the model having been taken from the mouth of
a strong healthy young man of one or two and
twenty years of age, heir to a title, accustomed all
his life to the comforts which wealth can give,
brought up in the country, not over studious, and
fond of out- door exercise and country sports. He
had kept out of the dentist's hands until he got
toothache at school, and, in accordance with school
practice, "had it out"; that is, had an upper
and a lower molar extracted on the right side,
while the corresponding teeth on the left side, not
having ached, were " stuffed." After this he again
kept clear of the dentists until he was past sixteen,
when he came into my hands. I thought it was
too late then to extract on the left side, but I
am convinced now that it would have been better if
I had done so, even if the gaps did not quite close
up, for, as will be seen, every tooth, except the
wisdom tooth, on that side, together with the central
and lateral incisors on the right side, have been
filled on both approximal surfaces, and the molars
and one of the bicuspids on the grinding surfaces.
One central incisor is dead, and has been filled into
the root, and the first molar has been treated in the
same manner. Probably the incisors were already
decayed when the two molars on the right side were
extracted ; but after that operation no other teeth on
that side were affected by caries, and at the present
time the canine, two bicuspids, and two molars are
86 DENTAL PRACTICE =
perfectly sound. I cannot imagine a more con-
clusive proof of the advantage of extracting certain
teeth for the preservation of the others than this ;
but I doubt whether this view of the subject was in
the mind of the operator when he removed the two
teeth.
87
CHAPTER IV.
Irregularities.
After the molars are extracted, the gain of addi-
tional room should be at once taken advantage of,
if any considerable change is to be made in the
position and articulation of the teeth ; and if extrac-
tions have not been necessary, the time when
irregularities can be corrected with ease is rapidly
passing away. Very prominent upper teeth should
be pushed back, narrow upper jaws should be
widened, "under hung" jaws reduced by either
forcing the lower teeth back, or pushing the upper
ones forward, which is generally the easier way if
it suits the face. These cases are often spoken of
as family peculiarities, and therefore not to be
meddled with ; but it is difficult to see why a de-
formity that is curable, should be perpetuated
because it is an heirloom. It will be useless, how-
ever, for the dentist to urge the treatment if
parents do not care about it. The appliances
necessary for operations of this nature have to be
worn constantly, day and night, at meal times and
play time. They are sometimes so secured in the
mouth that they cannot be taken out by the patient,
but usually they can be removed for cleansing night
88 DENTAL PRACTICE.
and morning, and this is all the indulgence that
can be permitted. They are often so constructed
that bands or springs of gold or platinum are
conspicuously visible in the front of the mouth,
and children wearing them have to make up their
minds to give up parties for the time, or stand a
little chaffing from their young friends, for they
cannot have the plates out of their mouths for an
evening's amusement. It therefore requires some
degree of resolution and ability to deny one's self,
on the part of the child, and such encouragement
on the part of the parent as can only be given
when there is an appreciative desire to assist the
dentist in every possible way. The fullest co-opera-
tion on the part of parent and child must be
secured, and failing this, the most skilful dentist
will not accomplish anything of importance in
correcting malposition of the teeth ; and the most
probable result will be a feeling that the one party
has been unjust, and the other incompetent. On
the other hand, when everybody really wishes for
success in treating such cases, almost anything is
possible. The dentist is not weighted with the
depressing feeling that he is the only one interested
in the case, and that the other parties are only
obeying his instructions under protest. The child is
encouraged to persevere by the quick instinct which
tells when others are sympathetic or the reverse,
and the parent, interested in what is shown to be
possible, gains confidence as the work progresses,
takes care that instructions are carried out, and
IRREGULAKITIES. 89
that the work shall not fail from negligence. Clean-
liness should be insisted upon, and in this too the
parents' aid is needed, for some of the retaining
plates have to be worn for months, and if there is
not scrupulous cleanliness, we may be doing harm
to some of the teeth while improving others. If
the plate is of such a nature that it can be taken
out of the mouth, it should be removed twice a
day, and those parts which are covering, or in
contact with, the teeth, should be carefully cleansed
with a brush. The teeth also must be kept as clean
as possible, by using a soft brush, or if the teeth
and gums are too sore for that, a small sponge fixed
on a handle should be used, and every part that can
be reached when the plate is immovable should be
sponged with a weak solution of carbolic acid, or
phenate of soda, or sanitas ā any of which pre-
parations can be effectively used to keep down
inflammation, and assist in keeping the parts clean,
and removing lodgments of food. If the gums swell,
as they may do if many teeth are being moved at
the same time, the pressure should not be increased
for a few days, and astringents may be used with
advantage.
