Diseases of the Jaws, 3d edition.", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0483.jp2"}, "484": {"fulltext": "476 THE TREATMENT AND FILLING OF BOOT CANALS.\\ngr. vj doses of potassium iodid are to be administered every three hours.\\nShould there be evidence of detachment of the periosteum, evidenced by\\nboggy swelling, a bistoury is to be passed boldly to the bone, making a\\nlarge and free incision.\\nTreatment of Chronic Pericementitis.\\nThe most usual form of chronic apical pericementitis is that associ-\\nated with pus formation. It will be discussed in the succeeding chapter\\nunder the head of Chronic Apical Abscess.\\nA not inconsiderable number of cases may be seen in which pus\\nformation is not evident and yet a chronic inflammation is present in\\nthe tissues of the apical region. If the pulp chamber be open the\\ncause is evident, and its treatment has been described. A not inconsid-\\nerable number of cases are due to malocclusion. This point is to be\\ncarefully observed, for it frequently affects teeth containing vital pulps\\nand free from caries. The tooth is slightly loose and sore to pressure.\\nExamination reveals abnormal occlusion, either too severe or in the\\nwrong direction. Should the tooth contain a filling, it usually gives a\\nnormal response to applications of heat and cold examining the filling\\na spot is seen marking excessive occlusion in both cases grinding off\\nthe redundant tooth structure or filling and applying a counter-irritant\\nover the apex subdues the inflammation. Its exciting cause being\\nremoved, it subsides.\\nA class of cases is occasionally met with in which there is evidence\\nof sluggish and persistent inflammation about the apices of pulpless\\nteeth which have been filled acute inflammatory disturbance of a\\nsevere grade occurs but seldom. The most common cause of this con-\\ntinued inflammation is probably the decomposition of a minute filament\\nof pulp tissue which has not been removed from a canal or, again,,\\nwell-cleansed canals which have not been filled to the apex. Such\\ncases are those of mild sepsis perfect restoration to health is only pos-\\nsible by re-cleansing, sterilizing and perfectly filling the canals. These\\nteeth are always more or less hypersensitive even though it be unnoticed,,\\nand therefore are not of a full measure of service until cured.\\nOther cases in which there is reasonable assurance of perfect steril-\\nization and complete filling exhibit vascular sluggishness over the apex\\nof the root. Continued and repeated massage is beneficial, 1 the disorder\\nbeing apparently due to paralysis of vessel walls and not to septic\\ncauses. The tonus of the vessels may be improved by application of\\nthe galvanic current. This principle has wide application in general\\nmedicine and surgery.\\nIt is to be remembered that when the tissues about the apex of a\\n1 Dr. W. F. Rehfuss, International Dental Journal, vol. xi. p. 581.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0484.jp2"}, "485": {"fulltext": "TREATMENT OF CHRONIC PERICEMENTITIS. 477\\nroot have been irritated, it may be for months, by the products of a\\ndecomposing pulp, a series of degenerative changes may have occurred\\nin them which require some time to remedy. Sterilization should be\\nprolonged, and too hasty a stopping of the canal be avoided. In such\\ncases, after each periodical treatment the canal should be dressed with\\nsome stimulant antiseptic campho-phenique oil of cinnamon, or the\\nadmirable 1, 2, 3 mixture of Dr. Black\\nOil of cinnamon, 1 part\\nCarbolic acid, 2 parts\\nOil of wintergreen, 3\\nRepeated applications of tr. aconit. et iodin. are to be made to\\niiie gums.\\nA source of chronic apical pericementitis frequently not detected\\nuntil abscess has formed and discharged, it may be, at a distant point\\nis found in the death of a pulp from thrombus or jugulation. At some\\nperiod the tooth has received a blow, or, it may be, has been moved\\ntoo rapidly by a regulating appliance, or idiopathic pulpitis has occurred.\\nYears afterward, a chance examination may reveal a deeper color of\\nthe gum overlying the tooth than over the others by reflected light it\\nshows an opacity or discoloration of the body of the tooth. It may be\\nslightly sore to percussion, which elicits a dull sound. Dead pulp is\\ndiagnosticated the tooth is opened under extraordinary antiseptic pre-\\ncautions and cleansed freely with sodium dioxid the ideal material in\\nthis instance dried, and filled at least tentatively with salol.\\nAnother class of cases in which a similar condition of the pulp is\\nfound consists of those in which a pulp has died from repeated thermal\\nshock received through a metallic filling placed in too close proximity\\nto it. Although constructive action resulting in secondary deposits is\\nthe usual consequence of such irritation, profound degenerative changes\\nin the tissue of the pulp frequently occur at later periods. The treat-\\nment is the same as in the preceding case.\\nUnless the degree of antisepsis stated be employed in cleansing the\\ncanals of such cases, an annoying and it may be an obstinate perice-\\nmentitis is lighted up which is difficult to conquer.\\nA word of caution should be spoken in regard to the importance of\\nthe removal of inflammatory troubles, particularly the subacute forms,\\nwhich affect the apical pericementum. It is supposed and with good\\nreason that not only may tumor formations have their beginning in\\nchronic inflammations various reflex disturbances of sensation and of\\nspecial sense may be traced to such sources but any inflammation\\nhaving such an anatomical situation is a smouldering fire which may\\nunder certain systemic conditions become a pathological conflagration.", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0485.jp2"}, "486": {"fulltext": "", "height": "4564", "width": "2840", "jp2-path": "americantextboo00kirk_0486.jp2"}, "487": {"fulltext": "CHAPTER XVIII.\\nDENTO-ALVEOLAR ABSCESS.\\nBy Henry H. Burchard, M. D., D. D. S.\\nDefinition. In describing the septic inflammation affecting the\\ntissues of the apical region in the previous chapter, it was stated that a\\ncommon result of the inflammatory action was cellular necrosis and pus\\nformation this condition is known as alveolar abscess or dento-alveolar\\nAlthough alveolar abscess affecting some other portion of the peri-\\ncementum may and does occur without death of the pulp/ septic infec-\\ntion and bacterial invasion of the tissues of the periapical region from\\ninfected pulp canals is the most common source and cause of the affec-\\ntion. The term as technically applied refers to septic apical pericemen-\\ntitis.\\nCauses of Dento-alveolar Abscess.\\nThe exciting causes of the disease process will be found in the pyo-\\ngenic cocci and probably other pyogenic organisms which inhabit and\\ndevelop in the deepest portions of the putrescent pulp, finding entrance\\nto the periapical tissues through the apical foramen of the tooth. Dr.\\nSchreier of Vienna found diplococcus pneumoniae to be the excitant of\\ninflammation in seventeen out of twenty cases of dental periostitis\\nexamined by him. 2 The ptomains and other waste products formed as\\nthe result of the life processes of these organisms cause poisoning and\\ndebility of the cellular elements of the part. Even granting that the\\norganisms are present as the exciting cause, there is another factor\\ninvolved which determines to a great extent the occurrence, time of\\noccurrence, and severity of the disease, i. e. the predisposing causes\\nincluding under this head the condition of the tissues which favors or\\ndeters the development of the organisms.\\nPredisposing Causes. It is unquestionably true that different in-\\ndividuals will exhibit in their tissues marked differences in the degree\\n1 Cases reported in Proc. Academy of Stomatology of Philadelphia, 1895.\\n2 Oesterr.-ungarische Viertelj. fur Zahnheilk., April 1893.\\n479", "height": "4544", "width": "2776", "jp2-path": "americantextboo00kirk_0487.jp2"}, "488": {"fulltext": "480 DENTO-ALVEOLAR ABSCESS.\\nof resistance to the invasion of disease causes. It is a well-recognized\\naxiom of pathology that one of the most potent antiseptics, if not the\\nmost potent, is the inherent resistance of healthy protoplasm that is,\\nhealthy tissues offer a barrier to the development of the exciting causes\\nof disease, while tissues which are debilitated through any of the many\\ncauses that affect them exhibit a diminished resistance to the invasion\\nof the causes of acute disease.\\nProminent among the causes which favor the development and ex-\\ntension of pyogenic processes are the inherited conditions indefinitely\\nclassified as strumous. The tissues of children having a family history\\nof, for example, syphilis or tuberculosis, frequently exhibit evidences\\nof lack of vital resistance. They are attacked and readily succumb to\\nagencies which affect children of healthy parentage but slightly if at all.\\nInflammations about the teeth or of the soft tissues of the mouth run a\\nsevere course septic affections of the pericementum are attended by\\ninvolvement of neighboring lymphatics and by evidences of septic\\nintoxication. These predispositions may persist throughout the life of\\nthe individual as a rule, however, they grow less pronounced or less\\n-evident with age.\\nAcquired cachectic conditions of the adult also form a strong pre-\\ndisposition to invasion of the tissues by pathogenic organisms. It is a\\nmatter of frequent observation that tuberculosis and, in a more pro-\\nnounced degree, syphilis are constitutional conditions which markedly\\ndiminish the resistance of the tissues. Inflammatory disturbances\\nwhich in an individual free from cachexia would probably be circum-\\nscribed, when they occur in the cachectic are diffuse and virulent.\\nLocal predisposing causes consist of faulty hygiene, producing debility\\nof the tissues, for it is noted that abscess is more likely to run a virulent\\ncourse in unclean mouths than in those kept free from fermenting and\\nputrefying masses this is a general, though not a universal truth.\\nPathology and Morbid Anatomy.\\nThe pathology of septic pericementitis has been described in Chapter\\nXVII. That of alveolar abscess begins as soon as there is death of\\ncellular elements in the exudation. The exudation is liquefied in the\\nfocus of the inflammation by the action of ferments the leucocytes are\\ninvaded by and strive to devour the pyogenic cocci which are present\\nthe species of warfare described by Metchnikofif; the leucocytes\\nsuccumb, die, and form pus corpuscles, which are found to contain the\\npyogenic cocci. The cellular exudate is then broken down into a\\ngranular detritus, which, with the dead corpuscles and peptonized effu-\\nsion, constitutes pus.\\nThe diplococcus of pneumonia is said to be a constant attendant", "height": "4608", "width": "2800", "jp2-path": "americantextboo00kirk_0488.jp2"}, "489": {"fulltext": "PATHOLOGY AND MORBID ANATOMY. 481\\non alveolar abscess, and this particular organism is believed by\\nSchreier to be the usual excitant of the inflammatory action in these\\ncases.\\nThe primary seat of the abscess is usually in the pericementum,\\nbetween its attachment to the cementum and its attachment to the\\nalveolus. From the central cavity of softening the necrotic process\\nspreads peripherally cell by cell the inflammatory wall forming the\\noutlines of the abscess and the exudates are liquefied and the cavity\\ngrows larger. The cancellated bone about the apex of the root is in-\\nvolved and becomes the seat of osteomyelitis and molecular necrosis.\\nLarger and larger grows the volume of the abscess until the periosteum\\ncovering the alveolar process is involved, softened, and raised from the\\nbone. The inflammatory action precedes the advance of the pus along\\nthe line of least resistance and if it run high the periosteum may be\\nsoftened over quite an extensive area and raised from the bone by the\\nexudation beneath it. The pus penetrating the periosteum, the soft tis-\\nsues are involved and softened, when the pus breaks through the mu-\\ncous membrane, discharging usually by the shortest route from the\\nabscess to the exterior. The progress of septic destruction is along the\\nline of least resistance, and although as a rule this points upon the ex-\\nternal surface of the gum immediately above the apex of the affected\\nroot, it may follow other directions. In some cases the pus finds exit\\nthrough the pulp canal of the affected tooth, forming what is commonly\\nthough incorrectly known as blind abscess. This form of abscess dif-\\nfers from that with external fistula as a result of its mode of formation\\nrather than because of any essential difference in its pathology. The\\nhistory of an acute inflammatory stage is usually absent or it has caused\\nbut slight disturbance. Invasion of the apical pericementum by bac-\\nteria has been slow and superficial and the inflammatory reaction\\nrestricted to the tissue immediately surrounding the apical foramen\\nthe necrotic process has been ulcerative in character, molecular death\\nof the membrane taking place slowly until the tissue about the foramen\\nis lost and the denuded apex projects into a necrotic cavity which allows\\nof drainage of its contents through the foramen and root canal. In\\nthese cases the abscess cavity is usually comparatively small, and the\\ninflammatory action is less severe than when the pus has a longer path\\nof exit (see Fig. 461).\\nThe pus may exhibit evidences of semi-encystment. Collections\\nmay apparently remain in the tissues of the gum for long periods with-\\nout fistula. A case in practice presented conditions similar to that\\nexhibited in the illustration (Fig. 462) it had existed for several years\\nabout a replanted tooth, and responded promptly to treatment.\\nIn other cases the line of tissue destruction and pus escape is along\\n31", "height": "4564", "width": "2760", "jp2-path": "americantextboo00kirk_0489.jp2"}, "490": {"fulltext": "482\\nDENTO-ALVEOLAR ABSCESS.\\nthe pericementum, the pus discharging at the neck of the affected tooth.\\nMany of these cases occur\\nin connection with pulpless\\nteeth which have elongated,\\nor those in which there has\\nalready been loss of peri-\\ncementum.\\nAbscesses upon the upper\\ncentral or lateral incisors may\\nFig. 461.\\nBlind abscess at the root of an upper\\nincisor (Black) a, abscess cavity\\nin bone; b, drill hole exposing the\\npulp chamber for treatment.\\nAcute alveolar abscess of a lower incisor with pus cav-\\nity between the bone and. the periosteum (Black)\\na, pus cavity in the bone b, pus between the peri-\\nosteum and bone c, lip d, tooth e, tongue.\\nperforate the nasal floor (see Fig. 463). After a period of marked perice-\\nFig. 464.\\nAlveolar abscess at the root of\\na superior incisor discharging\\ninto the nose (Black) a, large\\nabscess cavity in the bone b,\\nmouth of fistula on the floor of\\nnostril c, lip d, tooth.\\nAlveolar abscess at the root of an upper\\nmolar discharging into the antrum of\\nHighmore (Black): a, abscess cavity in\\nthe bone; b, mouth of fistula on the\\nfloor of the antrum c, pus in the antral\\ncavity.\\nmental disturbance, the inflammatory action running high, causing pain\\nand swelling of the nostril of the same side, the symptoms may suddenly", "height": "4612", "width": "2796", "jp2-path": "americantextboo00kirk_0490.jp2"}, "491": {"fulltext": "PATHOLOGY AND MORBID ANATOMY.\\n483\\nabate without any evident signs of pus having been discharged. Soon\\nafter a purulent discharge may be noted from the nostril, leading to the\\nbelief that purulent nasal catarrh (ozena) is present many of these cases\\nare diagnosed and treated as ozena. In injection of the pulpless incisor,\\nparticularly with pyrozone, the pus and fluid are seen to emerge from the\\nnostril, exhibiting the true source of the pus. Abscesses upon upper\\nsecond bicuspids and molars may perforate the floor of the antrum\\n(Fig. 464).\\nIn the lower jaw the pus may pass out of the alveolar process and\\nFig. 465. Fig. 466.\\nChronic alveolar abscess at the root of a lower incisor\\nwith a fistula discharging on the face under the\\nchin (Black) o, abscess cavity in the bone 6, b, b,\\nfistula following in the periosteum down to the\\nlower margin of the body of the bone and dis-\\ncharging on the skin.\\nChronic alveolar abscess of the root of\\na lower incisor with abscess cavity\\npassing through the body of the bone\\nand discharging on the skin beneath\\nthe chin (Black) a, very large ab-\\nscess cavity b, mouth of the fistula.\\nfail to perforate the overlying soft tissues, pursuing a path which may\\nlead to its exit upon the face beneath the jaw or chin (Fig. 465). In\\nothers the pus may burrow through the body of the bone and open\\nupon the face. (See Figs. 466, 467.)\\nIn a case of persistent fistula opening upon the side of the face over\\nthe body of the lower maxilla, there was no evidence of inflammatory\\ndisturbance in the edentulous gum. An exploratory incision, made at\\na point indicated by a probe passed into the sinus, revealed the presence\\nof a small root-fragment. Healing of the fistula was spontaneous upon\\nits removal. Prof. M. H. Oyer 1 records a case of abscess opening\\n1 Proc. Academy of Stomatology, 1896.", "height": "4568", "width": "2760", "jp2-path": "americantextboo00kirk_0491.jp2"}, "492": {"fulltext": "484\\nDENTO-ALVEOLAR ABSCESS.\\nover the body of the lower maxilla immediately anterior to the groove\\nfor the facial artery (Fig. 468). A flexible probe passed into the fistula\\nFig. 467.\\nFig. 468.\\nFistula passing down through the body of the\\nlower maxilla (Black).\\nAbscess with tortuous sinus opening upmi\\nthe face: A, tissue of cheek; B, floor\\nof mouth C, abscess tract.\\nappeared to enter the submaxillary triangle in the absence of evident\\ndental cause, the case had been diagnosticated and treated as abscess of\\nthe submaxillary gland. The direction taken by the probe gave no\\nindication of a tooth being involved. The usual therapeutic measures\\napplied to a submaxillary abscess proving unavailing, a serial examina-\\ntion, one of many, of the teeth of that side was made. In one tooth, the\\nsecond molar, was a large amalgam filling. The pulp responded, though\\nfeebly, to the usual tests for vitality upon entrance to the tooth the\\nanterior portion of the pulp was found partially vital, the posterior\\nportion dead and decomposing. The pulp was removed antiseptics\\nwere pumped through the posterior root, found exit at the fistula, and\\nthe causal relation of the putrescent pulp and the abscess was shown\\nby a prompt disappearance of the disease.\\nIn one case of abscess upon a lower third molar, the pus made en-\\ntrance into the tissues about the insertion of the internal pterygoid\\nmuscle. Cases have been recorded in which the pus from abscess about\\na lower molar has burrowed through the bone and, caught beneath the\\nplatysma myoides muscle, it has passed down the muscle, discharging\\nfrom an opening upon the neck or upon the shoulder.\\nAbscess upon an upper molar may find exit upon the face beneath the\\nmalar bone. Occasionally the duct of Steno may be involved in the\\nabscess tract and salivary fistula result. Dr. Black states 1 that the\\ncases of abscess opening beneath the malar bone are usually of the acute\\nvariety. As a rule, however, cases which exhibit the pus exit at a dis-\\ntance from the seat of abscess are of the chronic variety.\\nThe acute and chronic cases differ as to their clinical histories.\\n1 American System of Dentistry, vol. i. p. 940.", "height": "4612", "width": "2800", "jp2-path": "americantextboo00kirk_0492.jp2"}, "493": {"fulltext": "CLINICAL HISTORY OF ACUTE ALVEOLAR ABSCESS. 485\\nClinical History of Acute Alveolar Abscess.\\nCases of apical pericementitis in which suppuration occurs usually\\npresent pronounced evidences of severe inflammatory action. The\\nthrobbing and tenderness, swelling and vascular engorgement are\\nmarked there may be, and usually is, more or less febrile disturb-\\nance with its attendant symptoms a full, bounding pulse, more or less\\noedema of the surrounding parts, the eye of the affected side may be\\ninjected, etc., as described in Chapter XVII. under the head of Acute\\nPericementitis. In from twenty-four to forty-eight hours a spot of\\nfluctuation makes its appearance at the summit of the swelling, the spot\\nbecomes yellow and soon opens, affording escape to the abscess contents.\\nAs soon as the pus has discharged the inflammatory symptoms subside\\npromptly and a persistent fistula remains, communicating with the\\nabscess cavity. This comparatively benign course and termination is\\nnot universal. It is not at all uncommon to find cases which at the\\nheight of the inflammatory disturbance exhibit evidences of septic\\nintoxication. The septic substances formed by the micro-organisms,\\nand in other cases the organisms themselves, gain entrance to the lymph\\nchannels and are conveyed to the nearest lymphatic glands, producing\\nevidences of inflammation in them swelling and pain of these glands\\nare very common. Cases are recorded in which streptococci appear to\\nhave invaded the subcutaneous tissue, giving rise to marked phleg-\\nmonous inflammation. Dental literature contains the records of many\\ncases indicating the occurrence of a pyemic condition consequent upon\\nalveolar abscess organisms, by gaining entrance to the blood channels,\\nforming septic emboli.\\nThe mild and less severe cases run the average course described.\\nMany of them by finding early exit of the pus through the pulp canal\\nof the affected root have comparatively light inflammatory disturbance\\nin those cases in which the evacuation of the pus is delayed, or in\\nwhich the opening occurs at points distant from the disease focus, the\\ninflammatory action may be severe and prolonged. If the pus point\\ntoward the face, the skin, the subcutaneous tissues, and it may be the in-\\nternal periosteum also exhibit evidences of marked inflammation there\\nis much swelling, the skin may become (Edematous, there is redness,\\nheat, and throbbing pain. The external application of poultices by the\\npatient, not at all an uncommon mode of domestic treatment, may\\naggravate the symptoms, soften the tissues, and induce the progress of\\nthe pus to the exterior.\\nIf in any of the cases which point in the mouth an undue swelling is\\nformed at the height of prolonged inflammatory action, pus beneath the\\nperiosteum is to be feared, the pus stripping the softened membrane", "height": "4568", "width": "2760", "jp2-path": "americantextboo00kirk_0493.jp2"}, "494": {"fulltext": "486 DENTO- ALVEOLAR ABSCESS.\\nfrom the bone over a certain area. Should these cases not obtain quick\\nrelief by evacuation of the pus, necrosis of the denuded bone may occur\\n(Fig. 469). Keattachment of the periosteum may take place even after\\nextensive separation, provided the pus be evacuated early.\\nFig. 469.\\nNecrosis of the buccal plate of the alveolar process from alveolar abscess (Black).\\nCachectic conditions exert a strong modifying influence upon the\\ncourse and termination of alveolar abscess. In strumous or debilitated\\npersons the disease tends to invade neighboring structures, whose resist-\\nance is lessened. This is well illustrated by a case of obstinate maxil-\\nlary caries which destroyed the entire process of one side, the begin-\\nning of the disease being apical pericementitis of a lower bicuspid.\\nThe carious process became chronic soon after the extraction of the\\noifending tooth, and persisted until the death of the patient from\\ntuberculosis.\\nAlveolar abscess occurring in syphilitic patients is prone to involve\\nthe deep structures, and more or less necrosis is not an uncommon\\nsequel.\\nClinical History of Chronic Alveolar Abscess.\\nAfter the subsidence of the symptoms attendant upon the formation\\nand discharge of acute abscess, there is rarely a spontaneous healing or\\nfilling of the abscess cavity and tract with healthy granulation tissue\\nthe development of organisms in the abscess cavity and pulp canal con-\\ntinues and produces a continuance of the suppurative process, forming a\\nchronic abscess.\\nIn other cases abscess may have developed without marked inflam-\\nmatory symptoms, and yet a prolonged and obstinate pus formation\\noccurs in the tissues of the apical region, the pus finding exit through\\nthe pulp canal, constituting what is known as blind abscess, one of the\\nmost common of the chronic types.\\nMany of the cases which open upon the face are of the chronic\\nvariety during the development of the abscess and its discharge there", "height": "4608", "width": "2796", "jp2-path": "americantextboo00kirk_0494.jp2"}, "495": {"fulltext": "DIAGNOSIS AND PRO GNOSIS. 487\\nmay be but little evidence of inflammatory action about the affected\\ntooth. This is a common history of cases which have followed the\\ndeath of a pulp through trauma, years before the discovery of the ab-\\nscess. At some period a tooth receives a severe blow, and for some\\ntime is the seat of traumatic pericementitis, which subsides it may be\\nyears after that a fistula is established in the mouth or upon the face,\\nwithout a history of inflammatory disturbance.\\nAs pointed out by Dr. Black, the direction of pus-burrowing in\\nchronic abscess is determined by gravity thus, if the abscess be upon\\na lower incisor the pus may burrow, opening beneath the chin, as shown\\nin Figs. 467, 468.\\nSir John Tomes l has called attention to the tendency of pus to open\\nat the angle of the jaw in abscesses affecting the lower third molars (see\\ncases noted above).\\nDiagnosis and Prognosis.\\nDiagnosis. If the pericementum of a pulpless and open tooth have\\nbeen the seat of acute and marked apical inflammation of septic origin\\nfor a longer period than thirty-six hours pus is almost invariably\\nformed, and alveolar abscess is present. The diagnostic symptoms are\\nthose of acute pericementitis described in Chapter XVII. In case any\\nmarked inflammatory disturbance is found about the maxillary region\\neither within or without the mouth, examination of the teeth of the\\naffected side should always be made, as a large percentage of such in-\\nflammations are of dental origin. Any fistula existing in the maxillary\\nregions, either within or without the mouth, is to be suspected as having\\norigin in a septic pericementitis of some tooth.\\nA soft silver probe is to be passed along the tract to determine its\\ndirection and, if possible, which tooth is affected. As a rule, such a\\ntooth will itself exhibit objective evidences of abscess and the patient\\nwill give a history of subjective symptoms those of inflammation of\\npericementum.\\nShould the tooth indicated as the affected one be free from caries,\\nthe thermal test is to be applied to indicate the vitality or the necrosis\\nof the pulp. Should the tooth not respond to applications of a pointed\\npiece of ice, it is possible it may offer slight response to applications of\\nheat. It is next examined by light reflected from the ordinary, or\\nbetter, the electric mouth mirror, when, if the pulp be dead, opacity of\\nthe crown will be detected.\\nAn abscess upon an upper incisor opening upon the nasal floor may\\ncause a discharge simulating that of ozena an examination of the nose\\nwill reveal a teat-like elevation upon the mucous membrane covering\\n1 Dental Surgery.", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0495.jp2"}, "496": {"fulltext": "488 DENTO-ALVEOLAR ABSCESS.\\nthe nasal floor and an incisor beneath will be found carious and having\\na putrescent pulp, or, if non-carious, a history of traumatic pericemen-\\ntitis and a present opacity.\\nIt may be mentioned here in connection with death of the pulp from\\ntraumatism, that continued thread-biting, biting very hard substances\\nsuch as pieces of ice, nuts, etc., may cause death of the organ, presum-\\nably by thrombosis.\\nIt is possible that the direction taken by the probe which is passed\\ninto the fistula will point away from the teeth present, passing into a\\nspace from which a tooth has been extracted. In that event the pres-\\nence of a root fragment, or piece of necrosed process, may be suspected. 1\\nShould the neighboring teeth be excluded as causes of an inflammation,\\nthere should be no hesitation in making an exploratory incision down\\nto the end of the probe which has been passed into the fistula. Cases\\nof dentigerous cysts have been detected in this manner. This condition\\nwould, however, be suspected when there was an absence of a tooth or\\nteeth from the arch, no evidence past or present of pericementitis in\\nany of the teeth of the arch, and a cystic tumor present in the jaw, or it\\nmay be a fistula discharging upon the face after a history of maxillary\\nperiostitis.\\nCaries or necrosis, although in many cases the result of septic apical\\npericementitis, may yet exhibit fistulse opening into the mouth, without\\nevident connection with the teeth. As a rule, cases of necrosis exhibit\\nmarked and wide evidences of chronic inflammation of the tissues over-\\nlying the dead or dying bone there are usually several fistulse dis-\\ncharging from it.\\nCaries may have but a single fistula and simulate closely ordinary\\nalveolar abscess. Diagnosis is made by passing an excavator through\\nthe fistula. Dead bone is readily detected by touch, it has a rotten feel\\nin caries the instrument may be passed through the dead bone in various\\ndirections, and a characteristic dead sound is elicited by tapping upon it.\\nCareful examination of the teeth must be made in all of these cases, to\\ndetermine the condition of the pulp and pulp canals.\\nIn passing an instrument through a fistula to the apex of an ab-\\nscessed root, where the disease action has been of long duration, it may\\nbe found that the apex of the root is denuded of pericementum, and\\nroughened that is, the apical cementum is necrotic foreign deposits\\nmay be detected occupying portions of the necrotic area.\\nPrognosis. There are several factors which enter into the prognosis\\nof a tooth and its surroundings which are affected by alveolar abscess.\\nFirst, the severity and character of the inflammatory action and septic\\ninvasion. In cases in which inflammatory action is localized and pre-\\n1 See case Dr. Black, American System of Dentistry, vol. i.", "height": "4608", "width": "2796", "jp2-path": "americantextboo00kirk_0496.jp2"}, "497": {"fulltext": "TREATMENT. 489\\nsenting none or but little febrile disturbance the prognosis is, as a rule,\\nfavorable but a slight amount of tissue necrosis occurs. Should, on the\\nother hand, the inflammatory action proceed with volcanic violence, it\\nis possible that not only may the pericementum suffer extensively, but a\\nconsiderable portion of the periosteum over the process may be raised\\nfrom the bone during the escape of the pus. Should this separation of\\nperiosteum be maintained for more than a few hours, the underlying\\nbone may suffer to the extent of necrosis. In case of marked lymphatic\\ninvolvement, the neighboring glands being swollen and tender, or even\\nthe skin over them exhibiting evidences of glandular inflammation\\nbeneath, more or less septic intoxication will probably occur, and un-\\nless the focus of infection be promptly sterilized, septicemia is to be\\nfeared.\\nShould evidences of diffuse cellulitis occur, indicating the invasion\\nof streptococci into the adjacent soft tissues, it is a danger signal of\\nthreatening pyemia. 1 Heath 2 records a case of oedema of the glottis due\\nto the involvement of the connective tissues about the glottis in the\\noedema accompanying a developing abscess upon a lower molar.\\nThe prognosis is good in a vast majority percentage of cases, when\\nthe offending tooth is extracted early in the attack, or at its height\\nthis applies even with apparently very grave cases still the prognosis\\nas to the retention of the affected tooth is also very good, unless the\\nabscess run a phagedenic course. In many of the cases of chronic\\nabscess having a distant discharge the abscess may be cured and the\\ntooth retained. Other cases obstinately refuse to heal so long as the\\noffending tooth is present.\\nTreatment.\\nTreatment of Acute Abscess. The general principles of treat-\\nment of alveolar abscess are those for the treatment of abscess in any\\npart the details are of course modified in accordance with the anatom-\\nical peculiarities of the part to be acted upon. These principles are\\nthe removal of all dead matter, together with the active causes of the\\ninflammation and suppuration, i. e. micro-organisms and their products,\\nand the induction of a tissue regeneration which shall serve to restore\\nparts lost through the formation of the abscess. The therapeutic means\\napplied are instrumental and medicinal. The instrumental are the\\ninstruments employed to gain access to the focus of disease action, and\\nthose applied in the mechanical removal of dead parts. The medicinal\\nmeasures include the agents employed to wash out the abscess tract\\nsecond, those applied to destroy the active causes of the suppuration\\n1 See case Dr. E. C. Kirk, Proc. Odontological Society of Pennsylvania, 1892.\\n2 Injuries and Diseases of the Jaws, 3d ed.", "height": "4568", "width": "2752", "jp2-path": "americantextboo00kirk_0497.jp2"}, "498": {"fulltext": "490 DENTO-ALVEOLAR ABSCESS.\\nthird, the remedies applied to induce new tissue growth and next, those\\nemployed to maintain asepsis until the healing process is complete.\\nThe great primary objects in the management of acute alveolar\\nabscess are four First, if the case be seen early, to use every endeavor\\nto abort the inflammation, as described in Chapter XVII. Second,\\nto limit as far as possible the extent of pus formation, hence tissue\\ndestruction third, the earliest possible evacuation of the pus which has\\nformed fourth, the thorough sterilization of the abscess cavity and its\\nwalls.\\nCases when seen may be at any stage of the disease process from an\\nincipient pericementitis to the establishment of a fistula. The treatment\\nof the early cases is that of pericementitis. In all of these cases one fact\\nis never to be forgotten that the pulp canals are the centres of infec-\\ntion, and the more quickly and thoroughly they are drenched with\\npowerful antiseptics the more limited will be the inflammatory action\\nboth in degree and extent, and the more limited will be the pus forma-\\ntion. Attempts are therefore made to enter and sterilize cavities pari\\npassu with the antiphlogistic measures applied to abort or limit inflam-\\nmatory action.\\nTreatment of Abscess without Fistula. Abscess has been de-\\nscribed by the older surgical pathologists as the process through which\\nNature rids herself of an irritant. This is in a measure true, but it is\\nessentially a destructive and not a conservative process. Nature does\\nrid herself of the irritant through suppuration but it is done at the\\nexpense of tissue loss, and the wise surgeon endeavors to remove the\\nirritant and limit the destruction. After the inflammatory action has\\npersisted at its height for twenty-four hours, pus is probably present\\nin the tissues of the apical region if immediate exit be given to the pus\\nthe inflammatory symptoms w T ill subside. If the tooth be not so sensi-\\ntive as to preclude touch upon it, an endeavor is made, after washing\\nthe pulp chamber with powerful antiseptics, to pass a very fine Donald-\\nson^ bristle through the apical foramen. In many cases this may be\\ndone the pus escaping through the canal, the inflammatory symptoms\\nbegin to subside. This is a case of acute blind abscess its treatment\\nwill be first discussed.\\nThe conditions existing are more or less remnants of pulp tissue\\nundergoing putrefactive decomposition the contents of the dentinal\\ntubules are also in process of dissolution. Beyond the apical foramen\\nis a fibrous tissue containing bloodvessels and nerves, in the meshes of\\nwhich tissue pus is forming. Beyond the spots of suppuration, the\\ntissues, which are in small part fibrous but are mainly osseous, are the\\nseat of inflammation.\\nThe pus evacuated, the parts tend to spontaneous recovery provided", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0498.jp2"}, "499": {"fulltext": "TREATMENT. 491\\nthe sources of irritation be removed. The first step in sterilization is\\nthe destruction of putrescent matter in the pulp canals. If the tooth\\nbe sore after evacuation of the pus through the apical foramen, the\\npatient is directed to use repeatedly an antiseptic mouth-wash, 3 per\\ncent, pyrozone or any of the solutions of hydrogen dioxid, and report\\nin a few hours, when the broach is again passed through the apex of\\nthe root, the canal syringed out with hydrogen dioxid and dismissed for\\ntwenty-four hours, when the inflammatory symptoms will have so far\\nsubsided as to permit working upon the tooth. At this sitting, a slight\\nflow of pus will still be found the canals are syringed, rubber dam\\napplied, but never with a clamp on the. affected tooth. Sodium di-\\noxid either dry or in 50 per cent, solution is placed in the canals, and\\nfrequent re-applications made. At the expiration of about a half-hour\\nthe canals and abscess cavity are syringed out with an acid solution of\\nhydrogen dioxid, and dried. The canals will now be sterilized and also\\nthe general abscess cavity. It is possible, however, and probable, that\\norganisms may still occupy the deeper recesses of the tissue bounding\\nthe abscess cavity. The parts forming the abscess wall are of com-\\nparatively low vitality and may not dispose of organisms present as\\nwould be done in more vascular tissues. It is the usual practice, there-\\nfore, to apply to them a powerful antiseptic campho-phenique, Dr.\\nBlack s 1, 2, 3 mixture, and lysol are all admirable agents in this par-\\nticular they are pumped into the abscess sac as well as possible, and\\nthe excess in the canals wiped away with wisps of cotton.\\nThere will be, immediately following this operation, a greater or\\nless amount of exudation from the abscess walls, which diminishes as\\ngranulation proceeds about the apex of the root. The condition is one\\nof granulating ulcer. An escape is provided for this exudation by\\nleaving the dried canals unfilled for twenty-four hours, when a loose\\ncotton dressing may be applied, hermetically sealing the cavity com-\\nmunicating with the saliva after each dressing. In two days the dress-\\ning is removed, always sterilizing the tooth walls and isolating it when\\nthe cavity is to be opened. On the third day a larger dressing of\\ncotton, dipped in campho-phenique and wrung out, may be applied.\\nAfter two days, should the cotton exhibit little or no evidence of exuda-\\ntion, a firmer dressing is applied, to remain about four days the next\\ndressing remains a week, when the abscess cavity should be filled with\\ntender granulations. Pending the organization of the granulation tissue\\nthere is probably no better canal filling than salol having a core of\\ngutta-percha. It is unirritating and may be applied without causing\\nirritation. Dilute solutions of formaldehyd have been found to be\\nextremely useful in this class of cases as well as in all cases involving\\nsterilization of the pulp canal. The high antiseptic value of formalde-", "height": "4560", "width": "2788", "jp2-path": "americantextboo00kirk_0499.jp2"}, "500": {"fulltext": "492 DENTO-ALVEOLAR ABSCESS.\\nhyd and its great penetrating power place it among the most satisfactory\\nagents in the dental pharmacopoeia. For the treatment of root canals\\nwith apical pericementitis a wisp of cotton moistened with a 5 per\\ncent, solution of formalin (the 40 per cent, solution of the gas in\\nwater) and sealed in the canal will in a few hours completely sterilize it,\\nso that usually the canal may be permanently closed within twenty-four\\nhours. Rarely, a second dressing is required. Stronger solutions of\\nformalin are irritating and should be avoided, as they may cause\\nnecrosis if used beyond the strength stated, or even in that strength\\nif used in too large quantity or too frequently.\\nShould the effort to enter the apical region through the canal fail, and\\npus be present, an entrance should be effected through the gum. At a\\npoint on the gum immediately overlying the apex of the affected root,\\na pointed bistoury is quickly thrust down to the bone, the bleeding is\\nencouraged by the use of hot water for several minutes, when a pellet\\nof cotton which has been dipped into 95 per cent, carbolic acid is laid\\nagainst the periosteum at the bottom of the cut. In a few seconds a\\nspear drill driven by the engine is passed through the bone into the\\ntissues of the apical region. Any bleeding which may occur is encour-\\naged as above mentioned. For washing the incisions and the abscess\\nin such cases there is no agent more acceptable than a 20 per cent, solu-\\ntion of phenol sodique, it being both sedative and antiseptic. A thread\\nof floss silk dipped in carbolic acid is passed into the fistula to the seat\\nof abscess, its projecting edge lying upon the gum this will prevent too\\nrapid a healing of the fistula. The case now resembles an abscess with\\na fistulous opening, the next variety of acute alveolar abscess the treat-\\nment for both is the same.\\nTreatment of Abscess \u00e2\u0080\u00a2with Fistula. Cases of acute alveolar\\nabscess discharging through a fistulous opening are either seen when\\nthe pus has perforated the bone and is making its exit through the soft\\ntissues, or in cases where the inflammatory symptoms run high, the\\nusual methods of aborting the inflammation having failed, pus forms\\nand the abscess discharges rapidly, it may be within thirty-six hours,\\nThe use of pepper plasters and like devices to induce pointing of an\\nabscess are irrational they render no service which cannot be per-\\nformed better and more expeditiously by an incision made down to\\nthe bone by means of a sharp bistoury. In all cases of acute apical\\npericementitis where the swelling of the gum is marked, an early and\\ndeep incision is useful and advisable. If pus be already formed and\\nthe abscess pointing, escape is afforded it if the pus have not yet per-\\nforated the periosteum that structure receives early relief from a condi-\\ntion which might threaten it. The greater the swelling the more\\nimperative is the necessity for this incision, which must be freely made.", "height": "4604", "width": "2832", "jp2-path": "americantextboo00kirk_0500.jp2"}, "501": {"fulltext": "TREATMENT.\\n493\\nFig. 470.\\nA sharp curved bistoury is held as a pen, its point directed always\\ntoward the bone, and is passed boldly down to the bone immediately\\nover the apex of the root.\\nInflammatory symptoms, as a rule, subside promptly as soon as exit\\nis afforded the pus. As soon as the tooth may be operated upon, its\\ncanals are to be treated as virulently and deeply infected centres, opened\\nfreely and sterilized with the utmost thoroughness. The usual and\\nsatisfactory method of accomplishing this is by means of a 50 per cent,\\nsolution of sodium dioxid after which a stout syringe filled with 3\\nper cent, pyrozone is to have its contents driven forcibly through the\\nabscess tract, the application to be repeated until the peroxid comes\\naway clear. A few drops of campho-phenique or Dr. Black s 1, 2, 3\\nmixture are placed in the pulp canal by means of Flagg s dressing\\npliers. This may be drawn into the abscess sac along\\nits tract, emerging at the fistulous opening, by a little\\ndevice of Dr. T. M. Hunter. 1 One of the rubber cups\\nused for finishing fillings and cleaning teeth is to have\\nits tool opening filled with gutta-percha, the concavity\\nof the cup moistened and pressed flat against the gum,\\ncovering the fistula removing the pressure from the\\ncentre of the cup but keeping its edges closely in con-\\ntact with the gum, a suction is created drawing the\\nmedicament through the abscess tract. The writer has\\nused these cups, but mounted on a No. 300 mandrel\\n(Fig. 470), for this purpose for several years indeed\\nthe discovery that Dr. Hunter had employed and ad-\\nvised it as a means of emptying abscess cavities was a\\ngratifying surprise, as he states that they serve this\\npurpose admirably.\\nThe sterilized canals are now to be thoroughly filled with cotton twists\\nor gilling twine which has been moistened with the last-named antisep-\\ntic, or 5 per cent, formalin, the crown cavity sealed, and the case dis-\\nmissed. In twenty-four hours, only a slight serous exudate should be\\npressed from the fistula. In a week the abscess cavity should be\\nhealed. In that time a permanent canal filling may be inserted, but it\\nis wiser to defer the filling of the crown cavity for some time that is,\\nif it is to be filled with cohesive gold.\\nIn case of acute abscess w T here marked inflammatory symptoms with\\ninvolvement of neighboring parts persists after the evacuation of the\\npus, the gum overlying the tooth being purplish and tumid, the tooth\\nvery loose, and no diminution of the attendant fever, neighboring\\nstructures in addition to the tooth are in danger, and the latter should\\n1 Dental Cosmos, vol. xxxiv. p. 82.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0501.jp2"}, "502": {"fulltext": "494 DENTO-ALVEOLAR ABSCESS.\\nbe extracted. An early and free incision will frequently avert this con-\\ndition and necessity for extraction.\\nShould the case when first seen exhibit marked evidences of involve-\\nment of the tissues of the face, a threatening of the abscess toward\\npointing on the face, prompt and active measures are necessary. As a\\nrule in these cases the pernicious domestic practice of applying poultices\\nto the face has been followed, and in consequence the tissues of the\\ncheek are distended and softened, lessening the suffering but inducing\\nthe flow of pus along the line of softening. Compresses wet with lead-\\nwater and laudanum\\nIfy. Plumbi subacet., 3J\\nTr. opii, 3j\\nAqua?, Oj.\u00e2\u0080\u0094 M.\\nshould be laid upon the face, and an incision made at the line of junc-\\ntion of the cheek with the gum, down to the bone over the apex of\\nthe root. As a rule, in these cases the pus has found its way into the\\ntissues of the cheek, but drains through the incision a cut must always\\nbe made away from, not toward the cheek, to avoid cutting the facial\\nartery or any of its branches. Opening upon the face may be averted\\nby this means, even when the pus is beneath the skin. The danger of\\ninclusion of the duct of Steno should be borne in mind should the case\\nbe one of abscess upon an upper molar, and energetic measures pursued\\nto prevent the establishment of that annoying trouble, salivary fistula.\\nWhen fluctuation of the inflammatory tumor upon the face becomes\\nevident, indicating that an external opening must be made, it is prefer-\\nable that it be made with a sharp knife and not by suppuration. Scars\\nleft by abscesses discharging spontaneously are irregular and disfiguring,\\nthose following clean incision are but a line. A curved bistoury is used\\nto transfix the summit of the swelling, the knife is then carried outward,\\nmaking an incision about an inch long. In this as in all cases of abscess\\nwhere pus is detected the indication is to give it immediate exit.\\nIt occasionally occurs that abscess may be found upon the lateral\\naspect of a tooth containing a vital pulp. The tooth is free from\\ncaries, and is perfectly translucent. The most usual situations of these\\nabscesses are upon the labial faces of the anterior teeth and the buccal\\nfaces of the molars, between the gingival margin, which may be intact,\\nand the apex of the root. As a rule the evacuation of the pus and\\ndressing with antiseptics causes a speedy disappearance of the abscess.\\nLeft to themselves they discharge as a rule at the gum margin. They\\nare a frequent associate of the condition graphically described by Dr.\\nG. Y. Black as phagedenic pericementitis. Believers in the gouty\\norigin of this disorder note their occurrence in gouty patients. 1 In\\n1 Typical cases are recorded in Proe. Academy of Stomatology of Philadelphia, 1895.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0502.jp2"}, "503": {"fulltext": "TREATMENT. 495\\nthese cases the abscess is attended by more or less destruction of the\\npericementum. Cases may be seen in which the abscess involves the\\ntissues near the apex of the root, the pulp being vital its death, how-\\never, will doubtless result from the invasion.\\nAcute apical abscess may discharge at the margin of the gum, follow-\\ning the pericementum. These cases are to be treated as abscess with\\nfistula. In some cases subsequent to the treatment of the abscess there\\nappears to be a restoration of the pericementum lost in the formation of\\nthe fistula. In others a permanent loss of tissue results. This mode\\nof discharge is common about dead roots which have been in the jaw\\ncrown less for a long period a resorption of alveolar process has\\noccurred and the root is retained by fibrous tissue. The treatment in\\nthese cases is that accorded any and all roots which may not be made\\nserviceable extraction\\nTreatment of Chronic Abscess. For purposes of treatment,\\nchronic abscesses are divided into two classes those discharging through\\nthe pulp canal, what are known as blind abscesses second, those dis-\\ncharging upon the gum, at the neck of the tooth or in fact at any point,\\nthrough a fistula.\\nThe usual condition existent with the blind abscess, is a cavity\\nwhich may have any volume, its diameters, however, rarely exceeding\\nthree-eighths of an inch this cavity is bounded upon all sides by a\\nfibrous capsule, analogous to the indurated surroundings of an ulcer the\\nwall represented by the cementum of the affected tooth may be devoid\\nof fibrous tissue, the pericementum being necrotic. The pulp chamber\\nis the centre of infection the abscess cavity is the habitat of bacteria,\\nwhich cause the peptonization of the inflammatory exudate from the\\nwall of circumvallation, and destroy the exudation corpuscles, thus\\nproducing a continued pus formation. The observation and statement\\nof Dr. Black have been quoted above, wherein he states that gravity\\nlargely determines the direction pursued by the pus in chronic abscess.\\nThis tendency will be found to exist with the blind variety also.\\nThe tendency of long-continued pus formation about the roots of the\\nupper teeth will be to progress along the pericementum, resulting in a\\nmolecular necrosis of that structure from the apex downward. The\\ncondition is represented in Fig. 471. The extent to which the apex of\\nthe root projects into a cavity increases with the progress of the necrotic\\nprocess.\\nIn the lower teeth, the influence of gravity carries the suppurative\\nprocess away from the apex of the root, the abscess cavity increasing\\ndownward (Fig. 472).\\nIf the case be seen shortly after the subsidence of the inflammatory\\nattack which may have ushered in the suppurative process, the cavity", "height": "4560", "width": "2744", "jp2-path": "americantextboo00kirk_0503.jp2"}, "504": {"fulltext": "496\\nDEN TO- A L VEOLA E A BSCESS.\\nmay be very limited in size, only a trifling amount of the pericementum\\nbeing destroyed.\\nIt is advisable in these cases, after thorough sterilization of the canals\\nand dentin by means of sodium dioxid or formalin, to increase the size of\\nthe natural drainage-tube, by enlarging the pulp canal a fine Donaldson\\nFig. 471.\\nFig. 472.\\nChronic blind abscess of upper incisor, showing Chronic blind abscess upon lower tooth,\\ntendency of pus to progressively destroy peri- showing tendency of pus to sink into\\ncementum owing to the influence of gravity. the substance of the lower maxilla\\nowing to the influence of gravity.\\ncleanser should pass freely through the apical foramen. The abscess\\ncavity is now forcibly and thoroughly syringed out with 3 per cent,\\npyrozone. It is advisable after effervescence ceases to mechanically\\nwithdraw, or aspirate, the contents of the abscess. This may be readily\\ndone by passing the point of a syringe into the canal, filling around it\\nwith gutta-percha and withdrawing the piston, when the contents of the\\nabscess will flow into the syringe. Any instrument (syringe) employed\\nfor this purpose should soak for hours in an antiseptic before using it\\nin other cases (a 20 per cent, solution of phenol sodique is an excellent\\nsterilizing agent) the same syringe should never be used for any other\\npurpose. A small amount of 25 per cent, pyrozone, ethereal, may now\\nbe placed in the canals and pumped into the abscess cavity then canals\\nand sac are dried by means of warm blasts, and a wisp of cotton dipped\\nin campho-phenique and wrung out is packed in the canal. The\\npatient reports the day following, and if no discomfort be felt the tooth\\nremains closed until the following day. If upon opening the tooth no\\nevidence of exudation is seen, and no effervescence occurs upon applica-\\ntion of 3 per cent, pyrozone, the drying and dressing are renewed, to\\nremain about three days. If any evidence of pus be detected, the canals\\nand abscess are syringed with weak pyrozone, and a small amount", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0504.jp2"}, "505": {"fulltext": "TREATMENT. 497\\nof campho-phenique, Dr. Black s 1, 2, 3 mixture, or myrtol may be\\npumped into the abscess, and by repeated blowing of warm blasts driven\\ninto all parts of the cavity. In twenty-four hours a slight serous flow\\nshould be observed, but if after three days any evidence of pus be de-\\ntected, it is the signal to establish an external fistula. This is done in\\nthe manner before described. The treatment is now the same as that\\nfor the next class chronic abscesses having fistulous opening.\\nChronic Abscess with Fistulous Opening-. In these cases the\\ncanals are opened and sterilized as in all others by the powerful anti-\\nseptics named. The abscess tract is syringed out with 3 per cent, pyro-\\nzone until bubbling at the external orifice ceases. The canals are filled\\nwith campho-phenique, or the 1, 2, 3 mixture, after the dressing-pliers\\nmethod, and drawn into and through the abscess cavity and tract by\\nmeans of the rubber-cup device already mentioned. In cases in which\\nthe rubber-cup device fails to cause a flow of the medicament from the\\npulp chamber out through the fistulous tract, the result may be attained\\nby filling the canals and pulp chamber with the fluid desired for\\nexample, campho-phenique or strong carbolic acid, and then placing\\nover the cavity a pellet of unvulcanized caoutchouc or warmed and soft-\\nened gutta-percha base plate and exerting strong pressure upon it with\\na ball-end burnisher just enough smaller than the cavity to force the\\nmaterial well into the pulp chamber. This will cause the medicine to\\nflow out at the fistulous opening, where in the case of carbolic acid its\\npresence will be manifested by its coagulating effect upon the margins\\nof the fistulous orifice.\\nThe canals are to be temporarily filled with cotton saturated with an\\nantiseptic, and as a. rule the case proceeds rapidly to recovery. Fresh\\ncleansing and dressing are indicated if all evidences of inflammatory\\naction, seen in the gum color, are not absent in three days in a week\\nthe external fistula should be closed.\\nIf after a week the fistula remain open, discharging\\nserum, a sterilized excavator is passed through the\\nfistula and it may detect denudation and roughness of\\nthe apical cementum. After a root has been the seat\\nof chronic apical abscess for a long period, not only\\nmay the apical pericementum be destroyed (Fig. 473),\\nbut the cementum itself may become saturated with\\nthe products of decomposition and invaded by septic Chroni(\\norganisms. It is not uncommon to find deposits of ing denudation of\\nj c, i apex of root (a to ft),\\ncalculi upon the denuded cementum. feucn an apex with deposits f cai-\\nis the source of constant irritation it is a foreign culus u P\u00c2\u00b0 n cemen-\\ni turn.\\nbody, and is to be removed.\\nThe operation of removal is technically known as amputation of the\\n32", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0505.jp2"}, "506": {"fulltext": "498 DENTO-ALVEOLAR ABSCESS.\\napex. The canal thoroughly sterilized is to be solidly filled with gutta-\\npercha. A vertical incision is made which includes the fistula and\\nexposes the process the opening through the process is enlarged, by\\nsweeping around its borders a large dentate bur. The incision, open-\\ning and abscess cavity are now packed with cotton saturated with phenol\\nsodique, until all bleeding ceases.\\nThe necrosed cementum is now exposed a small and extremely sharp\\nfissure bur, driven rapidly, is laid against the distal wall of the root and\\na constant pressure upon the bur maintained until the dead part is ampu-\\ntated. A sharp scaler may now be employed to round the edges of the\\nroot and make the cut surface smooth.\\nThe cavity is syringed with phenol sodique, to thoroughly remove\\nall blood-clots favorable breeding-grounds for organisms as a final\\nmeasure the walls are touched with campho-phenique, and the edges of\\nthe incision brought together, using if necessary a stitch to unite the\\nupper edges. In the abscess cavity iodoform or nosophen gauze is to\\nbe packed, and renewed in a couple of days. For a week the patient\\nis directed to employ repeatedly a mouth- wash of 3 per cent, pyrozone.\\nNo attempt should be made to fill such a tooth with cohesive foil for\\nseveral months.\\nIn some of the cases of anomalous root form, such as a sharp bend\\nupon the upper end of the root, and which renders it impossible to\\ngain access to the apex of the root even through the aid of sulfuric acid,\\nit may be necessary to treat the abscess through the fistulous opening.\\nThe roots are sterilized and cleansed to as great a depth as possible by\\nthe aid of sulfuric acid and fine cleansers, and the endeavor made to\\nforce hydrogen dioxid through the apical foramen and out of the fistula\\nby means of a syringe. The cavity of the crown is filled with pink\\ngutta-percha, and through it the nozzle of a syringe filled with 3 per\\ncent, pyrozone is thrust, well up the canal. The piston of the syringe\\nis forced down it may be the solution will appear at the opening of\\nthe fistula, or it may be the solution will fail to penetrate the fora-\\nmen and its backward pressure will force the gutta-percha from posi-\\ntion. In that event myrtol is placed in the canal, which is filled with\\nthread holding the same material. Three per cent, pyrozone is injected\\ninto the abscess cavity through the fistula, until effervescence ceases.\\nThe nozzle of a minim syringe (Fig. 441). charged with campho-\\nphenique or the 1, 2, 3 mixture is passed into the abscess sac, and a\\ncouple of drops deposited. In very many cases the abscess will then\\nproceed to recovery. The treatment should be repeated if necessary.\\nIf several dressings applied at intervals of a week do not cause a\\ndisappearance of pus formation, amputation of the offending portion\\nof the root will be necessary. An heroic method of treating chronic", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0506.jp2"}, "507": {"fulltext": "TREATMENT. 499\\nabscesses which obstinately refuse to heal is by extraction and replanta-\\ntion. The method applies alone to single-rooted teeth, although it has\\nbeen successfully performed upon molars.\\nThe patient s mouth is to be sterilized, and the tooth extracted. It\\nis immediately placed in a solution of 1 1000 mercuric chlorid at a\\ntemperature of 120\u00c2\u00b0 F. It has been repeatedly asserted, however, with-\\nout satisfactory demonstration, that the cells of the deeper layer of the\\npericementum and the cementoblasts, and also the cement corpuscles\\nretain their vitality for some period after extraction, and immediate\\nreplantation results in a re-establishment of the physiological union\\nbetween the tooth and alveolus. It is certain that means and measures\\nwhich are necessary to thoroughly sterilize the tooth before its reinser-\\ntion would be fatal to any cellular vitality which might exist in the\\ncement urn and its covering.\\nThe pulp caual is opened from its apex and cleaned out with canal\\ncleansers, and pyrozone 25 per cent, placed in the canal, where it is al-\\nlowed to remain for some time. In the meantime the socket from which\\nthe tooth has been removed is syringed out with pyrozone, and should\\nthe pericementum not be adherent to the tooth, the depth of the socket\\nis scraped by means of large spoon excavators to remove the tissues\\nimplicated in the abscess. The cavity is washed out with pyrozone,\\nand a pledget of cotton which has been dipped in campho-phenique is\\nplaced in the socket at its bottom. The tooth is dried by means of\\nwarm air the soft tissues, if any be present, at the apex are cut away\\nfor about one-eighth of an inch. The canal is filled with gutta-percha\\nor solidly filled with gold, the end of the root cut off as far as it has\\nbeen denuded of pericementum, smoothed, and returned to the antiseptic\\nsolution. The cotton is removed from the tooth socket, which is\\nsyringed out with 3 per cent, pyrozone, and the tooth returned to posi-\\ntion. It is tied to the adjoining teeth by means of silk ligatures or held\\nin place by an appropriate retaining appliance.\\nOccasionally the seat of an alveolar abscess may be at the bifurca-\\ntion of the roots of a molar. This may occur upon vital teeth owing\\nto a foreign body being driven beneath the margin of the gums and into\\nthe point of bifurcation. In these cases it is noted that the inflamma-\\ntion affects the gum about the neck of the tooth over the apices of the\\nroots there may be no evidences of inflammation pus forms and dis-\\ncharges quickly. Syringing out the tract with 3 per cent, pyrozone\\nusually frees it from pus and the offending substance it may be a\\nbristle of a toothbrush and the case heals rapidly.\\nCases are seen in which the gum attachment about the neck of the\\ntooth is unbroken and free access may be had to the apex of each\\nroot of a tooth manifestly suffering from acute pericementitis, pre-", "height": "4564", "width": "2744", "jp2-path": "americantextboo00kirk_0507.jp2"}, "508": {"fulltext": "500 DENTO-ALVEOLAB ABSCESS.\\nsumably due to a putrescent pulp. In a day or two a discharge of\\npus may be noted about the neck of the tooth. Such teeth when\\nextracted exhibit an unmistakable abscess sac in the pericementum at\\nthe bifurcation of the roots. Whether the pyogenic organisms have\\ntraversed the dentin in the bottom of the pulp chamber and the\\ncementum beneath, and thus inaugurated the suppurative process, is\\nundetermined it may be, however, that waste products from this\\nsource following the channel named may have saturated the cementum\\nwith noxious material and caused the inflammation, or the organisms may\\nhave found entrance at the gum margin. The diagnosis of such a con-\\ndition is most uncertain before pus finds exit at the gum margin. Such\\na case is to be treated by sodium dioxid, full strength, placed in the\\nfloor of the cavity, frequently washed away and renewed until the base\\nof the pulp chamber is bleached lokite. The abscess cavity is syringed\\nout with pyrozone.\\nAnother variety of abscess should receive mention that occurring\\nabout lower third molars, affecting the gum tissues partially enclosing\\nthe emerging crown. The gum overlying and surrounding the erupting\\ntooth becomes reddened, tumid, and exquisitely sensitive if the inflam-\\nmation be not aborted by timely incision and antiseptic washes, pus may\\nform, and the gum acquire an ulcerous appearance. The treatment is\\nfree incision, dividing the swollen gum, and syringing with 3 per cent,\\npyrozone. If there be ulcerous surfaces they are to be touched with 50\\nper cent, solution of trichloracetic acid.\\nOccasionally the muscles of mastication may become affected by the\\ninflammatory process, and inability to open the jaws result. Such cases\\nare not uncommon when the eruption of the tooth is delayed by lack of\\nroom between the ramus of the jaw and the second molar. The extrac-\\ntion of this latter tooth may be required before relief is secured.\\nComplications of Alveolar Abscess.\\nThe complications of alveolar abscess are due in acute cases to the\\ninvolvement of other tissues than those commonly affected in the course\\nof abscess formation and discharge. They depend in great part upon\\npeculiarities of the anatomical relations existing between teeth and their\\nsurroundings, and, as anatomical variations are not uncommon in these\\nparts, aberrations of disease process may be found with unwelcome fre-\\nquency. An examination of some of Dr. Cryer s sections 1 will exhibit\\nin one case the root of a lower second bicuspid penetrating the passage-\\nway for the inferior dental vessels and nerves. It is quite possible that\\nan abscess upon such a tooth discharging about the fibrous sheaths of\\n1 Proc. of American Dental Association, 1895.", "height": "4612", "width": "2804", "jp2-path": "americantextboo00kirk_0508.jp2"}, "509": {"fulltext": "COMPLICATIONS OF ALVEOLAR ABSCESS. 501\\nthese vessels might travel to distant parts backward through the in-\\nferior dental foramen, or forward through the mental foramen.\\nThe roots of molar teeth instead of having their thinnest bony cov-\\nering overlying their buccal aspects, may have their apices almost per-\\nforating the lingual wall of the bone in others the apex of the root of\\na lower molar is found beneath the line of insertion of the mylo-hyoid\\nmuscle. Abscess from such a case as this would probably discharge not\\ninto the cavity of the mouth, but in the submaxillary triangle. (See\\nthe case of Dr. Cryer s noted early in the chapter.) Dr. Harrison\\nAllen records one of these cases. The septic roots of a lower third\\nmolar were the exciting cause of pericementitis, followed by osteitis\\nand maxillary periostitis. Pus found exit beneath the mylo-hyoid\\nmuscle and gravitated, forming a collection about the hyoid bone, and\\nfrom that point passed upward upon the face in the line of the facial\\nartery. The abscess in addition pressed directly upward against the\\nfloor of the mouth and caused unilateral glossitis, from the mechanical\\neffects of which upon the organs of respiration the patient died. The\\nduration of the extra -maxillary complication was but four days.\\nIn the progressive resorption of the inner substance of the superior\\nmaxillary bone which results in the formation of the maxillary sinus, a\\nprocess which certainly continues longer in some persons than in others,\\nthe bony structures may be removed to such an extent that but a thin\\nlayer of bone, periosteum and mucous membrane covers the apices of\\nthe roots of molars. Dr. Cryer s sections exhibit two cases in which\\nthe excavation of the sinus has proceeded down between the roots of an\\nupper molar, creating such a condition that abscess upon either palatal\\nor buccal roots must almost inevitably discharge into the sinus. No\\ndoubt many cases of incipient empyema of the antrum are aborted by\\nthe early extraction of abscessed molars, the antral complication being\\nunrecognized. It is presumable that most of the cases of empyema of\\nthe antrum afford subjective evidence comparatively early, owing to the\\nlighting up of inflammation and purulent catarrh.\\nThe student is advised, in studying the relations of the teeth with the\\nmaxillary sinus, to a careful and repeated reference to the sections of\\nDr. Cryer. He calls attention to a fact frequently overlooked and un-\\ntaught, that the orifice or opening connecting the maxillary sinus with\\nthe nasal passage is near the roof of the former, so that while the patient\\nis in the erect position collections of fluid must nearly fill the sinus\\nbefore there is a discharge. In the recumbent position, however, the\\nfluid escapes and may be found in the nostril of one side. This is\\nsymptomatic of antral empyema. In acute cases of the antral disease\\nthere is much swelling, oedema about the eyelid, etc. sharp lancinating\\n1 Garretson s Oral Surgery, 6th edition.", "height": "4568", "width": "2752", "jp2-path": "americantextboo00kirk_0509.jp2"}, "510": {"fulltext": "502 DENTO-ALVEOLAR ABSCESS.\\npains dart about the jaw. In the chronic cases, large accumulations of\\npus may occur and not be detected until the bone is thin and bulged,\\nemitting a crackling sound upon pressure. Extraction of the offending\\ntooth furnishes an outlet for the pus.\\nIt is usual to attempt the passage of an instrument through the\\npulp canals into the antrum and endeavor to preserve the tooth. Such\\na drainage is insufficient the wall of the antrum should be perforated.\\nThis little operation is readily done At a point about one-eighth of an\\ninch or more above the apices of the roots of the molars an incision is\\nmade through the mucous membrane of the buccal alveolar wall, clear\\nto the bone a spear-pointed drill, a large one driven rapidly by the\\nengine, is passed instantly through the outer antral wall. The drill\\nis directed upward and inward. The opening is made sufficiently large\\nto permit free irrigation. Into the opening thus made the point of a\\nsyringe, perforated to sprinkle, is placed, and the cavity washed out\\nwith 3 per cent, pyrozone which has been diluted one-half and made\\nfaintly alkaline by the addition of sodium dioxid. As pointed out by\\nDr. W. H. Atkinson many years ago, unless the irrigating fluid be\\nmade faintly alkaline it is irritating. As a stimulant injection to fol-\\nlow, LugoPs solution (liquor iodi compositus, gtt. xx to the ounce) is\\nexcellent. The canal of the tooth is to be thoroughly sterilized and\\nfilled.\\nIn the treatment of other complications, if the case be acute, the im-\\nmediate extraction of the offending tooth and the free use of antiseptic\\nmouth-washes will usually effect a cure. In the treatment of chronic\\ncases, if the focus of infection, the pulp canals, be made antiseptic and\\nthe medicinal agents can be introduced into the abscess tract through-\\nout, surprising cures may result, as the literature of dentistry testifies.\\nAbscess upon Temporary Teeth. Among the most trying classes\\nof cases with which the dental operator is confronted are those of peri-\\ncemental disturbance affecting the temporary teeth. The operator is\\ntorn by conflicting emotions the desire to afford quick relief to the little\\nsufferers and the hesitancy or dread of inflicting the amount of suffering\\nnecessary to relieve the acute pain. Fortunately the pain is relatively\\nless than in adults the tissues being softer the child escapes the agoniz-\\ning pain attending the rapid formation of pus in the apical tissues of the\\nadult. The swelling, redness, and febrile disturbance are usually greater\\nin the child than in the adult pus forms more quickly and makes its\\nappearance in the gum sooner. The principle of treatment is the same\\nas with the adult evacuation of the pus. The necessary incision may\\nbe made almost painlessly by employing a sharp-pointed bistoury hav-\\ning a razor-like edge. The child, reassured by a gentle examination\\nand firm kindness, is directed to open the mouth and close the eyes,", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0510.jp2"}, "511": {"fulltext": "COMPLICATIONS OF ALVEOLAR ABSCESS. 503\\nwhen the bistoury, held as a pen, is passed quickly into the swell-\\ning.\\nThe canals of temporary teeth are to be sterilized first with pyrozone,\\nnext with oil of cassia, and should be filled with balsamo del deserto.\\nDr. W. H. White, to whom we are indebted for the introduction of this\\nmaterial, states that in roots of temporary teeth in which it has been\\nplaced the resorptive process is not interfered with.\\nAbscess occurring upon temporary teeth should receive prompt at-\\ntention and treatment to avoid possible injury to the permanent tooth\\nbeneath this, however, does not appear to be as frequent as might be\\nsupposed. There is a tendency in strumous children toward marked\\nlymphatic involvement attending alveolar abscess and secondary\\nabscess of the lymphatic glands is not uncommon.\\nChronic abscess in the cachectic individual which may not respond\\nto the usual local measures of treatment may be materially benefited\\nby constitutional treatment. This comprises regulation of the functions\\nof the alimentary canal the use of such foods as beef peptonoids, mal-\\ntose, etc. Iron and arsenic are administered when the patient is, as is\\nusually the case, anemic. More important than any medicinal thera-\\npeutics is systematic exercise in the open air. Raising the bodily tone\\nraises the recuperative power of the tissues, and hitherto resisting dis-\\nease may be conquered.\\nPerforated Roots. Perforation of the walls of a root canal expos-\\ning the pericementum occurs, as a rule, in consequence of two causes\\nfirst, the invasion of dental caries; second, the injudicious or unskilful\\nuse of the reamer employed in enlarging canals, or, it may be, burring\\nthrough the walls in the forming of a socket for the reception of the\\npost of an Artificial crown.\\nThe direct consequence of the perforation is inflammation of the\\npericementum, and the usual result is ulceration of that structure. The\\nsymptoms and their severity are, as a rule, governed by the situation of\\nthe perforation. If this be at the lower half (toward the crown) of the\\nroot, there is usually a proliferation of tissue which intrudes upon the\\npulp chamber. This hypertrophied tissue may increase in amount, a\\nresorption of the edge portion of the process occur, and a fungous mass\\nbearing a close resemblance to fungous pulp bulge into the pulp cham-\\nber. In fact, in many cases it is impossible to distinguish between\\nthe naked-eye appearance of fungous pulp and the condition under\\ndiscussion. The growth fills the pulp chamber and obscures the per-\\nforation it is in addition, in many cases, exquisitely tender. In either\\nevent, whether pulp or hypertrophied gum, it is necessary to remove\\nthe growth.\\nA spray of ethyl chlorid directed against the mass is perhaps the", "height": "4568", "width": "2744", "jp2-path": "americantextboo00kirk_0511.jp2"}, "512": {"fulltext": "504 DENTO-ALVEOLAR ABSCESS.\\nmost effective anesthetic in a few minutes a sharp fine-pointed lancet is\\npassed around the growth as far as it can be, and the excised portion\\nremoved. An application of tannin will check the bleeding pledgets\\nof cotton dipped in tr. iodin. are packed against the remainder of the\\ngrowth and covered in with cotton and sandarac varnish for twenty-\\nfour hours. This dressing is renewed from day to day until, if it be a\\nfungous gum, the margins of the perforation are plainly seen. The\\ncanal is cleansed, sterilized, dried, and filled with salol and gutta-percha,\\nor with paraffin and gutta-percha, to about half its depth. The re-\\nmainder of the canal and crown cavity are washed out with 25 per cent,\\npyrozone, and a dressing of temporary stopping applied, filling the per-\\nforation and yet not exercising much pressure upon the soft tissues. In\\ntwo days the temporary stopping is removed and the cavity is washed\\nout with 3 per cent, pyrozone and dried. A piece of No. 60 gold is cut,\\nlarger than the aperture this is dipped in chloro-percha and laid over\\nthe perforation. A disk of gutta-percha larger than the piece of foil is\\nwarmed, laid upon the foil, and pressed against it, sealing it to the\\ncavity walls. The remainder of the cavity is then filled with zinc phos-\\nphate.\\nIn case the perforation should be nearer the apex of the root the dif-\\nficulty is greatly increased. Attempts at passing cleansers to the apical\\nforamen usually result in pricking the pericementum at the perforation\\nand a flow of blood follows, filling the canal. The cleansers are bent so\\nthat in passing them to the apex they press against the wall opposite\\nthe perforation the apical portion of the canal may be detected and\\ncleansed after this manner in some cases. The temporary dressings in\\nthese canals should be one of the antiseptic oils, cassia or myrtol. A\\ndressing of oil on cotton should remain a week, and no attempt at canal\\nfilling be made until all evidences of pericemental disturbance vanish.\\nA fine cone of gutta-percha is passed, when practicable, into the canal\\nbeyond the perforation the remainder of the canal is filled with chloro-\\npercha, and the silk points covered with gutta-percha. The canal at\\nthe proximal side of the perforation is filled with the solution, by means\\nof the long dressing pliers, the gutta-percha-covered silk being carried\\ngently in position while the general mass is fluid. Balsamo del deserto\\nshould apply well in these cases. The canal is filled, or partially filled,\\nwith the material, and a large gutta-percha point introduced.", "height": "4608", "width": "2840", "jp2-path": "americantextboo00kirk_0512.jp2"}, "513": {"fulltext": "CHAPTER XIX.\\nPYORRHEA ALVEOLARIS.\\nBy C. N. Peirce, D. D. S.\\nDefinition. Pyorrhea alveolaris is a generic term which, strictly\\ndefined, means a flowing of pus from an alveolus. It describes merely\\na symptom which may be and usually is attendant upon a variety of\\ndisorders. The term is applied in clinical dentistry to a complexus of\\npathological conditions which more or less clearly indicate a specific\\ndisease.\\nHistory. That pyorrhea alveolaris is not a recent disease, or one\\ndue to modern constitutional states alone, is rendered evident from the\\nexamination of the skulls of ancient as well as modern races. The\\nalveolar processes of many crania widely separated both in time and in\\nlocality exhibit marked impairment of structure which bears the closest\\nresemblance to that presented by processes which were known to have\\nbeen the result of pyorrhea during life.\\nRecorded observations of this disorder date at least as far back as\\n1746, when M. A. Fauchard described its essential clinical features, but\\nfailed to designate it by any specific term. Following this, communica-\\ntions describing the disease were published by Jourdain in 1778, by\\nToirac in 1823, and by M. Marechal de Calvi in 1860, in which it was\\ndescribed as a conjoint suppuration of the gums and alveoli, pyorrhea\\ninter-alveolo-dentaire, and gingivitis expulsiva respectively.\\nThe most important contribution to the knowledge of the nature of\\nthe disease which had up to that date been made was by Dr. E. Magitot\\nin 1867. In his paper he states that the disease is characterized by a\\nslow but progressive inflammation destructive of the periosteal mem-\\nbrane and cementum, proceeding from the neck to the apex of the root\\nand involving the loss of the teeth. From the exact seat of the lesion\\nhe designated the disease osteo-periostiti alveolo-dentaire. Soon after the\\nappearance of the periosteal inflammation, it became complicated with\\ndiseases of the gums and the osseous walls of the alveolus, though\\nthese are never primarily the seat of inflammation. Magitot regarded\\nthe causes of the inflammation as very complex, and to be sought for\\nnot in the teeth and gums, but in certain conditions of the general nutri-\\n505", "height": "4564", "width": "2744", "jp2-path": "americantextboo00kirk_0513.jp2"}, "514": {"fulltext": "506 PYORRHEA ALVEOLARIS.\\ntion. The gouty and rheumatic presented the disease most frequently,\\nthough its presence in those suffering from diabetes and albuminuria\\nwas extremely common. The deposition of tartar on the roots of the\\nteeth, which might at first glance be regarded as playing an important\\npart in the causation of the disease, Magitot considered as accidental\\nand not to be looked upon as a causative agent. With reference to the\\nefficacy of any treatment, however, he advised the removal of the tartar\\nas an indispensable preliminary. The points of diagnosis differentiating\\nbetween this condition and the former, that of gingivitis, however\\nsevere, were also clearly recognized and noted.\\nFollowing Magitot s able paper was one by Serran in 1880, in which\\nthe author took exception to certain of Magitot s views, as well as to the\\nterm by which the latter proposed to designate the disease. He recog-\\nnized, however, that the disease was most common in middle life and\\noccurred principally among the gouty, the diabetic, and the albuminuric.\\nHe believed that the primary manifestation was a local congestion of\\nthe gums, followed by an exudation into the peridental membrane which\\ndestroyed its vitality and led to the formation of pus and all the other\\nsymptoms and pathological conditions characteristic of the disease. A\\ncommission composed of MM. Depres, Delens, and Magitot was ap-\\npointed by the Societe de Chirurgie to consider the statements of Dr.\\nSerran. In this report 1 they denied the gingival origin of the dis-\\nease, and stated their belief that the periosteal membrane and the\\ncementum were the primary anatomical seat of the lesion that the\\nsuccession of morbid phenomena completely precluded the idea of an\\ninitial gingivitis that the disease begins without any trace of conges-\\ntion of the gums that after its formation the pus burrows toward the\\ngingival border, which it detaches without, however, for a time de-\\nstroying its normal aspect that only after considerable augmentation\\nof the flow of pus and the loosening of the teeth do the gums become\\nimplicated that the disease has nothing in common with the hypothesis\\nof a gingival malady, and that it is most frequently a manifestation of\\na general state, or a diathesis.\\nThese were the views entertained and published by French surgeons\\non the nature of pyorrhea alveolaris about the period when the\\ndisease began to receive consideration from American dentists. Though\\npyorrhea alveolaris had long been recognized in the United States and\\nvarious observations regarding its pathology and treatment had been\\npublished, it was not until Dr. John W. Riggs, in October, 1875, read\\na paper before the American Academy of Dental Surgery, entitled\\nSuppurative Inflammation of the Gums and Absorption of the Gums\\nand Alveolar Processes/ that the disease began to attract the attention\\n1 Bulletins et Memoires de la Societe de Chirurgie, tome vi. p. 411.", "height": "4580", "width": "2812", "jp2-path": "americantextboo00kirk_0514.jp2"}, "515": {"fulltext": "HISTORY. 507\\nits gravity merited. Notwithstanding the views entertained by Magitot\\nand others regarding the constitutional character of the disease, Dr.\\nRiggs in his communication l emphatically denied that the disease is an\\naffection of the bone or of the gums, or that it is hereditary or constitu-\\ntional, but, on the contrary, that it is the roughened teeth themselves,\\nin consequence of the accretions from whatever source derived, which\\nare the exciting cause of the inflammation that it is purely local in\\norigin, the result of concretions near and under the free margins of the\\ngums, the removal of which even in the third stage is followed by cure.\\nIn 1877 Dr. F. H. Rehwinkel 2 entered his protest against the\\ntheory of the local origin of the disease, and endeavored to prove that\\nit not only may but does exist independently of foreign deposit and\\nmust depend on other than merely local causes, and that it is an\\nhereditary and constitutional disease.\\nDr. L. C. Ingersoll, in 1881, published a paper entitled San-\\nguinary Calculus, 3 in which it was stated that the persistent flow and\\ndischarge of pus along the side of the tooth was caused by an inflamma-\\ntion and ulceration at or near the apex of the root as a result of which\\nmolecular death the liquor sanguinis escaped from the bloodvessels into\\nthe surrounding tissues and became disorganized, the lime salts crystal-\\nlized on the surface of the roots, and formed the deposit which from its\\norigin he designated sanguinary calculus. This deposition he re-\\ngarded as entirely distinct from salivary calculus, and as derived from\\nthe blood the result of inflammatory action and not its cause. In\\nother words, he held that pyorrhea is a local disease but beginning\\ncentrally that is, at or near the apex of the root.\\nIn 1882, Dr. A. Witzell read a paper before the German Society of\\nDentists, 4 in which it was asserted that the primary pathological change\\nwas an inflammation and caries of the alveolar border followed by a\\ndeposit just beneath the free margins of the gums, which became re-\\ntracted and reverted. The entrance of micro-organisms into this carious\\nregion developed pus which became more or less infectious. In conse-\\nquence he termed the disease infectious alveolitis. He regarded the\\ndisease as a primary local alveolitis, having no constitutional relations\\nwhatever, a molecular necrosis of the alveoli or caries of the dental\\nsockets produced by septic irritation of the medulla of the bone.\\nIn 1886, Dr. G. V. Black prepared for publication probably the\\nmost exhaustive paper in print in the United States, wherein pyorrhea\\n1 Pennsylvania Journal of Dental Science, vol. iii. p. 99.\\n2 Report of the Committee on Pathology and Surgery, Trans. American Dental Asso-\\nciation, 1877, p. 96.\\n3 Ohio State Journal of Dental Science, vol. i. p. 189.\\n4 Vierteljahresschrift filr Zahnheilkunde, 1882 British Journal of Dental Science, vol. xxv.\\np. 153.", "height": "4552", "width": "2768", "jp2-path": "americantextboo00kirk_0515.jp2"}, "516": {"fulltext": "508 PYORRHEA ALVEOLARIS.\\nalveolaris is treated as a local disturbance. 1 Calcic inflammation and\\nphagedenic pericementitis are the terms he employs to indicate its cha-\\nracter. Though he believes it to be wholly local, he thinks a serumal\\nor sanguinary deposit may be closely allied with its origin. He de-\\nscribes it as a destructive inflammation of the pericemental membrane,\\ndistinct from other inflammations of this tissue though having many\\nfeatures in common with them. The disease, he estimates, is essentially\\none of the peridental membrane rather than of the alveolus, though the\\ndestruction of these two structures is so nearly synchronous that it is\\ndifficult to say which has gone first.\\nIn 1886, Dr. W. J. Eeese read a paper before the Louisiana State\\nDental Association on Uremia and Its Effect on the Teeth, 2 in which\\nthe chemical, physiological, and pathological relations of uric acid to the\\ngeneral nutrition were discussed. In this communication Dr. Reese ex-\\npressed the opinion that the inflammation of the pericemental membrane\\nfollowed by suppuration and disorganization when in contact with the\\nsecretions of the mouth, is caused by the deposition of uric acid derived\\nfrom the blood that the disease should be termed phagedena peri-\\ncementi that pyorrhea alveolaris is a misnomer. He also stated\\nthat while the tophus on the roots of the teeth is the usual con-\\ncomitant of uric acid, it is not necessarily so, but that absorption of\\nthe pericemental membrane may take place without any deposit.\\nThough a local treatment was advocated, he stated that without sys-\\ntemic or constitutional treatment the return of the trouble may be\\nexpected.\\nDr. John S. Marshall, in 1891, expressed his conviction that pyor-\\nrhea has a constitutional origin and is closely allied to the rheumatic\\nor gouty diathesis that the deposition of the concretions upon the\\nroots of the teeth in those localities not easily reached by the saliva, or\\nin which the presence of the saliva would be an impossibility, is due\\nto the causes which produce the chalky formations found in the joints\\nand fibrous tissues of gouty and rheumatic individuals. 3\\nThe writer, in a series of papers published during 1 892-94-95/ pre-\\nsented a number of clinical and pathological facts which in their totality\\nit was believed established a kinship between pyorrhea alveolaris or\\nhematogenic calcic pericementitis and the constitutional state familiarly\\nknown as the gouty or uric acid diathesis.\\nRecent literature by American writers has dealt largely with the\\n1 Diseases of the Peridental Membrane having their Beginning at the Margin of\\nthe Gum, American System of Dentistry, vol. i. p. 953.\\n2 Dental Cosmos, vol. xxv. p. 550.\\n3 The Rheumatic and Gouty Diathesis, with its Manifestations in the Peridental\\nMembrane, Trans. American Medical Association, 1891.\\n4 International Dental Journal, vols, xiii., xv. and xvi.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0516.jp2"}, "517": {"fulltext": "TERMINOLOGY. 509\\nproblem of the etiology of the disease in question and has been princi-\\npally concerned in determining whether it is of constitutional origin or\\nof local origin, or of both. Of the more important recent writings on\\nthe subject may be mentioned those of Drs. E. T. Darby, H. H. Bur-\\nchard, G. V. Black, M. L. Rhein, E. C. Kirk, James Truman, Junius\\nE. Cravens, Louis Jack, R. R. Andrews, and R. Ottolengui.\\nTerminology. No disease in the whole domain of surgery has\\nreceived so many and such diverse names as the one under consideration.\\nEach succeeding title was an attempt at the production of a comprehen-\\nsive descriptive designation of the disease, but when it is recognized\\nthat the essential nature of the pathological processes involved is, even\\nnow, not fully made out, it is evident that the many names simply\\nrepresent as many diverse views and can therefore have no permanency,\\nnor do they, indeed, deserve any.\\nThe following is a fairly complete list of the synonyms of the dis-\\norder Suppuration conjointe Pyorrhea inter-alveolo-dentaire Gingi-\\nvitis expulsiva Osteo-periostiti-alveolo-dentaire Pyorrhea alveolo\\nCemento-periostitis Infectioso-alveolitis Pyorrhea alveolaris Calcic\\ninflammation Phagedenic pericementitis Riggs disease Hemato-\\ngenic calcic pericementitis Blennorrhea alveolaris Gouty pericemen-\\ntitis.\\nExamining the foregoing list, from the pathological point of view, it\\nwill be observed that there is a wide divergence of opinion as to the\\nconditions which should be included under the generic title of pyorrhea\\nalveolaris.\\nAs the term is now understood, pyorrhea alveolaris includes all of\\nthose cases of morbid action characterized by the following features\\nA molecular necrosis of the retentive structures of the teeth (their liga-\\nment, the pericementum), an atrophy of the alveolar walls, together\\nwith a chronic hyperemia of the gum tissue which leads to limited\\nhypertrophy. After a variable period the teeth drop out, and the mor-\\nbid action ceases with their loss. An examination of the roots of the\\nteeth before or after their exfoliation usually exhibits deposits of cal-\\nculi upon their surfaces. The disease is generally though not always\\nattended by a flow of pus from the alveoli.\\nClinically the cases in which these phenomena are observed may be\\ndivided into two classes First, those in which the disease process ap-\\npears to begin at the gum margin. The second class, those in connec-\\ntion with which there is much controversy, begin at some portion of\\nthe alveolus between the unbroken and apparently healthy gum margin\\nand the apex of the root, the pulp of the tooth being alive. These two\\nconditions are so clearly differentiated from one another that each re-\\nquires a separate description. Between these two classes, but intimately", "height": "4564", "width": "2736", "jp2-path": "americantextboo00kirk_0517.jp2"}, "518": {"fulltext": "510 PYORRHEA ALVEOLARIS.\\nassociated with the latter, are to be included the cases described by Dr.\\nG. V. Black l as phagedenic pericementitis.\\nClass I. Pyorrhea Alveolaris beginning at the Gum\\nMargin (Ptyalogenic Calcic Pericementitis).\\nThe first class those cases beginning not at, but immediately be-\\nneath the gum margin are perhaps the most common, are by some\\nerroneously supposed to be the only type of cases, and will require\\ndescription first, as their causes, progress, prognosis, and treatment\\ndiffer radically from those of the second class.\\nCauses of Class I. As in any disease, the causes of pyorrhea\\nalveolaris grouped as Class I. may be divided into predisposing and\\nexciting. The predisposing causes may all be included under the head\\nof disorders causing a subacute inflammation of the gingivae. General\\ncatarrhal conditions; small but irritating deposits upon the necks of the\\nteeth, as the accumulations upon the teeth of smokers fermenting\\ndeposits of food spirit-drinkers stomatitis, mouth-breathers gingivitis\\novercrowding of the teeth, mal-occlusion, and non-occlusion. The pre-\\ndisposing causes may also frequently be the exciting causes. The excit-\\ning causes proper are, however, subgingival scaly deposits of calculi.\\nClinical History. In the mouth of a patient of one of the above-\\nmentioned classes there will be noted at some period a gingivitis a\\nswelling of the gum which does not extend far from their margins.\\nIt is noteworthy that in these cases, as in the succeeding class, it is\\nusual to find the disease attack teeth which are comparatively or quite\\nexempt from the inroads of caries. Soon after the incipiency of the\\ndisease there may be squeezed from beneath the gum margins a detritus\\nof food debris and inspissated mucus. At a later stage a sharp scaler\\npassed beneath the gum margin may detach a flat greenish or black de-\\nposit of calculus. Later, the gingivae are seen to become swollen and are\\ngradually detached from the neck of the tooth, the flattened calculus in-\\ncreases in volume, and the irritation and injection of the gum deepens.\\nIt is probable that these deposits have their origin in a reaction be-\\ntween the altered mucous secretion of the gingival glands and the pro-\\nducts of lactic fermentation, their calcic salts being derived from the\\nsaliva. 2 The detachment of the gum does not become marked until\\nthese dark scaly deposits have encroached upon the margins of the\\nalveolus. Soon thereafter, or indeed before, evidences of infection are\\nobserved, from the fact that pus may be pressed from the pockets. The\\ndisease progresses, the teeth loosen, and ultimately drop out or are re-\\n1 A merican System of Dentistry, vol. i.\\n2 H. H. Burchard, Dental Cosmos, October, 1895.", "height": "4612", "width": "2792", "jp2-path": "americantextboo00kirk_0518.jp2"}, "519": {"fulltext": "PATHOLOGY AND MORBID ANATOMY.\\n511\\nFig. 474.\\nmoved with the fingers, the injected gum remaining as a flabby mass\\nand all evidences of dental disease ceasing with the loss of the teeth.\\nThe process may involve one, two, or more teeth and in some cases an\\nentire denture. The origin of these deposits as well as those of ordi-\\nnary calculi are so clearly traceable to the saliva that the writer has\\nsuggested for the conditions caused by them the name of ptyalogenic\\ncalcic pericementitis.\\nPathology and Morbid Anatomy. The appended figure, semi-\\ndiagrammatic, will illustrate clearly the nature of the disease process\\n(Fig. 474). It represents a longitudinal section through a tooth\\nand its alveolus, with the vascular supply to the tissues. The peri-\\ncementum and alveolar walls for some distance from the apex of\\nthe root are in a healthy condition. At the neck of the tooth are\\nseen two deposits of calculi a). The overlying gum (6, b) is\\nseen to be swollen and tumid at its edges. Immediately below the\\ncalculus, where it encroaches upon the pericementum, the latter tissue\\nand also a portion of the alveolar periosteum is seen to have under-\\ngone necrotic changes (d). The portion of alveolar wall uncovered\\nby periosteum is in process of dissolution. In the pocket beneath the\\ncalculus a collection of pus is seen (c, c), so that the tissues beyond\\nthe calculus are involved in suppura-\\ntive degeneration, which may be slow\\nor rapid in its progress.\\nThe diagnosis is by sight and touch\\nand not infrequently by odor, as par-\\nticularly in unhygienic mouths an offen-\\nsive odor attends the progress of the\\ndisease. The gums are tumid from\\nabout the necks of the teeth pus may\\nbe pressed, and touch demonstrates the\\npresence of flat, dark, and firmly ad-\\nherent scaly calculi.\\nThe prognosis is favorable at even\\nadvanced stages, provided certain con-\\nditions may be obtained, viz. a removal\\nor correction of the predisposing causes\\nand a perfect removal of the exciting\\ncauses.\\nTreatment. The treatment is based\\npurely upon the existing conditions, with two main objects in view.\\nThe first is to remove every source of irritation the second, to procure\\nsurgical rest until there is a return of the surrounding tissues to a\\nnormal condition.\\nPtyalogenic calcic pericementitis\\n(Burchard).", "height": "4552", "width": "2752", "jp2-path": "americantextboo00kirk_0519.jp2"}, "520": {"fulltext": "512\\nPYORRHEA ALVEOLARIS.\\ni\\nCushing s scalers.