Page:EB1911 - Volume 08.djvu/68

 restoration was effected by engrafting upon the prepared root a suitable crown by means of a wooden or metallic pivot. When possible, the new crown was that of a corresponding sound tooth taken from the mouth of another individual; otherwise an artificial crown carved from bone or ivory, or sometimes from the tooth of an ox, was used. To replace entire dentures a base-plate of carved hippopotamus ivory was constructed, upon which were mounted the crowns of natural teeth, or later those of porcelain. The manufacture of a denture of this character was tedious and uncertain, and required much skill. The denture was kept in place by spiral springs attached to the buccal sides of the appliance above and below, which caused pressure upon both jaws, necessitating a constant effort upon the part of the unfortunate wearer to keep it in place. Metallic swaged plates were introduced in the latter part of the 18th century. An impression of the gums was taken in wax, from which a cast was made in plaster of Paris. With this as a model, a metallic die of brass or zinc was prepared, upon which the plate of gold or silver was formed, and then swaged into contact with the die by means of a female die or counter-die of lead. The process is essentially the same to-day, with the addition of numerous improvements in detail, which have brought it to a high degree of perfection. The discovery, by Gardette of Philadelphia in 1800, of the utility of atmospheric pressure in keeping artificial dentures in place led to the abandonment of spiral springs. A later device for enhancing the stability is the vacuum chamber, a central depression in the upper surface of the plate, which, when exhausted of air by the wearer, materially increases the adhesion. The metallic base-plate is used also for supporting one or more artificial teeth, being kept in place by metallic clasps fitting to, and partially surrounding, adjacent sound natural teeth, the plate merely covering the edentulous portion of the alveolar ridge. It may also be kept in place by atmospheric adhesion, in which case the palatal vault is included, and the vacuum chamber is utilized in the palatal portion to increase the adhesion.

In the construction usually practised, porcelain teeth are attached to a gold base-plate by means of stay-pieces of gold, perforated to receive the platinum pins baked in the body of the tooth. The stay-pieces or backings are then soldered to the pins and to the plate by means of high-fusing gold solder. The teeth used may be single or in sections, and may be with or without an extension designed in form and colour to imitate the gum of the alveolar border. Even when skillfully executed, the process is imperfect in that the jointing of the teeth to each other, and their adaptation to the base-plate, leaves crevices and recesses, in which food débris and oral secretions accumulate. To obviate these defects the enamelled platinum denture was devised. Porcelain teeth are first attached to a swaged base-plate of pure platinum by a stay-piece of the same metal soldered with pure gold, after which the interstices between the teeth are filled, and the entire surface of the plate, excepting that in contact with the palate and alveolar border, is covered with a porcelain paste called the body, which is modelled to the normal contour of the gums, and baked in a muffle furnace until vitrified. It is then enamelled with a vitreous enamel coloured in imitation of the colour of the natural gum, which is applied and fired as before, the result being the most artistic and hygienic denture known. This is commonly known as the continuous gum method. Originating in France in the early part of the 19th century, and variously improved by several experimenters, it was brought to its present perfection by Dr John Allen of New York about 1846–1847. Dentures supported upon cast bases of metallic alloys and of aluminium have been employed as substitutes for the more expensive dentures of gold and platinum, but have had only a limited use, and are less satisfactory.

Metallic bases were used exclusively as supports for artificial dentures until in 1855–1856 Charles Goodyear, jun., patented in England a process for constructing a denture upon vulcanized caoutchouc as a base. Several modifications followed, each the subject of patented improvements. Though the cheapness and simplicity of the vulcanite base has led to its abuse in incompetent hands, it has on the whole been productive of much benefit. It has been used with great success as a means of attaching porcelain teeth to metallic bases of gold, silver and aluminium. It is extensively used also in correcting irregular positions of the teeth, and for making interdental splints in the treatment of fractures of the jaws. For the mechanical correction of palatal defects causing imperfection of deglutition and speech, which comes distinctly within the province of the prosthetic dentist, the vulcanite base produces the best-known apparatus. Two classes of palatal mechanism are recognized—the obturator, a palatal plate, the function of which is to close perforations or clefts in the hard palate, and the artificial velum, a movable attachment to the obturator or palatal plate, which closes the opening in the divided natural velum and, moving with it, enables the wearer to close off the nasopharynx from the oral cavity in the production of the guttural sounds. Vulcanite is also used for extensive restorations of the jaws after surgical operations or loss by disease, and in the majority of instances wholly corrects the deformity.

For a time vulcanite almost supplanted gold and silver as a base for artificial denture, and developed a generation of practitioners deficient in that high degree of skill necessary to the construction of dentures upon metallic bases. The recent development of crown-and-bridge work has brought about a renaissance, so that a thorough training is more than ever necessary to successful practice in mechanical dentistry. The simplest crown is of porcelain, and is engrafted upon a sound natural tooth-root by means of a metallic pin of gold or platinum, extending into the previously enlarged root-canal and cemented in place. In another type of crown the point between the root-end and the abutting crown-surface is encircled with a metallic collar or band, which gives additional security to the attachment and protects the joints from fluids or bacteria. Crowns of this character are constructed with a porcelain facing attached by a stay-piece or backing of gold to a plate and collar, which has been previously fitted to the root-end like a ferrule, and soldered to a pin which projects through the ferrule into the root-canal. The contour of the lingual surface of the crown is made of gold, which is shaped to conform to the anatomical lines of the tooth. The shell-crown consists of a reproduction of the crown entirely of gold plate, filled with cement, and driven over the root-end, which it closely encircles. The two latter kinds of crowns may be used as abutments for the support of intervening crowns in constructing bridge-work. When artificial crowns are supported not by natural tooth-roots but by soldering them to abutments, they are termed dummies. The number of dummies which may be supported upon a given number of roots depends upon the position and character of the abutments, the character of the alveolar tissues, the age, sex and health of the patient, the character of the occlusion or bite, and the force exerted in mastication. In some cases a root will not properly support more than one additional crown; in others an entire bridge denture has been successfully supported upon four well-placed roots. Two general classes of bridge-work are recognized, namely, the fixed and the removable. Removable bridge-work, though more difficult to construct, is preferable, as it can be more thoroughly and easily cleansed. When properly made and applied to judiciously selected cases, the bridge denture is the most artistic and functionally perfect restoration of prosthetic dentistry.

The entire development of modern dentistry dates from the 19th century, and mainly from its latter half. Beginning with a few practitioners and no organized professional basis, educational system or literature, its practitioners are to be found in all civilized communities, those in Great Britain numbering about 5000; in the United States, 27,000; France, 1600, of whom 376 are graduates; German Empire, qualified practitioners (Zahnärzte), 1400; practitioners without official qualification, 4100. Its educational institutions are numerous and well equipped. It possesses a large periodical and standard literature in all languages. Its practice is regulated by legislative enactment in all countries the same as is medical practice. The business of manufacturing and selling dentists’ supplies