Screws and springs, fixed in a vulcanite frame,
as the case may require, will move any number of
teeth to any necessary extent, even when, as the
following case will show, the patient is considerably
beyond the age at which these. operations are usually
undertaken. A young lady had never seen the left
upper canine, but a peculiar thickness in the palate
90
DENTAL PRACTICE.
immediately behind the lateral incisor indicated that
probably the tooth was there. When the young lady
was three and twenty, the point became visible far
inside the arch, and behind the lateral, which at
this time had become very prominent. There was
plenty of space for the canine in its natural position,
and I determined to try to move it. Fig. 40 shows
Figure 40. ā Sbowing a misplaced and very late erupting canine.
the position of the tooth when I commenced the
operation. After several ineffectual attempts to
apply the necessary amount of pressure, which was
difficult because the apparatus would slip off the
teeth now and then, I finally hit upon the plan
shown in Fig. 41. The frame of vulcanite fitting
tightly over the back teeth, so that it required con-
siderable force to remove it, enabled the patient to
masticate her food without permitting the lower
front teeth to come in contact with the apparatus for
IRREGULARITIES. 91
moving the tooth, which consisted of a thick strong
spring of gold, fixed in the buccal surface of the vul-
canite outside the second bicuspid and the molars,
with the point resting on the lateral. ' A triangular
boss was soldered on the spring at a point im-
mediately in front of the first bicuspid, so as to
Figure 41. ā Showing apparatus for moving misplaced canine.
make a flat surface at a right angle to the line in
which I wanted the tooth to move, and a hole was
drilled through this boss. A screw was then cut on
a piece of strong gold wire, with a pointed hook at
one end and a nut at the other. I then made
with a drill, a shallow indentation, in the enamel of
the lingual surface of the tooth, for the point of the
hook to rest in. The screw end of the hook was
then passed through the hole in the boss, and the
nut turned up, and a key fitting the nut given to
the patient with instructions to screw it up twice
in every twenty-four hours if the tooth did not get
too sore, and to let me see it once a week, to remove
92
DENTAL PEACTICE.
and cleanse the plate, and to see if all was going
on well. It will be seen at once that such an
apparatus would move any tooth to any distance,
the only difficulty was to make the plate itself
so fast that it could not be disturbed by the
turning up of the screw, or by mastication. The
tooth was moved to its proper position in six weeks
without any inflammation, and the lateral also was
pressed back to its place. The canine was easily
kept in its position by the occlusion of the jaws,
when it was once outside the lower teeth it could
not get back; but the lateral required a retaining
plate for some weeks, and even then it was left
off too soon, as the model of the mouth at the
present time will show, Fig. 42. The age of the
y^
Figure 42. ā Sbowing position of teeth from a model taken three years later.
patient, and the distance the tooth had to be moved,
made this rather a doubtful case at first, as most
young ladies of that age would not care to have
IRREGULARITIES.
93
such a clumsy apparatus in the mouth for several
months; but being convinced of the advantage to
herself, if it succeeded, she followed my instruc-
tions implicitly. The result was a perfect success,
for although it is three years since the operation
took place and the tooth is not even yet quite
down to its full length, it is steadily advancing,
and although the lateral is still a little prominent, it
has not got worse in the last two years, and is not
likely to change now.
Fig. 43 shows a case where the canine on the
Figure 43. ā Misplaced right canine and left first bicuspid.
right side was very prominent, and the first bicuspid
on the left side w^as also very prominent ā the lin-
gual cusp shutting outside the lower tooth. Fig. 44
shows the arrangement of springs for moving
these teeth into their proper positions ā the springs
from the palatine surface pressing the bicuspids
back into the space made by extracting the first
94
DENTAL PRACTICE.
molars, and the buccal springs pressing the promi-
nent teeth into the desired position.