\\nAs a general rule the first step of the operation consists in a careful\\nand thorough scaling of the teeth. It is essential that the use of bulky\\nscalers be avoided first, for the reason that they rarely reach the\\ndeepest portions of the deposits\\nsecond, that if they do, they cause\\nmore or less laceration of the gum,\\nwhich should be kept as free from\\ninjury as possible. The instru-\\nments employed for this purpose\\nby a majority of operators are the\\nset known as Cushing s scalers\\n(Fig. 475). Their mode of appli-\\ncation and their position relative\\nto the root are shown in Figs. 476,\\n477. No instrument with a draw\\ncut can remove these deposits with the same thoroughness as\\none operated with a push cut. With proper guarding it is\\nimprobable that these instruments should do harm to the\\nvital parts beyond the calculus. Great care should be exer-\\ncised in the use of pushing instruments to avoid forcing the\\ndislodged particles into the deeper tissues. The scaling is a\\ntedious operation, but one which should be persisted in until\\nthe root of the affected tooth is absolutely smooth. The scal-\\ning is alternated with a washing out of the pockets with 3\\nper cent, pyrozone or hydrogen dioxid, which washes out the\\ndetached particles of calculus and disinfects the parts. When\\nthe gums are tumid and interfere notably with the scaling pro-\\ncess, applications are made of a solution of trichloracetic acid\\n1 10 upon cotton tents this checks oozing, shrinks the gum,\\nS giving a better view of the parts, and tends to soften the de-\\nposits. l It not infrequently happens that the teeth have\\nsuffered such extensive loss of their retaining structures that\\nthe operation of scaling tends to still further loosen them. In\\nthese cases the correction of mal-occlusion and splinting the\\nteeth should be attended to before proceeding farther with the\\noperation. The teeth should be ligatured to their fellows,\\nand the excessive occlusion corrected by grinding away the\\npoints of contact with corundum wheels sufficiently to relieve\\nthe teeth of strain and to permit the fixing of a metallic splint\\nby means of which the teeth may be held firmly, during and subsequent\\nto the scaling operation. 2\\nSplints for these cases are usually swaged metallic caps made of\\n1 E. C. Kirk. 2 H. H. Burchard, International Dental Journal, August 1895.", "height": "4608", "width": "2808", "jp2-path": "americantextboo00kirk_0520.jp2"}, "521": {"fulltext": "PATHOLOGY AND MORBID ANATOMY.\\n513\\nNo. 31 metal, gold or silver, which are cemented to the teeth (Fig.\\n478). When the teeth have suitable forms, a succession of rings sol-\\ndered together may be employed in other cases the teeth are lashed\\ntogether by means of fine gold wire. For temporary use No. 31 or 32\\nannealed brass wire may be used, and when left in situ for weeks or\\nmonths it exerts no deleterious effect. In fact, it appears to possess\\nFig. 476.\\nShowing the manner of holding an instrument for detaching calcareous deposits when using the\\npushing motion. The third finger rests on the edges of the teeth, allowing freedom of the\\nhand to make rapid and effectual movements in dislodging the calculi.\\nantiseptic properties similar to those attributed to copper amalgam\\nwhen used as a filling material. Or, if frequently renewed, floss silk\\nmay be used. Devices for this purpose are as numerous as designs\\nfor bridge work.\\nEach root is to be perfectly scaled before proceeding to a second\\ntooth. At the completion of the scaling the pockets are freely syringed\\nout with pyrozone 3 per cent., and an application of an astringent made:\\na 10 per cent, solution of zinc chlorid, 20 per cent, solution of zinc\\n33", "height": "4568", "width": "2744", "jp2-path": "americantextboo00kirk_0521.jp2"}, "522": {"fulltext": "514\\nPYORRHEA ALVEOLARIS.\\niodid, or tr. iodin. U. S. P. diluted one-half with alcohol. Prepara-\\ntions of aristol and the officinal tincture of iodin are also used, all of\\nwhich subserve the desired end, to\\nsterilize the parts and to constringe\\nthe dilated vessels of the gum. An\\nantiseptic and astringent mouth-wash\\nFig. 478.\\nShowing the application of a thin flat\\ninstrument to the labial and approxi-\\nmal surfaces of an upper bicuspid\\n(pushing motion).\\nis prescribed which the patient is to\\nuse several times daily. The follow-\\ning preparation applied on a small roll\\nor tuft of cotton wool or by means of\\na soft toothbrush admirably meets the conditions\\n1^. Zinci ohlorid., cryst.,\\nAquse menthse pip.,\\nS. Apply locally to the gums.\\n3js;\\nfgiv.\u00e2\u0080\u0094 M.\\nAs early in the treatment as possible a thorough examination should\\nbe made with a delicate exploring instrument, so that any calculi which\\nmay be detected may be removed.\\nA method of treatment which has given much satisfaction to the\\nwriter is as follows First thoroughly cleanse the mouth and each\\nparticular pocket with hydrogen peroxid, electrozone, or some other\\nequally efficient antiseptic. Then with a blunt but flexible broach,\\ngold or steel, let each pocket from which pus has been issuing be very\\ncarefully saturated with trichloracetic acid this is repeated each visit\\nif pas continues to flow. Following this, the pockets and gingival\\nborders or margins are thoroughly treated with tincture of iodin, fol-\\nlowed with solution of hydronaphthol and alcohol. If the gingivse,\\nhowever, should be tumefied, an application of carbolic acid will prove\\nadvantageous\\n1^. Hydronaphthol, 31J\\nAlcohol, \u00c2\u00a3iv.\\nThis must be used with caution, for it is of sufficient strength to give\\nthe patient much discomfort if brought in contact with lips and tongue.\\nThe frequency of the visits and applications must depend upon the viru-", "height": "4580", "width": "2812", "jp2-path": "americantextboo00kirk_0522.jp2"}, "523": {"fulltext": "GOUTY PERICEMENTITIS. 515\\nlence of the disease. A wash for the patient s daily use made from the\\nfollowing formula will be of great service\\n1^. Hydronaphthol, gr. x;\\nGlycerol, 3j\\nAlcohol, ,lij\\nAquse dest., 3ij.\\nThe use of hydronaphthol in pyorrhea alveolaris was suggested by\\nProf. James Truman.\\nThe loss of alveolar w T alls is permanent the utmost the operator\\ncan hope in extreme cases is a reorganization of the tissues which\\nhave been softened as a consequence of the inflammatory action.\\nClass II. Pyorrhea Alveolaris of Constitutional Origin\\nGouty Pericementitis.\\nThe second class of pyorrhea cases those in which local therapeusis\\nhas not been attended with permanent good results are usually chronic,\\nextending over a variable period of time, owing to the fact that they are\\nbut the local expression of constitutional states. Of these many forms of\\npyorrhea, one is particularly persistent, terminating only, unless prop-\\nerly treated, with the exfoliation of the aifected teeth. This particular\\nform, which has been the subject of much discussion during the past\\ntwenty-five years, the writer believes to have been shown to be but a\\nlocal expression of the gouty diathesis and directly dependent on the\\ndeposition of the uric acid, urates, and calcium salts in the pericemental\\nmembrane though it is probable that allied and closely related com-\\npounds, such as the xanthin or alloxuric bases (xanthin, guanin, and aden-\\nin), may also be present in small quantities. Indeed, as the gouty diathe-\\nsis is largely dependent on a faulty metabolism of proteid compounds and\\nan imperfect elimination of nitrogen-holding derivatives, it is quite pos-\\nsible, though not proved, that any or all derivatives may be present in\\nany pathological deposition. Inasmuch, however, as the amounts of\\nthese compounds are small, uric acid and uratic salts must be regarded\\nas the chief of the specific irritants. As the origin of the salts is from\\nthe blood, the writer suggested the term hematogenic calcic pericementitis.\\nSubsequently Dr. E. T. Darby suggested the happily applicable term\\ngouty pericementitis.\\nClinical History. It is noted that many patients who have mag-\\nnificent dentures almost exempt from caries, at a period about middle\\nlife begin to have a loosening of the teeth which if unchecked leads\\nto the loss of the entire denture. The disease may be observed at\\nany stage from a slight loosening to impending exfoliation. An exam-\\nination of many cases will show that although they present apparently", "height": "4568", "width": "2744", "jp2-path": "americantextboo00kirk_0523.jp2"}, "524": {"fulltext": "516 PYORRHEA ALVE0LARI8.\\ndiverse conditions, yet beneath these differences there is a striking uni-\\nformity, particularly as to the family history of such patients.\\nA complete and accurate study of the succession of symptoms which\\na typical case of gouty pericementitis presents from its inception to its\\ntermination. is rendered difficult, owing to the lack of extended observa-\\ntion of the disease throughout the entire period of its evolution and dis-\\nsolution. This is especially true of this disease in its earlier stages.\\nNevertheless from an attentive study of a large number of individual\\ncases in various stages of development it is believed that a fairly cor-\\nrect picture can be deduced.\\nFirst as to the teeth themselves as stated, they are almost exempt\\nfrom recent caries. The teeth frequently exhibit a tendency to me-\\nchanical abrasion upon their cutting edges or labial surfaces. If the\\npatient be of a sanguine temperament, or this temperament combined\\nwith the bilious, the tendency to erosion is much more pronounced.\\nIt must be appreciated that this destruction of tooth tissue has nothing\\nin common with ordinary dental decay or with the results of friction\\nin mastication.\\nIn nearly all cases, should excavation of cavities in the teeth become\\nnecessary, or sections of lost teeth be examined, it will be found that the\\npulp has receded, i. e. has suffered a continued stimulation of its func-\\ntional activity to the extent almost of obliteration.\\nThe patient may consult the operator as to the causes of repeated\\nattacks of dental neuralgia, or the reason of consultation may be the\\nalteration of position of one or more teeth. An examination of the\\norgans, however, reveals no evident cause for either the neuralgia or the\\ndisplacement.\\nIf the malposed tooth be kept under observation it will usually be\\nseen to become elevated, loosen, and finally drop out. Other teeth\\nbecome affected in a similar manner. Dr. Burchard has classified the\\ncourse of pyorrhea as in three stages, as follows First, tooth indura-\\ntion second, erosion or chemical solution of the crowns of the teeth\\nthird, a loss of the retaining structures of the teeth. Pathologically\\nstated, there is first a stimulative stage; second, an irritative, charac-\\nterized by altered secretion (erosion) third, the necrotic.\\nThe altered secretion pertains to the labial glands largely, and the\\nnecrosis to the pericemental membrane and the apical end of the root\\nor that portion which has been denuded of the membrane while the\\nalveolar process never, in the writer s judgment, undergoes any change\\nexcept that of absorption and atrophy.\\nBy far the greater number of cases present themselves when the\\ndisease has made marked advance about one or several teeth and their\\nimmediate loss is threatened.", "height": "4612", "width": "2848", "jp2-path": "americantextboo00kirk_0524.jp2"}, "525": {"fulltext": "GOUTY PERICEMENTITIS. 517\\nAssuming that the gouty diathesis however well or poorly developed\\nmay be a predisposing cause, and the deposition of some characteristic\\nspecific gouty material from the blood into the pericemental tissues the\\nimmediate or exciting cause, we have an explanation for the irritation\\nand necrosis of the alveolo-cemental membrane, which even in its early\\nstages is easily recognizable. Coexistent with the pericemental hyper-\\nemia there is more or less redness and turgescence of the gums, accom-\\npanied by a sense of tenderness, soreness, and in many cases neuralgic\\npain, which latter symptom frequently precedes all other symptoms.\\nIn individuals already suffering from pyorrhea, the early irritative\\nstage of the disorder may be frequently observed in teeth previously\\nfree from all signs of the disease. In nearly all such instances the focus\\nof the diseased action is confined almost exclusively to the region toward\\nthe apical extremity of the root without there being the slightest evi-\\ndence of peripheral local gingivitis. Too much stress cannot be placed\\non this fact, as it unquestionably marks the incipiency of the disease and\\nis one of the early diagnostic symptoms.\\nSomewhere near the apex of the root a distinct swelling occurs simu-\\nlating an acute apical abscess. The tooth is sensitive upon percussion,\\nbut less so than when affected by purulent apical pericementitis more-\\nover by isolating the tooth it is found to respond to applications of\\ncold, proving that its pulp is alive. A bistoury passed into the swell-\\ning is followed by an escape of blood, and usually by a glairy purulent\\ndischarge also, although not always. In some cases a probe passed into\\nthe opening may show an absence of alveolar process at that point, and\\nby a roughness reveal the presence of a deposit upon the root of the\\ntooth.\\nThe teeth so affected usually present an appreciable elevation or\\nprotrusion from their alveoli in consequence of the enlarged or thick-\\nened and congested pericemental membrane. Should this congestion\\nbe permitted to continue, the inflammatory stage in consequence of the\\ncontinued presence of the irritating deposit will supervene, with its con-\\ncomitant symptoms, heat, pain, swelling, and marked impairment and in\\nsome instances total arrest of the functions of the tissues involved.\\nInflammation once established will eventuate in localized suppura-\\ntion with the abatement of the acute symptoms. The location of the\\nsuppurative process, if the case be seen and recognized early, will be\\nfound in the large majority of cases to be near the apical extremity of\\nthe root. As a rule, the pus takes the line of least resistance and bur-\\nrows directly along the side of the root and opens externally at the\\ngingival border. Occasionally the line of least resistance is toward\\nthe labial surface, with the discharge of pus on the gum opposite the\\nend of the root, thereby establishing a fictitious opening simulating", "height": "4568", "width": "2752", "jp2-path": "americantextboo00kirk_0525.jp2"}, "526": {"fulltext": "518 PYORRHEA ALVEOLARIS.\\nthe condition observed in an acute alveolar abscess these cases, how-\\never, are very limited in number.\\nOnce established, these conditions of increased vascularity, tumefac-\\ntion of the gums, and persistent discharge of pus may continue for\\nmonths or years the rapidity with which the disease progresses and\\nthe extent to which the lesions develop will be directly dependent upon\\nthe state of the general nutrition and habits of the individual.\\nAs a result of the continued irritation induced by the deposit, the\\ninflammation extends, the disturbed relation between blood and sur-\\nrounding tissues increases, and the gums become flaccid, spongy,\\naltered in color, and liable to hemorrhagic discharges. Associated with\\nthe congested and thickened condition of the pericemental membrane\\nthere is a gradual softening and absorption of the alveolar process, which\\nmay advance to such an extent as to almost or in some cases quite\\nexpose the root throughout its entire extent. The tooth thus freed from\\nits retentive structures becomes loose, is freely movable in its enlarged\\nand partially destroyed socket, is extremely liable to dislodgment by\\nslight mechanical means, or if by care these are avoided it will within\\na limited time be exfoliated in consequence of the final and complete\\ndestruction of all its retaining structures. With this final result the\\nprogress of the disease is arrested. The alveolar socket being freely\\nopened, the partially dead and decomposing tissues are removed and\\nthe remaining structures gradually restored to a normally healthy con-\\ndition by the usual processes of repair.\\nWhen once established, pyorrhea alveolaris does not confine itself\\nto any one tooth, but may extend to adjoining teeth or make its appear-\\nance in rapid succession in widely separated regions of the mouth in\\nthe lower as well as the upper jaws until the whole denture becomes\\ninvolved, with an eventual exfoliation of all the teeth and a complete\\nresorption of the alveolar process. When these exfoliated teeth are\\nexamined there will be found at some point of the root surface,\\nalmost always near the apex, an incrustation of a dark, rough cal-\\nculus, or it may be several of them, all minute. The origin of the\\ndeposits being clearly not from the saliva, which is the source of the\\ncalculi in the disease described under the head of Class I., it has been\\ncalled serumal or sanguinary calculus (Ingersoll, Black) the writer has\\nsuggested as the name of the disease caused by such deposits, hemato-\\ngenic calcic pericementitis.\\nThese assumed gouty deposits led the writer into an investigation\\nas to the family history of patients affected by this disease. Almost\\nwithout exception these individuals have been shown to be either the\\nvictims of some phase or form of gout, of alleged rheumatism or of\\nrheumatoid arthritis (rheumatic gout), or to have a clear family his-", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0526.jp2"}, "527": {"fulltext": "GOUTY PERICEMENTITIS. 519\\ntory of one of these disorders. Careful investigation by several other\\nobservers has brought to light similar testimony, particularly within\\nthe past three years (Kirk, Darby, Burchard, Jack, and others).\\nIt had been noted by succeeding generations of practitioners that the\\ntherapeutic resources (local) of dentistry were insufficient to either check\\nor cure the disease condition. All local means of treatment having\\nbeen exhausted and shown to be of little or no avail, there was a natural\\ninquiry into the exact nature of the predisposing and exciting causes of\\nthe malady, so that the therapeusis might be placed upon a rational basis.\\nNo purely local causes having been found sufficient to account for\\nthe dental condition, all constitutional states which were known to\\naffect the teeth or their alveoli were examined and compared with the\\nphenomena of the dental disorder. While it was and is found that\\nseveral constitutional conditions do predispose to pyorrhea alveolaris, a\\nflow of pus from a tooth socket, and most of these conditions may be\\nincluded under the heading of diseases of sub-oxidation, none of them\\nwas found to cause a disease having the precise clinical phenomena\\nnoted in connection with the one under discussion. By a process of\\nexclusion, and finally by direct clinical and experimental evidence, the\\nfield of inquiry was narrowed down to the conditions which clinical\\nmedicine has included under the heading of the disorders of the gouty\\ndiathesis.\\nIn order to clearly comprehend the connection of the general condi-\\ntion with the local disease it is necessary to examine the essential, the\\nintimate, nature of gout and its manifold manifestations. Much con-\\nfusion has arisen in the discussion of this subject due to the lack of\\nagreement of observers as to what constitutes gout, many apparently as-\\nsuming that gout is necessarily and inseparably connected with an acute\\nattack affecting the metatarso-phalangeal articulation (the great toe).\\nPathology of the Constitutional Morbid Condition. Pyorrhea\\nalveolaris regarded as a local manifestation of the gouty diathesis is\\nthe result of a deposition of uratic salts in the pericemental mem-\\nbrane these, acting as a local irritant, excite a specific inflammation\\nwhile, as in other manifestations, the deposition of the gouty material\\nis determined by an abnormal condition of the membrane, a condition\\nof impaired vitality, the result of some mechanical or other irritation,\\nwhich predisposes it to the infiltration.\\nAs no special manifestation of the gouty diathesis can be intelligently\\nunderstood without reference to its constitutional relations, it will not be\\nout of place to briefly consider the phenomena presented by (1) The\\ngouty diathesis as a constitutional malady (2) The special manifesta-\\ntion here under consideration as a molecular necrosis of the perice-\\nmental membrane, or pyorrhea alveolaris.", "height": "4564", "width": "2784", "jp2-path": "americantextboo00kirk_0527.jp2"}, "528": {"fulltext": "520 PYORRHEA ALVEOLARIS.\\nThe gouty diathesis, in the general acceptation of the term, is a con-\\nstitutional malady which manifests itself under a great variety of forms\\nin different individuals. It is characterized by an excess of uric acid\\nand its congeners in the blood, due either to increased production,\\nthrough impaired or imperfect assimilation of nitrogenous food, or to\\nimperfect elimination of the normal amount of urates by the kidneys.\\nIn either event there is a disturbance of the normal relations between\\nuric acid production and the general nutritional process. The protean\\nforms under which the diathesis manifests itself will vary in accord-\\nance with the type of constitution and with the peculiarities of organi-\\nzation and the degree of vitality of individual organs and tissues. The\\nlesions or pathological states observed are believed to be caused by the\\ndeposition into the tissues, from the blood, of urate of sodium. This\\ndiathesis is undeniably hereditary, as its presence is detectable in one\\nform or another in fully 75 per cent, of all cases in two and even three\\ngenerations. The diathesis can also be acquired by individuals who are\\nsubjected to the causes which rendered the diathesis hereditary. The\\nage at which the local expressions manifest themselves lies between the\\nthirty-fifth and fiftieth years, at a time when growth has ceased and the\\nfood supply is required only for tissue repair and heat production. It\\nis most common among those who lead sedentary lives, who indulge in\\nan excess of nitrogenous food beyond the capacity of the individual to\\nperfectly oxidize, and those who consume excessive amounts of fer-\\nmented and malted beverages and the heavier wines.\\nThe immediate cause of all gouty expressions appears to be the pres-\\nence of urates in the blood. The amount normally present is so slight\\nthat it is almost non-detectable by ordinary chemical methods. It was\\nshown by Dr. Garrod that in gouty conditions the amount was increased\\ntq as much as 0.175 per 1000 parts, and that this apparently small\\nquantity was quite sufficient to act as the irritating cause of gout a\\nfact corroborated by other observers.\\nThe various theories which have been advocated from time to time\\nin explanation of this uric acid increase in the blood plasma are unsatis-\\nfactory and contradictory whether it is the result of imperfect elimina-\\ntion or of increased production through excess of nitrogenous foods it\\nis difficult to state positively in the present state of pathology. It is\\nquite probable that the diathesis is a neurosis which affects simultane-\\nously the assimilative as well as the excretory functions of the body.\\nWhatever the explanation may be as to the accumulation of urates,\\ntheir presence in the blood is generally admitted to be the immediate\\ncause of any gouty manifestation. Dr. Dyce Duckworth states that No\\nconception of this malady is possible which should exclude from its\\npurview the part played in it by uric acid The most unequivocal", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0528.jp2"}, "529": {"fulltext": "GOUTY PERICEMENTITIS. 521\\nevidence of true gouty disease is that derived from the presence of\\nuratic salts in the tissues. The immediate cause for the deposition of\\nurates in individual tissues is to be sought for in a special vulnerability\\nof the tissues, a loss of vitality, the result of mechanical, chemical, or\\nvital influences. The views of Ebstein concerning the deposition of\\nuratic salts have found general acceptance. He has apparently demon-\\nstrated that, in all connective tissues, previous to the deposition there is\\na primary necrosis of tissue elements without which the crystallization\\ncould not take place that this disturbance of tissue vitality is the\\npredisposing factor and the crystallization the exciting factor of gouty\\nchanges. The blood plasma transuding through the walls of the capil-\\nlarv vessels carries with it urate of sodium in solution in the partially\\ndevitalized tissue inspissation occurs and in consequence crystallization.\\nThe urate of sodium as it accumulates acts as a specific irritant to\\nthe tissue, giving rise to a variety of phenomena in accordance with the\\ncharacter of the tissue involved. The gouty manifestations may be\\neither acute or chronic. In the acute forms the signs and symptoms\\nare those of an acute specific inflammation of a joint, usually that of the\\ngreat toe. Clinical study of pyorrhea cases strongly indicates that the\\ndisease frequently attacks the dento-alveolar articulation before other\\narticulations in point of time. The local symptoms, pain, heat, tume-\\nfaction are associated with marked constitutional reactions, disordered\\ndigestion, and numerous evidences of general disturbance of nutrition.\\nThe duration of the attack may be from a few days to several weeks.\\nRepeated attacks lead to an impairment of the functions of the joint\\nand a permanent alteration of its structure.\\nIn the chronic forms the symptoms are more widely distributed and\\ntheir intensity is less pronounced according to the tissues involved.\\nThe various manifestations may be classified as follows\\nArticular gout, in which the deposit occurs in joints.\\nTegumentary gout, in which the deposit takes place in the skin and\\nmucous membranes. Disease of the skin, such as eczema and psoriasis,\\nand catarrhal affections of the mucous membranes, such as pharyngitis,\\nchronic bronchitis, gastric and intestinal catarrhs, have long been\\nrecognized as expressions of gout.\\nVisceral gout, in which the deposit occurs in the viscera, such as the\\nlungs, heart, bloodvessels, spleen, liver, kidneys, i. e. giving rise to\\nvarious diseased conditions or giving a peculiar cast to disease already\\nestablished.\\nXervous gout, in which the nervous tissue is invaded, manifesting\\nitself in a loss of mental energy, despondency, irritability of temper,\\nheadaches, neuralgia, etc.\\nThe limits of this chapter do not permit, nor is it desirable, to enter", "height": "4564", "width": "2760", "jp2-path": "americantextboo00kirk_0529.jp2"}, "530": {"fulltext": "522 PYORRHEA ALVEOLARTS.\\nupon a detailed statement of the symptoms or diagnostic features of\\nthese various phases of the gouty diathesis suffice it to say that, under\\none form or another, they are frequently present and associated with\\npyorrhea alveolaris. The pathology of pericemental inflammation from\\nuratic deposition unfolds itself logically after a consideration of the\\ndiathesis in its constitutional aspects. Bearing in mind the fact that the\\nalveolo-cemental membrane is a member of the connective-tissue group, it\\nis not at all surprising that it also should become the seat of uratic deposits.\\nPathology of the Dental Disease. Unfortunately the anatomical\\nrelations of the parts and other factors prevent the dental observer from\\ncollecting a complete and connected series of observations as to the exact\\npathology of the disease, so that our deductions in this direction are\\nnecessarily confined to a basis of clinical records.\\nIt is a natural inference that the pericementum is the part attacked\\nbecause it is a point of minor resistance. The decreasing volume of\\npericementum which attends the progress of the disease in these cases\\nis necessarily followed by a contraction of the caliber of the blood-\\nvessels. It is not at all improbable that, as a consequence of the general\\nphysical condition, atheromatous changes occur in the pericemental\\nbloodvessels leading to their occlusion. If it be necessary, as some\\npathologists maintain, that a death of cells precede the deposits in\\ngout, this vascular change will account for the necrosis. The acid re-\\naction of the necrotic area causes the deposition of urates, which are\\ninsoluble in acids.\\nThe deposit is the source of an irritation which in most cases is\\nfollowed by inflammation, leading to inflammatory degeneration and\\nprobably coagulation necrosis of the cellular elements. The alveolar\\nwalls melt down particle by particle, the pericementum disappears, the\\ndiseased area usually becomes infected by pyogenic organisms, and the\\nprocess of suppuration is an additional factor leading to the exfoliation\\nof the teeth. As in necrotic areas of other parts, calcareous deposits\\noccur, which cover and almost entirely obscure the primary deposit\\nof urates.\\nThe condition following upon a deposit at the lateral aspect of a\\nroot, in its pericementum, is shown diagrammatically in Fig. 479. At a\\nis seen the calculus embraced by a territory of inflammatory corpuscles,\\nb. The pericementum which has so far escaped destruction is seen at c\\nand d, that at d nourished by the anastomosing vessels from the alve-\\nolar periosteum. At a later period this portion of pericementum be-\\ncomes involved in the degenerative process, and pus escapes at the neck\\nof the tooth. In other cases the inflammatory degeneration extends\\nfrom the deposit to the overlying gum, which is perforated.\\nIt is conceivable that such tissue changes should exist in consequence", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0530.jp2"}, "531": {"fulltext": "G UTY PERICEMENTITIS.\\n523\\nof injuries sustained during ordinary dental manipulations, the careless\\nuse of the teeth in biting unyielding substances, or even in the unwise\\nuse of toothpicks, brushes, etc. This supposition granted and of its\\ntruth there appears to be much evidence, for the disease not unfrequently\\nFig. 479.\\nHematogenic calcic pericementitis (Burchard).\\ndevelops after the operation of wedging, malleting, etc. it is reasonable\\nto believe that during the transudation of lymph through the lymph\\nchannels of the membrane, cementum, and dentin freighted with uratic\\nsalts, deposition and crystallization would readily take place in the\\ndento-alveolar articulation as in other localities of the body. Not\\nunfrequently has the writer recognized pus-exuding pockets resulting\\nsolely from wedging or long-continued malleting, and these in teeth that\\npreviously to the operation were as free from any appearance of either\\nof these conditions as a normal tooth could be, yet an idiosyncrasy\\nor predisposition existed the exciting cause only being needed to\\ndevelop it.\\nWith this deposit and accumulations between two unyielding bony\\nsurfaces and the pressure on the tissue elements in consequence, these\\nsalts will act as specific irritants and engender the well-known phe-\\nnomena pain, congestion, swelling, exudation, impaired nutrition,\\ntissue disorganization, the formation of pus, an osteomyelitis resulting\\nin the absorption of the alveolar process, and finally the exfoliation\\nof the teeth characteristic of pyorrhea alveolaris. The most general\\nseat for the deposition of these salts is toward the apex of the root,\\nwhere the texture of the alveolo-cemental membrane is less firm and\\ncompact, and more bulky.", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0531.jp2"}, "532": {"fulltext": "524 PYORRHEA ALVKOLARIS.\\nThe supposition that pyorrhea alveolaris is a local expression of the\\ngeneral diathesis has been converted into an actuality by the demonstra-\\ntion of the presence of uric acid and its allied salts in the incrustation\\nfound on the roots of the exfoliated teeth. The chemical analyses made\\nby Prof. Ernest Congdon of the Drexel Institute have demonstrated\\nthe presence of these salts beyond question. 1 All of the established\\ntests for uric acid were employed and in all instances crystals of uric\\nacid, sodium urate, and calcium phosphate were detected. In several\\ninstances sodium urates were most abundant. The constant presence\\nof these salts on the surfaces of the roots the presence of which is\\nascertained by proper analyses and aided vision taken in connection\\nwith the fact of the coexistence of gouty disorders in other tissues justi-\\nfies the belief that the form of pyorrhea alveolaris here described is a\\ngouty inflammation.\\nThe derivation of the salts from the blood, the abundance of the\\ncalcium salts present, and the primary location of the inflammatory pro-\\ncess suggested to the writer the term hematogenic calcic pericementitis,\\nthough it is admitted that the single epithet gouty pericementitis would\\nbe sufficiently explanatory and descriptive. The succession of patho-\\nlogical states is readily explained and justified by the uratic deposit.\\nThe formation of pus is preceded by a lowering of the vitality and solu-\\ntion of the pericemental tissues. This having been accomplished, the\\ndisintegrating peridental membrane affords a favorable nidus for the\\nentrance and development of micro-organisms, which can be effected\\neither by the route of the circulation or by lesions around the gum\\nmargins which give opportunity for direct infection from the oral fluids.\\nWhen organisms once gain access to the devitalized tissue they mul-\\ntiply with great rapidity, and in so doing increase the disintegration and\\nsolution of the pericemental membrane with the formation of pus. The\\nspecific bacteria which have been demonstrated to be present in the pus\\nare the usual forms the staphylococcus pyogenes aureus, citreus, and\\nalbus which though capable of producing pus are not pathogenic in the\\nsense that they are the causative agents of the pericementitis with the\\nformation of an abscess. The purulent fluid burrows in the line of\\nleast resistance, which in the majority of cases is toward the gum mar-\\ngin, whence it is discharged into the mouth, the fistulous tract thus\\nestablished constituting the well-known pyorrheal pocket.\\nBy the continued irritation of the uratic deposition and the co-opera-\\ntion of micro-organisms, the inflammatory process extends until the\\nmembrane is destroyed to such an extent that it is no longer capable\\nof nourishing and supporting the teeth.\\nThe absorption of the alveolar process is in accordance with the laws\\n1 See International Dental Journal, 1894, vol. xv. p. 1.", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0532.jp2"}, "533": {"fulltext": "GOUTY PERICEMENTITIS. 525\\ngoverning bone softening and absorption in general. Any constant\\npressure, whether from inflammatory exudation, from tumors, or from\\nmechanical or infective agencies which interfere with its nutrition, will\\nlead to softening and absorption. In pericementitis the effusion exerts\\na pressure in both directions, toward the cementum and toward the\\nalveolar walls as the latter are spongy in character, they readily yield\\nto the absorptive process. Should the pressure continue indefinitely,\\nor until the alveolar walls become denuded, caries or necrosis would\\ninevitably result. Fortunately this termination is seldom if ever seen\\nthe most careful examination of the alveolar process of a large number\\nof patients has failed to show any alveolar denudation never, in the\\nwriter s experience, has there been either caries, necrosis, exfoliation,\\nor sequestration of bone. Nor could there be, for the reason that the\\nteeth are removed either naturally or artificially before complete de-\\nstruction of the pericemental membrane has been accomplished. With\\nthe removal of the teeth and its associated irritants the process of re-\\npair at once begins. The dead and dying tissues are removed, and\\nfibrous tissues make their appearance, organization is established, and\\nin a short time all traces of abnormal action have disappeared.\\nDiagnosis. The diagnosis of pyorrhea alveolaris becomes compara-\\ntively easy when its constitutional relations, its mode of origin, its prin-\\ncipal symptoms and pathology are borne in mind. The only diseases\\nwith which it might be (indeed, has been) confounded are, first, that form\\nof pericementitis which has been designated a ptyalogenic calcic peri-\\ncementitis or, second, a general gingivitis due to some systemic dis-\\nturbance such as results from mercurial ptyalism or syphilis or, third,\\na severe inflammation of continuity due to some local disturbance such\\nas an ill-fitting partial denture or an impacted tooth, possibly a third\\nmolar, greatly aggravated by some morbid systemic condition. These\\nforms of pericementitis, however, present many points of contrast, dif-\\nfering in their clinical history, their pathology, symptomatology and\\nsusceptibility to treatment. In the hematogenic forms the patient, in\\nthe great majority of cases, presents some other manifestations more or\\nless pronounced, of the gouty or rheumatic diathesis.\\nThe age at which it makes its appearance is usually from thirty-five\\nto fifty years. The extreme pain frequently present around the roots of\\none or more teeth in the early stages, and before there is any evidence of\\na gingivitis the deviation in the position, and the apparent or actual\\nelevation of the tooth, with response to pressure the swelling or thick-\\nening of the pericemental membrane slight tumefaction of the gum\\nwith deep red or purplish color opposite the apical end of the root of\\nthe tooth or teeth affected and all of this before the appearance of pus\\nthe isolated character of the inflammation, being usually confined to one", "height": "4572", "width": "2804", "jp2-path": "americantextboo00kirk_0533.jp2"}, "534": {"fulltext": "526 PYORRHEA ALVEOLARIS.\\ntooth or two or more teeth in widely separated regions of the mouth\\nthe exudation and discharge of pus along but one side of the root,\\ndetaching the gum at the neck, thus establishing a sinus or pus pocket\\nthe increase of the flow of pus from the interior of the alveolus under\\npressure the usually limited amount of calcic deposition as contrasted\\nwith the ptyalogenic form the destruction of the pericemental mem-\\nbrane and the denudation of the cementum the absorption of the\\nalveolar process the loosening and exfoliation of the teeth indurated\\nin structure and changed in physical appearance are the main charac-\\nteristics of the disorder all these features taken in their totality so\\nindividualize this disease that there should be no difficulty in identi-\\nfying it.\\nIn the ptyalogenic form almost the opposite conditions prevail. As\\na general rule there is no evidence that there is any constitutional diath-\\nesis of which it might be an expression. The age at which it presents\\nitself extends from the eighteenth year, sometimes earlier, to any period\\nin later years, varying in its virulence with the varying systemic condi-\\ntions and food habits of the individual. The presence of a calcic depo-\\nsition around the neck of the tooth is often most abundant the primary\\ngingivitis occasioned by the presence of this mechanical irritant is not\\nconfined to one tooth nor to isolated regions of the mouth the subse-\\nquent extension (where neglected) and infiltration of this deposit into\\nand beneath the pericemental membrane the localization of the sup-\\npuration in the early stages around the margin of the gums the de-\\nlayed loosening of the teeth, the infrequent loss of the teeth and the\\nsusceptibility to successful treatment upon the removal of the salivary\\ndeposit these features taken together fully characterize this disease and\\nrender its identification easy.\\nContrasting these different inflammatory states of the pericemental\\nmembrane from their inception to their termination, it becomes evident\\nthat distinct yet closely allied diseases are here very frequently confused\\nand associated.\\nCausation. If we take as our point of departure the postulate that\\nhematogenic calcic pyorrhea alveolaris is but a special manifestation of\\nthe gouty diathesis, we should expect to find in its causation the same\\npredisposing and exciting agencies operative as in the production of all\\nother manifestations of the general diathesis.\\nPredisposing Causes. 1. Heredity. Among the predisposing\\ncauses may be mentioned heredity, which may be regarded as one of\\nthe most important factors concerned in its development. The writer\\nfeels justified in asserting, after a careful investigation into the family\\nhistory of a large number of pyorrhea patients that fully 90 per cent,\\nmanifest an hereditary tendency to this disorder, parents and grand-par-", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0534.jp2"}, "535": {"fulltext": "GOUTY PERICEMENTITIS. 527\\nents having been victims of the same disease. Magitot was impressed\\nwith the significance of this fact years ago, and stated that pyorrhea\\nextended through two and three generations and made its appearance\\nat corresponding periods of life and in similar types of constitution.\\n2. Sex. As far as the writer s observations extend, sex does not\\nappear to have much influence in the production of pyorrhea, women\\nseeming to be equally affected Avith men eliminate the masculine\\ndietary habit and there would certainly be little difference in the pre-\\ndisposition to the disease.\\n3. Age. The age at which pyorrhea most frequently presents itself\\nis the period of middle life that is, between the ages of thirty and\\nfifty. It may be, though it is very rarely seen before the age of\\nthirty, and still less frequently does it make its appearance after the\\nage of sixty. These observations are corroborated by the writings of\\nMagitot and others. It is very evident that pyorrhea is a disease\\nbelonging largely to a period of life when growth has ceased and food\\nis required only for tissue repair and the production of heat.\\n4. Diet. A careful investigation into the dietary of pyorrhea\\npatients will disclose the fact that there is usually a consumption of\\nexcessive quantity of both albuminous and starchy foods, much more\\nthan is necessary for the maintenance of the nutrition, and more than\\ncan be completely oxidized under the customary or existing modes of\\nthe individual s daily life. Coincidently there is also a diminished\\nconsumption of water, leading to an imperfect elimination and a reten-\\ntion of the products of this incomplete oxidation. In connection with\\nexcessive consumption of food must be also mentioned as co-operative\\nfactors the use of fermented malt liquors, the richer claret wines, cham-\\npagnes, etc. While perhaps no one class of foods can be said to be\\nespecially active in the causation of pyorrhea it is evident that exces-\\nsive quantity and variety, by impairing the activity of the digestive appa-\\nratus and giving rise to a large quantity of nitrogenized waste products\\nthrough imperfect oxidation, would materially impair and lower the func-\\ntional activity of the system generally and individual tissues in particular.\\n5. Sedentary Occupations. Occupation is also an important factor\\nin the production of pyorrhea. In the majority of instances the disease\\nmakes its appearance in those who are obliged to lead lives of enforced\\ninactivity school teachers, accountants, etc. All sedentary occupations\\nwhich necessitate insufficient personal exercise will favor the imperfect\\noxidation of food and at the same time retard the elimination of waste\\nproducts.\\nExciting Causes. The immediate agency in the development of\\npyorrhea is undoubtedly the deposition in the pericemental mem-\\nbrane of waste products of nitrogenous metabolism in combination", "height": "4572", "width": "2808", "jp2-path": "americantextboo00kirk_0535.jp2"}, "536": {"fulltext": "528 PYORRHEA ALVEOLARIS.\\nwith calcium salts derived from the blood. This morbific material, play-\\ning the part of foreign bodies, irritates and excites the membrane to\\ninflammatory activity and all its attendant symptoms. But even ad-\\nmitting this deposition, there must be some predisposition on the part\\nof the membrane which makes it specially liable to such deposition.\\nThis, it is believed, is in harmony with gouty deposition in all other\\ntissues of the body it is to be found in impaired nutrition and lowered\\nvitality in consequence of mechanical strain from an overcrowding of\\nthe dental arch, contusions or injuries consequent upon the usual and\\napparently unavoidable dental manipulations, such as wedging and\\nmalleting, and similar procedures. It may be from the unskilful em-\\nployment of toothpicks, toothbrushes, etc. though these latter are rare\\nas compared with other acts and conditions which may impair the nor-\\nmal nutritional condition of the pericemental membrane. On numer-\\nous occasions where the predisposition existed, pyorrhea has devel-\\noped immediately following operations upon one or more teeth. Prof.\\nArmand Depres 1 attributes considerable importance to the overcrowded\\ncondition of the dental arch as a predisposing cause in the develop-\\nment of pyorrhea.\\nTreatment. The treatment of gouty pericementitis resolves itself\\ninto both local and constitutional.\\nThe local treatment is to be directed toward removal of the deposit\\nand the control and the suppression of the inflammation and its con-\\ncomitants, and has been already described at p. 511 in connection with\\nthe study of ptyalogenic calcic pericementitis.\\nConstitutional Treatment. Whatever the predisposing cause may be,\\nthe immediate or exciting cause must ever be borne in mind. This, it\\nis believed, to a certain extent at least is found in all of those mechani-\\ncal agencies, so well known to the dentist, which impair or lower the\\nnutritional level of the pericementum, thus rendering it liable, under\\ncertain systemic conditions, to a deposition of uratic salts. The ques-\\ntion has been raised as to why the membrane of one or more teeth\\nwidely separated or occupying positions on opposite sides of the mouth,\\neither simultaneously or successively becomes the seat of inflammation\\nwhen there is no continuity of structure. The answer to this must be\\nfound in the fact that impaired nutrition and lowered vitality in such\\nstructures are due in the majority of instances to mechanical injury of\\nthese. Malocclusion may be noted as a fruitful cause. It is certainly\\nwithin the experience of many observant dentists that pyorrhea has not\\ninfrequently developed around a tooth after it has been subjected to the\\nnecessary mechanical manipulations incident to tooth protection and\\ntooth preservation.\\n1 Legons de Clinique chirurgicale, p. 9-656.", "height": "4608", "width": "2856", "jp2-path": "americantextboo00kirk_0536.jp2"}, "537": {"fulltext": "GOUTY PERICEMENTITIS. 529\\nThis apparent interference with the nutrition of the pericemental\\nmembrane before the deposit of uric acid salts takes place is in accord-\\nance with what is believed to hold true for other manifestations of the\\ngouty diathesis. As a prophylactic measure, therefore, it is suggested\\nthat whenever there is the slightest tendency to pyorrhea, or any other\\nevidence of the gouty diathesis, great care should be exercised in all\\ndental operations, so as not to impair the nutrition of the pericementum\\nand thus establish the necessary condition for the uric acid deposit also\\ncorrection of all cases of malocclusion surgical rest as far as possible.\\nThe constitutional treatment which has been indicated as efficient in\\nthe elimination of already established uric acid conditions and the\\nrestoration of a faulty nutrition to its normal state may with great\\npropriety be subdivided into hygienic and medicinal.\\nThe hygienic treatment embraces systematic outdoor exercise, stimu-\\nlation of the functional activity of the excretory organs, the skin, bowels,\\nand kidneys, and regulation of the diet, which must be insisted upon in\\nall well-marked cases, and especially with those who, for various reasons,\\nlead sedentary and inactive lives. Increased muscular activity quickens\\ncirculation, induces deeper and fuller respiratory movements, leads to\\ngreater vigor in the general nutritive processes waste products are\\nremoved more rapidly and the combustion of the food increased by the\\nabsorption of a large amount of oxygen. The promotion of the func-\\ntional activity of the eliminating organs is well recognized as an import-\\nant hygienic measure.\\nThe perspiratory and sebaceous glands and the surface capillary circu-\\nlation should all be stimulated by sponging of the skin with cold water,\\nvigorous friction, and an occasional Turkish bath, where such treatment\\nis not contraindicated by pulmonary or cardiac affections. Where the\\nliver and intestinal glands are deficient in secretion with prevailing\\nconstipation, they should be stimulated into activity by the use of\\nsaline waters most excellent for this purpose being the Hunyadi Janos\\nand Frieclrichshalle. These are especially to be commended because\\nthey contain a large percentage of sodium and magnesium sulfates,\\nboth of which are useful as eliminating agents.\\nThe kidneys should be assisted in the excretion of waste products\\nby the free use of negative waters, or waters in which the saline con-\\nstituents are present in minimum quantity.\\nHot or distilled water in sufficient quantity will flush the alimentary\\nGanal, increase the volume of blood, and stimulate the kidneys to\\nincreased activity. It is not only a common observation, but rather\\na remarkable fact, that gouty patients are inclined to drink but a com-\\nparatively small quantity of water. One quart of hot water taken\\ndaily, in four doses, before breakfast, between meals, and at bedtime, is\\n34", "height": "4572", "width": "2808", "jp2-path": "americantextboo00kirk_0537.jp2"}, "538": {"fulltext": "530 PYORRHEA ALVEOLARIS.\\nconsidered most beneficial in its effects in dissolving and removing irri-\\ntating products.\\nThe most important of the hygienic measures in the treatment of\\nall gouty manifestations is that pertaining to the diet. As uric acid is\\na liitrogenized compound and therefore presumably one of the imper-\\nfectly oxidized products of albuminous or nitrogenized food, it is desir-\\nable that such foods be excluded as far as possible from the daily\\ndiet. The value of this measure is admitted and insisted upon by all\\nclinicians.\\nIn the milder manifestations of the gouty diathesis such as we\\nassume exists in pyorrhea, it is not so imperative that all albuminous\\nfood be prohibited nevertheless, as many patients are consumers of\\nlarge quantities of meat, it would be well to insist, if the effort to\\ncure is to be made, upon the total exclusion of beef, veal, mutton, and\\npork, restricting the patient in albuminous diet to white meat of fowl,\\noysters, fish, and lobsters. Cheese, beans, and the white of eggs are\\nconsidered objectionable, and in many cases of acute gout are strictly\\nprohibited by the attending physician.\\nExperience has shown that various alcoholic drinks, such as cham-\\npagnes, port, madeira, and sherry, are particularly liable to give rise to\\nthe accumulation of uric acid. The lighter wines, as claret and hock,\\nare not considered so injurious. The malt liquors, beer, ale, and porter,\\nare also by many clinicians considered in their influence to be great\\noffenders.\\nThe medical and constitutional treatment, it is obvious, should be\\ndirected toward the elimination of uric acid and its compounds. For\\nthis purpose remedies which promote the formation of soluble and\\neasily diffusible products which are readily eliminated by the kidneys\\nare indicated. From time immemorial the alkalies and alkaline com-\\nbinations have been used with marked success in the management of all\\nphases of the gouty diathesis.\\nThe treatment of acute gout necessitates, of course, different or more\\nvigorous remedies than those required for the subacute or chronic forms\\nwith which the dental practitioner will be called upon to deal.\\nOf the various alkalies, lithium compounds the citrate and car-\\nbonate have been found well adapted to the milder phases of the\\ndisease. The writer has had much satisfaction in using, on the sugges-\\ntion of Dr. E. C. Kirk, the tartarlithine lithium bitartrate, also alka-\\nlithia prepared in the same form as the above-named compounds com-\\npressed tablets containing five grains each one tablet three or four\\ntimes daily will be found sufficient. Should the use of these lithia\\ntablets not agree with the patient, the potassium carbonate in ten-grain\\ndoses, in some simple bitter gentian or quassia water three or four", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0538.jp2"}, "539": {"fulltext": "GOUTY PERICEMENTITIS. 531\\ntimes daily, may be substituted. A valuable adjunct to the medicinal\\ntreatment is the free use of alkaline waters, which assist in the elimi-\\nnation of waste products, though it is probable that the good effects\\nattributed to these are largely due to the quantity of liquid consumed.\\nThe Saratoga, Vichy, alkaline waters of Wisconsin, the Marienbad,\\nCarlsbad, Apollinaris, etc. have all been found efficacious. Should\\nthe patient be very dyspeptic, as is frequently the case, remedies\\ndirected to the digestive viscera are of course indicated. If anemia be\\na concomitant, iron and quinin will be necessary. A combination\\nwhich has been found of great value in improving the quality of the\\nblood is one of iron and a salt of potassium. Bland s pill, consisting\\nof these two ingredients, is a desirable form for administration one\\nthree times a day will be sufficient.\\nThere is in addition one factor which may be regarded as therapeutic\\nor at least prophylactic, and which is deserving of more than a passing\\nnotice, viz. the exercise of great care in the avoidance of injuries to the\\npericemental membrane, wherever there is a possibility of the presence\\nof the unfortunate diathesis.\\nHowever ingenious our interpretation of pathological conditions\\nmay be, and however plausible our deductions may appear, the ultimate\\ntest of their value will be the readiness with which they yield to and\\ndisappear under appropriate treatment.\\nIf pyorrhea alveolaris be a manifestation of the gouty diathesis, and\\nthe symptoms and pathological conditions which characterize it be ex-\\ncited and maintained by the deposit and pressure of uric acid and its\\nsalts, it should be in general terms amenable to the therapeutic measures\\nwhich have been efficacious in the treatment of all other forms of gout\\nin other portions of the body. It must be borne in mind, however, that\\nthough a case be cured for a period of six months, or even a year, this\\ndoes not preclude a relapse should the patient return to an improper\\ndiet or irregular mode of life. It is hardly necessary to say that this\\nis true of all diathetic diseases. In individuals predisposed to uric acid\\naccumulations, a new mode of life is to be instituted and followed with\\nextreme care for a long period of time.\\nThe conclusions entertained may be represented in a condensed form\\nin the following postulates\\n(1) Pyorrhea alveolaris of constitutional origin which is its most\\ndestructive and unyielding form primarily begins as a local inflam-\\nmatory disorder in tissues on the side of the root near the apical ex-\\ntremity, and secondarily advances in the very large majority of cases\\ntoward the gingival borders.\\n(2) The cause of this inflammation, or gingivitis and pericementitis,\\nis the plasma exudation from the bloodvessels, freighted with salts", "height": "4564", "width": "2812", "jp2-path": "americantextboo00kirk_0539.jp2"}, "540": {"fulltext": "532 PYORRHEA ALVEOLARIS.\\nwhich in their deposition and crystallization upon the cementum of the\\nroot and infiltration of the more vascular tissues, exert the influence\\nof foreign bodies and react as irritants.\\n(3) The salts in question, as disclosed by chemical analysis, are cal-\\ncium and sodium urates, free uric acid, and calcium phosphate.\\n(4) The chemical nature of these salts indicates a condition of the\\nblood in which there is an excess of uratic salts and uric acid due to\\neither increased formation or imperfect elimination.\\n(5) The excess of these salts, as is well known, is regarded by gen-\\neral pathologists as indicative of a faulty metabolism, and is the imme-\\ndiate cause of a series of local disturbances to which the term gouty has\\nbeen applied, the nutritional disturbance giving rise to what is known\\nas the uric acid diathesis.\\n(6) An attentive study and accurate observation of the various\\norgans and tissues of patients suffering with pyorrhea alveolaris have\\ndisclosed the coexistence, in a very large proportion of them, of one or\\nmore local expressions of this constitutional diathesis.\\n(7) Recognition of the fact that a constitutional malady presents\\nitself, one phase of which only has claimed the attention of the dental\\npractitioner, indicates that a treatment designed to be curative must\\nhave reference not only to the local expression, but especially to this\\nimportant systemic condition as well.\\n(8) Results from constitutional treatment in connection with the\\nusual local applications in a number of well-authenticated cases of\\npyorrhea alveolaris have been so markedly satisfactory that the writer\\nfeels fully justified in his assumptions regarding the origin of the\\ndisease.\\nWhile the foregoing pages embody views quite consistent with an\\nextended experience, yet the writer fully appreciates the fact that many\\nabnormal conditions closely allied in superficial characteristics to those\\nabove recognized and described may exist without any other local\\nexpressions indicating a uric acid dyscrasia.\\nThe association of the class of dental diseases included under the\\ngeneric title of pyorrhea alveolaris with conditions of general mal-\\nnutrition has been recognized by many writers during the past hun-\\ndred years, but until within very recent times no systematic attempt\\nhad been made at their classification. Dr. M. L. Rhein, who has\\nclosely studied the relations existing between general disorders and the\\ndental diseases, finding that many general diseases are accompanied by\\nthe symptom pyorrhea alveolaris, and that the dental disorder persists\\nso long as the general disease is in activity, suggests that the diseases\\nknown under the latter title be divided into two classes pyorrhea\\nsimplex and pyorrhea complex.", "height": "4612", "width": "2880", "jp2-path": "americantextboo00kirk_0540.jp2"}, "541": {"fulltext": "GOUTY PERICEMENTITIS. 533\\nUnder the head pyorrhea simplex are included all of those varie-\\nties and cases in which local therapeutic measures suffice to effect\\na cure. 1\\nPyorrhea complex covers those cases and varieties in which local\\ntherapeusis fails to subdue the dental disease, and which are associated\\nwith some perversion of general nutrition. This class is subdivided\\ninto four groups (o) Those due to nutritional disorders such as gout,\\ndiabetes, chronic rheumatism, nephritis, scurvy, chlorosis, anemia,\\nleukemia, pregnancy (6) Those occurring during attacks of acute infec-\\ntive diseases, as typhoid fever, tuberculosis, malaria, acute rheumatism,\\npleurisy, pericarditis, syphilis (c) Those due to nervous disorders,\\ncerebral diseases, spinal diseases, neurasthenia, hysteria (d) Con-\\nditions resulting from the action of toxic drugs mercury, lead,\\niodids.\\nDr. Rhein believes from his studies that each member of the group\\nof pyorrhea complex has a distinctive clinical expression, which might\\nbe utilized as diagnostic signs of the constitutional conditions.\\nOne who is familiar with oral abnormalities and able to differentiate\\nthem must be very liberal in the interpretation of causes in order to\\nembrace the wide range of pathological conditions which, in some stages\\nof development, present appearances that would or could very properly\\nbe termed pyorrhea alveolaris, yet whose very ready response to topical\\nremedies would naturally suggest that they were not associated with a\\nuric acid habit. While fully recognizing the fact that this uric acid\\ndyscrasia can be associated with almost any disease which is a concomi-\\ntant of malnutrition, we must remember and fully appreciate the fact\\nthat imperfect assimilation of food and faulty metabolism are often\\nresponsible for local abnormalities, and at the same time they may be\\nfactors in the establishment of a uric acid dyscrasia.\\nIn one s judgment of the soundness or unsoundness of theories or\\nhypotheses, the fact must not be overlooked that affections of the kid-\\nneys, the liver, the lungs, the heart, the mucous membrane, the stomach,\\netc. may exist without any other recognized expression, or we may have\\nirritation of the pericemental membrane alone associated with any one\\nof them, the disturbance of the normality of this tissue being severe or\\nslight as the functional or organic abnormality of the organ is exalted\\nor inconspicuous.\\nWhile in the previous pages the treatment advocated had reference\\nmainly to that form of pyorrhea the concomitant of the gouty diathesis,\\nit must nevertheless be borne in mind that a similar condition of the\\npericemental membrane is at times associated with other perversions of\\nthe general nutrition, as pointed out by Dr. M. L. Rhein, and which\\n1 Denial Cosmos, 1894, p. 780.", "height": "4572", "width": "2808", "jp2-path": "americantextboo00kirk_0541.jp2"}, "542": {"fulltext": "534 PYORRHEA ALVEOLARIS.\\ntherefore must receive treatment especially adapted to the general con-\\nstitutional state.\\nInasmuch as these constitutional conditions are complex in their\\nmanifestations and their medicinal and hygienic management almost\\nexclusively in the hands of the physician, the duty of the dental prac-\\ntitioner is confined largely to the question of diagnosis the local treat-\\nment, however, must be varied in accordance with the peculiarities of\\nthe local pathological condition.", "height": "4580", "width": "2880", "jp2-path": "americantextboo00kirk_0542.jp2"}, "543": {"fulltext": "CHAPTER XX.\\nDISCOLORED TEETH AXD THEIR TREATMENT.\\nBy Edward C. Kirk, D. D. S.\\nDiscoloration of a tooth is consequent upon death of its pulp.\\nWhile death of the pulp does not always or necessarily involve dis-\\ncoloration of the tooth structures, yet when the condition does exist the\\ngeneral cause is as stated. Reference is here made to a progressive\\ninterstitial staining of the entire dentin structure, and is exclusive\\nof certain metallic stains, and also localized stains resulting from the\\nimbibition of pigmentary matters which occasionally are observed where\\nsmall areas of dentin have become denuded of enamel covering, or\\nwhere the latter has been so imperfectly formed as to afford an in-\\nsufficient barrier to the ingress of pigmentary matters from the food\\nor oral secretions.\\nThree classes of conditions are presented for consideration and treat-\\nment First, cases where discoloration has resulted from death of the\\npulp due to causes other than its exposure second, discoloration from\\npulp death consequent upon exposure and third, special discolorations\\ndue to adventitious causes superadded to the conditions affecting the\\ncases included in the foregoing second division.\\nAny of the numerous traumatic causes which bring about death of\\nthe pulp, e. g. blows, sudden contact with hard substances, biting\\nthreads, violent thermal shocks, the injudicious application of continuous\\nforce in regulating, or the application of arsenous oxid to the dentin\\n(see p. 425), where no exposure or only minute exposure of the pulp\\nexists, may produce hyperemia and congestion of the pulp, or strangu-\\nlation of its circulatory system, the formation of emboli, thrombus,\\nhemorrhagic infarct, etc., leading to a breaking down of the corpus-\\ncular elements of the blood, the escape of hemoglobin from the stroma\\nof the red corpuscles, its solution in the blood plasma, and resulting\\ninfiltration of the tubular structure of the dentin by the hemoglobin\\nsolution, giving the tooth a distinctly pinkish hue when examined by\\ndirect or transillumination.\\nTeeth so affected rapidly change in color through various gradations\\nin tint from the original pinkish hue, which becomes yellow this, grow-\\ning darker, passes into brown, and after the lapse of considerable time\\nthe tooth may become a permanent slaty gray or black.\\n535", "height": "4556", "width": "2792", "jp2-path": "americantextboo00kirk_0543.jp2"}, "544": {"fulltext": "536 DISCOLORED TEETH AND THEIR TREATMENT\\nThe violence of the pulpitis preceding the death and disintegration\\nof the pulp, in a considerable degree determines the rapidity of the\\nprocess of subsequent tooth discoloration. Where congestion of the\\npulp has been relatively slight and the necrotic process has proceeded\\nslowly, the sudden infiltration of the dentin with hemoglobin does not\\noccur, consequently the initial change in color following complete death\\nof the pulp may be so slight as to escape detection except upon most\\nsearching examination with special means of illumination, and even\\nthen may be manifested only by a slight diminution in the normal\\ntranslucency of the tooth as compared with adjoining teeth. Such teeth,\\nhowever, if permitted to remain untreated, eventually grow darker,\\nand while they may not acquire a degree of discoloration equal to those\\nwhich have suffered sudden and violent death of the pulp, still they\\nbecome so unsightly as to demand treatment for the restoration of\\ntheir normal color.\\nThe Rationale of the Process of Discoloration. In teeth dis-\\ncolored as a consequence of the death of the pulp without its exposure\\nviz. those of the first class it is evident that the sources of pigmenta-\\ntion are internal to the tooth and are to be sought for solely in the\\nproducts of decomposition of the elements of the pulp tissue and of its\\nvascular supply.\\nThe proteid elements of the pulp tissue are complex combinations\\nof carbon, oxygen, hydrogen, nitrogen, sulfur, and phosphorus, which\\nin their gradual breaking down by the process of putrefactive decom-\\nposition are split up finally into carbon dioxid, water, ammonia, and\\nhydrogen sulfid, with possibly the formation of traces of phosphatic\\nsalts. The group of substances entering into the composition of the\\nhistological elements of pulp tissue contains no constituents which in\\nthe progressive changes resulting from putrefactive decomposition\\nshould form compounds likely to cause permanent discoloration of\\nthe tooth structures.\\nWhen, however, the vascular supply is considered as a factor, the\\nexplanation of the cause of discoloration in the cases in question\\nbecomes reasonably clear. The red blood corpuscles contain as their\\ncharacteristic component hemoglobin or oxyhemoglobin according as the\\nblood is venous or arterial, and this substance is its essential coloring\\ningredient. When undergoing gradual decomposition, hemoglobin\\npasses through a variety of alterations in its chemical constitution,\\naccompanied by a corresponding series of color changes.\\nA familiar illustration of these color changes is furnished by the\\ncycle of color alterations witnessed in a bruise. Immediately following\\nan injury to the flesh, of the character alluded to, an extravasation of\\nblood in the bruised territory occurs, causing undue reddening of the", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0544.jp2"}, "545": {"fulltext": "RATIONALE OF THE PROCESS OF DISCOLORATION. 537\\nskin this is soon followed by an increasing darkening of the tissue,\\nuntil there results what is popularly termed a black-and-blue spot.\\nFurther decomposition of the coloring matter of the extra vasated blood\\ninduces a variety of color changes ranging through the scale of yellows\\nand browns, until the pigmentary matter is finally removed by absorp-\\ntion through the capillary bloodvessel system of the part.\\nIn passing through its cycle of color changes, hemoglobin undergoes\\nseveral alterations in composition during which a number of definite\\ncompounds are formed, each having marked chromogenic features. Of\\nthese decomposition products, methemoglobin (brownish red), hemin\\n(bluish black), hematin (dark brown or bluish black), and hematoidin\\n(orange), are the most important and best known. While the gradual\\ndecomposition of the coloring matter of the blood here noted may and\\ndoubtless does account for certain phases of tooth discoloration, other\\nfactors which exert a profoundly modifying influence upon the process\\nare yet to be considered.\\nThe putrefactive decomposition of the proteid elements of the pulp\\nresults, as before stated, in the production of hydrogen sulfid in con-\\nsiderable quantity. The albumins contain from 0.8 to 2.2 per cent, of\\nsulfur (Hammarsten) which in the splitting up of the compound during\\nputrefaction yields a large amount of hydrogen sulfid. In pulp decom-\\nposition this hydrogen sulfid is generated in contact with the hemoglobin\\nand necessarily exerts a marked modifying action upon the decomposi-\\ntion process of that substance. Miller says, If a current of sulfuretted\\nhydrogen is conducted through fresh blood or a solution of oxyhemo-\\nglobin in the presence of air or oxygen, sulfomethemoglobin is formed,\\nwhich is greenish red in concentrated solutions and green in dilute solu-\\ntions. If we lay a freshly extracted tooth in a mixture of meat and\\nsaliva so that a part of the enamel surface remains free, and moisten\\nthe surface with blood, it will take on a dirty-green color if kept at\\nblood temperature in an absolutely moist condition for from twenty-four\\nto forty-eight hours. It is quite possible that the dirty-green deposits\\nwhich form in putrid conditions of the mouth, in stomatitis mercurialis,\\nscorbutica, gangrenosa, etc., or even in inflammatory conditions of less\\nimportance, as well as in cases of absolute neglect of the care of the\\nmouth, may owe their green color to the presence of sulfomethemo-\\nglobin.\\nAs in pulp decomposition hydrogen sulfid is being formed in the\\npresence of hemoglobin, this fact warrants the belief that a combina-\\ntion takes place resulting in the formation of this same compound,\\nwhich Miller regards as productive of certain stains upon the external\\nsurface of the teeth.\\nThe slaty gray or bluish pigmentation always noticeable upon the", "height": "4564", "width": "2820", "jp2-path": "americantextboo00kirk_0545.jp2"}, "546": {"fulltext": "538 DISCOLORED TEETH AND THEIR TREATMENT.\\nvisceral walls and frequently beneath the skin of animal bodies under-\\ngoing putrefactive degeneration is a familiar example of the action of\\nhydrogen sulfid upon decomposing hemoglobin in hemorrhagic extrava-\\nsations, and is a process and form of pigmentation exactly analogous to\\nthat which is here described as taking place in the dentinal structure\\nfrom putrefactive decomposition of the pulp. When red corpuscles\\nare just beginning to disintegrate, the coloring matter formed is hemo-\\nglobin but the yellow and brown granular masses found in cells and\\nlying free in tissues are, as a rule, derivatives of hemoglobin, not hemo-\\nglobin itself. These derivatives are divided into two groups according\\nas they contain iron or not, the former being called hemosiderin, the\\nlatter hematoidin. l When acted upon by ammonium sulfid (a deriv-\\native of putrefactive decomposition of albumin) hemosiderin becomes\\nblack, iron sulfid being formed. 2 Grohe 3 believes that as a result of\\nputrefaction iron is liberated from its compound with hemoglobin, so\\nthat when thus freed it readily combines with the hydrogen sulfid.\\nIron is the most important element to be considered in the list of\\nfactors causing the discoloration of this group of cases. It is the iron\\nconstituent of the red corpuscles which is the essential chromogenic\\nfactor from first to last in their cycle of color changes.\\nThe process of putrefactive decomposition consists of a series of\\nchemical changes wrought out through the agency of micro-organisms,\\ninvolving the breaking down by successive stages of highly complex\\norganic compounds and their resolution into compounds of much sim-\\npler constitution. It is not known to what extent this splitting up of\\nthe components of the pulp and its vascular elements is ultimately car-\\nried in the series of changes resulting in the permanent discoloration\\nof the tooth. From what is known of the ultimate composition of the\\ncompounds involved it may, however, be safely inferred that, reduced\\nto its lowest terms, the result would be the formation of iron sulfid, the\\nelements of which, with the exception of some unimportant alkaline and\\nearthy salts, are the only ones entering into the original compounds\\nwhich are fixed and therefore capable of forming a stable residuum in the\\ntubular structure of the dentin. While iron sulfid as such cannot be\\nheld wholly accountable for the final bluish-black color of a tooth which,\\nhas reached the stage of permanent discoloration, the pigmentation is\\nalmost certainly due either to it or to some allied compound in which\\niron and sulfur, with some organic constituents, largely enter, and which\\nby a further slight decomposition would yield true iron sulfid.\\nThe significance and importance of a recognition of the possible\\npresence of the iron compound as a factor in tooth discoloration is\\nfurther brought out in the study of bleaching methods (pp. 542 and 558).\\n1 Ziegler, General Pathology, 1895. 2 Ibid. 3 Virchow s Archiv., Bd. xx.", "height": "4608", "width": "2880", "jp2-path": "americantextboo00kirk_0546.jp2"}, "547": {"fulltext": "DISCOLORATION FOLLOWING DEATH OF THE PULP. 539\\nDiscoloration of Teeth following Death of the Pulp consequent\\nupon its Exposure. When death and decomposition of the pulp is\\nconsequent upon exposure of that organ, through caries or otherwise, to\\nthe irritative influences of infective agents present in the oral secretions\\nand food, or to thermal shock, etc., the putrefactive process involving\\nthe pulp tissues is modified in character and rapidity to a degree which\\nmay affect the character of the resulting discoloration. Thus the yel-\\nlowish or brownish discoloration so often seen in teeth whose pulps\\nhave been devitalized through systemic or traumatic causes, and which\\nin many cases appears to be more or less permanent in character, is\\nrarely observed in those teeth whose pulps have been devitalized through\\nexposure by caries.\\nIn these latter cases the progress of the putrefactive process is com-\\nparatively rapid, the conditions being more favorable so that the color-\\ning matter of the blood is sooner reduced to its lowest terms in the scale\\nof decomposition products, i. e. to the slaty blue or black pigmentation\\nbefore noted. In addition to the increased rapidity of putrefactive de-\\ncomposition incident to cases of discoloration following pulp exposure,\\nanother and important modifying factor in the process of discoloration\\nis the ingress afforded to the oral fluids, food materials, and other ad-\\nventitious substances which find their way into the mouth and ulti-\\nmately, through the open cavity of the tooth, to its pulp canal and\\nthence to the tubular structure of the dentin. These extraneous sub-\\nstances, in the course of time, may infiltrate the tooth structure, and\\nwhile no especially noticeable or characteristic effect may be observed\\nso far as color is concerned, yet they frequently exert an influence upon\\nthe coloration of the tooth which so alters its character as to render\\nsuccessful bleaching treatment extremely difficult and a resort to special\\nmethods or a variety of methods necessary.\\nThe introduction of fatty or oily substances or of astringent and\\ncoagulant matters, for example, may act upon the coloring matter in\\nsuch a way as to permanently set it in the same manner that mor-\\ndants form insoluble compounds or lakes with the dye-stuffs used in\\nthe dyeing of textile fabrics.\\nAnother and important class of substances which frequently are the\\ncause of staining of the tooth structure are metallic salts which are used\\nin dental therapeutic treatment or are accidentally formed during the\\napplication of corrosive medicaments to the teeth, through the action of\\nsuch remedies upon fillings in situ or upon the instruments by which\\nthe applications are made. For example, the use of iodin or sulfuric\\nacid in connection with steel instruments and the subsequent use of\\nmedicaments containing tannin as an ingredient.\\nThe treatment of these conditions w T ill be separately considered.", "height": "4552", "width": "2800", "jp2-path": "americantextboo00kirk_0547.jp2"}, "548": {"fulltext": "540 DISCOLORED TEETH AND THEIR TREATMENT.\\nTooth-Bleaching. Use of Ohlorin.\\nNature of the Problem Involved in Tooth-Bleaching The\\nbleaching process is dependent upon a chemical reaction between a com-\\npound having color and some substance capable of so affecting its com-\\nposition that the color is discharged, or, in other words, of so affecting\\nthe integrity of the color molecule as to destroy its identity, which\\nresults in a loss of its distinguishing characteristic, viz. its color.\\nThe substances concerned in discoloration of tooth structure, as has\\nbeen previously shown, are derived from the pulp and its vascular\\nelements and the organic contents of the tubular structure of the dentin,\\nthrough the gradual putrefactive processes which become operative\\nsubsequent to the death of the pulp. These pigmentary products of\\npulp decomposition we know to be organic in character; and further,\\nthat they exhibit the property of color by virtue of definite conditions\\nof molecular composition- that is to say, a certain arrangement of a\\ndefinite kind and number of atoms has resulted in the formation of a\\nmolecule having its individual group of chemical and physical prop-\\nerties, among which latter is a characteristic color.\\nWhatever brings about an alteration in the composition of the mole-\\ncule at once destroys the identity of the matter so treated. Hence if\\nwe can act upon the coloring matter which gives rise to the staining of\\na tooth by means of an agent capable of effecting an alteration in the\\natomic arrangement or composition of the color molecule, we may expect\\nto remove or discharge its color feature.\\nTwo general classes of substances have been successfully used as\\nbleaching agents First, those which act by virtue of their power to\\nevolve oxygen in the active or nascent condition, and known as oxidiz-\\ning agents second, those which act in an opposite manner by virtue\\nof their strong affinity for oxygen and which are called reducing agents.\\nThe oxidizing bleachers destroy the identity of the color molecule by\\nseizing upon its hydrogen element to form water. The reducing agents\\nact by removing the oxygen atom from the color molecule to form by-\\nproducts depending upon the character of the reducing agent used.\\nChlorin and its associates iodin and bromin act as indirect oxidizing\\nbleachers the dioxid of hydrogen and of sodium are direct oxidizers.\\nPotassium permanganate may also be classed with this group, though its\\nsuccessful use as a bleaching agent depends upon a subsequent treat-\\nment of the substance to be bleached with some solvent capable of re-\\nmoving the manganese dioxid formed as a by-product of the action of\\nthe permanganate. It has somewhat extensive and satisfactory use as\\nan agent for bleaching sponges, and has been used for bleaching teeth,\\nbut is of greatly inferior value to other agents for the latter use.", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0548.jp2"}, "549": {"fulltext": "TOOTH-BLEACHING\u00e2\u0080\u0094 USE OF CHLORIN. 541\\nThe only agent belonging to the group of reducing bleachers which\\nhas thus far been found available for bleaching teeth is sulfurous oxid,\\neither in the gaseous condition or in aqueous solution.\\nChlorin as a Bleacher. The general use of chlorin as a bleaching\\nagent in the arts no doubt suggested its use in the treatment of tooth\\ndiscoloration. Its introduction as a tooth-bleaching agent, as well as the\\nassembling of the general principles of tooth bleaching into a co-ordi-\\nnate system, are due to Dr. James Truman, whose method depends upon\\nthe liberation of chlorin from calcium hypochlorite, commonly called\\nbleaching powder or chlorinated lime, in the pulp chamber and cav-\\nity of decay in the tooth. Chlorin is liberated from the bleaching pow-\\nder by the action of dilute acetic acid this taking place in contact with\\nthe discolored structure, it is rapidly bleached as a result of the action\\nof the chlorin upon the coloring matter contained in the dentinal tubules.\\nNumerous modifications of this original method of bleaching tooth struc-\\nture have been suggested, but, as the ultimate result in each is accom-\\nplished through the activity of chlorin, a rational understanding of the\\nmode of action of chlorin in this relation is of importance as an aid\\nto the intelligent use of those methods for tooth-bleaching which are\\ndependent upon or owe their efficacy to that agent.\\nChlorin is an elementary gaseous body, greenish in color, soluble in\\nwater, having a disagreeable odor, intensely irritating to the air-passages\\nwhen inhaled, and poisonous when breathed in sufficient quantity. It\\nhas a strong affinity for all metallic bodies, entering into direct combi-\\nnation with a number of them, under favorable circumstances, with\\ngreat energy forming, as a rule, compounds that are soluble in water.\\nOne of its distinguishing features and one which is directly concerned\\nin its use as a bleaching agent is its strong affinity for hydrogen. So\\nstrong is this affinity, that when a molecule of chlorin is brought into\\ncontact with a molecule of water under favorable conditions, the hydro-\\ngen of the water molecule is seized upon by the chlorin to form chlor-\\nhydric acid and the oxygen is set free in the nascent state, a condition\\nunder which its oxidizing powers are exhibited in their greatest intensity.\\nThis powerful affinity of chlorin for hydrogen enables it to decompose\\nmany other hydrogen-containing molecules in a similar manner, form-\\ning chlorhydric acid and destroying the identity of the matter acted\\nupon.\\nIt has been shown that all organic compounds which are the products\\nof the vital processes of the animal body contain hydrogen as an im-\\nportant constituent. This applies also to the decomposition products\\nwhose presence in the tubular structure of the dentin is the cause of\\ntooth discoloration.\\nThese organic stains exhibit the property of color by virtue of", "height": "4568", "width": "2812", "jp2-path": "americantextboo00kirk_0549.jp2"}, "550": {"fulltext": "542 DISCOLORED TEETH AND THEIR TREATMENT.\\ncertain definite conditions of molecular composition hence, if chlorin\\nis caused to act upon the coloring matter which causes the staining of\\na tooth, by seizing upon and combining with the hydrogen of the\\norganic pigment, the identity of the compound as such is destroyed,\\nand its characteristic feature, that of color, is lost.\\nThe principle here outlined is involved in what is termed the direct\\naction of chlorin in bleaching. There is, however, another method by\\nwhich chlorin is believed to act as a bleacher in which its function is\\nindirect. In some cases it has been observed that chlorin fails to act\\nexcept in the presence of moisture, and the rationale of this is that the\\nbleaching under such conditions is effected by nascent oxygen liberated\\nfrom the water molecule when the chlorin combines with its hydrogen\\nto form chlorhydric acid thus Cl 2 H 2 2HC1 O. That such\\nis the nature of the process in many cases is a reasonable deduction\\nfrom the behavior of chlorin under analogous conditions where it acts\\nindirectly as an oxidizing agent.\\nWhatever may be the exact nature of its ultimate action, it is to be\\nborne in mind that its bleaching effect is due solely to the alteration\\nwhich it makes in the composition of the color molecule, and that it\\nhas no solvent power whatever on the organic matter upon which it\\nacts. It changes its characteristics, but does not remove it by solution.\\nIt should be also noted in this connection that the chlorin compounds\\nof most of the metallic elements, especially when in dilute solution, are\\nalmost colorless as compared with many of the other metallic com-\\npounds the oxids and sulfids for example. Hence it is that where\\nstains owe their color to the presence of certain organic compounds\\nwith some of the metals, or even where the coloration is due to decom-\\nposition products of hemoglobin, the color may readily be discharged\\nby chlorin, but if the iron chlorid thus produced remains in the tooth\\nstructure it is gradually decomposed and new combinations of it are\\nliable to occur, which results in a return of the discoloration.\\nAll tooth-bleaching methods should aim not only to discharge the\\ncolor by suitable chemical means, but should go farther than this and,\\nas far as it may be possible to do so, remove all organic debris from the\\ntubules, for as long as any remains the tendency to a return of the dis-\\ncoloration is always a possible and indeed probable menace to the com-\\nplete and permanent success of the operation.\\nWhere the tubular contents cannot be successfully removed, the\\ntendency to a return of discoloration may be combated by hermetically\\nsealing the tubular orifices with an impermeable resinous varnish or\\npermanently coagulating them. This feature is described more fully in\\nrelation to the details of the bleaching procedure.\\nTeeth Suitable for the Bleaching Operation. In deciding upon", "height": "4580", "width": "2896", "jp2-path": "americantextboo00kirk_0550.jp2"}, "551": {"fulltext": "TOOTH-BLEACHING\u00e2\u0080\u0094 USE OF CHLORIX. 543\\nthe advisability of attempting the bleaching operation in any given case,\\nthe general conditions which determine the judgment of the operator\\nwith respect to all dental operations should govern his course.\\nAs all therapeutic and restorative measures in dentistry are a series\\nof compromises with disease conditions or their sequelae, it is the duty\\nof the operator under all circumstances to capitulate upon the basis of\\ngreatest advantage to the patient. Therefore if discoloration of a tooth is\\npractically the only factor in the problem presented by a given case,\\nthe effort should be made to restore the organ to its normal condition\\nof color. The same rule should be applied to all cases of discolored\\nteeth in which structural loss by caries or fracture has not been so great\\nas to preclude a satisfactory restoration by proper filling or replace-\\nment of the lost structure by a porcelain inlay. The cases in which it\\nis not advisable to attempt a bleaching operation are only those in which\\nloss of structure is so extensive as to require a crowning operation.\\nIn the judgment of many operators it is considered useless to at-\\ntempt the bleaching of any teeth excepting the incisors, because of the\\ndifficulty and length of time frequently required for the successful\\nbleaching of canines, bicuspids, and molars, owing to the thickness of\\ntheir walls and the consequent depth of structure requiring treatment.\\nIt is also held to be useless to attempt the bleaching of teeth which\\nhave been discolored by metallic stains throughout their structure.\\nThe fallacy of such a view is self-evident when it is considered that if\\nany portion of the dentinal structure of a discolored tooth is amenable\\nto the bleaching treatment, its complete restoration is simply a question of\\ncontinuance or repetition of the operation until the desired end is attained.\\nWith regard to discoloration by metallic stains, while teeth so af-\\nfected present problems of great complexity, and require not only\\nspecial study but the application of special methods of treatment based\\nupon proper recognition of the chemical relationships involved between\\nthe nature of the stain and that of the agent used for its removal, the\\nattempt should be made in justice to the patient, even though ultimate\\nfailure result, in order that the necessity for destruction of the natural\\ncrown for the purpose of its replacement by an artificial substitute may,\\nif possible, be postponed for as long a period as may be attainable.\\nPreparation of the Tooth for the Operation of Bleaching Cer-\\ntain general details are necessary to be observed in the preparation of\\nteeth for the bleaching operation, whatever may be the method of treat-\\nment employed.\\nAppropriate treatment for the removal of all septic matter from the\\npulp chamber and canal, and for the relief of any existing condition of\\nirritation of the pericemental membrane and tissues of the apical region,\\nshould have been carried out and the tooth brought to the condition in", "height": "4560", "width": "2812", "jp2-path": "americantextboo00kirk_0551.jp2"}, "552": {"fulltext": "544 DISCOLORED TEETH AND THEIR TREATMENT\\nwhich permanent closure of the apical foramen of the root may be safely\\nperformed.\\nThe rubber dam should be adjusted with especial care and only\\ninclude the tooth to be bleached. If two adjoining teeth are to be\\nbleached they may both be isolated by the dam, but in no case should\\none or more adjacent normal teeth be included with the tooth to be\\nbleached. While the inclusion of teeth adjacent to the one which is the\\nsubject of any ordinary dental operation is in nearly all cases desirable,\\nthere are good reasons why such a plan should not be pursued in the\\nbleaching procedure. The chemicals used for the purpose may possibly\\nhave some disintegrating or solvent action upon the enamel structure,\\nand such action, should it occur, should be confined strictly to the tooth\\nundergoing treatment and held within the limits of safety by close\\nobservation and appropriate treatment, which conditions cannot be as\\nthoroughly controlled and the process as satisfactorily managed when\\nseveral teeth are included within the territory of operation.\\nFurthermore, as nearly all of the bleaching agents used or those\\nwhich are employed as adjuvants in the process have a more or less\\nirritative or escharotic effect upon the soft tissues of the mouth, extra\\nprecautions must be taken, in adjusting the dam, against leakage at its\\nattachment to the cervix of the tooth. As the chances of leakage are\\ngreatly multiplied when several holes are punched in the dam for ad-\\njustment to as many teeth, it is for this reason also that no other than\\nthe tooth to be treated should have the dam adjusted to it.\\nSupposing the tooth to be an upper incisor, the dam should be\\nslipped over it and the margin of rubber encircling the cervix should\\nbe gently carried under the free margin of the gum either by means of a\\nsmall flat burnisher of suitable angle and curvature, or by means of a\\nwaxed floss-silk thread. One or two turns of a ligature should then be\\nthrown around the cervix below the dam to hold it securely in place.\\nThe dam may be fixed with greater security, especially as against any\\naccidental traction made upon it during the operation, by fastening it\\nwith a ligature made as follows and thrown around its cervix\\nA piece of waxed ligature silk about eighteen inches in length has\\na large knot tied at about its middle portion by making six or eight\\nturns of the thread loosely around the end of the index finger of the\\nleft hand. Upon withdrawing the finger a series of loops are had\\nthrough which one of the free ends of the thread is now passed, as\\nin making the first half of a flat knot, as illustrated in Fig. 480.\\nBy drawing upon the free ends of the thread until all of the loops\\nare closed upon themselves, a hard knot of more or less spheroidal\\nshape is formed about midway between the ends of the ligature. The\\nligature so prepared is placed around the tooth in such a manner that", "height": "4608", "width": "2860", "jp2-path": "americantextboo00kirk_0552.jp2"}, "553": {"fulltext": "TOOTH-BLEACHING\u00e2\u0080\u0094 USE OF CHLOBIN. 545\\nthe knot as described shall be located upon and at the middle portion\\nof the palatal cervical margin. A half knot is then made by tying the\\nligature in front so that it shall rest directly opposite the palatal knot,\\nviz. at the middle portion of the labial cervical margin. The ligature\\nis drawn into fairly close contact with the tooth, and, with both ends\\nheld firmly in the left hand and drawn somewhat tense, the portion\\nencircling the tooth is firmly but gently forced up against the rubber\\nFig. 480.\\ndam and gingival margin, the ligature at the same time being drawn\\ntightly until the anatomical constriction of the tooth at its cervix will\\nserve to hold it from slipping downward, especially upon the palatal\\naspect of the tooth.\\nWhen the ligature is found to be securely placed as described, the\\nknot upon the labial aspect is completed and further enlarged in bulk\\nby re-tying the thread four or five times. The free ends of the ligature\\nshould then be cut off close to the knot. As an additional safeguard\\nagainst leakage of irritating bleaching agents through the cervical\\nattachment of the dam, and out upon the soft tissues, it is well after\\nmaking the tooth perfectly dry to paint the ligature and a narrow band\\nof its adjacent territory with chloro-percha, which will effectually prevent\\nany accident from leakage.\\nThe placing of a large knot upon the palatal aspect at the cervical\\nmargin has another decided advantage in that it not only holds the dam\\nmore securely against slipping downward, but holds it away from the\\npalatal surface, which is ordinarily the point of entrance to the pulp\\nchamber and canals in these cases. The point of canal entrance may,\\nhowever, be through an approximal cavity, if such an one affords\\nsufficient access.\\nThe canal filling in all cases of bleaching without exception should\\nbe gutta-percha. No other material used for canal filling possesses the\\ngenerally desirable qualities needed for that purpose in this class of\\ncases. The extent of the canal filling should include one-third, or at\\nleast not over one-half, of the distance from the apex. A considerable\\nportion of the canal beyond the level of the gingival margin is thus\\nleft unfilled in order that the coronal end of the root may be bleached\\nas well as the tooth crown. This is especially necessary where more\\nor less recession of the gum from its normal attachment has occurred,\\n35", "height": "4556", "width": "2808", "jp2-path": "americantextboo00kirk_0553.jp2"}, "554": {"fulltext": "546 DISCOLORED TEETH AND THEIR TREATMENT.\\nleaving the cervical cementum exposed to the action of the oral fluids,\\nfood, etc., which have a tendency to cause discoloration of the exposed\\nroot tissue.\\nThe root being filled as directed, all fillings wherever existent in the\\ntooth should be removed. This is a preliminary procedure which\\nshould not be omitted in any case, but where any bleaching method is\\nused which involves the employment of chlorin as the active agent it\\nbecomes imperatively necessary for reasons which are explained in con-\\nnection with the description of the chlorin methods (page 547). Aside\\nfrom other considerations, the removal of all fillings preparatory to the\\nbleaching operation has a decided value in facilitating the process by ex-\\nposing an increased area of the dentinal structure and thereby permit-\\nting the action of the bleaching agent over a larger territory of ingress.\\nWhen all fillings or softened tooth structure have been removed, as\\nwell as all septic and extraneous matter of whatever character, by\\nmechanical process, the tooth should be washed thoroughly with dilute\\nammonia water, or better with a hot solution of borax in distilled water\\nin the proportion of $j to fgj. The object of this treatment is to re-\\nmove by saponification and solution all fatty matters which may obstruct\\nthe ingress of the bleaching agent into the dentinal structure.\\nIn nearly all cases where discoloration has occurred from a decom-\\nposed pulp and where the canals and pulp chamber have been left\\nuntreated, there will be observed, on opening into such a pulp\\nchamber for the first time, a dark layer of oily or greasy material\\nlining its walls. The thorough removal of this dark layer should\\nbe effected prior to any attempt at bleaching, as it appears to prevent\\nthe ingress of the bleaching agent into the dentinal structure. The\\nmost satisfactory method for removing the dark greasy layer is by the\\nuse of suitable instruments either properly shaped spoon or hoe ex-\\ncavators or round burs in the engine. The thorough removal of this\\nlayer necessitates free access to the pulp chamber, which should be\\nas a general rule obtained by means of an ample opening upon the\\nlingual aspect of the tooth in the case of incisors, and through the\\nmorsal surface in bicuspids, etc.\\nHaving by mechanical means and through the agency of borax or\\nammonia and hot distilled water effected a thorough cleansing of the\\ninterior portion of the tooth, it should next be dried to the extent of\\nhaving all superfluous moisture removed, and it will then be in condi-\\ntion for the application of whatever method of bleaching may be chosen\\nfor the particular case in hand.\\nDr. James Truman s Method. This, as before stated, was the first\\nmethod successfully employed for bleaching teeth. It consists in liberat-\\ning chlorin from ordinary chlorinated lime by means of a weak acid", "height": "4612", "width": "2872", "jp2-path": "americantextboo00kirk_0554.jp2"}, "555": {"fulltext": "TOOTH-BLEACHING\u00e2\u0080\u0094 USE OF CHLOBIN. 547\\nin the pulp chamber of the tooth. Any acid will effect the liberation of\\nchlorin from the bleaching powder, but acetic, tartaric, or oxalic are\\ngenerally used. Care must be observed in selecting a good quality of\\nbleaching powder, as that substance rapidly undergoes decomposition\\nspontaneously, especially in a moist atmosphere. Good chlorinated lime\\nis a dry powder having a strong odor of chlorin. If it is moist or pasty\\nand has but a feeble odor it should be rejected as worthless. Brands\\nof bleaching powder dispensed in metallic packages should not be used,\\nas they are invariably contaminated with metallic chlorids due to the\\nslow action of the contents upon the containing package. This is par-\\nticularly the case where sheet-iron boxes are used. The return of dis-\\ncoloration in many cases after bleaching by the Truman method is\\nundoubtedly due to the use of bleaching powder so contaminated.\\nThe powder dispensed in glass bottles or in paraffined paper cartons\\nis more reliable.\\nIts application to the tooth may be effected in several ways\\n(a) By packing the dry powder in the pulp chamber and then moist-\\nening the latter with the acid\\n(6) By mixing the powder with sufficient distilled water to make a\\ncoherent mass which is more easily manipulated, then packing it in the\\npulp chamber and applying the acid\\n(c) By first moistening the interior of the tooth with the acid, next\\ndipping the instrument into the powder and then into the acid, each\\ntime carrying the mixed materials into the tooth until the desired\\nchange of color is produced.\\nProbably the most satisfactory method is to pack the dry powder\\ninto the tooth and apply the acid to it, after which immediately seal the\\ncavity with a single pellet of gutta-percha. By using a 50 per cent,\\nsolution of acetic acid the evolution of chlorin will take place with a\\nsatisfactory degree of uniformity, and not so rapidly as to interfere with:\\nits penetration throughout the discolored tubular structure of the dentin..\\nThe bleaching mass may be sealed in place by means of oxyphosphate\\nof zinc if desired, but it is usually unnecessary to use anything other\\nthan gutta-percha or one of the soft temporary stopping materials for\\nthis purpose.\\nThe case may be dismissed for one or two days and the treatment as\\noutlined repeated at similar intervals until the tooth is restored to\\nnormal color.\\nThe instruments used in connection with this process should be of\\nvulcanite, bone, ivory or wood. Upon no consideration should steel,,\\ngold, or platinum instruments be used, as chlorin acts directly upon\\neach of these metals, forming soluble chlorids which if carried into the\\ntooth structure will give rise to a permanent staining of most intract-", "height": "4560", "width": "2804", "jp2-path": "americantextboo00kirk_0555.jp2"}, "556": {"fulltext": "548 DISCOLORED TEETH AND THEIR TREATMENT.\\nable character. The only metals which may be safely used in connec-\\ntion with any chlorin process of bleaching are zinc and aluminum,\\nthe chlorids of which are colorless. Aluminum instruments for the\\npurpose may be quickly improvised out of wire or heavy plate. Gold\\ninstruments have been recommended, but they are open to the very\\ngrave objection of forming a chlorid by direct combination with chlorin,\\nwhich salt is one of the most important staining media known to the\\nhistologist as a matter of fact the writer has seen several cases\\nwhere a permanent purple staining of the tooth has resulted from\\nneglect to remove gold fillings before applying the chlorin method of\\nbleaching, and there is certainly no reason why the same result should\\nnot follow the using of gold instruments in the same connection.\\nWhen the tooth has been restored to its proper color it should be\\nthoroughly washed with very hot distilled water, dried out with bibu-\\nlous paper and thoroughly desiccated with a current of dry hot air,\\nafter which the canals, pulp chamber, and cavities should be filled with\\noxy chlorid of zinc.\\nThe final filling of the cavities of entrance and of decay should be\\npostponed until by a lapse of considerable time the permanence of the\\noperation has been established. This probationary period may with\\nadvantage be prolonged to four or six months.\\n^The final washing of the tooth with hot distilled water previous to\\nthe insertion of the oxychlorid of zinc filling is a feature of the opera-\\ntion which requires special care and attention. As left after the appli-\\ncation of the bleaching agent, the pulp chamber and canals and denti-\\nnal structure are filled with free chlorin in solution, calcium acetate, or\\nother salt of calcium depending upon the nature of the acid used in\\nthe process, and some undecomposed bleaching powder. These sub-\\nstances should be thoroughly removed by the hot-water douche. At\\nleast a pint of water should be strongly injected into the interior of the\\ntooth by means of a large bulb syringe, before the dam is removed. A\\ntowel held in close proximity to the tooth will catch the water as it re-\\nturns from the tooth and protect the clothing of the patient. Distilled\\nwater should in all cases be used for this irrigating douche, as river\\nwater and many other specimens of water from natural sources contain\\niron in solution, which could readily become a contaminating factor\\nleading to subsequent return of discoloration.\\nOxychlorid of zinc is selected as the permanent filling for the pulp\\nchamber for the reason that it is necessary to so act upon the bleached\\norganic residuum in the tubular structure as to prevent any alteration\\nof its character which may result in the production of a subsequent\\ncoloration. Zinc chlorid possesses the property of converting many\\norganic substances into unalterable compounds by its coagulant action,", "height": "4608", "width": "2856", "jp2-path": "americantextboo00kirk_0556.jp2"}, "557": {"fulltext": "TOOTH-BLEACHING\u00e2\u0080\u0094 USE OF CHLORTN. 549\\nthus tanning or mummifying animal tissue and preserving it indefi-\\nnitely. A mass of oxychlorid of zinc, before it sets, i. e. before chemical\\ncombination takes place between the oxicl-of-zinc powder and the zinc\\nchlorid liquid, is functionally free zinc chlorid and as a matter of fact\\nthe properties of zinc chlorid are manifested by such a mass for a con-\\nsiderable period of time after the mass has apparently set. When\\nintroduced into the pulp chamber and canal, its action upon the organic\\ndebris in the tubuli is as stated, and the material, if the operation has\\nbeen successfully performed, is effectually prevented from further alter-\\nation, upon which condition the permanence of the operation depends.\\nAnother method for preventing subsequent alteration of the bleached\\norganic debris in the tubular structure is to thoroughly desiccate the\\ntooth by means of the hot-air blast and saturate the dentin with some\\ninsoluble resinous varnish, such as copal ether varnish, or what is still\\nbetter the solution of trinitrocellulose in methyl alcohol, known in com-\\nmerce as kristaline or at the dental depots as cavitine. The\\npulp chamber and canals may then be filled with any suitable filling.\\nAs between the oxychlorid of zinc filling and the varnish lining the\\nchoice in general should be of the former. The varnish lining is adapt-\\nable more especially to cases of long standing where complete liquefac-\\ntion of the tubular contents has left them practically empty, and where\\nas a consequence there is nothing upon which zinc chlorid can exert its\\ncoagulating effect.\\nOther Chlorin Methods. The solution of chlorinated soda known\\nas Labarraque s solution, or Liquor soda? chloratse U. S. P., may be\\napplied to the previously desiccated tooth structure until the dentin\\nis saturated with the solution, after which an application of a dilute\\nacid is made which liberates chlorin. The chemical principles in-\\nvolved are exactly analogous to those upon which the method with\\nbleaching powder depends, the only difference being that the source\\nof the active agent, chlorin, is in one case its calcium compound, which\\nis a dry powder, and in the second case the analogous soluble sodium\\ncompound of chlorin is the material from which the active agent is\\nevolved.\\nThe precautions necessary to be observed are exactly the same as\\nthose required in Truman s method already described. The results\\nobtained by this process are not as thorough or as satisfactory as by the\\nTruman method.\\nChlorin per se has been used for tooth-bleaching, and was the basis\\nof a method devised by Dr. E. P. Wright of Richmond, Ya.\\nWright s method involved the use of a complicated apparatus by\\nwhich a glass vessel of about a half-liter capacity, and filled with chlorin\\npreviously prepared in the laboratory, was connected by means of a", "height": "4556", "width": "2784", "jp2-path": "americantextboo00kirk_0557.jp2"}, "558": {"fulltext": "550 DISCOLORED TEETH AND THEIR TREATMENT.\\ndoubly perforated rubber stopper and two pieces of rubber tubing with\\na glass adapter, around the open end of which was tied the rubber dam\\nencircling the tooth to be operated upon. About midway of the length\\nof one of the rubber tubes connecting the chlorin reservoir with the\\nrubber dam was interposed an ordinary syringe bulb, so arranged with\\nhard-rubber valves that by repeatedly compressing and relaxing it the\\nchlorin would be drawn from the reservoir and injected through a glass\\ndelivery jet into the pulp chamber. Return of the gas to the reservoir\\nwas provided for by the second piece of rubber tubing first alluded to.\\nIn this way a continuous jet of chlorin was thrown into and about the\\ntooth, which by means of the rubber dam, was placed in a close cham-\\nber forming a part of the apparatus none of the gas could escape into\\nthe surrounding atmosphere. The complexity of the apparatus was\\na formidable obstacle to the general use of the method and it was\\nabandoned, though the results were in many cases very satisfactory.\\nThe Dioxid Bleaching Methods.\\nBleaching by Means of the Dioxid of Hydrogen and the Dioxid\\nof Sodium. The commercial introduction of solutions of hydrogen\\ndioxid marked a new era in the operation of bleaching discolored teeth.\\nThe bleaching property of hydrogen dioxid had been known to chemists\\nfor many years, but the application of this property to tooth-bleaching\\ndates from the medicinal use of hydrogen dioxid solutions for the treat-\\nment of purulent conditions of the pulp canal and about the roots of\\nteeth. When applied in the canals of discolored and infected teeth it\\nwas observed that a noticeable bleaching of the discolored structure\\nresulted. The hint thus given was further studied until it was found\\nthat under proper conditions the whole structure of a discolored tooth\\nmight be successfully restored to normal color.\\nThe earlier preparations were found to be lacking in strength\\naqueous solutions containing more than 3 or 4 per cent, of absolute\\nhydrogen dioxid were found to be too unstable to keep for any length\\nof time, and hence were unreliable. The problem of securing a stable\\nhigh-percentage solution of the dioxid was solved by using ether as a\\nmenstruum, and the 25 per cent, solution of hydrogen dioxid made by\\nMcKesson Robbins of New York and sold as caustic pyrozone\\nis now generally used where hydrogen dioxid is employed as a bleaching\\nagent in connection with discolored tooth structure.\\nHydrogen dioxid, H 2 2 belongs to the class of oxidizing bleach-\\ners, and owes its activity in this respect to the weak state of chemical\\ncombination in which one of its atoms of oxygen is bound to the water\\nmolecule. Many substances serve to disrupt the compound and liber-\\nate one of its oxygen atoms. In contact with pus, blood, inspissated", "height": "4612", "width": "2880", "jp2-path": "americantextboo00kirk_0558.jp2"}, "559": {"fulltext": "BLEACHING BY HYDROGEN DIOXID. 551\\nmucus, albumin, and in fact almost every kind of dead organic matter,\\nits decomposition takes place, evolving oxygen and decomposing the\\norganic matter either wholly or in part. Hydrogen dioxid does not\\nbleach all of the decomposition-products of hemoglobin with equal\\nfacility. It quickly removes the pink discoloration following the initial\\nextravasation of hemoglobin into the dentin, but when the brown stage\\nhas been reached indicative of the formation of hematin its action is but\\nslight. Later, however, it bleaches more readily. The refractory\\nnature of hematin with respect to hydrogen dioxid has been experimen-\\ntally tested upon the substance out of the mouth.\\nIn bleaching discolored teeth with hydrogen dioxid the ethereal 25\\nper cent, solution known as pyrozone is directly applied to the internal\\nportions of the tooth upon small pledgets of cotton or cotton wisps\\nrolled upon a fine flexible canal instrument. After each application\\nthe ethereal menstruum is evaporated by blasts of warmed air from a\\nhot-air syringe, and the applications similarly made are repeated until\\nthe desired effect is produced. It has been found in practice that more\\nrapid and permanent effects are produced when the pyrozone solution\\nis rendered alkaline. This may be readily done by the addition of a\\nfew drops of liquor ammonia? fortior or by a solution of one of the\\ncaustic alkalies, e. g. sodium or potassium hydroxid or sodium dioxid.\\nA very satisfactory method of securing the alkaline effect in this pro-\\ncess is that suggested by Dr. D. N. McQuillen. His method is to\\nfirst treat the pulp chamber and canals with applications of Schreier s\\nKalium-natrium preparation and after the debris from its action has\\nbeen mechanically removed with instruments and cotton twists, with-\\nout washing the canal, an application of pyrozone is made. The\\nbleaching action follows with great rapidity, and has apparently greater\\npermanence than where the pyrozone is used alone. In cases where\\nthe action proceeds very slowly, for example when at the end of a thirty\\nminutes continuous treatment the bleaching is not complete, it is well\\nto seal an application of pyrozone upon cctton in the canal and allow it\\nto remain for twenty-four hours, when a second treatment will usually\\ncomplete the operation.\\nIn this as in all bleaching operations it is advisable to fill the tooth\\ntemporarily with some easily removable filling in order to test the per-\\nmanence of the operation, and after the lapse of a reasonable time if\\nthere is no tendency to a return of the discoloration the canals and\\ncavity may be permanently filled.\\nDr. Harlan s method consists in acting upon hydrogen dioxid by\\naluminum chlorid. The aluminum salt is packed in the cavity and\\nmoistened with the dioxid. The technique of the procedure is the\\nsame as for the methods already described. This process was origin-", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0559.jp2"}, "560": {"fulltext": "552 DISCOLORED TEETH AND THEIR TREATMENT.\\nally classified with the chlorin methods, as the decomposition was sup-\\nposed to take place according to the following equation\\nA1 2 C1 6 3H 2 2 Al 2 O s 3H 2 6C1.\\nExperimental study of the reaction between aluminum chlorid and\\nhydrogen dioxid by the writer developed the fact that oxygen and not\\nchlorin was given off, and that the aluminum chlorid was unaltered\\nduring the process. Hence it was discovered that the reaction was\\nsimply due to a catalytic action of the aluminum salt (a property\\nwhich in this relation it shares in common with many other metallic\\nsalts), whereby nascent oxygen is liberated from the hydrogen dioxid.\\nThe process, therefore, has no greater value than those in which hydro-\\ngen dioxid is directly applied. The aluminum chlorid being an active\\ncoagulant is contraindicated as a factor in the bleaching process until\\na point has been reached where a coagulant is needed as a fixative after\\nthe bleaching has been effected.\\nThe Sodium Dioxid Method. Sodium dioxid, Na 2 2 is the chem-\\nical analogue of hydrogen dioxid, and like the latter is characterized\\nby the readiness with which it parts with its atom of loosely com-\\nbined oxygen under similar circumstances* The essential difference in\\nits properties is the character of its by-product after its decomposition\\nhas taken place. Itself a strong caustic alkali, it still retains its alka-\\nline and caustic properties after the loss of one of its atoms of oxygen,\\nbecoming Na 2 0, which in combination with water is ordinary sodium\\nhydroxid or caustic soda. This substance as well as the sodium dioxid\\nhas not only a saponifying property for all of the vegetable and animal\\noils and fats, but also a solvent action upon animal tissue. This property\\nis of great value in removing from the dentin structure all of the con-\\ntained organic matter, whether normal or in a state of decomposition.\\nHaving the oxidizing and consequently the bleaching quality in addi-\\ntion to its solvent and saponifying properties it is, therefore, one of the\\nmost valuable bleaching and detergent agents at our command. The\\nsubstance is dispensed as a yellowish white powder in tin cans or\\nglass bottles hermetically sealed, as it is very hygroscopic and after\\ntwenty-four hours exposure to moist air absorbs nearly its own weight\\nof water it also loses much of its activity.\\nFor use as a bleaching agent it is applied to the dentin in saturated\\nsolution. In making the solution especial care is necessary in order to\\navoid elevation of temperature, by reason of the energy with which it\\nenters into combination with the water. If the solution is allowed\\nto become heated in the making, decomposition of the compound with\\nloss of oxygen occurs and its bleaching power is destroyed. The", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0560.jp2"}, "561": {"fulltext": "BLEACHING BY SODIUM DIOXID. 553\\nsolution is best made by pouring into a small beaker of about one\\nounce capacity about two drachms of distilled water, and immersing the\\nbeaker in a larger vessel or dish containing ice-water or pounded ice\u00c2\u00bb\\nThe can containing the dioxid powder should then have its lid per-\\nforated with a number of small holes similar to the lid of a pepper\\ncaster, and the powder be slowly dusted into the distilled water in the\\nsmall beaker or the powder may be gradually dropped into the water\\nby tapping it from the point of a knife or spatula. The powder is\\nadded to the water until the solution assumes a semi-opaque appearance,\\nindicating the point of saturation. On removing the beaker from the\\ncooling mixture, the dioxid solution will in a few minutes assume a\\ntransparent, straw-colored appearance and is ready for use.\\nThe applications are to be made similarly to the hydrogen dioxid\\napplications, but upon asbestos fiber instead of cotton, as the latter is\\nacted upon by the sodium dioxid and converted into a glue-like mate-\\nrial, amyloid, which is difficult to remove and interferes with the suc-\\ncess of the operation.\\nAfter the dentin, which should have been previously desiccated, is\\nthoroughly saturated with the dioxid solution an application of 10 per\\ncent, sulfuric acid should be made, which neutralizes the strong alkali,,\\nforming sodium sulfate and hydrogen dioxid, thus\\n]S T a 2 2 H 2 SO, NaJ30 4 H 2 2\\nThe reaction is usually attended with some effervescence, which taking\\nplace in the tubular structure of the dentin, mechanically forces out its\\ncontents and thus exerts a detergent action upon it. The tooth should\\nnow be washed with hot distilled water in copious quantity and the\\ndioxid application repeated, omitting the subsequent treatment with\\nacid but washing again thoroughly with the hot water.\\nSodium dioxid solution, as prepared for bleaching, may be applied\\nto the pulp chamber and root canal without the preliminary treatment\\nrequired where other bleaching agents are employed. It is without\\nharmful irritative action upon the apical tissues unless used in excess\\nor forced through the foramen by careless manipulation. It is a power-\\nful germicide and disinfectant, and therefore peculiarly suited to the\\ntreatment of putrescent cases, which by its action are rendered sterile\\nand aseptic as well as bleached at one operation. Its saponifying and\\nsolvent properties completely remove the greasy dark layer of decom-\\nposed material which is found lining the pulp chamber and canals\\nalluded to on page 546, so that the use of the sodium dioxid method\\nmakes unnecessary the application of borax or ammonia for its removal\\nas a preliminary. When used for its sterilizing property the foramen", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0561.jp2"}, "562": {"fulltext": "554 DISCOLORED TEETH AND THEIR TREATMENT.\\nshould be allowed to remain unsealed until after the bleaching operation\\nhas been completed. It sometimes happens that the improvement in\\noolor following the application of the dioxid methods is only partial\\nand the result falls short of restoration to normal or, in other words,\\nthe bleaching reaches a certain point beyond which the color resists the\\nfurther action of the bleaching agent. In such cases the decomposition\\nof the color molecule has probably resulted in the formation of iron\\noxid as an end-product. In practice this residual discoloration can\\ngenerally be removed by treatment with oxalic acid. A small crystal\\nis to be sealed in the moist pulp chamber for twenty-four hours,\\nand afterward washed out with a copious irrigation of hot distilled\\nwater.\\nThe sodium dioxid method removes more completely than any\\nother the tubular contents, and the result is unique from the fact\\nthat not only is the tooth restored to normal color but to normal\\ntranslucency the opaque white effect resulting from other methods\\nof bleaching is due to the bleached organic debris remaining in the\\ntubuli, but by the solvent action of the strong caustic alkali this is\\nremoved. The final treatment of the tooth is the same in this as in\\nother methods, though the dentin should be desiccated and saturated\\nas thoroughly as possible with an unalterable varnish before the final\\nfilling is inserted.\\nThe Sulfurous Acid Method. Reference has already been made\\nto sulfurous acid as the single example of the reducing type of bleach-\\ning agent. Its activity is due to its affinity for oxygen, and it bleaches\\nby seizing upon and combining with that element of the color molecule,\\nthus destroying its identity and consequently its color. Attempts have\\nbeen made to utilize the bleaching property of sulfurous acid in the\\ntreatment of discolored teeth by direct applications of the solution of the\\ngas in water and by igniting small quantities of sulfur in the root canal\\nby means of the electro-cautery wire. These methods have, however,\\nproved inefficient. The gas may be successfully used in bleaching teeth\\nby evolving it from its compounds placed in the cavity and root canal\\nin a manner analogous to that employed in the Truman chlorin process\\nalready described. For this purpose the writer s method may be con-\\nveniently employed 100 grains of sodium sulfite and 70 grains of\\nboric acid are separately desiccated and afterward ground together in 2\\nwarm dry mortar. The powder is then to be transferred to a tightly\\nstoppered bottle. For bleaching purposes the powder is packed into the\\nroot canal and cavity of the tooth, and then moistened with a drop of\\nwater and the cavity immediately closed as tightly as possible with a\\nstopping of gutta-percha previously prepared and warmed. A reaction", "height": "4612", "width": "2888", "jp2-path": "americantextboo00kirk_0562.jp2"}, "563": {"fulltext": "CATAPHORIC BLEACHING OF TEETH. 555\\n-ensues between the boric acid and sodium sulfite whereby sulfurous\\nacid is liberated, thus\\n2H3BO3 3]Nra 2 S0 3 2]N T a 3 B0 3 3H 2 +3S0 2\\nThe process is effective in many cases where the chlorin methods have\\nfailed, but is slow in its action and is largely superseded by the dioxid-\\nof -hydrogen and dioxid-of-sodium methods.\\nCataphoric Bleaching op Teeth.\\nSince the revival of interest in cataphoresis and its application to\\ndental operations its possibilities as an adjuvant in the tooth -bleaching\\nprocess are being investigated with much promise of valuable results.\\nIt has been found that aqueous solutions of hydrogen dioxid may be car-\\nried into the dentinal structure with great ease by the cataphoric action\\nof the continuous current. The appliances necessary for tooth-bleaching\\noperations by this means are practically the same as those required in the\\ntreatment of hypersensitive dentin, and are detailed at length in the\\nchapter dealing with that subject (page 189). The resistance offered by\\nthe hard structures of the tooth is much greater after loss of the tooth\\npulp, requiring a much higher voltage pressure to drive the bleaching\\nagent into the tissue. While in some cases 25 to 30 volts will be all\\nthat is necessary, some cases will require as high as 60 volts to carry\\n1.5 milliamperes of current through the dentin. The ethereal solution\\nof hydrogen dioxid has been found to oppose too great resistance to\\nthe current, but the aqueous solution containing a slight addition of\\nsome salt to increase its conductivity is entirely manageable.\\nA 25 per cent, aqueous solution of hydrogen dioxid may be quickly\\nmade by shaking together in a test tube one volume of water and two\\nvolumes of 25 per cent, pyrozone. The H 2 2 dissolves in the water,\\nand the ether of the pyrozone may be removed by pouring the mixture\\ninto a small evaporating dish of porcelain or glass and gently heating it\\nover a water bath until all of the ether has evaporated. The addition\\nof a small quantity of sodium acetate or sulfate will greatly diminish\\nthe resistance of the solution to the passage of the current.\\nWith the tooth isolated by the rubber dam and having received the\\ntreatment preliminary to bleaching, as already described in detail, the\\naqueous solution of H 2 2 is dropped upon cotton within the tooth\\ncavity and a platinum needle anode is applied in contact with it.\\nThe cathode may be a sponge electrode moistened with salt solution and\\nheld in the hand or applied to the cheek or neck. The hand, however,\\nis preferable because of the amount of voltage required in the operation.\\nGreat care must be exercised that the external surfaces of the tooth are", "height": "4556", "width": "2764", "jp2-path": "americantextboo00kirk_0563.jp2"}, "564": {"fulltext": "556 DISCOLORED TEETH AND THEIR TREATMENT.\\nkept dry so that short-circuiting of the current may not take place. In\\nsome cases a more rapid effect is obtained by making contact of the\\ncathode pole through a needle electrode upon the external surface of the\\ntooth, and with the anode applied to the pyrozone solution on cotton\\nwithin the tooth. The cotton must at all times be kept wet with the\\nsolution.\\nThe arrangement of the electrical terminals with respect to the\\nbleaching operation is both theoretically and practically correct as de-\\nscribed, viz. the flow of current should be from the anode point through\\nthe bleaching solution and tooth and the body of the patient to the\\ncathode. In practice it has been found in some cases which have failed\\nto bleach with the elements arranged in the series as stated, that upon\\nreversing the poles and direction of current flow the bleaching has\\nrapidly followed. The explanation of this apparent paradox is that\\nby the application in normal order H 2 2 was first carried into the\\ntubular structure, and the reversal of the current has acted upon the\\ntubular contents now saturated with the dioxid, and by its propulsive\\nas well as electrolytic effect removed the pigmentary matter pulp ward\\nfrom the tubuli. Bleaching with reversed poles would be impossible\\nwithout previous saturation of the dentin by the dioxid solution.\\nDr. M. W. Hollingsworth has devised an ingenious anode for feed-\\ning the bleaching solution or other medicament into the cavity as de-\\nsired. The instrument (Fig. 154) is described in Chapter VII.\\nAnother device by Dr. Hollingsworth is of especial value, as it\\nmakes possible the enveloping of the entire tooth with the bleaching\\nfluid in which it is immersed as in a bath. The appliance is shown in\\nFig. 481.\\nDr. Hollingsworth s device for applying the bleaching agent to the tooth.\\nsitu in Fig. 481, and consists of a thin vulcanized caoutchouc bulb\\nshaped like the bulb of a medicine dropper. Through a perforation\\nat its rounded end made with the ordinary rubber dam punch, the\\ntooth is slipped by mounting the bulb on the applicator (Fig. 482), and", "height": "4612", "width": "2872", "jp2-path": "americantextboo00kirk_0564.jp2"}, "565": {"fulltext": "CATAPHORIC BLEACHING OF TEETH. 557\\nforcing it over the tooth as though it were a rubber dam. A glass tube\\nFig. 482.\\nApplicator.\\nis then attached to the open end of the bulb, and to the glass tube is\\nconnected a spiral platinum wire electrode (Fig. 483). Before the elec-\\nFig. 483.\\nTube electrode.\\ntrode is attached the bulb and glass tube are completely filled with the\\naqueous pyrozone solution by means of a duplex syringe (Fig. 484), the\\nFig. 484.\\nDuplex syringe.\\nlower and larger bulb of which exhausts the contained air in the appa-\\nratus and the smaller thumb bulb injects the bleaching solution into the\\nexhausted apparatus. Connection is now made with the source of cur-", "height": "4540", "width": "2700", "jp2-path": "americantextboo00kirk_0565.jp2"}, "566": {"fulltext": "558 DISCOLORED TEETH AND THEIR TREATMENT.\\nrent as usual, and the bleaching is very rapidly effected. Dr. Hol-\\nlingsworth recommends the addition of about 1 per cent, of zinc sulfate\\nto the aqueous pyrozone solution, which not only diminishes the resist-\\nance to the passage of the current, but has a coagulating effect upon\\nthe bleached organic matter which gives it translucency and greatly\\nenhances the permanency of the operation. The results obtained by\\nthis method are extremely satisfactory.\\nBleaching Methods for Special Stains.\\nPulpless teeth are especially liable to discoloration from external and\\naccidental causes. If decayed and the cavity has remained unfilled for\\na length of time many substances which find their way into the oral\\ncavity either as food or as medicine may produce discoloration when\\nabsorbed by the tooth through the open cavity walls.\\nMetallic salts are particularly apt to cause such staining by reaction\\nwith the sulfids with which the dentin structure is usually saturated\\nduring decomposition of its organic contents. Many of the medica-\\nments used in pulp-canal treatment or even for hypersensitive dentin\\nmay stain the tooth structure, and finally the action of sulfids in the\\nstructure of a pulpless tooth may react with amalgam fillings, forming\\nsalts of mercury^ silver, tin, copper, etc., which are absorbed by the\\ntooth, resulting in its discoloration. The treatment of these stains,\\nwhich were grouped as Class III. at the beginning of this chapter,\\nis extremely difficult and often unsatisfactory. However, there may\\narise individual cases of discolorations of this class where it is of the\\nutmost importance to remove them, and much may often be accom-\\nplished when the causes of the discoloration are known and the proper\\nbleaching method is applied.\\nGold stains may arise, as has been already indicated, from the inju-\\ndicious use of gold instruments or failure to remove all gold fillings\\nwhen applying some one of the chlorin methods of bleaching. In the\\ncourse of time where this has happened the tooth assumes a pinkish\\nhue which merges into a characteristic violet or purple, finally becom-\\ning black.\\nIron stains may arise from the use of steel instruments in connection\\nwith the chlorin methods of bleaching or in contact with iodin or any\\nof the mineral acids in connection with canal treatment. The iron\\nstain is yellowish at first, gradually becoming brown and finally black.\\nCojyper and nickel stains may arise from contact with these metals\\nor their alloys, as copper amalgam or nickel or German silver\\ndowels for artificial crowns or anchorages for fillings. The stains\\nfrom these metals are for copper, bluish to black, and for nickel a\\ncharacteristic chlorophyll green which eventually becomes black.", "height": "4612", "width": "2880", "jp2-path": "americantextboo00kirk_0566.jp2"}, "567": {"fulltext": "BLEACHING METHODS FOR SPECIAL STAINS. 559\\nThe best general treatment for all of the foregoing stains is to\\nre-bleach the tooth by the chlorin method, with especial care as to the\\nseveral precautions already recommended, and when the color of the\\nmetallic stain has been discharged by conversion of the dark-colored\\nsalt into a soluble chlorid, wash the tooth thoroughly first with dilute\\nchlorin water 50 per cent., and afterward with hot distilled water to\\nremove all of the metallic chlorid which has been formed. The process\\nmay require repetition to secure permanent results.\\nSilver stains are comparatively easy to remove, either by an applica-\\ntion of the chlorin method or by saturating the tooth with tincture of\\niodin, thus converting the silver salt into a chlorid or iodid as the case\\nmay be, after which it may be dissolved out with a saturated solution\\nof sodium hyposulfite applied as a bath to the tooth. For this pur-\\npose the Hollings worth bulb dam (see Fig. 483) answers admirably,\\nand although the experiment has not as yet been tried, there is good\\nreason to believe that the cataphoric method with electrodes applied in\\nreverse order would under these circumstances greatly facilitate the\\nsolution and removal of the metallic salts.\\nMercurial stains are always black from the formation of mercuric\\nsulfid, and are removable by the same method as are silver stains, with\\nthe exception that where the stain has been converted into a chlorid\\nby the chlorin method, the mercuric chlorid is best removed by an\\naqueous ammoniacal solution of hydrogen dioxid, or Avhen the stain\\nhas been converted into mercuric iodid by the use of a saturated solu-\\ntion of potassium iodid. In both cases a final washing with hot dis-\\ntilled water is a sine qua non.\\nManganese stains frequently occur from the use of potassium per-\\nmanganate, in solution or in substance, in the treatment of putrescent\\ncanal conditions. The manganese stain is a characteristic mahogany\\nbrown. It is very readily removed by a 25 per cent, aqueous solution\\nof hydrogen dioxid in which oxalic acid crystals have been dissolved\\nto saturation. A few applications of this mixture will quickly de-\\ncolorize the stain, after which a liberal treatment of hot distilled water\\nis required as in the foregoing cases.\\nIn all cases a careful diagnosis of the chemical nature of the dis-\\ncoloration should be made when possible. Much information upon this\\npoint may be gained by a detailed study of the present condition of the\\ntooth and its environment, but in addition to this the patient should be\\nquestioned as to the history of the case, and especially as to its previous\\ntreatment. The data thus obtained should be carefully noted and treat-\\nment instituted in accordance with the conditions to be met.\\nSuccess in the bleaching of teeth demands a recognition of the fact\\nthat each case presents individual peculiarities, that the problem is", "height": "4560", "width": "2768", "jp2-path": "americantextboo00kirk_0567.jp2"}, "568": {"fulltext": "560 DISCOLORED TEETH AND THEIR TREATMENT.\\nessentially a chemical one always, and that the bleaching method in any\\ngiven case must be selected with especial reference to the character of\\nthe discoloration and applied with due care as to its details in order that\\nthe chemical requirements of the operation may be intelligently met\\nwithout which care success is impossible.", "height": "4612", "width": "2860", "jp2-path": "americantextboo00kirk_0568.jp2"}, "569": {"fulltext": "CHAPTER XXI.\\nEXTRACTION OF TEETH.\\nBy M. H. Cryer, M. D., D. D. S.\\nIndications for the Operation.\\nIt is impossible to formulate a set of exact rules by which the prac-\\ntitioner may be governed, in deciding upon the extraction of teeth. So\\nmany circumstances both local and general must be taken into consid-\\neration that little more can be done than to suggest the most important\\ncauses which demand the operation.\\nDeciduous Teeth. The indications for extracting deciduous teeth\\nare\\nFirst When the teeth are a source of irritation affecting the gen-\\neral health or comfort of the child and do not respond to treatment.\\nSecond When the deciduous teeth are preventing the eruption of\\nthe permanent teeth into their normal positions. Occasionally a de-\\nciduous tooth will assist in the proper placing of a permanent one,\\nin which case it should not be removed as long as it is of such\\nuse.\\nThird When a lower permanent incisor shows signs of erupting on\\nthe labial side of the deciduous tooth, the latter should be removed at\\nonce, but if the erupting tooth appears on the lingual side the removal\\nof the deciduous tooth may in that case be delayed somewhat longer.\\nFourth When upper permanent incisors show a tendency to erupt\\non the palatal side of the temporary teeth, the latter should be extracted,\\nbut when they are erupting on the labial side the deciduous teeth may\\nbe allowed to remain for a time, as they are often useful in forcing the\\npermanent teeth outwardly. This, however, must be closely watched\\nto prevent the permanent incisors from moving too far.\\nPermanent Teeth. The indications for extraction of the permanent\\nteeth are\\nFirst Diseased roots which cannot be cured and so made useful\\nfor crowning, or assisting in retaining a bridge, plate, or other pros-\\nthetic device.\\n36 561", "height": "4556", "width": "2808", "jp2-path": "americantextboo00kirk_0569.jp2"}, "570": {"fulltext": "562 EXTRACTION OF TEETH.\\nSecond Teeth of mastication that have lost their occluding teeth\\nand in consequence thereof are being pushed from their alveoli and are\\na source of trouble. As a rule, this refers only to the second or third\\nmolars, and more particularly to the third molar. When it occurs with\\nother teeth the opposite vacant space should be filled by an artificial\\ntooth to prevent the extrusion of the natural tooth.\\nThird When incurable abscesses originating from teeth in the\\nupper jaw tend to open into the nasal chamber, maxillary sinus, or\\nzygomatic fossa, the teeth associated with such abscesses should be ex-\\ntracted. When diseased teeth are the exciting cause of an incurable ab-\\nscess in the lower jaw which opens or threatens to open externally on\\nthe chin, jaw, or below the bone into or upon the neck, they should be\\nremoved.\\nFourth Teeth which occupy irregular positions in the arch, that\\ncannot be corrected so as to become useful or contribute to the gen-\\neral symmetry of the mouth, should be removed.\\nFifth Erupting teeth that are retarded because of lack of room\\nin the jaw, if giving pain, should be extracted or else the tooth that is\\npreventing the eruption should be removed. A marked example of\\nthis is often found in the eruption of the third molar when all the other\\nteeth are of good size and are in place. These molars when retarded\\ncause the greatest distress, sometimes producing serious results, and\\nmust be extracted if they cannot be safely removed the second molar\\nmay be extracted, in consequence of which the third molar will usually\\nbe erupted near its place. When an upper third molar is erupting\\nunder the same circumstances there is usually less difficulty, as having\\nbut slight resistance distally it can erupt outwardly or slightly back-\\nward, though, should it impinge upon the soft tissues covering the ramus\\nof the lower jaw, it should be extracted.\\nSixth Teeth so badly diseased that they will not respond to treat-\\nment and are a source of discomfort to the patient should be removed,\\nas they impair the general health.\\nSeventh First molars. There has been much discussion regarding\\nthe early extraction of these teeth, many claiming that if the pulp of\\none becomes devitalized at an early period of life and it is deemed best\\nto extract it, the other three should also be removed. No fixed general\\nrule, however, can be given each case must be considered separately.\\nThere are cases where the extraction of all is necessary, and others\\nwhere it would be a most unwise thing to do. When the anterior teeth\\nare fully in position, the bicuspids occluding correctly with their oc-\\ncluding teeth and the second molars are about to erupt, the case may\\nthen be one for extracting the four first molars, provided it be neces-\\nsary to extract one of them, or if it be likely that one or more of them", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0570.jp2"}, "571": {"fulltext": "INDICATIONS FOR THE OPERATION. 563\\nwill be lost in a few years. If, however, the bicuspids are not in good\\nposition, it is better not to extract the first molars, as they assist in keep-\\ning the jaws the proper distance apart, and preventing the lower anterior\\nteeth from biting against the upper gum.\\nRemoval of Sound Teeth Preparatory to Inserting- Artificial\\nDentures. When preparing the mouth for an artificial denture the\\nremoval of sound teeth may be indicated as a measure of expedi-\\nencv in relation to mechanical and hygienic considerations. For ex-\\nample\\n(1) Roots which a plate or bridge would cover, excepting when they\\nassist in holding the device.\\n(2) Teeth from which the gums have receded to such an extent as\\nto become useless or unsightly.\\n(3) Teeth that are being extruded from their alveoli from the ab-\\nsence of occluding teeth. The extraction of these depends, however,\\non the extent of elevation and the possibility of placing occluding\\nartificial teeth in position.\\n(4) Where there is but one tooth remaining, or two teeth standing\\ntogether, or in certain cases when several isolated teeth remain which\\ncannot be made to contribute to the mechanical adaptation of an arti-\\nficial denture, extract when in the upper jaw. They interfere with the\\nfitting of an upper plate, but in the lower jaw they may be useful in\\nretaining the plate.\\n(5) When there are two teeth, one on each side of the upper jaw, in\\ngood position and desirable shape for clasping, do not extract unless\\nthey are the third molars or the oral teeth.\\n(6) In preparing the upper jaw when two canine teeth alone remain,\\nor when there is also a molar or bicuspid, or both, and it is decided to\\nextract the molars and bicuspids, then extract the two canine teeth also.\\nIt has been claimed by some of the very best dental practitioners, whose\\nopinions must be respected, that by keeping these teeth the expression\\nof the face is less likely to be marred. For the following combined\\nreasons, however, extraction is advised\\na. It is very difficult to obtain a correct impression of the mouth\\nwhile these teeth only are in position.\\nb. It is nearly impossible to perfectly match, grind, and arrange the\\nlateral incisors beside single canines.\\nc. The adhesion of the plate to the mouth is interfered with, as air\\nand food work in between the plate and these natural teeth.\\nd. The plate is very much weakened by being cut out for the accom-\\nmodation of these teeth at what might be termed the abutments of the\\narch.\\nIn the lower jaw single teeth which are sound are usually of great", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0571.jp2"}, "572": {"fulltext": "564 EXTRACTION OF TEETH.\\nimportance. They should not be removed, as they assist in retaining\\na denture by means of clasps or other devices. Especially is this true\\nin persons advanced in years, as then the alveolar process is generally\\nmuch absorbed. If the lower process is much absorbed even an imper-\\nfect tooth will do good service of this character for a time, and if it is\\nthe first plate the patient has worn it will serve a good purpose by\\nassisting in the retention of the plate until the patient has become ac-\\ncustomed to it, after which the tooth, if giving trouble or if it is un-\\nsightly, may be removed and an artificial one placed on the plate.\\nInstruments and Accessories for Extracting.\\nThe instruments used in extracting teeth are forceps and elevators\\nof various shapes and sizes.\\nForceps. The forceps should be made of steel of the best quality\\nfor the purpose obtainable, in order to give great strength and stiffness,\\nand at the same time toughness, so that they will not break. Forceps\\nthat will spring or bend destroy the sensitivity of the hand using them\\nin such a way as to prevent the operator from discerning in what di-\\nrection the resistance to extraction is being made. The beaks of the\\nforceps as a general principle should be shaped so as to fit and adjust\\nthemselves to as great a surface of the various teeth or roots as pos-\\nsible so that they may take a firm hold. They should be at such an\\nangle in relation to the handles as will permit them to be easily and\\nreadily placed in the proper position without obscuring the view of the\\ntooth to be extracted. The inner surface of each beak should be concave\\nin a transverse section and without serrations, as these are of no assist-\\nance, but tend to weaken the beaks and are difficult to clean. The edges\\nof the concave portion should be sharp enough to cut through the alveolar\\nprocess if necessary. The points of the beaks should be sharp and\\ntapering so they can be forced into position. The handles should be of\\na shape to allow a firm grasp, and as the hands of different operators\\nvary in shape and size it will be evident that the same size of forceps\\nhandles will not be perfectly satisfactory to all. The curvature of the\\nhandles should vary according to the general or special use of the for-\\nceps. The curved ends, as seen in Fig. 485, are of little use, and should\\nbe done away with in all forceps excepting perhaps those made especially\\nfor the upper and lower molars.\\nThe joints of extracting instruments should be so made that the\\nhandles can be separated by some simple mechanism to permit of\\nthorough and easy cleansing. Figs. 485 and 486 represent an instru-\\nment of this character. There are others of the same nature, but", "height": "4608", "width": "2868", "jp2-path": "americantextboo00kirk_0572.jp2"}, "573": {"fulltext": "INSTRUMENTS AND ACCESSORIES EOR EXTRACTING.\\n565\\nFig. 485.\\nthis being the most simple and\\nthe strongest should be gen-\\nerally adopted unless a similar\\ndevice can be adapted to the\\nknuckle-jointed instrument.\\n(Fig. 487.)\\nThere should be no sharp\\nangles or crevices, and if the\\nordinary forceps is used, that\\nportion around the joint in a\\ntransverse section should be oval.\\nForceps are often made with\\noctagonal joints, but these should\\nbe condemned, as they may\\nnot only hurt the lips of the\\npatient, but in case of a slip,\\nwhich may happen with the best\\noperators, they are more liable to\\ncause injury by striking the other\\nteeth moreover they are very\\nclumsy and require more room.\\nFig. 486.\\nAntiseptic universal lower molar forceps.\\nJoint of an antiseptic lower molar forceps", "height": "4556", "width": "2764", "jp2-path": "americantextboo00kirk_0573.jp2"}, "574": {"fulltext": "566\\nEXTRACTION OF TEETH.\\nFig. 487.\\nUnless the antiseptic joint\\n(Figs. 485 and 486) is used the\\nunion of the joints is usually\\nmade upon one of two principles\\nfirst, by one half passing into a\\nmortise in the other and held in\\nthe centre by a pinion (Fig. 488).\\nThe second is known as a\\nknuckle-joint (Fig. 487) made\\nby each portion being let half\\nway into the other and held to-\\ngether by a screw. This is a\\nneater joint and does away with\\nmany of the objectionable fea-\\ntures noted in other forms of\\nforceps joint.\\nAll handles should be ser-\\nrated as shown in the illustra-\\ntions, and the instruments if\\nproperly cared for need not be\\nnickel-plated. The number of\\nforceps in a practical set will\\nvary with the requirements of\\nevery individual who extracts\\nteeth, therefore only the general\\nprinciples which should govern\\nthe selection of a set of instru-\\nments will be here given at the\\nsame time the uselessness of a\\nvery large selection is here em-\\nphasized. As an illustration of\\nthe range of tooth extractions\\nwhich may be performed with a\\nlimited number of instruments\\nthe forceps represented by Figs.\\n488 and 489, showing the exact\\nsize, will serve as examples.\\nThey are smaller than the ones\\ngenerally used, especially in\\nAmerica.\\nThe instrument shown in Fig.\\n488 may be used almost universally for the upper teeth.\\nFig. 489 is a forceps of the same general character as that in Fig.\\nKnuckle-joint root forceps.", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0574.jp2"}, "575": {"fulltext": "INSTRUMENTS AND ACCESSORIES FOR EXTRACTING. 567\\n488, only the beaks are at a different angle with the handles. This pair\\nFig. 488.\\nFig. 489.\\nat\\nm\\nami\\nUniversal upper incisor and root forceps.\\nUniversal lower incisor and root forceps.\\nmay be used similarly for the lower teeth. These forceps are useful in\\nall cases, except in the full arch, when either a first or second molar is", "height": "4560", "width": "2764", "jp2-path": "americantextboo00kirk_0575.jp2"}, "576": {"fulltext": "568\\nEXTRACTION OF TEETH.\\nFig. 490. Fig. 491.\\nm\\nFor the ten upper anteiior teeth\\nRoot, upper front. Straight.", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0576.jp2"}, "577": {"fulltext": "INSTRUMENTS AND ACCESSORIES FOR EXTRACTING. 569\\nFig. 492.\\nto be extracted. If the teeth are large, the jaw strong, and the\\ngrinding surfaces concave, it is\\nbetter to use the special lower\\nmolar forceps as shown in Figs.\\n485 and 498.\\nFig. 490 and Fig. 491 rep-\\nresent very useful forceps for\\nextracting the ten upper an-\\nterior teeth. Fig. 491 has\\nlonger beaks and its points are\\nfiner. In skillful hands where\\ntoo great a force will not be\\nbrought to bear on the points\\nthey are the better forceps.\\nUnder nitrous oxid and where\\nmany teeth are to be extracted,\\nthus requiring rapid work, the\\ninstrument shown in Fig. 490\\nis preferable.\\nFigs. 492 and 493, right and\\nleft, represent forceps specially\\nused for extracting the first and\\nsecond upper molars on either\\nside. The outer beak is made\\npointed for the purpose of pass-\\ning in between the buccal roots,\\nthe inner beak is concave in\\norder to grasp the palatal root.\\nFigs.495and 496 show bayonet-\\nshaped forceps, that illustrated\\nby Fig. 495 being especially\\nmade for extracting the upper\\nthird molars, Fig. 496 being\\nused for upper roots. The ends\\nof the handles of all forceps\\nwhich are forced in by the palm\\nof the hand should have abroad\\nsurface as shown in Fig. 496.\\nThese forceps are popular with\\nmany operators. The writer\\nconsiders them clumsy, as they\\nobscure the proper view of the\\ntooth and its associated parts.\\nline of\\nRight upper molar.", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0577.jp2"}, "578": {"fulltext": "570\\nEXTRACTION OF TEETH.\\nFig. 493.\\nFig. 494.\\nLeft upper molar\\nHawk-beaked forceps.", "height": "4612", "width": "2864", "jp2-path": "americantextboo00kirk_0578.jp2"}, "579": {"fulltext": "INSTRUMENTS AND ACCESSORIES FOR EXTRACTING. 571\\nFig. 495. Fig. 496.\\nW\\nUniversal upper third molar.\\nDorr s upper root forceps.", "height": "4564", "width": "2764", "jp2-path": "americantextboo00kirk_0579.jp2"}, "580": {"fulltext": "572\\nEXTRACTION OF TEETH.\\nFjg. 497.\\nFig. 498.\\nUniversal lower canines and bicuspids.\\nUniversal lower molars, designed by Dr.\\nChapin A. Harris.", "height": "4616", "width": "2860", "jp2-path": "americantextboo00kirk_0580.jp2"}, "581": {"fulltext": "INSTRUMENTS AND ACCESSORIES FOR EXTRACTING. 573\\nFig. 499.\\nFig. 501.\\nRoot, lower. Half curved.\\nElevator.\\nRight and left scalers\\nused for extracting\\nroots.", "height": "4544", "width": "2776", "jp2-path": "americantextboo00kirk_0581.jp2"}, "582": {"fulltext": "574 EXTRACTION OF TEETH.\\nForceps for Extracting Lower Teeth. Instead of the beaks of the\\nforceps being nearly on a line with the handles as in those for the upper\\njaw, they are bent at nearly a right angle. For the incisors of the lower\\njaw there are no better forceps than those shown in Fig. 489. This\\ninstrument is very useful in extracting the lower third molar when fix-\\nation of the jaw from diffuse cellulitis in the region of the temporo-\\nmaxillary articulation renders it difficult to open the mouth sufficiently\\nfor inserting a larger instrument. In such cases the forceps should be\\ncarried backward in the vestibule of the mouth with the inner beak\\npassing between the upper and lower teeth when the beaks reach the\\nthird molar the inner beak can usually be forced over the inner surface\\nof the tooth and into position, after which the tooth can be grasped\\nand extracted. The forceps represented in Fig. 488 can also be used\\nto advantage for these teeth, the operator standing behind and working\\nover the head of the patient, as shown in Fig. 546.\\nFig. 494 exhibits a hawk-beaked forceps for extracting the anterior\\nlower teeth. It is very popular with some operators, especially those\\nin Europe. The writer does not recommend it.\\nFig. 497 also exhibits a special instrument. It is made for extract-\\ning the lower canine and bicuspid teeth of either side. Fig. 498 is a\\nspecial instrument used for the lower molars of either side. The beaks\\nare pointed, with a convexity on each side of the point to allow it to\\npass in between the roots. The two concave portions fit against each\\nroot.\\nFig. 499 represents a universal lower root forceps.\\nElevators or Root Extractors. There are many kinds of\\nelevators used in extracting roots. Some are also occasionally used in\\nthe extraction of teeth (usually the third molar).\\nFig. 500 shows one of the most useful forms of this instrument. It\\nis especially useful in extracting third molars when the teeth in front\\nof them are in position.\\nFig. 501 represents two elevators they are similar to right and\\nleft scalers, being made somewhat heavier; they are extremely use-\\nful in extracting roots. They are so unlike an extracting instru-\\nment that patients do not dread the appearance of them as they do\\nthat of forceps. By carefully inserting the blade with the point\\ntoward the root to be removed, between it and the adjoining root or\\ntooth, and giving a slight rotary motion, the point will force the root\\nfrom its socket with but little pain.\\nFigs. 537 and 538 illustrate two other forms of elevator, with their\\nmode of application in the removal of roots.\\nLancets. Figs. 502 and 503 represent various forms of lancets,\\nthe more useful of which are Nos. 1 and 5, which are all that are", "height": "4608", "width": "2856", "jp2-path": "americantextboo00kirk_0582.jp2"}, "583": {"fulltext": "INSTRUMENTS AND ACCESSORIES FOR EXTRACTING. 575\\nrequired for lancing in extracting or for relief of retarded eruption of\\ndeciduous or other teeth. They are also useful in general surgery of the\\nmouth. The handles should be made of metal instead\\n502, of wood, in order that they may be thoroughly sterilized.\\nFig. 503.\\nLancets with ebony handles and with solid steel handles.\\nScissors. A good pair of curved scissors, as shown\\nin Fig. 504, should be at hand in case a portion of\\ngum tissue is found to be attached to the root. If the\\nscissors were slightly more curved they would be even\\nbetter adapted for this purpose.\\nIn connection with the instruments already men-\\ntioned, there should be a mouth mirror (Fig. 505)\\nand a few excavators and probes for general exami-\\nnation of the teeth, especially for examining the position\\nand character of a root or impacted tooth which it is\\npurposed to extract.\\nMouth Props. When an anesthetic is to be given\\nit is advisable to use some kind of a mouth prop, in\\norder to keep the mouth well open. Some operators do\\nnot use them, as they may interfere with the giving of\\nthe anesthetic by impeding respiration upon beginning\\nthe administration. The majority of patients, if asked\\nto hold the mouth open while taking the anesthetic,\\nespecially nitrous oxid and oxygen, will keep it open\\nduring the anesthetic stage.\\nFig. 506 illustrates excellent props devised by Dr. Frederic Hewitt,\\nof London, England.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0583.jp2"}, "584": {"fulltext": "576\\nEXTRACTION OF TEETH.\\nFig. 504.\\nThe Mechanical Mouth-opener (Fig. 507). This instrument\\nis made in various shapes and sizes. It is inserted between the jaws\\nwhen the props are to be removed or in eases of trismus, and may also\\nbe used to separate the jaws and retain them so in eases of emergency\\nor during certain operations within the oral cavity.\\nAll dentists, and especially those\\nwho extract teeth, should have at\\nleast one pair of pharyngeal for-\\nceps (Fig. 508). It is possible that\\nthey may never be used, but on the\\nother hand an accident may occur\\nsuch as a fragment or tooth slip-\\nping into the pharynx, where if the\\nfinger cannot reach it this instru-\\nment will be absolutely necessary.\\nSurgical Anatomy. To extract\\nteeth successfully it is first neces-\\nsary to be perfectly familiar with\\nthe general shapes of the different\\nFig. 505.\\nCurved scissors.\\nMouth mirror.\\nteeth and their position in relation to the jaw and to their associates, in\\norder that the operator may intelligently apply the force in the line of\\nthe least resistance required for their removal. This knowledge cannot\\nbe obtained from books they are but the guides to it. The jaws of the\\ndead subject must be dissected both the cleaned bones and those with\\nthe soft tissues left upon them. Dissection means that not only\\nshall the superficial relations be studied, but that the bones shall be cut\\nin various directions, both with the saw and other instruments, until", "height": "4616", "width": "2832", "jp2-path": "americantextboo00kirk_0584.jp2"}, "585": {"fulltext": "SURGICAL ANATOMY.\\n577\\nthe relations of the teeth of the upper jaw with the floor of the nasal\\nchamber and the maxillary sinus are fully understood. In the lower\\njaw the relations of the teeth with the inferior dental canal and the\\nposition of the roots, especially those of the third molar, must also be\\nthoroughly known.\\nFig. 506.\\nHewitt s mouth props (half size).\\nThe alveolar process of both jaws is made up of two plates, external\\nand internal, consisting of dense compact bone without a true line of de-\\nFig. 507.\\nMechanical mouth-opener (half size).\\nmarkation between the process and maxilla proper. The interspaces be-\\ntween these plates formthe sockets for the teeth and are surrounded by a\\nFig. 508.\\nPharyngeal forceps (half size).\\nvery thin cribriform plate of cortical bone. The remaining space is filled\\nwith cancellated tissue, small bony channels, connective tissue, nerves,\\n37", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0585.jp2"}, "586": {"fulltext": "578\\nEXTRACTION OF TEETH.\\nvessels, etc. As this process belongs to the teeth, being developed with\\nthem, and is for the purpose of holding them in position, it disappears to\\na greater or less extent when the teeth are lost. The resorption of this\\nprocess does not take place alike in each jaw. In the upper jaw the\\nexternal plate disappears more rapidly and to a greater extent than\\nthe inner plate in the lower jaw the resorption of the two plates is\\nabout equal in extent and rate. The inner plate of the upper jaw is\\npartially supported by the external plate of the palatal process, in fact\\none merges into the other. The outer alveolar plate of the upper jaw\\nbeing resorbed to a greater extent than the inner one is of advantage\\nto the dentist in fitting teeth to the gums consequently, in extrac-\\ntion that fact should be remembered and injury to the internal plate\\navoided. At the same time it does no harm to remove a small por-\\ntion of the outer plate, though loss of the gum tissue should be\\navoided if possible. In the lower jaw it is not so important to avoid\\nFig. 509.\\nAlveoli of permanent teeth\u00e2\u0080\u0094 upper jaw.\\nremoving slight portions of the inner plate, as resorption takes place\\nabout equally in the two plates.\\nThese plates may be resorbed in such a manner that a slight ridge\\nis left between the places which they occupied. This resorption of\\nboth plates of the alveolar process of the lower jaw makes it more diffi-\\ncult to fit single plain teeth in the lower than in the upper jaw.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0586.jp2"}, "587": {"fulltext": "SURGICAL ANATOMY.\\nFig. 510.\\n579\\nAlveoli of permanent teeth\u00e2\u0080\u0094 lower jaw.\\nFig. 509 shows the alveoli of the upper denture, Fig. 510 that of\\nthe lower.\\nFig. 511.\\nTypical upper and lower jaw.\\nFig. 511 illustrates a typical upper and lower jaw, the external sur-", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0587.jp2"}, "588": {"fulltext": "580\\nEXTRACTION OF TEETH.\\nfaces of the crowns of the teeth, also a normal occlusion. Figs. 512\\nand 513 illustrate the occluding surfaces of the teeth and their relations\\nwith each other. They are made from the same skull as Fig. 511.\\nFig. 512.\\nShowing the occlusal surfaces of the upper teeth. (From same skull as Fig. 511.)\\nFig. 514 is from a photograph taken from the right side of a skull.\\nIt gives a good representation of a fairly normal occlusion of the\\nFig. 513.\\n9\\nShowing occlusal surfaces of the lower teeth. (From same skull as Fig. 511.)\\nteeth, their shape, roots, and their relation with the cancellated tissue\\nand the inferior dental canal or cribriform tube of the lower maxilla.", "height": "4612", "width": "2848", "jp2-path": "americantextboo00kirk_0588.jp2"}, "589": {"fulltext": "SURGICAL ANATOMY.\\nFig. 514\\n581\\nShowing the buccal surfaces of the crowns and roots in position.\\nFig. 5 15.\\nFrom the same jaw as Fig. 514.)", "height": "4560", "width": "2764", "jp2-path": "americantextboo00kirk_0589.jp2"}, "590": {"fulltext": "582\\nEXTRACTION OF TEETH.\\nIn the upper jaw the bone is thin over the position of the molar teeth,\\nand their roots are comparatively straight; none of these should be\\ndifficult to extract. The buccal roots of the first molar are somewhat\\ndivergent from each other. The same roots of the second molar spread\\nonly slightly as they leave the crown and close in at the points. The\\nFig. 516.\\nHs Mec\\nT Ns Hp\\nHs, Hiatus semilunaris; Mec, middle ethmoidal cells; CI, crystalline lenses; Up, uncinate pro-\\ncess Mt, middle turbinated bone Mm, middle meatus Ms, maxillary sinus Im, inferior\\nmeatus It, inferior turbinated bone V?n, vestibule of mouth 1st M, first molar Dis. r. 1st M,\\ndistal root first molar Idn, inferior dental nerve T, tongue Ns, nasal septum Hp, hard\\npalate.\\nroots of the third molar are together and slightly curved backward. In\\nthe lower jaw the roots are comparatively straight. Those of the first\\nmolar are spread only a little apart, this being the usual condition.\\nThe roots of the second molar are almost straight and are nearly parallel\\nwith each other. The anterior root of the third molar curves slightly\\nbackward until it joins the posterior root.\\nFig. 515 is taken from the left side of the same jaw as Fig. 514. In\\nFig. 514 the roots have been exposed down to their apices in Fig. 515\\nonly the external or cortical plate has been removed. These two illus-", "height": "4580", "width": "2852", "jp2-path": "americantextboo00kirk_0590.jp2"}, "591": {"fulltext": "SURGICAL ANATOMY.\\n583\\ntrations give a correct idea of the relations of the teeth to the internal\\nstructures of the jaw.\\nFigs. 516 and 517 are good illustrations of the relations of the roots\\nFig. 51\\nOms\\nOms\\n1st M 1st M\\nOms, Opening maxillary sinus 1st M, first molar.\\nwith the floor of the maxillary sinus usually found in the white race.\\nIn the negro there is usually a considerable thickness between the\\nteeth and the floor of the sinus. It will be noticed that the roots of\\nthe molars pass up on both sides of the sinus, and because of this fact\\nit is necessary in extracting teeth from a jaw of this character to use\\nFig. 518.\\nAr 1st M, Anterior root of first molar; E 2d Bi, root of second bicuspid; Idn, inferior dental\\nnerve U, U-shaped or cortical portion of lower jaw.\\nthe greatest caution, otherwise a portion of the floor of that cavity might\\nalso be removed. Or if a tooth be broken and much upward force used", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0591.jp2"}, "592": {"fulltext": "584\\nEXTRACTION OF TEETH.\\nin endeavoring to take hold of the root, the latter could easily be forced\\ninto the sinus. The lower portion of Fig. 516 gives a general idea\\nof a transverse section of the lower jaw made posterior to the mental\\nforamen. Especial attention is drawn to the U-shaped formation of\\nthe cortical portion of the lower jaw which terminates in the two plates\\nof the alveolar process, and between which the roots are imbedded in\\nthe cancellated tissue. It also shows how the roots extend toward the\\ninferior dental nerve. There is no line of demarkation between the\\nalveolar process and the body of the bone.\\nFig. 518 shows the relation, length, and position of the second bicus-\\nFig. 519.\\npid, showing that its root is sometimes placed to the inner side of the\\nanterior root of the first molar. The roots of these bicuspids are flat, as\\nwill be seen by looking at Fig. 533. On taking into consideration their", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0592.jp2"}, "593": {"fulltext": "SURGTCAL ANATOMY.\\n585\\nlength, position, and thinness it will be readily seen why it is so often\\ndifficult to extract them without breaking.\\nFig. 519 is taken from horizontal sections of the lower and upper\\njaws, showing the transverse sections of the roots of the teeth. The\\nsection is made a little above the margin of the alveolar process of the\\nupper jaw and a little below in the lower. The illustration shows the\\nshape and position of the various roots, with their relations to the pro-\\ncess and to each other. Particular attention should be given to the fact\\nFig. 520.\\nRSdBi\\nR 1st Bi\\nRe Rli\\nDn, Dental nerve R 3d M, roots of third molar; R 2d M, roots of second molar; R 1st M, distal\\nroot of first molar; R 2d Bi, root of second bicuspid; R 1st Bi, root of first bicuspid; Re,\\nroot of canine Rli, root of right lateral incisor.\\nthat the roots and process are in such close relation as to make it im-\\npossible to force the beak of a forceps between them without breaking\\none or both plates of the process. The lines leading from the roots\\nshow the proper direction for applying what is known in extracting\\nas the u out-and-in motion.\\nFig. 520 represents a horizontal section made through the lower jaw\\nnear the ends of the roots, and from the same bone as that shown in the\\nlower half of Fig. 519. The cancellated portion with the soft tissue\\nfilling the spaces can be plainly seen. The nerve passing into its tube,\\nthe ends of the roots of the second and third molars, the tip of one of", "height": "4552", "width": "2792", "jp2-path": "americantextboo00kirk_0593.jp2"}, "594": {"fulltext": "586\\nEXTRACTION OF TEETH.\\nthe roots of the first molar, and the roots of the first and second bicus-\\npids are all plainly shown. A little of the lateral incisor can be noticed,\\nbut the centrals do not reach so far down.\\nFigs. 521 and 522 are taken from a sagittal section of the upper\\njaw, external to the infraorbital foramen, and through the roots of the\\nFtg. 522.\\njf*\\nOm\\nIfs, Infraorbital sinus If, infraorbital foramen\\nPic, piece of paper passing through infraorbital\\ncanal Ms, maxillary sinus Aa, apical abscess.\\nOm, Opening into malar bone\\nIfs, infraorbital sinus.\\nmolar teeth. This illustration shows how the roots often extend above\\nthe lower portions of the floor of the sinus, an abscess from the palatal\\nroot of the first molar having discharged into the floor of the sinus\\nat the point Aa.\\nIt has been demonstrated both anatomically and clinically that in-\\nfectious matter from a suppurating tooth may eventually give rise to an\\ninflammation of the meninges of the brain. Should pus from a dento-\\nalveolar abscess discharge into the maxillary sinus it may pass out into\\nthe hiatus semilunaris and ascend into the frontal sinus or in the vicin-\\nity of the cribriform plate of the ethmoid through the infundibulum when\\nthe passage through the hiatus into the middle meatus is small or con-\\nstricted, as it usually is when inflamed, or the pus may pass directly\\nthrough the infundibulum. Recent research has shown that the frontal\\nsinus, the cribriform plate of the ethmoid, and the meninges of the brain\\nare in close relation at the anterior portion of the cribriform plate, a dis-\\neased condition at which point is liable to involve all three structures.\\nFig. 523 is from a longitudinal section of the lower jaw, and gives a\\ngood idea of the cancellated tissue, the relations of the sockets of the\\nteeth to one another, and the position of the inferior dental canal.", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0594.jp2"}, "595": {"fulltext": "SURGICAL ANATOMY.\\nFig. 523.\\n587\\nFig. 524.\\n4\\nII", "height": "4560", "width": "2764", "jp2-path": "americantextboo00kirk_0595.jp2"}, "596": {"fulltext": "588\\nEXTRACTION OF TEETH.\\nFig. 524 is taken from several transverse sections of a lower jaw.\\nThe bone is not quite normal, as several teeth were extracted before\\ndeath, the loss having caused changes in the character of the bone.\\nSome of the sections show but one canal while in others there are many,\\nrequiring close observation to tell in which the nerves and vessels have\\npassed. At point D it will be seen that the root of the second molar\\npenetrates the true nerve canal.\\nFig. 525.\\nFig. 525 is taken from the inner side of the right half of a lower\\njaw. The second molar has been broken off, the roots still remaining\\nFig. 526.\\nin position. The points of the roots of the third molar pass out through\\nthe inner wall a considerable distance below the mylo-hyoid ridge. A", "height": "4580", "width": "2920", "jp2-path": "americantextboo00kirk_0596.jp2"}, "597": {"fulltext": "SURGICAL ANATOMY.\\n589\\nportion of the ridge has been cut away, exposing the remainder of the\\ninternal surface of the roots. This will be further alluded to when ex-\\ntraction of the lower third molar is considered.\\nFigs. 526 and 527 are from the outer side of the right half of a lower\\nFig. 527.\\njaw, Fig. 526 showing an impacted third molar lying horizontally in\\nthe jaw. Fig. 527 is of the same jaw with the tooth removed from its\\nbed, showing the inner surface. The second molar is a pulpless tooth\\nthe distal root of which shows where the impacted tooth has pressed\\nagainst it, causing the absorption of a portion of the root and exposing\\nthe pulp canal within, producing death of that organ. This must have\\ncaused neuralgia. The cancellated tissue of this bone, it will be noticed,\\nis not like that \u00e2\u0080\u00a2shown in Fig. 512, the change in the character of this\\ntissue being the result of irritation caused by the impacted tooth. It\\nwill be seen that the roots of the other teeth in this jaw are longer\\nthan usual, the canine tooth passing below the nerve and to the outer\\nside.\\nFigs. 528 and 529 represent the inner side of the left half of a lower\\njaw. It shows an impacted third molar pointing slightly downward.\\nThe distal root of the second molar is slightly absorbed. On uncover-\\ning the tooth and taking it from its bed, it was found to be incased in a\\nthin shell of bone as though the dental sac had ossified separately around\\nthis tooth this thin incasement of bone may, however, have been an\\ninflammatory product. The inner portion of this shell can be seen in\\nposition. The nerve and its accompanying tissue passes into the infe-\\nrior dental foramen immediately against the shell and has the appear-", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0597.jp2"}, "598": {"fulltext": "590\\nEXTRACTION OF TEETH.\\nance of being flattened out. It divides and sends a branch around the\\ninternal half of the shell.\\nFig. 528.\\nInner side of left half of lower jaw, showing an impacted third molar.\\nFigs. 530 and 531 are taken from the right and left halves of the\\nlower jaw. Fig. 530 shows the internal surface of the right half;\\nFig. 529.\\n(Same as Fig. 528.)\\nFig. 531, the external surface of the same. In Fig. 530 the roots\\nof the third molar curve backward, are joined together, and are so", "height": "4580", "width": "2912", "jp2-path": "americantextboo00kirk_0598.jp2"}, "599": {"fulltext": "SURGICAL ANATOMY.\\n591\\nenlarged by an abnormal deposit of cementum caused by continued\\nhyperemia due to the prolonged irritation that the form of each root\\nis lost the bone also is much thickened. Fig. 531 shows an impacted\\nFig. 530.\\nRight half of lower jaw.\\ntooth pressing directly against the one in front of it, the roots of which\\nhave become much enlarged by the deposit of cementum. The sur-\\nrounding bone is also thickened and much more compact than the nor-\\nmal bone. The character of the cancellated tissue of the lower jaw is\\nlost by the deposit of bone caused by continued irritation of that tissue.\\nFig. 531.\\nLeft half of lower jaw.\\nFigs. 532 and 533 show the normal forms of the teeth, and Fig. 534\\nis taken from a group of abnormal teeth. If only normal conditions\\nof the teeth had to be considered, as shown in Figs. 532 and 533, ex-", "height": "4560", "width": "2764", "jp2-path": "americantextboo00kirk_0599.jp2"}, "600": {"fulltext": "592\\nEXTRACTION OF TEETH.\\ntraction would be a very simple operation, but unfortunately this is\\nseldom the case. It often happens that even when the teeth them-\\nselves are normal they are situated in abnormal positions, and for this\\nFig. 532.\\nDeciduous teeth\u00e2\u0080\u0094 left side (Burchard).\\nreason alone their extraction becomes necessary. In fact, so varied and\\ncomplicated are the different abnormalities presented that it would be\\nimpossible to describe them all. The diagnosis of unerupted teeth occu-\\nFig. 533.\\nPermanent teeth\u00e2\u0080\u0094 right side (Burchard).\\npying abnormal positions has been greatly facilitated by special applica-\\ntions of the skiagraphic method. Its general use in this connection is\\nbut a question of time and further development. A careful study of\\nthe complications most frequently occurring will, however, give good\\npreparation for meeting the emergencies.\\nFigs. 525 to 531 and 535 show abnormal positions of various teeth.\\nIt will be readily seen that no set of rules could be made to govern the", "height": "4612", "width": "2832", "jp2-path": "americantextboo00kirk_0600.jp2"}, "601": {"fulltext": "GENERAL PRINCIPLES.\\nFig. 534.\\n593\\ny\\np q r\\nAbnormalities in teeth.\\nextraction of these teeth therefore only the general principles govern-\\ning extraction can be here set forth.\\nGeneral Principles in Extracting Teeth.\\nThese principles may be classified under the following heads\\n(1) Management and Position of Patients.\\n(2) Selection of Instruments.\\n(3) Technique of the Operation.\\n38", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0601.jp2"}, "602": {"fulltext": "594 EXTRACTION OF TEETH.\\nManagement of Patients. The first important step toward a suc-\\ncessful operation in dentistry is to gain the confidence of the patient,\\nwho must be brought to rely entirely on the judgment and skill of the\\nFig. 535.\\nAbnormal jaw showing impacted canines.\\noperator. If the operator feels entire confidence in his own ability to\\nsuccessfully carry out an operation he can, by his manner of approaching\\nthe patient, impart a feeling of almost absolute trust in his skill. This\\nfeeling of confidence in himself should be cultivated, as it is evident\\nthat a slight nervousness on his part, even though he be most skillful,\\nAvill tend to alarm the patient to such an extent as may cause great\\ninterference with the operation.\\nPosition of the Patient. The principal object to secure in\\nplacing the patient is to obtain a good view of the affected tooth and\\ncontiguous parts after which the position should be made as comfort-\\nable as possible both for the patient and operator, taking care that the\\nterritory of operation can be reached with but little strain or effort.\\nThe position both of patient and operator varies slightly for the\\nextraction of each tooth. The main points to be observed are to have\\nthe particular tooth to be operated upon in view, and the head of the pa-\\ntient in such a position that it can be controlled by the left arm and hand.\\nThe chair should be steady, strong, and comfortable, with arms and\\na good head-rest of rather a concave shape. It should also have a suit-\\nable foot-rest. When the regular dental chair is not obtainable, an\\nordinary strong wooden chair can be used. If two of these chairs are\\nplaced back to back the extra one gives a good place for the left foot\\nof the operator, and a head-rest may* thus be made of his thigh. The\\npatient should be directed to grasp the seat at both sides with his", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0602.jp2"}, "603": {"fulltext": "GENERAL PRINCIPLES.\\n595\\nhands. At times it may be necessary to extract while the patient is in\\nbed or on an operating table in such cases the operator must obtain\\nthe best position available. Where an operating table or couch is used\\nit is well, if possible, to stand at the head of the couch or table and a.\\nlittle to one side of the patient. By reaching over the head, the for-\\nceps shown in Fig. 488 may be used to advantage in work on the lower\\njaw the same forceps may be used for the upper jaw by standing to\\none side of the patient. If the operator is ambidextrous, so much the\\nbetter, as it is very advantageous to be able to use the instrument in the\\nleft hand, especially in extracting the teeth of the right side of the lower\\njaw. If, however, only the right hand can be used, the operator should,\\nas a rule, stand at the right of the chair, the left arm and hand being\\nused in various ways to control the head of the patient. The mouth is\\nopened as far as necessary, and the left hand is then used to hold the\\nlips away and keep the jaw as steady as possible. (See Figs. 543, 544.)\\nSelection and Use of Instruments. The selection of instruments\\ndepends on the nature of the operation to be performed. The means\\nused in extraction should be of the most simple character. Many de-\\nciduous teeth and permanent teeth from about which most of the pro-\\ncess has been resorbed can often be easily extracted with the thumb\\nand finger. Children feel less apprehension with this method than\\nwhen an instrument is used. The thumb should be covered with a\\nnapkin and placed on the inner surface of the tooth with the fingers\\nagainst the outside of the jaw. The tooth is then forced outwardly\\ntoward the cheek or lips. The roots of the deciduous teeth often break,\\nbut this is of little importance, for when extraction is demanded the roots\\nare weakened by the natural process of resorption and will soon disappear.\\nElevators of the various patterns shown in Figs. 500, 501, 536, 537, and\\nFig. 536.\\nManner of holding elevator Fig. 500.\\n538 should be used whenever practicable for removing roots, and in some\\ncases teeth also. Fig. 500 is especially useful in removing the third", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0603.jp2"}, "604": {"fulltext": "596\\nEXTRACTION OF TEETH.\\nmolars. When the internal anatomy of the jaws is well understood,\\nthis will be appreciated.\\nFig. 537.\\nElevator in use labially.\\nFig. 519 shows how firmly the roots are embraced at their necks\\nbetween the two hard plates of compact tissue. It is usually impossible\\nFig. 538.\\nElevator in use lingually.\\nto force an instrument between the roots of teeth and these plates with-\\nout breaking the internal or external walls of the latter. The cancel-\\nlated tissue between these plates is, however, soft and yielding, and into", "height": "4604", "width": "2840", "jp2-path": "americantextboo00kirk_0604.jp2"}, "605": {"fulltext": "GENERAL PRINCIPLES. 597\\nthis a properly shaped elevator can be passed between the roots. After\\npushing the instrument with the point toward the root to be extracted\\nand the back toward the contiguous tooth or root, using the latter as a\\nfulcrum, revolve the elevator slightly, prying at the same time, and the\\nroot will leave its socket with little or no injury to the surrounding tis-\\nsue. Elevators should be firmly grasped and held in such a manner\\nthat if a breakage or slip should occur the instrument will be prevented\\nfrom wounding the soft tissue. If root forceps were used in cases of\\nthis kind it would be almost impossible to avoid injuring one or the\\nother of the plates when removing the root. It is often advisable to\\nuse the forceps by passing the beaks between the plates and grasping\\nthe root on its approximal surfaces, instead of the external and internal\\nsurfaces. Even whole teeth may be extracted in this way when there\\nare no adjoining teeth or roots. A similar plan is sometimes used in\\nrapid extracting under nitrous oxid, where roots or teeth have been\\nextracted on each side of a tooth, the beaks passing into the sockets\\nof the extracted teeth, thus grasping the tooth to be removed on its\\napproximal sides. This mode of operating must be followed with\\ncare, especially in teeth situated below the maxillary sinus, as the floor\\nof that cavity may be easily injured. (See Figs. 516 and 517.)\\nLancing. Lancing for extraction is not usually required, though\\nthere are cases where it is quite necessary. If the teeth have been\\nstanding alone for a long time, especially those in the back part of the\\nmouth, the gums are apt to become firmly attached to them when this\\nis the case it is well to sever the connecting tissue by the use of the\\nlancet before extracting. In extracting roots where it is necessary to\\nremove a portion of the external plate of the alveolar process, it is well\\nto make an incision in a line over the root, through the gum to the\\nbone it is even advisable to slightly dissect the gum and periosteum\\nfrom the bone on each side of the cut. This is done in order that the\\nexternal beak of the forceps may be passed along the bone as far as de-\\nsired. By thus lancing, the parts will afterward come together and\\nquickly heal, whereas if the gum is cut by the forceps it will not heal\\nso well. In extracting roots in the lower jaw, if the lancing w r ould\\ncause the blood to cover the parts and obscure the operator s view it\\nshould be omitted.\\nUse of Forceps. As nearly all operators are right-handed, the\\ninstruction as to the use of forceps will be given with that understand-\\ning, most of the special instruments being made for that hand. The\\nforceps are grasped in the right hand with the palm toward the body,\\nthe thumb on top of and partially between the handles (w r hich will indi-\\ncate to a great extent the amount of pressure being exerted upon the\\ntooth), pressing against the handle nearest the palm just back of the", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0605.jp2"}, "606": {"fulltext": "598\\nEXTRACTION OF TEETH.\\njoint. The first finger should rest a little between the handles, thus\\ngiving a firmer grip on the right handle (see Fig. 539), which might be\\nFig. 539.\\nUse of forceps.\\ntermed the fixed, or passive, handle while the other one is the movable,\\nor active, handle. Many operators do not place the first finger between\\nFjg. 540.\\nUse of forceps.\\nthe handles (see Fig. 540). The second and third fingers pass to the\\noutside of the left handle and are used to close the forceps, while the", "height": "4608", "width": "2840", "jp2-path": "americantextboo00kirk_0606.jp2"}, "607": {"fulltext": "GENERAL PRINCIPLES. 599\\nlittle finger resting between the handles is used to open the forceps,\\nthe thumb being used to force the beaks into the required position.\\nAfter the forceps are in position for extracting, the first finger is\\nplaced along the side of the second finger to give more power to\\nextract.\\nAfter it has been decided to extract by using the forceps, the par-\\nticular forms indicated must be selected and arranged in a convenient\\nplace, ready for immediate use as needed. Especially should this be\\nthe case when the operation is done under the anesthetic influence of\\nnitrous oxid. It is under such conditions that the fewer forceps used\\nthe better the writer generally uses but one forceps (Fig. 489) for the\\nextraction of any or all teeth except the first and second molars for\\nthose teeth, when the other teeth are in position, he advises using the\\nspecial forceps.\\nHaving the patient s head in position, the forceps are grasped as\\npreviously described and the beaks adjusted to the tooth. As a rule,\\nthe inner beak should be placed in position first, and then the outer\\none this is very important, especially for the lower teeth taking care\\nnot to include a portion of the tongue or the soft tissues of the floor\\nof the mouth, as both are liable to get in the way. When the forceps\\nare adjusted to the inner and outer surfaces of the tooth, they should\\nbe forced between it and the gum until they come in contact with the\\nedge of the alveolar process. It is a common error of students to use\\ntoo much force in pressing the handles together; only sufficient force\\nshould be used to securely hold the tooth or root. The forceps should\\ngrasp as much of the roots as possible, avoiding pressure upon the\\ncrown and being careful not to force the beaks between the alveolar\\nplates, as this would result in breaking one or both plates over the\\ntooth or root extracted and also over the adjoining tooth. Cases have\\noccurred in which the entire external plate of one side has been forced\\noff in this way.\\nAt times it may be advisable to take away a portion of the outer\\nplate, in which case the lancet shown in Fig. 502 should be used to cut\\nthrough the gum a little beyond the point of process to be removed,\\ndissecting up the gum slightly the inner beak is then adjusted and the\\nouter one passed between the divided gum and the process as far as\\nrequired the forceps should then be closed with only sufficient force\\nto cut through the bone and grasp the tooth, taking care not to\\ncrush it.\\nAfter the forceps are in position the tooth is loosened by rotating it\\nslightly if it be a round conical-rooted tooth, such as a central incisor,\\nbut if it be a flattened one it should be removed by an outward and\\ninward movement.", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0607.jp2"}, "608": {"fulltext": "600 EXTRACTION OF TEETH.\\nBy the u out-and-in motion is meant that after the forceps are ap-\\nplied the force used in loosening teeth is directed in such a manner\\nthat the tooth is worked outward and inward from the median line\\nof the mouth (see Fig. 51 9, in which the lines show the direction of\\nthe motion for each tooth). The individual teeth do not always bear\\nthe same relation to the median line of the jaw as shown in Fig. 519.\\nWhen the axis of a tooth is not regular it should be loosened by mov-\\ning backward and forward, and the movement should be in line\\nwith its strongest diameter, which lessens the danger of breaking the\\ntooth.\\nIn the upper jaw the inward movement is made after the outer, but\\nwith not so much force, as the structure on the inner side is more\\ndense.\\nEotation of a tooth in extracting is seldom practiced, as the single-\\nrooted teeth are usually flattened and teeth that have more than one\\nroot cannot be rotated. Of the single-rooted teeth, the upper central\\nincisors alone have roots nearly conical in shape which permit rota-\\ntion as well as the out-and-in motion. A rotary motion is usually of\\nadvantage in extracting the roots of the upper first bicuspid when\\ndouble, and of the upper molars after the crowns are broken away so\\nthat the roots are disunited. These roots are usually round, conical,\\nand somewhat curved in shape.\\nIf possible, the tooth should be kept in view during the operation\\nso that the results of the movements may be seen. A beginner may\\nlet the forceps slip and extract the wrong tooth when he is not observ-\\ning each movement, but an experienced operator can depend on his sense\\nof touch to a very great extent. The amount of pressure a tooth will\\nstand while loosening it by an out-and-in motion depends on the size,\\ncondition, and density of the bony tissue surrounding it. Experience is\\nthe only reliable guide in this matter. When a tooth resists ordinary\\neffort, if the operator is not quite sure of the cause of the resistance\\nof the tooth, it is better to desist temporarily and allow the patient to\\nrest in order to investigate the condition of the tooth and its surround-\\nings. Fig. 530 will give some idea of the causes of the resistance\\noffered by apparently normal crowns.\\nAfter the forceps are applied and the tooth slightly moved, if the\\noperator has a cultivated sense of touch he will feel that the tooth is\\nyielding in one particular direction as a general rule the tooth should\\nbe carried in that way.\\nThe force applied to safely and judiciously extract teeth should be\\nmade with arm and wrist motion if the whole body is used the sense\\nof touch is blunted and accidents are liable to occur.\\nExtracting- Deciduous Teeth. In extracting the deciduous teeth", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0608.jp2"}, "609": {"fulltext": "GENERAL PRINCIPLES\u00e2\u0080\u0094 DECIDUOUS TEETH.\\n601\\nthe principles involved are nearly the same as for the permanent. A\\ncare, however, must be taken that is not necessary with the perma-\\nnent teeth, i. e. to avoid injuring the developing permanent teeth that\\nare situated immediately beneath them.\\nFig. 541, which shows all the deciduous and the developing perma-\\nnent teeth except the third molars, gives a true idea of their relative\\npositions. Special attention is drawn to the position of the crowns of\\nthe bicuspids as related to the deciduous molars. It will be seen that\\nthey are situated between the roots of the latter teeth, and by using\\nundue force in adjusting the forceps these crowns could easily be mis-\\nplaced, extracted, or injured.\\nIf the deciduous teeth are extracted at the proper time they can\\nusually be removed by the thumb and finger as described. If not,\\none of the forceps shown in Figs. 488 and 489 should be used.\\nFig. 541.\\nDentures of a child six years of age.\\nExtraction of Individual Permanent Teeth.\\nThe anatomy of the individual teeth and the majority of their\\noften-repeated variations as well as the general principles govern-", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0609.jp2"}, "610": {"fulltext": "602 EXTRACTION OF TEETH.\\ning the extracting operation being understood, the extraction of each\\ntooth will now be studied, those of the upper jaw being first\\nconsidered.\\nThe Upper Teeth.\\nTHE CENTRAL INCISOR.\\nThis tooth has a strong, round conical root. The forceps are carried\\ninto position by placing the inner beak at the palatal surface of the neck\\nof the tooth the outer one is then placed in position and the instru-\\nment forced upward with a slight rotary motion between the gum and\\nthe tooth until it comes in contact with the alveolar process. As the\\nroot is round and conical, it is loosened by rotation and the out-and-\\nin motion and then removed by drawing it directly from its socket.\\nIt is, as a rule, easily extracted.\\nTHE LATERAL INCISOR.\\nThis tooth is much smaller than the central. The root is flattened\\nand somewhat curved, the apex being often bent in the direction\\nof the canine teeth. After applying the forceps as directed for\\nthe central incisor, the motion should be outward and inward. As\\nthe tooth has a delicate root, the force used must be light. When\\nloosening and removing it, care must be exercised, as its root is not\\nstraight. The tooth is carried in the direction of the least resistance,\\nwhich is usually toward the canine tooth.\\nTHE CANINE.\\nThis tooth is usually more firmly set in the jaw than any other, and\\nit often requires considerable force to break up its attachments. The\\nroot is long and slightly flattened. After applying the forceps its\\nattachments are broken up by the out-and-in motion. After loosening\\nit is usually easily removed from its socket. As this tooth is erupted\\nafter the adjoining teeth are in position, it is often malposed. If the\\ndeciduous canine has been lost before its proper time, and the first\\nbicuspid has pushed forward, there is no room for the canine to take\\nits true position. This irregularity varies to a great extent. The\\ncanine may also be out of position from unknown causes. A marked\\nspecimen is seen in Fig. 535, where both canines are impacted. They\\nwere entirely covered by a bony lamina.\\nSometimes the roots of these teeth project into the maxillary sinus,", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0610.jp2"}, "611": {"fulltext": "THE VPPER TEETH. 603\\nor even into the nasal chamber, while the crowns are impacted be-\\ntween the palatal plate and the plate forming\\nthe floor of the nose. Fig. 542 represents a Fig. 542.\\ncanine, lateral, and central incisor which were p\\nextracted from the sinus, the roots being Oi f j\\nimbedded in its inner wall. Teeth thus im- wA r*$\\npacted are often a source of trouble in vari-\\nf l\\nous ways and when discovered should be re- CL\\nmoved. When the tooth is SO covered by bone Canine, lateral, and central\\nthat the forceps cannot be applied the bone S2S\u00e2\u0084\u00a2? from\\nmust be cut away sufficiently to allow the forceps\\nto grasp it. A very good instrument for removing the bone in the\\nupper jaw is the elevator shown in Fig. 500 after the point has been\\nsharpened it may be used as a chisel or gouge.\\nTHE BICUSPIDS.\\nThe first bicuspid usually tas a bifurcated root and the only motion\\nthat can be used safely for loosening is the out-and-in, as these roots are\\nsometimes considerably divergent. The removal after loosening is not\\nalways easily accomplished, a little outward pressure being frequently\\nnecessary. If the force required is used too suddenly the inner root is\\nliable to break.\\nThe second bicuspid usually has a single flattened root, though occa-\\nsionally it is bifurcated. The motion used to loosen this tooth is the\\noutward and inward, using the same precaution as with the first bicus-\\npid on account of the possibility of a double root.\\nTHE FIRST AND SECOND MOLARS.\\nThese teeth are nearly similar, having three roots, two buccal and\\none palatal, which vary so much in degrees of separation that no set\\nrule can be given for their extraction. The roots of the first are usually\\nmore divergent than those of the second. Only the out-and-in motion\\ncan be used, rotation being out of the question in loosening them, as\\nthe roots often diverge to a great extent. (See p, Fig. 534.) After the\\ntooth has been loosened there is at times a difficulty in removing it,\\non account of the distance around the three roots owing to their\\ndivergence this distance is greater than the size of the anatomical\\nneck of the tooth corresponding to the opening of the socket. The\\nonly general rule that can be given is to carry it in the direction of\\nthe least resistance. Each tooth has more or less of an individual\\ncharacter, and therefore the operator must be governed by circum-\\nstances. The main precaution to be observed is not to be in too\\ngreat haste, as there is danger of breaking one of the roots or re-", "height": "4548", "width": "2700", "jp2-path": "americantextboo00kirk_0611.jp2"}, "612": {"fulltext": "604\\nEXTRACTION OF TEETH.\\nmoving a large piece of the outer plate of the alveolar process. (See\\nAccidents, p. 612.)\\nTHE THIRD MOLAR.\\nThis tooth so varies as to the shape and number of its roots that it\\nis seldom spoken of as an abnormal tooth, no matter in what form or\\nFig. 543.\\nShowing position for extracting upper teeth of left side.\\nposition it may be found the greater number have roots curved back-\\nward and outward. Their position in the jaw also varies considerably,\\nThe forceps shown in Fig. 488 is the instrument to use in extracting.\\nAfter the forceps have been firmly placed, the principal motion is the\\nout-and-in, though more out than in. If there is much resistance the\\nhand should be carried outward and upward, or in the direction of the\\nleast resistance. This tooth is sometimes erupted at the side of the", "height": "4612", "width": "2840", "jp2-path": "americantextboo00kirk_0612.jp2"}, "613": {"fulltext": "THE UPPEE TEETH. 605\\nalveolar process (Fig. 545) with its occlusal surface pointing toward\\nFig. 544.\\nShowing position for extracting upper teeth of right side.\\nthe cheek. It is not well to have the mouth opened too far, as it\\nbrings the coronoid process of the lower jaw in the way.\\nFig. 545.\\nAn impacted third molar.\\nIn stating the general rules of extracting, caution was given not to", "height": "4552", "width": "2768", "jp2-path": "americantextboo00kirk_0613.jp2"}, "614": {"fulltext": "606 EXTRACTION OF TEETH.\\nmake the movements faster than could be seen this applies very partic-\\nularly to the third molar. It is so near the ascending ramus in the\\nlower jaw that it is possible, especially when the roots are curved and\\nspread out, to fracture this angle, or in the upper jaw the tuberosity may\\nbe broken away, thus opening into the maxillary sinus. The gum tis-\\nsue often adheres to the posterior portion of this tooth when this hap-\\npens it is best to desist from attempts at extraction and sever the tissue\\nfrom it with a curved lancet or scissors before removing the tooth with\\nthe forceps, or, as before advised, dissect the gum away before applying\\nthe forceps.\\nThe Lower Teeth.\\nAs a rule, the teeth of the lower jaw are more difficult to extract\\nthan are those of the upper jaw, the lips and cheeks being in the way.\\nThe tongue is also troublesome, covering the tooth, and when the inner\\nbeak of the forceps is placed in position especial care must be used to\\nprevent part of the tongue or floor of the mouth from being caught in\\nthe instrument.\\nTHE ORAL OR ANTERIOR TEETH.\\n(For position see Fig. 546.)\\nThese six teeth have small single, straight, compressed roots. Their\\nextraction is only necessary when they become loosened by accident or\\nfrom disease or when it is necessary to clear the mouth for inserting\\nartificial teeth. The operator should stand a little back and to the\\nright side of the chair, being somewhat elevated above the usual posi-\\ntion. Pass the first finger of the left hand between the lips and the\\nalveolar border, and place the remaining fingers beneath the chin with\\nthe thumb on the inside of the teeth. For the incisors use the lower\\nroot forceps shown in Fig. 499 or the universal forceps shown in Fig.\\n489. The canines are larger and more firmly set delicate root forceps,\\ntherefore, are not usually suitable the instrument shown in Fig. 489\\nor, better, the bicuspid forceps (Fig. 497) are much to be preferred.\\nAn out-and-in motion is proper for loosening all these teeth.\\nTHE BICUSPIDS.\\nThe lower bicuspids have compressed roots seldom bifurcated, and\\nare generally extracted by the out-and-in motion. The special forceps\\nfor these teeth should be made so that they grasp a considerable por-\\ntion of the surface of the tooth. These teeth are often difficult to\\nextract without breaking when all the teeth are in position, the roots\\nbeing long and narrow and often situated in an awkward position. As\\nshown in Fig. 518, the position of the roots of the second bicuspid is\\na little to the inner side of the anterior root of the first molar. The", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0614.jp2"}, "615": {"fulltext": "THE LOWER TEETH. 607\\ntooth illustrated in this particular case would be very difficult to ex-\\ntract without breaking.\\nFig. 546.\\nShowing position for extracting lower anterior teeth.\\nTHE FIRST MOLAR.\\n(For position see Fig. 547 for the left side, Fig. 548 for the right\\nside.)\\nThe first molar, if in a mouth where all the teeth are in position, is\\ngenerally the most difficult of all the teeth to extract. The roots are\\nusually long and diverging. It is lower in the arch than the other\\nteeth, and is in fact similar to an inverted keystone consequently,\\nwhen extracted it is drawn through the arch. When the teeth are close\\ntogether the second bicuspid and second molar yield a little, but great\\ncare must be taken that one or both of these teeth are not extracted", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0615.jp2"}, "616": {"fulltext": "608\\nEXTRACTION OF TEETH.\\nwith the first molar. In placing the forceps on the lower molars the\\npoints of the beaks of the special molar forceps (Fig. 485 or 498) are\\nplaced in between the roots on each side of the tooth. Care should\\nbe exercised to avoid including a portion of the tongue or soft tissues\\nof the floor of the mouth in the forceps. If the forceps are not well\\nplaced the wrong tooth may be extracted as it is possible for them to\\nslip in between two teeth.\\nIn loosening these teeth the out-and-in motion is used, and as they are\\nwedged in it is often necessary to continue this motion while extracting\\nthem from their sockets. At times it is advisable to move the tooth out-\\nFig. 547.\\nShowing position for extracting lower teeth of the left side.\\nwardly after it has been slightly lifted from its socket. Occasionally the\\nroots diverge so far that either the crown has to be broken from the\\nroots at their bifurcation or the tooth divided in the line of bifurcation\\nwith splitting forceps each root being then extracted separately.\\nTHE SECOND MOLAR.\\nThe roots of this tooth are not as diverging as those of the first\\nmolar, as may be seen by examining Fig. 514, nor is the tooth wedged\\nin as tightly as in the case of the first molar.\\nThe out-and-in motion is required for these teeth, using the same\\nprecautions that are necessary in the extraction of the first molar.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0616.jp2"}, "617": {"fulltext": "THE LOWER TEETH.\\n609\\nTHE THIRD MOLAR.\\nIn these teeth the roots may vary so much in number and shape\\nthat there can hardly be said to be a typical third molar. Fig. 514\\nshows what might be called a normal third molar, but these are only\\nfound in well-developed jaws, where the teeth are not so large as to\\ncause crowding. They vary in character from the one shown in Fig.\\nFig. 548.\\nShowing position for extracting lower teeth of the right side.\\n514 to the two shown in the right and left jaws represented in Figs.\\n530 and 531. Figs. 526, 527, 528 and 529 show other forms and posi-\\ntions of the third molar. There are also third molars having three,\\nfour, or five roots, a, Fig. 534, shows another form of the third molar;\\nb, c, d, e, and show where the third molar has united with the second\\nmolar; g and h illustrate three molars united; jf, h f I, m, n, o, andp show\\nvariations of roots. The positions these teeth occupy may vary in all\\ndegrees from that shown in Fig. 514 to those shown in Figs. 525-531.\\nWhere the third molar is in the position shown in Fig. 514 and there\\nare no other complications, its extraction is easy. The tooth is removed\\nby placing either the special lower molar forceps shown in Fig. 498 or\\nthe forceps shown in Figs. 488 and 489 in position, and using the out-\\nand-in motion with a slight raising of handles. If 488 be used the\\n39", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0617.jp2"}, "618": {"fulltext": "610 EXTRACTION OF TEETH.\\nbeaks should be turned downward and the handles carried upward.\\nBut when it is of irregular form and position, as shown in the various\\nillustrations, the difficulty increases with the degree of variance from\\nthat of the normal tooth shown in Fig. 514. These cases should be\\nclosely studied. If portions of the teeth are in view, as shown in Figs.\\n530 and 531, they will assist to some extent in the diagnosis of the\\nposition of the roots. In this particular case, the bone as well as the\\nroots being much hypertrophied, it would be impossible to extract the\\nroots without fracturing the process to a greater or less extent. It will\\nbe noticed, on examining the section Fig. 530, that to have fractured\\nthe inner portion of the jaw the inferior dental nerve and vessels and\\nalso the mylo-hyoid nerve and vessels would be endangered. If in\\nattempting to extract this tooth it should not yield to a pressure which\\nif increased would break the bone, it is better to desist and cut away\\nthe bone with a bur (shown in Fig. 587) in the surgical engine, as\\nwas done in the case of the specimen from which the illustration was\\nmade. Those represented in Figs. 526, 527, 528, and 529 would be\\nmore difficult to diagnosticate, as no portion of the teeth is in view.\\nIf trouble existed in this region, the explorations would have to be\\nmade with sharp steel probes. The bone would then have to be cut\\naway until the tooth could be grasped by the forceps, the forceps shown\\nin Fig. 488 being the most useful for this purpose.\\nIn Fig. 525 the third molar is in such position as to be easily ex-\\ntracted, though if proper care were not used the extraction might have\\nserious consequences. It will be noticed that the points of the roots are\\njust through the inner U-shaped cortical portion of the lower jaw below\\nthe mylo-hyoid ridge and project into the submaxillary region. Now,\\nshould this tooth or the roots be pushed downward in attempted ex-\\ntracting, as is sometimes taught, it might be forced into the submaxillary\\nregion and consequently be lost for a time, with the possibility of having\\nto perform a subsequent surgical operation to cut it out from the neck.\\nAn impacted third molar often causes great distress by initiating an\\ninflammation which extends to the region surrounding the angle of the\\njaw, and often including the temporo-maxillary articulation and soft\\nparts within the mouth. Under these conditions the jaws can only be\\npartly opened, deglutition is impaired, and solid food cannot be taken.\\nOne of two things must be done either the offending tooth or the\\none in front of it must be extracted. Every effort should be used to\\nextract the third molar if any part of the tooth can be seen, the diffi-\\nculty is not so great the inflammation of the adjacent parts will gen-\\nerally quickly subside. As the mouth can only be opened slightly,\\nit is impossible to use the large special molar forceps. An elevator\\nis sometimes recommended in these cases, but it may prove to be a", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0618.jp2"}, "619": {"fulltext": "TREATMENT AFTER EXTRACTION. 611\\ndangerous instrument to use under such conditions, for when the tooth\\nis lifted out of its position in the mouth, it might easily slip back into\\nthe larynx. It is well in some cases to loosen a tooth with an ele-\\nvator and then remove it with the forceps shown in Figs. 488 or 489,\\nFig. 549.\\nShowing the direction in which the lower third molar is to be extracted.\\nas they are small and are so shaped that the beaks can be carried back\\nto the tooth mainly along the vestibule of the mouth, the inner blade\\nbeing placed between the teeth by passing the forceps back of the second\\nmolar. Often it is impossible to see completely what is being done,\\ntherefore it is not well for a beginner to undertake this kind of extract-\\ning. After the forceps is in position the tooth should be worked in\\nany direction in which it will yield this is generally outward, upward,\\nand backward, in the manner of unfastening a hook. (See Fig. 549.)\\nWhen the third lower molar is impacted near the angle of the jaw, it\\nmay be necessary to open it from the outside through the soft tissues.\\nWhen such is the case the surgical engine should be used for cutting\\nthe bone.\\nTreatment after Extraction.\\nThe operator should recognize immediately any accident that may\\nhave happened during the operation of extraction, and treat it as the\\ncircumstances indicate but if nothing unusual occurs, then the patient\\nmay be allowed a few moments rest, after which the mouth should be\\ncarefully examined. If there are any loose portions of the process or\\npieces of gum hanging to the parts operated upon, they should be re-\\nmoved by any convenient means, such as a curved pair of scissors or\\na curved lancet (Figs. 502 and 504).\\nWhen several teeth have been extracted leaving ragged edges of the\\nouter walls of the alveolar process, these should be removed with the", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0619.jp2"}, "620": {"fulltext": "612 EXTRACTION OF TEETH.\\nexcising forceps, or better still, by the use of either forceps Fig. 488 or\\n489, according to circumstances, as the beaks can be carried between the\\ngum and the process better than can the blades of the excising forceps.\\nAn antiseptic mouth- wash consisting of a tablespoonful of phenol\\nsodique to a glass of water should be used several times daily for the\\nnext few days. Any other suitable antiseptic mouth -wash which may\\nbe more agreeable to the patient may be used instead, though the phenol\\nsodique is highly efficacious.\\nOccasionally, in a few days after extraction, pain will be noticed in\\nand about the alveolus, especially when the tooth has been the seat of\\npericemental inflammation. Relief in such a case is usually given by\\nremoving any clot that may have formed, and breaking down the de-\\ngenerated tissues which should have adhered to the root. A pledget of\\ncotton saturated with the full-strength solution of phenol sodique or\\ncampho-phenique should then be inserted as a dressing.\\nAccidents.\\nWhen accidents of any kind whatever occur, the operator should be\\ncalm and appear perfect master of the situation. He should be pre-\\npared to successfully deal with whatever conditions may arise.\\nOne of the most common accidents is the breaking of a whole or\\nportion of a tooth or root. If the operator has any doubt of his ability\\nto remove the tooth entire, he should inform the patient that there is a\\npossibility of its breaking, in which case not to be alarmed. If the\\ntooth is removed without breakage so much the better even if it does\\nbreak it will not cause alarm to the patient. It is more desirable that\\nall of a tooth should be removed, for if its surrounding membrane has\\nbeen inflamed, or if a root has been broken having a portion of the\\npulp attached, either will be the source of obstinate pain.\\nIt is better, however, under some circumstances, to let certain roots\\nremain if they are broken, than to break away a large amount of process.\\nRoots are sometimes so situated that they can be easily forced into the\\nmaxillary sinus (see Figs. 516 and 517), or into the submaxillary region\\n(see Fig. 525), or upon the inferior dental nerve. If there are good\\nreasons for believing that the root will not cause undue pain, and there\\nis danger of breaking a large amount of process, it is preferable to let\\nit remain, as in a short time the contraction of the soft parts and the\\nexpulsive efforts of Nature will force the root outward and it can then\\nbe removed without danger. If roots are forced into the maxillary\\nsinus they must be followed and removed.\\nWhen several teeth are to be extracted under an anesthetic, if the\\ngum should adhere unduly to one of them, the operator should desist\\nfrom its removal and proceed with the other extractions, after which", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0620.jp2"}, "621": {"fulltext": "ACCIDENTS.\\n613\\nthe adherent gum should be severed with a curved lancet or a pair of\\ncurved scissors and the tooth then removed. If the gum be much\\ntorn and the bone exposed to a great extent, it should be held in place\\nby a few interrupted sutures. If, however, proper care is taken in ex-\\ntracting, this should not occur.\\nIn extracting crowded teeth, or those having frail alveolar surround-\\nings, it is possible to remove a piece of the alveolar plate, especially in\\nFig. 550.\\nFig. 551.\\nFig. 552.\\nFig. 553.\\nFig. 554.\\nFig. 555.\\nFig. 556.\\nFig. 557.\\nFig. 558.\\nextracting the first and second molars, the broken piece extending back-\\nward, forward, or in both directions to the adjoining tooth. (See Figs.\\n550 to 558.) The tooth in front may even be partially lifted from\\nits socket. As soon as the operator sees the impending accident he\\nshould either stop and see if his method of extraction could be im-\\nproved, or, this point being negatively decided, hold the parts in posi-\\ntion with the left hand as well as he can, and after the tooth is removed\\nforce the injured parts into position they will usually stay, but if not^\\nappliances of appropriate form can be used for retention.\\nIn extracting the upper third molar, the tuberosity is sometimes\\nbroken away, opening into the maxillary sinus (see Figs. 550, 551, 552,", "height": "4548", "width": "2788", "jp2-path": "americantextboo00kirk_0621.jp2"}, "622": {"fulltext": "614 EXTRACTION OF TEETH.\\n555, and 558, showing where teeth have been carried away with the\\ntuberosity). If it is a simple fracture the parts can be forced into place\\nand they will in a short time reunite. But if the parts are torn loose it\\nwill be of little use to try to replace them the best course is to trim\\naway the ragged edges, using the curved scissors for this purpose.\\nAfter such a fracture it is possible that hemorrhage may occur from\\nrupture of the superior dental artery. This is sometimes difficult to\\ncontrol. One of the best remedies, however, is to tightly pack the parts\\nwith medicated gauze. This application must be left in for a few days\\nand then be carefully removed. It is sometimes well to take out only\\npart of the gauze at a time, the loosened portions being cut off with a\\npair of curved scissors. Hemorrhage after extraction usually ceases in\\na short time, and then there is no occasion for treatment when, how-\\never, the adjoining parts are much inflamed, or the patient is in an\\nanemic condition, or the case is one of hemorrhagic diathesis, special\\ntreatment will be necessary.\\nHemorrhage of extraction may be divided into tw T o classes, arterial\\nand capillary. When arterial, it is usually located in the socket of\\nthe tooth, and may usually be stopped without much difficulty by taking\\na twist of absorbent cotton, shaping it into a thin tapering roll, and\\nthoroughly packing the socket. Before inserting the cotton tampon,\\nit should be rolled in tannic acid until the fibers will hold no more,\\nthen the cotton is to be packed tightly into the alveolus with a dental\\nplugger. In packing the cotton it is well to begin at one end and\\ncrimp it upon itself until the socket is entirely filled. A narrow strip\\nof iodoform gauze when packed in the same way makes a good plug,\\nand the more rapid healing of the parts afterward and freedom from\\nany offensive odor makes it a more satisfactory tampon than the tannic\\nacid and cotton plug, though the styptic quality of the latter makes it a\\nmore efficient hemostat. The plug in a few cases may require retention\\nin position by compression. This is accomplished by holding a few\\nfolds of muslin or similar material over the plug, closing the mouth\\nand binding the jaws together with a few turns of a Barton s bandage.\\n(See Figs. 559 and 560.) The 25 per cent, ethereal solution of hydrogen\\ndioxid in small quantity on cotton packed into a bleeding socket is a\\nmost efficient styptic, and will effectually control severe hemorrhage\\nafter extraction. Care must be exercised not to use the solution in\\nexcess, as it may cause injury to adjacent parts.\\nWhere hemorrhage occurs from the surrounding tissue, as in patients\\nin an anemic condition or in cases of hemorrhagic diathesis, the case\\nusually falls into the hands of a general practitioner for systemic\\ntreatment, but the local treatment usually employed by physicians in\\nthese cases is often unsatisfactory, many using MonsePs solution of", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0622.jp2"}, "623": {"fulltext": "ACCIDENTS. 615\\npersulfate of iron, which, although it may be a good styptic for use in\\nFig. 559. Fig. 560.\\nBarton s head bandage.\\nother parts of the body, should not be used in the mouth. The local\\ntreatment in such cases, whether soon after extracting or not, is first\\nto remove all clots from the wound and find the exact place or places\\nfrom which the blood is exuding. A suitable styptic and compression\\nare the principal means used for stopping it, the latter perhaps being\\nthe most important. Tannic acid applied on cotton, lint, or similar\\nsubstances, is a good styptic to use in the\\nmouth. Iodoform gauze, for the reasons al- 56 ^1\\nready given, is better, although it has not\\nbeen generally used in this connection. Com-\\npression can be applied as the ingenuity of\\nthe operator may direct. When a hemor-\\nrhage occurs from a socket between good\\nnil Showing compress and ligatures.\\nteeth, it can be readily controlled by two\\nligatures, making one fast to each tooth, then placing in position and\\ntying the four ends together over the compress, as shown in Fig. 561.\\nIn a few rare cases an impression of the parts should be taken in wax\\nor other modelling compound in order that a rubber or metallic plate\\ncan be made to hold the styptic compress in position. After the com-\\npress is in position warmed modelling compound can be placed over it\\nand the jaws brought together and retained in place by a head bandage.\\nA plug of hardening plaster of Paris may be made and forced into\\nthe bleeding socket in obstinate cases, or in extremis the extracted tooth\\nmight be soaked well in phenol sodique and reinserted.\\nThe systemic treatment is often important; if the patient is seen\\nto be anemic or known to be of the hemorrhagic diathesis, the treat-", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0623.jp2"}, "624": {"fulltext": "616 EXTRACTION OF TEETH.\\nment should be begun before extracting. This is done by thoroughly\\nbuilding up the system by a course of hygienic and tonic treatment.\\nThe cause of bleeding in cases where the hemorrhagic diathesis exists\\nis but imperfectly understood the blood may be so defibrinated that it\\nhas lost the power of coagulation and so will not form a clot, or the\\nmuscular coats of the vessels have lost their tonicity, either through\\ngeneral debility or the lack of energy in the vasomotor nervous system,\\nwhich prevents their contracting so as to close the lumen. Certainly\\nthe walls of the capillaries permit free transudation of the blood.\\nIn good health the proper coagulation and the contraction of the blood-\\nvessels will stop the hemorrhage even when an artery of consider-\\nable size is lacerated, especially if the flow be held in abeyance by arti-\\nficial means for a short time. It is when the blood will not coagulate\\nand the vessels fail to contract that a thorough systemic treatment must\\nbe given. This lack of normal function on the part of the blood and\\nvessels may arise from various diseases, and in order to judiciously\\ntreat a patient exhibiting the hemorrhagic diathesis a thorough exam-\\nination must be made and such treatment given as the diagnosis indi-\\ncates. Among the most common causes of hemorrhage are anemia,\\nsyphilis, purpura, tuberculosis, and a generally impaired vitality, rarely\\nan over-acting heart the passive hyperemia attendant upon a weak\\nheart is a potent factor requiring a course of preliminary treatment.\\nSpecific and special diseases must of course receive the treatment\\npeculiar to these conditions. On general principles the following tonics\\nare advisable Quassia, cinchona and its alkaloids, iron in its various\\nforms, sulfuric and hydrochloric acids, arsenic, phosphorus, nux vomica\\nand its alkaloid strychnin. With these general tonics various hemo-\\nstatics can be given, such as alum, tannic acid, ergot, erigeron Cana-\\ndensis, and gallic acid. Very frequently the digestive organs require\\nspecial medication, when such remedies as pepsin, pancreatin, hydro-\\nchloric acid, and bismuth subnitrate are indicated.\\nThe following prescriptions have proved to be very excellent in\\ntheir special province.\\nAs general tonics\\nStrychnia? sulphatis,\\nAcidi arsenosi, ad. gr. j\\nQuinise sulphatis, gr. xxx\\nFerri sulphatis exsiccat., gr. xv.\\nM. et ft. piluke No. xxx.\\nS. One immediately after each meal.\\n1^. Elixir ferri, quinise et strychnia?, f^iv.\\nS. Teaspoonful four times daily.", "height": "4608", "width": "2856", "jp2-path": "americantextboo00kirk_0624.jp2"}, "625": {"fulltext": "USE. OF GENERAL ANESTHETICS. 617\\nTo improve digestion and assimilation\\n1^. Acidi hydrochlorici diluti, f^ij\\nExt. ignatise amaris fid., f^j\\nPepsin, 3iss\\nExt. ipecacuanha? fid., TTLiv\\nInfusi gentianse comp., q.s. ut ft. f 3yj. M.\\nS. Dessertspoonful in sherry glass of water immediately after\\nmeals.\\nIn cases of undue hemorrhage after extracting, it is well to adminis-\\nter a hemostatic while at the same time styptics and pressure are being\\napplied locally. The following are very good\\n1^. Vin. ergotse (Squibb s), f^iij.\\nS. Teaspoonful every two hours.\\n1^. Ext. ergots solidificat., 3j\\nExt. cannabis indicse, gr. v\\nStrychnia? sulphatis, gr. ss.\\nM. et ft. pilulse No. xxx.\\nS. One pill three times a day.\\nGallic acid and aromatic sulfuric acid may be administered.\\nDigitalin exhibited in doses of y 1 to a grain three or four times daily\\nfor a series of weeks will often effect such change in the capillaries as to\\novercome the hemorrhagic tendency. This has been repeatedly and suc-\\ncessfully accomplished in epistaxis, and as the conditions are analogous\\nit can be employed in this diathesis with expectation of similar results.\\nExtraction under the Influence of General Anesthetics.\\nWhile it is undoubtedly true that the extraction of teeth under the\\ninfluence of a general anesthetic is in accordance with the general spirit\\nof the age which seeks to spare all suffering or cause the infliction of\\nbut slight pain, yet many evils attend such general and too often\\nindiscriminate use. A patient under the effect of so powerful a\\ndrug that consciousness is destroyed is nearer death than an ordinary\\nhuman being, since the primary depressive influence upon the high\\nnervous centres may speedily pass to the lower vital centres in the\\nmedulla oblongata. l\\nThe indiscriminate use of general anesthetics, beside their possible\\ndanger to life and health, has an accompanying evil in the demand\\nfor the extraction of teeth which are salvable and useful, but which\\n1 H. A. Hare, in Park s Text-Book of Surgery, vol. ii.", "height": "4568", "width": "2768", "jp2-path": "americantextboo00kirk_0625.jp2"}, "626": {"fulltext": "618 EXTRACTION OF TEETH.\\na patient insists upon having removed in order to avoid the discom-\\nfort attendant upon their treatment and filling. No one questions\\nor denies the enormous benefit of general anesthetics in dentistry,\\nparticularly when painful operations are to be performed upon ner-\\nvous women and children, but if the patient be willing to suffer a little\\npain it is generally better to extract without a general anesthetic, as in\\nthat case the patient can assist the oj)erator by keeping the head in\\na desired position with the mouth and lips well open, and in various\\nother ways, while under the influence of an anesthetic the muscles\\nsupporting the head, jaws, and cheeks are so relaxed that it is difficult\\nto keep the mouth and lips well open.\\nIf the operation is to extract a difficult tooth, the operator is limited\\nto the time when the patient is under the influence of an anesthetic, and\\nin the case of nitrous oxid the time is Yery short but without an anes-\\nthetic there is not this limitation as to time, and the extraction may be\\ndone with that care and deliberation essential to a proper operation. It\\nis an important rule in any branch of surgery that the time required to\\ndo an operation must be sufficient to do it properly and without un-\\nnecessary injury to the adjoining tissues.\\nExamination of a Patient before the Administration of a Gen-\\neral Anesthetic. The physical examination should be made in such a\\nway that it will not cause alarm to the patient. The result of this ex-\\namination governs the selection of the anesthetic, and to some extent\\nshows how far the patient should be carried under its influence. It has\\nbeen said that a greater amount of care should be used if the patient\\nhas or is suspected of having organic or functional disease of either the\\nheart or the lungs. This is quite true, but at the same time the greatest\\namount of care should be observed in all cases. For the physiological\\naction of various anesthetics the student is referred to special works on\\nthis subject.\\nThe question often arises whether anesthetics should be used at all\\nif the patient has either organic or functional disorder of the heart.\\nThat depends to a large degree on other conditions of the patient. If\\nthe shock of extraction will be less under ether or nitrous oxid, then by\\nall means give the anesthetic and carry the patient fairly well under its\\ninfluence, so that there will be neither pain nor knowledge of the ope-\\nration. Occasionally patients suffering from heart disorders can bear\\na certain amount of pain without shock in such cases it is better, if\\nthe operation be a simple one, to extract while in the normal condition.\\nThe use of ether for extracting has certain advantages. If for any\\nreason the operation requires longer time for its performance than the\\ninfluence of the nitrous oxid will last say from one to two minutes\\nit is better to use ether. Ether can be given after the patient has", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0626.jp2"}, "627": {"fulltext": "USE OF GENERAL ANESTHETICS.\\n619\\nFig. 562.\\nbecome anesthetized by nitrous oxid and oxygen and he may be kept un-\\nder its influence for a considerable time in this way the struggling stage\\nof ether is avoided. When the teeth are to be extracted at the patient s\\nhome or at any other place outside of the office, ether is more conve-\\nniently carried than nitrous oxid. If properly used and the patient has\\nperfect confidence in the operator, it can be so administered that one,\\ntwo, or three teeth may be extracted during what is known as the first\\nstage of ether anesthesia, before complete\\nunconsciousness and long before the strug-\\ngling stage commences.\\nThe best way to accomplish this is to\\nadminister the ether in a cone made by a\\nnapkin or towel, with the small end slightly\\nopened so as to allow the patient to inhale\\na small quantity of air it also permits the\\npatient to exhale freely and with a less suf-\\nfocating effect. It is well to place in the\\ncone a small soft sponge that has been well\\nwashed with hot water. After the cone is\\nready the patient should be instructed to\\nbreathe several long and full inhalations this\\nclears the lungs of much impure air and ac-\\ncustoms the patient to the\\nkind of breathing required.\\nThen the appliance is placed\\nin front of and some distance\\nfrom and above the mouth\\nand nose, being careful to\\nallow none of the ether to\\ndrop from the cone upon the\\nface, as it will demoralize the\\npatient. The inhaler is to be\\nadvanced toward the face\\nslowly and gradually, watch-\\ning the effect upon the pa-\\ntient if there is a tendency\\nto cough, the advance should\\nbe interrupted until this has\\npassed. After the cone has closed tightly over the mouth and nose,\\nit is a good plan to ask the patient to hold up the left hand as long\\nas possible this will concentrate his thoughts upon the act and away\\nfrom the operation. When the hand begins to fall, the request to raise\\nthe hand should be repeated it will soon fall, and in a few seconds\\nNitrous oxid gasometer.", "height": "4552", "width": "2788", "jp2-path": "americantextboo00kirk_0627.jp2"}, "628": {"fulltext": "620\\nEXTRACTION OF TEETH.\\nafterward one, two, or three teeth may be removed, the number de-\\npending entirely upon their position and the difficulty to be overcome\\nin their extraction. As soon as the teeth are extracted the head of\\nthe patient should be raised from the head-rest and the body carried\\nforward, and, having a hand cuspidor in front, the patient should be\\n_, Water line\\nTo gas cylinder\\nSectional view of gasometer.\\nrequested to eject the blood from the mouth this direction is usually\\ncomplied with. The patient in most instances recovers in a few\\nmoments and with no disagreeable after-effects, but if the ether is\\ncarried beyond the struggling stage to the point of complete sur-\\ngical narcosis the nauseating after-effects are very disagreeable unless\\nthe patient has been thoroughly prepared for the occasion.\\nNitrous oxid is the anesthetic most commonly administered for the", "height": "4608", "width": "2864", "jp2-path": "americantextboo00kirk_0628.jp2"}, "629": {"fulltext": "USE OF GENERAL ANESTHETICS. 621\\nextraction of teeth, and under ordinary circumstances is the best. Until\\nlately every operator was his own maker of the gas this was a great\\ndisadvantage but now it can be procured in a liquefied form com-\\nFig. 564.\\nNitrous oxid inhaler.\\npressed in cylinders. There are many different appliances used for\\nthe administering of this gas even when using it in a condensed form.\\nOne of the most prominent is that shown in Figs. 562 and 563, in", "height": "4548", "width": "2784", "jp2-path": "americantextboo00kirk_0629.jp2"}, "630": {"fulltext": "622\\nEXTRACTION OF TEETH.\\nwhich the gas is drawn into a reservoir and then passes through a flex-\\nible tube to the mouth-piece (Figs. 564 and 565).\\nFig. 565.\\nHood inhaler.\\nThe two principal mouth-pieces are Fig. 564, which should have\\nthe detachable lip-shield removed so that the tube may be placed\\ndirectly into the mouth and the lips compressed around the tube by\\nthe operator, at the same time closing the nostril by the thumb\\nand finger, and Fig. 565, which is known as a hood inhaler; it is", "height": "4580", "width": "2880", "jp2-path": "americantextboo00kirk_0630.jp2"}, "631": {"fulltext": "USE OF GENERAL ANESTHETICS.\\n623\\nFig. 566.\\nStand for compressed gas cylinder, gas bag, tube, and inhaler.", "height": "4556", "width": "2784", "jp2-path": "americantextboo00kirk_0631.jp2"}, "632": {"fulltext": "624\\nEXTRACTION OF TEETH.\\nmade to cover the nose as well as the mouth. The advantage of the\\nfirst mouth-piece is that the lips may be closely watched for the change\\nof color denoting oxygen-starvation of the blood, which the experienced\\noperator combats by admitting a certain amount of air with the gas as\\nrequired. Fig. 567 represents a portable appliance to be used at a\\npatient s home or away from the regular office.\\nFig. 567.\\nPortable nitrous oxid apparatus.\\nDr. Hewitt s Method.\u00e2\u0080\u0094 Dr. Frederick Hewitt of London, England,\\nhas devised the apparatus shown in Figs. 568 and 569. The three\\ncylinders contain the compressed gas, two being filled with nitrous oxid\\nand one with oxygen. The valves of the cylinders are opened by a key\\nwhich is controlled by the foot of the operator. The tube passing from\\nthe cylinders to the receiving-bag is double, a smaller tube being placed\\nwithin the outer larger tube. The receiving-bag is also double, being\\ndivided by a rubber septum into two compartments which have their\\noutlet in the double tube which leads to the inhaler. To the receiving-\\nbag is attached a mixing-chamber, and to this the inhaling-tube or hood\\nis fastened. This appliance is used very successfully in England and\\nhas been introduced into the United States. It has proved satisfactory\\nto all who have tried it. The bags and tubing should be made of\\nmore durable material when intended for use in the American climate.", "height": "4580", "width": "2872", "jp2-path": "americantextboo00kirk_0632.jp2"}, "633": {"fulltext": "USE OF GENERAL ANESTHETICS.\\n625\\nThe manner in which the appliance is used is as follows The valves\\nin the mixing-chamber (Fig. 569) are closed, then oxygen is let into its\\ncompartment of the receiving-bag until the latter is nearly filled, when\\nthe nitrous oxid is admitted into its compartment. The patient being\\nprepared, the inhaling-tube or hood is placed in position, and the\\npatient is directed to breathe\u00e2\u0080\u0094 long, full, and steadily. If the tube is\\nused it is necessary to close the nose by the thumb and finger.\\nFig. 568.\\nComplete apparatus of Dr. Hewitt for administering mixed nitrous oxid and oxygen.\\nThe valves are not changed for a few inhalations, during which time\\nonly air is inhaled then, pressing the indicator a downward to the first\\nnotch 6, the air is cut off, and the patient receives pure nitrous oxid\\nthis is allowed for a few more inhalations, and then the indicator is car-\\nried to the next notch and one part of oxygen is allowed to pass into\\nthe respiration. When the indicator is carried to the third notch two\\nparts are received by the patient, and so on until the maximum amount\\nof oxygen required by the patient has been reached.\\nIt has been found by careful study of many thousands of cases and\\nby special scientific investigation that the asphyxia! condition incident\\nto most cases of nitrous oxid inhalation is quite unnecessary to the pro-\\n40", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0633.jp2"}, "634": {"fulltext": "626\\nEXTRACTION OF TEETH.\\nduction of nitrous oxid anesthesia. It is also justly considered to be\\nsubjecting a patient to an unwarrantable danger to permit the asphyxial\\neffect to manifest itself to a profound degree, as in many cases it is\\na menace to life and health, and might have a fatal eifect. The object\\nof Dr. Hewitt s method is to control or eliminate the asphyxial element\\nby administering a requisite amount of oxygen.\\nFig. 569.\\nShowing arrangement of the mixing-chamber, with dial and valve for controlling the\\nrelative proportions of the gases.\\nNo fixed rule can be laid down for the quantity of oxygen to be\\nadded, as each case will require a different amount and this amount\\nvaries during the several stages of the anesthetic procedure. The\\noperator is guided entirely by the symptoms of the patient during the\\nadministration, his object being to avoid on the one hand the tendency\\ntoward asphyxia indicated by cyanosis of the lips, and return of con-\\nsciousness and sensation on the other hand, which is easily produced\\nby an excess of oxygen. By the admixture of oxygen, as in Dr.\\nHewitt s method, the anesthesia is somewhat prolonged over the ordinary\\nnitrous oxid method and is slower of induction, but there is entire\\nabsence of cyanosis, stertorous breathing, jactitation, or any of the\\nsvmptoms of asphyxia. The modification of the Hewitt apparatus\\nthat has been lately introduced embodies certain features that make it\\nan improvement on the original apparatus. The arrangement of the\\nmixing-chamber in reference to the bags containing the gases is such as\\nto enable the operator to more accurately control the mixture that is", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0634.jp2"}, "635": {"fulltext": "USE OF GENERAL ANESTHETICS.\\nFig. 570.\\n627\\nApparatus for administering nitrous oxid and oxygen combined: a, key to oxygen bag; b, key to\\noxygen cylinder c, gauge showing percentage of oxygen being administered d, mixing-\\nchamber e, key to nitrous oxid cylinder key to nitrous oxid bag.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0635.jp2"}, "636": {"fulltext": "628 EXTRACTION OF TEETH.\\nadministered to the patient. By a turn of the levers a and (Fig. 570)\\nany gradation of the gases may be obtained, from pure nitrous oxid on\\nthe one hand to pure oxygen on the other. The construction of the\\napparatus is such as to better withstand the climatic conditions than the\\nHewitt apparatus. A brief description will suffice to show the working\\nof the apparatus.\\nThere are two cylinders, one containing compressed nitrous oxid and\\nthe other compressed oxygen.\\nTwo bags, one of black material containing the nitrous oxid, the\\nother of red material containing the oxygen.\\nThe key to each cylinder (see h and e) opens the valve and allows\\nthe gas to pass into its respective bag.\\nBy opening the valve (see of the nitrous oxid bag the gas passes\\ninto the mixing-chamber, from which it flows through the covered rub-\\nber tube to the inhaler.\\nWhen it is desired to combine oxygen with nitrous oxid, open\\ngauged valve (see a, c) to the oxygen bag this will admit the oxygen\\ninto the mixing-chamber. Both gases will pass through the tube to\\nthe inhaler.\\nThe proportion of oxygen used will be determined by the degree\\nto which the gauged valve is opened.\\nBy closing the valve of the nitrous oxid bag, oxygen can be given\\nseparately.\\nSimilar results are obtained when air is admitted, instead of oxygen,\\nto the patient during the nitrous oxid administration. The details of\\nthis procedure are set forth in the following chapter.", "height": "4608", "width": "2872", "jp2-path": "americantextboo00kirk_0636.jp2"}, "637": {"fulltext": "CHAPTER XXI. (Continued).\\nEXTRACTION OF TEETH UNDER NITROUS OXID\\nANESTHESIA.\\nBy J. D. Thomas, D. D. S.\\nWhere the operation would cause excessive pain, the extraction of\\na tooth without the aid of an anesthetic is to-day little short of bar-\\nbarous. It is cruel to the patient, and if the subject be a child,\\nwantonly so. Very few people can submit to the operation without\\nmore or less physical resistance, and even though this be involuntary\\nno operator can do full justice in such a case, no matter how skillful he\\nmay be. Such resistance causes more or less unnecessary strain to be\\napplied in one direction or another against the process, which results in\\nincreased inflammation as a sequence. Besides, as a rule the liability\\nof breaking the tooth or portions of the alveolar plate or other accidents\\nis increased a hundredfold.\\nNitrous oxid is in all respects the very best anesthetic for the pur-\\nposes of the dentist. Properly used, it is almost entirely free from\\ndanger and is rarely productive of nausea or depression as an after-\\neffect, even temporarily. It seldom requires over sixty seconds to pro-\\nduce anesthesia, and in less than that period of time the patient is\\nfully recovered, with no knowledge of the operation, and is ready to\\ndepart as soon as bleeding ceases. To accomplish such a result, of\\ncourse, requires experience and some degree of dexterity, but the con-\\nditions are such that any dentist with a fair amount of experience can\\noperate successfully with it for the removal of from one to four or five\\nteeth, and perhaps more the main essential in operating by the aid of\\nnitrous oxid being to utilize every second of time during the period of\\nanesthesia, and not to waste it in hunting forceps or deciding how they\\nshould be used.\\nThe best success is obtained by formulating a system of working by\\nwhich one can accomplish the most in the shortest space of time. The\\noperating period seldom extends over forty-five seconds and often less,\\nso that every second wasted in any way whatever is so much time lost,\\nand success is diminished to just that extent.\\nNitrous oxid must be absolutely pure, and if be kept over water it\\n629", "height": "4564", "width": "2764", "jp2-path": "americantextboo00kirk_0637.jp2"}, "638": {"fulltext": "630 EXTR ACTIOS OF TEETH UXDEE XITROUS OXID.\\nmust be fresh. Id former times when the dentist manufactured his own\\ngas, to insure perfect purity it was necessary to test the ammonia nitrate\\nbefore using it for making the nitrous oxid, but at the present day the\\npure gas is made with great accuracy by the manufacturers and is\\nsupplied chemically pure, compressed in cylinders, so that the individ-\\nual dentist is relieved of the responsibility of manufacturing his own\\ngas and of the troubles necessary to secure purity.\\nThe first essential to success in its administration is a perfect\\ninhaler. This should be sufficiently large to permit the patient to\\nbreathe without the slightest exertion. Patients are always in a more\\nor less nervous state upon approaching the dental chair for extraction.\\nThere is usually accelerated heart-beat and consequently deranged\\nrespiration, and unless they can breathe through the inhaler with per-\\nfect freedom they labor under a sense of suffocation which adds greatly\\nto their apprehension and disturbs their equanimity while passing under\\nthe influence of the anesthetic.\\nThe inhaler shown in Fig. 565 is perhaps the best one upon the\\nmarket, but has the disadvantage of having hard disk valves, and\\nwhile the size is sufficiently large for most purposes the space between\\nthe outer circumference of the disk and the inner circle of the pipe is\\nso small that it does not at all times permit of free ingress of the gas\\nto the lungs, and, besides, such valves are not always airtight.\\nThe best inhaler is one made of vulcanized rubber turned to the\\nproper dimension and fitted with valves made of rubber dam (Fig.\\n571). These valves have the property of fitting closely, making the\\nFig. 571.\\nThomas s inhaler.\\npassages airtight, and being flexible they admit the gas to the lungs\\nwith little or no obstruction. This inhaler is the one employed by", "height": "4580", "width": "2880", "jp2-path": "americantextboo00kirk_0638.jp2"}, "639": {"fulltext": "ADMINISTRATION OF NITROUS OXID. 631\\nmost operators who make a specialty of extraction, and is made only\\nupon special order.\\nIn giving nitrous oxid it is necessary that the valves of the inhaler\\nshall be airtight, for if there is a leakage by which air is constantly\\nbeing admitted, it will interfere greatly with the production of the\\ndesired results. The hood face-piece should never be used. Aside from\\nthe impossibility of fitting the face so closely as to preclude the admis-\\nsion of some air during the administration, particularly when beard\\nexists, it covers the lips from view, and these are an important index\\nduring the process of anesthesia the color of the blood as shown\\nthrough the mucous membrane of the lips should never be lost to\\nsight.\\nThere is no separation of the elements of nitrous oxid at the tem-\\nperature of the human body, or during its inhalation, consequently it\\nis practically an inert gas so far as its power to support life is con-\\ncerned. It possesses strong anesthetic properties but it is also to a\\ndegree productive of asphyxia, and the color of the lips must be ob-\\nserved as a guide to indicate the extent to which asphyxia is taking\\nplace. It has been previously said that the valves of the inhaler must\\nbe airtight, for a constant leakage of air will prevent the production\\nof complete anesthesia, and yet at the proper time during the inhala-\\ntion the admission of air, controlled by opening the nose or raising the\\nlips, is not only desirable but essential to the proper and successful ex-\\nhibition of the anesthetic.\\nBy the judicious admission of air at the proper time the accompany-\\ning symptoms of approaching asphyxia are obviated and perfect anes-\\nthesia is secured without any of the convulsive muscular twitching\\nwhich takes place when the pure gas is given. Dr. Hewitt of London\\nadvocates the admixture of oxygen with nitrous oxid, for which he has\\nintroduced the appliances described on p. 624, but by admitting air as\\nhere suggested similar results are obtained with less manipulation.\\nThe use of props to keep the jaws open is necessary to insure success.\\nThey give free scope for operating, and there is no time lost in prying\\nthe mouth open, as nearly always happens when props are not used.\\nProps made of hard wood and of different sizes are the most satisfactory\\nthey should have strings attached, more to reassure the patient than\\nfor any other reason. Unfortunately, a number of years ago a patient\\ndied as a result of getting a cork in the larynx, and this has never been\\nforgotten. Consequently the string is an assurance to the patient that\\nthe prop cannot slip down the throat.\\nThe ordinary dental chair is not desirable for use in administering\\nnitrous oxid, particularly those chairs having stationary footstools at-\\ntached. Patients are sometimes restless, and every motion made by the", "height": "4548", "width": "2776", "jp2-path": "americantextboo00kirk_0639.jp2"}, "640": {"fulltext": "632 EXTRACTION OF TEETH UNDER NITROUS OX IB.\\nfeet upon a fixed footstool will produce a responsive movement of the\\nbody, thereby increasing the risk of accident to the part being operated\\nupon. A detached stool upon casters is easily pushed away, so that\\nany disposition to move the extremities may be permitted without\\naffecting the stability of the upper part of the body.\\nThis apparent resistance on the part of the patient is not necessarily\\nthe indication of a knowledge of what is being done the upper brain\\nfunction may be paralyzed while the sensory peripherals and motor\\nganglia are not, under which circumstances the patient is not thoroughly\\nanesthetized. Resistance may take place at the beginning or just at the\\ntermination of the anesthetic procedure, and if the operator ceases at\\nonce the patient will declare absolute unconsciousness of the operation.\\nIt is, however, sometimes permissible to operate during the stage just\\nnoted in cases where the systemic conditions are such that it would be\\nunwise to carry the patient to the state of profound insensibility. These\\nare, however, exceptions and not the rule. To have the exhibition per-\\nfectly satisfactory there should be no resistance or outcry.\\nA competent assistant is necessary, not only as a protection against\\ncharges which might be suggested by lascivious dreams as has occurred\\nwhen ether has been employed (though the period of insensibility under\\nnitrous oxid is so short that it would seem that no one, however evilly\\nor honestly disposed, could ever sustain such a charge) but an assist-\\nant can render much aid by holding the tube, lowering or raising the\\nhead, taking care that the operator does not bruise the lips, holding the\\npatient if restless, particularly the hands, and waiting upon the patient\\nduring recovery from the anesthetic.\\nThe assistant should be a woman, as it adds very materially to the\\ncomfort of female patients to have such a person in attendance.\\nThe operator should receive the patient in such a manner as to\\ninspire entire confidence. If necessary, any doubts or possibilities of\\naccident should be clearly explained to the patient, so that in the event\\nof untoward results there will not be a humiliating sense of failure.\\nThe patient is seated, and after a careful examination has been made\\nand the condition of the tooth or teeth is ascertained, the prop is placed\\nwhere it will be least in the way. The assistant then places the tube\\nin the mouth and the patient is directed to close the lips and breathe\\nthrough the mouth instead of the nose in the meantime closing the\\nnostrils with the third finger and thumb of the left hand, the first and\\nsecond pressing the upper lip about the mouthpiece, while the thumb\\nand fingers of the right hand support the lower lip.\\nWhile inhaling the gas it is desirable that patients should breathe\\nas in ordinary respiration, for two reasons First, if instructed to take\\nlong and deep breaths they exert themselves beyond their natural", "height": "4580", "width": "2888", "jp2-path": "americantextboo00kirk_0640.jp2"}, "641": {"fulltext": "THE OPERATION OF EXTRACTION. 633\\nrhythm, and Avith unconsciousness comes involuntary suspension for some\\nseconds, and should it occur in one who becomes quickly asphyxiated\\nthe few seconds of suspension are sufficient to produce alarming symp-\\ntoms which will require some effort to counteract. Second, if the\\npatient breathe slower or less deeply than is natural there is a sense\\nof suffocation produced which grows in intensity until unconscious-\\nness supervenes, when the lungs and diaphragm will exert their func-\\ntion, producing violent respiratory effort which will be followed by\\nmarked exhaustion upon recovery. None of these effects need be\\nproduced if the operator have complete control of the situation.\\nNo one can explain the symptoms of approaching and complete\\nanesthesia in such a manner as will inform a novice sufficiently well to\\nundertake the responsibility of administering the gas these can only be\\nlearned through observation and experience, but the first prominent\\nindication will be a discoloring of the lips and subsequent pallor of\\ncountenance, which is not, however, an indication of cardiac depres-\\nsion, but is due to the blood color shown through the skin. Should\\nthe patient be of the blonde and florid type this appearance will be\\nmore marked, and it is here that the admission of a small amount\\nof air is called for, particularly if the blueness seems to approach\\nmore rapidly than the anesthesia.\\nIf the pure gas is given to complete narcosis, there will be twitching\\nof the muscles of the neck and wrists. Stertor and irregular breathing\\nand sometimes decided convulsive action occur, which to one inexperi-\\nenced becomes distressing, if not alarming, to behold.\\nAll these symptoms are at once relieved by air-breathing, and if\\nthere is a judicious admission of air during the administration of the\\nanesthetic they will be avoided entirely.\\nThe patient being anesthetized and the instruments being always in\\nplace so that there will be no delay in picking up the pair of forceps\\nrequired, so that every second of time may be utilized by the work\\nin hand the next step is the extraction.\\nThe Operation of Extraction. The proper way to perform the\\noperation is to stand in one position, at the right side of the patient,\\nduring the whole proceeding. For extracting with the greatest facility\\nthe operator should assume such a position that in standing erect the\\npatient s head will be about opposite his upper waistcoat pocket. To\\ndo this a pair of stools should be used, one just back of the chair and\\nerne by the side which may be easily pushed aside when not needed.\\nWhile administering, the operator can stand upon the floor, and ascend\\nthe stool just before the time for operating. This position is assumed\\nby the most successful operating specialists, and is adopted as the result", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0641.jp2"}, "642": {"fulltext": "634 EXTRACTION OF TEETH UNDER NITROUS OXID.\\nof long experience and dictated by the desire to bring about a position\\nfor work which permits of its most rapid performance and at the same\\ntime enables the operator to bring to bear the greatest amount of force\\nwith the least physical exertion.\\nWhen extracting, for example, a lower tooth, and it is necessary to\\nforce the beaks of the forceps well down through the process, the\\ninstrument is manipulated by the hand and wrist with the arm held\\nclosely to the body to steady it. The weight of the body is allowed to\\ndescend to the proper degree by bending the knees, and when the for-\\nceps are fixed, should force for pulling be required, the straightening of\\nthe knees will raise the body, the arm being held firmly as described.\\nThe hand will be used exclusively for manipulating and guiding, while\\nthe force will be supplied by straightening the knees much the same as\\nis applied in lifting weight from the ground. Of course, to become\\nexpert one must have all of his limbs equally trained.\\nIn operating on the upper jaw the method is much the same, only\\nreversed, bending the knees first to lower the body and forcing the\\ninstrument to position by straightening and throwing as much of the\\nbodily weight upon the arm, by bending the knees, as is necessary for\\npulling. By so doing a tooth will never be allowed to leave the socket\\nsuddenly as by a jerk, for the operator has perfect control of his hand\\nand wrist, and the danger of bruising the opposite teeth in either jaw by\\nthe forceps is avoided.\\nThe Forceps. Seven pairs of forceps are all that are used by the\\nwriter for extraction in ordinary cases. For the upper teeth, a right and\\nleft pair for the molars, a bayonet-shaped instrument with the outer beak\\npointed to fit between the buccal roots, and both beaks serrated. In\\nworking upon both sides of the mouth a pair without pointed beaks may\\nbe used with advantage to avoid changing. One alveolar pair suffices\\nfor the roots of all molars and bicuspids on either side. These are\\nmade bayonet-shaped with smooth concave beaks, but having well\\nsharpened edges. The pair for the incisors is straight, with beaks simi-\\nlar to the alveolar pair, and when extracting, say all the upper teeth,\\ncan be used upon all ten front ones with equal facility.\\nFor teeth in the lower jaw the molar pair is made w T ith both beaks\\npointed, serrated, and gracefully curved so as to bring the force as nearly\\ndirect as possible; these are equally applicable for all the molars on\\neither side and are shaped the same as the alveolar pair. The alveolar\\npair are shaped the same as those for the molars, have smooth concave\\nbeaks with sharp edges, and are used for all molar roots and bicuspids\\n(Fig. 572). The pair for front teeth is curved under the handle and\\nmay have serrated beaks, as the roots of the lower centrals and laterals", "height": "4604", "width": "2872", "jp2-path": "americantextboo00kirk_0642.jp2"}, "643": {"fulltext": "THE OPERATION OF EXTRACTION.\\n635\\nFig. 572.\\nAlveolar forceps.\\nare so flat that a sharp beak is apt to cut\\nthem off, if too much grasp is applied.\\nThey seldom require the force necessary\\nin the extraction of other teeth.\\nThe writer prefers forceps that are not\\nnickel-plated, as this imparts a slippery\\nor greasy feeling to the handle, making\\nthe hold less secure, which induces an\\nincrease of force in the operator s grasp, with\\ngreater liability of cutting or crushing the teeth.\\nWith forceps having beaks that are not serrated,\\nteeth having conical tapering roots will prevent\\nthe perfect fitting of the cutting edge these will\\nsometimes slip through the posterior opening of\\nthe upper or lower alveolar pairs with great force.\\nThe writer has seen, in one instance, a tooth slip\\nthrough the beaks of an unserrated pair of for-\\nceps and break a pane of glass in front of the\\nchair, and an under single molar root which\\nshot up with sufficient velocity to penetrate the\\nsoft palate.\\nIn extracting, particularly under nitrous\\noxid, no instrument should be used which will\\nnot securely retain any tooth or root until it is\\nsafely placed outside the mouth.\\nElevators are wholly out of place when work-\\ning under an anesthetic. They permit no control\\nof the root or tooth whatever, and the liability\\nof a tooth slipping into the throat under such\\ncircumstances is too great to warrant the risk.\\nThe art or knack of extract-\\ning does not consist of giving a\\nrotary motion to one kind of\\ntooth and a lateral or in-and-out\\nmotion to another, but rather of\\nworking the tooth in the socket\\nwithout any pulling until it is\\nstarted or loosened from its at-\\ntachment, when the pulling force\\nmay be applied, and to do this the\\nforceps must be placed upon a\\ntooth so nicely that the tooth and\\ninstrument will feel to the hand", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0643.jp2"}, "644": {"fulltext": "636 EXTRACTION OF TEETH UNDER NITROUS OXID.\\nas one continuous object, so that the slightest motion in any direction\\nwill have immediate effect in starting the tooth. The operation is\\ncompleted by continued working while the pulling is applied in the\\ndirection which will prove the most effective in dislodgment.\\nThis working should be done with as little motion as is possible,\\nfor the smallest degree of straining upon the process laterally only\\nadds so much more distention to the alveolar plates, and increases the\\ninflammation and pain after the operation. When nitrous oxid was\\nfirst introduced and extracting was transferred to those who made it a\\nspecialty, it was noticed that there was less soreness of the mouth follow-\\ning the operation, and it was thought by some that the oxygen of the\\ngas produced a beneficial effect upon the blood which caused better\\nhealing, but such is not the case.\\nThe object, in extracting, of one who becomes expert by constant\\npractice is to save the surrounding parts from all unnecessary strain,\\nconsequently less pain and soreness follows the operation. There are\\nteeth having curved and divergent roots, and cases of exostosis, which\\nwill require great effort to remove, but even in these the position as-\\nsumed and the process of working the tooth in the direction of\\nthe force applied all tend to accomplish the result with less injury than\\nwould be otherwise produced.\\nIn this way the breaking of a tooth need seldom occur unless inten-\\ntionally. If in extracting an upper or lower molar one finds by the\\nextra amount of force required that it will not readily yield, then it is\\nbetter to break the crown off and with the sharp alveolar forceps remove\\nthe roots separately. This can be done with less injury to the alveolar\\nplates than if much greater force were applied to remove the tooth\\nas a whole.\\nThere will be cases of fracture of points of roots which are much\\ncurved or divergent, but many of these retained fragments may be per-\\nmitted to remain until in the process of exfoliation they come to the\\nsurface if their retention is regarded as likely to give rise to less\\ntrouble than the injury incident to their removal would cause. But\\nthese need rarely occur if the operator has by experience acquired that\\nsense of feeling which tells him at once the direction of the curve or\\nthe size of the exostosis.\\nInverted or impacted third molars are the most difficult cases which\\npresent themselves for extraction. Instead of being surrounded by\\npliable process they are planted in compact bone at the angle of the\\njaw, bound in by the second molar in front and hard bone on the\\nbuccal side, so that above it in the angle is the only direction offered\\nfor removal, working them toward the tongue where the bone is\\nthinnest.", "height": "4612", "width": "2864", "jp2-path": "americantextboo00kirk_0644.jp2"}, "645": {"fulltext": "THE OPERATION OF EXTRACTION. 637\\nIn addition to the difficulty in removing these teeth, this severe\\nprocess of pressing the inner alveolar plate toward the tongue excites\\na state of inflammation, easily communicated to the soft tissues of the\\nthroat, and the after-effects assume in many cases such serious condi-\\ntions that it is better practice to remove the second molar.\\nIf the third molar is sound it may remain and will cause no further\\ntrouble, as the primary difficulty was caused by crowding and pressing\\nupon the second molar and should it be necessary, from decay, to re-\\nmove it, the extraction of the second molar first, renders the operation\\nsimple and easy of accomplishment.", "height": "4552", "width": "2704", "jp2-path": "americantextboo00kirk_0645.jp2"}, "646": {"fulltext": "", "height": "4580", "width": "2880", "jp2-path": "americantextboo00kirk_0646.jp2"}, "647": {"fulltext": "CHAPTER XXI. (Concluded).\\nLOCAL ANESTHETICS AND TOOTH EXTRACTION.\\nBy Henry H. Burchard, M. D., D. D. S.\\nPrior to the discovery and application of cocain, the local anes-\\nthetics employed to produce a condition of analgesia of the structures\\nsurrounding a tooth to be extracted were sprays of extremely volatile\\nsubstances. Through the rapid evaporation of a spray of one of the\\nlighter hydrocarbons, a condition of refrigeration of tissues was brought\\nabout during which a tooth could be extracted painlessly. Sprays of\\nrhigolene and of ethylic ether have been superseded by those of ethyl\\nand of methyl chlorid, these substances being more volatile directed\\nin a fine spray over the gum of the tooth to be extracted, an intense\\nlocal anemia is produced, and as a consequence analgesia results. If\\nthe refrigeration be rapidly produced and the operation be performed\\npromptly upon the attaining of analgesia, the frozen tissues recover\\nwith but slight reaction. It is to be remembered that the tissues are\\nfrozen, and if the action be prolonged a condition akin to chilblain is\\npresent. The mode of application is as follows: All of the mucous\\nmembrane, except that over the roots of the doomed tooth, is to be pro-\\ntected from the spray by means of napkins. The spray is directed\\nagainst the exposed gum, the vial containing the ethyl chlorid being\\nheld about a foot from the mouth. When the gum becomes intensely\\nanemic, indicated by pronounced whiteness, the tooth is to be extracted.\\nEthyl chlorid must be kept in a cool place, and far from any flame it\\nis inflammable and explosive.\\nPreparations containing cocain (benzoyl-methyl-ecgonin) have to\\na great extent superseded all other local anesthetics employed for this\\npurpose. It was clearly shown soon after the introduction of this\\nalkaloid that its local anesthetic action when applied to the gums did\\nnot extend beyond the depth of the mucous membrane, so that its epi-\\ndermic application does not render the operation, of tooth extraction\\npainless. The hypodermatic application was found to render the tissues\\ninfiltrated perfectly analgesic. A recklessness was evinced in its use\\nafter this method which was promptly followed by repeated disasters\\n639", "height": "4552", "width": "2760", "jp2-path": "americantextboo00kirk_0647.jp2"}, "648": {"fulltext": "640 LOCAL ANESTHETICS AND TOOTH EXTRACTION.\\na formidable list of casualties grew. Reports of cases of respiratory\\nand of cardiac paralysis following its employment were not uncommon.\\nIt apparently needed disaster to demonstrate that cocain belonged in the\\ncategory of actively poisonous alkaloids, being by no means the bland\\nand safe agent many operators seemed to think it. This lesson, learned\\nat great cost, is one the operator is ever to heed, particularly in the\\nhypodermatic employment of the agent. Dr. M. H. Cryer has re-\\nported l cases of ascending degeneration of the trunks of the maxillary\\nnerves following upon cocain injections about the jaws.\\nFor the origin, composition, physiological effects, and toxicology of\\nthe drug the student is referred to the standard works upon materia\\nmedica. There are several points, however, which cannot be over-\\nemphasized, the first being in regard to the drug itself. A full dose of\\ncocain hydrochlorid by the stomach is about gr. f The composition\\nof the commercial specimens is not constant some of them appear to\\ncontain the actively poisonous alkaloid isatropylcocain. A safe dose\\nwhen applied hypodermatically is not in excess of gr. j-.\\nThe lethal effect of cocain is upon the respiratory centre. Its\\nabsorption is followed by a stimulation of the cardiac and respira-\\ntory functions, which is commonly followed by a reaction, the stimu-\\nlation giving way to depression. Idiosyncrasies as to the effects of\\ncocain are common cases of susceptible women have been noted in\\nwhich gr. produced toxic effects, It is to be noted that the depres-\\nsion following as a secondary effect upon the primary stimulation may\\nnot occur for an hour or later.\\nIn prescribing cocain for hypodermatic injection, the analgesic is\\nthe first element to be considered in the prescription. The dose is not\\nto exceed gr. -J-. The second factor demanding attention is a physio-\\nlogical antidote, one which will not neutralize the analgesic effect and\\nyet will prevent the toxic action of the cocain upon the cardiac and\\nrespiratory functions. Morphin is that agent. As its full physiological\\neffect is not required, a small dose, gr. will be sufficient. The next\\ningredient of the prescription is an agent which shall prevent abrupt\\nspastic contraction of the arteries and heart. Trinitrin is this agent.\\nOne drop of the 1 per cent, solution is the indicated dose.\\nFungi develop freely in solutions of cocain, so that if the pre-\\nscription is to be a permanent solution, an antiseptic is required to\\nprevent decomposition. Cinnamic alcohol answers well for this pur-\\npose. One drop of carbolic acid to each half-grain of cocain is an\\nefficient antiseptic. By boiling cocain is split up into methyl, benzoic\\nacid, and ecgonin, so that cocain solutions cannot be sterilized by\\nboiling.\\n1 Proc. Academy of Stomatology, Philadelphia, 1896.", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0648.jp2"}, "649": {"fulltext": "COCAIN. 641\\nThe dose commonly employed of the components of the prescription\\nis\\n1^. Cocainse hydrochloride gr. -J-\\nMorphinse sulph., gr.\\nor Atropine sulph., gr. j^\\nTrinitrin. (1 per cent, sol.), gtt. j\\nAcid, carbolic, gtt. j\\nAquse, q. s. 3ss. M.\\nS. The above represents a half-syringeful and is a full dose.\\nThis solution has been employed with general success, provided\\nstrict antiseptic precautions have been taken. Untoward results are\\noccasionally found even with this seemingly safe formula.\\nIn the hypodermatic use of cocain the relatively safe maximum dose\\nshould never be exceeded and the exact amount administered in a given\\ncase always definitely known. A common error has been the dependence\\nupon solutions of a given percentage composition. The danger of such\\ndependence becomes evident when it is considered that the safe maxi-\\nmum dose of cocain salt may be easily exceeded by the use of a sufficient\\nquantity of a low-percentage solution, while on the other hand it is\\nquite possible to keep within the limits of safety by using minute\\nquantities of a high-percentage solution. The supposed harmlessness\\nof a dilute cocain solution is erroneous and misleading unless the factor\\nof the absolute quantity of the drug contained in a given amount of\\nsolution is constantly kept in mind.\\nA method which is in all respects safer and which enables the oper-\\nator at all times to know the exact amount of cocain salt injected is to\\nmake the solution upon the basis of eight grains of the salt to one ounce\\nof the menstruum, which will give one grain in each drachm and of\\na grain in each minim. Of such a solution from five to eight minims\\nmay be injected about a tooth with a reasonable degree of assurance\\nthat the safe limits of physiological effect have not been exceeded.\\nThe menstruum in which these ingredients are combined is an inter-\\nesting feature. It has been repeatedly shown that the injection of a\\nquantity of water will produce anesthesia of a region. The nerve fila-\\nments are compressed by the fluid and do not transmit painful impres-\\nsions.\\nDr. Schleich of Greifswald l follows, for the induction of local anes-\\nthesia for operations in general surgery, an infiltration method. The\\ninjection is divided and the punctures made seriatim about the territory\\nto be operated upon. The remarkable feature of his procedure is the\\nminute dose employed. He uses a 1 4000 solution of cocain, to which\\n1 T. Parvin, Proc. Phila. Co. Med. Soc, Nov. 13, 1895.\\n41", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0649.jp2"}, "650": {"fulltext": "642 LOCAL ANESTHETICS AND TOOTH EXTRACTION.\\nis added l of 1 per cent, sodium chlorid and a small quantity of 4 per\\ncent, tricresol. One syringeful, about a drachm, is sufficient to infil-\\ntrate the tissues about a tooth and render its extraction painless. A\\ndrachm of the 1 4000 solution contains about gr. T of cocain. The\\nstrongest solution employed by Schleich is a 1 500. A drachm of such\\na solution would contain less than gr. of cocain. Dr. W. F. Litch\\n(ibid.) has pointed out that low-percentage solutions will give a safer\\nresult than those of high percentage, even though the absolute amount\\nof the drug should be the same. It is seen, therefore, that the quan-\\ntity of menstruum in which the dose of cocain is suspended is an im-\\nportant consideration.\\nTablets for making Schleich s solutions may be had of pharmaceu-\\ntists. Tablets for making the strong solution contain\\nJfy. Cocaina? hydrochl., gr.\\nMorphinse hydrochl., gr.\\nSodii chlorid., gr.\\nS. Dissolve in Vf[ 100 of distilled water.\\nAlmost without exception the nostrums advertised and sold under\\nhigh-sounding titles, for employment in this field, contain cocain.\\nNeither their names nor any information vouchsafed by their venders\\ngive any indication of the amount of alkaloid present, and so all of\\nthem should be tabooed. It is nothing short of criminal to employ\\nthese nostrums without a knowledge of their exact composition.\\nTropacocain (benzoyl pseudo-tropin) has been employed to render\\nthe operation of tooth extraction painless. It possesses decided advan-\\ntages over cocain. It is only one-half as toxic has but slightly de-\\npressant action upon the cardiac ganglia has no paralyzant action upon\\nthe respiration anesthesia is more quickly produced, and its solutions\\nare slightly antiseptic. Solutions of the drug are made in distilled\\nwater the full dose is gr. to\\nThe reader, of course, at once draws the correct inference that\\nSchleich s method gives promise of safety. Applications made hypo-\\ndermatically of the elaborated prescription presented are not without\\ndanger even in physiological dose.\\nIt is necessary that the field of operation be made aseptic before\\ninjection. The mouth should be washed repeatedly with a powerful\\nantiseptic, 3 per cent, pyrozone, 10 per cent, electrozone, or 3 per cent,\\nformaldehyd solution.\\nThe syringe should be aseptic repeated washing of syringe and\\npoints in a 25 per cent, solution of phenol sodique will serve this end\\nwithout detriment to the syringe piston or the metallic parts of the:", "height": "4580", "width": "2864", "jp2-path": "americantextboo00kirk_0650.jp2"}, "651": {"fulltext": "SCHLEICH S SOLUTIONS. 643\\nsyringe. A syringe having stout finger-rests and holding one drachm\\nis employed. The needles should be reinforced for half their length,\\nand should have sharp, fine points.\\nThe gum is to be dried and touched with a 20 per cent, solution of\\ncocain in five minutes the needle may be inserted painlessly. The\\nsyringe is filled with the analgesic solution, the needle screwed on, and\\nthe piston pressed down until all air is expelled from the syringe and\\nneedle. The latter is now thrust into the gum about midway between\\nthe neck of the tooth and the apex of the root, until it comes in contact\\nwith the alveolar process, when it is slightly withdrawn and a few\\ndrops of the solution are driven into the tissues. A second injection is\\nmade over the apex of the root if the strong solutions be used, the\\namount of fluid injected must not contain more than gr. -J- of cocain\\neven though several punctures be made. Care must be exercised to\\nconfine the injection to the tissues of the gum if the submucous tissue\\nbeneath the junction of the cheek and gum be injected into, alarming\\nemphysema may result.\\nFor multirooted teeth an injection is made over each root. If\\nSchleich s solution be employed, a full drachm of fluid should be in-\\njected, until the gum over the tooth is tense and white, when extrac-\\ntion may be accomplished painlessly.\\nIn some instances the intense anemia present at the moment of\\nextraction may be succeeded by local hemorrhage as soon as reaction\\nis established. An antiseptic hemostatic should be applied to the\\nalveolus after extraction phenol sodique, full strength, is an admirable\\nagent for this purpose.\\nThe imminent dangers to be feared in this connection are first, the\\ntoxic effects of the drug. As these are usually manifested in contrac-\\ntion of the bloodvessels the antidote is amyl nitrite. A supply of pearls\\neach containing tTliij of amyl nitrite should be kept in the medicine\\ncabinet. When a patient exhibits great pallor, a small pulse, and bluish-\\nwhite lips, one of these pearls is crushed in a napkin and the nitrite\\nquickly inhaled. The conjoint administration of gtt. xx. aromatic\\nspirits of ammonia, or about half an ounce of brandy, is advised.\\nShould these measures not prove promptly effective, artificial respiration\\nshould be immediately begun and be prosecuted vigorously.\\nThe second danger is septic infection, either through imperfectly\\nsterilized instruments or by carrying septic organisms from the mucous\\nmembrane covering the gum into the deeper tissues during the opera-\\ntion of injection. This is avoided by a careful sterilization of the\\nsyringe before it is used, and the repeated applications of antiseptic\\nmouth- washes previous to injection. Prescriptions which contain a\\nlarge percentage of carbolic acid are liable to cause sloughing.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0651.jp2"}, "652": {"fulltext": "644 LOCAL ANESTHETICS AND TOOTH EXTRACTION.\\nInjections forced between the periosteum and bone may produce\\nserious injury.\\nThe introduction of eucain as a local anesthetic was due to the\\nobserved chemical similarity of that synthetic body with cocain an\\ninstance of presaging the physiological effects of a drug by its chemical\\ncomposition. Its local effect upon bloodvessels is to produce hyper-\\nemia, instead of the ischemia induced by cocain. It is less poisonous than\\ncocain and its solutions are chemically more stable. Its primary action\\nupon the central nervous system is one of exaltation, and this is followed\\nby paralysis, the effect being central, not ascending. The sedative\\ncentral influence causes a quickening of the heart-beats through sedation\\nof the inhibitory (pneumogastric) nerves. Although eucain is less toxic\\nthan cocain it also produces a greater degree of analgesia so that the\\ndose need not be greater than that of cocain, about to f of a grain\\nbeing the maximum.\\nEucain may be kept in permanent and stable solution in distilled\\nwater. A 10 per cent, solution may be made in distilled water (48\\ngrains of eucain hydrochlorid to the ounce of distilled water) and the\\nsolution sterilized by boiling, which does not decompose eucain. From\\nfive to eight minims of such a solution is a proper dose. The precau-\\ntions to be observed and the mode of application are the same as for\\ncocain.\\nBesides the dangers arising from the hypodermatic administration\\nof a physiological overdose of this class of analgesic drugs, and the local\\ndanger of infection from non-sterile solutions or instruments, there is to\\nbe strongly emphasized the danger of local necrosis due to the poisonous\\neffect of the drugs themselves upon the tissue elements when directly\\ninjected. In nearly all cases in which extraction is sought the tissues\\nabout the tooth are in a condition of lowered vitality, brought about by\\nthe local toxemia resulting from the infection which has produced the\\ninflammatory process. The injection of a protoplasmic poison, such as\\ncocain, eucain, and their congeners, into the inflamed territory causes a\\nstill further depression of vital resistance, which, if sufficiently pro-\\nnounced, may become total and permanent. Hence, tissue-death or\\nnecrosis, with subsequent sloughing, will necessarily result.\\nWhere the inflammatory process about a tooth is at all pronounced,\\nit is much Aviser to discard local anesthetic methods for the far safer\\nprocedure of general anesthesia induced by nitrous oxid or ether.", "height": "4580", "width": "2856", "jp2-path": "americantextboo00kirk_0652.jp2"}, "653": {"fulltext": "CHAPTER XXII.\\nPLANTATION OF TEETH.\\nBy Louis Ottofy, D. D. S.\\nThe transplantation of a tooth signifies the insertion of a nat-\\nural tooth into a natural alveolus other than the one it originally occu-\\npied. The tooth may be an old and dry specimen transplanted into an\\nalveolus from which a tooth has been recently removed, or it may be a\\nfreshly extracted tooth transplanted from one part of the mouth of an\\nindividual to another part of the mouth of the same individual, or it\\nmay be a freshly extracted tooth transplanted from the mouth of one\\nperson into that of another.\\nReplantation signifies the replacing of a tooth in the alveolus\\nwhence it had been removed by design or accident. The operation may\\nbe performed at once or at any time before the socket is filled with new\\ntissue.\\nUnder the term implantation are included all those operations\\nwhich involve the formation of an artificial alveolus for the reception\\nof the root of a human tooth. The operation of altering the size or\\nform of an existing alveolus to receive a tooth belongs to this class,\\nalthough it is a combination of trans- and implantation.\\nThe operation of replantation probably far antedated that of trans-\\nplantation, as the latter preceded implantation, but its definite history\\nis unknown. It is safe to presume that it has been practiced ever since\\nmankind conceived of the natural healing power of the body. Even\\nwhen performed with crudity and without any clear comprehension\\nof the mode of repair, favorable results have been reported. The ope-\\nration is at present an uncommon one the condition for the relief of\\nwhich it was at one time practiced with comparative frequency, chronic\\nalveolar abscess, has been found amenable to less radical treatment.\\nThe operation of transplantation is first noted in the writings of\\nAmbroise Pare in the sixteenth century, though credit has generally\\nbeen given to Dr. John Hunter, who gave the subject considerable\\nattention. Hunter s experiment of implanting a tooth in the comb of\\na cock is classical. The records of the operation do not exhibit any\\n645", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0653.jp2"}, "654": {"fulltext": "646\\nPLANTATION OF TEETH.\\ngreat measure of success attending it. Hunter noted cases of trans-\\nplantation of dead teeth which remained for years.\\nNo one disputes with Dr. Younger of San Francisco the authorship\\nof the operation of implantation. The date of his first operation was\\nJune 15, 1885, although Bourdet in 1780 was the first to mention the\\noperation, stating that irresponsible persons claim to make a socket,\\nand implant into it a tooth. An attempt at partial implantation is\\nrecorded in Dental Cosmos, vol. xix. p. 258.\\nIn order that an intelligent conception may be had of the intimate\\nnature of the biological conditions which surround the teeth after inser-\\ntion by either of these operations, it is essential to study the general\\nFig. 573. 1\\nFig. 574.\\n1 1\\n15 1\\nA tooth and its normal attachment and vascular\\nsupply 1, 1, Apical pericementum in which\\nis seen the main pericemental artery, 5 2, 2,\\nanastomosing bloodvessels or channels of\\nthe alveolar walls 3, 3, the marginal anasto-\\nmosis of alveolar and pericemental arteries.\\nConditions following replantation: 1, 1 The\\npericementum and inflammatory effusion\\nbetween pericementum and alveolar\\nwalls 2, 2, source of blood-supply to the\\narea of repair 3, 3, terminations of alveo-\\nlar arteries 5, obliterated apical artery.\\nprocesses which attend the repair of tissues, and their behavior toward\\nforeign bodies.\\nAs all of these operations are performed under the strictest antiseptic\\nprecautions, the consideration of bacterial influence is omitted at this\\njuncture. As it is impossible to secure specimens which would show\\nthese several parts in their true relations, the illustrations are neces-\\nsarily diagrammatic and theoretical.\\n1 Figs. 573-576 are from drawings by Dr. H. H. Burchard.", "height": "4612", "width": "2860", "jp2-path": "americantextboo00kirk_0654.jp2"}, "655": {"fulltext": "BIOLOGICAL CONDITIONS IN PLANTATION\\n647\\nFig. 573 exhibits a longitudinal section of an incisor, its attachments\\nand support, together with its vascular supply, in its normal relations,\\nthe bloodvessels from the pericementum anastomosing with those of\\nthe alveolar periosteum. The pericemental space is filled with fibrous\\ntissue. To avoid confusion the nerves and veins have been omitted.\\nFig. 574 represents the conditions following replantation. The tooth\\nhas been sterilized and its pulp canal hermetically sealed. The perice-\\nmental bloodvessels have been destroyed in extraction. Portions of\\nthe pericementum are seen clinging as fibrous remnants to the cemen-\\ntum. The remainder of the alveolus is filled with inflammatory corpus-\\nFig. 575.\\nFig. 576.\\nConditions following transplantation 1, 1\\nEmbryonic tissue which will be organ-\\nized into repair tissue replacing the\\noriginal pericementum 5, obliterated\\napical vessels.\\nConditions following implantation 1, 1, Alveo-\\nlar arteries 2, 2, gingival margin 3, inflam-\\nmatory still unorganized tissue filling the\\nspace between the cementum and walls of\\nthe artificial alveolus 4, 4, phagocytes, mul-\\ntinucleated cells attacking cementum of im-\\nplanted tooth 5, obliterated apical vessels.\\ncles. The vascular supply to the regenerated pseudo-pericementum is\\nderived first from the vessels of the alveolar periosteum via the alveolar\\nprocess.\\nFig. 575 shows the conditions existing soon after the operation of\\ntransplantation. The mechanical violence of extraction has irregularly\\nenlarged the natural alveolus. The tooth, its apex rounded, is shown\\nwith the blunted extremity. The vascular supply is similar to that\\nof Fig. 574. The alveolar space is filled with inflammatory corpuscles.", "height": "4568", "width": "2768", "jp2-path": "americantextboo00kirk_0655.jp2"}, "656": {"fulltext": "648 PLANTATION OF TEETH.\\nFig. 576 exhibits the conditions probably existent soon after an im-\\nplantation operation. The vascular supply is the same as shown in Figs.\\n574 and 575. Instead of having a layer of periosteal bone, the for-\\nmation of the artificial alveolus is into the spongy medullary bone.\\nThe artificial alveolus, being necessarily different in size and outline\\nfrom the tooth, is filled with inflammatory products. Some of the cells,\\nbecoming multi-nucleated, are seen to be exercising their phagocytic\\nor, in this connection, resorptive function upon the cementum.\\nReplantation and Transplantation.\\nReplantation. In the present state of dental practice the following\\nconditions may be regarded as warranting replantation\\n(1) When a tooth has been dislodged by traumatism, a blow by a\\nball, club, or fall, etc.\\n(2) When a tooth has been accidentally removed by the slipping of\\nthe forceps during the performance of a dental extraction.\\n(3) When some disease, otherwise incurable, affects either the root or\\nsome portion of its alveolus.\\nThe first two causes are practically the most frequent under which\\nreplantation is justifiable.\\nIn case a tooth has thus been dislodged and found, it should at once\\nbe cleansed of all foreign matter and then be carefully examined for\\nfractures or other injury. Any cavities present should be filled, the\\ncontents of the root canal removed, and the space filled in the manner\\ndescribed later fractured or abraded portions or surfaces are to be made\\nsmooth, and the tooth placed in an antiseptic solution. A careful ex-\\namination of the socket should then be made. It will be noticed when\\nthe accident has befallen a young individual, that as a result of the\\nflexibility of the bone, the alveolar process is seldom fractured an\\naccident more prone to happen in adult life.\\nSome discrimination should be exercised as to the promptness with\\nwhich to replant the tooth. If there is considerable inflammation as\\nthe result of injury, it is not advisable to immediately replace the tooth.\\nIn that event the socket should be made aseptic and if possible normal\\nhemorrhage re-established. As a general rule several days should be\\nallowed to intervene when the inflammation is excessive otherwise a\\ntooth may be replaced at any time as soon as it has been prepared.\\nThe governing pathological principle is as follows Immediately after\\nan injury, a certain amount of inflammation takes place and there is\\nretrograde metamorphosis a destruction or breaking down of tissue\\nand this is not the most favorable time to expect re-attachment to take\\nplace. As a rule, within a few days a building-up process, constructive", "height": "4604", "width": "2852", "jp2-path": "americantextboo00kirk_0656.jp2"}, "657": {"fulltext": "REPLANTATION AND TEA NS PLANTATION. 649\\nmetamorphosis, has set in, and the replacement of a tooth at this time is\\nlikely to be followed by more favorable results. This period sets in at any\\ntime from three days to a week, the socket being then partially filled\\nwith active living cells. Just prior to the replacement of the tooth the\\nsocket and the gum surrounding it having been cleansed and sterilized,\\nthe tooth itself being brought forth from its antiseptic medium, it must\\nbe promptly replanted. As a rule, constant but not severe pressure will\\npermit the tooth to assume its original position in the socket, although\\nsometimes it is necessary to remove a part of the apex of the root or\\nslightly deepen the socket by means of a suitably shaped bur. It hap-\\npens occasionally that the location of the tooth and the general surround-\\nings are such that a tooth like this may be retained without any further\\nattachment, but as a rule it is not safe to trust to uncertainties regarding\\nthe attachment of the tooth. An impression of the tooth and its neigh-\\nbors can be quickly secured with Melotte s compound or in clay, a die\\nis easily made, from which a cap, such as will be described, is quickly\\nmade.\\nIt is needless to dwell upon the second cause mentioned. No dentist\\ncan ever be excused for accidentally removing a sound tooth, but in\\ncase the accident does happen the above procedure is indicated.\\nThe opportunities enumerated under the third section are also, for-\\ntunately, exceedingly rare. The cases in which formerly replantation\\nwas resorted to, on the ground that the case was incurable, are now\\nmuch less frequently met with, and when they are encountered they\\noften yield to treatment, which is now more clearly understood such\\nas amputation of the root, removal of the necrosed portion of the\\nalveolar process, etc. When, however, it has been decided to extract\\na diseased tooth and to replant it, diseased portions of the root should\\nbe removed and a sufficient time allowed to elapse before replantation\\nfor the socket and tissues to have assumed a healthy aspect, even if\\nthis should necessitate the enlargement of the socket.\\nIn cases of pyorrhea alveolaris, which sometimes has been suggested\\nas coming under this class, treatment by replantation is out of the ques-\\ntion, provided the case has made sufficient progress to suggest such\\na course. Replantation implies the presence of a socket, and when\\npyorrhea alveolaris has made any great degree of progress, the socket\\nis wanting. Hence it is but in rare cases that an attempt to cure by\\nthis method is justifiable.\\nDr. Louis Jack 1 has recorded marked success in several cases at-\\ntending an operation of modified replantation for the cure of some of\\nthe earlier phenomena of phagedenic pericementitis, notably the common\\nmalposition due to what has been termed voluntary tooth movement.\\n1 See Trans. Academy of Stomatology, 1895.", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0657.jp2"}, "658": {"fulltext": "650 PLANTATION OF TEETH.\\nTransplantation. There is a broader range for the practice of\\ntransplantation than either of the other operations treated in this\\nchapter. As has been seen, replantation is limited in its application,\\nand implantation must, from the nature of the operation, be also con-\\nfined to a comparatively circumscribed sphere.\\nThe operation may be performed at any period of an individual s\\nlife, although as a rule young, vigorous, and mature adult life offers the\\ngreatest promise of success. Any socket in any part of the mouth,\\nwhen placed in a healthy condition, is a more or less favorable location\\nfor the reception of a tooth about to be transplanted. It is true that\\nsometimes a socket needs to be enlarged or deepened for this purpose,\\nbut this is a comparatively simple matter. Before the advent of the\\nintelligent practice of crown and bridge work, treatment of diseases\\nof the pulp and peridental membrane, the bleaching of teeth, and the\\nintelligent practice of orthodontia, transplantation was resorted to as a\\nremedy for the correction of many trivial disorders. In the light of\\nthe present day, transplantation is confined to sockets whence teeth\\nhave been removed for any cause which could not be remedied by some\\nother method of treatment sockets which remain as the result of the\\nloss of teeth from accident of any kind (the lost teeth not having been\\nrecovered) from which roots beyond salvation have been extracted\\nfrom which diseased teeth must be removed from which roots have\\nbeen removed having carried crowns or having served as abutments for\\nbridges until their period of usefulness has passed.\\nThe same rule laid down for the care of a socket previous to re-\\nplantation holds good for transplantation namely, that inflammation\\nmust be reduced, and the tooth transplanted into the socket at a time\\nwhen progressive constructive metamorphosis is taking place. This\\nperiod is stated as usually from three to seven days after the removal\\nof the tooth. In instances where considerable disease, such as a chronic\\nalveolar abscess of years standing has been present, even a longer time\\nshould be allowed to intervene before transplantation.\\nPreparation of Teeth for Plantation.\\nWith the exception of such special directions as are necessary in\\neach class of the operations described in this chapter, the following\\ngeneral directions are applicable to all cases.\\nThe Scion Tooth. For replantation a recently dislodged tooth is\\nsupposed to be at hand, hence there is a fresh tooth. For transplanta-\\ntion it is implied that the tooth is either at hand or about to be secured,\\nbut in a case of transplantation or implantation the age of the tooth\\nmay be unknown and indefinite. Teeth have been planted whose age\\nand origin have been absolutely unknown, and they have become firm", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0658.jp2"}, "659": {"fulltext": "PREPARATION OF TEETH FOR PLANTATION. 651\\nin their new locations. Nevertheless it seems reasonable to take the\\nground that whenever it is possible, teeth should be fresh and something\\nof their previous environment should be known. There are no cases\\non record where disease has been transmitted through the medium of a\\nplanted tooth, although portions of the early literature of this subject do\\nindicate such results. The principal objection to old and dry teeth is\\nthat, the water having been evaporated, these teeth are almost invaria-\\nbly fractured or cracked from shrinkage. When these fractures extend\\nto the crown portion, the enamel frequently chips off within a short\\ntime after the tooth has been planted while in some instances the\\nentire root has been fractured. Another objection to teeth promiscu-\\nously gathered is that it is seldom possible to find teeth in which the\\ncrowns are sufficiently perfect to be serviceable and to be presentable\\nin the mouth. The crown of a dry tooth permits of but slight altera-\\ntion with the grinding stone or sandpaper disk without endangering its\\nintegrity Avhile if it is affected by caries to such an extent as to require\\nan extensive operation, the life of the filling is likely to be of shorter\\nduration than a similar operation performed on a freshly extracted tooth\\nor a tooth with living connections. For this reason it is preferable to\\nuse only the roots of teeth, attaching to them artificial crowns. This\\npermits the selection of a crown suitable in size, color, and shape, and\\nwhich may be ground for articulating purposes an important matter\\nin these cases.\\nIf therefore an old, dry tooth must be used, let it be carefully\\nselected with regard to the absence of checks or cracks or fractures,\\nand if it be impossible to secure a tooth with such a crown, let there be\\nselected a good root to which a crown, as described later, can be\\nattached.\\nIf a freshly extracted tooth can be secured, even though the crown\\nmay be slightly carious, the necessary filling operation is advisable, and\\nsuch a tooth should be used, if possible.\\nRoot-filling. Roots may be filled either from the apex or through\\nan opening or cavity in the crown. Gutta-percha seems to answer all\\nthe necessary purposes, but for a short distance from the apical extrem-\\nity it is well to fill with gold wire or foil.\\nPericementum. The theory that the pericementum becomes revivi-\\nfied does not seem to be tenable at least the proposition that life is\\nmaintained in the pericementum for any considerable period of time\\nafter the tooth has been removed from vital attachment is not in accord\\nwith general physiological laws, although periosteum as a tissue main-\\ntains its vitality for a time after separation. 1 For the purpose of secur-\\ning an attachment there is no necessity for the presence of the perice-\\n1 See Ziegler s General Pathology.", "height": "4544", "width": "2796", "jp2-path": "americantextboo00kirk_0659.jp2"}, "660": {"fulltext": "652 PLANTATION OF TEETH.\\nmentum but it is reasonable to assume that the nearer to natural states\\nthe root and the socket are in, the more favorable will be the prognosis.\\nIt is therefore a safe rule to follow, to preserve as much of the perice-\\nmentum as is possible. The preservation of the pericementum has an\\nadvantage from the fact that after the tooth has been planted, the peri-\\ncementum under the influences of bodily heat and moisture expands\\nand thus acts in the nature of a sponge graft, enabling the tissues to\\nmore quickly obliterate spaces which are present and to attach them-\\nselves to the root.\\nSubsequent Care of Planted Teeth. Numerous methods for the\\nretention of planted teeth have been recommended by various authors\\nat different times. While many of them are original and ingenious, all\\nare to be condemned except those means which look to the firm, rigid,\\nimmovable retention of the planted tooth for a definite period, that of\\nsurgical repair. Neither the rubber-dam splint, silk ligature, nor gold\\nor other metal wire comes under this heading. Planted teeth must be\\nretained immovably for a period of two to six weeks, occasionally from\\ntwo to eight, ten, or twelve weeks. The shortest time of immobility\\nconsistent with subsequent attachment is preferable. The tooth to be\\ntransplanted or implanted should be fitted after preparation in a model,\\nmade from an impression of the gum where the tooth is to be planted\\nand of the adjoining teeth, as shown in Fig. 577.\\nAn impression is then taken of it and of the adjoining teeth on each\\nside. A retention cap is then swaged to cover the grinding surfaces\\nof three or more teeth, half the length of the crown on the labial surface\\nand nearly the full length on the lingual or palatal surface, as shown\\nin Fig. 578.\\nFig. 578.\\nModel showing prepared tooth in place Model showing retention cap\\na, Gold filling at cervical joint. in situ.\\nThe cap may be made of pure gold, platinum, or German silver.\\nThe gauge, according to the metal used, should be from No. 32 to\\nNo. 38. This cap is cemented upon the crowns adjoining the planted\\ntooth in such a manner that it may be removed without disturbing the", "height": "4608", "width": "2864", "jp2-path": "americantextboo00kirk_0660.jp2"}, "661": {"fulltext": "PREPARATION OF TEETH FOR PLANTATION. 653\\nplanted tooth. The operator can remove the cap by springing the\\nmetal away from the teeth, examine the condition of attachment of the\\nplanted tooth, and replace the cap if it should be necessary. Where\\nthe articulation interferes with the retention of the cap, the latter may\\nbe ligated to the adjoining teeth in addition to being cemented to them,\\nand still admit of removal without disturbing the planted tooth. There\\nis at present no method of ligaturing or banding the teeth which will\\npermit removal of the ligature or band without more or less disturbance\\nof the planted tooth.\\nAside from the necessity of immobility for a certain period, the\\nplanted tooth and surrounding tissue generally require but little atten-\\ntion. In occasional cases the tissues may be stimulated, by painting\\nthe gum with a mixture of equal parts of tincture of aconite root,\\nchloroform, and iodin paint (the latter is a saturated solution of iodin\\nin alcohol), or by the use of stimulating mouth-washes, notably those\\ncontaining capsicum. The patient should be cautioned to encourage\\nthe downward growth of the gum by the use of the toothbrush, to\\nprevent the accumulation of remnants of food or saliva, and to pre-\\nvent their subsequent putrefaction should particles become unavoidably\\nlodged around the tooth or cap. This is best accomplished by using a\\ncamel s-hair brush dipped in hydrogen clioxid or pyrozone, electrozone,\\nmeditrina, etc., washing out the interstices frequently. A syringe or\\nspray from an atomizer may be used.\\nArtificial Roots. Experiments have been performed looking\\ntoward the use of roots other than those of natural teeth. Eoots made\\nof ivory, corrugated or perforated porcelain, lead, gold, platinum, and\\nother metals have been used. The writer s experiments in this direc-\\ntion have all resulted in failure. There is no recorded evidence that\\nany have resulted successfully.\\nMode of Attachment. As to the mode of attachment of planted\\nteeth the subject is clouded in obscurity. From the nature of the con-\\nditions it is difficult to secure definite information. Dr. Younger holds\\nto the belief that the pericementum becomes revivified and hence the\\nattachment is almost physiological. Others maintain that the filling\\nof the space around the root of the tooth with compact bone tissue\\nis sufficient to account for the retention of the tooth. In the appear-\\nance of planted teeth which have failed there should be found the best\\nillustrations of the causes of success. It is probable that a planted\\ntooth, by reason of the absence of the cushion formed by the living\\npericementum, causes more or less irritation in the socket; that this\\nirritation leads to resorption of the root; that in this resorption and\\nihe subsequent filling up of these resorbed surfaces are found reasons\\nfor the success of the operation. Fig. 579, at a, a, shows how a par-", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0661.jp2"}, "662": {"fulltext": "654 PLANTATION OF TEETH.\\ntially resorbed root may be retained in place. The length of time\\nduring which a planted tooth is retained depends entirely upon the\\nrapidity of the resorptive process and the activ-\\nFig. 579. ity of the tissues in maintaining a healthy con-\\ndition. Replanted and transplanted teeth have\\nbeen known to do good service for from twenty\\nto forty years. The time of the observation as\\nto implanted teeth is shorter, the oldest cases\\nbeing less than twelve years old. In the writer s\\nobservations, extending over a period of nearly\\nten years, a number of teeth have been noted\\nAn implanted tooth in which have been retained successfully for that\\nsitu.- a, a, excavations of period; how much longer they will remain ser-\\nthe cementum due to re- n\\nsorptive process. viceable, and what percentage ot success will\\nattend later cases, will require further time to\\ndetermine. Dr. Younger has had successfully implanted teeth under\\nobservation for eleven years.\\nPrecautions. There is no special danger connected with any of the\\noperations described in this chapter, provided the usual antiseptic pre-\\ncautions are observed and dangerous anesthetics avoided. Aside from\\nthese, during the operation of replantation and transplantation no\\nspecial skill is necessary certain precautions are, however, essential.\\nInasmuch as implantation is an essentially esthetic operation, it should\\nbe borne in mind that it is confined principally to the ten anterior teeth,\\nand that it is more frequently performed in the upper jaw than in the\\nlower. The territory involved is therefore limited. The operator who\\ncontemplates forming in this territory a socket for the reception of the\\nroot of a tooth should be intimately acquainted with the anatomical\\nand histological relationships of the various parts.\\nIn the first place it should be remembered that Avhere alveolar\\nresorption has taken place, the relative depth of bone is considerably\\nless than where a tooth is still in situ and surrounded by the abnormal\\nalveolar process. The operator must therefore not penetrate deeper\\ninto the bone than the original depth of the socket may have been.\\nIndeed, it is not as a rule necessary to penetrate so far.\\nIn the upper jaw the principal danger in making a socket for the\\nreception of central incisors lies in the proximity, posteriorly, of the\\nanterior palatine nerve, artery, and vein, which have their exit from the\\nbone through its foramen, often near the roots of these teeth. With\\nthe lateral incisor the principal precaution necessary is the preservation\\nof the labial plate of the alveolus. If the lost tooth has been absent\\nfor some time, and much resorption has taken place, it is sometimes im-\\npossible to drill a socket so that the tooth has a proper direction and", "height": "4612", "width": "2844", "jp2-path": "americantextboo00kirk_0662.jp2"}, "663": {"fulltext": "PREPARATION OF TEETH FOR PLANTATION. 655\\nprominence in the arch, and vet be able to secure a bone covering for\\nits labial surface. As a rule there is sufficient process in the canine\\nregion to enable the operator to secure all the attachment desirable.\\nThe bicuspid and molar regions present the danger of perforation of the\\nfloor of the maxillary sinus, This is liable to happen anywhere from\\nthe first bicuspid to the second molar. Extreme caution should be ex-\\nercised to avoid it. In two instances in practice the perforation was fol-\\nlowed by no unpleasant complications. Care was taken not to infect the\\nsinus, the teeth were implanted in the usual manner, and the cases re-\\nsulted successfully. Subsequently one of these teeth was lost, but dur-\\ning the process of root attachment or encystment the perforation into\\nthe sinus was closed.\\nIn the lower jaw the principal difficulties encountered are the follow-\\ning In the incisive region there is a deficiency of alveolar process, and\\nhence much difficulty is encountered, at times, in securing a sufficiently\\ndeep bony socket. At the location of the canine tooth the lower jaw-\\nbecomes broader and there is usually sufficient room to enable the\\nmaking of a good socket. In the bicuspid region the principal pre-\\ncaution necessary is in regard to the mental foramen. It must be borne\\nin mind that normally the exit of the nerves and vessels at this point\\nis directly below the second bicuspid tooth and that when resorption of\\nthe alveolar process has taken place this foramen is often near the upper\\nborder of the jaw. From this point posteriorly implantations are rarely\\nperformed, and when done the principal precaution must be in regard\\nto the inferior dental canal, which is near the surface if much resorp-\\ntion has taken place.\\nArtificial Crowns. The precautions necessary in the selection of\\na tooth for transplantation or implantation have been noted, and it\\nmight be proper at this time to describe the prepara-\\nn l a Fig. 580.\\ntion oi a root with an artificial crown, presuming that\\nit is only in rare instances that a suitable entire\\nnatural tooth can be obtained. Attention was called\\nto the necessity of securing asepsis of the root, and\\nthe filling of the root-canals has been described. The\\nmost suitable form of crown has been found to be the\\nLogan, which is ground to suit the occlusion and Natural root with\\nartificial crown.\\ncemented into the root canal without much regard as\\nto a careful fit at the cervix of the crown to the root. After the\\ncement has hardened, the margin between the root and crown is pre-\\npared with engine burs, and a filling of gold introduced, making a\\ncircle around the tooth. When this is polished down there is a\\nperfect gold filling level with the root and crown, which is preferable\\nto a soldered band. (See Fig. 580.)", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0663.jp2"}, "664": {"fulltext": "656 PLANTATION OF TEETH.\\nGeneral Considerations.\\nAsepsis. The operations described in this chapter must always be\\nperformed under perfect aseptic conditions that is, the hands and\\nperson, instruments and other accessories, the tooth about to be planted,\\nand the field of surgical operation, must be maintained in a clean,\\naseptic condition.\\nAny of the usual, accepted methods can be resorted to. As a rule,\\nhowever, the drugs selected for this purpose should not be of an irri-\\ntating nature. For the hands and person, pure soap followed by a 5\\nper cent, solution of carbolic acid is sufficient. The instruments and\\nother accessories can be kept free from inoculating bacteria by the use\\nof pyrozone, formalin, euthymol, or a 5 per cent, solution of carbolic acid.\\nThe use of bichlorid of mercury in the proportion of 1 part to 2000 of\\nwater is also permissible, although it is not as advisable on account of\\nits irritating nature. The sterilization of the tooth about to be planted\\ndiffers according to circumstances. A tooth whose source is unknown,\\nand which has been kept in a dry state for a long period, will not be\\nbenefited by being placed into an antiseptic solution until just prior to\\nthe time when it is to be used. Hence dry teeth can be kept in any\\nclean box covered with clean cotton until they are ready for use. After\\nthe necessary preparation hereinafter described, the dry tooth should be\\nplaced in a solution of glycerol and carbolic acid (about 5 per cent, of\\nthe latter), and just before using, it can be placed in a pyrozone solu-\\ntion or in a solution of carbolic acid and water. Freshly extracted teeth\\nshould, of course, have their pulp chambers and root canals cleansed\\nand hermetically sealed, and then be placed at once in fluid, preferably\\nin glycerol to which a few drops of carbolic acid have been added.\\nThe field of operation may be quickly sterilized and cleansed of\\n^adhering mucus by mopping the surface with a ball of cotton saturated\\nwith hydrogen dioxid 3 per cent, solution just previous to operating.\\nIt is, of course, of exceeding importance that the socket into which\\na tooth is about to be planted shall be free from disease germs or\\nbacteria. As a general rule flowing blood is the best of antiseptics,\\nwashing away any bacteria which may become lodged from external\\nsources, hence so long as a socket is constantly being filled with flow-\\ning blood during an operation, but little further care need be bestowed\\nupon it. As a general rule the socket and the tissues surrounding it\\nwill react more quickly after operation the less the medication has been\\nhence the very slightest and mildest of antiseptics are indicated. Zinc\\nchlorid 2 to 5 grains to the ounce of lukewarm water, hydrogen dioxid\\n3 per cent., or the 5 per cent, solution of carbolic acid in lukewarm\\nwater, give most satisfactory results. These solutions will be found\\nquite sufficient to maintain the field of surgical operation aseptic.", "height": "4612", "width": "2848", "jp2-path": "americantextboo00kirk_0664.jp2"}, "665": {"fulltext": "GENERAL CONSIDERATIONS. 657\\nAnesthesia. For the purpose of allaying pain, the use of anes-\\nthetics is justified when imperatively demanded, but unfortunately, in\\nthe plantation of teeth the benefits derived are frequently outweighed\\nby the disadvantages accruing from their use.\\nAnesthetics are either general or local. An operator would scarcely\\nbe justified in assuming the risks attendant upon the use of chloroform,\\nethylic ether, ethyl bromid, or any of the combinations in which these\\nanesthetics are administered. Nitrous oxid would, in the majority of\\ninstances, be contra-indicated by reason of the shortness of the period\\nof anesthesia which it induces.\\nThere do not appear to be any records of satisfactory results with\\nhypnosis. That field is open to the intelligent investigator whose\\ninclinations lie in that direction. Local anesthesia, therefore, is the\\nmeans generally employed. The use of cataphoresis with local anes-\\nthetics has not as yet been satisfactory for this purpose.\\nThe method adopted has usually been confined to the injection or\\nother introduction of cocain, the dose being variable, but usually about\\n5 to 15 minims of a 4 per cent, solution of the hydrochlorid. A seri-\\nous objection has been noted to injection through the gum, viz. that\\nmore or less sloughing or destruction of the tissues may result, and this\\nis very unfavorable for subsequent success. In replantation or trans-\\nplantation, sufficient anesthesia is often obtained from the wash used in\\ncleansing the socket but in implantation the formation of the new\\nsocket is often an exceedingly painful operation, and in these cases\\ngood results may be had by dipping the instrument with which the\\nsocket is being made, into crystals of cocain, and thus by the friction\\nof the instrument rubbing it into the parts that are being operated\\nupon.\\nThe subject of anesthesia may be dismissed with the sole injunction\\nthat its use should be resorted to only in those instances where it is\\nabsolutely necessary. The majority of the cases of plantation are per-\\nformed with no more pain than is inflicted in filling operations.\\nThe same care should be given to the retention of transplanted\\nteeth as is given to the retention of replanted teeth. Teeth thus\\ncarefully transplanted, in individuals of good health, often remain as\\nuseful members for a number of years. In the past insufficient atten-\\ntion has been given to asepsis, and this, coupled with the fact that the\\nroot had not always been properly filled, has not resulted in as much\\nsuccess as is attained with present methods, and yet transplanted teeth\\nare known to have remained in a healthy and serviceable condition\\nfor from twenty to forty years.\\n42", "height": "4564", "width": "2776", "jp2-path": "americantextboo00kirk_0665.jp2"}, "666": {"fulltext": "658 PLANTATION OF TEETH.\\nThe Operation of Implantation.\\nImplantation, in order to yield the best results, should be confined\\nto mouths which are habitually clean and free from disease, and to a\\npart of the individual s life during which the power of the developed\\nmental processes is not impaired. Unclean personal habits, the ex-\\ncessive use of stimulants, and occupations calling for an unusual ex-\\npenditure of nerve force are unfavorable. A suitable case having been\\nselected, an impression of the space and of the teeth adjoining it is\\ntaken. A plaster cast is made, the proper-sized socket drilled therein,\\nthe tooth is selected and prepared, either with or without an artificial\\ncrown in the manner previously described, the occlusion is adjusted,\\nand a retention cap is made. These preliminaries having been satis-\\nfactorily accomplished the case is ready for the operation. Under the\\nheading of General Considerations the question of anesthesia has been\\nalready treated.\\nThe first step in the operation is the making of an incision through\\nthe gum tissue. A number of different kinds of incisions have been\\nrecommended by different operators, nearly all of them looking toward\\nthe preservation of the largest amount of gum tissue. Some recom-\\nmend a crucial incision X, turning back the four corners of the gum\\ntissue. Others have recommended an incision in the shape of the letter\\nH, turning back the two flaps thus made.\\nThe principal objection to all of the incisions recommended lies in\\nthe fact that they all look toward the preservation of the gum tissue\\nequally for the labial and lingual surfaces while, as a matter of fact, if\\nproper provision is made for the protection of the cervical line on the\\nlabial surface, the lingual surface will take care of itself, for it will be\\nnoticed in cutting through the gum tissue that it is much thinner where\\nit- reflects over the alveolar border upon its labial aspect than upon its\\nlingual. Hence, frequently, if no attention whatever has been paid to\\nthe retention of gum tissue on the lingual surface, the neck of the\\ntooth will nevertheless be sufficiently protected.\\nFig. 581.\\nIncision in gum for implantation.\\nAnother serious objection to an incision which leaves two or more\\npoints or margins to be preserved, is that the tenacity of the gum tissue", "height": "4616", "width": "2840", "jp2-path": "americantextboo00kirk_0666.jp2"}, "667": {"fulltext": "THE OPERATION OF IMPLANTATION.\\n659\\nFig. 582.\\nn\\nChisels.\\nN\\nmakes it utterly impossible to preserve these various flaps and projec-\\ntions intact from the cutting instruments.\\nThe writer s method consists in an incision resulting in one flap,\\nwith a view of protecting the labial surface of the tooth to p IG 533\\nbe implanted, and of preserving this single flap from in-\\njury during the progress of the operation. A combina-\\ntion, or rather a modification, of the most suitable incis-\\nions recommended is therefore the one shown in Fig. 581.\\nThis incision is made with ordinary chisels as shown\\nin Fig. 582, cutting with the chisel to and\\nincluding the periosteum, lifting it for-\\nward and holding it out of the way of\\nthe operator by means of an instrument\\nsimilar to the one shown in Fig. 583.\\nThe operation thus far is usually sim-\\nple and as a general rule not very pain-\\nful. The drilling of the socket varies\\nwith different individuals according to\\nthe density of the bone, the length of\\ntime that the tooth has been out, etc.\\nIn some instances the reamer or trephine or knife pro-\\ngresses rapidly, while in others progress is very slow, or\\nsometimes variable as the instrument enters into medul-\\nlary spaces or passes through the more or less dense parti-\\ntions which divide these medullary spaces from each other.\\nThe operator will determine during the operation, by\\nthe progress he is making with different instruments,\\nAvhich are the best to use. In some instances the entire\\nsocket can be made with an ordinary engine bur, while\\nin others the strongest instruments especially designed for\\nimplantation are none too strong. In some instances an\\ninstrument which clears itself well during one operation\\nclogs annoyingly during another. It is desirable to de-\\nscribe at this point the various useful instruments which\\nhave been designed and are now upon the market. While\\nall of them are not necessary, some one or more of each\\nclass are indispensable. The trephines of Dr. Younger,\\nof San Francisco, which have been improved by Dr. W.\\nW. Walker of New York, have (as shown in Fig. 584), a\\nset-screw collar, also shown detached, which slides on the\\nshank and is first fixed by a set-screw as a gauge of the\\nlength of the tooth root. As will be noticed the trephines\\ncut only on the edge, and hence they do not entirely clear themselves\\n11\\nInstrument for\\nholding flap\\nduring the\\noperation.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0667.jp2"}, "668": {"fulltext": "660\\nPLANTATION OF TEETH.\\nthe reamers described on a previous page are then used to remove the\\ncore and enlarge the socket.\\nFig. 584.\\no OOO\\nFig. 585.\\nYounger- Walker trephines.\\nRollins spiral\\nknives.\\nThe spiral knives (Fig. 585) devised by Dr. W. H. Rollins of\\nBoston are in many cases very useful.\\nThey are also open to the objection of clogging. As an improve-\\nment upon these the spiral crib knife shown in Fig. 586 has the\\nadvantage of permitting the core to pass within it.\\nFig. 586.\\nFig. 587.\\nOttofy spiral\\ncrib knife.\\nTwo forms of Cryer s\\nspiral osteotome.\\n12 3 4 5\\nOttolengui s reamers.\\nDr. R. Ottolengui, of New York, has devised a set of reamers (Fig.\\n588). There are nine leaves to each reamer and each leaf is divided\\ninto five teeth. Three of the leaves reach the apex of the cone point\\nand thus allow a more rapid forward drilling into the bone. A sliding\\ncollar forms a gauge to indicate the proper depth to drill.", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0668.jp2"}, "669": {"fulltext": "THE OPERATION OF IMPLANTATION.\\n661\\nThe reamers designed by Dr. Younger, illustrated in Fig. 589, are\\nalso very suitable for this purpose. Dr. Oyer s spiral osteotome two\\nforms of which are shown in Fig. 587, one with dentate edges the other\\nwithout is an admirable instrument for forming the artificial socket.\\nWhen it is necessary to deepen or alter the shape of the socket, it is\\ndone very simply with either the ordinary burs of the dental engine or\\nwhat is preferable, a bur with a long shank such as shown in the\\naccompanying illustration (Fig. 590).\\nFig. 590.\\nu\\n12 3\\nDr. Younger s reamers.\\n12 3 4\\nEngine burs with long shank.\\nThe following are to be recommended Nos. 1 and 3 of the Walker-\\nYounger trephines, Nos. 1 and 3 of the Younger reamers, Nos. 1 and\\n2 of the Rollins spiral knives, Nos. 1 and 2 of the Ottofy spiral crib\\nknives, and Nos. 1, 3, and 4 of the Ottolengui reamers and Cryer s\\nosteotome.\\nDuring the progress of the drilling of the socket, the tooth should\\nbe frequently inserted until a proper adjustment has been secured.\\nOccasionally these teeth can be implanted and so perfectly fitted that it\\nis almost impossible to remove them with the unaided fingers while at\\ntimes the bone is so cancellated, and the tissues so flabby, that a socket\\ndrilled never so carefully will not retain the tooth in place. Nothing\\nis gained by a too close adjustment of the root, as pressure must un-\\ndoubtedly be exerted, and pressure causes resorption, and may be fol-\\nlowed by inflammation. A fair, moderate fitting of the root is all\\nthat should be aimed at. Just before the final adjustment the socket,\\ngums, tooth, and all parts contiguous thereto, should be placed in an\\naseptic condition and the cap adjusted in the manner before described.\\nThough the tooth may be adjusted to its socket so that immediately\\nafterward it exhibits much firmness, yet in a few days subsequent to\\nthe operation it invariably shows less rigidity and an apparent tendency", "height": "4572", "width": "2776", "jp2-path": "americantextboo00kirk_0669.jp2"}, "670": {"fulltext": "662 PLANTATION OF TEETH.\\nto loosening. This result is probably due to the resorption of those\\nareas of contact between the tooth and its artificially formed alveolus\\nwhere the greatest amount of pressure is exerted. The period of\\nloosening is generally quickly followed by a progressively increasing\\nfirmness and immobility of the tooth caused by calcification of the\\nexudate thrown out by the walls of the alveolus in the process of repair\\nof the surgical injury to which it has been subjected by the operation.\\nPlanted teeth, when lost, are lost as a rule as a result of resorption of\\ntheir roots. The process seems analogous to the resorption of the\\nroots of deciduous teeth. Present records seem to indicate that re-\\nsorption of the roots is slowest in progress in replanted teeth it is\\nmore rapid in transplanted teeth, and most rapid in implanted teeth.\\nIntelligent observation over replantations and transplantations extends\\nfrom twenty to forty years. The observation of Dr. Younger of\\nimplanted cases extends at this writing to about twelve years, and he\\nhas had successful cases under observation which have remained in the\\nmouth over ten years. The writer has the records of cases which have\\nremained and done good service for ten years.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0670.jp2"}, "671": {"fulltext": "CHAPTER XXIII.\\nMANAGEMENT OF THE DECIDUOUS TEETH.\\nBy Clark L. Goddard, A. M., D. D. S.\\nEruption. The first operation the dentist is called upon to perform\\nfor the deciduous (temporary) teeth is lancing the gums as an aid to\\neruption of those organs. This is not necessary in normal but only\\nin pathological cases. Although gum tissue in its normal condition is\\ncomparatively insensitive, when it is inflamed it is exceedingly tender.\\nThe principal source of pain, however, is not in the tissue overlying,\\nbut when a tooth, bound down by the dense gum tissue above it, by its\\nown growth presses upon the formative organ below, it causes pain\\nwhich in many cases may be so excessive as to cause reflex disorders\\nof alarming character.\\nDr. J. W. White l says The manifestation of functional inharmony\\nfrom pathological dentition will depend, as in trouble arising from any\\nother disturbing cause, upon the temperament and health of the child,\\nits dietetic management, and its hygienic surroundings. In some cases\\nthere is a gradual development of biliary, gastric, enteric, and cerebral\\ncomplications, a slow but steady loss of vital power, with no effort at\\nrecuperation and feeble resistance to the undermining influences which\\ngradually but surely wear out the young life.\\nIn other cases the indications of disturbance of function are mani-\\nfested primarily in the nervous system the symptoms are all charac-\\nteristic of acute derangement and are dangerous from their violence\\nand uncontrollability. High fever, vomiting, choleraic diarrhea, men-\\ningitis, convulsions, stupor and death are the rapidly succeeding 1\\nphenomena. Between these two phases there is every conceivable\\ngrade of symptoms, every imaginable complication.\\nBy many, as an objection to lancing the gums it has been urged that,\\nin case the tooth does not erupt immediately, cicatricial tissue is formed\\nover it which will bind the tooth down more rigidly than before. Cica-\\ntricial tissue is, however, of a lower degree of organization than normal\\ntissue, and is more easily broken down.\\n1 Amer. System of Dentistry, vol. iii. p. 327.\\n663", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0671.jp2"}, "672": {"fulltext": "664\\nMANAGEMENT OF THE DECIDUOUS TEETH.\\nFig. 591.\\nThe indications for interference are not so much local as general\\nthe fretfulness, inability to sleep, and other symptoms mentioned by\\nDr. White. The gum tissue over the erupting tooth may or may not\\nbe highly inflamed, but the absence of such inflammation\\ndoes not contraindicate lancing. In fact some of the\\ngravest systemic disturbances occur where no local mani-\\nfestations are evident.\\nThe object is to divide the gum tissue which binds\\ndown the tooth and to allow it free egress. The most\\nsuitable instrument is shaped like that shown in Fig. 591\\nand sometimes used for lancing around teeth before ex-\\ntraction. It should be held like a pencil in writing, so\\nthat one or more fingers can form a rest and guide.\\nFor operating on the lower jaw the child is best seated\\nin the lap of the operator with the head against his breast.\\nBy passing the left arm around the infant s head and in-\\nserting the left thumb in its mouth with the fingers under\\nthe chin, the lower jaw can be held rigidly while the right\\nhand performs the operation.\\nFor operating on the upper jaw it is best to lay the child\\nacross on the nurse s lap. The operator takes the head on\\nor between his knees, opens the mouth by inserting one or\\nmore fingers of the left hand, and holds the thumb and\\nforefinger on each side of the alveolar ridge, thus prevent-\\ning injury to contiguous parts during possible struggles\\nof the child.\\nFor incisors a simple longitudinal incision is made, a\\nlittle longer than the cutting edge of the tooth. The\\nlancet should be sharp, so as to easily penetrate to the\\ntooth. No harm will be done except to the blade of the\\nlancet. For the canines a single incision is good, but a\\ncrucial incision is better. Sometimes lancing is necessary\\nfor the canine after it is partially erupted, as the gum\\ntissue, pierced by the point only of the tooth, may form a\\ndense ring around this point and interfere with further\\neruption. In such a case a division of this ring in two or\\nmore opposite places will give relief.\\nFor the molars a crucial incision is best, one cut ex-\\ntending from the posterior buccal to the anterior lingual\\ncusp, and the next from the posterior lingual to the ante-\\nrior buccal. Sometimes lancing is necessary for these\\nteeth after partial eruption. After the cusps have pierced the gum,\\nthe tooth may be held back by the bands of tissue in the sulci. In\\nGum lancet.", "height": "4612", "width": "2848", "jp2-path": "americantextboo00kirk_0672.jp2"}, "673": {"fulltext": "ERUPTION AND DURATION. 665\\nsuch cases division of these bands in the same direction as before de-\\nscribed for an unerupted tooth will give relief. Sharp-pointed curved\\nscissors are well adapted to this latter operation.\\nFig. 592 will illustrate the direction of the incisions described. The\\nrelief afforded is generally immediate. In one case a child who had\\nbeen fretful for several days, and who had not slept at all during the\\nday, was asleep in the writer s arms within five minutes after the ope-\\nration. The gum tissue is not very\\nsensitive, so the operation is often\\npainless. The little sufferer will\\noften recognize the relief obtained \\\\T/ S\\nand point to other portions of the\\ngums for further relief.\\nDuration of the Deciduous\\nTeeth. The importance of filling s\\ncavities in the children s temporary\\nteeth is often overlooked, even by\\ndentists themselves, as these teeth are Lines of incision in lancing a, a, over the\\nt -i i i molars ;b,b, over the canines and incisors\\nSupposed tO be lost SO early as to before eruption c c c, over the molars\\nrender such Operations Unnecessary. and canines after partial eruption (J. w.\\nr\u00e2\u0084\u00a2 it i t White).\\nlhis is generally true with the in-\\ncisors, is less true with the canines, while the molars often need at-\\ntention. Fig. 541 (see Chapter XXL) shows the relations of the\\ndeciduous to the permanent dentures in a child of about six years\\nof age. A study of the following table will show that while the\\nincisors are superseded early by their successors the molars are in\\nplace nearly twice as long\\nTime of Eruption. Loss. Duration.\\nCentral incisors 6-8 months. 6th-7th year. 5 J to 6 1 years.\\nLateral 7-9 7th-8th li\\nFirst molars 14-16 9th-10th 7\u00c2\u00a3 9\\n(1 yr. 2 m.-l yr. 4 m.)\\nCanines 17-18 flnf. 8th-10th\\n(ljyrs.) lSup.llth-12th 7 10\\nSecond molars 18-24 12th-13tk 10 11\\n(1^ yrs.-2 yrs.\\nThe temporary molars should be preserved for three reasons\\n1st. To prevent the child suffering pain.\\n2d. To allow proper mastication of food.\\nThis latter is of extreme importance, as these years are especially\\nimportant ones in the child s growth. If he is prevented by pain from\\nproperly masticating his food it will not be assimilated, and a habit of", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0673.jp2"}, "674": {"fulltext": "666\\nMANAGEMENT OF THE DECIDUOUS TEETH.\\nswalloAving food without masticating may be continued even when the\\npermanent teeth have erupted.\\n3d. To preserve the fulness of the arch for the permanent teeth.\\nEarly loss of the deciduous second molar will allow the first per-\\nmanent molar to move forward and occupy room that should be pre-\\nserved by the bicuspids. Early loss of the first temporary molar will\\nallow the second temporary and the first permanent molar to move\\nforward.\\nThe crowns of the temporary molars are much larger than the\\nnecks, and caries of the approximal surfaces will allow them to crowd\\ntogether with the same result. Approximal fillings inserted should be\\nso shaped as to preserve the original contour. If the first permanent\\nmolar thus moves forward of its natural position a smaller arch is left\\nfor the successional teeth. The result may be a constricted arch, a\\npointed arch, upper protrusion, or the labial displacement of the\\ncanines.\\nFig. 593. 1\\n10\\nii ;ti jXJT 9\\nDecalcification of the deciduous teeth. The numbers indicate years.\\nOdontalgia. The first visits by children are usually for the relief\\nof toothache, and may occur at any age from two years upward.\\nThe first treatment of most children s teeth should be palliative.\\nIn many cases a fear of the dentist has been engendered, which it should\\nbe the prime object to remove. Make the acquaintance of the little\\npatient in the reception room, talking perhaps of things altogether\\nforeign to the case in hand, and distract its attention. If the child is\\nvery timid examine the teeth while it is seated in an ordinary chair, or\\nin its parent s lap, and apply some dressing to relieve the pain.\\nIn the operating room the chair should be adjusted to its smallest\\nsize a special child s seat may be used, or a cushion half the size of the\\nchair seat, and not too soft. The child s head should be made comfort-\\nable in the head-rest. The operator should not let the child detect him\\nin an endeavor to hide instruments the necessary ones may be shown\\nto him if they arouse his curiosity, and their purpose explained.\\n1 Prof. Pierce in Amer. System of Dentistry, vol. iii. p. 639.", "height": "4608", "width": "2848", "jp2-path": "americantextboo00kirk_0674.jp2"}, "675": {"fulltext": "ODONTALGIA. 667\\nOn account of the difficulty the child has in making himself under-\\nstood, or from his not knowing what he wishes to describe, diagnosis is\\ndifficult. A child cannot always distinguish just where pain is felt, nor\\nalways remember its exact location. In most cases the first occurrence\\nof pain is during mastication.\\nIt is necessary to ascertain whether pain is caused by an erupting\\ntooth, a nearly exposed pulp, a pulp inflamed and dying, a putrescent\\npulp, or an alveolar abscess. If the nearly exposed pulp is suspected,\\ntest it by the application of a drop of cold water. Pain during masti-\\ncation may be caused by thermal changes, by pressure of food in the\\ncavity, or by pressure on a tooth whose pericementum is inflamed.\\nIf the tooth is aching while the child is in the chair, syringe out the\\ncavity with warm Avater, dry it with bibulous paper, and apply a pledget\\nof cotton saturated with oil of cloves, campho-phenique, or whatever\\nhas been found effective with permanent teeth. Fletcher s carbolized\\nresin l has been invaluable for this purpose in the writer s practice.\\nApplied on a pellet of cotton it acts as an anodyne, and the resin\\nhardens in the cotton, forming with it a temporary stopping which will\\neven bear the force of mastication for a few days. It is sometimes\\nbest to renew this dressing a few times before attempting a more per-\\nmanent treatment or filling.\\nIf the child cannot be brought to the office again within a few days,\\nlet the parent provide himself with a bottle of the carbolized resin and\\nan inexpensive pair of dressing pliers. Instruct the patient how to\\napply the cotton dressing. This is the best domestic remedy for odon-\\ntalgia. Other medicaments may be used by the parent, such as oil of\\ncloves, campho-phenique, etc., but their effect is much more temporary.\\nA more durable dressing may be made by mixing zinc oxid and car-\\nbolized resin to the consistence of putty and applying it in the cavity\\npreviously dried. It hardens under moisture, and makes a stopping\\nthat will remain, in some cases, for several weeks.\\nDuring such palliative treatment, sometimes unavoidably extended\\nover several weeks or even months, the child is growing older, is gain-\\ning experience, is becoming used to manipulation, begins to recognize\\nthe benefit of treatment of the teeth in a word, is being trained or\\neducated for a good patient for whom more permanent operations may\\nbe attempted.\\nProf. L. L. Dunbar says As a domestic palliative always at\\nhand, in the treatment of pulp exposure and restricting odontalgia, use\\nammonia on cotton its repeated use will devitalize the pulp, at the\\nsame time effecting its removal by saponification.\\n1 Carbolic acid,\\nResin (colophony), da. ^j\\nChloroform, 15SS.", "height": "4572", "width": "2776", "jp2-path": "americantextboo00kirk_0675.jp2"}, "676": {"fulltext": "668 MANAGEMENT OF THE DECIDUOUS TEETH.\\nTreatment with Silver Nitrate.\\nMore than forty years ago the application of silver nitrate for\\narresting decay was advocated, but for many years no notice was taken\\nof it. Within the last five years it has been advocated again, especially\\nfor use in the temporary teeth. The fact that it blackens the decayed\\nsurface is not as objectionable as with permanent teeth. Dr. Stebbins 1\\nadvocated the use of a solution of the crystals of silver nitrate in cari-\\nous cavities in temporary teeth. He applies it by means of a small\\nstick inserted in a socket instrument as shown in Fig. 594. Many\\nFig. 594.\\ncases will need no further treatment, decay being completely arrested.\\nSome cases will need secondary treatment after a few months. In\\nmany cases he advises filling the cavity with gutta-percha after the\\napplication.\\nDr. C. N. Peirce 2 advises saturating pieces of blotting paper with\\n40 per cent, solution of silver nitrate, and keeping these on hand for\\nuse.\\nDr. E. C. Kirk advises the use of asbestos felt for saturation with\\nthe solution in preference to blotting paper or cotton. He says 3 The\\ncontact of silver nitrate with vegetable fiber of any sort involves not\\nonly a destruction of the fiber but also of the silver nitrate, so that the\\npreparation in a short time loses its desirable qualities. He advises\\nthat the asbestos felt be heated before the blowpipe before saturation,\\nto burn out any organic material which may be present.\\nDr. A. M. Holmes 4 advises its use as follows for approximal cavities\\nCut away the walls to a V shape, and with a piece of gutta-percha,\\nsoftened by heat, of the proper size to fill the space, bring the surface\\nto come in contact with the diseased part of the teeth, into contact with\\nthe powdered crystals of silver nitrate and carry it to the place in the\\ntooth or teeth prepared for its reception, packing it firmly and leav-\\ning it there to be worn away by use in mastication. When that takes\\nplace, the surfaces of the teeth treated will be found black and hard,\\nwith no sensitiveness to the touch or to change of temperature, and\\nthey will remain so indefinitely. In case the child is so timid as to\\n1 International Dental Journal, 1891, p. 661. 2 Ibid., 1893, p. 152.\\n3 Dental Cosmos, 1893, p. 667. Ibid., 1892, p. 982.", "height": "4580", "width": "2848", "jp2-path": "americantextboo00kirk_0676.jp2"}, "677": {"fulltext": "FILLING MATERIALS. 669\\nprevent this course, dry the cavity, take out as much softened dentin\\nas the patient will permit, carry the crystals on softened gutta-percha\\ninto the cavity and pack it, leaving it until such time as desirable to\\nmake a more thorough operation.\\nIn the writer s opinion it is better to open approximal cavities from\\nthe occlusal surface rather than make V-shaped spaces, as the full\\ndiameter of the teeth should be left to preserve the fulness of the\\narch.\\nSilver nitrate in its action penetrates but a short distance.\\nThe Character of the Patient.\\nThe conditions of operating on the deciduous teeth vary so much\\nfrom those pertaining to the permanent teeth that a different consid-\\neration must be taken of filling materials.\\nThe little patients mouths are small. They are often too young to\\nreason with or to understand the purpose of the operation. They have\\nbeen too often frightened by thoughtless remarks of their elders in\\nspeaking of their dentist.\\nOftentimes the first sitting must be utilized merely to make the\\nacquaintance of the child, perhaps cleaning the teeth a little, or intro-\\nducing some palliative dressing in an aching tooth. The greatest care\\nshould be taken not to hurt the child. After it has gained a little\\nexperience it recognizes the benefit of the treatment, and will often\\nsubmit to operations that older patients even shrink from.\\nFilling Materials.\\nG-utta-percha. Pink base-plate gutta-percha is a most valuable\\nfilling material. In approximal cavities where it is not exposed to\\nwear and where the shape of the cavity is such as to retain it, it is\\npractically indestructible. In occlusal and compound cavities in which\\nit is exposed to wear it has wonderful durability, lasting in some cases\\nfor several years.\\nDirections for Use. Cut the gutta-percha in small pieces and place\\nthem on a gutta-percha warmer (see Fig. 304), where they can be kept\\nsoft but not heated enough to injure the material. The instruments\\nalso should be warmed (see Fig. 293).\\nOcclusal Cavities. Cut away the margins of thin enamel with\\nsuitably shaped chisels, and remove the decayed and softened dentin\\nwith scoop and hatchet excavators. Do this as thoroughly as the\\npatient will permit, but do not sacrifice the patient to thoroughness, for\\nthe thorough removal of softened dentin is not as essential as with per-\\nmanent teeth, because the gutta-percha is, by mastication, kept in such", "height": "4568", "width": "2768", "jp2-path": "americantextboo00kirk_0677.jp2"}, "678": {"fulltext": "670 MANAGEMENT OF THE DECIDUOUS TEETH.\\naccurate contact with all the walls of the cavity that further soften-\\ning will go on very slowly if at all. No special attention need be paid\\nto the form of the cavity, except that its mouth should not be larger\\nthan the rest, nor should any parts of the cavity be inaccessible to the\\nfilling material. After excavating, dry the cavity with bibulous paper,\\nand apply campho-phenique, oil of cloves, or carbolic acid, to sterilize\\nany softened dentin which may not have been removed. For drying\\ncavities, prepare paper cylinders, of different sizes, as follows Tear\\nthe bibulous paper in strips from half an inch to two inches in width.\\nRoll or twist each of these strips into a rope, but not too tightly just\\nenough to retain the shape. Cut these ropes into cylinders from a\\nquarter to half an inch in length. Some of these will be as large\\naround as a lead pencil and others no larger than the lead itself.\\nProtect the tooth from moisture as well as possible. For lower\\ncavities fold a small napkin diagonally from the corner till it is about\\nhalf an inch wide. Put the end of this between the gum of the upper\\ncanine and the lip and extend the napkin back between the upper\\nmolars and the cheek beyond the last tooth, then down behind the last\\nlower molar, and press it between the lower teeth and tongue. Tell\\nthe patient to raise the tongue as it is applied, then to lower the tongue\\nand hold the napkin with it. The part of the napkin between the\\nupper teeth and the cheek will cover the mouth of the duct of\\nSteno, and prevent or absorb the flow of saliva. It is better to cover\\nthe mouth of this duct with a piece of spunk about half an inch in\\ndiameter before applying the napkin. The folds of napkin between\\nthe lower teeth and tongue and under the tongue will absorb the saliva\\nfrom the submaxillary glands. This part of the napkin can be held in\\nplace with a mouth mirror or other blunt instrument, by the operator\\nor assistant. After applying the napkin use a large bibulous paper\\nCylinder to absorb the moisture from the tooth to be filled and also\\nfrom contiguous ones. With smaller cylinders or pellets dry the cavity.\\nApply once more campho-phenique or other medicament, and absorb\\nthe excess.\\nThe gutta-percha having been meanwhile warmed and softened,\\npick up a small piece of it with a cold round-pointed instrument\\nand press it into the cavity. If the cavity is not large, a single\\npiece of gutta-percha of a diameter less than that of the cavity, but\\nlonger than the cavity is deep, can be pressed in quickly and at one\\nmovement. For medium-sized cavities select a piece of gutta-percha\\nlarge enough to cover the floor of the cavity and press it into place\\nwith a cold instrument, as a warm instrument might drag it from its\\nplace. Add similar pieces, pressing each one to the place in which it is\\ntill the cavity is full. If at any time the gutta-percha in the", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0678.jp2"}, "679": {"fulltext": "FILLING MATERIALS. 671\\ncavity becomes so hard as to lose its plasticity, apply a warm instrument\\nto soften the surface, so that the next piece will adhere to the others.\\nAs the filling nears completion select a small piece for the last, just\\nlarge enough to complete the filling and no more, so that none will\\nhave to be trimmed away, for in trimming the surplus away the filling\\nmay be drawn from contact with the walls of the cavity.\\nIn filling large cavities it may be necessary to hold the first piece in\\nposition with another instrument till sufficient material is added for self-\\nretention. At the completion of the filling slight pressure with a warm\\ninstrument should be made in such a manner as to force the material\\nagainst all the margins of the cavity.\\nApproximal Cavities. Where possible, approximal cavities\\nshould be opened from the buccal surfaces, as advised by Dr. Bon-\\nwill, as in such cases gutta-percha fillings will not be exposed to the\\nforce of mastication. This plan is not often practicable because the\\npatient is seldom presented till the cavity has become visible by open-\\ning into the occlusal surface of the tooth. In such cases cut away the\\nenamel only enough to give access to the cavity, excavate the decayed\\ndentin, and trim the buccal, lingual, and cervical walls until a smooth,\\nfirm margin is obtained.\\nIn filling such a cavity use small pieces of softened gutta-percha,,\\npressing each piece where it is to remain, and avoid a surplus. Press\\nthe gutta-percha against the adjoining tooth as if it were a matrix or a.\\nfourth wall of the cavity and let it remain. It is useless to trim it\\naway from the adjoining tooth, because the force of mastication would\\nsoon spread the filling against it again.\\nIf an approximal cavity cannot be readily shaped so that it will\\nretain the gutta-percha, it may be packed against the adjoining tooth,\\nas if it were an occlusal cavity. It will prevent decay, especially if sil-\\nver nitrate is applied as described on page G68, and maybe retained till\\nthe patient is older, when a more thorough operation may be performed.\\nThe spreading of the gutta-percha by the force of mastication will\\ntend to separate the teeth which is sometimes an advantage and also\\nto press upon the gum in the interproximal space which is a disad-\\nvantage. In filling children s teeth we cannot always reach the ideal,\\nbut must select the method and material which will have the greatest\\nadvantage with the least disadvantage. If the teeth separate so much\\nthat the pressure of the gutta-percha upon the gum tissue becomes a\\nserious annoyance, some other material must be substituted. Zinc\\nphosphate cement is probably the best.\\nTo prevent the impinging of the gutta-percha upon the gum in the\\ninterproximal space, Dr. M. W. Hollingsworth l has invented a space\\n1 Dental Cosmos, 1896, vol. xxxviii. p. 553.", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0679.jp2"}, "680": {"fulltext": "672\\nMANAGEMENT OF THE DECIDUOUS TEETH.\\nguard, consisting of a concave elliptical piece of metal coated on the\\nconvex surface with gutta-percha. This guard is to bridge over the\\ninterproximal space. It is placed in position with the instrument\\nshown in B, Fig. 595, which is warmed slightly, so that the point can\\nFig. 595.\\nFig. 596.\\nenter a small hole in the guard and adhere to the gutta-percha on the\\nunder side, as shown at c. The guard is placed in the cavities, after\\nwarming the gutta-percha, as shown in Fig. 596, and thus covers the\\ncervical borders. Gutta-percha is now filled in over the guard as if\\nthe two cavities formed a single crown cavity.\\nAdvantages of Gutta-percha. It is easily applied to the cavity it is\\ninsoluble is durable even when masticated upon is a non-conductor of\\nthermal impulses the filling is finished as soon as the cavity is full it\\nspreads under the force of mastication, and is thus kept in contact with\\nthe walls of a cavity it can be used even under moisture.\\nDisadvantages. Gutta-percha is softer than other filling materials,\\nand hence wears away more rapidly. In approximal cavities it will\\nspread the teeth apart, and may then press upon and irritate the gum.\\nDryness of the cavity, though very desirable, is not absolutely neces-\\nsary.\\nAdvantages of Zinc Phosphate Cement. It is a poor conductor of\\nheat it withstands the force of mastication better than gutta-percha\\nit adheres to the walls of the cavity, and hence will remain where no\\nother material can it is easily applied its color may be selected to\\nmatch the tooth.\\nDisadvantages. Absolute dryness of the cavity is a prerequisite to\\nits success it must be kept dry for several minutes after it is inserted\\nin the cavity. Zinc phosphate cement disintegrates in some mouths\\nmuch more rapidly than in others. If placed too near the pulp it may\\nby chemical irritation devitalize it.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0680.jp2"}, "681": {"fulltext": "FILLING MATERIALS. 673\\nApplication of the Rubber Dam. While many hesitate to attempt\\nthe use of the rubber dam with children, it will be found upon trial that\\nmost of them will submit to it without trouble, and many will prefer it\\nto other means of keeping cavities dry.\\nAlthough there is an advantage in applying the rubber dam before\\nexcavating because dryness makes the teeth less sensitive, and a clearer\\nview of the cavity is obtained still, for the sake of not tiring the little\\npatients by too long restraint in one position, it is better to do most of\\nthe excavating before its application.\\nThe small size of the necks of the deciduous teeth compared with\\nthat of the crowns renders the retention of the rubber dam easier than\\nwith permanent teeth. Even considering the smallness of the patients\\nmouths, the application of the rubber dam is not difficult in many\\ncases.\\nFor retaining the rubber dam on the second molar a clamp will\\nsometimes be necessary, but for the other deciduous teeth a floss silk\\nligature will be sufficient. Having punched holes of suitable size\\nthrough the rubber dam, apply it over the teeth affected. If the cavity\\nis in the occlusal or buccal surface only, it will not be necessary to\\napply it over more than one tooth, but if the cavity is in the approximal\\nsurface it will be necessary to apply the rubber dam over two or some-\\ntimes three teeth, or even more, if several cavities are to be filled at one\\nsitting.\\nIt is not always necessary to tie a ligature around the neck of the\\ntooth, as merely passing the Avaxed floss silk between the teeth will\\noften force the rubber around the neck of the tooth enough to retain it\\neven above an approximal cavity. The silk may then be removed by\\ndrawing the end through between the teeth.\\nWith a thin burnisher or spatula turn up the edge of the rubber\\naround the neck of the tooth toward the gum. The tendency of the\\nrubber then will be to slide in that direction and not off over the\\ncrown. If a ligature be necessary to hold the rubber above the edge of\\nan approximal cavity tie it tightly around the neck of the tooth, even\\nforcing it toward or under the edge of the gum with an instrument when\\nnecessary. The clamp on a second molar may often be dispensed with\\nafter a ligature is applied, unless it is needed to hold the rubber out of\\nthe operator s way. The only object in omitting the clamp is to pre-\\nvent pain or discomfort to the child.\\nIf a simple ligature will not retain the rubber on a second molar\\nbefore the first permanent molar has appeared, its efficiency may be\\ngreatly increased by stringing a bead, about an eighth of an inch or less\\nin diameter, on the thread and tying a simple knot in it so that the bead\\nwill be in about the middle of the ligature. Tie the ligature around\\n43", "height": "4576", "width": "2768", "jp2-path": "americantextboo00kirk_0681.jp2"}, "682": {"fulltext": "674 MANAGEMENT OF THE DECIDUOUS TEETH.\\nthe tooth so that the bead will lie against the distal surface of the\\nsecond molar on or near the gum. This bead will prevent the rubber\\nslipping off the tooth. A short cylinder of bibulous paper can be tied\\nin the ligature and applied with the same effect, and even a large knot\\nin the ligature on the distal surface of the tooth will often answer the\\npurpose.\\nThe corners of the rubber dam should be held out of the way by a\\nsuitable holder extending around the head. The lower border may be\\nheld out of the operator s way by small weights, hooked in the edge.\\nDry the cavity and the whole tooth or teeth, and complete the\\nexcavation.\\nPilling- Cavities with Cement. As cement can be applied easily\\nin undercuts and very irregularly shaped cavities it is not necessary to\\ncut away the enamel more than is sufficient to enable the operator to\\nthoroughly remove the disintegrated dentin. Even the thorough re-\\nmoval of the latter is not as essential for a cement filling as for other\\nmaterials, for, if the edge of the cavity can be made smooth and the\\nsoftened dentin be thoroughly sterilized, the cement will hermetically\\nseal it and prevent further disintegration until it is worn away beyond\\nthe sound edges.\\nThe operator may take much greater risks in leaving disintegrated\\ndentin than with permanent teeth, for the object is simply to retain the\\ntooth till the time arrives for its successor to appear.\\nIt must be remembered in excavating cavities in deciduous teeth\\nthat the pulp is much larger in proportion to the size of the crown than\\nin permanent teeth, and that in trying to make undercuts or retaining\\ngrooves deep enough to retain a filling, the pulp may be exposed an\\naccident which should be carefully guarded against, for the pulp has\\nnot even the recuperative power possessed by the pulp of a permanent\\ntooth, and in case of its death it is more difficult to give a deciduous\\ntooth proper treatment. Moreover, death of the pulp prevents normal\\nresorption of the root and may thus cause irregularity of the permanent\\nteeth.\\nFor most cases the cement should be mixed as thick as can be easily\\nand quickly manipulated, but if the pulp is nearly exposed the cement\\nshould be used so thin that it can be applied without pressure, by\\nflowing it over the floor of the cavity. Cement mixed moderately\\nthin will adhere better to the walls of the cavity than when it is as\\nthick as it is possible to apply it. The thinner the cement, the longer\\ntime it will take to harden, but the thicker it is mixed the more dur-\\nable it will be. Do not keep the little patient in a constrained posi-\\ntion longer than necessary. The easier the first operation is for him\\nthe more readily will he return for the second.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0682.jp2"}, "683": {"fulltext": "FILLING MATERIALS. 675\\nIf the pulp is very nearly exposed apply Fletcher s carbolized resin\\nover the floor of the cavity. For this purpose remove the stopper of\\nthe bottle till by evaporation the carbolized resin has thickened to the\\nconsistence of molasses. Dip a small probe in this thickened mass, so\\nthat a small drop will adhere to the end. This drop may be then con-\\nveyed to and spread over the floor of the cavity. This will prevent\\ncontact of the cement with the most sensitive dentin and lessen the\\npossibility of deleterious action on the pulp.\\nWhere it is possible to apply the rubber dam and excavate thoroughly\\nthe same excellent result with cement may be expected as when it is\\nused in permanent teeth, but often it is not possible to operate as\\nthoroughly.\\nBy applying melted paraffin 1 or sandarac varnish to the cement the\\nrubber dam may be removed sooner than otherwise, and the cement\\nwill be protected from moisture by the coating of paraffin or varnish.\\nAs paraffin is insoluble in any agent that can attack it in the mouth,\\nthe more it is absorbed by the cement the longer it will protect it from\\neverything but wear therefore, do not be content to merely flow the\\nmelted paraffin over the cement, but hold a heated instrument in contact\\nwith the filling and keep the paraffin melted until all that is possible is\\nabsorbed. If an approximal filling has been inserted pass a very thin\\nheated spatula between the cement filling and the adjoining tooth to\\nmake sure that the paraffin covers it to its cervical margin.\\nWhen the rubber dam cannot be applied, cement may still be used\\nwith success if the cavity can be kept dry with napkins or rolls of\\ncotton or spunk until it is inserted and quickly covered with melted\\nparaffin.\\nDeep cavities may be advantageously lined with cement and protected\\nwith paraffin till the cement is hard, Avhen the paraffin may be removed\\nand gutta-percha or amalgam inserted.\\nCavities in Incisors. Decay in deciduous incisors is much more\\nrare than in the other teeth, and they are lost so early in child life that\\nit is seldom necessary to fill them. Zinc phosphate cement is the best\\nfilling material for these teeth, because they are so small that it is very\\ndifficult to shape the cavities properly for retaining other materials.\\nIf it is found that cement disintegrates rapidly in approximal cavities,\\nan attempt should be made to shape them so as to retain gutta-percha.\\nThe first filling of cement may have removed the sensitiveness suf-\\nficiently to allow deeper excavating at a subsequent sitting, or there\\nmay have been a deposit of secondary dentin, thus removing the pulp\\nfrom danger of exposure in properly shaping the cavity.\\nAmalgam. While amalgam is a valuable filling material, its use\\n1 Dr. Bonwill s suggestion.", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0683.jp2"}, "684": {"fulltext": "676 MANAGEMENT OF THE DECIDUOUS TEETH.\\nnecessitates much greater care in the preparation of cavities than is\\nnecessary with gutta-percha or cement, for it neither spreads under\\nmastication like the former nor does it adhere to the walls of a cavity\\nlike the latter. The spreading of gutta-percha will stop a leak that\\nwould be fatal to an amalgam filling, and cement will adhere in a cav-\\nity from which amalgam would be easily dislodged.\\nAmalgam should be used when the decay can be thoroughly excava-\\nted and the cavity prepared with strong smooth edges, and good under-\\ncuts or retaining grooves. As amalgam is a better conductor of thermal\\nimpulses than either of the materials before mentioned it will not be\\ntolerated so near the pulp, hence deep cavities must be lined with either\\ngutta-percha or zinc phosphate.\\nThe large size of the pulp of deciduous teeth greater in proportion\\nthan that of the permanent teeth must not be forgotten in exca-\\nvating, and often it is impossible to make suitable retaining grooves for\\namalgam without cutting dangerously near the pulp, especially in ap-\\nproximal cavities.\\nThe preparation of occlusal cavities is comparatively simple, as the\\nenamel may be easily cut away so as to make firm edges, slightly\\nbevelled, and to allow thorough excavation of softened dentin.\\nThe burring engine can be used to greater advantage Avith children\\nthan many would suppose. The whirring noise often distracts their\\nattention from a slight pain they might otherwise notice, and the assur-\\nance that the work can be done more quickly is a great encouragement.\\nIn preparing approximal cavities for amalgam a free opening should\\nbe made in the occlusal surface and given a dovetail shape, extending\\nfarther upon the occlusal surface in proportion to the size of the cavity\\nthan in permanent teeth, because more reliance must be placed on it for\\nretention than upon lateral grooves, for there is not much depth of\\ndentin in which to make them. The cervical border of the cavity must\\nbe smooth and the floor at right angles to the long axis of the tooth.\\nThe lateral walls must be cut smooth and bevelled, and may be\\nslightly grooved. If the cavity extends below the\\nmargin of the gum the latter should be crowded\\naway with a temporary stopping or by packing a\\ntightly rolled pledget of cotton between the teeth\\nand relying on its swelling.\\nWhile the application of a rubber dam is not as\\nPrepared cavity showing essential as in using cement, it is a great advantage,.\\nbevelling of enamel ft 7 7\\nedges, a,a, and square for it renders the proper preparation of the cavity\\nbase for filling, b. more cer t a in, but it need not be applied till the\\ncavity is nearly prepared. Its use is more often necessary with the\\nlower teeth than with the upper.", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0684.jp2"}, "685": {"fulltext": "EXPOSED PULPS. 677\\nAmalgam should not be mixed too dry, but should be plastic enough\\nto be packed easily without crumbling. In occlusal cavities introduce a\\npiece half as large as the cavity, and with a small ball burnisher spread\\nit over the floor of the cavity toward the walls. Introduce other smaller\\npieces and proceed as before until the cavity is nearly full. Excess of\\nmercurv is thus forced to the edges of the cavity, whence it can be\\nbrushed away with cotton or bibulous paper.\\nThe last pieces of amalgam should be wafered, as recommended\\nbv Prof. J. Foster Flagg that is, squeezed in chamois skin with large\\nflat-nosed pliers till as much mercury as possible is pressed out (see\\nFig. 288). This leaves the amalgam in a thin, brittle wafer, too hard\\nfor ordinary use. Break it up in pieces half the diameter of the cavity.\\nPress one of these in the middle of the nearly completed filling. It\\nwill readily absorb the excess of mercury that has been worked to the\\nsurface, and can be spread toward the margins with a round burnisher.\\nOther pieces can be burnished on till the filling is quite hard.\\nIn filling approximal cavities the same plan may be followed if a\\nmatrix of thin steel or German silver be used. In lieu of the matrix\\na very thin spatula may be held between the teeth.\\nWhenever possible, fillings in deciduous molars should be contoured\\nto avoid the crowding of food between the teeth and also to prevent the\\nfirst permanent molar from crowding them together and thus taking up\\nroom which will be needed by the bicuspids.\\nThe child should be cautioned against masticating too soon upon\\napproximal fillings, though no caution is needed in case of occlusal fill-\\nings hardened by the wafering process.\\nTin and gold are excluded from the list of desirable filling materials\\nfor temporary teeth, not because they are not good filling materials but\\nbecause the circumstances are such that they cannot be used to advan-\\ntage. Though a small gold filling may be inserted in a few minutes in\\nan occlusal cavity, the insertion of a large gold filling would be inflict-\\ning a needless cruelty on a child on account of the length of time it\\nmust be held in one position.\\nAs the insertion of a tin filling is nearly if not quite as difficult and\\ntedious an operation, it is open to the same objection.\\nExposed Pulps.\\nOn account of the difficulty of properly capping an exposed pulp in\\na deciduous tooth, the operation should seldom be attempted. It is\\nbetter to devitalize the pulp and remove it.\\nThe writer has found the following formula l an excellent one\\n1 Used bv Dr. E. N. Clarke in the fifties.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0685.jp2"}, "686": {"fulltext": "678 MANAGEMENT OF THE DECIDUOUS TEETH.\\nAcidi arseniosi,\\nMorphia? acetatis,\\nPulv. opii, da. pars wq.\\nCreosoti q. s. to make paste.\\nWhy opium and acetate of morphia should both be used in the same\\nprescription is not clear, as their properties are so nearly the same, but\\nthe paste has been satisfactory in devitalizing pulps with no pain, or\\nwith a minimum amount. Other formulas may be equally satisfactory.\\nIn occlusal cavities its application is simple. Excavate the softened\\ndentin as thoroughly as possible without inflicting pain, using spoon-\\nshaped excavators to prevent puncturing the pulp. If the excavation\\ncan be carried far enough to apply the paste directly to the pulp its\\naction will be more rapid. Dry the cavity, apply a small amount, not\\nlarger than half a pinhead in size, with a small probe and cover it with\\na pellet of cotton, or place in the cavity a small pellet of cotton one\\nside of which has been touched to the paste. Add enough pellets of\\ndry cotton to fill the cavity, then apply a drop of sandarac varnish, suf-\\nficient to saturate at least half the depth of cotton. This is a better\\nplan than dipping the pellets in the varnish before inserting, because an\\nexcess of the latter is apt to come in contact with the pulp and cause\\npain, or, penetrating between the paste and the pulp, may render the\\nformer inoperative. Temporary stoppings such as Gilbert s, White s, or\\nFowler s are excellent for sealing the cavity, but take a little more\\ntime than cotton and varnish. Such temporary stopping should be well\\nsoftened by heat to prevent pressure on the pulp in its insertion. A\\ngood plan is to warm the end of the long stick of stopping and press\\nit into the cavity, using the remainder of the stick as a handle, then\\nremove the surplus and smooth with a warm instrument.\\nIn approximal cavities extending near or under the margin, the gum\\nshould be protected, before applying the paste, as follows\\nMake, by rolling between the fingers, a cylinder of cotton as long\\nas the width of the tooth and about the size of the lead of a pencil.\\nSaturate it with sandarac varnish and pack it between the teeth upon\\nthe gum, extending part of it below the edge of the cavity, thus sealing\\nthis portion of the cavity and reducing it nearly to the form of an\\nocclusal cavity. Paste applied in an approximal cavity so protected\\ncannot flow upon the gum unless too great a quantity has been used.\\nThe paste should be applied and sealed as in an occlusal cavity.\\nDevitalizing fiber is very satisfactory and may be used with less\\nfear of its affecting the gum tissue.\\nThe paste may be allowed to remain in the cavity for from twelve\\nto forty-eight hours. The possibility of the dressing being dislodged, so", "height": "4580", "width": "2828", "jp2-path": "americantextboo00kirk_0686.jp2"}, "687": {"fulltext": "FILLING PULP CANALS. 679\\nas to allow the paste to come in contact with the gum tissue, should\\nwarn one to have the patient return much sooner than when the case\\nis an occlusal cavity from which it is impossible for the paste to escape.\\nMuch has been said about the danger of application of arsenic in\\ndeciduous teeth when the roots are undergoing resorption, but the\\nwriter has never seen any bad effects from such use still it must be\\nadmitted that the ratio of danger varies with the degree of resorption\\nof the root. An examination of Prof. Peirce s diagram (Fig. 593) will\\nshow the average amount of resorption at different ages, and enable\\none to discriminate. The writer believes that the sensitiveness of a\\ndeciduous pulp varies inversely with the amount of resorption of the\\nroot, and that devitalization is called for in very few cases in which\\nthere is clanger of deleterious action.\\nProf. L. L. Dunbar advises the use of aqua ammonia? for devitaliz-\\ning the pulp of a temporary tooth, by applying it on a pledget of cotton\\nin the cavity, one or two applications being sufficient in most cases.\\nThis plan is not open to the objections urged against the use of arsenous\\noxid.\\nWhen the pulp is devitalized, open the cavity freely into the pulp\\nchamber and apply on cotton a solution of tannic acid in glycerol.\\nLeave this about a week, by which time the pulp tissue will have be-\\ncome so hardened by the tannin that it may be removed much more\\nreadily than without such treatment.\\nThe application of mummifying paste is advised by many, after\\ndevitalization, to avoid the necessity of removing the pulp. If a real\\nmummifying paste can be found, its application will be the ideal\\ntreatment.\\nFilling Pulp Canals.\\nIn the pulp canals apply iodoform paste made by mixing iodoform\\nand glycerol to such a consistence that it can be readily applied on a\\nprobe.\\nFill the pulp chamber with temporary stopping or gutta-percha,\\nand the cavity with cement, gutta-percha, or amalgam according to\\nindications.\\nIf the tooth be very frail, fill the cavity with cement, because, owing\\nto its adhesive properties, it strengthens the tooth. If the cavity be\\napproximal and it is desirable to wedge the teeth apart, use pink gutta-\\npercha.\\nIf the walls be strong and some time will elapse before the natural\\nexfoliation of the tooth will occur, fill with amalgam.\\nIf absorption of the roots occurs, the iodoform in the canals will not\\ninterfere.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0687.jp2"}, "688": {"fulltext": "680 MANAGEMENT OF THE DECIDUOUS TEETH.\\nSalol, which was advocated as a root filling for permanent teeth by\\nDr. A. E. Mascort l of Paris, France, is well adapted also for filling the\\ncanals of deciduous teeth. It is a white crystalline powder, insoluble\\nin water and glycerol, but soluble in alcohol, ether, chloroform, etc.\\nfuses at 40\u00c2\u00b0 C. but crystallizes quickly again. Melted together, salol\\nand aristol, salol and iodoform, or salol and paraffin, become liquid\\nlike salol alone. After a pulp canal is thoroughly dried the salol may\\nbe fused on a small spatula and carried to the canal, into which it will\\nbe taken by capillary attraction or a broach may be heated and inserted\\nin the salol. A small quantity will adhere like a drop of liquid and\\nmay thus be carried to the canal. The heated broach may be again\\nintroduced in the canal to insure thorough application. Dr. Mascort\\nuses the hypodermic syringe with a small needle for introducing into\\nthe canals. It will crystallize in a very short time, making a solid fill-\\ning. Though the writer has not had much experience with salol as a\\nroot filling, he is so far well pleased with the result. (See Chapter\\nXVII., p. 439.)\\nAlveolar Abscess.\\nThe treatment should be the same as with the permanent teeth, that\\nis, removal of the cause which is, almost invariably, a decomposed\\npulp. Even with a decomposed pulp an abscess seldom occurs if there\\nbe any opening from the cavity of decay to the pulp chamber, unless\\nsuch opening has become stopped by some foreign substance.\\nMake a free opening into the pulp chamber and with a syringe\\nwash out as much of the contents as possible. Dry the chamber and\\nwith a minim syringe (see Chapter XVII. Fig. 441), or drop tube,\\n.apply hydrogen dioxid. While capillary attraction will carry this\\ninto a dry canal, the application of a nerve broach, preferably platino-\\niridium, will serve to mix it thoroughly with the contents of other\\ncanals, and increase its efficiency.\\nIf a fistulous opening has formed through the outer alveolar plate\\nbut not through the gum, an opening should be made through the latter\\nwith a sharp lancet about five minutes after the application of 4 per\\ncent, cocain hydrochlorid solution on a wad of cotton.\\nIf hydrogen dioxid can be forced from the pulp chamber through\\nthe root canals and fistulous opening, the accumulated pus will be\\nthoroughly evacuated and the cure hastened. As a rule, however, the\\nabscess disappears after the cause is removed, that is, the putrescent or\\ndecomposed contents of the pulp chamber and canals.\\nAfter drying the pulp chamber and canals, apply iodoform paste\\n1 Dental Cosmos, 1894, p. 352.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0688.jp2"}, "689": {"fulltext": "PROPHYLACTIC TREATMENT. 681\\ntherein and seal the cavity for a few days with temporary stopping.\\nWhen the inflammation of the pericementum has disappeared the pulp\\nchamber and canals may be filled as before directed.\\nIn many cases the inflammation of the pericementum will be so\\ngreat, or in popular expression the tooth so sore to the touch,\\nwhen the case is presented that at the first sitting nothing more can be\\ndone than to make an opening into the pulp chamber to allow the escape\\nof pus or gases of decomposition. By this means the pain will be re-\\nlieved and the rest of the manipulation and treatment may be left till\\nthe inflammation has subsided.\\nProphylactic Treatment.\\nThis lies more in the hands of the parent than of the practitioner,\\nbut should be strongly urged by the latter upon the former. The nurse\\nor parent should begin early to clean the child s teeth by means of a\\ncloth wrapped around the finger. If the teeth cannot be kept clean in\\nthis manner a small brush should be used, especially after eruption of\\nthe molars. Floss silk should be used daily between the teeth. One\\nend of the silk should be held in each hand in such a manner as to pass\\nover the end of each index finger and be made taut between them.\\nThis taut part can be pressed down between the teeth and passed up and\\ndown against the approximal surface of each tooth, then one end of the\\nthread should be released from one hand and pulled through the\\ninterdental space with the other.\\nThis will drag out any particles of food that may be there, and is\\nmuch better than the toothpick for the purpose. If particles of\\nmeat or other food have lodged so firmly that the plain waxed silk\\nwill not dislodge them, tie a single knot in the thread and pull that\\nthrough.\\nThis cleansing with the cloth, brush, and silk should be done before\\nthe child retires at night, for that is the period of decay. The parts\\nare at rest longer than at any other time, and the fluids of the mouth\\nare not kept in circulation between the teeth by means of the tongue,\\nlips, and cheeks. Theoretically the teeth should be thus thoroughly\\ncleaned after each meal, but satiety breeds disgust, and it is not\\nbest to insist on more than will probably be accomplished.\\nChildren will soon learn to use the brush and floss silk themselves,\\nand finding the mouth much more comfortable when clean they will\\nendeavor to keep it so. Many a child has been denied candy for vears\\nfrom the belief that sweets decay the teeth, but parents may be as-\\nsured that no harm will be done if the sweet is not allowed to\\nremain between and around the teeth till it becomes acid, and that", "height": "4568", "width": "2796", "jp2-path": "americantextboo00kirk_0689.jp2"}, "690": {"fulltext": "682 MANAGEMENT OF THE DECIDUOUS TEETH.\\nmay be prevented by cleansing the teeth after the candy or sugar is\\neaten. A child may be taught cleanliness in this manner who would\\nbe only taught rebellion by the repeated denial of sweets, the reason of\\nwhich he cannot understand.\\nProphylactic mouth-washes should be used such as listerine diluted\\nto a 10 per cent, solution.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0690.jp2"}, "691": {"fulltext": "CHAPTER XXIY.\\nORTHODONTIA EXCLUSIVELY AS AN OPERATIVE\\nPROCEDURE.\\nBy Clark L. Goddard, A. M., D. D. S.\\nThe Normal Arch. As the study of physiology is necessary before\\nthe study of pathology, so is a study of the normal arrangement of the\\nteeth necessary before the treatment of their irregularities should be\\nundertaken.\\nThe ideal facial profile is shown in Fig. 598. The face from the\\nFig. 598.\\nThe facial profile.\\nhair to the chin measures three-fourths of the whole height of the head.\\nThe forehead to the root of the nose measures one-fourth, the nose one-\\nfourth and the mouth and chin one-fourth. The distance vertically\\nfrom the root of the nose to its lower border is equal to the distance\\nfrom this point to the bottom of the chin. Of this latter distance one-\\nhalf is occupied by the lips and one-half by the chin. The nose, then,\\nequals in length the lips and chin.\\n683", "height": "4576", "width": "2788", "jp2-path": "americantextboo00kirk_0691.jp2"}, "692": {"fulltext": "684\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nThe upper dental arch is shown in Fig. 599. The six anterior teeth\\nare arranged in the segment of a circle. The bicuspids and molars\\nFig. 599.\\nNormal upper dental arch.\\nform almost straight diverging lines from the canines, though the posi-\\ntion of the third molar is somewhat outside of that line.\\nThe normal occlusion of the teeth is shown in Fig. 600. The\\nsix upper anterior teeth close over the six lower from a third to a half\\nFig. 600.\\nNormal occlusion.\\nof the length of the latter. The lower second bicuspid occludes between\\nthe cusps of the two upper bicuspids and is the hey to the occlusion;\\nthis is a point easily remembered. Each bicuspid and molar of each\\njaw, excepting the upper third molar, is antagonized by two of the", "height": "4612", "width": "2824", "jp2-path": "americantextboo00kirk_0692.jp2"}, "693": {"fulltext": "DISTAL OCCLUSION.\\n685\\nteeth of the opposite jaw. The buccal cusps of the lower teeth close\\nbetween the buccal and lingual of the upper, and the lingual cusps of\\nthe upper close between the lingual and buccal cusps of the lower.\\nAs the lower jaw moves laterally during mastication the cusps of the\\nbicuspids and molars grind upon each other, while the six anterior teeth,\\noverlapping but not touching, pass by each other and escape wear. In\\norder to touch the cutting edges of the upper and lower incisors upon\\neach other the lower jaw is protruded, and at such a time the masticat-\\ning teeth do not occlude.\\nMal-occlusion may be of many kinds and degrees, to which no\\ngeneral description can be given. The eruption of a single tooth\\nlabially or lingually or turned on its axis may disarrange the occlusion\\nof all the neighboring teeth or even all the teeth of both arches. Like-\\nwise the loss of a single permanent tooth or its failure to erupt may\\nhave a more disastrous effect.\\nThere are many cases, however, in which both arches are normal,\\nyet their relation to each other is such that it results in mal-occlusion.\\nThe nature of such mal-occlusion of the arches as a whole may be\\nindicated by the position of the second lower bicuspid, which is the\\nFig. 601.\\nDistal occlusion of the jaws.\\nkey to the occlusion according to its position, the occlusion of the\\narches may be described as normal, distal, mesial, lingual, or buccal.\\nIf the key tooth, the second lower bicuspid, closes between the\\nupper bicuspids, with its buccal cusp between their buccal and lingual\\ncusps, the occlusion, both of the key tooth and all the others, is normal\\n(Fig. 600).\\nDistal Occlusion. If the key tooth closes posteriorly or back of\\nthe normal position to any degree, even to the width of a bicuspid or\\nmore, the occlusion is distal, as shown in Figs. 601 and 603. This\\nmal-occlusion may be on one or both sides of the mouth. It may be\\ndue to lack of development of the lower maxilla, or the fault may be\\nin the temporo-maxillary articulation.", "height": "4572", "width": "2792", "jp2-path": "americantextboo00kirk_0693.jp2"}, "694": {"fulltext": "686\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nAn upper protrusion may be described as a distal occlusion of the\\nlower jaw on both sides (or a bilateral distal occlusion).\\nMesial Occlusion. If the key tooth closes anteriorly or mesially\\nto the normal position to any degree, even to the width of a bicuspid\\nor more, the occlusion of the jaws is shown to be mesial (Fig. 602).\\nThis may occur on one or both sides of the mouth and may be the fault\\nof the teeth themselves, if the abnormality is slight. It may be due\\nto lack of development of the upper maxilla, as in Fig. 779 or abnor-\\nmal development of the lower maxilla, as shown in Fig. 780, both\\nFig. 602.\\nMesial occlusion of the jaws (also buccal occlusion and mesio-buccal occlusion).\\nbeing cases of lower protrusion. Hence lower protrusion may be de-\\nscribed as mesial occlusion of the lower jaw (or lower maxilla).\\nBuccal Occlusion. If the lower arch is wider than the upper, so\\nthat the buccal cusps of the lower bicuspids and molars do not close\\nbetween the buccal and lingual cusps of the upper teeth, but close\\noutside in any degree, even to the width of a cusp or more, the key\\nwill be found in a buccal position, and the whole occlusion is buccal,\\nas shown in Figs. 602 and 781.\\nThis may occur on one or both sides of the arch (unilateral or\\nbilateral), and may be due to a narrow upper arch or a wide lower\\narch.\\nLingual Occlusion. If the lower arch is so narrow that the buc-\\ncal and lingual cusps of the lower bicuspids do not close between the\\nbuccal and lingual cusps of the upper teeth, but close inside or\\ntoward the median line of the mouth to any degree, the key tooth\\nwill be found in a lingual position and the whole occlusion is lingual\\n(Fig. 807).\\nThis may be due to a slight disarrangement of the teeth themselves,\\nor to abnormal development of the upper or lack of development of\\nthe loAver maxilla.\\nLingual occlusion may occur on one or both sides of the arch (uni-\\nlateral or bilateral), or-there may be lingual occlusion on one side and\\nbuccal occlusion on the other.", "height": "4604", "width": "2816", "jp2-path": "americantextboo00kirk_0694.jp2"}, "695": {"fulltext": "LABIAL ASPECT.\\n687\\nIn cases of bilateral mal-occlusion either buccal or lingual expansion\\nof the lower or upper arch is indicated.\\nTwo of these positions may occur at once while the single arches\\nthemselves are comparatively normal.\\nA disto-lingual occlusion is shown in Figs. 603 and 807.\\nA mesio-buccal occlusion is shown in Figs. 602, 780, and 781.\\nFig. 603.\\nFig. 604.\\nDisto-lingual occlusion of the jaws.\\nLabial Aspect. In examining the upper six anterior teeth from\\nthe labial aspect (Fig. 604) it will be seen that they touch each other\\nat one point only, about one-fourth\\nof the distance from the cutting edge\\nto the gum also that the long axes\\nof the teeth are not parallel, but the\\ncrowns slant toward the median line.\\nOf the six upper anterior teeth the\\ncentral incisors are the longest, the\\nlaterals next, and the canines short-\\nest, though popularly the canine is\\nthought to be the longest tooth be-\\ncause of its prominence and the length of its cusps. It will be\\nnoticed that the gum line is higher on the canine, thus adding to its\\napparent length.\\nA line connecting the cutting edges and cusps of half the upper\\nteeth forms a double curve, highest at the third molar and lowest at the\\ncentral incisor, the line of beauty, while such a line on the lower teeth\\nforms but one curve, highest at its ends.\\nWhile the aim of the student of orthodontia will be to correct all\\nirregularities and reduce the abnormal to the normal, it will be possible\\nin many cases to do this only in degree. The normal may always be\\napproached, but not always attained.\\nThe six anterior upper teeth.", "height": "4572", "width": "2784", "jp2-path": "americantextboo00kirk_0695.jp2"}, "696": {"fulltext": "688\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nOrder of Eruption of Permanent Teeth}\\n1. Central Incisors from 6th to 8th year.\\n2.\\nLateral\\nu\\n7th\\n9th\\n3.\\nLower Canines\\na\\n8th\\n10th\\n4.\\nFirst Bicuspids\\na\\n9th\\n10th\\n5.\\nSecond\\na\\n10th\\n12th\\n6.\\nUpper Canines\\nu\\n11th\\n12th\\n7.\\nFirst Molars\\na\\n5th\\n6th\\n8.\\nSecond\\na\\n12th\\n14th\\n9.\\nThird\\nu\\n17th\\n25th\\nWhile most tables place the eruption of all the canines after that\\nof the bicuspids, it will be noticed that in this the lower canine pre-\\ncedes and the upper canine follows both bicuspids.\\nThe lateral incisor fails to erupt more often than any tooth except\\nthe third molar. It also erupts out of line more often than any tooth\\nexcept the canine.\\nFig. 605.\\nUpper and lower casts showing in the same mouth the two irregularities mentioned on page 689!\\nThe lateral incisor is duplicated more often than any other tooth,\\ncases of five or six incisors sometimes arranged in the normal curve\\n1 Farrar, Treatment of Irregularities of the Teeth, vol. i. p. 483.", "height": "4604", "width": "2816", "jp2-path": "americantextboo00kirk_0696.jp2"}, "697": {"fulltext": "THE DECIDUOUS TEETH.\\n689\\nof the arch, but more often crowded out of line, being seen occasionally.\\nThis is evidently a reversion to the six incisors of the normal mam-\\nmalian formula\\n3_3 i_i 4_4 3_3\\nJ 3^3 C lH Pm 4=4 M 3=3\\n44.\\nOccasionally a bicuspid (premolar) is duplicated, a reversion to the\\nbefore-mentioned type, in which four premolars are normal.\\nThe difference in the order of eruption of the upper and lower canines\\nhas an effect upon the position of those teeth. The upper canine erupts\\nout of line more often than the lower, while irregularity of the lower\\nbicuspids is more frequent than of the upper. In each case, being the\\nlast of the successional teeth to erupt, there is often insufficient room to\\nenable them to assume their normal positions. (See Fig. 605.)\\nThe Deciduous Teeth.\\nThe position of the deciduous teeth is almost always normal. One\\nor two teeth may be misplaced, either by an inherited tendency or by\\nFig. 606.\\nUpper and lower jaws of a child aged about six and a half years, showing portions of the\\ndeveloping permanent teeth and the roots of the deciduous teeth.\\npernicious habits, such as sucking the thumb. The irregularity, how-\\never, is so slight and so infrequent, and the deciduous teeth are retained\\nin the mouth for so short a time, that there is no occasion for treatment.\\nA regular arch of the deciduous teeth does not, however, foretell a\\nregular arch of the permanent teeth. Fig. 606 will make evident that\\nthe crowns of the permanent incisors, canines, and bicuspids are formed\\n44", "height": "4572", "width": "2792", "jp2-path": "americantextboo00kirk_0697.jp2"}, "698": {"fulltext": "690 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nin the jaw before the roots of the deciduous teeth are absorbed. From\\nwant of space they are crowded together, and already present all phases\\nof irregularity.\\nThe late Prof. J. H. M Mullen said of such cases When we are\\nexamining a series of jaws of different ages, arranged so as to show\\ndeciduous and permanent teeth, it is not a surprising matter that there\\nshould be irregularity in the permanent set but when observing their\\ncrowded and irregular arrangement in the jaw prior to eruption, it is\\nrather a matter of astonishment that they should ever assume a regular\\nsymmetrical appearance.\\nAs the permanent teeth are larger than the deciduous, the question\\nnaturally arises, How is room provided for them\\nThis may be answered, first, by dividing the permanent teeth into\\ntwo classes those which replace the deciduous teeth and those which\\ndo not. For the first class that is, the incisors, canines, and bicuspids\\nroom is made by interstitial growth and by the fact that the biscuspids\\nare smaller than the deciduous molars which they replace. For the\\npermanent molars room is made by growth of the posterior portion of\\nthe jaw.\\nEtiology of Dental Irregularities.\\nThe causes of irregularities of the teeth may be divided into three\\nclasses hereditary, constitutional, and acquired.\\nAs children inherit other peculiarities of structure from father,\\nmother, grandparent, or even from more remote ancestors, so may irreg-\\nularities of the teeth be inherited. The causes are operative before the\\nbirth of the child.\\nHereditary causes may be divided into two (a) Direct, in which a\\nchild inherits some distinct irregularity just as he may inherit some\\nother distinctive feature. (6) Indirect, in which he inherits separate\\npeculiarities which combined will cause an irregularity. For example,\\nlarge teeth may be inherited from one parent and small jaws from the\\nother, and thus will be produced an irregularity of some kind, but not\\ninherited directly from either. A child may inherit tone of voice,\\npeculiar gait, or other habit so he may inherit a habit which will cause\\nan irregularity. The intermarriage of different races is a prolific cause\\nof irregularities of indirect heredity.\\nDr. Talbot 1 defines as constitutional irregularities those that\\ndevelop with the osseous system, such as those due to excessive devel-\\nopment or to lack of development of either the upper maxillary, inter-\\nmaxillary, or lower maxillary bones, or of the ramus or body of the\\nlatter too high vault, too narrow vault, etc.\\n1 Etiology joJ Osseous Deformities of Head, Jaws, and Face, 3d ed. p. 16.", "height": "4608", "width": "2816", "jp2-path": "americantextboo00kirk_0698.jp2"}, "699": {"fulltext": "ETIOLOGY OF DENTAL IRREGULARITIES. 691\\nA constitutional irregularity may be hereditary or may be due to\\nsome cause affecting the osseous system, such as lack of development\\nof the bones about the nasal cavity from lack of circulation of air\\nthrough this cavity and connecting sinuses, due to mouth-breathing.\\nThe result may be a high vault with a small and narrow arch, and\\nconsequent crowding and various irregularities of the teeth.\\nAn acquired irregularity may be due to\\n(a) Too long retention of deciduous teeth.\\n(6) Too early extraction or loss of deciduous teeth.\\n(c) Injudicious extraction or early loss of permanent teeth.\\n(d) Delayed eruption of permanent teeth.\\n(e) Pernicious habits (thumb-sucking, etc.).\\nThe presence of supernumerary teeth, etc. (See page 697.)\\nFig. 607.\\nLingual eruption of permanent incisors due to too long retention of deciduous incisors.\\nToo long retention of deciduous incisors may cause lingual eruption\\nof permanent incisors (see Fig. 607) or rotation of the same.\\nToo long retention of deciduous canines may cause either lingual\\neruption (Fig. 700) or labial eruption of permanent canines (608).\\nToo long retention of deciduous molars may cause a constricted arch\\n(Figs. 609 and 610; also page 785).\\n(a) Long Retention of Deciduous Teeth. A tooth may be deflected\\nfrom its normal position in erupting by the presence of a supernumerary\\nor deciduous tooth the root of which has not been absorbed. Death of\\nthe pulp of a deciduous tooth will prevent its normal or physiological\\nresorption. It may then be removed by a pathological process which\\nis much slower, or it may not be removed at all, but remain indefinitely,\\nor till removed by the forceps.\\n(6) Too Early Extraction of Deciduous Teeth. As Nature pro-\\nvides for the shedding of the deciduous teeth at the proper time, inter-\\nference by extraction should be avoided in all possible cases.\\nUnless the deciduous teeth are retained, the natural expansion of the", "height": "4540", "width": "2804", "jp2-path": "americantextboo00kirk_0699.jp2"}, "700": {"fulltext": "692 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFig. 608.\\nLabial eruption of permanent canines due to too long retention of deciduous canines.\\nFig. 609.\\nFigs. 609 and 610 Semi-constricted arch due to too long retention of deciduous molars.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0700.jp2"}, "701": {"fulltext": "ETIOLOGY OF DENTAL IRREGULARITIES. 693\\njaw by interstitial growth will be interrupted. When a deciduous tooth\\nis extracted, the contiguous teeth, whether deciduous or permanent,\\ntend to move toward each other and occupy the space which should be\\npreserved for the succeeding tooth.\\nBut one rule is needed, as follows Extract a deciduous tooth only\\nwhen it deflects its successor.\\nRules against Extraction of Deciduous Teeth. 1. Do not\\nextract a deciduous lettered to make room for a permanent central incisor.\\n2. Do not extract a deciduous canine to make room for a permanent\\nlettered incisor.\\nRequests for such extraction will often be made by the parent, to\\nwhom the explanation should be made that such extraction is liable to\\nprevent the natural growth of the jaw for the accommodation of the\\npermanent teeth also that, while the six anterior deciduous teeth are\\nreplaced by larger permanent ones, the four temporary molars in each\\njaw are replaced by the smaller bicuspids, and that when this takes\\nplace, irregularities of the incisors, especially the lower ones, will cor-\\nrect themselves, unless the teeth are too large for the jaw, which cannot\\nbe foretold with certainty at this age. Even if it could, no extraction\\nof deciduous teeth would be of benefit, but rather positive harm.\\n3. Do not extract a deciditous second molar till the first permanent\\nmolar is firmly fixed in place, and not then unless the second bicuspid\\nhas erupted or is about to erupt out of position.\\nRequests for extraction of deciduous molars are made on account\\nof cavities of decay, which should be filled and the teeth preserved for\\nservice in mastication.\\nThe only exception to these rules is in cases of incurable alveolar\\nabscess, which may endanger the alveolar border and the tooth forming\\nbeneath.\\n(c) Early Loss of Permanent Teeth. Irregularities may be due\\nalso to early loss or injudicious extraction of permanent teeth.\\nAn early loss of first permanent molars may cause upper or lower\\nprotrusion.\\nAn early loss of lateral incisors causes a narrowing of the anterior\\nportion of the arch and deprives the angles of the mouth of their\\nproper contour.\\nA loss of canines causes a depression of the angles of the mouth and\\nwing of the nose.\\n(r/) Delayed Eruption of Permanent Teeth. The delayed eruption\\nof any permanent tooth, after the loss of its deciduous predecessor, will\\nallow the teeth on each side of the space to move toward each other and\\nthus prevent eruption, or crowd the erupting tooth out of the line either\\nlabially or lingually.", "height": "4556", "width": "2788", "jp2-path": "americantextboo00kirk_0701.jp2"}, "702": {"fulltext": "694\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIt is often of the utmost importance to ascertain whether a tooth is\\ndelayed in eruption or is permanently absent. The tooth most likely\\nto be absent is the third molar. The one next most likely to be absent\\nis the lateral incisor, generally referred to as the missing lateral.\\nIn case the permanent laterals do not erupt at the proper time, the\\nquestion often arises with a crowded arch, whether to preserve space\\nfor them in hopes of their eruption, or to allow the other teeth to crowd\\nalong and occupy the space. Hitherto it was impossible to answer this\\nquestion, but lately science has come to our aid, and by the skiagraph\\nthe uncertainty can be made a certainty.\\nFig. 611.\\nFig. 612.\\nFigs. 611-614, and the following description 1 by Dr. J. N. M Dowell,\\nwill illustrate the subject of delayed eruption\\nFig. 613.\\nFig. 614.\\nFig. 611 shows the models of a boy eight years old. The space\\nfor the laterals is entirely closed up. The teeth in both the upper\\nand lower arches were regulated, making the necessary room for the\\nlaterals in the upper arch (see Fig. 612). This space was retained for\\ntwo years, and at the end of that time there was still no sign of the\\n1 Dr. J. N. M Dowell, Dental Cosmos, March 1900, vol. xlii. p. 237.", "height": "4612", "width": "2856", "jp2-path": "americantextboo00kirk_0702.jp2"}, "703": {"fulltext": "ETIOLOGY OF DENTAL IRREGULARITIES.\\n695\\nlaterals. Examination gave no indication of delayed teeth, but the\\nresult of the z-ray (Fig. 613) showed the laterals high up in the\\nprocess still only partly developed. It was several months later\\nbefore there were any indications of the laterals making their appear-\\nance. Fig. 61-4 shows the same case eight months after the s-ray was\\ntaken.\\nOftentimes the occlusion is sadly impaired by the non-eruption of\\na bicuspid impacted between contiguous teeth. The skiagraph Fig.\\n615 reveals the exact position of the delayed tooth and shows the im-\\nportance of making room for its eruption. Fig. 616 shows a second\\nbicuspid caught under the shoulder of a first bicuspid, and suggests that\\nit can be released by forcing the latter into an upright position.\\nThe exact position of a delayed canine may be revealed, and the\\nquestion settled whether it be possible for it to erupt without assistance,\\nor whether it can even be forcibly erupted.\\nFig. 615.\\nFig. 616.\\nIn some cases a deciduous tooth remains in place long after the time\\nwhen it should have fallen out. It may be so firm as to cause serious\\ndoubts about the advisability of extracting it, even though there is mal-\\nocclusion while it is in place. The skiagraph will reveal the presence\\nor absence of the bicuspid, and show whether extraction should be\\nresorted to or not.\\nThe method of making the skiagraph is thus described 1 by C.\\nEdmund Kells, D. D. S., of New Orleans\\nOne of the requirements in obtaining a skiagraph is that the object\\nto be pictured and the plate or film must be held perfectly still during\\nthe process. It is frequently possible to cut the film the proper shape,\\ninclose it in a black (light-proof) envelope, and allow the patient to\\nhold it in the mouth in the desired position but on general principles\\nthis is not satisfactory, more especially with children, as it is liable to be\\nmoved during the exposure.\\n1 Dental Cosmos, October 1899, vol. xli. p. 1014.", "height": "4532", "width": "2816", "jp2-path": "americantextboo00kirk_0703.jp2"}, "704": {"fulltext": "696 ORTHODONTIA AS AN OPERATIVE PROCEDURE\\nThe method now employed, after much experimenting in that line,\\nis as follows\\nA cast is made of the portion of the mouth to be skiagraphed,\\nand a small piece of modeling compound moulded over the crowns of\\nthe teeth thereon. A piece of aluminum (this metal being almost\\ntransparent to the rays) of about 26 or 28 gauge is cut to the desired\\nsize and shape and bent to fit the cast as well as possible. This is\\nslotted along the edge toward the crowns of the teeth, and thereby\\nattached to the modeling compound referred to above. This forms\\na convenient little film-holder, which when placed in the mouth will\\nallow the patient to close the teeth upon it, and thus hold it securely\\nin position, without danger of its moving, for a much longer time than\\nis necessary to take the picture.\\nThe next step is to cut the plate or celluloid film, whichever is to\\nbe used, to the proper size and envelop it neatly in black paper, gluing\\ndown all the edges with paste, and securing it to the plate-holder by\\ntwo or more small aluminum clamps.\\nThis is all that is usually necessary but if it is deemed advisable\\nto protect the envelope from moisture, as is sometimes the case, more\\nespecially for lower teeth, then it is covered with thin tin foil or\\nwaterproof paper neatly pasted down, care being taken not to have the\\nfoil (if that is used) doubled upon the side to be exposed. While this\\nmay appear to be a long process, it is quickly accomplished, and the\\ninvariably satisfactory results obtained warrant the trouble taken.\\nThe patient is then seated in a chair with a photographer s head-\\nrest to hold the head, the Tesla screen put in place, and the tube brought\\nto about ten or twelve inches from the face and placed so as to throw\\nthe best shadow of the parts upon the film. The length of exposure\\ndepends upon the thickness of the parts to be penetrated, the working\\ncondition of the apparatus, and the distance of the patient from the\\ntube, the time being proportional to the square of the distance. From\\nsixty to ninety seconds are necessary for ordinary cases, ranging perhaps\\nup to one hundred and twenty seconds for third molars and heavy jaws,\\nwhile twenty to forty seconds are sufficient for some favorable cases in\\nthinner bones.\\nIn some of the large cities skiagraphs can be readily obtained from\\nexperts with the Rontgen ray, who make it a business to accommodate\\nphysicians and others desiring their services. Any expert dentist with\\na slight knowledge of photography can readily prepare the film for the\\npurpose.\\n(e) Pernicious Habits. The habit of thumb-sucking may cause\\nupper protrusion (see Fig. 757), lack of anterior occlusion (Fig. 801),\\nor a constricted arch (Fig. 798).", "height": "4608", "width": "2832", "jp2-path": "americantextboo00kirk_0704.jp2"}, "705": {"fulltext": "ETIOLOGY OF DENTAL IRREGULARITIES. 697\\nThe habit of sucking the finger or lip may cause protrusion of either\\njaw according to the position of the finger or lip.\\nWhile thumb-sucking sometimes causes the irregularities mentioned,\\nit is not a frequent cause, and it is a singular fact that the habit does\\nnot cause irregularity of the deciduous teeth.\\nThe habit of mouth-breathing, whether owing to nasal obstructions\\nor not, may cause lack of anterior occlusion see (e), page 786 or\\napparent lower protrusion see (e), page 774.\\nOther Causes of Irregularity. Obstruction of the nasal cavity\\nby a deflected septum, enlarged turbinate bones, polypi, adenoid growths\\nin the nasopharynx, enlarged tonsils, or any other cause, by preventing\\nfree circulation of air through the nasal cavity, may be the cause of a\\nlack of development of the frontal, sphenoidal, ethmoidal, and maxil-\\nlary bones. This lack of development may produce a high and con-\\ntracted vault, with a narrow and small arch and consequent crowding\\nof the teeth into various irregularities.\\nLack of development of the intermaxillary bone may cause (a) a pointed\\narch (page 757), (6) lack of anterior occlusion (page 786), or (c) prom-\\ninent canines and depressed laterals see (a), page 745.\\nDisparity in size between the teeth and the jaw may be due to either\\nof two widely different causes, and yet produce several similar irreg-\\nularities.\\n(1) This disparity in size may be due to teeth too large for the jaw\\n(indirect heredity page 690).\\n(2) It may be due to premature loss of deciduous second molars and\\na forward movement of the permanent first molars, thus shortening the\\narch and making it too small for the ten teeth that are to occupy it.\\nThe result may be\\n(a) Prominent canines and depressed laterals (Class 7, page 745).\\n(b) Pointed arch (Class 8, page 757).\\n(c) Upper protrusion (Class 9, page 760).\\n(d) Constricted arch (Class 12, page 784).\\n(e) Lower protrusion (Class 10, page 773).\\nThe same condition in both jaws at once may cause similar irregu-\\nlarities in both jaws. One of the most notable of these is double pro-\\ntrusion (Class 11, page 782).\\nLoss of the deciduous second molar on one side may cause any of\\nthese irregularities on that side only, such as a semi-constricted or\\nsemi-pointed arch.\\nChanges in Surrounding Tissues when Teeth are Moved.\\n1. Resorption and Deposition. When a single tooth is moved in\\nany direction, there is first a compression of the soft and then of the hard\\ntissues in front of the tooth, and at the same time a stretching of the", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0705.jp2"}, "706": {"fulltext": "698 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nperidental membrane behind the tooth. This is succeeded by resorp-\\ntion of the hard tissues in front by osteoclasts and formation of new\\nbone by the osteoblasts behind the moving tooth.\\nThis latter action is much slower than the former, and depends on\\nthe tooth being held firmly in its advanced position. Any slight return\\nwill interfere with the formation of new tissue, and a tooth repeatedly\\nmoved forward and allowed repeatedly to recede will never become firm.\\nWhen a tooth is rotated in its socket, there must be a stretching\\nof the fibers of the peridental membrane. If the fibers had not con-\\nsiderable elasticity, those opposing the rotation of the teeth would be\\nruptured instead of stretched, and would not tend to twist the tooth\\nback to its old position. A tooth is sometimes forced back by the pres-\\nsure of adjoining teeth, but such contingencies are not here under con-\\nsideration. If the root is curved or is not round, there may be some\\nresorption and rebuilding of the walls of the alveolus.\\n2. Bending of the Alveolar Ridge. When several teeth are\\nmoved in the same direction at the same time there is a movement of\\nthe alveolar ridge as if it were a semi-plastic mass. This movement is\\neasily proved by the following observations\\nAfter a case of upper protrusion is reduced the labial portion of the\\nalveolar ridge appears no thicker than before. If the only movement\\nwere of the roots through the ridge by resorption in advance of the\\nmoving tooth and formation of new bone behind, the labial portion\\nwould remain as prominent as before.\\nIn spreading the arch rapidly, if movement took place only after\\nresorption, the teeth might be pushed out of the ridge, but the external\\nplates of the alveolar process will be found no thinner than before,\\nwhile the vault of the palate is perceptibly broadened.\\nDr. C. S. Case says that when teeth and roots are moved forward,\\nsometimes ridges will appear on the outer surface of the alveolar\\nprocess, but that the spaces or hollows between will soon fill up so as to\\npresent an even surface.\\n3. Separation of the Superior Maxillae at the Symphysis.\\nWhen strong pressure is applied upon molars and bicuspids to spread\\nthe arch the superior maxillae may be separated at the symphysis. (See\\nFigs. 617 and 618.)\\nSuch separation was first recorded by Dr. E. C. Angell of San Fran-\\ncisco 1 in 1885, and has been noticed by Guilford, Black, Talbot, Farrar,\\nOttolengui, and others since. Drs. Talbot 2 and Ottolengui 3 regard it\\nas an advantage as giving room for re-arranging crowded incisors more\\n1 Dental Cosmos, vol. ii. p. 540.\\n2 Discussion in World s Columbian Dental Congress, vol. ii. p. 722.\\n3 Dental Practitioner, vol. xxxv., No. 4, October 1894.", "height": "4604", "width": "2832", "jp2-path": "americantextboo00kirk_0706.jp2"}, "707": {"fulltext": "ETIOLOGY OF DENTAL IRREGULARITIES. 699\\nFig. 617.\\nSymphysis of superior inaxillee, before spreading arch.\\nquickly than in any other way and maintaining crowns and roots in an\\nupright position.\\nFig. 618.\\nSeparation of superior maxillae at symphysis, after spreading arch.\\n4. Depression of the Roots ix the Sockets. In reducing\\ncases of lack of anterior occlusion by means of elastics extending from\\na chinpiece to a cap to the top of the head, Prof. Guilford x says\\nThe condyles of the lower jaw will be tipped somewhat out of their\\ncavities, and the latter be partially filled up with new ossific material\\nat the same time the tendency will be to shorten the posterior occlud-\\ning teeth by forcing them farther into their sockets.\\nCharles S. Tomes 2 in a similar case questioned whether the closure\\nof the front teeth was effected by an elongation of the ascending\\nramus of the jaw or by the antagonizing teeth being depressed and, so\\nto speak, forced farther into their sockets, and concludes, I am\\ninclined to think the latter is the true explanation.\\n1 Orthodontia, 2d ed., p. 196. 2 Kingsley s Oral Deformities, p. 121.", "height": "4560", "width": "2764", "jp2-path": "americantextboo00kirk_0707.jp2"}, "708": {"fulltext": "700 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nPathological Conditions which may be Caused by\\nIrregularities of the Teeth.\\nUnder this head may be mentioned dental caries, gastric disorders,\\nand deposition of salivary calculus.\\nCaries. In the normal arch the teeth touch each other at one point\\nonly, and fluids are freely circulated between and about them by the\\ntongue, lips, and cheek. When the teeth are irregularly arranged broad\\nsurfaces often come in contact, the convex surface of one incisor may\\nbe partially imbedded in the concave surface of another, or three teeth\\narranged as in a triangle form between them a cul-de-sac. In all such\\ncases the maintenance of cleanliness is difficult if not impossible, and\\ncaries is the probable result.\\nDyspepsia. Any deviation from the normal arch will cause also\\na deviation from the normal occlusion, so that proper trituration of the\\nfood is interfered with if not positively prevented. Such lack of\\nthorough mastication will throw unusual burdens upon the digestive\\norgans, resulting in their greater or less derangement.\\nThe question of occlusion is exceedingly important, and often decides\\nthe method of treatment of an irregularity or of making room, or of\\nundertaking any treatment whatever.\\nIn most cases of complicated irregularity there is already mal-\\nocclusion of the masticating teeth, and every endeavor should be made\\nto move the teeth, so as to improve the occlusion and make it as nearly\\nnormal as possible.\\nWhen the occlusion is already normal and the irregularity is slight\\nbut cannot be reduced without seriously deranging one or both sides of\\nthe mouth, it may be best to permit the irregularity to remain, as the\\nleast of the two evils.\\nIn any case of widening or spreading, should either arch be made too\\nwide for the other, that also should be spread to restore or improve the\\nocclusion.\\nIf either arch be too small for the other, the sole object in spreading\\nmay be to improve the occlusion.\\nIf in any case room must be made by extraction, the most serious\\nconsideration must be given to the choice of the tooth or teeth whose\\nremoval will least derange the occlusion, if already good and if other-\\nwise, selection may be so made as to improve it.\\nThe tooth most often under discussion in this respect is the perma-\\nnent first molar. This is a very valuable tooth for mastication, and its\\nloss may render all the teeth on that side of the mouth useless for that\\nfunction. The teeth back of the space may tip forward and those ante-\\nrior to it may tip backward, so that they all present only points and", "height": "4580", "width": "2840", "jp2-path": "americantextboo00kirk_0708.jp2"}, "709": {"fulltext": "ACCIDENTS WHICH MAY HAPPEN DURING TREATMENT. 701\\ncusps to the cusps of opposing teeth, instead of the normal interlock-\\ning of cusps which gives the greatest efficiency.\\nThe question as to the extraction of a tooth will depend also on\\nits condition. In the writer s opinion it will be better in many cases\\nto crown the roots of a molar decayed too much for filling, and remove\\nsome other tooth that is less useful in mastication. (This question is\\nfurther discussed on page 745.)\\nSalivary Calculus. As the accumulation of salivary calculus is\\nimpossible upon parts of the teeth subjected to use in mastication or\\neasily cleansed with the brush, so any abnormality of arrangement that\\nprevents thorough use of the brush favors the deposit, with all of its\\npossible consequences.\\nAccidents which may Happen during Treatment.\\nDeath of the Pulp. This may occur from strangulation at the\\napical foramen from too rapid movement of the tooth. The possibility\\nof this accident is least when movement is begun while the apical fora-\\nmen is large, before the root is completely formed it increases with the\\nage of the patient, and is greatest after the root is fully formed and the\\nforamen is constricted to its permanent size.\\nDeath of the pulp may also occur from rupture of the bloodvessels\\nat the apex of the root from too rapid elevation of the tooth. The\\nliability of such accident will vary according to the age of the patient\\nand size of the apical foramen.\\nRupture of the Pericementum. This may occur also from too\\nrapid elevation of a tooth. After such an accident, a tooth returned\\nto its socket would be in the condition of a replanted tooth, subject\\nto the same chances of attachment and retention.\\nPermanent Enlargement of the Alveoli. Dr. Talbot says\\nThe probability of a perfectly satisfactory result in regulating\\ndecreases yearly after the age of puberty, and after the age of twenty-\\nsix the chances of a really satisfactory result are very meagre, for at\\nthis time the entire osseous system is fully developed and there is little\\nprobability of extensive deposit of ossific material.\\nThe writer would, however, fix the date later than that perhaps\\nat thirty years.\\nPressure at any age will cause resorption, therefore teeth may be\\nmoved in the case of adults, though more slowly on account of the greater\\nrigidity of the alveolar process. Greater force will be needed to produce\\nresorption in advance of the moving tooth, and there is a possibility,\\neven a probability, that no ossific deposit will take place behind the\\n1 Irregularities of the Teeth and their Treatment, 2d ed., p. 172.", "height": "4548", "width": "2764", "jp2-path": "americantextboo00kirk_0709.jp2"}, "710": {"fulltext": "702 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nroot. The result is an enlarged socket in which the tooth never again\\nbecomes rigid.\\nPermanent enlargement of the alveoli may occur also from not\\nretaining teeth fixedly in their new position but allowing them to move\\nback and forth. The action of the osteoblasts in forming new bone is\\nthus interfered with so much as to absolutely prevent it, and the result\\nis an enlarged alveolus.\\nInjury to the Enamel (Caries). This may occur from too long\\nretention of either regulating or retaining appliances in contact with\\nthe teeth.\\nBands that are to be retained more than a few weeks should be\\ncemented upon the teeth and carefully watched, as a loose band will\\nFig 619 surely result in a softening of the enamel under\\nit, sometimes even to the extent of forming a\\ncavity.\\nRetaining appliances should be so constructed\\nRound and flat contacts that no flat or broad surfaces remain in contact\\nin regulating fixtures. with the teeth. A round wire is as efficacious\\nas a flat bar, and the tooth under it is easily kept clean, as the point\\nof contact is so small. (See Fig. 619.)\\nAppliances, Materials, Methods, and Forces Employed.\\nDefinitions. To prevent repetitions a few appliances and materials\\nwill be briefly described.\\nRubber Band. A section cut from French rubber tubing from\\nto J of an inch in diameter and from -fa to -J- of an inch wide. (See\\nFig. 620.) These lose their elasticity by remaining stretched, and should\\nbe changed at least twice a week.\\nFig. 620.\\nIll\\nBicuspid. Molar.\\nRubber tubing for bands. Adjustable bands (Angle).\\nGauge. In indicating the thickness of plate and size of wire the\\nnumber referred to is that of B. S. gauge, e. g. wire No. 20, plate\\nNo. 27, etc.\\nTube or Tubing. Made of a strip of platinum-gold or German\\nsilver No. 27 to No. 32 gauge and J of an inch or less wide, drawn\\nthrough successive holes in a draw-plate until a tube is formed and\\nreduced to the desired size. (See Fig. 628.) To make a tube to fit any", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0710.jp2"}, "711": {"fulltext": "APPLIANCES, MATERIALS, METHODS, AND FORCES EMPLOYED. 703\\ndesired wire or screw, take a strip three and one-third times the diam-\\neter of the wire or screw.\\nMagill Band. The invention of Dr. W. E. Magill. A strip of\\nplatinum, gold plate, or German silver, No. 30 to 36 B. S. gauge,\\npreferably the latter, from to -J- of an inch wide,\\nbent around a tooth in the mouth or on a plaster cast, IG 622#\\nand soldered at the overlapping ends. This is cemented\\nto a tooth with zinc phosphate. (See Figs. 622, 647,\\net seq.)\\nAdjustable Band (Angle s). A band of German silver from\\nto of an inch wide and No. 36 B. S. gauge, to one end of which\\nis soldered a short tube and to the other a screw, which is passed\\nthrough the tube and tightened around the tooth with a nut. (See\\nFig. 621.) Cement should be placed inside the band before apply-\\ning it.\\nBand Ribbon. This is best made from platinum or German silver\\nwire No. 13, rolled to No. 34 or No. 36 plate. This is tougher than\\nwhen cut from plate of the same thickness. For the anterior teeth the\\nwriter often uses, however, gold-faced platinum rolled to the gauge\\nmentioned. It has the strength of platinum and the color of gold,\\nwhich is preferred by many patients.\\nTo this band may be soldered a tube, hook, screw, or any appliance\\ndesired.\\nJack-screw (Angle s). A tube pointed at one end, in which is\\ninserted a screw about No. 16 B. S. gauge,\\nFig. 623.\\nwith a nut resting on the open end of the tube.\\nThe end of the screw is flattened or bifur-\\nAngles jack-screw.\\ncated. The length of the tube determines\\nthe length of the jack-screw. (See Figs. 623 and 643.)\\nDrag-screw (Angle s). A wire\\nbent at right angles at one end,\\nthreaded at the other with a nut. (See\\nFig. 624.)\\nPiano Wire. Piano strings. Steel\\nAngle s drag-screw.\\nwire, elastic, yet soft enough to bend\\neasily with pliers, from No. 20 to No. 24 B. S. gauge used for\\nsprings and elastic levers. (No. 20 B. S. gauge corresponds to\\nabout No. 15 of piano wire gauge.)\\nLigatures. Floss silk well waxed.\\nTwisted Ligatures.\u00e2\u0080\u0094 Twisted silk No. A or 00 or linen thread\\nunbleached No. 50, well waxed.\\nThese are very useful in moving teeth, either ligated directly on the\\nteeth or in connection with other appliances. When tied tightly from", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0711.jp2"}, "712": {"fulltext": "704\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\none tooth to another there is an immediate movement by slight com-\\npression of the peridental membrane then as the twisted fibers swell\\nthe ligature is shortened and more pressure exerted.\\nIt is to be understood that in the majority of illustrations in this\\nchapter in which rubber bands are shown as the moving force, ligatures\\nmay be substituted. They should be renewed every day or two.\\nTwisted wiee ligatures of platinum, copper, brass, or German\\nsilver wire are excellent for intermittent movement of teeth. Dr. Angle\\nsuggests No. 28 B. S. gauge as the best size (Figs. 726 and 727).\\nNorton-Talbot or Coil Spring. A spring of piano wire No.\\n20 to No. 24 B. S. gauge coiled upon itself one or more times.\\nFig. 625.\\nTalbot springs.\\nThe best size of coil is that made around a piece of the same wire.\\n(See Figs. 625, 741, and 742.)\\nMatteson Spring. A spring of piano wire No. 20 to No. 24 B.\\nS. gauge, with two coils a half-inch or more apart. (See Figs. 626, 651,\\nand 744.)\\nFig. 626.\\nFig. 627.\\nFig. 628.\\nf~\\\\\\nMatteson spring.\\nSwaged caps.\\nMetallic tubing.\\nCement. Zinc phosphate is more adhesive than oxychlorid of zinc\\nit should be mixed thin and applied to the tooth and band or cap.\\nEubber dam should, if possible, be applied to the teeth before using\\nthe cement.\\nSwaged Caps (Matteson s). Caps swaged to fit over the whole\\nor part of a tooth and secured with cement. To these caps are soldered\\nhooks, bars, tubes, levers, etc. (See Fig. 627.)", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0712.jp2"}, "713": {"fulltext": "APPLIANCES, MATERIALS, METHODS, AND FORCES EMPLOYED. 705\\nLock-nut. A second nut screwed up against the first neces-\\nsary in some cases to prevent retrograde action by the patient s\\ntongue.\\nLabial Bow. A bow of stiff wire, German silver, or clasp gold,\\nabout No. 16 B. S. gauge, extending from the buccal surface of the\\nteeth on one side of the mouth around the arch to a corresponding posi-\\ntion on the other side. It may be held in place by inserting the ends\\nin a plate (Fig. 711) or in tubes soldered to bands cemented on suitable\\nteeth (Figs. 713, 729, 759). The ends of the bow may be screw-cut\\nand furnished with nuts, as shown in these figures, or bent in bayonet-\\nshape (Fig. 741).\\nLingual Bow. A similar bow on the lingual surface of the arch,\\nwith the ends inserted in tubes on the lingual surface of bicuspid or\\nmolar bands, screw-cut with nuts (as in Fig. 715 or 716) or bent into\\nhooks (as in Fig. 667).\\nLabial and lingual bows are often used advantageously together\\nand attached to the same teeth, as in Fig. 669 or 713.\\nAuthor s Partly- made Appliances. Fig. 629 shows the writer s\\nsystem of partly-made appliances. Each consists of a piece of band-\\nFig. 029.\\nG H\\nPartly-made appliances.\\nribbon bent into an open loop. To each is soldered a tube, hori-\\nzontal or crosswise, round or flat, or a wire, in line or at right angles.\\nThese can be made by the practitioner in leisure moments, and kept\\nin stock. When a patient is in the chair, one of the open bands can\\nbe bent around any tooth, with the tube or wire in any position de-\\nsired. The open ends can then be drawn tightly around the tooth\\nand the sides burnished to fit accurately. Remove the band, cut the\\n45", "height": "4556", "width": "2796", "jp2-path": "americantextboo00kirk_0713.jp2"}, "714": {"fulltext": "706\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nends as shown in Fig. 630, A, bend one over the other, as in b,\\npinch them tightly together, so as to hold while soldering. Grasp the\\nband with the pliers as shown in Fig. 631, and apply solder and\\nheat to the inside of the joint. The pliers will protect the tube or\\nFig. 630.\\nA, Band fitted B, ready for soldering.\\nwire from unsoldering. The surplus ends can then be cut away, as in\\nmaking a plain band. E, in Fig. 629, shows two open bands soldered\\nto a long tube for making a double anchorage appliance, such as\\nshown in Fig. 730. D has a flat tube, which may be used as in Fig.\\nFig. 631.\\nSoldering joint in open band.\\n739. F will make a retainer, like Fig. 653 or 677, while G and H\\ncan be bent into hooks for various purposes.\\nThe writer finds these partly-made appliances a great saving of\\ntime, as a great variety of complete appliances can be made from them\\nwhile the patient is in the chair.\\nFigs. 745 and 746 show how an expander can be made in a similar\\nmanner.\\nForce. Constant Force That exerted by compressed rubber\\nor a spring of clasp gold or piano wire.\\nIntermittent Force That exerted by a screw, which allows\\nperiods of rest after each application also that exerted by compressed\\nwood or twisted ligatures of silk or linen.", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0714.jp2"}, "715": {"fulltext": "APPLIANCES, MATERIALS, METHODS, AND FORCES EMPLOYED. 707\\nMethods. Xo one method is applicable to all cases, so that it is\\nnecessary to select from various methods the simplest and most efficient\\nfor treating each kind of irregularity. During the last twenty years\\nthere have been presented by specialists in orthodontia many different\\nplans of regulating. These are known as their special methods aud\\nare designated by the names of their originators.\\nThe first extensive description of regulating appliances was that\\nby Dr. Norman ^Y. Kfngsley, in his book on Oral Deformities,\\nin 1880. Most of the appliances described in his book were taken\\nfrom original articles previously written by him for dental jour-\\nnals, while a number were selected from articles by other well-known\\nwriters.\\nThe first to claim a distinct method or system was De. J. N. Fa rear\\nin articles published about 1875, and further elucidated in book form\\nin 1888. His system is based upon the adoption of the screw as a\\nmotive force. The originator claims the screw to be the only force\\nwhich should be used, because it is intermittent and gives the parts a\\nperiod of rest after each application. Very ingenious devices have been\\ninvented by him by which the screw is applied successfully to all kinds\\nof movement, but as a rule his appliances are more complicated than\\nthose of any other system.\\nThe Coffin method was introduced at the International Medical\\nCongress in London, in 1881, by Walter H. Coffin. The elasticity of\\nCoffin split plate for spreading the upper arch.\\npiano wire is used as a motive force, by anchoring it in vulcanite plates.\\nThe most notable example of this method is the Coffin split plate for\\nspreading the arch. (See Figs. 632, 633, and 634.)\\nThe Angle method depends chiefly on the screw for force, though\\npiano wire and twisted wire ligatures are also used.\\nDr. Angle was the first to advocate extensive use of German silver\\nfor regulating appliances. The advantages of this alloy are such that\\nit now is more largely employed than any other material.", "height": "4556", "width": "2776", "jp2-path": "americantextboo00kirk_0715.jp2"}, "716": {"fulltext": "708\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nA new application of force has been lately introduced, viz. the\\nelongation of wire by pinching or compressing it with special round\\nFig. 633.\\nFro. 634.\\nCoffin spring plate for lower arch.\\nCoffin spring plate for single teeth.\\npliers, shown in Fig. 676. This may be used in many places instead\\nof the jack-screw.\\nThe construction of jack-screws and drag-screws has been greatly\\nsimplified. Thin soldered bands are cemented to the teeth, or anchor\\nbands, the ends of which are united by screw and nut. To these\\nbands tubes are soldered for the attachment of appliances which are so\\nconstructed that force once applied need not be withdrawn till the en-\\ntire movement is accomplished. A rest may be allowed, but no back-\\nward movement. Thus no interference is made with building up the\\ntissues behind the tooth.\\nAppliances, complete or in parts, to be adapted to special cases have\\nbeen put on the market by Prof. Angle. These more nearly fill the\\nwant of one who cannot make all his appliances.\\nDr. V. H. Jackson s method consists in the use of piano wire or\\nother elastic wire for force and the attachment of the wire to the teeth,\\nin most cases, by means of a crib made of the wire itself, and not\\nby means of bands or plates.\\nFor full descriptions of these methods the student is referred to the\\nwritings of the authors themselves. 1\\nGeneral Directions.\\nAll metallic bands which are to remain in contact with the teeth for\\nany length of time should be cemented to them with zinc phosphate, to\\nprevent deleterious action of acids of fermentation which would be gen-\\nerated and retained between bands and teeth. The rubber dam should\\nbe applied whenever possible to the tooth to be banded, and to one or\\n2 In the American Text-Book of Prosthetic Dentistry, edited by Dr. Charles J. Essig,\\nwill be found a chapter on Orthodontia Technic, by the writer, in which the making\\nof regulating appliances is described much more fully than is possible here.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0716.jp2"}, "717": {"fulltext": "GENERAL DIRECTIONS. 709\\nmore teeth on each side. In some cases it may be applied to fourteen\\nteeth at once. The teeth should be thoroughly dried and cleaned the\\ncement mixed thin is applied to the tooth and to the inside of the band,\\nand the latter is pushed or malleted firmly to place. The teeth should\\nbe kept dry for ten minutes or longer after the cement is applied. If\\nthis is not possible, where napkins are used, varnish or melted paraffin\\nmay be applied over the cement at the edges of the band for the pur-\\npose of excluding moisture as long as possible. Bands may be fast-\\nened in a similar way by chloro-percha.\\nDuring the time of regulating and while retaining appliances are in\\nposition, bands should be examined frequently. If one becomes loose\\nit should be removed, and cemented on again.\\nThe patient should keep a brush at the office for use when appli-\\nances are removed, and the appliances should be very carefully cleansed\\nby the operator before they are replaced. When plates are used espe-\\ncial care should be taken.\\nDuring the time that immovable appliances are worn, the patient\\nshould be provided with a bulb syringe with which dilute listerine or\\nother antiseptic mouth-wash can be thoroughly applied under bars,\\nscrews, springs, etc., or wherever the brush cannot reach.\\nTeeth should generally be moved a little farther than the desired\\nposition, because there is almost always a slight return of the tooth\\ntoward its old position after the retaining appliance is removed. This\\nretrograde movement is less likely to occur with canines when room has\\nbeen made by extraction.\\nThe age at tchich correction should be begun depends on the presence\\nof sufficient teeth for anchorage. It should be commenced as soon as\\nappliances can be used to advantage.\\nThe writer believes in early correction, in some cases as early as the\\nage of seven years. The advantage of early correction is that the\\nalveolar process is less rigid and the alveoli larger than when the child\\nis older, and hence less resistance is offered. At the age mentioned the\\ndeciduous molars are firm, and in some cases remain so until the child is\\nten or twelve years of age. (Seepage 712 and following pages for cases\\nthat demand early treatment.) At an early age new tissue is built up\\naround the tooth more quickly, as the osteoblasts are in a more active\\ncondition; hence retaining appliances need not be worn so long.\\nTeeth tend to move into their proper positions if room is made for them.\\nThis seems especially true of the canines. In many cases after extrac-\\ntion of a first bicuspid the canine will move to its place without assist-\\nance. (See Figs. 723 and 724.)\\nSufficient explanation should be made to the child to overcome any\\ndread or fear which may have been engendered.", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0717.jp2"}, "718": {"fulltext": "710\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nThe parent or guardian should see that the child follows the opera-\\ntor s directions carefully, and should be given instructions as to the\\ncourse to pursue in case any appliances become dislodged. When screws\\nare used an intelligent parent or guardian may assist by turning them\\naccording to instructions. If the patient is old enough, and desirous of\\naiding, he may be intrusted with such duties. Screws or nuts should be\\ngiven about half a turn twice a day.\\nRubber bands should be renewed at least twice a week. Piano-wire\\nsprings should have their force renewed by bending (or straightening),\\nabout twice a week.\\nSilk or linen ligatures should be renewed daily or at least every\\nother day. They should be well waxed, as then they are applied more\\nreadily. Moisture soon penetrates the wax and swells the fibers, pro-\\nducing pressure in the direction intended.\\nWire ligatures should be twisted daily (Figs. 726 and 727).\\nThe amount of force which may be used will vary with individuals.\\nWhen a new appliance is used, no force should be applied for a few\\ndays, till the patient becomes accustomed to the apparatus, then slight\\nforce may be applied, and increased after a few days, but in no case\\nshould excessive force be used. That is, in no case should force be used\\nstrong enough to cause continued pain or loss of sleep, nor should it\\nmake the teeth tender enough to prevent mastication.\\nImpressions should be taken of the teeth of both jaws in all but very\\nFig. 635.\\nAngle s impression tray.\\nsimple cases. Trays with high sides and flat floor should be used.\\nThose designed by Prof. Angle are especially adapted to the purpose\\n(Figs. 635 and 636).\\nModeling compound is best adapted for impressions of most\\ncases. It should be placed in cold water and slowly heated in order to", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0718.jp2"}, "719": {"fulltext": "GENERAL DIRECTIONS. 711\\nsoften it uniformly. It should not be used hot enough to be painful to\\nthe patient. Warm the tray before filling it so that the impression\\nmaterial may adhere to it when it is removed from the mouth. When\\nthe compound has been placed in the mouth and pressed against the\\nteeth, draw the lip over the edge of the tray, and press on the lip so as\\nFig. 636.\\nAngle s impression tray.\\nto force the material as far up on the ridge as possible, thus obtaining\\nan impression of the alveolar Avails.\\nSpecial cases may need the more absolute accuracy of plaster-of-\\nParis, but such cases are rare.\\nAvoid an excess of material in the palatal portion of the tray, as the\\nsurplus pressed backward is apt to drag at the necks of bicuspids and\\nmolars. When the material has been pressed into correct position,\\napply cold water with a syringe to the tray and under the lip and\\ncheeks till the material is hard.\\nCasts made from these impressions should be articulated either with\\nwire hinges or by extending the rear portions, and preserved for fre-\\nquent examination. If the casts are held together by a plaster articu-\\nlator, 7 it should be open in the rear, so that the lingual surfaces and\\ncusps of the teeth can be examined while the teeth occlude. An extra\\ncast will often be needed, on which to make appliances. During treat-\\nment, casts should be made at interesting stages to record progress.\\nBefore deciding upon treatment study the case in action and repose\\nobserve the movements of the lips in speaking and laughing notice\\nhow much the gums are disclosed, if at all, or with what difficulty the\\nteeth are covered by the lips. Study the profile. If the irregularity", "height": "4544", "width": "2780", "jp2-path": "americantextboo00kirk_0719.jp2"}, "720": {"fulltext": "712 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\naffect the contour of the lips, have a photograph taken which will show\\nthe profile, or take impressions of the lips, nose, and chin, or of the\\nwhole face, with plaster.\\nStudy the casts also before deciding on the treatment or appliances.\\nIn some cases make an extra cast, cut off the malposed teeth with a\\nthin saw and re-arrange them in normal relationship. Much may be\\nlearned by such means.\\nClassification of Irregularities.\\nAberrations from the normal arch are almost numberless, and almost\\nevery writer adopts a different nomenclature to express the malpositions\\nthat he wishes to describe.\\nIn speaking of single teeth, it seems the best plan to describe their\\npositions in relation to the normal curve or arch (Fig. 599) or the lines\\nof normal eruption (Fig. 600). Thus, a tooth erupted within the normal\\narch is well described by the term lingual eruption, or as a tooth erupted\\nlingually. A tooth erupted outside the normal arch is well described by\\nthe term labial eruption, or as a tooth erupted labially. A tooth in the\\nnormal line, but turned on its own axis, is rotated.\\nFor convenience in description, irregularities are here arranged in\\nfifteen classes. The first six have reference to single teeth, and nearly\\nall the rest to the arches as a whole in relation to each other and to the\\ncontour and profile of the face.\\n1. Lingual eruption A tooth erupted lingually.\\n2. Labial eruption A tooth erupted labially.\\n3. A tooth rotated.\\n4. A tooth extruded.\\n5. A tooth partially erupted.\\n6. Several teeth in any or all of these positions.\\n7. Prominent canines and depressed laterals.\\n8. Pointed arch. (V-shaped.)\\n9. Upper protrusion.\\n10. Lower protrusion.\\n11. Double protrusion.\\n12. Constricted arch. (Saddle-shaped.)\\n13. Lack of anterior occlusion.\\n14. Excessive overbite.\\n15. Separation in the median line.\\nClass 1. Lingual Eruption A Tooth Erupted Lingually. The\\noperations and appliances presented for the first four classes are for single\\nteeth, but they will apply in most cases to two or more teeth in the same\\nmalposition. In Class 6, appliances will be described which are better\\nsuited to several teeth than to single ones.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0720.jp2"}, "721": {"fulltext": "LINGUAL ERUPTION.\\n713\\nThe earliest cases requiring treatment are of Class 1, and often pre-\\nsent as early as the age of six or seven years, and before the tooth has\\nfully erupted. If an upper central has erupted inside the normal line\\nso as to bite inside of the line of the lower incisors when it is not more\\nthan half erupted, the case demands immediate treatment, because the\\nfarther the tooth erupts the greater will be its malposition, for it\\noccludes on the inclined plane formed by the lingual surface of the\\nlower incisor.\\nOne of the oldest appliances for moving a tooth forward or outward\\nconsists of a vulcanite plate with a piece of soft rubber or compressed\\nwood attached to the edge so that it will press upon the malposed\\nFig. 637.\\nFig. 638.\\nPlate with box, a b, rubber or compressed\\nwood in box.\\nRubber tied on a plate\\ntooth. The plate may be ligated firmly to the deciduous molars. The\\nsoft rubber may be held in a box cut in the edge of the plate (Fig.\\nFig. 639.\\nPlate with gutta-percha extension.\\n637), and increased in thickness as the tooth advances, or a piece about\\n^g of an inch thick may be ligated to the edge by silk passing through\\nholes near by (Fig. 638). As the tooth moves forward the plate may", "height": "4552", "width": "2776", "jp2-path": "americantextboo00kirk_0721.jp2"}, "722": {"fulltext": "714\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFig. 640.\\nbe built out at this point by gutta-percha filled into a box cut in the\\nedge and pressed against the tooth while still soft. The rubber may be\\nligated on the outer edge of the gutta-percha, which may be increased\\nin amount at each visit (Fig. 639).\\nThe inclined plane, as illustrated in Fig. 640, may be made in\\nvarious forms. It is one of the oldest forms of\\nregulating appliances, and one of the most inef-\\nficient. It depends for its success wholly on the\\nco-operation of the patient. With young patients\\nits use is not as successful as with older. The\\nprinciple is, that biting on the inclined plane\\nslides the tooth forward, but soon the biting produces inflammation in\\nthe pericemental membrane, a soreness of the tooth as popularly\\nexpressed, when every bite causes pain and the patient naturally refrains\\nfrom biting. It is efficient only with older patients who exhibit a de-\\ntermination to help the operation. The most efficient appliance is one\\nwhich does not depend on the will of the patient for its action.\\nFig. 641 shows a very efficient appliance used by Dr. Mattesom\\nFig. 641.\\nInclined plane.\\nTube, band, and spring appliance (Matteson).\\nWith young patients he prefers to band the first deciduous and first\\npermanent molars, and joining these bands by a connecting strip on the\\nbuccal surface and a piece of metal tubing closed at one end on the\\npalatal surface. A piece of piano wire is inserted in the tube and the\\nfree end allowed to press against the tooth to be moved. It is best kept\\nin place by a band cemented on the tooth with a lug or half-section of\\ntubing soldered to its lingual surface.\\nIf the band is made as recommended by Prof. Angle, by drawing\\nthe band material around the tooth with a pair of pliers and soldering\\ntogether the projecting ends, this projecting portion may be left long\\nenough so that a notch may be cut in it for the piano wire to rest in.\\nIn many cases of the age under consideration the second deciduous\\nmolar alone will be firm enough to be banded for anchorage. With", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0722.jp2"}, "723": {"fulltext": "LINGUAL ERUPTION.\\n715\\nan older patient whose teeth are more firmly set, a bicuspid or first\\nmolar alone will often be sufficient\\nfor anchorage. Fig. 642.\\nFor short teeth, such as decidu-\\nous molars or partially erupted\\nbicuspids or molars, Dr. Matte-\\nson uses swaged caps, made with\\nMellotte s moldine and fusible\\nallov, so as to fit over the whole\\ncrown and be cemented in place.\\nTwo or more teeth may be in-\\ncluded in one cap, and tubes may\\nbe soldered on either side for the\\nattachment of springs, etc. (See\\nFig. 627.)\\nA similar use of the piano-wire spring, but retained by the Jack-\\nson crib, is shown in Fig. 642. Fig. 647 shows a different form of\\ncrib. Both Matteson s and Jackson s appliances are applicable to any\\nof the six anterior teeth.\\nA jack-screw with the flattened end resting in a slot in a band\\ncemented on the tooth to be moved and the other end soldered to a\\nCrib and band (Jackson).\\nFig. 643.\\nAngle s jack-screw.\\nband on a second bicuspid or first molar for anchorage, or resting in a\\nsocket in said band, is very efficient for moving a tooth outward, but is\\nmore applicable to laterals and canines than centrals. (See Fig. 643.)\\nAnother plan of retention of the anchor end of the jack-screw is to\\nslip the open end of the tube over a pin or lug projecting from the", "height": "4556", "width": "2768", "jp2-path": "americantextboo00kirk_0723.jp2"}, "724": {"fulltext": "716\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nmolar band. The lug may be easily made by properly shaping the\\nprojecting ends left after soldering the band. The teeth selected\\nfor anchorage should be as nearly as possible in line with the move-\\nment desired, and it is best in many cases to solder a bar on the lingual\\nsurface of the anchor band, so that it will rest on contiguous teeth and\\nthus increase the power of resistance.\\nalbot s spring with bands.\\nFig. 644 shows Dr. Talbot s coiled spring, with one end inserted in\\na small socket soldered to an anchor band on a molar and the other in\\na socket on a band on the lateral. If the bands are thickened on one\\nFig. 645.\\nPlate and coil spring for moving canine.\\nside, holes may be punched for the reception of the ends of the spring.\\nPiano wire may be anchored in a plate so as to force a tooth outward.\\n(See Fig. 634.)\\nIn some cases the lower incisors impinge so closely upon the necks\\nof the upper as to leave no room for appliances unless the bite is\\nopened, which is seldom necessary.", "height": "4580", "width": "2824", "jp2-path": "americantextboo00kirk_0724.jp2"}, "725": {"fulltext": "LINGUAL ERUPTION.\\nIll\\nPlate Axchorage. The canine is such a difficult tooth to move\\nthat very firm anchorage is necessary. A plate constructed so as to\\ncover the crowns of the bicuspids and molars will anchor all the\\nteeth together and give plenty of resistance to a spring inserted as\\nin Fig. 645 and pressing against the tooth to be moved. The end\\nof the spring may rest in a hole or socket in a band cemented to\\nthe tooth.\\nFig. 646 shows an appliance operating outside the arch. A band\\nFig. 646.\\nWriter s appliance, close bite baud and outside spring.\\ncemented on the first molar with a tube on its buccal surface forms the\\nanchorage. In this tube is inserted a piano wire, which is bent to con-\\nform to the arch of the teeth and its free end inserted in a tube or hook\\non the labial surface of a band cemented on the tooth to be moved.\\nIt may be applied to any of the six anterior teeth. If applied to a\\ncentral or lateral the wire may rest on the cuspid as a fulcrum, which\\ngives it greater power.\\nThe Jackson crib may be used for anchorage instead of the band\\nand tube, as shown in Fig. 647.\\nA bicuspid is easily moved out into line by the appliance shown in\\nFig. 648. The screw, which passes through a bar about of an inch\\nwide, soldered to a band on a convenient tooth, may be cut off as the\\ntooth is moved out. The same appliance may be used as a retainer.\\nThe appliance shown in Fig. 649 is highly recommended by Dr.\\nTalbot, and described by him as follows It is made of German silver,\\nwhich possesses all the requisite qualities. He has three thicknesses of\\nit ready for use, Nos. 29, 31, and 32, U. S. gauge. Strips are cut to\\nof an inch wide accordingly as strength is required, and bent with\\nsmall round-nosed pliers into the shape represented at a to fit the teeth.\\nThis is removed every day and with round-nosed pliers the ends are", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0725.jp2"}, "726": {"fulltext": "718 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nbent, and the spring shortened and forced to place upon the teeth. The\\nFig. 647.\\nFig. 648.\\nCrib, spring, and band (Jackson).\\nBar, band, and screw.\\nlittle spring acts in two directions first, to carry the teeth laterally\\nand thus provide room secondly, to draw the irregular teeth into\\nposition. In the hands of the writer this has been a very efficient\\nappliance.\\nFig. 649.\\nGerman-silver spring (Talbot).\\nMaking Room. If the adjacent teeth overlap the one out of posi-\\ntion it is best to make room before attempting to move it, because it\\ncannot advance until room is made for it, and force spent on it will be\\nof no avail unless the tooth acts as a wedge to force the others apart.\\nA piece of compressed wood, one of the oldest forces used in ortho-\\ndontia, can be used in many cases as shown at a, Fig. 650. Cut a piece\\nof wood about a third larger than the space, compress it with pliers or\\nthe vise; and insert it with the grain parallel to the axis of the teeth.\\nIf the sides are made slightly concave, it will hold in place better. As\\nthe wood absorbs moisture it will swell and press the teeth apart.", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0726.jp2"}, "727": {"fulltext": "LINGUAL ERUPTION.\\n719\\nA better method of gaining room is to cement bands on the two\\nadjacent teeth with tubes on the labial surfaces. In these tubes insert\\na Matteson spring, as shown in Fig. 651. As soon as sufficient room\\nFig. 651.\\nlljuky^\\nCompressed wood fur making room.\\nMatteson spring applied to bands.\\nis gained, a straight wire may be inserted in the tubes across the space.\\nA rubber band stretched over the malposed tooth from this wire will\\nsoon move it into place.\\nFig. 652 shows a very satisfactory modification of the above appli-\\nance, using intermittent force instead of constant. A screw with two\\nFig. 652.\\nWriter s appliance for making room and moving tooth out.\\nnuts on it, or one collar and one nut, is inserted in the tubes, and the\\nnuts screwed against the tubes. If one of the nuts is turned two or\\nthree times a day, the teeth will soon be moved apart. The nuts will\\nhold the teeth apart while a rubber band or ligature passed over the\\nscrew and the malposed tooth will soon draw it forward, or if the rubber\\nband is applied while the contiguous teeth are being spread apart, the\\ntooth will move forward as room is made for it.\\nRetainer. The best retainer for a single tooth moved forward\\nconsists of a Magill band with a round wire soldered on its labial sur-\\nface. (See Fig. 653.) A round wire is better than a flat bar, because", "height": "4572", "width": "2788", "jp2-path": "americantextboo00kirk_0727.jp2"}, "728": {"fulltext": "720\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nit rests on the tooth at one point only and there is less liability of food\\nlodging under it, as illustrated in Fig. 654.\\nFig. 653.\\nFig. 654.\\nWriter s retainer band and round\\nwire.\\nRound and flat contacts\\nin regulating fixtures.\\nWhen a band is to be used as part of an appliance for moving a\\ntooth into place, as in Fig. 643, a tube can be soldered to its anterior\\nFig. 655.\\nProviding in advance for retention (Angle)\\nsurface. After the tooth is moved into position this same band may\\nbe used as a retainer by passing a wire through the tube so that its\\nFig. 656.\\nFig. 657.\\nAngle s retainer.\\nTalbot s retainer.\\nends will rest on adjacent teeth. This wire can be fastened in the tube\\nwith cement. (See Figs. 655, 656, and 657.)\\nClass 2. Labial Eruption A Tooth Erupted Labially. The sim-\\nplest method of moving such a tooth backward is by a rubber band or\\nligature looped over one tooth on each side of the prominent one, and\\npassing over its labial surface. (See Fig. 658.) Although this is effec-\\ntive in simple cases there is the theoretical objection that the rubber\\nband or ligature tends to draw the contiguous teeth toward the promi-", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0728.jp2"}, "729": {"fulltext": "LABIAL ERUPTION.\\n721\\nnent one and thus to impede the very movement desired. One practical\\nobjection is that the rubber band tends to rotate the teeth over which\\nit is looped. The rubber band may be ligated to the second tooth on\\neach side and passed under the first.\\nFig. 658.\\nRubber band and ligature.\\nThe next simplest method is the strip of elastic German silver as\\ndescribed by Dr. Talbot just the reverse of that shown in Fig. 649.\\nOne of the oldest appliances and an excellent one is shown in Fig.\\n659. It consists of a plate fitting the roof of the mouth, held by atmos-\\npheric pressure in contact with the lingual surfaces of the teeth except\\nwith that of the prominent one. A rubber band stretched over this\\ntooth is attached to the plate at some point directly in line with the\\nmovement desired, and far enough from the tooth to give the desired\\namount of force. For attachment a hook may be vulcanized, or a hole\\ndrilled in the plate at an acute angle, and a wooden peg inserted, which\\nis kept tight by swelling. Another simple way to attach the rubber\\nband is to drill two holes through the plate and tie with thread. This\\n46", "height": "4564", "width": "2736", "jp2-path": "americantextboo00kirk_0729.jp2"}, "730": {"fulltext": "722\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nhas one advantage, that the patient may be allowed to remove the plate\\nfor cleansing without danger of losing the rubber band.\\nIf the adjacent teeth need to be moved apart to make room, the\\nrubber band may be fastened to the\\nplate at two points, as shown by the\\ndotted lines in Fig. 659, or farther\\napart, so as to press laterally as\\nwell as backward.\\nThe plate may be ligated to teeth\\non each side of the mouth to hold it\\nmore securely, and a silk or linen\\nligature may be substituted for the\\nrubber band.\\nFig. 660 shows Dr. Talbot s plan of gaining room by means of a\\ncoiled spring with the ends resting on the teeth to be spread apart.\\nThe plate may be dispensed with by cementing a band, to which a\\nhook has been soldered, on some tooth in line with the movement de-\\nsired, and stretching a rubber band from the prominent tooth over this\\nhook. The anchorage may be increased by a wire or bar soldered to the\\noutside of the band so as to rest on contiguous teeth. (See Fig. 661.)\\nFig. 661.\\nTalbot s spring with bands, for making room.\\nBand and bar for anchorage; rubber band for drawing tooth in (Guilford).\\nIn order to apply the force in the proper direction in moving a cen-\\ntral incisor, it may be necessary to use a tooth on each side of the mouth\\nfor anchorage, in which case it is better to extend a rubber band from\\neach anchor tooth to a hook on the lingual surface of a band on the\\ncentral. (See Fig. 662.)\\nThe occlusion may be such that the cutting edges of the lower in-\\ncisors nearly or quite touch the necks of the upper or the gum, and\\nthus prevent the use of any appliance on the lingual surfaces of the\\nteeth without opening the bite, which it is best to avoid if possible. In\\nsuch cases (see Fig. 663) cement a band on a bicuspid or first molar on", "height": "4580", "width": "2828", "jp2-path": "americantextboo00kirk_0730.jp2"}, "731": {"fulltext": "LABIAL ERUPTION.\\n723\\neach side, with a tube on the buccal surface. Through these tubes\\naround the arch, and in contact with the prominent tooth, extend a\\nFig. 662.\\nDouble anchorage for elastic traction.\\nlabial bow of stiff wire, No. 16 B. S. gauge, screw-cut at the ends.\\nPlace nuts on the ends of the bow spring behind the tubes. By turn-\\nFig. 663.\\nLabial bow for drawing tooth in.\\ning the nuts pressure is brought to bear on the prominent tooth. To\\nprevent the wire sliding on the surface of the tooth, cement on it a\\nband on which is soldered a lug or a half-section of tubing in which\\nthe wire can rest or use Angle s notched band. (See Fig. 771.) If\\nelastic wire, such as platinum-gold or German-silver wire, drawn hard,\\nis used, constant force can be applied, as, when the nuts are turned, the\\nwire will be bent and in its tendency to straighten will press on the\\ntooth.\\nFig. 664 shows an appliance which may be used with much satisfac-\\ntion. In this case the first molar has been previously extracted. The", "height": "4564", "width": "2752", "jp2-path": "americantextboo00kirk_0731.jp2"}, "732": {"fulltext": "724 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nline between the central incisors is to the right of the median line of the\\nface. The bicuspids are to be pushed back and the incisors toward the left\\nat the same time. The appliance works on the principle of two wedges\\ndrawn toward each other. On the canine is cemented a band with a\\nshort tube on its lingual surface. In this tube is placed one of Angle s\\nshort drag-screws, while the other passes through a strip of metal about\\nFig. 664.\\nWriter s appliance for making room and drawing cuspid in.\\n-J- of an inch wide which rests on the first bicuspid and the lateral.\\nThis strip is bent so as to form one wedge while the canine serves as\\nanother. The nut on the end of the screw draws the two wedges, that\\nis, the canine and the strip, toward each other and spreads the lateral\\nand bicuspid from one another. The strip is altered in form as the\\nwork progresses always, however, retaining its wedge shape. The\\nsame appliance may be worn as a retainer after the canine is in\\nplace.\\nClass 3. Rotated Teeth. While attachment may be made to a\\ntooth for rotating it by ligatures (a modification of the clove hitch) or\\nby drilling pits in which are inserted screws or pins secured by cement,\\nthe first of these serves only a temporary purpose, and the second\\nmutilates the tooth more than is warrantable except in extreme cases.\\nFor the incisors the best attachment is a Magill band not thicker\\nthan No. 36 B. S. gauge, to which is soldered a hook, pin, or tube.\\nFor the canines a swaged cap is better, as it may be cemented more\\nfirmly in place.\\nTo rotate an incisor which overlaps the adjacent tooth, cement a\\nband on the tooth with a hook on either the labial or the lingual surface.\\nFrom this hook extend a rubber band or ligature to a vulcanite plate\\nheld by atmospheric pressure. Secure the rubber band to the plate by\\nligating through two holes. (See Fig. 665.) The plate should be cut\\naway slightly as the tooth rotates. The point of the attachment to the\\nplate will vary according to the direction of force needed. By attach-\\ning at C, Fig. 712, room may be gained by attaching the rubber band\\nso that it will press against the adjacent tooth, over which the offending\\none may be lapped.", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0732.jp2"}, "733": {"fulltext": "ROTATED TEETH.\\n725\\nThe plate may be dispensed with by attaching the rubber band to\\nsome other tooth for anchorage\\nFig. 665. (Fig. 666), or to a lingual bow\\nas shown in Fig. 667.\\nFig. 666.\\nPlate and band for rotating.\\nTwo Magill bands for rotating.\\nExtra force may be gained in rotating by passing the rubber once\\naround the tooth after attaching it to the hook, as a rope is wound\\naround a windlass.\\nIf it be necessary to rotate a tooth outwardly, attach bands with\\ntubes to any two convenient teeth such as canines or bicuspids extend\\nFig. 66\\nWriter s lingual bow and hook band for rotation.\\na wire bow from one to the other, as in Fig. 668, and use this as a point\\nof attachment for the rubber band. The ends of the bow are prevented\\nfrom passing too far through the tubes by the bending in bayonet shape\\nor by pinching the posterior ends of the tubes. If the canines are used\\nfor anchorage, solder the tubes vertically to the bands and bend the\\nends of the bow at right angles.\\nForce may be applied to the tooth from two directions by making\\nhooks on both sides of the band and extending a rubber band or ligature\\nfrom one hook to a labial bow and from the other to the lingual bow, as\\nshown in Fig. 669, A and B.", "height": "4564", "width": "2744", "jp2-path": "americantextboo00kirk_0733.jp2"}, "734": {"fulltext": "726 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFig. 668.\\nLabial bow and hook band for rotation.\\nIn many cases another tooth which needs rotating may be used for\\nanchorage, and thus double rotation is accomplished, either in the same\\nFig. 669.\\nA, Rubber band from lingual hook to labial bow B, from labial hook to lingual bow.\\nor opposite directions. A study of the illustrations Figs. 670-673\\nwill show the student how the different movements are accomplished.\\nFig. 670.\\nFig. 671.\\nFig. 672.\\nFig. 673.\\nmgjgim.\\nBandage for double rotation.", "height": "4580", "width": "2816", "jp2-path": "americantextboo00kirk_0734.jp2"}, "735": {"fulltext": "ROTATED TEETH.\\n727\\nIn many cases a tooth may be moved out of or into the normal line and\\nrotated at the same time by applying the force to a hook on a band.\\nWhere a jack-screw is used it can be applied at the mesial or distal\\nportion of the tooth as needed. (See Fig. 674.)\\nFig. 674.\\nFig. 676.\\nAngle s jack-screw for moving tooth outward and\\nrotating.\\nFig. 675 shows one of Prof. Angle s\\nmethods, which he describes as follows\\nFig. 675.\\nAngle s pinched wire for extension and rotation.\\nThe tooth was banded and one of\\nthe pipes soldered to the mesio-lingual\\nFig. 677.\\nRetainer.\\ngle s pliers for pinching wire.\\nangle of the band one end of a piece of wire of suitable length was\\ninserted into this pipe and the other end secured in a pit formed in the", "height": "4540", "width": "2668", "jp2-path": "americantextboo00kirk_0735.jp2"}, "736": {"fulltext": "728\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nenamel of the second deciduous molar. Force was exerted upon the\\ntooth to be moved by occasionally pinching this wire with the regu-\\nlating pliers (Fig. 676), two or three pinches being enough to lengthen\\nthe wire sufficiently to move the tooth as far as should be done at one\\nsitting.\\nThe simplest retainer is a band with a short piece of round wire\\nsoldered to it, so that it will impinge upon the adjacent tooth. It is\\nnecessary sometimes to fasten such a lug on each side of the band.\\n(See Fig. 677.)\\nWhen double rotation has been accomplished, the teeth may be\\nretained by soldering the bands together at the points of contact.\\nAngle s appliance for double rotation is easily understood from an\\nexamination of Figs. 678 and 679. The piano-wire spring should not\\nbe larger than No. 24 B. S. gauge.\\nFig. 678.\\nFig. 679.\\nAngle s appliance for double rotation.\\nAlthough this appliance is very effective, two difficulties attend its\\nuse. Sometimes the spring fails to slide through the tubes as the teeth\\nFig. 680.\\nFig. 681.\\nGuilford s lever for rotating.\\nAngle s detachable lever for rotating.\\nrotate and the teeth are spread slightly apart. This tendency can be\\nobviated by tying a silk ligature from one tube to the other.\\nSometimes the distal surfaces of the teeth will turn forward, so that\\nthey will stand wholly out of the line of the other teeth. This can be\\nprevented by soldering lugs on the lingual surfaces of the bands, to rest\\non the laterals. In some cases, as the centrals turn, these lugs will\\nslide on the inclined plane formed by the lingual surfaces of the laterals", "height": "4580", "width": "2832", "jp2-path": "americantextboo00kirk_0736.jp2"}, "737": {"fulltext": "EXTRUSION.\\n729\\nFig. 682.\\nand either push the laterals up in the socket or elongate the centrals.\\nThis may be prevented by bands on the laterals with a projection on\\n-each, under which the lugs will rest and be prevented from moving.\\nAnother method of rotating is by means of a lever attached to a band\\non the tooth as shown in Fig. 680. The end of the lever is bent in the\\nform of a hook, from which a rubber band passes over some convenient\\ntooth. Prof. Angle has made the lever detachable (Fig. 681) by solder-\\ning a tube to the band and inserting in it a piece of piano wire. The\\nother end of the wire is bent in the form of a hook and ligated to some\\n-convenient tooth, or placed under a hook soldered to a band on such\\ntooth.\\nFig. 682 shows Dr. Matteson s swaged cap on a deciduous molar,\\nwith a hook for this purpose. In\\nusing the lever special care must be\\ntaken not to let it rest on any tooth\\nbetween the anchorage and the of-\\nfending tooth, otherwise it will move\\nthe tooth out of line.\\nClass 4. Extrusion, or a Tooth\\nExtruded. The simplest treatment\\nfor a tooth that is extruded is to\\ngrind it shorter. As grinding alters\\nthe natural shape of the tooth in\\nproportion to its extent, other means\\nare sometimes necessary.\\nA tooth sometimes elongates, in\\nregulating, by the carelessness of the patient or operator, or by unfore-\\nseen complications. In such a case an immediate, even though tem-\\nporary, appliance is necessary. Tie a ligature around the necks of the\\nadjacent teeth with the knots between each and the offending tooth.\\nExtend one end of each ligature lingually and one labially. (See Fig.\\nFig, 683.\\nMatteson s swaged cap for anchorage.\\nWriter s plan for reducing extruded teeth.\\n683.) Tie the lingual ends together behind the long tooth, and in the\\nsame knot tie a slender rubber band. (See Fig. 684.) Tie the labial", "height": "4568", "width": "2752", "jp2-path": "americantextboo00kirk_0737.jp2"}, "738": {"fulltext": "730\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nends together in front of the long tooth. Next stretch the rubber band,\\nfrom the lingual surface of the neck, over the cutting edge, and tie it\\nFig. 684.\\nFig. 685.\\nWriter s plan for reducing extruded teeth.\\nto the knot on the labial surface. (See Fig. 685.) The tooth is thus\\nhung in a sling which will force it up into place.\\nAnother simple plan is that suggested by Dr. William Herbst for\\nretaining a replanted tooth. It is shown in Fig. 687. It consists in\\nFig.\\nFig. 687.\\nHerbst method of reduction and retention.\\ncutting a short and narrow strip from a piece of rubber dam (Fig. 686)\\nand perforating it in such a manner that when in position the crowns\\nof two teeth on either side of the one affected will protrude through the\\nopenings while the elongated tooth will be partly covered and pressed\\nupon by the intervening portion of the rubber. (See Fig. 687.)\\nFig. 688.\\nAppliance for reducing extrusion.\\nA better plan is to band one tooth on each side and connect the\\nbands on both labial and lingual surfaces by a wire soldered to both\\nbands, or resting in tubes soldered to the bands (Fig. 688), or soldered\\nto one band and resting in a hook on the other. A twisted ligature or\\nslender rubber band stretched from the lingual to the labial wire, over\\nthe cutting edge of the long tooth, will soon force it up. (See Fig. 689.)\\nA small cap with a notch in it may be cemented to the end of the long", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0738.jp2"}, "739": {"fulltext": "PARTIAL ERUPTION.\\n731\\ntooth, to prevent the rubber band from slipping off. When the tooth is\\nmoved to its desired position it may be retained by substituting a small\\nFig. 689.\\nFig. 690.\\nWriter s appliance for reducing extrusion.\\nDetails of appliance shown in Fig.\\nplatinum wire or silver suture wire for the rubber band, or three bands\\nmay be soldered together and cemented to the teeth.\\nClass 5. Partial Eruption. A tooth may need elevating because\\nit has not fully erupted or because a piece has been broken from the\\ncutting edge. If the short tooth is an incisor, proceed as follows On\\nthe adjacent teeth cement bands or caps which are connected by a wire\\nat or near the cutting edge. On the short tooth, as near the gum as\\nFig. 691.\\nWriter s method of elevating.\\npossible, cement a wide band which has a hook or pin on both labial\\nand lingual surfaces. From one hook stretch a very slender rubber\\nband or twisted ligature over the wire to the other hook. (See Fig. 691.)\\nLess force is required for elevating a tooth than for any other move-\\nment, as a conical root is drawn from a conical socket, and care must\\nbe taken not to move the tooth too rapidly lest the pulp be ruptured\\nat the apical foramen or the peridental membrane be ruptured. If\\nthe wire is soldered on the cutting edges of the caps, it will prevent\\nthe possibility of drawing the tooth too far. For retention substitute\\na small platinum or silver suture wire for the rubber band, or apply\\nthree bands soldered together. A broken tooth may be elevated by\\nmeans of the same kind of appliance (see Fig. 692), and then the cut-\\nting edge ground to conform to the other teeth.\\nFor a partially erupted canine an excellent plan is that of Prof.\\nAngle, shown in Fig. 693.", "height": "4560", "width": "2736", "jp2-path": "americantextboo00kirk_0739.jp2"}, "740": {"fulltext": "732\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nWhere the canine has not erupted far enough for cementing a band\\nor swaged cap on it, a small hole may be drilled in the tooth, in which\\nFig. 692.\\nWriter s method of elevating broken tooth.\\na small screw or pin is secured by cement. This may be afterward\\nfilled with gold, or with a piece of a small glass rod, as described by\\nProf. L. L. Dunbar. 1\\nIn some cases it is advantageous to use teeth of the lower jaw for\\nanchorage, as shown in Fig. 694.\\nThe patient may remove the rubber band from the upper tooth while\\neating. As rubber bands are liable to be broken by a too sudden\\nFig. 693. Fig. 694.\\nAngle s method of forcible eruption.\\nAngle s method of using the lower jaw for\\nanchorage.\\nopening of the patient s mouth, it is well to attach two or three to the\\nlower tooth, as a reserve in case one is broken between visits of the\\npatient. The lower metal band may be dispensed with by ligating the\\nrubber band to the neck of the tooth. As the rubber band tends to\\ndraw the ligature away from the gum, inflammation is not likely to\\nensue as in many other uses of such a ligature.\\nFigs. 695 and 696 show how this plan has been successfully applied\\nby the writer for elevating bicuspids and molars which do not occlude.\\nBands with hooks are attached to both upper and lower teeth and a\\nrubber band stretched from each upper hook to a corresponding lower\\none, or the place of either upper or lower band is supplied by a liga-\\n1 Pacific Coast Dentist, vol. i. p. 14.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0740.jp2"}, "741": {"fulltext": "PARTIAL ERUPTION.\\n733\\nture. The teeth, being drawn out of their sockets toward each other,\\nwill soon meet and adapt their occlusal surfaces to each other. This\\nFig. 695.\\nWriter s plan of occluding bicuspids and molars.\\nadaptation may be assisted by grinding or re-shaping any cusps that\\nmay be an obstruction. The case shown in Fig. 696 was treated in\\nRestoration of occlusion.\\nthe infirmary of the Dental Department of the University of Califor-\\nnia by a senior student under the writer s directions. An unexpected\\nresult was also obtained. The upper arch was much narrower than the\\nFig. 697.\\nLabial bow for elevating centrals and depressing canines.\\nlower. The upper teeth were drawn outward as well as downward and\\nthe arch was widened.\\nThe following case will serve to illustrate reciprocal movement", "height": "4568", "width": "2736", "jp2-path": "americantextboo00kirk_0741.jp2"}, "742": {"fulltext": "734 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nThe central incisors of a patient about twenty years of age were par-\\ntially denuded of enamel for about T of an inch from the cutting edge.\\nThe lateral incisors had the same defect at the cutting edge only. It\\nwas thought best to elevate the central incisors, and grind off the por-\\ntion denuded of enamel. Bands were fitted to the centrals (Fig. 697)\\nwith hooks on their labial surfaces pointing upward, also on the canines\\nFig. 698.\\nLabial bow for retention.\\nwith hooks pointing downward, and on the second bicuspids with tubes\\non their buccal surfaces. A wire bow was extended from the tube on\\nthe left bicuspid to the tube on the right, and caught under the hooks\\non the canines. Slender rubber bands were then stretched from the\\nwire over the hooks on the centrals, and soon elevated them sufficiently\\nto grind off the denuded portion. The same appliance was used as a\\nretainer by bending the bow wire upward slightly and hooking it over\\nthe hooks on the incisors.\\nThe elevation of a broken upper incisor is sometimes interfered\\nwith by occlusion of the lower incisors on the slanting lingual surface\\nFie. 699.\\nFlattening lower arch with labial bow.\\nso that it is necessary to shorten the lower incisors by grinding. In\\nsome cases it is warrantable to grind away the upper incisor on the\\nlingual surface, where too much grinding of the lower teeth would mar\\ntheir appearance. In the case just described it was necessary to press\\nthe lower incisors back by flattening the arch as shown in Fig. 699.\\nThe following case of forcible eruption may be instructive\\nMiss R. W., aged eighteen, presented herself with the point of the", "height": "4580", "width": "2808", "jp2-path": "americantextboo00kirk_0742.jp2"}, "743": {"fulltext": "PARTIAL ERUPTION. 735\\nupper left canine erupting behind the lateral incisor while the deciduous\\ncanine was still in place. The cusp had penetrated the gum about a\\nFig. 700.\\nForcible eruption of canine.\\nyear before, but had during that time made no progress in eruption.\\nThe w r riter decided to cause the tooth to erupt forcibly, by means of a\\ncoiled spring as suggested by Dr. Talbot. As the deciduous canine was\\nlarge and firm and but slightly decayed, it was thought best to let it\\nremain in place till the permanent tooth was erupted far enough to see\\nif it were well formed. By depressing the gum slightly a hole was\\nShowing result of operation.\\ndrilled in the enamel in the lingual surface of the tooth. In this hole\\nwas inserted one end of a coiled spring, which was attached to a plate,\\nas shown in Fig. 700, which shows the cusp emerging from the gum.\\nThe tooth was soon erupted to its normal length, when the deciduous", "height": "4568", "width": "2736", "jp2-path": "americantextboo00kirk_0743.jp2"}, "744": {"fulltext": "736\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ncanine was extracted. By means of a rubber band from a labial bow,\\nthe ends of which rested in tubes attached to bands on right and left\\nbicuspids, the tooth was readily brought into line as shown in Fig. 701\\nFig. 702.\\nFig. 703.\\nA band-and-bar retainer (Fig. 653) was applied to keep the tooth in\\nplace till it became firm.\\nTooth Shaping. The operation of grinding has been referred to\\nin the shortening of an extruded tooth, and also for re-shaping a tooth\\nfrom which a corner has been broken after having first elevated the\\ntooth. (See Fig. 692.) It may be advantageously employed for re-\\nshaping teeth which have been left longer than the contiguous ones by\\nthe wearing away of the latter, as shown in Figs. 702-705, suggested\\nby Dr. W. S. How. 1\\nIn many instances upper incisors are worn away on their lingual\\nsurfaces, leaving thin edges of labial enamel which are easily broken\\naway irregularly. (See Fig. 706.) These broken edges may be re-\\nmoved and the teeth improved very much in appearance by grinding.\\nThe cusps of bicuspids and molars sometimes interfere with the\\nFig. 704.\\nFig. 705.\\nFig. 706.\\nlljlli\\nWorn or broken teeth (Farrar).\\ndesired movement of an antagonizing tooth and may be reduced by\\ngrinding so as to present no obstruction.\\nLower canines which prevent upper canines or lateral incisors from\\nmoving into their proper position may have the apex of the cusp ground\\naway, and in some cases even a portion of the labial enamel may be re-\\nmoved to advantage. An incisor which inclines toward the contiguous\\ntooth so much as to present one angle lower than the other may have\\nthis corner ground away so as to present the cutting edge in line with\\nthe other teeth. Fig. 707 shows how much of the enamel of a tooth\\nmay be removed in various cases without exposing the dentin.\\n1 Dental Cosmos, vol. xxviii. p. 741.", "height": "4580", "width": "2764", "jp2-path": "americantextboo00kirk_0744.jp2"}, "745": {"fulltext": "PARTIAL ERUPTION.\\n737\\nTruing up is a term applied by Dr. Farrar to the process of\\nremoving overlapping portions of teeth so that they will present a nor-\\nmal appearance. (See Figs. 708 and 709.)\\nMuch discomfort may be prevented if the corundum wheel be\\nheld as in Fig. 710, as the tooth is supported by the contiguous ones\\nFig. 707.\\nShowing thickness of enamel (Farrar).\\nand less jar is felt. Fine-grained wheels should be used and the sur-\\nface should afterward be thoroughly polished by means of cuttlefish\\ndisks, or with felt or wooden wheels carrying polishing powder. If\\nthe grinding should not be carried so far as to be painful a slight sensi-\\ntiveness may be felt for a few days, when the operation may be resumed.\\nCataphoresis has been successfully applied by the writer for allaying\\nsensitiveness. If a tooth needs to be reduced considerably in length\\nTruing up (Farrar).\\nthe dentin may be exposed on the cutting edge with impunity, as it\\nis kept free from decay by the tongue and lips. The enamel may be\\nbeveled on one or both surfaces to reduce the thickness of the cutting\\nedge.\\nApproximal Surfaces. In rare instances the removal of a slight\\namount of enamel from approximal surfaces of incisors or canines is\\n47", "height": "4564", "width": "2728", "jp2-path": "americantextboo00kirk_0745.jp2"}, "746": {"fulltext": "738\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\npermissible for the purpose of making room,\\nconfined to teeth easily kept clean, to\\nteeth unusually rounded on their ap-\\nproximal surfaces, and they should be\\nreduced only to a normal contour and\\nFig. 709.\\nThe operation should be\\nFig. 710.\\nTruing up (Farrar).\\nPosition of corundum wheel (Farrar).\\nbe thoroughly polished. Flat approximal surfaces should never be\\nproduced, as caries is almost sure to be the result. The patient should\\nbe warned to use extra care with the brush and floss silk.\\nDisks or strips of sandpaper, emery, or garnet may be used for\\nremoving a portion of enamel, after which cuttlefish disks or strips\\nshould be used for polishing.\\nClass 6. Two or More Teeth in Any or All of the Five Mal-\\npositions. One of the oldest and simplest appliances, which requires\\nvery little skill in its construction, is shown in Fig. 711. It can be\\nFig. 711.\\nLabial bow and plate. (From Kingsley.)\\nused with either upper or lower jaw, and consists of a vulcanite plate\\nfitted against the lingual surfaces of the teeth. Imbedded in this plate\\nare the ends of a wire which extends through such gaps, when the jaws\\nare closed, as are most favorable, and around the buccal and lingual\\nsurfaces of the teeth. A round wire is much better than a flat strip of\\nplate for this bow, as it can be bent up toward the gum line or down\\ntoward the cutting edges of the incisors according to the necessities of", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0746.jp2"}, "747": {"fulltext": "SEVERAL TEETH IN MALPOSITION. 739\\nthe case. The cut shows the manner of attaching rubber bands by\\nwhich teeth may be drawn forward. The bow should be from to\\nof an inch in advance of the teeth to be moved, and may be elongated\\nfrom time to time by hammering the sides on the beak of an anvil.\\nBy attaching rubber bands or twisted ligatures to the plate, teeth may\\nbe drawn into the arch, as shown in Fig. 712, B. By stretching rubber\\nbands or twisted ligatures from either the wire or plate to hooks such\\nas shown in Fig. 712, A, teeth may be rotated. For such purpose it\\nis in some cases best to solder hooks on both labial and lingual surfaces\\nof a band, and thus apply force from wire and plate at the same time.\\nBy attaching a rubber band at that part of the wire which emerges\\nfrom the plate (Fig. 712), a tooth may be drawn backward along the\\nridge. If the wire extends near to the cutting edge, an incisor may be\\nFig. 712.\\nPlate and wire bow for moving teeth in all positions.\\nextruded by ligating a rubber band at the neck and extending it to the\\nbow, or by applying a twisted ligature in the same manner. In some\\ncases it is necessary to ligate the plate firmly to temporary molars or\\nbicuspids. This has a wider range of use than any other single appli-\\nance, for with it teeth may be moved outward or inward, rotated or\\nelongated, or the arch may be spread. (See Fig. 712, A, B y C, D.)\\nIt is, however, much less stable and much more uncleanly than are\\nmany other appliances attached directly to the teeth.\\nThe same movements may be made with the bows shown in Fig. 713.\\nBands are cemented on one or two teeth on each side of the mouth, pre-\\nferably two for stability, in which case the bands should be soldered\\ntogether. Tubes are soldered on both buccal and lingual sides of the\\nbands. In these tubes are inserted wire bows, screw-cut on the ends\\nand supplied with nuts. One bow extends around the labial and the\\nother around the lingual surfaces of the teeth.", "height": "4568", "width": "2728", "jp2-path": "americantextboo00kirk_0747.jp2"}, "748": {"fulltext": "740\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nTo these wire bows, rubber bands may be attached to move teeth in\\nall directions, for instance at B y for moving a lateral incisor into the\\narch at A, for rotating a central incisor at D, for drawing a canine\\nbackward along the ridge; and at C, for drawing a lateral forward.\\nFig. 713.\\nLabial and lingual bows for teeth in all positions.\\nThis last rubber band should not be applied till after the canine has\\nbeen moved out of the way.\\nThis appliance, made up of labial and lingual bows, has as wide a\\nrange of application as the plate and bow, and is much more stable as\\nFig. 714.\\nAppliance for rotating several teeth at one time.\\nwell as much more cleanly. Fig. 714 shows the use of this appliance\\nfor rotating several teeth at one time.\\nThe bows may be used independently as follows The labial bow may", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0748.jp2"}, "749": {"fulltext": "SEVERAL TEETH IN MALPOSITION.\\n741\\nbe used for moving incisors backward by placing the nuts behind the\\ntubes (Fig. 663), or for moving incisors forward by placing the nuts in\\nfront of the tubes and ligating the wire to the incisors, or putting it\\nFig. 715.\\nLabial and lingual bow.\\nunder hooks soldered to bands on the incisors. It may be used for the\\nattachment of rubber bands or twisted ligatures for drawing incisors for-\\nward (Fig. 729), in which case the wire may be bent in a bayonet shape\\nat the ends, or the rear ends of the tubes may be closed.\\nFig. 716.\\nLingual bow for moving incisors forward (Matteson).\\nThe lingual bow may be used for moving any or all four incisors\\nforward by placing the nuts in front of the tubes. The anterior portion\\nof the wire may rest in notches in the bands on the incisors (Fig. 716),", "height": "4564", "width": "2752", "jp2-path": "americantextboo00kirk_0749.jp2"}, "750": {"fulltext": "742\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFig. 717.\\nor a short piece of wire may be soldered to the front of the bow and\\ninserted between the centrals above the points and their mesial sur-\\nfaces. Other short wires may be soldered on so as to engage the distal\\nborders of the laterals to prevent their being moved sideways. (See\\nFig. 715, b.)\\nFig. 717 shows the writer s modi-\\nfication of the Coffin spring plate for\\nmoving incisors forward. A wire\\nshould be imbedded in the anterior\\nportion of the plate to project between\\nthe centrals to prevent sliding on the\\ninclined surfaces.\\nEetention of Teeth Moved\\nForward. This has often been ac-\\ncomplished by a simple vulcanite\\nplate retained by atmospheric pressure\\nand impinging on the lingual surfaces\\nof all the teeth involved. Objections\\nto this are that it is easily displaced,\\neven sometimes by the incisors on whose inclined surfaces it impinges\\nretention of fermenting debris or secretions in contact with the teeth,\\nand liability to be left out by the carelessness of the patient, when the\\nteeth return partly to their malpositions. Fig. 718 shows a retaining\\nWriter s modification of Coffin split vul\\ncanite plate.\\nFig. 718.\\nE.H.A.\\nAngle s retainer.\\nappliance of Prof. Angle s, consisting of a wire bent so as to rest in\\ncontact with the lingual surfaces of the teeth involved, soldered to\\nbands on the canines, and the ends cemented in pits drilled in the\\nmolars. It may be used in the lower arch as well as the upper. In\\nmany cases the anterior portion only of this appliance may be used.", "height": "4580", "width": "2784", "jp2-path": "americantextboo00kirk_0750.jp2"}, "751": {"fulltext": "RETAINING PLUGS.\\n743\\nSeveral teeth moved in different positions may be retained by bands\\nsoldered together and cemented in place. (See Fig. 719.)\\nFig. 720 shows Dr. Case s retainer, 1 which consists of a series of\\nbands soldered together at their points of contact with an excess of\\nFig. 719.\\nFig. 720.\\nBands soldered together for retention.\\nCase s retainer.\\nFig. 721.\\nSwaged strip for strengthening.\\nsolder in front. The labial surfaces of all but the end bands are then\\ncut away so as to leave only a small portion between the teeth, and\\nthese portions filed so as to resemble gold fillings. The appliance is\\nstiffened by soldering a piece of swaged plate to the lingual surfaces.\\n(See Fig. 721.) The bands should be constructed of very thin gold-\\nfaced platinum or German silver, prefer-\\nably the former, and the whole appliance\\nfirmly cemented to the teeth.\\nRetaining Plugs. It not infre-\\nquently happens that on account of the\\ncrowded and irregular positions of teeth,\\ncavities of decay have been formed which\\ncan be used, as suggested by Dr. Farrar, for the insertion of gold\\nretaining plugs or fillings. For instance, approximal fillings may be\\ninserted in an incisor and built out so as to touch the contiguous teeth\\nfor retaining a tooth or a tooth that has been moved into line may be\\nretained by gold fillings inserted in approximal cavities and built out\\nlaterally so as to rest on the labial or lingual surfaces of contiguous\\nteeth or a tooth that has been rotated may be retained by one such\\nfilling.\\nThis method of retention is especially useful with patients who have\\nadvanced beyond the years in which it is generally considered advisable\\nto regulate teeth. The writer had a patient forty-five years old for\\nwhom he moved two teeth forward into line. After an immovable\\nretaining appliance had remained in place for over two years the teeth\\nupon being released moved back perceptibly. Gold fillings were inserted\\nin approximal cavities and built out as suggested above, with the inten-\\ntion of leaving them indefinitely.\\nCare should be taken to make these projections as slender as the\\n1 Ohio Dental Journal, January 1898, vol. xvii. No. 1.", "height": "4552", "width": "2672", "jp2-path": "americantextboo00kirk_0751.jp2"}, "752": {"fulltext": "744 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nstrength of the gold will permit, so that the point of contact with the\\nenamel will be as small as possible.\\nLower Incisors Crowded in All Positions. This is a very common\\nirregularity owing to the teeth being too large for the incisor space, or\\nthe space being encroached upon by the canines.\\nThe simplest way to make room is to extract one of the crowded\\nteeth. The four teeth are so nearly of the same size that few can tell\\nwithout counting whether there are three or four between the canines.\\nWhen room has been made, the remaining teeth may be brought into\\nline by the same means that have been described for upper incisors.\\nThe labial bow attached to bands on bicuspids or canines will form\\nattachment for rubber bands or ligatures for moving the incisors into\\nposition. In some cases it is better to spread the arch as shown in Fig.\\n733. Owing to the relative positions of the alveoli of the central incisor\\nand canine to that of the lateral incisor there is always a tendency for\\nthe lateral incisor to erupt within the arch of the adjoining teeth.\\nIn selecting the tooth for extraction in such cases it would seem most\\nnatural to take the one most out of position labially or lingually but\\nFig. 722.\\nthat is not always best, because it often happens, as Dr. Case has\\nshown, that the contiguous teeth already lean toward each other, and\\nif drawn together after removal of such teeth will only lean toward\\neach other all the more noticeably with quite a V-shaped space at the\\ngum.\\nIf possible, the tooth for extraction should be so selected that the\\ncontiguous teeth lean from each other (Fig. 722), so that when drawn\\ntogether they will be forced into an upright position. If, however, a\\nwrong selection should have been made, the roots of the contiguous\\nteeth may be forced toward each other by the appliance shown in Fig.\\n821. 1\\nCaution. Before deciding on extraction in such cases the operator\\nshould satisfy himself that the lower arch does not need expanding to\\nmake room for the crowded incisors.\\nIf by removing a tooth the lower arch is allowed to contract and the\\n1 Dr. Case, Dental Review, 1898, p. 584.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0752.jp2"}, "753": {"fulltext": "PROMINENT CANINES AND DEPRESSED LATERALS. 745\\nbicuspids move nearer the median line, their cusps may by wedging con-\\ntract the upper arch and cause crowding of the upper incisors. Fig.\\n733 shows an appliance for expanding the lower arch.\\nClass 7. Prominent Canines and Depressed Laterals. Etiology.\\nThis common form of irregularity may be due to\\n(a) Lack of development of the intermaxillary bone constitutional.\\n(6) Teeth too large for the jaw indirect heredity teeth from one\\nparent and jaw from the other. (See page 690.)\\n(c) Premature loss of the deciduous second molars and forward move-\\nment of the permanent first molars acquired.\\n(d) Premature loss of the deciduous canines acquired.\\n(Figs. 605, 723, and 725 illustrate irregularities under Class 7.)\\nTreatment To make room for proper arrangement of the teeth in\\nthis class, it is necessary either to expand the arch or to extract one or\\nmore teeth.\\nIf the irregularity is slight, and the arch is narrower than the oc-\\ncluding one, expansion is indicated.\\nIf both arches are narrow, both should be expanded to restore proper\\nocclusion.\\nUnless the arch will admit of expansion to advantage, extraction is\\nbetter.\\nIf expansion would make the arch too large, or the anterior teeth\\ntoo prominent, extract.\\nIf the superior maxilla itself is so narrow that expansion would\\nmake the bicuspids and molars slant outward too much, extract.\\nIf caries is prevalent, extract.\\nIn favor of expansion, it may be said that if the full number of teeth\\nare retained, the pain of extraction is obviated, and the narrow arch is\\nwidened to correspond with the other features.\\nIn favor of extraction Room is gained more easily the treatment\\nis simplified, as there are fewer teeth to be moved the teeth are retained\\nin their new positions more easily, because if the full number of teeth\\nbe retained the same cause that produced the irregularity may tend to\\nreproduce it, while if room be made by extraction the action of the lips\\nand tongue tends to move the teeth into the normal arch.\\nIn many cases no other treatment than extraction is necessary, as\\nshown in Figs. 723 and 724.\\nHaving decided upon extraction in any case under consideration, the\\nchoice lies between a lateral incisor and some tooth posterior to the\\ncuspid. The canine should never be extracted, as on account of its\\nlong root and prominent position its loss causes a depression of the\\ncorners of the lip and wing of the nose which can never be remedied.\\nThe choice between a lateral incisor and some tooth posterior to the", "height": "4564", "width": "2736", "jp2-path": "americantextboo00kirk_0753.jp2"}, "754": {"fulltext": "746\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ncanine depends on the position of the apex of the root of the canine,\\nand also of the lateral. If the apex of the root of the canine is so\\nFig. 723.\\nCase treated by extraction only.\\nsituated that the crown slants away from the median line, or will do so\\nafter being moved into its normal position, the extraction of one or both\\nlaterals may be admissible. If a lateral is unusually far back of the\\nnormal line and the apex of the root also, when the tooth is moved\\nFig. 724.\\nShowing the same denture as Fig. 723 a few months after extraction.\\nforward till the cutting edge is in line with the centrals the neck of\\nthe tooth will be back of its proper position that is, the tooth will\\nhave an unnatural slant forward. This is not of as much importance as\\nthe position of the apices of the roots of the canines, but it should be\\ntaken into consideration in connection with the other factors.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0754.jp2"}, "755": {"fulltext": "PROMINENT CANINES AND DEPRESSED LATERALS.\\n747\\nOne method of moving incisor roots is shown in Figs. 823-827.\\nIn very rare cases a central incisor may be extracted to gain room\\nthat is, if very badly decayed, if an incurable abscess exist, or if only\\nthe root remain and cannot be crowned to advantage.\\nIn the lower arch an incisor may be extracted to advantage in many\\ncases the four teeth are so nearly alike in appearance that the absence\\nof one is not noticed.\\nIf in a given case it seems best to extract some tooth posterior to\\nthe canine, the choice will be between a bicuspid and the first molar.\\nIf the bicuspids and first molar be equally sound, extract the first\\nbicuspid. That will leave two teeth for anchorage in retracting a\\ncanine (Fig. 725, left), or, if the second molar be erupted far enough,\\nWriter s modification of Guilford s appliance.\\nthree teeth may be utilized. Very secure anchorage is necessary in\\nthis instance, for the canine is the most difficult tooth to move, and\\noftentimes the two anchor teeth will move more readily than the canine.\\nIn some cases the canine needs to be moved back but little then the\\nsecond bicuspid only need be used for anchorage (Fig. 725, right), and\\nthe two teeth moved toward each other to fill up the space. The molar\\nwill follow, owing to the tendency of the posterior teeth to move\\nforward. This forward movement or migration of molars is very\\ncurious, and is often a very great hindrance in regulating, since they offer\\nless resistance as anchor teeth from that very cause. Fig. 728 shows\\na case in which a molar has moved so as to touch the canine, yet still\\nretains its upright position. The upper molar in migration has less\\ntendency to tip forward than the lower. If, however, the second bicuspid\\nor first molar be so defective as not to be preserved by filling, the defect-\\nive tooth should be extracted. This, however, will complicate the case,\\nas there are more teeth to be moved and fewer for anchorage. On\\naccount of the value of the molar in masticating and in preserving\\nnormal occlusion, it should not be extracted unless caries has advanced", "height": "4552", "width": "2764", "jp2-path": "americantextboo00kirk_0755.jp2"}, "756": {"fulltext": "748\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nso far that there is a doubt whether the tooth can be saved by filling or\\ncrowning. (See page 744 on extraction.)\\nIn using the appliance shown in Fig. 725 rubber bands are gener-\\nally utilized for applying force, but twisted ligatures of silk, linen, or\\nwire may be used, as shown\\nin Figs. 726 and 727, in which\\ncase there is less liability to\\npericemental inflammation.\\nFig. 727.\\nFig. 726.\\n(Same as Fig. 725, but with wire.)\\nTwisted ligatures of silk, linen, or wire.\\nTubes are soldered on the buccal surfaces of the bicuspid or molar\\nbands and shaped so as to serve for hooks. They are afterward utilized\\nfor holding a labial bow (Fig. 729).\\nAfter the canine is moved into position, it may be retained by sub-\\nstituting fine platinum or silver suture wire for the rubber bands. The\\nFig. 728.\\nShowing migration of molars. Eight first molar in contact with first bicuspid, and\\nleft touching the canine.\\nbuccal tubes, which served as hooks in the first case (see Fig. 726), may\\nnow be utilized for inserting the ends of a wire bow which passes in\\nfront of the incisors. Eubber bands or twisted ligatures from this bow\\nwill draw the lateral incisors forward. (See Fig. 729.) An inner bow\\nmay be placed in the lingual tubes and utilized for drawing central", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0756.jp2"}, "757": {"fulltext": "PROMINENT CANINES AND DEPRESSED LATERALS.\\n749\\nincisors backward, or rotating them, as is often necessary in such\\ncases.\\nFig. 729.\\nFig\\nLabial bow added to retracting appliance.\\nIf either canine needs rotating, a rubber band will be needed on\\none side of the tooth only, and\\nthe hook may be so placed on\\nthe band that the tooth will be\\nrotated while it is being drawn\\nback.\\nProf. Angle advises the use\\nFig. 730.\\nStationary anchorage (Angle).\\nAngle s drag-screw.\\nof the drag-screw for retracting canines, as shown in Fig. 730. By\\nsoldering a long tube to two bands which are cemented to two teeth,\\nand extending the drag-screw through this tube, he reduces to a mini-\\nmum the possibility of the teeth tilting. This appliance is very\\neffective. The position in which the hook is attached to the canine\\nband will depend on whether it should be rotated or not in retraction.\\n(See Fig. 731.)\\nAfter the canines are moved to their new position the same appli-\\nance may remain as a retainer. It will be found that a canine moved\\ninto its proper place, when room has been made by extraction, will need\\nretention less than any other tooth.\\nGreater anchorage may be obtained by a plate such as shown in\\nFig. 732, for it impinges upon the anterior alveolar ridge and in-", "height": "4564", "width": "2784", "jp2-path": "americantextboo00kirk_0757.jp2"}, "758": {"fulltext": "750 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ncisors as well as upon the posterior teeth. Its use is especially ad-\\nvantageous when a second bicuspid or first molar has been extracted,\\nfor then one or two teeth must be moved before the canine. The cut\\nwill explain the method of applying force to the teeth to be moved.\\nThe wire or clasp should encircle the posterior tooth, for greater anchor-\\nage. After the second bicuspid has been drawn back, the first can be\\nmoved in the same manner then the canine. In many cases it will\\nFig. 732.\\nPlate for retraction.\\nbe best to move the canine by the reciprocal appliance shown in Fig.\\n733, so as to relieve the anchor teeth from undue strain.\\nIt is to be clearly understood that the condition shown in Fig. 732\\nmust be one of necessity, not of choice.\\nThe molar is so important in masticating and in preserving the normal\\nrelation and interlocking of cusps of occluding teeth that it should not\\nbe removed if it can be avoided.\\nPresent methods of crowning molars are so successful and perma-\\nnent that in most cases crowning should be resorted to if the tooth is\\ntoo far gone to be filled, even if a sound bicuspid must be removed to\\ngive room.\\nFig. 733 shows a reciprocal appliance for these cases by Dr. R. L.\\nTaylor, of San Francisco. The laterals are drawn forward and the\\ncanines pushed back and elevated at the same time, after the first\\nbicuspids have been extracted to make room. This has proved a valu-\\nable appliance and is well adapted to such cases as are shown in Fig.\\n732, after the bicuspids have been moved back.\\nFig. 734 shows a valuable appliance by Prof. Guilford for moving\\nfour incisors forward, and bicuspids back, to make room for canines.\\nHe thus describes it Magill bands were made to fit the laterals, with\\ngold spurs extending along the palatal surface of the centrals to insure\\nuniform movement of the four incisors. Palatal bands were also at-\\ntached to the first bicuspids. All of these bands were reinforced with", "height": "4604", "width": "2776", "jp2-path": "americantextboo00kirk_0758.jp2"}, "759": {"fulltext": "PROMINENT CANINES AND DEPRESSED LATERALS.\\n751\\nan additional piece of platinum soldered to the portion next to the\\nspace. Through these reinforcements, at about the centre of the tooth,\\nFig. 733.\\nDr. R. L. Taylor s reciprocal appliance.\\nholes were drilled entirely through the bands. Piano wire was next\\nbent into the form of small U-shaped springs, with the ends at right\\nangles, similar to Dr. Talbot s plan but without the coil. Grasping\\nthese near the neck with a pair of narrow-beaked right-angle forceps,\\nFig. 734.\\nGuilford s appliance for increasing space.\\ntransversely grooved near the points to seize the wire, the springs were\\nplaced in position with their ends resting in the holes in the bands. As\\nfrom time to time the force of these springs became spent they were\\nremoved and their power renewed by enlarging their curves.\\nIn case of extraction of first molars, the bicuspids may be moved\\nbackward and the incisors forward by Prof. Guilford s appliance.\\nFig. 735 shows Prof. Angle s method of reinforcing the anchor\\nteeth by a wire bar extending to the lateral incisor.", "height": "4568", "width": "2776", "jp2-path": "americantextboo00kirk_0759.jp2"}, "760": {"fulltext": "752\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIn many cases, after extraction of a first bicuspid the only problem\\nFig. 735.\\nAngle s reinforcement.\\nis to draw the canine into line or move it lingually. This may be ac-\\ncomplished by any of the appliances described in Class 2.\\nFig. 736.\\nlYimiiiiiiiiiii\\nDrawing canine in.\\nFig. 736 shows another method of Prof. Angle s for drawing the\\nFig. 737.\\ncanine in\\nJackson s appliance for lower arch.\\nThe lower canine is the most difficult tooth to move. If the first\\nbicuspid be extracted to make room, the second bicuspid and first molar\\nwill in many cases be moved forward in an attempt to use them as", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0760.jp2"}, "761": {"fulltext": "PROMINENT CANINES AND DEPRESSED LATERALS.\\n753\\nanchorage in retracting the canine either with a screw or elastics. If\\na first molar has been lost, we have the sum of difficulties, three teeth\\nto move and only the second molar for anchorage. It is often neces-\\nF r;J8 sary to construct an appliance\\nof such a shape that all the\\nother teeth can be used as\\nanchorage.\\nFig. 739.\\nJackson s appliance for lower arch.\\nFlat tube for piano-wire spring.\\nFigs. 737, 738 show Dr. Jackson s method of retracting the lower\\ncanine in such cases. The base wire rests against all teeth that it is\\nnot desired to move and gives effective anchorage.\\nFig. 739, A, shows another method of applying a piano-wire spring\\nby bending a loop on one end and inserting it in a flat tube soldered\\nto a molar band the spring is thus prevented from turning. The loop\\nFig. 740.\\nStability of anchorage.\\nmay be so bent that the spring may be inserted in the posterior end of\\nthe flat tube, as shown at b, Fig. 739.\\nWhen great immobility of the anchorage tooth is required, use for\\nbanding material German silver or platinized gold, No. 30 gauge and\\nas wide as the tooth will permit. When these are contoured and fitted,\\nsolder the power tube at the gingival margin. (See Fig. 740.) This\\nshould be sufficiently long to permit reinforcing it at either end with\\nsolder to the full width of the tooth, and large enough to carry a\\npower rod that will be inflexible. Where it is possible, the power tube\\nmay rest above the gingival margin, soldered to an extension plate\\nthat is fitted or swaged to the surface of the crown, and so shaped as to\\nfreely clear the gum.\\n48", "height": "4560", "width": "2792", "jp2-path": "americantextboo00kirk_0761.jp2"}, "762": {"fulltext": "754\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIf the power tube is extended forward to the first bicuspid and\\nits anterior end allowed to rest upon a narrow projection soldered to\\nthe bicuspid band, it will add greatly to the stability of the anchorage.\\nIt will be seen that any tendency of the molar to tip forward\\nwill carry the anterior end of the tube almost directly toward the\\nFig. 741.\\nAuthor s combination for expansion.\\nroot of the bicuspid, the movement being prevented by the rest. Nor\\nwill any such device offer any special obstruction to the movement of\\nthe bicuspid, the rest sliding along the tube.\\nThe power bar, or drag-screw, should end in a hook engaged in\\na tube on the canine or any other tooth that needs to be moved.\\nMatteson caps in place of bands in appliance for expansion.\\nSpreading the Arch.\u00e2\u0080\u0094 For spreading the arch an appliance\\nshould be firmly fixed upon the teeth and should have sufficient power,\\nwhich can be well regulated. For such an appliance the writer has\\nmade a combination of Magill bands, Angle s jack-screw, and the coil", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0762.jp2"}, "763": {"fulltext": "SPREADING THE ARCH.\\n755\\nspring, as shown in Fig.\\nsame purpose, it has this\\nthe lingual surfaces of\\nholes in which are fitted\\nscrew. This bar should\\nposition of the screw or\\nwhich needs the greater\\n741. While resembling other devices for the\\ndistinction The bar connecting the bands on\\nthe teeth is perforated at short intervals by\\nthe ends of a Talbot spring or an Angle jack-\\nbe stiff, about ]S T o. 23 B. S. gauge. The\\nspring may be changed, according to the part\\nexpansion. If necessary, two springs or two\\nWriter s combination with Angle s jack-screw\\njack-screws may be used at the same time. The coiled spring should\\nbe bent to conform to the palatal vault, so as to interfere but little\\nwith the patient s tongue as does the jack-screw.\\nIn case of very short molars and bicuspids it is best to use Matte-\\nson caps in place of bands, as shown in Fig. 742.\\nFig. 744.\\nWriter s appliance for widening lower arch and moving incisors forward.\\nFig. 743 shows the use of the jack-screw and Fig. 744 the appliance\\nfor the lower arch. In this the Matteson spring is used with two coils", "height": "4556", "width": "2800", "jp2-path": "americantextboo00kirk_0763.jp2"}, "764": {"fulltext": "756\\n0RTH0D0N1IA AS AN OPERATIVE PROCEDURE.\\nbetween which is a straight part Avhich lies near the floor of the\\nmouth.\\nWhen the arch has been spread the bent wire c, Fig. 741, is sub-\\nstituted for the spring or jack-screw for retention. It may lie along\\nthe necks of the teeth, and in such position be utilized for attachment\\nof rubber bands for retracting or rotating incisors, as shown in Figs.\\n667 and 713. The long wire a, 6, Fig. 741, is used for moving incisors\\nforward, as shown in Fig. 729. These two wires are the labial and\\nlingual bows previously referred to.\\nFig. 745 shows one of the author s partly made appliances,\\nwhich can be readily applied to the teeth of a patient or to a plaster\\nFig. 745.\\nPartly made appliance for expansion.\\ncast by bending the partly made bands around the teeth and completing\\nthem as in Fig. 630.\\nFig. 746.\\nPartly made expander applied to plaster cast.\\nThe perforated bar soldered to the first band ribbon slides through a\\nflat tube on the second band ribbon, and thus allows adjustment accord-\\ning to the amount of room desired between the bands. Fig. 746 shows\\nthe completion of the appliance.", "height": "4608", "width": "2816", "jp2-path": "americantextboo00kirk_0764.jp2"}, "765": {"fulltext": "THE POINTED OR GOTHIC ARCH.\\n757\\nClass 8. The Pointed or Gothic Arch (the V-shaped Arch)\\n(called the Lancet Arch by Dr. Guilford). Etiology. The pointed\\narch (generally miscalled the V-shaped arch) may be due\\n(a) To the presence of teeth too large for the jaw indirect heredity; or\\n(b) To the first permanent molar having moved forward from its\\nnormal position on account of premature loss of the second deciduous\\nmolar acquired.\\nIn either case, taking the first molar as a fixed point for the base of\\nthe arch on each side, the teeth forward of that point must arrange\\nthemselves in a portion of the jaw which is too small for them. The\\nincisors erupt first, the bicuspids next, and the canines last. It depends\\non the manner of approximal contact whether the result is a pointed\\narch, a constricted arch, or results in Class 7 Prominent canines and\\ndepressed laterals/\\nIf all of these teeth erupt in proper alignment, they will touch each\\nother approximally like the stones of an arch the second bicuspid not\\nPointed arch (V-shaped arch).\\nhaving sufficient room either from its extra size or because the first\\nmolar has taken part of its room will crowd the first forward, and the\\ncanine, erupting as a wedge in front of the bicuspids, which are immov-\\nably fixed against the first molar, will crowd the incisors forward,\\nbecause they are situated in a thin alveolar process which is easily\\nmoved. As the incisors move forward, crowding upon each other, they\\nrotate in their sockets and assume the V shape. 1\\n(c) The teeth may assume a pointed arch from having too much\\nroom, either on account of extraction or from being too small for the jaw.\\nWhen the teeth are deprived of approximal support there is a tendency\\nfor the sides of the arch to flatten or move toward the median line.\\n1 See Talbot, 3d ed., chap, xxxii., and Ottolengui, Dental Cosmos, June 1892.", "height": "4560", "width": "2792", "jp2-path": "americantextboo00kirk_0765.jp2"}, "766": {"fulltext": "758\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nThe semi-V of Dr. Talbot s classification is one in which the causes\\nnamed have operated on one side only of the arch. Fig. 748 shows a\\nsemi-V arch due to the last cause\\nmentioned.\\n(d) The V shape assumed by\\nthe central incisors may be due to\\nlack of development of the inter-\\nFig. 749.\\nSemi-V-shaped arch.\\nApices of roots too near together.\\nmaxillary bone at the median suture. This would bring the apices of\\nthe roots of these teeth nearer each other than is normal. As the teeth\\nerupt they may come in contact with each other above the gum line, but\\nbe separated from each other at the mesio-incisal angles. If they are\\nnow crowded together by the lateral incisors, or if an attempt be made\\nto draw them together by means of a rubber band or ligatures, they will\\nroll upon each other in such a manner that when the mesio-incisal\\nangles touch they have also assumed a V shape with the apex of the\\nV pointing forward.\\nConversely, when a V shape of this kind is reduced by double rota-\\ntion, 1 the teeth will assume the position shown in Fig. 749.\\nThe old theory that it was due to mouth-breathing is no longer ten-\\nable, as it has been demonstrated that the pressure of the muscles upon\\nthe teeth in such action is not sufficient to cause this deformity. This\\nhas been proved by examination of a great number of children in schools\\nand public institutions.\\nTreatment The treatment of the pointed arch depends on the\\nrelation in size between the jaw and teeth. If the teeth are not too\\nlarge for the jaw, and the deformity consists in the flattening of the\\nsides of the arch, the operation is comparatively simple. If pressure\\nbe brought to bear on the summit or point of the arch while the base on\\neach side is fixed, the sides will spring outward like an arch of whale-\\nbone. (See Fig. 750.)\\nMany pointed arches are also cases of upper protrusion, and will be\\ntreated of under that division.\\nOne of the oldest appliances and a very satisfactory one is shown in\\n1 See Class 3.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0766.jp2"}, "767": {"fulltext": "THE POINTED OR GOTHIC ARCH 759\\nFig. 751. The posterior teeth should be partially surrounded by the\\nFig. 750.\\nAngle s appliance for spreading arch and reducing V shape.\\nplate, or by wire or clasps imbedded in the plate, to give firm anchor-\\nage. The rubber bands attached to the T-piece between the central\\nincisors should be attached to the edges of the plate as shown, in order\\nto apply the force in a direct line with the movement desired.\\nPlate for reducing V arch (Kingsley).\\nBands and a labial bow (Fig. 759) may be used, in which case the\\nbands should be applied to the posterior teeth. The bow should be of\\nelastic wire, not smaller than No. 16, and so shaped as to press on the\\ncentrals only at first. As these teeth move back and press on the late-\\nrals, and these in turn on the canines, and so on, the arch will spread\\nout and can thus be moulded to the shape that has been given to the\\nbow. This may be assisted by rubber bands from the bow over the\\nbicuspids and canines.", "height": "4560", "width": "2776", "jp2-path": "americantextboo00kirk_0767.jp2"}, "768": {"fulltext": "760\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIn some cases the arch must be spread before attempting to reduce\\nthe V shape, in which case the appliance shown in Fig. 741 may be used.\\nFig. 752 shows the second stage in the treatment of a pointed arch.\\nThe arch is first spread by means of a coil spring acting on a band\\nFig. 752.\\nWriter s lingual bow and rubber bands for rotation after spreading the arch.\\non the first bicuspids, reinforced by bars resting on the canines and\\nsecond bicuspids. After sufficient room has been gained the lingual\\nbow may be inserted to retain the width of the arch. From this bow\\na rubber band or a twisted ligature should be extended to a T-piece\\nbetween the central incisors or to a hook on a band on each central\\nincisor for the purpose of rotating.\\nFig. 753.\\nUpper protrusion\u00e2\u0080\u0094 cause (a) or (b).\\nClass 9. Upper Protrusion. Etiology. Protrusion of the upper\\nanterior teeth may be due to several causes\\n(a) Abnormal (excessive) development of the upper maxilla con-\\nstitutional.\\n(6) Teeth too large for the jaw indirect heredity.\\n(c) Premature loss of the second deciduous molar, and forward move-\\nment of the first permanent molar acquired.", "height": "4604", "width": "2776", "jp2-path": "americantextboo00kirk_0768.jp2"}, "769": {"fulltext": "UPPER PROTRUSION.\\n761\\n(d) Thumb-sucking acquired. (See Fig. 757.)\\n(e) Lack of development of the lower maxilla (the upper protrusion\\nis then apparent rather than real) constitutional.\\nFig. 754.\\nProtrusion\u00e2\u0080\u0094 cause (c) (Talbot).\\nPremature loss or injudicious extraction of the first permanent\\nmolars acquired. Prof. Guilford says of such extraction The re-\\nsult is that the lateral pressure so necessary to proper expansion is lack-\\ning in one jaw while in the other normal enlargement continues.\\nFig.\\nFig. 756.\\nApparent protrusion due to lack of develop-\\nment of lower maxilla (Talbot).\\nDr. Louis Jack s drawing (in Dental Cosmos)\\nshowing deformity from too early extrac-\\ntion of first permanent molar.\\n(g) Weak structure of the upper maxilla, which allows the teeth to\\nbe forced forward by occlusion with a large lower maxilla of hard and\\ndense structure with short rami acquired. (See Fig. 757.)", "height": "4556", "width": "2800", "jp2-path": "americantextboo00kirk_0769.jp2"}, "770": {"fulltext": "762\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\n(h) It may be due to extraction of the lower first molars at an age\\nwhen they were the only masticating teeth, as might be the case during\\nan interval between the loss of the deciduous molars and the eruption\\nof the bicuspids. The impaction of the lower incisors upon the inclined\\nlingual surfaces of the upper incisors might move them forward, thus\\ncausing upper protrusion. (See Fig. 756.)\\nThumb-sucking. To this practice were formerly ascribed all cases of\\nupper protrusion, until inquiries developed the knowledge that in a\\nFig. 757.\\nUpper protrusion\u00e2\u0080\u0094 cause (d), from thumb-sucking. (Talbot.)\\nmajority of cases no such habit had existed, or, if so, had been aban-\\ndoned before the eruption of the permanent teeth. The fact that the\\nhabit of thumb-sucking, which usually begins before the temporary\\nteeth are erupted, is indulged in during the years when the bony parts\\nare especially soft and yielding and is discontinued before the eruption\\nof the permanent teeth, and that nevertheless upper protrusion rarely\\noccurs with the deciduous teeth, has completely overthrown the old\\ntheory. Yet thumb-sucking is occasionally persisted in till twenty-\\neight permanent teeth are erupted, and occasionally causes protrusion.\\nDr. Ottolengui says l It seems to me that if it is ever true at all\\nthat thumb-sucking can cause a protrusion of the jaw, we have it within\\nour means to determine when such a condition has so resulted. If a\\ngiven case of protrusion is attributable to thumb-sucking, it must of\\nnecessity follow that had the child not practiced the habit the jaw\\nwould not have protruded. Admitting this, then, we come to this\\nthat the protrusion has occurred in one of two ways First, the length\\nof the arch around the circle has not been enlarged, but the projection\\nhas been produced by a flattening of the sides pointed arch. The teeth\\n1 Dental Cosmos, 1892, vol. xxxiv. p. 447.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0770.jp2"}, "771": {"fulltext": "UPPER PROTRUSION.\\n763\\nbeing normal, but simply distorted, it must follow that such a case could\\nbe restored without extracting any teeth, or in plainer language, that by\\nwidening the jaw and reducing the forward prominence we may obtain a\\nnormal mouth with all the teeth in proper position. The second class of\\ncases is where the length around the arch is increased, thus accounting for\\nPointed arch.\\nProtrusion with spaces. Protrusion teeth too large.\\nLabial bow for three cases of protrusion.\\nthe anterior prominence. In such a case the pressure would be supposed\\nto have moved the teeth forward, new tissue forming the Avhile. The\\nresult would be a normal occlusion from the bicuspid region backward,\\nbut a protrusion forward, with a distinct spacing between the teeth.\\nThis of course would be another condition which could be corrected\\nwithout the loss of a tooth.\\nFig. 759.\\nLabial bow for reducing upper protrusion.\\nTreatment. The treatment of upper protrusion will be considered\\nunder four heads\\nA. Where there is a flattening of the sides of the arch (pointed arch).\\nB. Where there are spaces between the teeth.\\nC. Where a tooth must be sacrificed on each side to make room.", "height": "4568", "width": "2792", "jp2-path": "americantextboo00kirk_0771.jp2"}, "772": {"fulltext": "764\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nD. Where there is not sufficient anchorage inside the mouth.\\nThe first three classes may be treated in the same manner, by means\\nof the labial bow shown in Fig. 759. The bow should be of stiff\\nelastic wire, not smaller than No. 16, which will retain its shape, and\\nshould be bent at first into the exact form desired for the arch in the\\nfinished case, and should be prevented from sliding toward the gum\\nby notched bands on central incisors.\\nIn class A (pointed arch) it will press on the central incisors only,\\nand cause the flattened sides of the arch to spread outward. If they\\ndo not readily do so, rubber bands may be extended from the sides\\nof the bow over any teeth desired.\\nIn most cases the greatest possible stability of anchorage is neces-\\nsary then bands for the bicuspid and both should be soldered to-\\ngether (Fig. 760, Such bands should be made of No. 30 band\\nFig. 760.\\nIncreased anchorage.\\nribbon as wide as the crown will allow. Fig. 629, E, shows the double\\nband partly constructed.\\nIn many cases the second molar is too short for a band, but some-\\ntimes a stiff wire may be extended back from the first molar band so as\\nto hook around the second molar, perhaps extending slightly under the\\ngum or pressing it away (Fig. 760, 6).\\nIn class B the teeth will be drawn toward each other and the spaces\\nclosed and in class C if the first bicuspids are extracted the six anterior\\nteeth will be drawn back till the canines occupy the vacant spaces. If\\nthese six teeth were in the curve of the normal arch they will be moved\\nback in the same position. If some are more prominent than others,\\nthe more prominent ones will be drawn back first and all moulded into\\nthe desired alignment.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0772.jp2"}, "773": {"fulltext": "UPPER PROTRUSION.\\n765\\nThe tooth to be extracted will depend or the same rules as in Class\\n7 Prominent canines and depressed laterals.\\nIn some cases the upper protrusion is slight, so that the anterior\\nteeth do not need to be moved back more than half the space left by\\nGuilford s appliance for retracting upper incisors.\\nthe first bicuspids. Then it is an advantage to have the posterior teeth\\nthe anchor teeth move forward half the distance and fill up the gap,\\nunless that plan would disarrange the occlusion, in which case the\\nIII\\nLabial bow and plate (Kingsley).\\nbicuspid only may be moved forward so as to divide the space. The\\ncusps of the upper bicuspid and the occluding teeth may in some cases\\nbe advantageously ground so as to improve the occlusion.\\nFig. 782 shows Prof. Angle s appliance for reducing the lower arch,\\nwhich can be applied also to the upper. By a careful examination it\\nwill be seen to be practically a labial bow made up in three sections.", "height": "4568", "width": "2784", "jp2-path": "americantextboo00kirk_0773.jp2"}, "774": {"fulltext": "768\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIn obstinate cases it would be the best appliance, for sometimes with\\nthe bow the teeth crowd together and tend to overlap. This is impos-\\nsible with Angle s appliance, for all the force is applied to the canines,\\nwhich in turn draw the incisors along: with them.\\nFig. 763.\\nJackson s method.\\nThe anterior teeth may be moved back by means of a plate and\\nelastic bands such as shown in Fig. 761. The plate should be well\\nsecured by clasps around the molars.\\nFig. 762 shows Dr. Kingsley s plate with a labial bow of stiff wire,\\nthe elasticity of which is depended upon for moving the anterior teeth.\\nAt each visit of the patient the ends of the bow are bent so as to re-\\nFig. 765.\\nCase of upper protrusion.\\nResult of treatment with cap and bit.\\nnew the pressure. This is an excellent appliance for reducing a pointed\\narch.\\nIt is sometimes advisable to retract the canines first, by some of the\\nmethods described in Class 5, and then the incisors by the plan just\\nmentioned.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0774.jp2"}, "775": {"fulltext": "UPPER PROTRUSION.\\n6\\nFig. 763 shows the use of piano wire after the method of Dr.\\nJackson, which explains itself. The springs attached to the vulcanite\\nplate or to the Jackson base wire and crib following around from each\\nside of the labial surfaces of the canines and incisors, pass each other at\\nthe median line and press like long fingers.\\nFor moving back the roots of the teeth after the crowns have been\\nmoved, see page 796.\\nClass D may include any of the others. The anchorage may be\\ninsufficient for the first two classes on account of the loss of posterior\\nteeth from caries. In class C the teeth to be moved may exceed in\\nFig. 766.\\nWriter s form of cap and bit for retraction.\\nnumber the anchor teeth so that the latter will move instead of the\\nanterior teeth. Fio;s. 764 and 765 show such a case. In such in-\\nFig.\\nThe bit.\\nstances it is necessary to use the back of the head for anchorage.\\nThe first recorded instance of such use was by Dr. Norman W.\\nKingsley in 1865.\\nVarious complicated appliances for attachment to the anterior teeth\\nhave been described by different authors. Fig. 766 shows a very simple", "height": "4572", "width": "2784", "jp2-path": "americantextboo00kirk_0775.jp2"}, "776": {"fulltext": "768\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\none first used by the author in 1880. It consists of a vulcanite cap fit-\\nting the labial and part of the lingual surfaces of the anterior teeth (Fig.\\n767). In this is imbedded a steel or German-silver wire, about No. 12,\\nso that the ends will protrude between the lips at the corners of the\\nmouth. These ends are bent into hooks, and extended far enough so\\nthat elastics from them to the cap on the back of the head will not touch\\nthe cheeks. These extended arms may be bent to conform to the curve\\nof the cheeks, but should not touch them. The cloth cap is such as any\\nseamstress can make easily, and extends forward above and below the\\near. On these projecting ends are sewed dress-hooks. For power use\\nround or flat elastic cord. Tie a knot in one end, place it in the hook\\nFig. 768.\\nTen teeth moved at once. Condition before treatment.\\nFig. 769.\\nSame denture after treatment.\\nabove the ear, extend it forward over the hook of the bit and back\\nto the hook on the cap below the ear, and tie a knot in it to secure it.\\nIn most cases two or more strands will be needed if so, extend the", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0776.jp2"}, "777": {"fulltext": "UPPER PROTRUSION.\\n69\\ncord forward again over the hook on the bit, and back again to the\\nupper or to the lower hook. By thus varying the number of strands\\nfrom the hook above or below the ear, the movement may be made\\ndirectly backward from the cutting edges, or upward and backward\\nsomewhat in the line of the roots, in which case the teeth will be forced\\nup into the sockets, or shortened. The ends of the wire passing out\\nof the corners of the mouth may be adjusted by bending upward\\nto just the right degree, so that the pressure of the bit will not be\\non the cutting edges, but at the necks of the teeth, or even higher, so\\nas to move the roots and process also. To insure this, the vulcanite\\nportion of the bit should pass over the cutting edge so as to grasp\\nthe lingual surface.\\nThis cap-and-bit appliance may be worn at night only, or at such\\nother times as will not prevent the patient from attending school. The\\nmovement will be facilitated if a retaining appliance be worn during\\nsuch times as the cap is not in use. The posterior teeth will often\\nafford sufficient anchorage for retention.\\nThis appliance is especially valuable in cases in which it is necessary\\nto select for extraction second bicuspids or first molars on account of\\ncaries, for then the number of teeth for anchorage is decreased and the\\nnumber to be moved is increased.\\nFigs. 768 and 769 show a case in which ten teeth were moved at\\nonce, by this appliance.\\nFig. 770.\\nAngle s appliance for retraction.\\nDuring the daytime, when the cap is not worn, the teeth may be\\nretained by the labial bow shown in Fig. 759, which explains itself.\\n49", "height": "4548", "width": "2788", "jp2-path": "americantextboo00kirk_0777.jp2"}, "778": {"fulltext": "770 ORTHODONTIA AS :AN .OPERATIVE, PROCEDURE.\\nThe nuts should be turned in the inorriing only enough to retain but,\\nnot to move the teeth.\\nIf the upper protrusion is complicated with other irregularities, such\\nas a pointed arch, or single teeth in any of the first five positions, Prof.\\nAngle s appliance shown in Figs. 770, 771 will be found very satisfac-\\ntory. The labial bow is held in position by bands on the central in-\\ncisors, having notches formed in the united ends on the labial surfaces,\\nc, c. The ends slide through tubes on molar bands. From the front\\nof the bow projects a short wire ending in a ball on which is adjusted\\nthe socket of the traction bar, A. From the ends of this traction bar\\nrubber bands extend to a cap on the back of the head, as shown\\nin Fig. 772. As this wire bow is moved backward by the external\\nFig. 772.\\nAngle s cap.\\nforce, it will move the teeth with which it comes in contact and mould\\nthe arch to the shape of the bow or, if single teeth need special move-\\nments such as rotation, elevation, etc., it may be accomplished by means\\nshown in Fig. 713. Dr. Angle advocates the use of wire ligatures\\nwith the bow for various movements of the teeth, as shown in Fig.\\n773. The rubber bands shown on the sides of the bow are for retain-\\ning the teeth during the day, while the cap is not worn.\\nFor retention, nothing is better than the labial bow, as shown in\\nFig. 759 but Dr. Case s retainer (Fig. 720) is much less conspicu-\\nous. The anchor bands may be placed on the second bicuspids or first\\nmolars, or on both.\\nJumping the Bite. Many cases of apparent upper protrusion\\nare due to lack of development of the lower maxilla, so that the lower\\nteeth close one cusp back of the normal position and the lower second", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0778.jp2"}, "779": {"fulltext": "JUMPING THE BITE. 771\\nbicuspid closes behind the upper second instead of in front of it, which\\nis the normal articulation. Fig. 774 shows such a case of disto-\\nlingual occlusion.\\nFig. 773.\\nE.H.A.\\nWire ligatures with the bow, for various movements of the teeth\\nIf the lower jaw can be moved forward the width of a bicuspid, or\\nless, sometimes, the normal occlusion will be produced. This move-\\nment is termed jumping the bite, 7 and originated with Dr. N. W.\\nKingsley more than twenty years ago.\\nThe lower jaw may be voluntarily moved forward but not backward.\\nAny patient with an abnormal occlusion can move the lower jaw for-\\nFig. 774.\\nDisto-lingual occlusion.\\nward the width of a tooth and thus occlude normally. If this can be\\nmade a permanent habit, the patient will have jumped the bite.\\nUnless some change takes place in the glenoid cavity, such as a filling\\nup of its posterior portion, or in the condyle, such as the bending of the\\nneck, as suggested by Dr. Case, or in the angle of the jaw itself, so as\\nto prevent the jaw from moving back into its old position, the new\\nposition cannot be maintained.\\nThe first recorded operation of this kind was described as follows", "height": "4568", "width": "2752", "jp2-path": "americantextboo00kirk_0779.jp2"}, "780": {"fulltext": "772\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nby Dr. Kingsley 1 Fig. 775 shows another application of the in-\\nclined plane somewhat out of the ordinary course. It was adapted\\nto the inside of the upper dental arch, and the inclined surface pro-\\njected below and caught the lower incisors. The object was, not to\\nprotrude the lower teeth, but to change or jump the bite in the case of\\nan excessively retreating lower jaw. In the engraving is shown a\\nFig. 775.\\nKingsley s appliance for jumping the bite.\\ngold bar worn across the front of the upper incisors to reduce their\\nprominence.\\nFigs. 776, 777 illustrate a case treated by Dr. E. H. Cutter of Cam-\\nbridge, Mass., and show the bite jumped half the width of a bicuspid.\\nHe says 2 I made a plate for the upper arch thickened only\\nbehind the front teeth where depressions were made to receive the\\nFig. 776.\\nCutter s case of jumping the bite.\\npoints of the lower incisors and held firmly in place by wire\\nclasps encircling the first molars I made several plates of this\\ncharacter, as the amount to be gained had to be gradually accomplished.\\nThe patient was twelve years old, and but one permanent second molar\\nhad erupted when the work was completed all four of these molars\\n1 Oral Deformities, p. 84. 2 International Dental Journal, vol. xv. p. 355.", "height": "4616", "width": "2776", "jp2-path": "americantextboo00kirk_0780.jp2"}, "781": {"fulltext": "LOWER PROTRUSION.\\n773\\nhad erupted and interlocked with each other. The result was that the\\npatient could comfortably bring her jaws together only as they had been\\nnewly related.\\nDr. Talbot says l I have never been able to jump the bite\\nWere such a thing possible, one of two things must take place. First,\\nabsorption and deposition of bone cells at the weakest part of the jaw\\nFig. 777.\\nCutter s case after adjustment.\\nnamely at the angle Second, there must be a forward movement,\\nby absorption, of the condyle in the glenoid cavity.\\nFig. 778 shows Prof. Angle s method of jumping the bite by\\nmeans of a spur imbedded in the lower permanent molar, thus com-\\npelling the normal closure of the jaw.\\nFig. 778.\\nV\\nAngle s method of jumping the bite.\\nClass 10. Lower Protrusion. Etiology. This irregularity is in\\nmost cases constitutional and may be attributable to the following\\ncauses\\n(a) Excessive development of the ramus of the lower maxilla, as\\nshown in Fig. 780 constitutional.\\n(b) Excessive development of the body of the lower maxilla, as\\nshown in Fig. 781 constitutional.\\n(c) The habit of finger-sucking, in which the finger is hooked over\\nthe lower teeth acquired.\\n1 Dental Cosmos, vol. xxxiv. p. 791.", "height": "4552", "width": "2748", "jp2-path": "americantextboo00kirk_0781.jp2"}, "782": {"fulltext": "774 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\n(d) Teeth too large for the jaw and therefore projecting forward of\\ntheir natural position\u00e2\u0080\u0094 indirect heredity.\\n(e) The lower protrusion may be apparent and not real, owing to\\nlack of development of the upper maxilla. This may be due to nasal\\nFig. 779.\\nLower protrusion (Talbot).\\nobstruction (page 697) or to the injudicious extraction of the first per-\\nmanent molars, as in cases of apparent upper protrusion acquired.\\nIt may result from the upper oral teeth having erupted back\\nof their proper position, so as to bite inside of the lower incisors.\\n(g) Mal-occlusion of incisors.\\nFig. 780.\\nExcessive development of ramus (Talbot).\\nTreatment If the teeth are too large for the jaw, room may be made\\nby extraction of the first bicuspids, unless teeth posterior to them are\\nselected on account of caries.\\nThe anterior teeth may be moved back by the labial bow shown in", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0782.jp2"}, "783": {"fulltext": "LO WER PROTR USION.\\n775\\nFig. 759. Teeth as far back as possible should be selected for anchor-\\nage. The anterior portion of the bow should be as near the cutting\\nedges of the incisors as the occlusion will allow and may be prevented\\nfrom sliding toward the gum by one or more small hooks over the cut-\\nting edges of the teeth or by bands on incisors or canines with lugs or\\nnotches. (See Angle s notches in retracting appliance, Fig. 771, o, c.)\\nDr. C. S. Case utilizes the upper teeth for anchorage. The labial\\nbow previously referred to is applied to the lower teeth and has a\\nbutton attached to it near the canine on each side. From this button\\na rubber band is extended to a similar button soldered to a band on\\nan upper molar, as far back as possible. The tendency of this is to\\nFtg. 781.\\nExcessive development of body of lower maxilla (Talbot).\\ndraw the upper teeth forward, but more especially to draw back the\\nanterior lower teeth and also the jaw itself.\\nFig. 782 shows Prof. Angle s appliance for this purpose the large\\nFig. 782.\\nAngle s appliance.\\ntraction screw being attached to clamp bands which encircle the first\\nlower molars and the angles of which are hooked into small staples", "height": "4560", "width": "2752", "jp2-path": "americantextboo00kirk_0783.jp2"}, "784": {"fulltext": "776\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nsoldered to bands upon the distal angles of the canines/ while a piece of\\ngold wire attached by solder connects these bands and passes in front\\nof the incisors. This cap and traction bar may be used in connection\\nwith this appliance by applying the latter to the projection in front.\\nFig. 783.\\nAllan s appliance.\\nWhile more complicated than the appliance shown in Fig. 760, it must\\nbe very efficient.\\nConstant force may be used by such an appliance as is shown in\\nFigs. 762 or 763. The form of plate should be modified for the lower\\narch.\\nWhen the posterior teeth do not give sufficient anchorage, an exter-\\nnal appliance must be resorted to. The cap and bit shown in Fig. 766\\nmay be applied to the lower teeth, or Angle s appliance (Fig. 770) may\\nbe used if the six anterior teeth are not in proper alignment in respect\\nto each other.\\nIf the protrusion is an example of true prognathism that is, due\\nto the lower maxilla being larger or longer than the upper from either\\nof the causes mentioned external force alone can be of use.\\nBy a cup of metal swaged to fit the chin and connected by rubber\\nbands with a cap on the back of the head, as shown in Fig. 783 or in\\nFig. 784, the protrusion may be reduced.\\nHow this is accomplished is a matter of dispute, some maintaining\\nthat the lower maxilla is bent at the angle and others that the condyle\\nis pushed back in the glenoid cavity. Dr. G. S. Allan said in 1878,", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0784.jp2"}, "785": {"fulltext": "LOWER PROTRUSION. 777\\nThe jaw at that period of life is completely developed and hardened\\nconsequently any efforts that may be made will not affect the\\njaw-bone itself. The only way in which the change can be made is by\\npushing the jaw back into the glenoid cavity. Absorption takes\\nplace at the posterior side of the condyles, with filling in of the ante-\\nrior. Prof. Angle says, The object is by continued pressure to bend\\nFig. 784.\\nAngle s chin retractor.\\nthe jaw at the angles, but only in very young patients do we believe\\nthis even possible. We think that in two cases we have succeeded.\\nCases sometimes occur in which the fault is in both jaws the upper\\njaw is not prominent enough while the lower is too prominent, and the\\nresult is lower protrusion. Fig. 788 shows such a case, in which\\nthe fault lies partly in the spaces between the lower bicuspids and the\\nfirst molar. The appliance was made after a similar one by Dr. Case.\\nIt consists of bands on the lower canines joined by a wire that encircles\\nthe incisors and the ends of which are bent into hooks. On the upper\\nfirst molars are cemented bands with buccal hooks. A strong rubber\\nband was extended from the hook on the lower canine to the hook on\\nthe upper molar band. The result is shown in the second cast (Fig.\\n789). The patient was lost sight of after that. Just what changes\\ntook place is uncertain, whether the movement was wholly of the\\nlower teeth or whether there was a forward movement of the upper\\nteeth also. The writer is inclined to the latter opinion.\\nWhen the prognathism is apparent and not real (e) and the\\nproper treatment is to move the upper incisors forward, and in some\\ncases the canines also. (For appliances adapted to this purpose see\\nFigs. 716 and 717, in Class 6.)", "height": "4568", "width": "2744", "jp2-path": "americantextboo00kirk_0785.jp2"}, "786": {"fulltext": "778\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nIn some, lower protrusion from this cause is apparent only when\\nthe patient masticates. Figs. 785 and 786 will illustrate this condition.\\nFig. 785.\\nFig. 786.\\nApparent lower protrusion\u00e2\u0080\u0094 during mastication.\\nThe patient s natural occlusion.\\nIf the upper incisors erupt slightly back of their proper position the\\ncutting edges will occlude with the cutting edges of the lower incisors.\\nAs eruption continues they will open the bite (Fig. 786) so that the\\npatient must throw the lower jaw forward in order to occlude the bicus-\\nFig. 787.\\nThe same denture after treatment.\\npids and molars. (See Fig. 785.) It is quite possible that this will\\nresult in a permanent protrusion of the lower jaw. The case shown in\\nFigs. 785 and 786 was an argument against that, however, and against\\n-the possibility of jumping the bite (see page 770), for the patient\\n-was thirty years old, and never protruded his lower jaw except when\\nmasticating. For many years mastication had been attended with\\nneuralgia in the temporo-maxillary articulation, caused by the unnatural\\nstrain, yet this neuralgia disappeared entirely after the upper incisors\\nand canines had been moved forward enough to close in front of the\\nlower. The teeth were moved by the split plate shown in Fig. 717.\\nIn moving forward the upper anterior teeth in cases of apparent\\nlower protrusion, such as shown in Fig. 785, or those due to lack of\\ndevelopment of the upper maxilla, it sometimes occurs that when the\\ncutting edges overlap the lower incisors the crowns have a very\\nunnatural slant forward, and the roots need to be moved forward.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0786.jp2"}, "787": {"fulltext": "LOWER PRO TR USION.\\n779\\nAt the World s Columbian Dental Congress in 1893, Dr. C. S, Case\\npresented casts and appliances for this operation, which are shown in\\nChapter XXV., Figs. 839, 842, 893, and 895.\\nFig. 7\\nLower protrusion (fault in both jaws).\\nFig. 789.\\nResult of reciprocal appliance.\\nBy this means the entire anterior plate of the alveolar process is\\nmoved forward with the roots of the teeth and the sunken lip restored\\nto its natural fulness.\\nSee facial contour in Figs. 840 and 843.\\nSurgical Treatment of Lower Protrusion. The following extracts are\\nfrom a description, by Dr. J. W. Whipple of St. Louis, of the case\\nshown in Fig. 790.\\nThere had been apparently an abnormal growth of the body of the\\nmaxilla between the first and second bicuspids on the left side and be-\\ntween the first molar and second bicuspid on the right side, the space\\nseparating these teeth being respectively one-quarter and one-eighth of\\nan inch, causing the elongation of the jaw horizontally, which projected\\nthe lower teeth a quarter of an inch beyond and in front of the upper\\nones. The occlusion was destroyed. This elongation, Dr. Whipple", "height": "4552", "width": "2768", "jp2-path": "americantextboo00kirk_0787.jp2"}, "788": {"fulltext": "780\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nstates/ had taken place between 1891 and 1896, the patient being\\neighteen years of age when he first saw him. Dr. Whipple advised the\\npatient to consult Dr. E. H. Angle, who first suggested the advisabil-\\nity of resorting to double resection in this case. About a year after-\\nward an operation was performed, and about a quarter of an inch was\\nremoved from the body of the bone on each side, Dr. V. P. Blair\\nbeing operator-in-chief.\\nAn incision was made about half an inch in length along the base\\nof and just interior to the lower border of the maxilla. A cross incision\\nwas made of the same length, about on a line with the mental foramen.\\nThe centre of these incisions was interior, upon the borders of the\\nneck. The muscles and other integuments were now detached from the\\nFig. 790.\\nLower protrusion. (Dr. Whipple s case.\\njaw-bone. Dr. Blair had devised or had constructed a double bone-\\nsaw, consisting of two saws, four inches long, attached to a single handle,\\nand so adjusted as to make a cut in the clear just as wide as the space\\nbetween the two bicuspids on the left side. The sawing was done\\nthrough the incision from and through the internal surface of the bone\\nfrom the upper border down to the base. No vessels were ligated, as\\nthe hemorrhage was not profuse after the vessels emptied themselves.\\nThe bone was cut almost, but not quite, through. No attention was\\ngiven to the inferior dental canal.\\nA small hole was now drilled through the bone on each side of the\\ncut, near the lower border, for the reception of a wire ligature.\\nThe second right bicuspid having been previously extracted, the\\noperation just described was repeated on the right side.\\n1 Dental Cosmos, 1898, vol. xl. p. 552.", "height": "4580", "width": "2784", "jp2-path": "americantextboo00kirk_0788.jp2"}, "789": {"fulltext": "LOWER PROTRUSION. 781\\nAfter the holes were drilled the remainder of the sawing was done\\non both sides, and the two small sections of the jaw removed.\\nu Soft copper wire ligatures were now passed through the holes from\\nthe external surface. These were crossed on the internal surface, grasped\\nwith a pair of pliers, and twisted until the several* parts were drawn\\ntogether at the lower border, forming an apparently close and smooth\\nabutment of the opposing ends.\\nThe copper wire ligatures proved ineffectual, so clamp bands,\\nwith buccal tubes, were applied to the molar and bicuspid on one side,\\nand to the molar and canine on the other, and traction screws ex-\\ntended through the tubes. By tightening the nuts on these screws the\\nparts of the jaws were brought again in contact. As an additional pre-\\ncaution, bicuspid fracture bands were placed on the first upper and\\nsecond lower bicuspid.\\nFig. 791.\\nResult of surgical treatment of lower protrusion. (Dr. Whipple s case.)\\nA figure-8 ligature of brass wire was adjusted to the little knobs\\non these bands, and the rear fragment was firmly ligated to the upper\\njaw. All the various parts were held absolutely without change for\\nfive weeks. The patient lived on liquid food and suffered no great in-\\nconvenience physically.\\nA four- tailed plaster bandage was adjusted and retained without\\nchange for four weeks/\\nWithin eight or nine weeks the appliances were removed from both\\nsides, osseous union having taken place. Subsequently some of the\\nposterior teeth were lengthened by means of gold crowns, and the\\nocclusion restored. The final result is shown in Fig. 791.\\nThere was an entire loss of sensation in the lower lip, caused by\\ncutting the sensory parts of the inferior dental nerve.\\nThe pulps of the middle part of the jaw do not seem to have been\\naffected at all.", "height": "4560", "width": "2744", "jp2-path": "americantextboo00kirk_0789.jp2"}, "790": {"fulltext": "782 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nThe gentleman s appearance is greatly improved. No one would\\nsuspect that such an operation had been performed.\\nDr. Angle suggests that in such cases the chin is usually very promi-\\nnent, so that there is more or less lingual inclination of the lower incisors\\nand that the section of bone removed should be wedge-shaped, wider at\\nthe lower border, instead of with parallel sides.\\nHe also suggests that the best way to hold the parts of the jaw in\\nplace would be to make a cap or splint of metal or vulcanite that would\\nfit over the crowns of the teeth and cement it in place, as is done in\\nthe fractures. To properly construct such a cap or spliut, plaster models\\nshould be made of both upper and lower jaws, then sections cut out of\\nthe lower one so that the teeth could be properly adjusted to the upper,\\nFig. 792.\\nVulcanite or metal splint.\\ntaking careful measurements of the parts. On this reconstructed model\\na vulcanite or metal splint should be formed, as shown in Fig. 792.\\nAfter the sections of the jaw are removed and the anterior portion forced\\nback in contact with the remainder, the splint can be cemented on the\\nteeth to hold the parts firmly in correct position.\\nClass 11. Double Protrusion, or Protrusion of Both Upper and\\nLower Teeth.\u00e2\u0080\u0094 Occasionally there is protrusion of both upper and\\nlower teeth on account of their being too large for the jaws. The lips\\nappear very much thickened, or are unable to cover the teeth. A case\\nof this character (shown in Figs. 793 and 794) was treated by the writer,\\nprimarily with the cap and bit, such as are shown in Fig. 766, and\\nsecondarily by means of labial bows, shown in Fig. 795. The vulcanite\\nbit was made to fit over the anterior part of the bows upon both upper\\n1 Dental Cosmos, 1898, vol. xl. p. 635.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0790.jp2"}, "791": {"fulltext": "DOUBLE PROTRUSION.\\n783\\nand lower incisors when the mouth was closed, and was worn except\\nduring school hours, the patient being a school-girl aged seventeen.\\nFig. 793\\nFig. 794.\\nDouble protrusion. (Corrected.)\\nThe bows, which were used only for retention, had their ends secured\\nin tubes on bands cemented to the first molars. The anterior part of\\nthe upper bow rested in notched bands cemented on the central incisors.\\nThe anterior part of the lower bow was held in place by notched bands\\non the lower canines. The nuts of each bow were tightened every\\nFig. 795.\\nEetaining appliance.\\nmorning just enough to make up for the movement produced by the\\ncap and bit during the night. There were thus utilized four anchor\\nteeth in each jaw, the right and left first molars and second bicuspid.\\nThis was sufficient for retention of the six anterior teeth, though it\\nwould not have been sufficient for their retraction. If these anchor\\nteeth moved forward it was not noticeable, for no space was left between\\nthe first and second molars, though that fact might be accounted for by", "height": "4564", "width": "2728", "jp2-path": "americantextboo00kirk_0791.jp2"}, "792": {"fulltext": "784\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\na forward movement of the second molars of their own accord. Treat-\\nment of this case was begun in March, 1895, and in August the six\\nFig. 796.\\nFig. 797.\\nBefore.\\nAfter.\\nDouble protrusion.\\nanterior teeth had been moved back till the canine touched the second\\nbicuspids. (Figs. 793 and 794.)\\nThe same bands and bows were worn about two months longer for\\nretention, after which the teeth remained firmly fixed. The change in\\nthe contour of both lips was most marked. (See Figs. 796 and 797.)\\nFig. 798.\\nSaddle-shaped arch.\\nThe relation of these cases of protrusion to facial contour is dis-\\ncussed at length in Chapter XXV.\\nClass 12. Constricted Arch (Saddle -shaped). Etiology. The\\nconstricted arch may be due primarily to the same cause as the pointed\\narch that is, (a) teeth too large for the jaw, or (b) the first permanent\\nmolar being forward of its natural position on account of premature loss", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0792.jp2"}, "793": {"fulltext": "CONSTRICTED ARCH. 785\\nof the second deciduous molar, (c) Too long retention of deciduous\\nmolars, which may deflect the erupting bicuspid toward the median line.\\nIn either of the first two cases the position of the second bicuspid\\nin eruption will determine the character of the arch. If it erupts in\\nan exact line between the first bicuspid and the first molar it will crowd\\nthe anterior teeth forward (Fig. 799, B), but if it erupts to the slightest\\ndegree to one side of the direct line, it will itself be crowded out of the\\narch lingually or buccally (Fig. 799, A). The former occurs much more\\nFig. 799.\\nShowing crowding of bicuspid or canine, or both, out of line (Ottolengui).\\nfrequently. When the canine erupts between the lateral and first bicus-\\npid in proper alignment it will gain space in the line of least resistance,\\nand thus crowding the first bicuspid will force it back against the\\nsecond, which in turn will be crowded still more inside the arch, thus\\nproducing the constricted arch.\\nIf the canine erupts before the bicuspids, it forms with the in-\\ncisors a firm base and is not easily moved on account of its long root.\\nThe first bicuspid erupts next, and the second bicuspid, coming later,\\nwill, for want of room, be crowded inside the arch. The conditions\\nmay not be the same on both sides of the mouth. The crowding may be\\non one side only, producing the semi-saddle arch, or varying on the two\\nsides may produce the semi-saddle on one side and on the other the\\nsemi-V, or the canine may be crowded entirely out of the arch (Class 7).\\nTreatment. The treatment of the constricted arch will depend upon\\nwhether the case is one of normal teeth and a small arch which will\\nadmit of enlarging, or whether the arch when spread would be too\\nlarge for the other features.\\nIf the arch will admit of enlarging, it may be done by banding the\\nteeth that are inside, and applying a jack-screw or Talbot spring be-\\n50", "height": "4572", "width": "2668", "jp2-path": "americantextboo00kirk_0793.jp2"}, "794": {"fulltext": "786\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ntween them, as shown in Fig. 741, thus forcing them outward till they\\nare in proper alignment.\\nIn case of a semi-saddle-shaped arch (Figs. 609 and 610) that is,\\none in which the irregularity is confined to one side three or more\\nteeth on the opposite side should be grouped together for anchorage.\\nIf the case is an aggravated one which will not admit of expansion,\\nextraction must be resorted to selecting, of course, the tooth or teeth\\nmost out of line.\\nClass 13. Lack of Anterior Occlusion. Etiology. This irregu-\\nlarity is generally of constitutional origin, and may be due\\n(a) To lack of development of the ramus of the lower maxilla.\\n(See Fig. 800.)\\n(b) To lack of development of the anterior portion, or\\n(c) To hypertrophy of the posterior portion of the alveolar process.\\n(d) It may be acquired by thumb-sucking, as shown in Fig. 801.\\nThe jaws being held apart thus pre-\\nvents normal eruption of the anterior\\nteeth and consequent development of\\nFig. 801.\\nFig. 800.\\nLack of anterior occlusion (Talbot).\\nLack of anterior occlusion caused by thumb-\\nsucking (Talbot).\\nthe anterior portion of the alveolar ridge, or allows excessive develop-\\nment of the posterior portions.\\n(e) It may be acquired from the habit of mouth-breathing, which,\\nrelieving the molars from pressure, permits abnormal development of\\nthe alveolar process containing them. A case recently occurred in\\nthe writer s practice which illustrates this. The patient was fifteen\\nyears of age, and was a mouth-breather. There was a space of an\\neighth of an inch between the cutting edges of the upper and lower\\nincisors, while three or four years before she could bite off a thread\\nwith these same incisors.\\nThat the opening was not caused solely by the eruption of the\\nsecond molars was shown by the fact that the first molars occluded\\nequally well. The case was reduced by grinding the molars till the", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0794.jp2"}, "795": {"fulltext": "LACK OF ANTERIOR OCCLUSION.\\n787\\nincisors touched, yet not enough of the teeth was removed to render\\nthem sensitive. Figs. 802 and 803 illustrate this case.\\nFig. 802.\\nLack of anterior occlusion.\\nLack of anterior occlusion is often accompanied, as shown in these\\nfigures, by other irregularities, which may be treated subsequently.\\nFig. 803.\\nFirst bicuspid removed to make room for canine occlusal defect remedied by grinding.\\nFig. 804 shows a case due to lack of development of the inter-\\nmaxillary bone. When nine years old both upper central incisors were\\nFig. 804.\\nLack of development of intermaxillary bone\\nknocked out without fracturing the teeth or the process. The writer\\nreplanted the teeth after removing the pulps and filling the canals with\\ngutta-percha. The teeth at that time were about two-thirds erupted,\\nand did not erupt any farther. The growth of the process surrounding", "height": "4544", "width": "2648", "jp2-path": "americantextboo00kirk_0795.jp2"}, "796": {"fulltext": "788 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nthese teeth was arrested and that of the intermaxillary bone and ad-\\njacent part of the upper maxilla retarded as shown. The cast was\\nmade at the age of sixteen, at which time one of the teeth was still so\\nfirm as to permit the insertion of a gold filling, while the other was so\\nloose from resorption of the root that it was extracted. The socket\\nwas deepened and enlarged and a tooth implanted.\\nThe influence of heredity may be prominent in this deformity, several\\nmembers of one family presenting the condition.\\nWhile this irregularity is generally of constitutional origin it is not\\nalways developed till the eruption of the second and third molars, or, if\\nslight, while the first molar is the posterior tooth, is increased in de-\\ngree by the eruption of the second and the third molars, just as a pair\\nof dividers kept open a certain distance by a prop two inches from the\\njoint will be opened farther if a prop of the same height be placed\\nbetween the first one and the joint.\\nThe writer has been fortunate enough to be able to watch the devel-\\nopment, in its later stages, of such a case. The occlusion at the first\\nvisit of the patient was entirely with the second molars, and the cut-\\nting edges of the upper and lower incisors were a quarter of an inch\\napart. As the patient had suffered during childhood from what she\\ncalled bone disease she was afraid to submit to any treatment for\\nbringing the anterior portion of the jaws nearer together. Gold crowns\\nwere placed over the lower first molars, to occlude with upper teeth,\\nand increase the power of mastication. Within two or three years\\nafterward the third molars erupted and opened the jaws to such an\\nextent that the gold crowns lacked more than a sixteenth of an inch\\nof touching the upper teeth. This case was undoubtedly due to the\\nshortness of the ramus of the lower jaw.\\nTreatment. The simplest treatment of such cases is to grind down\\nthe cusps of the occluding teeth. In simple cases this can be done so as\\nto enable the incisors to bite upon each other. (See Figs. 802 and 803.)\\nThe third molars may interfere so much that their extraction will be\\nindicated. By the use of articulating paper the occluding points which\\nneed grinding may be easily located.\\nIn some cases there may be a malocclusion of the cusps only, so\\nthat grinding them away will be sufficient, while in other cases a con-\\nsiderable portion of the tooth must be ground away. Prof. Guilford\\nsuggests grinding as much as possible without causing too great pain,\\nand then administering an anesthetic and continuing the grinding.\\nThe sensitiveness of the exposed dentin may afterward be obtunded\\nby repeated applications of either zinc chlorid, caustic potash [potas-\\nsium hydroxid], or silver nitrate. Where neither of these will avail\\nsufficiently, it may be advisable to devitalize the pulps of two or more", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0796.jp2"}, "797": {"fulltext": "LACK OF ANTERIOR OCCLUSION.\\n789\\nof the teeth most interfering with occlusion, and then continue grind-\\ning until the necessary change is effected. x\\nThe writer has lately applied cataphoresis successfully after having\\nFig. 805.\\nKingsley s appliance for forcing molars into their sockets.\\nground the teeth away till they were quite sensitive. The operation was\\nthus continued two or three times in succession till the required reduction\\nwas effected.\\nFig. 806.\\nKingsley s appliance for forcing molars into their sockets.\\nBy the use of a chinpiece and cap on the head similar to that shown\\nin Figs. 783 and 784 for reducing lower protrusion the anterior por-\\ntion of the jaws may be closed. There are three possible solutions as\\n1 Orthodontia, 2d ed., p. 195.", "height": "4560", "width": "2668", "jp2-path": "americantextboo00kirk_0797.jp2"}, "798": {"fulltext": "790\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFig. 80/\\nto how the change is effected (1) filling up of the glenoid cavity, (2)\\nelongation of the condyle, or (3) the forcing of the molars into their\\nsockets. The latter is the most plausible explanation, judging from\\nexperience in cases of Class 4.\\nFig. 805 shows an appliance devised by Dr. Kingsley for forcing\\nthe upper molars into their sockets, and described by him as follows\\nA frame covered the bicuspids and molars of the upper jaw, with arms\\ncoming out of the corners of the mouth and extending along the cheeks\\nto a point exactly opposite the centre of the pressure required within\\nthe mouth a small wire passed in front of the incisors to keep them\\nfrom springing forward and two elastic straps connected this frame with\\nthe skull-cap exactly as seen in Fig. 806. Both these elastics were re-\\nquired, partly to prevent any tendency of the recently moved incisors\\nfrom carrying the whole apparatus forward, but particularly to keep the\\nproper balance of the skull-cap, the strain of either elastic alone having\\na tendency to pull it out of place.\\nClass 14. Excessive Overbite. Etiology. Overbite as illustrated\\nin Fig. 807 is due (a) to lack of development of the posterior portions of\\nthe jaws and process, or (6) to excessive\\ndevelopment of the anterior portions\\nof the same so that the upper incisors\\nand canines close entirely over the\\nlower and hide them from view, while\\nthe cutting edges of the lower teeth\\nimpinge either upon the necks of the\\nupper or upon the gums behind them,\\nsometimes to such an extent as to\\npenetrate the gum tissue.\\nThis condition is often associated\\nwith other irregularities particularly\\nprotrusion of the upper incisors, of\\nwhich it may be the cause.\\nWhile many cases may be improved by grinding the cutting edges\\nof the lower incisors, it is not always sufficient, as the relative condi-\\ntions remain the same.\\nThe treatment of such cases consists in (a) forcing the upper anterior\\nteeth up into their sockets, (b) depressing the lower anterior teeth in\\ntheir sockets, (c) causing the bicuspids and molars to erupt far enough\\nto overcome the deformity, or (d) all three movements combined.\\nIf the whole fault lies with the upper incisors and canines from their\\nhaving erupted too far, they may be forced up into their sockets by an\\nappliance such as is illustrated in Fig. 808, reported by Dr. Kingsley in\\n1866. It consisted of a gold frame over the cutting edges of the in-\\nOverbite (Talbot).", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0798.jp2"}, "799": {"fulltext": "EXCESSIVE OVERBITE.\\n91\\ncisors and canines. From this frame a post projected from each corner\\nof the mouth, and from these posts strips of brass (detachable) extended\\nupward and backward and were connected by elastic ligatures with a\\nKingsley s appliance.\\ncap on the back of the head. It will be noticed that the attachment to\\nthe cap is above and forward of the ear. The cap should be so adjusted\\nas to bring the pressure as much as possible in a line with the roots\\nunless it be desirable to move the crowns backward at the same time, in\\nwhich case attachment to the\\ncap may be made below the\\near as w T ell as above it, as\\nshown in Fig. 766.\\nFigs. 809 and 810 show a\\nCase s appliance.\\ncase of overbite treated by Dr. C. S. Case, in which, he says, the jaws\\nwere opened by permanently lengthening the posterior teeth. His", "height": "4560", "width": "2668", "jp2-path": "americantextboo00kirk_0799.jp2"}, "800": {"fulltext": "792 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nmethod of treatment he describes as follows I inserted a simple black\\nrubber plate that covered the roof of the mouth and possessed a thick-\\nened portion in front to receive the thrust of the six lower anterior\\nteeth The posterior teeth were thus prevented from forcible\\nocclusion until Nature had produced in them a sufficient growth and\\nfixed them permanently in their extended positions.\\nUnless such a plate rests on the inclined surfaces of the canines (and\\nincisors also, in some instances) the force in biting will cause it to injure\\nthe soft parts on which it rests. To prevent it from moving the canines\\noutward clasps should be extended around them, or the plate should be\\nprovided with a labial bow and clasps or extensions of the plate around\\nthe first or second molars, similar to the plate shown in Fig. 762, except\\nthat the plate should extend forward to the incisor teeth. The bow\\nwill prevent any forward movement of the upper incisors, and may\\neven be used to reduce their prominence by pressure upon them.\\nDr. Cutter 1 of Cambridge, Mass., describes a case in which the\\nposterior teeth were lengthened by a similar plate, and the lower jaw\\nbrought forward at the same time, by so shaping the plate that the\\nlower incisors bit upon an inclined plane. (See Figs. 776 and 777.)\\nDr. Andrews 2 describes a similar case as follows I had a patient\\na little over twelve years of age, the cutting edge of whose lower\\nincisors touched the upper gum so as to irritate it. A platform plate\\nsuch as Dr. Cutter describes was worn for about two months. The\\nFig. 811.\\nWriter s appliance for depressing lower incisors.\\nlower centrals, laterals, and canines struck against the plate and allowed\\nthe bicuspids and molars to elongate. After a time I found there was\\none-eighth to a quarter of an inch space between the lower incisors and\\nthe upper gum in closing the mouth.\\nFig. 695 shows how the writer elongated upper and lower bicus-\\npids and molars so that they could occlude. The same plan might be\\nfollowed with all of the bicuspids and molars at the same time, while\\nthe jaws are held open with such a plate as that shown in Fig. 810.\\n1 International Dental Journal, vol. xv. pp. 353-355. 2 Ibid., pp. 382, 383.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0800.jp2"}, "801": {"fulltext": "EXCESSIVE OVERBITE. 793\\nFig. 811 shows a plan for forcing lower incisors into their sockets.\\nA metal cap is swaged to fit over the occlusal edges. To this is sol-\\ndered a wire which extends out of the corners of the mouth and is bent\\ninto hooks at each end. From these hooks rubber bands extend to a\\nchinpiece. To prevent this chinpiece from sliding forward it is neces-\\nFig. 812.\\nDavenport s appliance for raising the bite.\\nsary to extend a tape from it around the patient s neck. This appliance\\nwas suggested by the interdental splint.\\nFig. 812 shows an appliance for raising the bite, by Dr. W. S.\\nDavenport, exhibited at a meeting of the American Dental Society of\\nEurope, Aug. 5, 1895. The means employed for correcting the irreg-\\nFig. 813.\\nCase s appliance for raising the bite.\\nularity was to insert a bridge appliance, which was fastened by means\\nof gold caps to the second molars, and brought forward a few lines\\nabove the molars and bicuspids, resting with a gold saddle on the six\\nfront teeth. In two weeks the arch was spread and the teeth were", "height": "4564", "width": "2648", "jp2-path": "americantextboo00kirk_0801.jp2"}, "802": {"fulltext": "794 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ndrawn up to a normal position by the use of ligatures which were\\nlooped around the bicuspids and molars, and fastened at the lingual\\nsurface, then tied to the masticating surface of the bridge above. 1\\nFig. 813 shows an appliance of similar character devised by Dr.\\nC. S. Case. 2 The object of the appliance is to depress the lower incisors\\nin their sockets, and raise the bicuspids, and first molar also, when\\npossible, so as to change the whole line of occlusion and open the bite.\\nOn each molar first or second according to the age of the patient\\nis placed a hollow crown, on the buccal surface of which is soldered\\nan open tube or trough, opening upward. On each bicuspid is soldered\\na band with a buccal hook pointing downward, also on the first molar\\nif the second has been used for supporting the hollow crown. On the\\nincisors are cemented bands with hooks turned upward. A labial bow\\nof elastic German silver or piano wire has its ends inserted in the\\ntroughs of the hollow crowns, its front resting above the hooks on the\\nincisors and its sides pressed under the hooks on the bicuspids and\\nfirst molar. The action is such as to depress the incisors and elevate\\nthe bicuspids and, if possible, the first molar also. The hollow crown\\nshould be high enough to open the bite the required distance.\\nClass 15. Separation in the Median Line. The simplest treatment\\nof this irregularity is to draw the centrals together with a rubber band or\\nwith twisted silk or linen ligatures passed two or three times around the\\nteeth. They can be retained by a wire band passing around both teeth.\\nIn some cases it is better to cement on the lateral incisors bands\\nwith tubes on the labial surfaces and draw them toward each other by\\nmeans of a long drag-screw, as shown in Fig. 814.\\nFig. 814.\\nAppliance for regulation and retention.\\nThe same appliance serves for retention by adding cement to the\\nscrew behind the nut to prevent its loosening. The advantage of this\\nplan is that the space is left next to the canines instead of between\\nthe centrals and laterals, and also that the centrals will be more easily\\nretained in their new position if they are supported by the laterals. If\\nthe central incisors are far apart and the roots are parallel, they will\\nslant too much when moved together as described. It is necessary\\n1 Dental Review, Feb. 15, 1896, p. 126. 2 Ibid., Dec. 1895, p. 867.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0802.jp2"}, "803": {"fulltext": "MOVING THE ROOTS OF TEETH.\\n795\\nto also move the roots of these teeth the method of performing that\\noperation is described in the following section.\\nMoving the Roots of Teeth.\\nIn the foregoing methods of moving the teeth the apex of the root\\nremains stationary and the crown swings from that point like a pen-\\ndulum. In most cases that is the only movement necessary, in\\nothers it is the only movement possible, yet in many cases it is very\\nundesirable.\\nThe first published appliance for moving the apices of the roots of\\nteeth was that described by Dr. J. N. Farrar. 1 (See Figs. 815 to 818.)\\nFig. 815.\\nFig. 816.\\nFig. 817.\\nFig. 819.\\nThe central incisors were separated as shown in Fig. 815, the roots\\nbeing parallel. In drawing them together by a clamp band (p) the\\nteeth tilted toward each other until they touched at\\nthe mesio-incisal angles Fig. 816). Up to this time\\nthe apices of the roots were practically the fixed points,\\nand the alveolar process between the roots was con-\\ndensed and absorbed as the teeth moved. As soon\\nas the crowns touched each other at the mesio-incisal\\nangles these became the fixed points, and, as the power\\nwas still continued at the necks of the teeth, the roots began to move\\n1 Dental Cosmos, vol. xxiv. p. 190.\\nIncisor guide.", "height": "4560", "width": "2704", "jp2-path": "americantextboo00kirk_0803.jp2"}, "804": {"fulltext": "796\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\ntill they were practically parallel (Fig. 818). To prevent the crowns\\nsliding past each other and overlapping, a guide was constructed as\\nshown in Fig. 819. The same appliance will serve for retention.\\nIf after extracting a crowded lower incisor the teeth on each side\\nof the space are found to lean toward each other, as in Fig. 820,\\nFig. 820.\\nAppliance for moving roots of lower incisor and cuspid.\\nthe roots may be moved toward each other so that the crowns will\\nbe parallel to each other. Dr. C. S. Case has devised an appliance\\nfor this purpose, shown in Figs. 821 and 822. Bands are fitted\\nto the teeth on each side of the space, and sometimes to the second\\ntooth also. From these bands stiff bars extend downward parallel\\nwith the surface of the gum from an eighth to a third of an inch below\\nFig. 821.\\nFig. 822.\\nAppliance for moving roots.\\nthe margin. On the lingual surface similar bars extend about the\\nsame distance. On the free ends of the bars are soldered hooks or\\nheaded pins, so that a rubber band or a ligature can be extended\\nfrom one labial bar to the other, and from one lingual bar to the\\nother. The direction of force is thus brought low enough to move\\nthe roots as well as the crown of the teeth. Suture wire may be\\nsubstituted for the rubber band or ligature for retention.\\nIn some cases of upper protrusion the alveolar process is so promi-\\nnent that when the crowns of the teeth are moved back to the desired", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0804.jp2"}, "805": {"fulltext": "MOVING THE ROOTS OF TEETH.\\n797\\nposition the roots have not moved with them, and the upper lip is\\nstill too prominent. So also in some cases the palatal portion of the al-\\nveolar ridge is so dense that it does not yield readily, and as the crowns\\nmove backward the edge of the process acts as a fulcrum and the ends\\nof the roots move forward. The prominence of the lip is thus increased.\\nIn the World s Columbian Congress, 1893, Dr. C. S. Case showed\\ncasts and models of such cases and appliances by which the roots and\\nthe whole anterior alveolar process can be moved back and the promi-\\nnence of the upper lip reduced to a normal contour. For illustrations\\nand descriptions of this operation the reader is referred to Chapter\\nXXV., and especially to Figs. 847, 853, 854, 855, 896, and 897.\\nFig. 823 shows Dr. Farrar s appliance for moving forward the\\nroots of incisors by working on the lingual side of the arch. The\\nFig. 823.\\nFarrar s appliance for moving incisor roots forward.\\nFig. 824.\\nbase of support is a transpalatal screw-jack, anchored by two clamp\\nbands that embrace the side teeth from this jack to the posterior sides\\nof the necks of the incisors and lying close to the sides of the arch are\\ntwo other screw-jacks to press against these front teeth. To hold these\\njacks upon them, each incisor has upon it a\\nbroad ferrule (cemented) with a U-shaped lug\\non the lingual side, near the gum (see F, in\\nthe lower part of Fig. 823), in which a bar\\nconnecting the anterior ends of the jacks rests.\\nTo hold firmly the end of the crown of each\\nincisor, and prevent them from moving for-\\nward when these jacks are set at work against\\nthe necks of the teeth, the ends are tied to the\\ntranspalatal jack by two wire cords connecting\\nwith a crossbar lodged in other U-shaped lugs soldered to the labial side\\nShowing attachment of cross-\\nbar.", "height": "4560", "width": "2704", "jp2-path": "americantextboo00kirk_0805.jp2"}, "806": {"fulltext": "798\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nof the ferrules near the ends of the teeth, as represented by Fig.\\n824.\\nFig. 825 shows another of Dr. Farrar s appliances for the same\\npurpose, which makes use of a labial bow for retaining the ends of\\nFig. 825.\\nFarrar s appliance for moving roots forward.\\nthe incisors, and omits the transpalatal jack, thus simplifying the\\napparatus.\\nFig. 826 shows Dr. Farrar s appliance for drawing back the roots\\nof upper incisors. The crowns\\nFig. 826. are gtayed by an inside rectan-\\nI gular frame resting in U-shaped\\nlugs at the ends of the crowns\\nand braced against nuts soldered\\nto two anchor clamp bands on\\nthe side teeth. The roots are\\ndrawn back by a labial bow, at-\\nFig. 827.\\nCross section.\\nFarrar s appliance for moving roots back.\\ntached to the clamp bands by screws. Fig. 827 shows a cross section\\nof such an appliance.", "height": "4612", "width": "2776", "jp2-path": "americantextboo00kirk_0806.jp2"}, "807": {"fulltext": "IMMEDIATE MOVEMENT OF TEETH.\\n799\\nImmediate Movement op Teeth.\\nThe forcible rotation of a tooth by the forceps was recommended by\\nMr. John Tomes. 1 He said the operation had been frequently performed\\nby himself and others, without devitalizing the pulp except in one hos-\\npital case that the best age for the operation was eight or nine years\\nthat he had performed it for patients thirteen years of age and for one\\npatient of fifteen. The operation has been performed by many since\\nthen, and for older patients also, being preferred by some to the longer\\nbut less painful plan usually followed.\\nThe beaks of the forceps should be carefully fitted to the neck of\\nthe tooth, which should be protected by sandpaper, emery cloth or lead\\nfoil. Tomes recommends that in some cases the tooth be rotated half\\nway at first, then allowed to rest for a couple of weeks before being ro-\\ntated to place. The operation is confined, of course, to teeth with straight\\nconical roots. Even a slight curve in the root such as is frequently\\nfound with the lateral incisor would render the operation impossible.\\nImmediate Regulating of Inlocked Teeth. Dr. L. C. Bryan 2 has\\nadvocated the immediate movement of single teeth, situated inside the\\nFig. 828.\\narch, especially canines and laterals. The following is his description\\nof the operation The treatment which I have finally adopted is to\\ninject cocain and either partially cut away the thick intervening alveolar\\nprocess with drills and fissure burs, or, when the process is thin, bodily\\nwedge the outer alveolar wall away with a half-round wedge-shaped\\nchisel, by inserting the point of the instrument between the crown and\\nthe bone and forcing it up along the root until enough space is secured\\nfor the tooth to be brought out into place outside the lower tooth. This\\n1 Tomes, Dental Surgery, 2d ed., p. 162. 2 Dental Review, 1892, vol. vi. p. 859.", "height": "4564", "width": "2600", "jp2-path": "americantextboo00kirk_0807.jp2"}, "808": {"fulltext": "800 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nlatter I formerly accomplished by pressing the wedge-shaped instrument\\nor the inner beak of a suitably formed forceps up along the lingual sur-\\nface of the tooth until the crown was forced outward sufficiently to be\\nfirmly grasped. It was then brought gradually out into place.\\nAnother and better plan was by the use of forceps specially made\\nfor the purpose, shown in Fig. 828.\\nFollowing is a description of an operation by Dr. Bryan, at the\\nWorld s Columbian Dental Congress in Chicago, August, 1893, from\\nthe report of the Committee on Clinics l The patient, a fifteen-year-\\nold girl, had a right upper lateral incisor locked behind the lower\\nincisors with sufficient space between the upper central and canine for\\nimmediate regulation. Cocain was injected and a perpendicular incision\\nwas made with a small circular saw through the gum and half through\\nthe alveolar septum on both sides of the root of the lateral from the\\napex of the root to the crown of the tooth. A three-inch flat steel\\nguard, lined on the gum side with rubber of an inch thick, was\\nfitted to the curve of the gum and formed a rest for the long, round\\nfront beak of the forceps the other beak rested against the distal wall\\nof the lateral up to the gum. With slight pressure the connection of\\nthe tooth with the distal alveolar wall was severed, and the tooth came\\nFig. 829.\\nImmediate movement of bicuspid (Cunningham\\neasily forward to its place in the arch in front of the lower teeth, bring-\\ning with it the front wall of the alveolus, firmly attached to the root\\nand ready to heal quickly and reunite with the neighboring borders of\\nalveolus. The apex of the root was not disturbed in its position, so that\\nthe nerve and vessels would remain intact, as will always be the case\\nif the operation is correctly and carefully performed.\\nMoving- Several Teeth by the Immediate Method. Dr. Geo.\\nCunningham of Cambridge, England, began the use of this method in\\n1 Transactions, vol. ii. p. 997.", "height": "4608", "width": "2768", "jp2-path": "americantextboo00kirk_0808.jp2"}, "809": {"fulltext": "IMMEDIATE MOVEMENT OF TEETH.\\n801\\n1886 by forcing with the forceps an inlocked bicuspid into the position\\nof a molar which he had just extracted. The tooth became firm in its\\nnew position, but the pulp did not survive the operation. Figs. 829 and\\n830 were made from photographs of casts of the case, before and after\\ntreatment.\\nFig. 830.\\nImmediate movement of bicuspid (Cunningham). After treatment.\\nFigs. 831 and 832 show casts of a case in which he forced five teeth\\ninto new positions. The following is his description u The patient hav-\\ning been anesthetized (nitrous oxid and ether), the molar was extracted,\\nand after fracture of the alveolar process between the teeth both bicuspids\\nFig. 831.\\nFig. 832.\\nImmediate movement of five teeth (Cunningham\\nwere luxated backward by means of Physick s forceps. The canine and\\nlateral incisor were similarly treated with the additional help of guarded\\nordinary forceps. On endeavoring to luxate the central incisor, owing\\nto a curved and distorted root, it slipped down between the beaks of the\\nforceps, and thus became completely dislocated from its socket and all\\n51", "height": "4548", "width": "2696", "jp2-path": "americantextboo00kirk_0809.jp2"}, "810": {"fulltext": "802 ORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nits normal attachments Considerable force had to be exerted to\\nthrust it into its new position. The teeth were ligated, etc.\\nAmong other directions he gives the following All being ready, cut\\nthe alveolar process with a thin saw -J of an inch to 1 J inches in diameter,\\nnot thicker than note-paper, into such sections as are necessary\\nForceps, elevator, or other instrument is used for pushing, pulling, or\\nrotating the tooth sections into place.\\nHe advises that the teeth should be retained by ligatures of silk or\\nwire or a splint of German silver or platinum bands soldered together,\\nand that the articulation of the teeth be adjusted by grinding, etc.\\nImmediate or surgical regulating is not recommended by these advo-\\ncates for all cases, but only for those in which all circumstances favor\\nit, such as lack of time for other treatment, desire of patient, yielding\\nalveolar process, abundance of room, etc. While it is a possible opera-\\ntion, it will never become a frequent one.\\nCombined Method, Surgical and Mechanical. Dr. Talbot advo-\\ncates the surgical removal of a portion of the alveolar process in\\nFig. 833.\\nSurgical retraction of lower cuspids (Talbot).\\nthe path of the advancing tooth while a tooth is moved by usual\\nmeans, thus avoiding the delay caused by the slow process of\\nabsorption. This is especially advantageous in case of very dense\\ntissue and in cases in Avhich it is difficult to secure sufficient\\nanchorage. By thus removing the chief obstruction, teeth may be\\nmoved by depending on an anchorage that in ordinary cases would be\\nentirely inadequate. He says x\\nFor seventeen years I have adopted surgical treatment, but have\\nnot made public my methods, since incidental conversation with some\\n1 Dental Cosmos, 1896, vol. xxxviii. p. 909.", "height": "4580", "width": "2788", "jp2-path": "americantextboo00kirk_0810.jp2"}, "811": {"fulltext": "IMMEDIATE MOVEMENT OF TEETH.\\n803\\nof the best men from time to time revealed that they had not taken\\nkindly to it. I therefore wished to give it sufficient trial before\\nrecommending it to the profession. I have met with such markedly\\nuniform success that I do not hesitate to recommend it to all practi-\\nFig. 834.\\nSurgical retraction of incisors and cuspids (Talbot).\\ntioners as perfectly safe and reliable with the antiseptic care required\\nin surgical operations. This method consists in removing entirely the\\nalveolar process in the line of travel of the tooth to be moved, leaving\\na small amount of process about the root of the tooth, holding intact\\nFig. 835.\\nSurgical correction of malposed cuspid (Talbot).\\nthe peridental membrane. This is accomplished with coarse-cut Reve-\\nlation burs, or those that will cut in all directions. They can thus be\\nused as drills in certain conditions to be mentioned later on.\\nIf the canines require to be carried backward, make an appliance\\nwith bands about the first and second molars, with cap upon the canines\\nand a bar with screw and nut upon the end, as recommended by Dr.", "height": "4564", "width": "2696", "jp2-path": "americantextboo00kirk_0811.jp2"}, "812": {"fulltext": "804\\nORTHODONTIA AS AN OPERATIVE PROCEDURE.\\nFarrar. Extract the first bicuspid and adjust the appliance use a sharp\\nnew bur dipped in five per cent, carbolic acid or one per cent, corrosive\\nsublimate or listerine. Then, resting the hand against the canine, cut\\nout the palatal and buccal V-shaped plate, making a concave surface\\nof the alveolar process, as illustrated in Fig. 833.\\nIf the upper incisors are to be carried back, cut semicircular\\nspaces just posterior to the teeth to be moved (Fig. 834). To carry a\\ncanine into place which is erupting into the vault of the mouth, remove\\nthe alveolar process in the direction of the line of travel (Fig. 835).\\nIn moving teeth laterally by a jack-screw, it will be found that not\\ninfrequently one tooth moves faster than the other. To bring both to\\ntheir proper position cut out the alveolar process on the side of the\\nslowest-moving tooth, and both will come into proper position (Fig. 836).\\nTo rotate a tooth, cut a circular groove as deep as possible around the\\ntooth, leaving enough process to hold the peridental membrane intact\\n(Fig. 837). In this manner teeth may be moved very rapidly and with-\\nFig. 837.\\nFig. 836\\nSpreading cuspids (Talbot).\\nRotation (Talbot).\\nout much pain. This should always be done by means of screws. By\\nthis method we have the tooth or teeth to be moved completely under\\ncontrol. Any of the teeth in the mouth may be used for the fixed\\npoint of resistance, thus doing away with all unsightly appliances out-\\nside the mouth. When in place, they should be anchored in the usual\\nmanner. Antiseptic washes should be used from time to time, such as\\none per cent, corrosive sublimate, listerine, or five per cent, carbolic acid.\\nIn operations of this nature the peridental membrane and also the\\nperiosteum are apt to be injured. This was the particular question in\\nrecommending it to the profession. Although I have had a few cases\\nof infection, I am quite certain now that such injuries are not of any\\nserious consequence, since with proper precaution no bad results will\\nfollow.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0812.jp2"}, "813": {"fulltext": "CHAPTER XXV.\\nTHE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nBy Calvin S. Case, D. D. S., M. D.\\nI. Influence op the Teeth on the Physiognomy.\\nIn the developmental processes of animal life the teeth have proba-\\nbly been more influential than any of the other organs in shaping the\\nbones of the head especially in determining the physical characteristics\\nof the physiognomy. The physical shape and structure of the jaws\\nconclusively show the influence that the teeth have exerted in different\\nspecies in response to Nature s law to propagate that which would best\\nsubserve them in the performance of their functions. The importance\\nof the teeth, therefore, and their inherent demand upon surrounding\\nanatomical structures for proper means of development, sustenance, and\\nuse, is evidence that they exert, during development, a more or less im-\\nmediate influence in determining the size and shape of the maxillary\\nbones, and thus indirectly are extensively influential in characterizing\\nthe individual shape of the human face.\\nOften the position of the anterior teeth and alveolar process is such\\nas to impress upon the contiguous features, even in repose, certain con-\\nditions which vary from a slight imperfection in esthetic contour to a\\nmost distressing facial deformity. Nor are these dento-facial imperfec-\\ntions always wholly due to a malposition of the teeth, so much as to a\\nlack of normal symmetry in the size or shape of the maxillary bones\\nupon which so large an area of the face is dependent for its contour.\\nThese conditions may have arisen from the direct inheritance of a\\nparental deformity, or from the inharmonious union of unaltered types,\\nas the teeth of one parent and the jaws of another. It is equally true\\nthat the union of harmonious types often results in symmetrical condi-\\ntions which neither parent possesses.\\nAmong local causes, or those which operate after birth in the pro-\\nduction of facial imperfections, may be mentioned habits, impaired\\ndentition, delayed and injudicious extraction of the deciduous teeth or\\nfirst permanent molars, and mal-occlusion.\\nThe influence of the teeth during the time of their eruption (produ-\\n805", "height": "4560", "width": "2700", "jp2-path": "americantextboo00kirk_0813.jp2"}, "814": {"fulltext": "806 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\ncing on the one hand the excessive pressure of large teeth and concomi-\\ntant alveolar development, and on the other a lack of pressure from an\\nirregularity or injudicious extraction) in effecting a change in the in-\\nherent shape or size of the maxillary bones beyond that which the\\nalveolar process is forced to assume to accommodate them, has been a\\nquestion of considerable controversy. It is reasonable to assume, how-\\never, that natural influences exerting a slight force upon the immature\\nmaxillary or other bones, during early stages of their growth, would\\nFig. 838.\\nFig. 839.\\nFig. 840.\\nhave somewhat the same effect that is known to be possible later by\\nartificial force.\\nThe following case will serve to illustrate this principle\\nPatient aged thirteen years. When presented the upper incisors\\nwere fully the width of a tooth posterior\\nto a normal position, and so badly in-\\nlocked, in occlusion, that the crowns were\\nnearly hidden behind the lower. (See\\nFig. 838.) With the exception of the\\nupper canines, which were forced slightly\\nout of alignment, all the other teeth in\\nboth jaws were in proper position and\\nocclusion. (See Fig. 839.) The posterior\\nposition of the inlocked incisors was not\\ndue, in the slightest degree, to a lingual\\ninclination of their crowns, but the re-\\ntrusion extended to the roots as well\\nand seemed to involve the intermaxil-\\nlary process, producing a decided depression of the overlying featureSc\\n(See Fig. 840.)\\nThe probable history of the cause of this condition is as follows\\nThe lower incisors erupted much earlier than the upper, and there being", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0814.jp2"}, "815": {"fulltext": "INFLUENCE OF THE TEETH ON THE PHYSIOGNOMY. 807\\na short-bite occlusion, as soon as the upper incisors began to erupt they\\nbecame inlocked with the lower incisors. At this time the roots and\\nsurrounding processes were in an immature condition. As the crowns\\ncontinued to erupt they slid down the posterior faces of the lower in-\\ncisors, where they were retained during the continued development of\\nthe roots in the opposite direction, the force being sufficient to prevent\\nthe natural growth and development of the entire intermaxillary process,\\nwhich normally would have carried them bodily forward to an harmo-\\n(Before.) (After.)\\nnious position. As the oilier teeth came into place the lateral portions\\nof the jaw were allowed to normally develop in harmony with the natural\\ngrowth of the other parts. Thus the canines and bicuspids were found\\nin their proper relative positions as regards the lower.\\nFig. 842. Fig. 843.\\nForce was applied with the contouring apparatus described in section\\nVI. of this chapter. In less than six months the incisors were carried\\nbodily forward in an upright position, together with the entire surround-\\ning alveolar ridge and intermaxillary process (see Figs. 841 and 842),", "height": "4560", "width": "2696", "jp2-path": "americantextboo00kirk_0815.jp2"}, "816": {"fulltext": "808 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nFig. 844.\\nwith a perfect correction of a very unhappy facial deformity. (See\\nFig. 843.) Fig. 844 is from a photograph taken three years after the\\ncompletion of the operation.\\nIn dental orthopedia we possess the great advantage over general\\northopedia of applying force directly\\nto the bone itself, through the medium\\nof the teeth, without the intervention\\nof the soft and sensitive tissues.\\nThe teeth imbedded in the alveolar\\nprocess, that in turn is firmly united to\\nthe true bone, may be considered, when\\nin the grasp of a regulating machine,\\nas an integral part of it, firmly and di-\\nrectly attached to that part of the bone\\nwe desire to move, and capable of\\nexerting the quality and direction of\\nforce the machine gives to them.\\nThis force being applied unitedly to a number of teeth standing side\\nby side, the surrounding and contiguous bone which is largely a can-\\ncellated structure is carried bodily in the direction of the force not\\nby the fracture of its substance or to any great extent by a metamor-\\nphosis of tissue, but by the bending, condensation and elongation of its\\ncellular structure the whole adapting itself to a new form, in which\\nposition the immediate interstitial tension of its particles is soon relieved\\nand brought to equilibrium by Nature though it may require to be\\nheld in that position for many months before there is an entire relief\\nfrom the inherent tendency to return to the primary position.\\nIn contemplating the treatment of a dental irregularity a careful\\nstudy of the physiognomy in different attitudes of expression should be\\nmade, with the view of determining the relative position of teeth and\\nfacial contours. The value of a careful preliminary facial examination\\nand comparison cannot be overestimated, for it is often the only guide\\nto correct treatment.\\nFor instance, since it has become possible to expand or retract the\\nanterior portion of the upper apical arch with the surrounding bone in\\nwhich the moving roots are imbedded, we are no longer confined to the\\npossibility, and frequent questionable propriety, of permanently moving\\nthe lower jaw forward or backward to correct a facial deformity which\\npertains exclusively to the upper maxillae and middle features of the\\nface.\\nH. Principles of Facial Orthopedia.\\nThe portion of the human face that it is possible to change with a\\ndental regulating apparatus may be said to lie between two diverging", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0816.jp2"}, "817": {"fulltext": "PRINCIPLES OF FACIAL 0RTH0PED1A.\\n809\\nFig. 845.\\nlines which arise at a point below the ridge of the nose and curve down-\\nward to inclose the alee and depressions on either side thence laterally\\nto encircle a portion of the cheek, and downward to inclose the entire\\nchin. (See Fig. 845.)\\nWithin this ovoidal area are the main features of expression.\\nWithin this space the slightest change of\\ncontour will often produce a marked effect\\nupon the entire physiognomy and give a\\ndifferent expression to the countenance.\\nIt is here that an inherited or an acquired\\nlack of symmetry in the size, shape, or\\nposition of the teeth and jaws produces\\nthose marked changes of facial contour\\nwhich characterize different physiogno-\\nmies. This area may be termed the\\nchangeable area in contradistinction to\\nthe more stable features, or unchangeable\\narea.\\nFor convenience of ready reference,\\nthe features in that portion of the change-\\nable area which are bounded laterally by\\nthe naso-labial lines may be divided into four segments as follows\\nSegment 1. The end of the nose and the upper portion of the upper\\nlip, including the naso-labial depressions.\\nFig. 846.\\nUnchangeable area\\nChangeable area\\nSegment 2. The lower portion of the upper lip.\\nSegment 3. The lower lip.\\nSegment 4- The chin.", "height": "4556", "width": "2696", "jp2-path": "americantextboo00kirk_0817.jp2"}, "818": {"fulltext": "810 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nIn the preliminary examination of the physiognomy from a purely\\nesthetic standpoint with a view of correcting a dento-facial deformity\\nor imperfection by applying force to the teeth, there are certain promi-\\nnent features to be especially observed and their relative position care-\\nfully noted. These may be divided into two classes first, those which\\nlie in the unchangeable area, as the forehead, bridge of the nose, and\\nmalar prominences; second, those in the changeable area.\\nThe four segments in the latter class shown in Fig. 846 are change-\\nable in their relations to each other, and also in their individual relation\\nto features in the unchangeable area. For instance, it is possible to pro-\\ntrude or retrude the upper portion of the upper lip with the depressions\\non each side of the nose, the nasal septum, and the end of the nose,\\nwithout changing the lower portion of the upper lip in its relation to\\nother parts. (See Fig. 855.) The same is true of the other segments\\nin fact, a retrusion of the second segment and a protrusion of\\nthe first may be accomplished at the same time. (See Figs. 853\\nand 854.)\\nIf the lower jaw be mechanically protruded or retruded bodily, the\\nlower lip will of necessity be carried forward or backward with the\\nchin, unless a special operation is performed on the lower teeth to pre-\\nvent it from changing its relations to the upper lip.\\nThose portions of the changeable area which lie over the bicuspids\\nand first molars shown in Figs. 845 and 846 and separated from the\\nlips by the naso-labial lines, may be considered as separate segments, as\\nthe causes which influence a change in the contour of the cheeks differ so\\ndecidedly from those which change the more anterior areas. The lateral\\nexpansion or contraction of the dental arches will often change the con-\\ntour of the cheeks with no effect upon the labial area, if the anterior\\nteeth remain unchanged in position. Again, a decided retrusion of the\\nanterior teeth and process with no lateral expansion of the arch will\\ninvariably result in giving to the cheeks a fuller contour, by relieving\\nthe tension of muscular tissues. The same result will often be obtained\\nin closing the characteristic open bite of a mouth-breather by grinding\\nthe posterior teeth, and also by retracting a prognathous lower jaw.\\nIn a study of profiles we frequently observe a lack of perfect har-\\nmony in the position of the chin. The lower jaw is apparently\\nprotruded, or retruded, so as to mar the esthetic perfection of the\\nphysiognomy, and yet were these same faces examined by a trained\\nobserver he would find in a large proportion the lower jaw in perfect\\nharmony with the unchangeable area, and that the appearance of its\\nmalposition was an effect due wholly to a protrusion or retrusion of the\\nupper jaw and teeth. In other words, it is a common error to imagine\\nthe chin imperfectly posed because it is not in harmonious relations to", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0818.jp2"}, "819": {"fulltext": "UPPER DENTAL AND MAXILLARY PROTRUSIONS. 811\\nthe other features of the changeable area, instead of comparing it,\\nas we should do, to the more stable or unchangeable features of the\\nphysiognomy.\\nIn examining the physiognomy of a patient, the head should be in\\nan upright position, on a line with that of the observer, and the face\\nstudied from different angles while in repose and in action.\\nAVhile looking at the profile in repose the most important thing to\\ndetermine is the relative position of the chin with the forehead, malar\\nprominences, and bridge of the nose. If its position is harmonious\\nwith the unchangeable area and the lower lip is well posed, it indicates\\nthat the operation of facial contouring should be performed if any-\\nwhere upon the upper jaw and teeth. For if the first and second seg-\\nments are abnormally protruded it will cause a chin to appear retruded\\nthat is perfectly harmonious in its relations to the principal features of the\\nface. (See Fig. 847.) Again, a retruded or contruded upper arch with\\na depression of those features which are supported by the upper maxilla?\\nwill cause a perfectly posed lower jaw and chin to appear protruded or\\nprognathous as instanced by the cases illustrated in sections I. and IV.\\nin which the facial effect, before treatment, was that of protruded lower\\njaw, but which were perfectly corrected by an anterior movement of\\nthe upper incisors and intermaxillary processes.\\nHI. Upper Dental and Maxillary Protrusions.\\nFigs. 847 and 848 will serve to illustrate the class of facial de-\\nformities known as abnormal upper protrusions, and the advantage of\\nretruding the upper anterior teeth and surrounding process.\\nFig. 847.\\nIn Fig. 847 wide interdental spaces between the upper teeth per-\\nmitted the reduction without extracting. In Fig. 848 the upper first\\nbicuspids were extracted.", "height": "4564", "width": "2680", "jp2-path": "americantextboo00kirk_0819.jp2"}, "820": {"fulltext": "812 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nIf the operation of jumping the bite were performed in these\\ncases, there would no doubt be an improvement of the original appear-\\nance of the physiognomy, by the bringing of the chin and lower lip\\ninto more perfect harmony with the upper but this would not be cor-\\nrect treatment, because, as will be observed, the chin is in not far\\nFig. 848.\\nfrom perfect position when compared with other features of the un-\\nchangeable area.\\nThe principles involved in the correction of this class of facial\\ndeformities may be diagram matically illustrated as follows\\nFig. 849.\\nFig. 850.\\nFig. 849 is a profile view of a typical case of abnormally protruded\\nupper jaw. It will be observed that the chin appears retracted.\\nFig. 850 shows the improved effect that would be produced by", "height": "4608", "width": "2736", "jp2-path": "americantextboo00kirk_0820.jp2"}, "821": {"fulltext": "UPPER DENTAL AND MAXILLARY PROTRUSIONS.\\n813\\njumping the bite in bringing segments 3 and 4 into more perfect\\nharmony with segments 1 and 2 yet not to be compared with that per-\\nfection of symmetrical contour shown by Fig. 851, where the chin and\\nlower lip are permitted to remain in their original harmonious position\\nwhile the end of the nose and upper lip are retruded into harmony with\\nthe whole.\\nThe three faces have been made exactly alike with the exception\\nas shown by the cross lines of certain mechanical movements of the\\nprofile outlines in the changeable area. In Fig. 850 the outlines of\\nsegments 3 and 4 are forced farther forward, and in Fig. 851 segments\\nFig. 851.\\nFig. 852.\\n1 and 2 are carried back as they would be by a retruding apparatus\\nattached to the teeth.\\nIn comparing Figs. 849 and 851 the difference in esthetic effect is\\nquite striking, and it is one also which would seem to be hardly possible\\nwith so little change in the outlines of a comparatively small area. By\\ncutting a piece of black paper to the exact outlines of Fig. 851 and\\nplacing it upon Fig. 849 the real and only difference in the two figures\\ncan be plainly seen as in Fig. 852.\\nWhen such a change is produced in the features of a human face the\\ndifference is greatly enhanced because of the harmonious perfection of\\nother contours not shown by the figures.\\nIt is a noteworthy fact that a very little change in the peripheral\\nshape or position of certain bones of the face on which the features are\\ndependent for their character and form a change so trifling that it could", "height": "4564", "width": "2688", "jp2-path": "americantextboo00kirk_0821.jp2"}, "822": {"fulltext": "814 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nhardly be measured resulting in a slight filling out or depression of\\ncertain contours, will often beautify to a remarkable degree the ap-\\npearance of a face that would otherwise be quite plain and unattractive.\\nThis is true of all the more common cases of upper protrusion and\\nretrusion which show an abnormal prominence or depression along the\\nupper as well as the lower portion of the upper lip, and especially of\\nthose which seem to involve the entire intermaxillary process, influ-\\nencing the antero-posterior position of the wings and end of the nose.\\nIn cases of protrusion, by applying a retracting force especially\\ndirected to the roots and crowns of the anterior teeth, the surrounding\\nalveolar process and anterior portion of the maxillae will be forced\\nback, allowing the upper lip to fall into a more graceful and easy pose,\\nleaving the nostrils less broad and open, the upward curve of the nose\\nstraightened, and its pug-like appearance removed.\\nWhen an upper protrusion is due alone to a labial inclination of\\nlarge crowded teeth, with no marked protrusion over the apical zone, or\\nin segment 1, the extraction of the first or second bicuspids is indicated,\\nand the application of force to the crowns at such points and in such\\ndirection as will best overcome the malposition.\\nMany instances have arisen, in the practice of dentists who were\\nopposed to the extraction of teeth, where the above condition has\\nactually been produced in the operation of crowding irregular teeth into\\nalignment that were too large for an already perfectly harmonious\\nmaxillary arch. (See Figs. 875 to 878 inclusive, in section V.)\\nThere are innumerable instances where a labial inclination of both\\nthe upper and lower anterior teeth produces a pronounced protrusion of\\nthe lips with a very unpleasant expression in their management, espe-\\ncially if in occlusion the lower anterior teeth are even with, or in front\\nof, the uppers. The fact that the most natural occluding position of\\nthe lower front teeth is somewhat posterior to the upper teeth permits\\nthe graceful curve of the lower lip which is so necessary to the esthetic\\nperfection of the chin.\\nIn order to correct a pronounced facial deformity of this character\\nproduced by large teeth crowded into arches that are too small for them,\\nbut otherwise harmonious in size, it will often be necessary to extract a\\nbicuspid from each side from both the upper and lower jaws. Some-\\ntimes the extraction from the lower of a central incisor will be suf-\\nficient.\\nInstances frequently arise where the position and labial inclination\\nof the upper anterior teeth produce a relative protrusion of the incisal\\nzone and a contrusion of the apical, with a protrusion of the lower\\nportion of the upper lip and a slight depression of the upper portion,\\ndeepening the naso-labial depressions. If the depression of segment 1", "height": "4608", "width": "2736", "jp2-path": "americantextboo00kirk_0822.jp2"}, "823": {"fulltext": "UPPER DENTAL AND MAXILLARY PROTRUSIONS.\\n815\\nbe not too pronounced, it may be restored by a slight forward movement\\nof the anterior apical zone, accomplished in the retrusion of the incisal\\nzone by force applied at the incisal ends of the teeth alone, with the\\nview of producing, as far as possible, a fulcrum force at the lingual\\nmargins of the alveoli.\\nIf the malformation is produced by an inharmonious union of\\nFig. 853.\\nmaxillae and teeth, as in the former case, the extraction of an upper\\nbicuspid from each side will be indicated. Figs. 853 and 854 were made\\nfrom the models of a case of this character, before and after treatment.\\nThe upper first bicuspids had been extracted some time before the\\npatient presented for treatment.\\nIn contradistinction to this class of deformities, there is another\\nFig. 854.\\nquite as common though not so frequently recognized as an abnor-\\nmality in which all the conditions are reversed, in that the teeth have\\na lingual inclination with protrusion of the apical zone and maxillae.\\nThe teeth of these cases are commonly regular in alignment, and\\nowing to their lingual inclination the occlusal zone may be in proper\\nrelative position. (See Fig. 855.)", "height": "4556", "width": "2688", "jp2-path": "americantextboo00kirk_0823.jp2"}, "824": {"fulltext": "816 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nThe facial imperfection which consists principally in a prominence\\nor bulging along the higher portions of the upper lip and in the region\\nof the nasal alee is often quite pronounced. When this is caused partly\\nby the canine roots the difficulties are much increased in the case of\\npatients older than thirteen. The fact that the roots of the canines are\\nsurrounded by the most dense portion of the alveolar process, and their\\nmovement bodily in a posterior direction requiring the resorption of a\\nlarge portion of bone, makes this operation one of the most difficult in\\ndental orthopedia.\\nFig. 855 is from the models of a patient over twenty years of age,\\nFig. 855.\\nand will serve to illustrate a case before and after treatment of abnormal\\nprotrusion of the roots of the upper anterior teeth, alveolar process and\\nmaxillae the axis of the incisors being inclined lingually.\\nIt will be observed that the canines have been moved bodily in a\\nposterior direction notwithstanding the advanced age of the patient.\\nIf regulating appliances are properly constructed that will permit\\nthe production of an independent static fulcrum at the occlusal ends of\\nthe teeth, so that the entire power of the machine may be directed and\\nmaintained upon the roots (see Figs. 896 and 897, in section VI.) per-\\nfect contrusion of the prominence will slowly but surely result.", "height": "4580", "width": "2736", "jp2-path": "americantextboo00kirk_0824.jp2"}, "825": {"fulltext": "UPPER DENTAL AND MAXILLARY RETRUSIONS. 817\\nIf the teeth are crowded, overlapping, or turned on their axes, a\\ncorrection of alignment may require the extraction of a bicuspid on\\neach side in order to regulate them without an abnormal protrusion of\\ntheir crowns. This is especially indicated when much retrusion of the\\ncanine roots is desired.\\nIV. Upper Dental and Maxillary Retrusions.\\nFacial imperfections which are due to insufficient fulness of contour\\nin the central features of the physiognomy are quite common, and vary\\nin degree from conditions that are hardly noticeable to those which may\\nwell be classed among the most unhappy of facial deformities.\\nThere are two distinct classes of this type of facial irregularity\\none being due to a lack of development of the intermaxillary portion\\nof an otherwise harmonious upper jaw the other to the fact that the\\nentire upper jaw itself is too small and too posteriorly placed, in its\\nrelations to other parts.\\nThe teeth and alveolar process of the retracted parts are prevented\\nfrom assuming harmonious relations, and consequently the overlying\\nfeatures are more or less depressed in proportion to the contruded or\\nretruded frame upon which they depend for their contour.\\nThe primary cause of these conditions may be often very obscure\\nand admit of nothing more tangible than conjecture, and, not unlike\\nmany of the causes of irregular teeth, be really immaterial to the work\\nof correction.\\nIt may have been caused by the exertion of local physical forces\\nduring the early years of immaturity (as, for instance, the mal-eruption\\nand occlusion of the teeth) or a local disturbance and interruption of\\nnutrition from prenatal or postnatal causes and lastly, but by no means\\nrarely, by inherent physical tendency.\\nClass 1 Retruded Upper Incisors and Intermaxillary Process.\\nIn the more pronounced deformities of this class the physiognomy\\nwill often appear flattened, with prominent cheek bones and protruding\\nchin and lower lip the upper incisors occlude evenly with or posterior\\nto the lower incisors, and at times are extensively inlocked in this posi-\\ntion, as instanced by the case fully described and illustrated in section I.\\nThe upper incisors, Avhich alone have their origin in the intermax-\\nillary process, are in their entirety posterior to a normal relative posi-\\ntion. The labial inclination of the crowns, together with the deepened\\nincisive fossse, will show at once the contruded position of the roots and\\ntheir maxillary surroundings.\\nThe upper lip resting upon the retruded teeth and the overlying\\nprocess is proportionately depressed. Nor does the facial defect end\\nhere. The entire lower portion of the nose, supported as it is by the\\n52", "height": "4560", "width": "2608", "jp2-path": "americantextboo00kirk_0825.jp2"}, "826": {"fulltext": "818 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nFig. 856.\\nnasal cartilages which spring from the anterior nasal spine and lateral\\nborders of the nasal orifice, is often decidedly affected in shape by the\\nretracting influence of its supports.\\nWhen there is a decided retrusion of the entire upper lip and lower\\nportion of the nose, with alse resting in deep depressions caused by the\\nunusual prominence of the naso-labial\\nfolds, the effect is that of an abnormal\\nprotrusion of surrounding parts, pro-\\nducing at times a startling expression\\nof maturity that is only common to\\npersons of advanced age. This expres-\\nsion can be seen in Fig. 856, which is\\nthat of a girl only twelve years of age,\\nand will serve as a type of cases com-\\nmonly met with in practice.\\nClass 2 Retruded and Contracted\\nDental and Maxillary Arch. In this\\nclass of deformities the physiognomy,\\nin the more pronounced cases, has much the same characteristics as\\nthose described above, but presenting a more general retraction of\\nthe central features, with less pronounced naso-labial folds. The nose\\nis often thin and the nostrils pinched and though the end of the nose\\nmay be depressed, the distance from the tip to the more depressed lip\\nis often lengthened. If the patient is a mouth-breather with the\\nFig. 857.\\nFtg. 858.\\ntypical open bite, the deformity and the difficulties attending its\\nreduction will be greatly increased.\\nFig. 857 is from a profile model of a face of this class. Fig. 858\\nis from the same model photographed at a slightly different angle to\\nshow the angularity of the features.\\nFig. 859 is a view of the teeth in natural occlusion. The first lower", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0826.jp2"}, "827": {"fulltext": "UPPER DENTAL AND MAXILLARY RETRUSIONS. 819\\nbicuspids have been removed preliminary to retruding the anterior teeth\\nto reduce the abnormal protrusion of the\\nlower lip and esthetically deepen the\\ncurve between the border of the lip\\nand the chin. The figure has the ap-\\npearance of a perfect occlusion of all\\nthe molars, whereas, on account of the\\nvery great narrowness of the upper jaw,\\nthe buccal cusps of the second molars\\nonly, occluded with the lingual cusps\\nof the lowers.\\nFig. 860 shows palatal views of the\\nupper arch before and after treatment.\\nFig. 861 is a view of teeth in natural\\nocclusion after treatment. The entire upper dental arch, especially at\\nthe apical zone, was considerably enlarged. The open bite was par-\\ntially closed by grinding the molars and partly by extruding the teeth\\nanterior to the molars with small rubber bands extending from the\\nupper to the lower teeth. Fig. 862 is from a model of the face after\\ntreatment.\\nAs mentioned in section II., a depression of the central features\\nsuch as described is often mistaken for a prognathous jaw, and treated\\naccordinglv.\\nFig. 860.\\nA slight retraction of the lower jaw will in nearly every case of this\\ncharacter produce an improvement in the facial aspect, because the chin\\nand lower lip are brought into more perfect harmony with the depressed\\ncentral features. Such a change, however, when it is not demanded,\\ncan never cause the beautifying effect produced by forcing the depressed\\nfacial features in segments 1 and 2 forward, thus bringing into per-\\nfect harmony the entire physiognomy.\\nThis can be verified with any profile view of a typical case as Fig.", "height": "4548", "width": "2704", "jp2-path": "americantextboo00kirk_0827.jp2"}, "828": {"fulltext": "820 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\n863. Fig. 864 is the same face, except that the chin and lower lip have\\nbeen retruded, producing a certain improvement, but not to be com-\\npared with Fig. 865, where the chin and lower lip retain the same\\nrelative position to the unchangeable area as in Fig. 863, while segments\\nFig. 861.\\nFig. 862.\\n1 and 2 have been carried forward, with a result which proves (not\\nalone in theory, but in practice) this to be the only true course to bring\\nabout an harmonious and esthetic adjustment of all the features of the\\nphysiognomy. Fig. 866 shows the actual difference, which may be\\nverified upon trial, between Figs. 863 and 865.\\nFig. 867 will serve to illustrate the common result in practical oper-\\nations of this character.", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0828.jp2"}, "829": {"fulltext": "UPPER DENTAL AND MAXILLARY RETRUSIONS. 821\\nThe contouring apparatus (Fig. 895) that is used to accomplish these\\nFig. 865. Fig. 866.\\nresults is fully described in section VI. of this chapter. With it the\\nFig. 867.\\napical zone of the anterior teeth may be enlarged and advanced to any", "height": "4560", "width": "2696", "jp2-path": "americantextboo00kirk_0829.jp2"}, "830": {"fulltext": "822 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOVBS.\\ndesired degree while the movement and inclination of the crowns are\\nunder the perfect control of the operator.\\nIn this operation it will be found in a majority of cases, and espe-\\ncially with those which are begun as early as thirteen or fourteen years\\nof age, that the entire intermaxillary portion of the upper jaw may be\\ncarried bodily forward with the roots of the incisors.\\nThe depressed features of the physiognomy in segments 1 and 2\\nthat are dependent for their contour upon that portion of the max-\\nillae are thus brought into perfect harmony with other features of the\\nface.\\nIt is not here implied that there are not many cases of real prog-\\nnathous jaw where its retraction, if possible, would produce a most\\ndesirable result nor that such an operation is impossible if recognized\\nand treated sufficiently early with properly adjusted apparatus per-\\nsistently worn. The body of the lower jaw can certainly be forced back\\nto a more posterior position in its relations to the upper, partly by bend-\\ning the rami and necks of the condyles, and partly by absorption of the\\nposterior wall of the glenoid fossae.\\nThe many failures that have attended these operations have been\\nlargely due to the advanced age of the patients and much to the fact\\nthat the apparatus is dependent upon the will or caprice of the patient\\nfor its persistent application.\\nOn account of the early maturity and ossification of the lower\\nmaxilla, these operations should be undertaken as early as from five to\\nten years of age.\\nThe caps fitted to the head and chin should be made to exert a uni-\\nform pressure over the surfaces upon which they rest, admit of free\\nventilation, and the whole apparatus when in place should have no\\nprojecting parts which will interfere with the comfort of the patient at\\nnight.\\nFine wire gauze answers admirably for the body of caps. It can be\\ncut and readily shaped to any contour. First cut a narrow pattern of\\nthick paper to accurately fit the zone indicated by the desired border of\\nthe skull-cap. Duplicate this in thin tin solder the free ends together\\nand fit to the head to see that it takes the proper position and desired\\nflare. Cut the pieces of gauze a little in excess of the required size\\nand force it into the rim, where it should be tacked at one point only,\\nwith soft solder. The adjustment is finally perfected by again fitting it\\nto the head and a line drawn along the borders where it is to be com-\\npletely soldered. In constructing the chinpiece, first make a frame of\\nGerman-silver wire, which is then soldered to gauze as shown in Fig.\\n868 the whole to be shaped to produce an even pressure upon the\\nchin.", "height": "4604", "width": "2736", "jp2-path": "americantextboo00kirk_0830.jp2"}, "831": {"fulltext": "PHYSIOGNOMY AND THE SAVING OF TEETH.\\n823\\nFig. 868.\\nThe projecting ends of the wire are bent so as to lie close to the face,\\nand with sufficient extension to prevent\\nthe rubber bands pressing into the\\ncheeks. The ends are doubled toward\\neach other at the proper angle to re-\\nceive the bands.\\nSmall wire triangles serve to attach\\nthe rubber bands to the skull-cap, by\\nmeans of flat buttons sewed to the\\ngauze. Finally, cover the rim of the\\ncap with padded silk ribbon and line\\nthe chinpiece with some loosely woven\\nmaterial, binding the edges with silk.\\nThe skull-cap is admirably adapted\\nalso for applying a retruding force to the upper anterior teeth, by\\nmeans of a bar which engages with an encircling wire attached to\\nmolar anchorages.\\nV. The Relations of the Physiognomy to the Saving and\\nExtraction of Teeth.\\nIn its widest scope this subject includes the propriety of saving, and\\non the other hand, the propriety of extracting certain teeth of the\\ndeciduous as well as the permanent dental arches which in any way\\ninfluence the prevention, the production, or the correction of dento-facial\\nFig. 869.\\nFig. 870.\\nirregularities. Two phases of this subject will be here presented. The\\nfirst will be in regard to the saving or the extraction of the upper bicus-\\npids for patients older than fourteen, to correct a dental irregularity\\nthe second will deal with the early extraction of the bicuspids to pre-\\nvent an abnormal upper protrusion.\\nIn the common form of dental irregularity shown by Fig. 869, espe-\\ncially if only the model of the upper jaw were the subject of study, it", "height": "4552", "width": "2696", "jp2-path": "americantextboo00kirk_0831.jp2"}, "832": {"fulltext": "824 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nwould in all probability be decided to extract the first bicuspids as the\\nbest course to pursue as a first step toward securing a perfect alignment\\nof the dental arch and the proceeding would probably be correct as far\\nas the upper teeth alone were concerned. And again, if both upper and\\nlower models were studied in occlusion and the irregularity of the lower\\narch was as is usually the case in correspondence with that of the\\nupper, as shown in Fig. 870, the extraction of the lower first bicuspids\\nwould doubtless, and correctly, be decided upon. This plan of correc-\\ntion might even be decided upon after a superficial study of the face of\\nthe patient, which we may suppose to be similar to that shown in Fig.\\n871. Certainly the extraction of the lower first bicuspids, which have\\nFig. 871.\\njust begun to erupt, and the retraction of the anterior teeth would\\nreduce the apparent protrusion of the lower lip and bring it into more\\nperfect harmony with the depressed upper lip.\\nYet when this face is carefully studied from the higher standpoint\\nof esthetic development it becomes evident that the chin and lower lip\\nare not protruded, in their relations to the malar prominences, the bridge\\nof the nose, and the forehead, but that the central features of the physi-\\nognomy are depressed even to a decided retraction of the lower portion\\nof the nose and that which is really demanded in this case is the ad-\\nvancement or forward movement of the entire intermaxillary portion of\\nthe jaw and incisor teeth and further, every tooth in that dental arch\\nis necessary for the ultimate retention of the several parts in their\\ncorrected position.\\nIn the correction of malformations which demand the protrusion of\\nthe incisors bodily with the roots and intermaxillary process, the posi-\\ntion of the canines, as in this case, will frequently prevent the proper\\nattachment and application of apparatus for producing the desired\\neffect so that it often becomes necessary to first enlarge the dental arch\\nand force the crowns into partial alignment by ordinary means, pre-", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0832.jp2"}, "833": {"fulltext": "PHYSIOGNOMY AND THE SAVING OF TEETH\\n825\\nparatory to placing the incisors in the grasp of contouring forces. Fig.\\n872 shows the position of the teeth in this case in the intermediate\\nstage, the anterior teeth crowded into imperfect alignment, and with\\nno special facial improvement. (It may be added that at this stage\\nthe operation, cases of this kind have been considered finished,\\nm\\nuntil it was found possible to enlarge the apical arch.)\\nFig. 873.\\nFig. 874.\\nFig. 873 shows correctly the final result, which was accomplished\\nwith the contouring apparatus described in section VI. It will be\\nseen that the incisors are in an upright position and there is now\\nample room for all the teeth, while the remarkable improvement to the\\nphysiognomy is poorly shown by the face model Fig. 874.\\nAnother case, that of the upper arch, Fig. 875, if examined alone\\nFig. 87G.\\nand compared with the upper of the former case, or Fig. 869, will be\\nfound very similar. The same crowded condition of the teeth, the same\\nlack of sufficient room for the proper eruption of the canines and yet\\nthis is from the model of a case that absolutely demanded the extraction\\nof the bicuspids. At fourteen years of age the irregularity presented\\nthe appearance shown in the illustration Fig. 876, showing the models", "height": "4556", "width": "2696", "jp2-path": "americantextboo00kirk_0833.jp2"}, "834": {"fulltext": "826 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nof the case in occlusion. The patient was placed in charge of a dentist\\nwho attempted the correction of the irregularity without removal of the\\nfirst bicuspids Fig. 877 shows the result two years afterward.\\nIt will be seen that the incisors were forced forward to a decided\\nlabial inclination, for the purpose of crowding the canines into align-\\nment and all the anterior teeth are turned on their axes so as to\\noccupy the least possible space. Fig. 878 is from the model of the face\\nof the patient at that time.\\nThat a mistake was made in the plan of treatment pursued is evi-\\ndenced by the following considerations First, the protrusion of the\\ncrowns of the upper anterior teeth produces an unhappy expression\\nof the mouth that is equivalent to a deformity, and one that could not\\nbe remedied in this particular until certain members of the dental arch\\nwere removed. Second, if it were a case in which the maxillary arch\\nwas too small, with a depression of the overlying features of the face,\\nFig. 877.\\nFig. 878.\\nthe decided labial inclination of the teeth could be overcome by an\\nenlargement of the apical zone, which would have permitted a slight\\nretrusion of the occlusal zone with a partial, if not complete, regulation\\nof the dental and facial deformity. But this was not the condition,\\nand therefore could not be considered. The third and most effective\\nargument is one which should never be overlooked in all cases where\\nthe crowns flare outward. The conical shape of the teeth permits them\\nto stand in perfect alignment though with a decided labial inclination,\\nbut in this position the interproximal spaces so necessary to the preser-\\nvation of the teeth are so completely closed as to cut off the union of\\ninterproximal gum tissue, which must ultimately result in the resorp-\\ntion of the gum and alveolar process and all the dire consequences that\\nfollow.\\nHad the first bicuspids been extracted, many difficulties in the regu-\\nlation of the teeth would have been removed and what is of far", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0834.jp2"}, "835": {"fulltext": "PHYSIOGNOMY AND THE SAVING OF TEETH\\n827\\ngreater importance, there would have been a satisfactory result in the\\ndental arch and physiognomy. Or even further, had the upper first\\nbicuspids been extracted as soon as they erupted, together with the\\ndeciduous canines, as will be outlined in the second phase of the subject,\\nthe case would have required little or no other treatment.\\nFig. 879 shows the present position of teeth after regulation, bv re-\\ntruding the anterior teeth to fill spaces caused by the extraction of the\\nbicuspids. Fig. 880 is from a model of the face after treatment. It\\nFig. 879.\\nFig. 880.\\nFig. 881,\\nwill be seen that the interproximal spaces between the teeth are restored,\\nwhile the retrusion of the anterior teeth allows the lips to fall gracefully\\ninto proper position. The improvement in the facial aspect of this and\\nall other cases cannot be fully shown\\nby a plaster model of the face. Fig.\\n881 was made from a photograph of\\nthis patient, taken a few months after\\nthe completion of treatment.\\nThere are many instances where the\\nearly extraction of the bicuspids, as soon\\nas they can be reached with the forceps,\\nis demanded.\\nFor example, adult faces with ab-\\nnormal protruding upper jaws and\\nteeth, and with a bulged appearance\\nabout the lower portion of the nose\\nshould have been thus treated. The teeth are commonly large, prom-\\ninent, and crowded, though not always labially inclined.\\nThe ordinary upper protrusions which come under this head are\\nso common they will require no further explanation or illustration.\\nUpper protrusions where the teeth are not labially inclined are not\\nquite so common.", "height": "4560", "width": "2680", "jp2-path": "americantextboo00kirk_0835.jp2"}, "836": {"fulltext": "828 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nThe alveolar arch is necessarily prominent, though the deformity in\\nthe main, as in the more common forms of protrusion, is due to the\\nlarge size of the upper maxilla proper, far out of proportion to the\\nmore delicately chiseled features which it supports and forces into unsym-\\nmetrical contours. The depressions in which the wings of the nose rest\\nare more or less obliterated, as would be occasioned by the sting of a\\nbee or an alveolar abscess. The nostrils are broad and open, and the\\nend of the nose forced forward and upward [retrousse) by the protrusion\\nof the spinous process and cartilaginous septum. The upper lip being\\nstretched over its inharmonious frame is shortened so as to cover the\\nteeth with difficulty, and in action readily rises to an unpleasant ex-\\nposure of the teeth and gums.\\nThis is an extreme, though not uncommon, condition. Every stage\\nfrom this to perfect harmony characterizes the innumerable varieties of\\na certain type of physiognomy.\\nFig. 882 is from the face model of a young man, eighteen years of\\nage, and may be taken as a type of this character of facial deformity.\\nFig. 882.\\nFig. 883.\\nFig 883 shows the teeth in occlusion. The canines and canine emi-\\nnences are very prominent, and extend high up under the wings of the\\nnose.\\nHad this case received the early treatment here advocated, the\\ndeformity would have been prevented and the almost insurmountable\\ndifficulties attending its reduction during nearly three years of constant\\ntreatment altogether avoided.\\nAny one who has never attempted to move the roots of the canines\\nin a posterior direction for patients older than sixteen cannot begin to\\nappreciate the difficulties of such an operation.\\nAnd while the result is quite satisfactory under the circumstances,\\nas will be seen by Figs. 884 and 885, the physiognomy is not nearly", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0836.jp2"}, "837": {"fulltext": "PHYSIOGNOMY AND THE SAVING OF TEETH.\\n829\\nso perfect esthetically as it would have been had the case received proper\\nearly treatment.\\nThe important consideration from a surgical and artistic standpoint\\nin nearly all cases of abnormal upper protrusion is Has not Nature\\nbeen forced to produce these conditions, wholly or in part, to accommo-\\ndate teeth that were too large for the natural or inherent frame and\\noverlying features And could we have helped Nature in the early\\nyears of development, by making it unnecessary for her to produce this\\nexcessive growth of bone for the development and sustenance of all\\nthese large teeth?\\nThe same is true where the protrusion seems to have been caused\\nby the inheritance of an inharmoniously large jaw crowded full of\\nteeth.\\nWe certainly cannot reduce the size of the teeth, but we can reduce\\ntheir number, and in so doing reduce the size of the destined maxillary\\nFig. 884.\\nFtg. 885.\\nand dental arch. But we must make no mistake. The danger of ad-\\nvocating such a principle to those who have given this branch of den-\\ntistry little thought is that teeth will be extracted to accommodate an\\novercrowded condition in the arch, with little or no thought of the\\nphysiognomy, when a careful and properly pursued study of the features\\nand their comparison with the parental types will show that in reality\\nthe dental and maxillary arch should be enlarged, and every tooth re-\\nmain to induce its natural growth and development. If this has not\\nbeen attained by natural processes, every tooth should certainly remain\\nto hold the artificially developed arch in place.\\nHow are we to study the undeveloped face of a child, every linea-\\nment of which is passing through rapid changes of growth, with a view\\nof determining whether or not the dental arch and jaws will be too\\nprominent, or that other features will not enlarge to a harmonizing\\nproportion", "height": "4556", "width": "2688", "jp2-path": "americantextboo00kirk_0837.jp2"}, "838": {"fulltext": "830 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nA most wonderful provision of Nature in dentition causes the full-\\nsized crowns of teeth to erupt, as regards time, somewhat in proportion\\nto the natural growth and enlargement of the jaws. And even when\\nthey do not erupt earlier than is normal, or when their natural eruption\\nis not interfered with by the premature extraction of the deciduous\\nteeth, they are usually obliged to take an irregular position or attitude\\nat first, and await the growth of the jaw which permits them to become\\nregular.\\nIt is perhaps a safe general rule to never extract a permanent tooth\\nfor the purpose alone of correcting a dental irregularity, unless the jaw\\nhas ceased growing and never then unless it is shown by a careful study\\nof the position of the teeth their relation and occlusion that the den-\\ntal arch should not be expanded or by a study of the physiognomy,\\nthat the alveolo-dental arch should not be enlarged.\\nIn a study of the relations of the teeth, the jaws, and the physiog-\\nnomy of a child with the view of determining the advisability of extrac-\\ntion to correct or prevent the ultimate production of a facial deformity\\nor marked imperfection of the features, it may become necessary to\\nstudy the physiognomies of both parents and possibly other members\\nof the family, to correctly determine the influence of inheritance.\\nIn this comparison of temperament, physical frame, features, and\\nteeth, it may require no more than a glance to furnish all the data that\\nwill be of practical use.\\nUsually but one parent accompanies the little patient, and a study\\nof that one physiognomy may be a sufficient guide if not, other mem-\\nbers of the family should be seen.\\nIf there be a marked difference in the parents it may not be difficult\\nto determine from which the child has inherited the teeth, by the\\npeculiar shape and size of the incisors alone. But in regard to the\\nmaxillae in an undeveloped condition there will be more difficulty,\\nthough it is well to remember that the deciduous teeth are rarely irregu-\\nlar or disproportionate in size to the frame and facial features. If, there-\\nfore, there be a more than natural difference in the size of the permanent\\nand deciduous teeth it will indicate union of inharmonious types.\\nIn this connection it must not be forgotten that the crowns of the per-\\nmanent incisors are almost invariably far too large for their undevel-\\noped surroundings. The apparently disproportionate size of the cen-\\ntral incisors to that of the jaw is a subject of frequent and anxious\\nparental comment. If the occlusion of the incisor teeth be far from a\\nnormal type in their anterior relations, and the same condition exists\\nwith either parent, it is an indication of what the child will become if\\nunaided by dental skill, especially if a similarity be noted in other\\nparticulars.", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0838.jp2"}, "839": {"fulltext": "PHYSIOGNOMY AND THE SAVING OF TEETH. 831\\nWith differences in temperament, compare general shape and size of\\nthe eyes, brows, ears, and teeth.\\nOther features are so subject to change in the processes of natural\\ngrowth and development that they cannot be relied upon to furnish\\nlegitimate data. For instance, the nose may change in a few years\\nof late youthful development from one originally small and short\\nand over the nasal bones decidedly depressed to a form different in\\nevery particular.\\nWhen neither parent presents the same unsymmetrical relations that\\npromise to prevail in the child, the cause may be a union of the large\\nteeth of one parent with the small jaws of the other.\\nWhen the teeth of the parents are decidedly dissimilar in size, it\\nmay be possible, as before stated, to determine with certainty from\\nwhich parent the teeth of the child are inherited, and when the teeth\\nand jaws of the other parent are small and other features are similar\\nto those of the child, it indicates a union of undiluted types.\\nAll these things are of the utmost importance in determining the\\nimpropriety of extracting certain teeth to reduce an apparent abnormal\\nprotrusion, which may in time become symmetrical in its relation by\\nthe natural growth of the jaws and other features and also the equally\\nculpable error of saving teeth, or the failure to extract teeth, whose\\nvery presence in the arch obliges Nature to reproduce a parental\\ndeformity, or produce an acquired deformity, by an effort to sustain the\\nlarge teeth of one parent in conjunction with the small jaws of the\\nother.\\nFor a child with an abnormal upper protrusion similar to Figs. 886\\nand 887, with teeth prominent and crowded in an arch which does not\\nFig. 886. Fig. 887.\\nadmit of correcting by a lateral expansion, extract the first bicuspids as\\nearly as possible, even before their eruption is completed, together with\\nthe deciduous canines unless it be one of those very rare instances\\nwhere the first permanent molars cannot be saved.", "height": "4556", "width": "2680", "jp2-path": "americantextboo00kirk_0839.jp2"}, "840": {"fulltext": "832 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nThe same is true of the lower, when there is reason to believe\\nthere will be a disproportionate over-development of the lower dental\\narch.\\nIn the ordinary course of eruption the development and eruption of\\nthe permanent canines are doubtless more influential than those of other\\nteeth in emphasizing an anterior protrusion of the central features of\\nthe physiognomy.\\nIn the course of their eruption they are obliged to crowd into align-\\nment along the mesial surfaces of the roots and crowns of the first\\nFig. 888.\\nFig. 889.\\nFig. 890.\\nbicuspids which at this time represent the immovable bases of the\\narch with the result that the incisive and intermaxillary portion of\\nthe arch is forced forward to a more pronounced position. This move-\\nment has been shown to be not impossible or difficult of attainment by\\nartificial force, even much later in life.\\nWith the first bicuspids and deciduous canines removed sufficiently\\nearly there are numberless instances when the arch, anterior to the\\nsecond bicuspids, would be diminished the\\nwidth of a bicuspid, without resort to arti 1\\nficial means.\\nBy the exertion of a slight traction force\\nfrom an occipital base of anchorage the\\nsockets of the temporary canines will be\\nclosed by the permanent laterals, and the\\npermanent canines in the course of their\\neruption will be deflected into the alveoli\\nof the extracted bicuspids.\\nFigs. 888 and 889 represent one case out\\nof many under treatment by this method,\\nthough not all by the occipital method.\\nFig. 890 shows the position of the teeth after about two months", "height": "4580", "width": "2736", "jp2-path": "americantextboo00kirk_0840.jp2"}, "841": {"fulltext": "THE CONTOURING APPARATUS. 833\\nof traction force from molar anchorages the protrusion not being so\\npronounced as to demand the use of the skull-cap.\\nIt will be seen by the canine eminences though far better shown\\nupon the model itself that the position of the canine crowns is imme-\\ndiately over the former alveoli of the first bicuspids. As they continue\\nto grow downward in this somewhat open channel, their roots, which\\nare not at present developed, will grow upward, the teeth in their en-\\ntirety finally taking a position and inclination similar to that of the\\nbicuspids which they replace, and considerably posterior to that which\\nthey were otherwise destined to occupy.\\nThe patient, nine years of age, had the teeth, eyes, ears, and general\\ntemperament of the father, whose upper arch was abnormally protruded\\nin a similar manner, which was the raison d etre for dental aid.\\nHad the father s teeth been in proper relative and symmetrical\\nposition, and similar to the son s in other particulars w T hich could be\\nlegitimately used as data, it would have been an argument in favor\\nof non-extraction with the expectation of other treatment later but\\nit should not have been passed upon without seeing the mother. Had\\nthe mother s teeth been found small and the general physical features\\ncast in a more delicate mould than her husband s, investigations along\\nother lines w r ould have been required with the view of determining\\nif the child had not the large teeth of the father and small jaAvs of the\\nmother; in which case extraction would also have been indicated.\\nVI. The Contouring Apparatus.\\nThe limited area upon which force can be applied to a tooth, com-\\npared with that portion covered by the gum and imbedded in a bony\\nsocket, has made it next to impossible, with all ordinary methods, to\\nmove the apex of the root in the direction of the applied force nor\\ncould this ever be accomplished w T ith force exerted in the usual way at\\none point upon the crown, however near the margin of the gum it may\\nbe applied, for the opposing margin of the alveolar socket must receive\\nthe greater portion of this direct force, and in proportion to its resist-\\nance it will become a fulcrum exerting a tendency to move the apex of\\nthe root in the opposite direction.\\nBut if in the construction of the apparatus a static fulcrum is created\\nindependent of the alveolar process at a point near the occluding portion\\nof the crown, while the power is applied at a point as far upon the root\\nas the mechanical and other opportunities of the case will permit, the\\napparatus becomes a lever of the third kind, the power being directed\\nto a movement of the entire root in the direction of the applied force.\\nThis proposition is made plain by reference to diagrams. In Fig.\\n891 let A be a point upon a central incisor at wdiich force is applied in\\n53", "height": "4556", "width": "2680", "jp2-path": "americantextboo00kirk_0841.jp2"}, "842": {"fulltext": "834 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nthe direction indicated by the arrow, then will the opposing wall, B, of\\nthe alveolar socket near its margin receive nearly all of the direct force\\nand in proportion to its resistance will there be a tendency to move the\\nroot in the opposite direction. This will also hold good even if the\\nforce be applied at A, Fig. 892, or as far upon the root as may be per-\\nmitted by attaching a rigid upright bar, c, to the anterior surface of the\\ncrown the only difference being that the direct force is distributed\\nover a greater area. But if, as in Fig. 893, to the lower end of c a\\ntraction wire or bar, F, is attached and if the mechanical principles of\\nthe machine be further enforced by uniting its posterior attachment to\\nthe anchorage of the power bar, P, the anchorage force will be materially\\nneutralized and an independent static fulcrum at D created. The appa-\\nratus now will distribute its force over the entire root, and give com-\\nplete direction and control of whatever power is put into it. The\\nFig. 893.\\nentire tooth may be carried forward bodily or either end may be made\\nto move the more rapidly. The force thus directed to the ends of the\\nroots will have an increased tendency to move the more or less yielding\\nbone in which they are imbedded.\\nFor practical illustrations of what has been accomplished by an\\napparatus of this kind see cases described in sections L, IV., and V. of\\nthis chapter.\\nThe contouring apparatus is made entirely of German silver, with\\nthe exception of the nuts, which are of nickel. German silver is pre-\\nferred, not because it is cheaper than gold and platinum, but because it", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0842.jp2"}, "843": {"fulltext": "THE CONTOURING APPARATUS. 835\\npossesses certain qualities which render it adapted for the purpose to\\nwhich it is applied.\\nIn making the banding material for this apparatus, thoroughly an-\\nneal a piece of wire No. 13 and pass it through the rollers with an\\noccasional re-annealing until it is reduced in thickness to Nos. 35 and\\n38 (or 0.004 and 0.0056 of an inch). 1 This will give bands about J and\\nT 3 g- of an inch wide. Use the thinner material for the anterior teeth\\nand the thicker for the anchorage appliance. Before using, it should be\\nwound into rolls and brought to an even red heat, held there for ten\\nminutes, then allowed to cool slowly. This will ensure perfect softness\\nand adaptability.\\nIn taking the measurements for the bands, cut from the material\\nthe proper length, and, holding the ends of the loop between thumb and\\nfinger, pass it over the tooth to be fitted. When in place bend the ends\\nsharply at right angles and finally, grasping the two ends in the pliers,\\ndraw the band firmly around the tooth. The bands for the anterior\\nteeth should extend at this time sufficiently beneath the approximal bor-\\nders of the gum to assure complete extension to the labio- and linguo-\\ngingival borders. The approximal extension should be cut down to the\\ngingival border of the enamel in the final finishing of the apparatus.\\nAfter the bands are soldered carefully, fit and burnish them to the\\nteeth. In order to obtain perfect adaptation it often becomes necessary\\nto contour them slightly with the proper pliers. The joint which pro-\\njects on the anterior surface of the bands for the anterior teeth should\\nbe placed at one side of the middle to allow the upright bar c, Fig. 893,\\nto rest exactly along the median line.\\nWhen the teeth are so crowded together that the banding material\\ncannot be passed freely between them they should first be separated\\nwith waxed tape. It is to be preferred to rubber because sufficient\\nspace is obtained in twenty-four hours with little or no discomfort to\\nthe patient beyond the general soreness of the teeth, which must always\\nfollow the preliminary steps of a regulating operation. These tapes\\nare allowed to remain between the teeth renewing them each day till\\nthe final attachment of the apparatus.\\nThe first appliance to be described is that designed for moving the\\nroots of the upper incisors forward.\\nBefore it is possible to apply the contouring force it is frequently\\nnecessary to first move the crowns of very irregular teeth into align-\\nment somewhat and even to rotate them so as to bring them into a\\nposition to be properly grasped by the power bar of the apparatus.\\n(See Fig. 872, with description.)\\n1 In this description it will be understood that German silver is the metal indicated\\nand Brown Sharp s gauge that by which thicknesses are measured.", "height": "4556", "width": "2600", "jp2-path": "americantextboo00kirk_0843.jp2"}, "844": {"fulltext": "836 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nWhen the bands have been fitted as described above, they should be\\nplaced upon the four incisors and a plaster impression taken of the\\nlabial surfaces of the bands, teeth, and adjoining gum. For a tray to\\ncarry the plaster to place use a thin piece of lead cut the proper\\nsize.\\nAfter the impression is removed, carefully remove the bands and\\nplace them in their respective positions on the impression the joints\\nof the bands will serve to guide them to place. This when filled with\\nTeague s or other investing material will give a model with the bands\\nin position, to which may be fitted and soldered the upright bars.\\nThe upright bars are made of No. 14 wire, bent to fit the anterior\\nface of the band and tooth along the median line of its axis, and also\\nthe gum to about of an inch above its margin. In soldering them to\\nthe bands, completely fill the V-shaped spaces on either side the upright\\nbars, to give sufficient rigidity and finish to the appliance. After they\\nhave been soldered and removed from the model they are further finished\\nby filing the bars flat on the sides which lie next to the gum, tapering\\nthem to one-half their diameters at the upper ends. It is against this\\nsurface that the power bar, p, is to rest, as shown in Fig. 893. The\\nupright bar may also be flattened somewhat over the face of the tooth,\\nbut not at the point where it leaves the band for the gum, as full\\nstrength and rigidity are required here. (In Fig. 893 the engraver has\\nmade the upright bar appear far too light at this point marked c for\\npractical use in sustaining the great force of the power bar at B.)\\nThe bars having been cut off even with the occluding ends of the\\nteeth, and properly rounded and polished, the small transverse grooves,\\nD, may be cut just above the ends to receive the fulcrum wire, f, No.\\n24 gauge, which is much smaller than shown in Fig. 893.\\nIn constructing the anchorage portion of the apparatus to be attached\\nto the posterior teeth too much care cannot be observed in order that\\nthe several parts perform the work assigned to them and the greater\\nportion of force be neutralized at points of anchorage.\\nWhen the second molars have fully erupted, band the first and\\nsecond molars otherwise the second bicuspids and first molars and\\nsometimes all three teeth. Where it becomes advisable to apply this\\nparticular form of force before the eruption of the second bicuspids,\\nthe second deciduous and first permanent molars will answer for the\\npurpose.\\nThe banding material should be as wide as the tooth will permit,\\nand in thickness from Nos. 36 to 35 (or 0.005 to 0.0055 of an inch).\\nWhen the bands have been made as described and perfectly fitted, place\\nthem in the positions they are to occupy and take a plaster impression\\none side at a time allowing the plaster to barely cover the bands,,", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0844.jp2"}, "845": {"fulltext": "THE CONTOURING APPARATUS. 837\\nbut sufficiently extensive to show on the model the bicuspids and\\ncanines, for reasons that will become obvious.\\nAfter removal, replace the bands accurately in their positions in the\\nimpression, and fill as before with Teague s or any good investing\\nmaterial.\\nThis material will give a model that will hold the bands in exact\\nrelative position while they are being soldered, and one also that is suf-\\nficiently extensive to enable the placing and soldering of the tubes in\\nproper position and direction a thing of the utmost importance.\\nIn selecting the tubes the smaller should loosely fit the threaded end\\nof No. 20 wire, which is the size to use for the fulcrum wire, F. The\\nsize of the larger tube should be governed by the size of the power bar,\\ni. e. when the jaw is large with fully developed teeth, or when the dis-\\ntance is considerable from anchorage appliances to the upright bars on\\nthe anterior teeth, the size of the power bar, p, should be No. 14. It\\nshould rarely be smaller than No. 15, though when the operation is\\nattempted for very young children No. 16 will answer the purpose.\\nBut the ordinary German -silver wire of the shops of these sizes will\\nnot do. It must be specially prepared in order to withstand, without\\nbending, the great force exerted upon a bent bow or bar. All wire for\\npower bars should be drawn, without annealing, from No. 6, and be\\nnearly as rigid as tempered steel. In the selection of tubes the larger\\nshould loosely fit the threaded end of the power bar, and be to f of\\nan inch long.\\nAn important feature is the position of the power-bar tubes. They\\nshould be so placed and soldered to the anchorage bands that the power\\nbar when placed in the tubes will ex-\\ntend from it in a straight line to the ca- Fig. 894.\\nnines, where it bends over to engage with\\nthe upright bars, c. (See Fig. 893.) If\\nthis precaution be not taken, but instead the\\npower tubes are soldered in the ordinary\\nway, in contact with the buccal surfaces of\\nthe bands, the power bow, in most instances,\\nwill require to commence its encircling bend\\nimmediately upon emerging from the tubes,\\nwith a decided weakening of its rigidity and\\npossible failure.\\nIn order to obtain the proper position\\nit will often be advisable to rest the poste-\\nrior end of the larger tube upon that of\\nthe smaller, as shown in Figs. 894 and 895. All projecting portions\\nthat are liable to irritate the mouth should be rounded and polished^", "height": "4560", "width": "2668", "jp2-path": "americantextboo00kirk_0845.jp2"}, "846": {"fulltext": "838 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nIn soldering tubes to place use a slightly lower grade of silver solder\\nthan that used to join the bands. Use sufficient to thoroughly unite all\\nthe joints, and fill all V-shaped spaces, being careful to turn the joints\\nof the tubes toward the bands that they may be closed. Thoroughly\\nunite the approximal surfaces of the bands and reinforce the lingual V\\nwith an extra piece. (See Fig. 894.)\\nIn finishing the apparatus, the soldered parts should be boiled in a solu-\\ntion of sulfuric acid to remove the borax and oxids. After being neu-\\ntralized and brushed they are now ready for the trial fitting to the mouth.\\nIn this operation the bands should be perfectly fitted to the position\\nFig. 895.\\nProtrusion apparatus.\\nthey are to occupy the upright bars readjusted, if necessary, and all\\nsurplus material cut away\u00e2\u0080\u0094 sharp and rough surfaces smoothed and\\npolished, and the gingival and occluding edges of the bands carefully\\nburnished to the teeth.\\nIn constructing the power bar the anchorage attachments should be\\nplaced upon a plaster model of the teeth, in order to accurately deter-\\nmine its length and the lengths of its threaded ends, then properly\\nshaped to the gum over which it is to rest. It should be flattened in\\nthe rollers to about one-half its diameter along that portion which lies\\nin front of the bicuspids. In this operation it may become necessary\\nto roll the bar so that the bent bow is flaring, to fit the gums against\\nwhich it nearly rests, and to engage perfectly with the upright bars\\nespecially if the incisors are labially inclined.\\nWhen the apparatus is polished and heavily gold-plated it is ready\\nfor the final cementing to the teeth. Brush the teeth with pumice stone,", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0846.jp2"}, "847": {"fulltext": "THE CONTOURING APPARATUS. 839\\nplace a napkin in the mouth, and dry the teeth and surrounding gum\\nwith spunk. Pack it around the teeth, where it is held firmly in posi-\\ntion while the cement is being prepared and placed in the bands by an\\nassistant. See that all material used in polishing is removed from the\\ninner surface of the bands, and the surface scraped or scratched with a\\nsharp excavator.\\nThe cement should be mixed thoroughly, but rapidly, to the con-\\nsistence of thick cream, and scraped from the spatula along the upper\\nand inner edges of the bands.\\nWhen each part of the appliance is ready, force it quickly and firmly\\nto its position its final adjustment being perfected by the use of the\\nmallet on a large oval plugger resting upon the soldered parts.\\nAfter the anchorage attachments have been cemented in place, make\\nan appointment for the next day to attach the remainder of the appa-\\nratus, in order to allow the cement to become perfectly hardened, that\\nthe bands may not be dislodged, or even slightly started, by the strain\\nto which they are subjected in the final adjustment of the power bar.\\nAnother way is to adjust the anchorage attachments to the ends of\\nthe power bar out of the mouth after the parts have been perfected,\\nshaped, and fitted and cement the whole to place in this condition.\\nBy this method the whole apparatus can be attached to the teeth at one\\nsitting.\\nOn account of the intense rigidity of the power bar it is important\\nthat when it is in place on the teeth the threaded ends should lie within\\ntheir respective anchorage tubes without exerting the slightest force in\\nany direction until it is applied, as intended, by the power of the screws\\ntherefore great care should be observed in giving to it the proper shape,\\nby bending as accurately as possible upon the plaster model, and after-\\nward by a trial fitting in the mouth before cementing the anchorage\\nbands.\\nWith the anchorage attachments and power bar in position the bands\\nare to be cemented to the anterior teeth. As each band is carried to its\\nplace, it should be seen that the flattened surface of the upright bar is\\npressed down firmly upon the power bar, so that an even force will be\\ngiven to each of the teeth when power is applied it being presupposed\\nthat in the trial fitting of the parts the power bar was shaped so as to\\nengage perfectly with the upright bars the free ends of the latter ex-\\ntending slightly above it.\\nThe same kind of apparatus may be employed upon the lower in-\\ncisors with perfect success, though there will not be the same tendency\\nto carry the entire alveolar ridge forward with the roots as on the\\nupper the change being largely by a metamorphosis of alveolar tissue.\\nAn apparatus for contruding the roots of the anterior teeth is con-", "height": "4564", "width": "2704", "jp2-path": "americantextboo00kirk_0847.jp2"}, "848": {"fulltext": "840 THE DEVELOPMENT OF ESTHETIC FACIAL CONTOURS.\\nstructed in a very similar manner. The direction of the two forces\\nbeing reversed, it becomes necessary, however, to make certain import-\\nant variations. The power bar (p, Fig. 896) now exerting a traction\\nforce, No. 16 will be found sufficiently large for all purposes. It is\\nnot flattened, but rests in grooves cut in the anterior surfaces of the\\nFig. 896.\\nupright bars, B. The power-bar tubes should be soldered closely to the\\nanchorage bands so that the nuts which now work at the posterior ends\\nof the bar will not irritate the mucous membrane of the cheek. The\\nfulcrum bar, F, exerting in this apparatus a jack-screw force, should be\\nFig. 89\\nNo. 16. It is flattened along its middle portion to engage with the\\noccluding ends of the upright bars at D, provision being made for the\\npurpose in the construction.\\nThe power of the two forces being so great upon the upright bars,\\nwith a tendency to lift the occluding ends from their attachments, and\\nthus allow the free ends to press into the gum, it is important with this\\napparatus that the occluding end attachments be reinforced by soldering", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0848.jp2"}, "849": {"fulltext": "THE CONTOURING APPARATUS. 841\\nto the bands an extra piece of banding material that shall extend from\\nthe labial face over the occluding end of the tooth to the lingual portion\\n(shown in Fig. 897).\\nAfter the joint of the band has been soldered, the reinforcing piece,\\nof sufficient length for the purpose, should first be soldered to the labial\\nface alongside of the joint; then the band is perfectly fitted to the\\nnatural tooth the extra piece being bent over and burnished to its\\nposition on the labial surface, and the position of its end distinctly\\nmarked upon the band, to serve as a guide to soldering.\\nWhen the hoods are completed in this way and finally all placed on\\nthe tooth and perfectly fitted, an impression should be taken for fitting\\nand soldering the upright bars as described for the protrusion apparatus.", "height": "4564", "width": "2700", "jp2-path": "americantextboo00kirk_0849.jp2"}, "850": {"fulltext": "", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0850.jp2"}, "851": {"fulltext": "INDEX.\\nABSCESS, alveolar, in deciduous teeth,\\n680\\nchronic, with fistulous opening, 497\\ntreatment of, 495\\ndento-alveolar, 479\\nopening of, 494\\ntreatment of, 496\\nAcid conditions of the oral fluids, effect of,\\n191\\nAfter-treatment of pulp exposure, 415\\nAge, relation of, to pyorrhea, 527\\nAir, admixture of, with nitrous oxid, 631\\nAlbumin, action of mercuric chlorid on,\\n435\\nAlbuminous food, use of, in pyorrhea, 530\\nAlcohol, use of, in pulp treatment, 426\\nAlkalies, action of, on dental pulp, 434\\nuse of, in treatment of sensitive dentin,\\n194\\nAlkaline waters, use of, in pyorrhea, 530\\nAlkalithia, 530\\nAlloy and cement fillings, 367\\nAlloys, aging of, 253, 308\\nAlum, use of, in pulp devitalization, 441\\nAluminum amalgam, 314\\nAlveolar abscess, 479\\nat bifurcation of roots, 499\\nbrain infection from, 586\\ncauses, 479\\nchronic, 486\\nclinical history, 485\\ncomplications of, 500\\ndiagnosis and prognosis, 487\\npathology and morbid anatomy, 480\\ntreatment, 489\\nprocess, absorption of, in pyorrhea, 524\\naccidents to, after extraction, 612\\nanatomy of, 577\\nnecrosis of, 637\\nresorption of, 578\\nridge, bending of, in regulating teeth,\\n698\\nAlveoli, enlargement of, from regulating\\nappliances, 701\\nAlveolo-dental membrane, 91, 135\\nAmalgam as a cavity lining, 258\\nand gold fillings, 354\\nfirst use of, as filling material, 305\\nflow of, 308\\nmethods of use, 315\\nnature and properties of, 306\\nobjections to, 255\\nproportions of ingredients, 252\\nuse of, in deciduous teeth, 675\\nwafering of, 677\\nwar, 305\\nwashing of, 314\\nAmalgams as filling materials, 255\\nclassification of, 312\\nbinary, 312\\nternary, 313\\nquaternary, 314\\ncombination of, 361\\ncomposition of, 252\\ncontraction and expansion of, 307\\nedge strength of, 310\\nAmbidexteritv, advantages of, 595\\nAmeloblasts, 62, 100\\nAmmonia in pulp exposure, 667, 679\\nAmyloid, 437\\nAnchor bands for regulating, 706\\nAnchorages in approximal cavities, 230,\\n234, 237\\nAnesthesia by cataphoresis, 194\\ncomplete, symptoms of, 633\\ngeneral, 212\\nAnesthetics, general, examination of\\npatients, 618\\ntooth extraction under, 617\\nlocal, and tooth extraction, 639\\nuse of, in planting teeth, 657\\nAngles, avoidance of, in shaping cavities,\\n220\\nAngle s regulating appliances, 703, 711\\nretaining appliance, 742\\nAnnealing tray, electric, 275\\nAnodes for cataphoresis, 205\\nAntisepsis as related to the plantation of\\nteeth, 164\\nin dentistry, 157\\nin pulp treatment, 458\\nAntiseptic dressing for exposed pulps, 411\\nforceps, 565\\nmouth-wash, 458, 514\\nAntiseptics as sterilizers, 440\\nin pulp treatment, 433\\nAntral empyema, 501\\nAntrum, drainage of, 502\\nperforation of, in implanting teeth, 655\\nApical pericementitis, treatment of, 476\\nregion, mode of entrance to, 475, 492\\nAppliances used in examinations, 174\\nApproximal cavities, filling of, 286\\npreparation of, 229\\nsurfaces, examination of, for caries, 177\\ntreatment of, 262\\nin regulating, 737\\nof cavities on, 184\\nAppro ximo-incisal cavity, 234\\nArch, dental, 18\\nnormal, 684\\nsaddle-shaped, 784\\nsemi-V-shaped, 758\\nspreading of, 754\\n843", "height": "4556", "width": "2692", "jp2-path": "americantextboo00kirk_0851.jp2"}, "852": {"fulltext": "844\\nINDEX.\\nArch, dental, V-shaped, 757\\nAreas, eroded, 304\\nAristol as an antiseptic, 188, 435\\nArsenic, action of, on dental pulp, 422\\nuse of, in deciduous teeth, 679\\nArsenous acid in pulp devitalization, 421\\nArterial hemorrhage, treatment of, 614\\nArthur s method of filling, 262\\nArticular gout, 521\\nAsbestos felt, use of, with silver nitrate,\\n668\\nAsepsis, importance of, in planting teeth,\\n656\\nAsphyxia, avoidance of, in nitrous oxid\\nanesthesia, 625, 631\\nAssistant, necessity for, in nitrous oxid ad-\\nministration, 632\\nAutomatic mallets, 279\\nBACTERIA of pyorrhea, 525\\nBalsamo del deserto, 438\\nin temporary teeth, 503\\nBand matrices, 291\\nBands, regulating, 714, 719\\nBasal layer of Weil, 87, 128\\ntemperaments, 51\\nBasic zinc cements, 334\\nBattery cells, arrangement of, for electrical\\nosmosis, 198\\nBenzoyl pseudo-tropin, 642\\nBibulous paper, use of, in combination fill-\\nings, 356\\nBicuspids, early extraction of, 827\\nextraction of, 603, 606\\nmicroscopical anatomy of, 32\\npulp chambers of, 447, 448, 450\\nBinary amalgams, 312\\nBinoxid of tin, use of, in polishing teeth,\\n181\\nBit, regulating, 767\\nBite, jumping~of, 770, 812\\nraising of, 793\\nBlack s studies of amalgams, 253\\nBleaching agents, 540\\npowder, care in selection of, 547\\nteeth suitable for, 542\\nBlennorrhea alveolaris, 509\\nBlind abscess, 495\\nBlood as an antiseptic, 656\\nBlood-poisoning, danger to operator from,\\n164\\nBonwill s method of amalgam filling, 320\\nBows for regulating, 739, 765\\nBrain, infection of, from suppurating tooth,\\n586\\nBreathing, management of, in nitrous oxid\\nanesthesia, 632\\nBroach, employment of, as pulp extractor,\\n453\\nBromin as an antiseptic, 434\\nBrown bands of Retzius, 107\\nBryan s regulating method, 799\\nBuccal cavities, filling of, 283\\npreparation of, 226\\nBurnishers, oiling of, 360\\nBurs, forms of, 216\\nfor pulp-canal treatment, 452\\nCACHEXIA, influence of, in alveolar\\nabscess, 486\\nCalcic inflammation, 509\\nCalcific changes in dental pulp, 417\\nCalcification, process of, 73\\nCalcium salts, presence of, in stellate retic-\\nulum, 66, 83\\nCalco-globulin, 73\\nCalco-spherites, 70, 73\\nCallahan s method of pulp treatment, 462\\nCamphor in treatment of nausea, 248\\nCanal fillings, essential properties of, 436\\ntreatment, instruments for, 452\\nCandy, effects of, on the teeth, 681\\nCanines, eruption of, 690\\nextraction of. 602\\nmacroscopical anatomy of, 28\\nprominent, 744\\npulp chambers of, 447\\nrotation of, 750\\nCaoutchouc as a separator, 187\\nCap-and-bit regulating appliance, 767\\nCapillary hemorrhage, treatment of, 614\\nCapping pulps, methods of, 411\\nCaps, for treatment of prognathism, 822\\nplacing of, over exposed pulp, 412\\nswaged, for regulating, 704, 714\\nCarbolic acid as an anesthetic, 209\\nin pulp exposure, 409\\nin pulp treatment, 421\\nCaries, differentiation of, from alveolar ab-\\nscess, 488\\ndue to irregularities, 700\\nself-limited, 219\\nCataphoresis, dentinal anesthesia by, 194\\ntechnique of, 203\\nCataphoric bleaching methods, 555\\nCathode electrode for cataphoresis, 206\\nCaustic pyrozone, 550\\nCavities, approximal, filling of, 671\\nclassification of, 223\\nenlargement of, for pulp treatment, 459\\nfinishing margins of, 223\\nocclusal, filling of, 669\\npreparation of, 215\\nvarnishing of, 360\\nCavitine, 549\\nas a cavity lining, 258\\nCavity lining, 257\\nsimple, conversion of, into compound,\\n230\\nwalls, fracture of, 302\\nCement and alloy fillings, 367\\nand amalgam fillings, 351\\nand gold fillings, 353\\namalgam, and gold fillings, 358\\nfillings, burnishing of, 360\\nfluids, instability of, 338\\nlining for amalgam fillings, 323\\nparaffin coating for, 675\\nCemented inlays, 369\\nCementoblasts, 143\\nCemento-periostitis, 509\\nCements as filling materials, 255\\nuse of, in separations, 187\\nCementum, 132\\ncalcification of, 86", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0852.jp2"}, "853": {"fulltext": "INDEX.\\n845\\nCervical margins, exposure of, 187\\nChair, dental, requisites for, 594\\nform of, for nitrous oxid administration,\\n631\\nChart record of examinations, 178\\nChildren, treatment of, in the dental office,\\n666, 669\\nChildren s teeth, operations on, 502\\nChin, malpositions of, 810\\nChisels, use of, in opening cavities, 216\\nChloric! of silver cell battery for catapho-\\nresis, 202\\nChlorin, action of, on metals, 517\\nas a bleaching agent, 541\\nas a sterilizer, 434\\nChloroform as an anesthetic, 213\\nChloro-percha as a root-tilling, 438, 446\\nChromic acid as an anesthetic, 212\\nClamps, rubber dam, 244\\nCoagulants in pulp treatment, 434\\nCoagulation as a chemical process, 435\\nCobalt as a devitalizing agent, 424\\nCocain, antidotes for, 643\\nas a local anesthetic, 639\\ncataphoric use of, 195, 203\\nhypodermatic injection of, 640\\nin pulp treatment, 424\\nphysiological effects of, 640\\nrelief of hypersensitiveness by, 188, 193\\nSchleich s solution, 642\\ntoxic effects of, 643\\nCocoa butter as a lubricant, 361\\nCoffin regulating appliances, 707\\nspring plate, 742\\nCold as a test of pulp exposure, 406\\nColor, stability of, in amalgams, 255\\nCombination fillings, 345\\nfinishing of, 357\\nCompound cavities, combination tilling of,\\n348\\ntilling of, 287\\npreparation of, 233\\nCone, evolution of tooth forms from, 17\\nContact, points of, in teeth, 263\\nContour fillings, 261\\nContouring apparatus, Case s, 821, 833\\nContraction of amalgams, 307\\nControllers for cataphoresis, 199, 202\\nCopper amalgam, process of making, 312\\nstaining of teeth by, 558\\nCorundum wheels, use of, in regulating,\\n736\\nCotton as a canal filling, 464\\nas a root filling, 437\\nas a separator, 186\\nmethod, of introduction into root canals,\\n465\\nCounter-irritation in pulp exposure, 410\\nCrown, restoration of, with amalgam, 324\\nstructure, conservation of, in root filling,\\n458\\nCrowns, artificial, on natural roots, 655\\nCrver s studies of the maxillary sinus, 501\\nCrystal gold. 273\\nmat gold, 274\\nCunningham s regulating method, 800\\nCusp, supplementary, on first molar, 227\\nCusps, malocclusion of, 788\\nCuster s annealing tray, 275\\nCutter s regulating appliance, 792\\nDAVEXPORTS regulating appliance,\\n793\\nDecay, removal of, in preparation of cavi-\\nties, 217\\nDeciduous teeth, indications for extraction\\nof, 561, 689\\nmacroscopic anatomy of, 48\\nmanagement of, 663\\nDeformities, inheritance of, 805\\nDental arch, tvpal forms of, 18\\nfollicle, 71\\nformula of man, 22\\ngroove, 55\\npulp, capping of, 411\\nconservative treatment of, 401\\ndevitalization of, 421\\nembryology of, 87\\nexposure of, 403\\nsensitivity of, 402\\nridge, formation of, 55\\nsacculus, 41\\ntissue, structure of, 53, 96\\nDentate fissure burs, 452\\nDentin, analysis of, 121\\ncalcification of, 74\\ncarious, removal of, in preparation of\\ncavities, 218\\ndiscoloration of, 425\\ngerm, formation of, 60\\nhypersensitive, 189\\ntreatment of, 193\\ninfection of, 457\\nmatrix, 77, 121\\nnormal sensitivity of, 190\\nsecondary, 414, 417\\nstructural elements of, 120\\nDentinal anesthesia bv chemical agents,\\n207\\npapilla, embryology of, 70\\ntubuli, fibrillar structure of, 192\\nDentition, pathological, 663\\nDevelopment of dental tissues, 53\\nof jaws, 53, 94\\nDevitalizing fiber, 679\\npaste, 421, 423, 678\\nDiet, relation of, to pyorrhea, 527\\nDietetic treatment of pyorrhea, 530\\nDigitalis as a hemostatic, 617\\nDioxid bleaching methods, 550\\nDisinfectants in pulp treatment, 433\\nDissection, necessitv for, 576\\nDistal cavities, filling of, 287, 294\\nocclusion of, 685\\npreparation of, 229, 231\\nDisto-incisal cavities, filling of, 288\\nDisto-labial cavities, filling of, 287\\npreparation of, 233\\nDisto-lingual cavities, filling of, 288\\npreparation of, 233\\nDisto-occlusal cavities, filling of, 290\\npreparation of, 237\\nDonaldson s pulp-canal cleaners, 454\\nDrag-screw, use of, in regulating, 749", "height": "4560", "width": "2696", "jp2-path": "americantextboo00kirk_0853.jp2"}, "854": {"fulltext": "846\\nINDEX.\\nDrill, safety, for pulp extraction, 455\\nDynamo, use of, for cataphoresis, 203\\nDyspepsia due to irregularities, 700\\nEBUKNATION, 190\\nEdge, restoration of, with gold, 286\\nEdge strength of amalgams, 253\\nof fillings, 345\\nElectric mouth-lamp, 176, 177\\nElectrical osmosis, 194\\nElectricity, cataphoric action of, 194\\ngeneral principles of, 196\\nElectrodes for cataphoresis, 266\\nElectro-magnetic mallet, 279\\nElectrozone, 434\\nElevators, 574\\nfor tooth extraction, 543\\nnon-use of, under anesthesia, 635\\nEmbryology of dental tissues, 53\\nEmbryonic mucous membrane, 54\\nEnamel, analysis of, 98\\ncalcification of, 82\\ncleavage of, 221\\ndrops, 84\\ninjury to, by regulating appliances, 702\\norgan, formation of, 60, 62\\nstructural elements of, 96\\nEngine burs, use of, in opening cavities,\\n215\\non children s teeth, 676\\nEroded areas, 304\\nEssential oils as antiseptics, 434, 436\\nEther, administration of, for anesthesia, 212\\nmode of administration, 619\\nuse of, in tooth extraction, 618\\nEthyl chlorid as a local anesthetic, 639\\nEucain as a local anesthetic, 644\\nExaminations, appliances used in, 174\\nrecord of, 178\\ntechnique of, 177\\nExcavators, forms of, 218, 232\\nExplorers, use of, in examinations, 175\\nExpression, features of, 659\\nExtracting, art of, 635\\nExtraction, after-treatment of, 611, 637\\nmode of, under anesthesia, 634\\nFACE, esthetic development of, 824\\nmeasurements of, 683\\nFace-piece, use of, in nitrous oxid adminis-\\ntration, 631\\nFacial contour, influence of the teeth on,\\n805\\ndeformities, correction of, 812\\nexpression, change of, by movement of\\nteeth, 809\\nprofile, ideal, 683\\nFacing amalgam, 323\\nFaught s electric heater, for gutta-percha,\\n329\\nFelt tin, 296\\nFibers of Tomes, 127\\nFilling materials for deciduous teeth, 669\\namalgam, 675\\nlack of edge strength, 345\\ngutta-percha, 669\\nselection of, 249, 267\\nFilling materials, table showing character-\\nistics, 370\\nzinc phosphate cement, 672\\nFillings, amalgam and gold, 354\\namalgams of different quality, 367\\ncement, amalgam, and gold, 358\\nand alloy, 367\\nand amalgam, 351\\nand gold, 353\\ncombination, 345\\ncrvstal mat and other forms of gold, 361\\nfinishing of, 297, 325, 335\\ngold and tin, 365\\ngutta-percha and amalgam, 361\\nand cement, 359\\nand gold, 361\\nnon-cohesive and cohesive gold, 363\\nremoval of, preparatory to bleaching, 546\\nrepair of, 301\\ntemporary, 213\\ntin and gold, 367\\ntin -gold, 365\\nzinc phosphate and amalgam, 346\\nFinishing bur for cavity margins, 222\\nFirth s method of pulp mummification, 441\\nFistula, treatment of, 497\\nFistulse of alveolar abscess, 482\\nFistulous abscess, treatment of, 492\\nFlagg s formula for amalgam, 313\\ngutta-percha softener, 328\\nFletcher s carbolized resin, 667, 674\\nmethod of mixing amalgams, 319\\nFloss silk, use of, in deciduous teeth, 681\\nin examinations, 179\\nFlow of amalgams, 308\\nForce, application of, in filling operations,\\n276\\nconstant, 706\\nintermittent, 706\\nForceps, antiseptic, 564\\nbest forms of, 564\\nextracting, manner of use, 597\\nfor extracting lower teeth, 572\\nforms of, for regulating, 799\\nknuckle-joint, 566\\nnecessary forms of, 635\\nnickel-plating of, 636\\npharyngeal, use of, 577\\nFormalin as an antiseptic, 469, 471\\nin pulp treatment, 422, 435\\nFurnaces for fusing porcelain, 393\\nGALVANIC current, application of, to\\nsensitive dentin, 200\\nGangrenous pulps, micro-organisms in, 430\\nGauge, plate, 704\\nGerman-silver matrix, 349\\nGermicides in pulp treatment, 433\\nGilded platinum, 358\\nGilling twine, use of, in polishing teeth, 182\\nGingivitis expulsiva, 505, 509\\nGlands of Serres, 90\\nGlossitis resulting from alveolar abscess, 501\\nGold, amalgamation of, in combination fill-\\nings, 357\\nand amalgam fillings, 354\\nand cement fillings, 353", "height": "4608", "width": "2776", "jp2-path": "americantextboo00kirk_0854.jp2"}, "855": {"fulltext": "INDEX.\\n847\\nGold, and platinum, 274\\nand tin fillings, 365\\nannealing of, 274\\nas a canal filling, 463, 467\\nas a filling material, 250, 267\\nas a root filling, 437\\ncohesive, 271\\ncombination fillings of, 361\\ncrystal, 273\\nmat, 274\\ndevice for rolling, 270\\ninlays, 396\\nnon-cohesive, 268\\nand cohesive, 363\\noverlapping of, in finishing fillings, 299\\npacking of, 275\\nplastic, granular qualities of, 367\\nplating, removal of, from steel, 365\\nstaining of teeth by, 558\\nuse of, in children s teeth, 677\\nGout, articular, 521\\nnervous, 521\\ntegumentary, 521\\nvisceral, 521\\nGouty diathesis, 519\\npericementitis, 509, 515\\ntheory of pyorrhea, 508, 518\\nGranular layer of Tomes, 125\\nGrooves, formation of, in shaping cavities,\\n221\\nGubernaculum, 72\\nGum, hypersensitiveness of, 188\\nincision of, for implantation of teeth, 658\\ninflammatory disturbance of, 183\\nlancing, indications for, 664\\nprotection of, in preparation of cavities,\\n228\\nscarification of, in pulp exposure, 416\\ntissue, embryology of, 90\\ntreatment of, after extraction, 613\\nGutta-percha and amalgam fillings, 361\\nand cement fillings, 359\\nand gold fillings, 361\\nas a canal filling, 463\\nas a root filling, 438\\nas a separator, 187\\nas a temporary filling, 214\\ncanal filling in bleaching operations, 545\\nclasses of, 326\\nexpansion of, 361\\nfillings, finishing of, 334\\nfirst use of, as a filling material, 326\\nheating of, 360\\nindications for employment, 327\\nmanipulation of, 329\\nphysical properties, 327\\nuse of, in deciduous teeth, 669\\nHARLAN S bleaching method, 551\\nHarvard cement for setting inlays, 385\\nHeat, evolution of, by engine burs, 218\\nHematogenic calcic pericementitis, 509\\nHemoglobin, decomposition products of,\\n537\\nHemorrhage, dental, causes of, 616\\ntreatment of, after extraction, 614\\nHemorrhagic diathesis, treatment of, 615\\nHemostatics, formulae for, 617\\nHerbst s matrices, 317\\nmethod of inlaying, 375\\nretaining method, 730\\nHeredity as a predisposing cause of pyor-\\nrhea, 526\\ninfluence of, on the teeth, 690\\nHewitt s anesthetic apparatus, 624\\nmouth-props, 577\\nHill s stopping, 326\\nHoe excavators, 232\\nHoles, arrangement of, in rubber dam, 241\\nHollings worth s cataphoric appliances for\\nbleaching teeth, 556\\nsyringe electrode, 206\\nHot-water douche in bleaching operations,\\n548\\nHow s method of packing gutta-percha, 330\\nof reshaping teeth, 736\\nHydrogen dioxid as a bleaching agent, 550\\nin pulp treatment, 460\\nHydronaphthol, use of, in pyorrhea, 515\\nHygienic measures in pyorrhea, 529\\nHypersensitive dentin, 189\\nHypnosis, 657\\nIMMEDIATE root filling, indications\\nfor, 431\\nwedging, 185\\nImplantation, first recorded operation, 646\\ninstruments for, 659\\nmode of operation, 658\\nprecautions for, 654\\nImpression trays for regulating, 710, 711\\nIncisal cavities, filling of, 285\\npreparation of, 229\\nIncisions for gum-lancing, 665\\nIncisor, central, extraction of, 602\\nIncisors, crowded, 744\\ndeciduous, filling of, 675\\nlateral, extraction of, 602\\nmacroscopical anatomy of, 22\\npulp chambers of, 446\\nrotation of, 724\\nInfection through instruments, 163\\nInfectioso-alveolitis, 509\\nInfectious alveolitis, 507\\nInflammation, treatment of, in root-filling,\\n474\\nInhaler, Allis s, 213\\nfor nitrous oxid administration, 630\\nInlays, amalgam, 371\\nantiquity of, 369\\ncompared with other fillings, 369\\ngold, 379, 396\\nhard-rubber, 399\\nporcelain, 374\\nInstruments, comfortable use of, 173\\ndisinfection of, 424\\nfor packing gutta-percha, 329\\nfor pulp-canal treatment, 452\\nselection of, 276\\nfor. tooth extraction, 595\\nIntermaxillary bone, non-development of,\\n787\\nInterproximal space as a predisposing cause\\nof caries, 177", "height": "4548", "width": "2704", "jp2-path": "americantextboo00kirk_0855.jp2"}, "856": {"fulltext": "848\\nINDEX.\\nInterproximal spaces, polishing of, 182\\nIodin, chemical action of, on hydrogen\\nsulfid, 471\\ntrichlorid as an antiseptic, 434\\nIodoform as a germicide, 435\\ngauze as a styptic, 614\\nin pulp devitalization, 422\\npaste, 678\\nIodol as a sterilizer, 435\\nIron, staining of teeth by, 558\\nsulfid as a factor in tooth discoloration,\\n538\\nIrregularities, classification of, 712\\netiology of, 690\\ntreatment of, 702\\nJACK-SCKEW regulating appliances,\\n703\\nJaws, development of, 53\\nseparation of, for tooth extraction, 575\\nKALITJM-NATKIUM, 434\\nKingsley s regulating plate, 738\\nKirk s method of making copper amalgam,\\n313\\nKristaline, 343, 549\\nas a cavity lining, 258\\nLABAKKAQUE S solution, 434\\nas a bleaching agent, 549\\nLabial cavities, filling of, 284\\npreparation of, 227\\nLancets, forms of, 575\\nuse of, in tooth extraction, 597, 599\\nLateral walls of cavities, lining of, 258\\nLaterals, depressed, 745\\nextraction of, for regulating, 745\\nLead as a filling material, 267\\nLeclanche battery for cataphoresis, 202\\nLeeches, application of, to gum, 474\\nLenses, magnifying, for examinations, 177\\nLigatures, adjustment of, 350\\nin bleaching operations, 545\\nplacing of, 244\\nvarnishing, 349\\nLight, management of, in examinations,\\n174\\nLingual cavities, filling of, 284, 285\\nocclusion, 686\\npreparation of, 227, 228\\nLining varnishes, 343\\nLithium compounds, use of, in pvorrhea,\\n530\\nLoop matrices, 290\\nLotion for alveolar abscess, 494\\nLugol s solution, 502\\nLysol in pulp treatment, 473, 474\\nMCQTTILLEN S bleaching method, 551\\nMagnifying lenses, 175\\nMallets, first introduction of, 279\\nforms of, 278\\nMalocclusion, 685\\nas a cause of pyorrhea, 528\\nMalpighian layer, 54\\nManganese stains of teeth, 559\\nMarginal cavity lining, 258\\nMass method of filling with gutta-percha,\\nool\\nMassage of the gums, 184\\nin pericementitis, 476\\nMatrices, improvised, 316\\nuse of, 290\\nin combination fillings, 347\\nMatrix, adjustment of, to tooth, 348\\nMatteson s regulating appliances, 704, 714\\nMaxilla, lower, excessive development of,\\n773\\nMaxillse, embryology of, 53\\nseparation of, by regulating appliances,\\n698\\nMaxillary rampart, 55\\nsinus, opening of, into nasal passage,,\\n501\\nrelation of tooth roots to, 583\\nMechanical mallet, 280\\nMeckel s cartilage, 54\\nMedicaments, cataphoric diffusion of, 195\\nMeditrina, 434\\nin pulp treatment, 473\\nMembrana eboris, 70, 74, 127\\nMembrana praeformativa, 85\\nMercury, percentage of, in amalgams, 253,\\n307\\nstaining of teeth bv, 559\\nMesial cavities, filling of, 287, 294\\nocclusion, 686\\npreparation of, 234\\nMesio-disto-incisal cavities, filling of, 288\\npreparation of, 234\\nMesio-disto-occlusal cavities, preparation\\nof, 238\\nMesio-incisal cavities, filling of, 288\\nMesio-labial cavities, filling of, 287\\npreparation of, 233\\nMesio-lingual cavittes, filling of, 288\\npreparation of, 333\\nMesio-occlusal cavities, filling of, 289\\npreparation of, 235\\nMetal fillings, effect of temperature on,\\n352\\npulp disturbance from, 419\\nMetallic fillings, insulation of, in catapho-\\nresis, 203\\nsalts, staining of teeth by, 537\\nstains, tooth discoloration by, 543\\nMetals, action of chlorin on, 547\\nas canal fillings, 437\\nmodification of alloys by, 314\\nMethyl chlorid as a local anesthetic, 639\\nMicro-organisms, invasion of pulp tissue\\nby, 429\\nMicroscopic specimens, preparation of, 76\\nMiller matrices, 317\\nMiller s experiments on pulp mummifica-\\ntion, 340\\nMineral acids, action of, on dental pulp,\\n434, 436\\nMixing tablet, 339\\nModelling compound as an impression\\nmaterial, 710\\nMoisture, avoidance of, in preparation of\\ncavities, 219, 239, 347\\nMolar, impacted, extraction of, 609, 636", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0856.jp2"}, "857": {"fulltext": "INDEX.\\n849\\nMolars, extraction of, 603, 607, 608\\nfirst, early extraction of, 562\\nmicroscopical anatomy of, 37\\npulp chambers of, 448, 449, 450, 451\\nsupernumerary, 48\\ntemporary, preservation of, 667\\nMonsehs solution as a styptic, 614\\nMorphia, treatment of sensitive dentin by,\\n193\\nMortars for mixing amalgam, 318\\nMouth, hygiene of, 182\\nmirror, use of, 175\\nopener, mechanical, 576\\npreliminary examination of, 173\\npreparation of, for local anesthesia, 643\\nMouth-breathing, irregularities caused bv,\\n566\\nMouth-props in tooth extraction, 575, 631\\nMouth-wash, antiseptic, 514\\nformula for, 183\\nMucous surfaces, treatment of, preliminary\\nto operation, 183\\nMuffles for baking porcelain, 393\\nMummification of the dental pulp, 439\\nMummifying paste, 441, 446\\nNAPKINS, use of, in filling operations,\\n246\\nNarcosis, symptoms of, 633\\nNasal floor, perforation of, bv alveolar ab-\\nscess, 483\\nNasmyth s membrane, 92\\nNausea, relief of, in filling operations, 247\\nNecrosis from alveolar abscess, 486\\nNerve instruments, 455\\nNervous gout, 521\\nNew-departure corps, 306\\nNickel, staining of teeth by, 558\\nNitrate of silver as an anesthetic, 212\\nNitric acid as an anesthetic, 212\\nNitrous oxid, advantages of, as an anesthetic,\\n629\\ncombination of. with oxygen, 624\\nin tooth extraction, 620/629\\ninhaler for, 630\\nmode of administration, 632\\nmouthpieces for, 622\\nportable apparatus, 624\\nNostrums, anesthetic, dangers of, 642\\nOBTUNDING- the pulp, pressure method\\nof, 425\\nOcclusal cavities, filling of, 282\\npreparation of, 224\\nOcclusion, anterior, lack of, 786\\ndistal, 685\\nline of. 19\\nlingual. 681\\nmal-, 685\\nmesial, 686\\nnormal, 579\\nOccluso-buccal cavities, filling of, 294\\npreparation of, 237\\nOccluso-lingual cavities, filling of, 294\\npreparation of, 238\\nOccupation, relation of, to. pyorrhea, 527\\nOdontalgia, treatment of, in children, 666\\n54\\nOdontoblasts, 76, 127\\nOil of cinnamon as a sterilizer, 441\\npad, substitute for, 360\\nOils, essential, as antiseptics, 434, 436\\nOperator, position of, at the chair, 173\\nOral fluids, effect of acid conditions of, 191\\nOrthopedia, facial, 808\\nOsmosis, influence of electrical current on,\\n194\\nOsteoblasts, 146\\nOsteoclasts, 148\\ndevelopment of, on dental pulp, 421\\nOsteo-periostiti-alveolo-dentaire, 505, 509\\nOut-and-in motion in tooth extraction,\\n585, 600\\nOverbite, excessive, 790\\nOxidizing bleachers, 540\\nOxvchlorid of zinc as a filling material.\\n255, 334\\nas a permanent filling, 548\\nOxygen as a sterilizer, 434\\ncombination of, with nitrous oxid, 624\\nOxysulfate of zinc, 343\\nOzena, alveolar abscess mistaken for, 483,\\n487\\nPACKING- of amalgam, 319\\nPain, diagnosis of, in children, 667\\nPain reflected from exposed pulps, 416\\nPalladium amalgam. 313\\nParaffin as a canal filling, 464, 467\\nas a root filling, 439\\ncoating for cement. 675\\nPatients, instructions to, 182\\nmanagement of, 594\\nphysical examination of, before anesthe-\\nsia. 618\\nposition of, in tooth extraction, 594\\nPepper plasters, use of. in abscess, 492\\nPericementitis, chronic, treatment of, 476\\ngouty, 515\\ntreatment of, 473\\nPericementum, embryology of, 91\\ninvolvement of, in pyorrhea, 522\\npreservation of. in implanting teeth, 652\\nrevivification of. 651\\nrupture of. from regulating appliances,\\n701\\nseptic infection of. 457\\nPeridental membrane, structural elements\\nof, 91, 135\\nPermanent teeth, indications for extraction\\nof, 561\\nPhagedenic pericementitis, 509\\nalveolar abscess associated with, 494\\nPhosphoric acid, impurities of, 337\\nPhvsiognomv. relations of, to the teeth,\\n805. 823\\nPiano-wire regulating appliances, 703\\nPink base plate as a temporary filling, 327\\nPlane, inclined, for regulating, 714\\nPlastic gold, combination of, with cement,\\n353\\ngolds, 361\\nroot fillings. 437\\nPlastics as filling materials, 305\\nPlate, regulating, 713, 721", "height": "4560", "width": "2688", "jp2-path": "americantextboo00kirk_0857.jp2"}, "858": {"fulltext": "850\\nINDEX.\\nPlatinum anode for cataphoresis, 205\\nmatrix for inlay work, 379\\nPliers, regulating, 727\\nPlugging instruments, selection of, 276,\\n282\\nPorcelain cavity stoppers, 374\\ninlavs, 374\\nbaking of, 393\\nfurnaces for baking, 393\\ngold matrices for, 376, 388\\nhigh-fusing and low-fusing tooth\\nbodies for, 375, 393\\ninsertion of, 384\\nmaking matrices upon models for, 400\\nmatching colors for, 386\\nplatinum matrices for, 376, 379\\npreparation of cavity for, 377\\nsetting of, 385\\nPosition at the dental chair, 175\\nPotassium carbonate, use of, in pvorrhea,\\n530\\nPoultices, use of, in alveolar abscess, 494\\nPressure method of obtunding the pulp, 425\\nProfiles, study of, 810\\nPrognathism, 822\\nProtrusions, lower dental, 773\\nupper dental, 811\\nPtyalogenic calcic pericementitis, 510\\nPulp, calcific changes in, 417\\ncanals, abnormalities of, 451\\ncleansing of, 456\\nenlargement of, 457\\nfilling of, in bleaching operations, 545\\nseptic, treatment of, 469\\nsterilization of, 491\\ntreatment of, in deciduous teeth, 679\\ncapping, 411\\nchambers, topographical anatomy of,\\n446\\ndeath of, from regulating appliances,\\n701\\ndevitalization, 421\\ndiscoloration of tooth from death of, 536,\\n539\\nexposure in deciduous teeth, 677\\nphenomena of, 405\\ntreatment of, 409\\nfunctions of, 131\\nmummification of, 429, 439\\nnodules, 419\\nobtunding of, pressure method, 425\\nreaction of, diagnostic value of thermal\\ntests to, 406\\nstones, 420\\nstructural elements of, 127\\nPulps, mummified, in root canals, 468\\nPumice, use of, in polishing teeth, 181\\nPunch, rubber dam, 241\\nPus, burrowing of, in alveolar abscess, 483,\\n487\\nevacuation of, in alveolar abscess, 490,\\n494\\nformation, results of, on tooth roots, 496\\nPutrefactive decomposition, process of, 538\\nPyorrhea alveolaris, causation of, 526\\nclassification of, 510\\ndiagnosis of, 525\\nPyorrhea alveolaris, gingival origin of,\\n506\\nhistory of, 505\\npathology of, 519\\nrecurrence of, 531\\nterminology of, 509\\ntreatment of, 528\\nalveolo, 509\\ncomplex, 532\\ninter-alveolo-dentaire, 485, 509\\nsimplex, 532\\nPyrozone as a bleaching agent, 551\\nuse of, in alveolar abscess, 498\\nin root filling, 469\\nQUATERNARY amalgams, 314\\nREAMERS, implantation, 555\\nuse of, in pulp canals, 455, 456, 461\\nRecords, preservation of, 416\\nRegulating appliances\\nAngle s, 703, 710, 711, 727, 728, 742,\\n752, 759, 769, 775, 776\\nCase s, 791, 793, 834\\nCoffin s, 707, 708\\nFarrar s, 795\\nGoddard s, 717, 719, 729, 730, 731, 732,\\n767, 792\\nGuilford s, 747, 751, 765\\nJackson s, 715, 752, 766\\nKingsley s, 738, 759, 789\\nMagill s, 703\\nMatteson s, 704, 714, 729\\nTalbot s, 716, 722\\ngeneral directions for, 708\\nsurgical methods in, 802\\nReplantation in alveolar abscess, 499\\nResin, carbolized, 667, 675\\nResistance, table of, 200\\nRestoration of teeth by cemented inlays,\\n369\\nRetaining appliances, contact of, 702\\ngrooves in approximal cavities, 230, 231,\\n236\\nplugs, 743\\nRetention caps for planted teeth, 652\\nRetrusions, upper dental, 817\\nRetzius, brown bands of, 107\\nRhein s method of packing amalgam, 322\\nRheostats for cataphoresis, 199\\nRiggs disease, 509\\nRobinson s remedy, 207\\nRoot canal fillings, 463\\ncanals, treatment and filling of, 429\\nfilling in bleaching operations, 545\\nRoots, anomalous, 450\\nartificial, 653\\nbroken, removal of, 612\\ndepression of, by regulating appliances,\\n701\\nextraction of, 574\\nmovement of, 795\\nperforation of, 503\\nrelation of, to maxillary sinus, 583\\nresorption of, in planted teeth, 661\\nRoyal mineral succedaneum, 305", "height": "4580", "width": "2776", "jp2-path": "americantextboo00kirk_0858.jp2"}, "859": {"fulltext": "INDEX.\\n851\\nKubber band for regulating, 702, 706, 720,\\n733\\ncup for emptying abscess cavities, 493\\ndam, adjustment of, 352\\nfor bleaching operations, 544\\napplication of, in children, 673\\nclamps, 244, 285\\napplication of, 245\\nholders, 245\\nmode of application, 243\\npunch, 241\\nshields, 247\\nuse of, in filling operations, 239\\nas a separator, 187\\nSALINE waters, use of, in pyorrhea, 529\\nSaliva, control of, in filling operations,\\n239\\nSalivary calculus, formation of, from irreg-\\nularities, 701\\nremoval of, 181\\nSalol as a canal filling, 464, 467\\nand gutta-percha canal filling, 492\\nas a root filling, 439\\nuse of, in deciduous teeth, 680\\nSandarac varnish, 343\\nSanguinary calculus, 507\\nScalers, Abbott s, 182\\nCushing s, 512\\nfor root extractiou, 573\\nSchleich s cocain solution, 642\\nSchreier s preparation in tooth-bleaching,\\n551\\nScissors, gum, 576\\nScrew matrices, 292\\nSecondary dentin, 414, 417\\nSelf-cleansing spaces, 262\\nSensitivity, zone of, in dental caries, 191\\nSeparations, methods of making, 185\\nSeparators, forms of, 186\\nSeptic infection of the dental pulp, 432\\nSex, relation of, to pyorrhea, 527\\nSharpey s fibers, 87\\nSheaths of Neumann, 121\\nShredded tin, use of, in root-filling, 467\\nSilver nitrate, use of, in deciduous teeth,\\n667\\npaste, 305\\nSilver-tin alloys, tables of results from an-\\nnealing, 309, 310\\nSimple approximal cavities, preparation of,\\n229\\ncavities, filling of, 282\\npreparation of, 224\\nSkiagraph, diagnostic uses of, 592\\nSoderberg s method of pulp mummifica-\\ntion, 441\\nSodium dioxid as a bleaching agent, 552\\nuse of, in septic pulp canals, 471\\nSoft gold, 363\\nand heavy gold, combination of, 364\\nSpace, retention of, in separations, 187\\nSpheroiding of amalgams, 308\\nSplints, metallic, for pyorrhea, 512\\nSpring device for regulating, 722\\nStains, special bleaching methods for, 558\\nStellate reticulum of enamel organ, 64\\nSterilization of exposed pulps, 409\\nof instruments by boiling in soda solu-\\ntion, 169\\nformaldehyd lamp for, 168\\nformalin as an agent for, 167\\nresults of tests of various agents for,\\n165\\nStorage batteries, use of, for cataphoresis,\\n202\\nStratum intermedium, 63\\nMalpighii, 54\\nStyptics for control of hemorrhage, 615\\nSulfuric acid in root canals, 456, 461\\nas a sterilizer, 434\\nether, advantages of, as an anesthetic,\\n212\\nmethod of application, 212\\nSulfurous acid as a bleaching agent, 554\\nSuppuration conjoint, 509\\nSymbols, examination, 179\\nSyringes for pulp-canal treatment, 453\\nwarm-air, 208\\nTALBOT S regulating appliances, 716,\\n722\\nTampon for controlling hemorrhage, 614\\nTannic acid in pulp exposure, 679\\nin pulp treatment, 422\\nuse of, in hemorrhage, 614\\nTap openings for pulp treatment, 459\\nTape as a separator, 186\\nTartarlithine, lithium bitartrate, 530\\nTaylor s regulating appliance, 751\\nTeeth, abnormalities in, 593\\naccidents to, during extraction, 612\\nanchorage of, in regulating, 715\\nbleaching of, 540\\nCarabelli s sectional views of, 442\\ncleansing of, 181\\ncrowded, extraction of, 613\\ndeciduous, alveolar abscess in, 680\\nduration of, 665\\neruption of, 663\\nextraction of, 595, 600\\nfilling of, 669\\nmacroscopic anatomy of, 48\\nprophylactic treatment of, 681\\npulp treatment of, 677\\nrules agains-t extraction of, 691\\ndiscoloration of, 535\\nby amalgam, 358\\nembryology of, 53\\nexamination of, preliminary to operation,\\n173\\nexfoliation of, in pyorrhea, 518\\nextraction of, 561\\nfor regulating, 746\\nunder anesthesia, 634\\nextrusion of, 729\\nforces used in moving, 708\\nhistology of, with reference to operative\\ndentistry, 93\\nimmediate movement of, 799\\nindications for extraction of, 561\\ninfluence of, on the phvsiognomv, 805,\\n823\\ninstruments for extraction of, 564", "height": "4540", "width": "2704", "jp2-path": "americantextboo00kirk_0859.jp2"}, "860": {"fulltext": "852\\nINDEX.\\nTeeth, irregularities of, 690\\nlabial displacement of, 720\\nlingual displacement of, 712\\nlower, extraction of, 606\\nmacroscopic anatomy of, 17\\nmovement of, in regulating, 709, 718\\nnormal forms of, 592\\nocclusion of, 19, 684\\noral, combination fillings for, 353, 355\\nextraction of, 606\\npartial eruption of, 731\\nparts of, most liable to caries, 177\\npermanent, order of eruption, 688\\nplantation of, 645\\nplanted, life of, 654\\nmode of attachment, 653\\nsubsequent care of, 652\\npulp chambers of, 446\\nrelation of, to temperament, 51\\nremoval of, for artificial dentures, 563\\nreplantation of, 648\\nin alveolar abscess, 499\\nreshaping of, 736\\nretention of, after regulating, 742\\nrotation of, 724\\nin extracting, 600\\nscaling of, in pyorrhea, 512\\nseparation of, 185, 243\\nsurgical anatomy of, 577\\ntemporary, abscess on, 502\\ncombination filling for, 359\\nindications for extraction of, 561\\nmanagement of, 663\\ntemperature sense of, 402\\ntransplantation of, 650\\nupper, protrusion, 760, 773\\nTegumentary gout, 521\\nTemperament, relation of teeth to, 51\\nTemperamental indications for pulp treat-\\nment, 415\\nTemperature sense of teeth, 402\\nTemporary stopping, 342, 438\\nTernary amalgams, 313\\nTherapeutic treatment of sensitive dentin,\\n193\\nTherapeutics of pulp treatment, 433\\nThermoscopic heater, 331\\nThumb-sucking, irregularities caused by,\\n696^\\nrelation of, to protruding teeth, 761\\nTin, as a canal filling, 463\\nas a cavitv lining, 258\\nas a filling material, 251, 267, 295\\ncohesive property of, 296\\nfelt. 296\\ninstruments for filling with, 296\\nshavings of, 296\\nshredded, 296\\nthermal conductivity of, 251\\nuse of, in children s teeth, 677\\nTin-gold, 365\\nTin and gold, 367\\nTissues, changes of, by movement of teeth,\\n697\\nTomes, fibers of, 127\\ngranular layer of, 125\\nTonics, general, 616\\nTonsils, enlarged, irregularities caused by,\\n697\\nTooth development, chronology of, 88\\nextraction, general principles in, 593\\nforms, evolution of, 17\\nvariations of, 50\\nmolar, impaction of, 589\\npreparation of, for bleaching, 543\\nstructure, discoloration of, by amalgam,\\n311\\nsaving of, by combination filling, 356\\nToothache, treatment of, in children, 666\\nTooth-brush, correct use of, 182\\nTownsend s alloy, 313\\nTransillumination of the teeth, 177\\nTransmission of oral diseases, 160\\nTrichloracetic acid, use of, in pyorrhea v 512\\nTropacocain as a local anesthetic, 642\\nTruman s bleaching method, 546\\nTuberculate teeth, 37\\nTutt s powder, 182\\nU KATES, accumulation of, in the blood,\\n521\\nUric acid theory of pyorrhea, 508\\nVARNISHING fillings, 333\\nVelvet gold cylinders, 289\\nVeratria, treatment of sensitive dentin by,\\n193\\nVisceral gout, 521\\nVulnerable point of cavities, 235\\nWATERING of amalgams, 320\\nWarmed air as an anesthetic, 207\\nWedges for regulating, 718\\nas separators, 185\\nuse of, in examinations, 177\\nWeston s method of mixing cements, 339\\nWillms controller for cataphoresis, 202\\nWright s bleaching method, 549\\nZINC chlorid as an anesthetic, 209\\nuse of, in root canals, 462\\noxychlorid as a canal filling, 463\\nas a root filling, 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