We frequently find that cases of projecting upper
teeth are complicated with extreme shortness of the
back teeth, which allows the lower incisors and
Figure 44. ā Plate for regulating teeth in Figure 43, as above.
canines to shut quite past their proper antagonists
of the upper jaw on to, and often making deep
indentations into the fleshy covering of the hard
Figure 45. ā Showing the upper front teeth projecting, and lower incisors
and canines biting into the hard palate.
palate. Fig. 45. To move the upper teeth back in
these cases, without also correcting this form of
IREEGULARITIES. 95
occlusion, would be manifestly fruitless labour and
trouble ; because, when moved back, the upper front
teeth would receive the bite of the lower ones upon
the incline of the lingual surface before the back
teeth were in contact, and it would not take long for
the powerful muscles which close the jaws to undo
such a piece of work. Therefore, the first step in
treating a case of this nature is to induce the
molars and bicuspids to elongate sufficiently to pre-
vent the possibility of the lower front teeth ever
again touching the palate. Seeing that the back
teeth would always elongate when they did not meet
an antagonist of the opposite jaw, it occurred to me
that, if a plate were so constructed that the whole
biting force of the jaws came upon the front teeth,
the back ones would increase in length to any
Figure 46. ā Showing form of plate to take pressure off the back teeth,
so as to allow them to elongate.
required extent. A vulcanite plate was easily made
of the required thickness at the point of contact of
the lower teeth, and, fitting the palate well, it could
96 DENTAL PRACTICE.
be kept in its place by suction. Fig. 46. This I
have found to be perfectly successful in a number
of cases that I have treated. Three months will be
about the time required to lengthen out the molars
and bicuspids so that the lower incisors would not
reach nearer than a tenth, or an eighth, of an inch
from the palate.
Fig. 47 gives a representation of a very in-
Figure 47. ā Projecting upper teeth, models taken after the upper six years
molars had been extracted.
teresting case of projecting front teeth, the young
lady being about fifteen years of age when she was
first brought to me for consultation. The upper
front teeth projected over, and when the mouth was
closed, were always lying upon the lower lip. There
were wide spaces between the teeth, and the utter-
ance of many sounds was quite indistinct ā indeed it
was on account of this indistinct utterance that she
came to consult me. The lower front teeth made
deep indentations in the mucus membrane covering
the hard palate, nearly a quarter of an inch
behind the central upper incisors. The age of
the patient making it extremely probable that the
IRREGULARITIES.
97
difficulty was increasing, from the development of
the wisdom teeth causing an increase of length in
the upper jaw, I determined to extract, at once, the
upper six-year molars. I then made a plate
such as I have just described, except that having
the spaces where the molars were extracted, I
could clasp the plate to the second bicuspids, and
thus leave the molars quite free. Fig. 48. It will
Figure 48.ā Showing the position of the bicuspids three months after the
extraction of the molars.
be seen that the lower molars were not extracted
in this case, as it was desirable to encourage
the development of the lower jaw as much as
possible, and I intended to force the upper bi-
cuspids back into the gaps left by the extraction
of the upper molars. In three months all the back
teeth had elongated, so that the molars and bicus-
pids would meet when the plate was in the
G
98 ā¢ DENTAL PEACTICE.
mouth and the jaws closed, leaving, when the
plate was taken out, a clear tenth of an inch
between the ends of the lower incisors and the
palate, which was in itself a great gain, as it gave
the tongue more room, and helped the power of
articulation. The next step was to move the bicus-
pids back, which was done by making a vulcanite
plate to cover the upper molars, in order to take
the bite of the lower teeth on the molars and the
incisors, leaving the bicuspids so that the lower
teeth could not touch them. A fixed nut was
placed in the substance of the vulcanite opposite
the buccal surface of the molar on each side. Then
a narrow strip of very thin gold, shaped like a
figure eight, was made to fit tightly over the bi-
cuspids on each side, and a piece, shaped like a
letter T, was soldered to the band, so that it would
slip between the two teeth and the
f ^>C\ cross lie in the sulci, to prevent
. YC^^'^^T bS^ ^^^ band slipping too high up un-
_ ā, . der the o-um. A small ring;, or
Figure 49. ā Snowing Ā° ^ _ "
the form of band rather a stud with a hole in it, cor-
and screw used in responding to the sizo of the screw
moving the bicus- -ā - ^
pids. The nut was holo in the fixod uut, was also
pSe.'"*'''ā¢'''"'*' soldered to the band opposite the
buccal surface of the second bicus-
pid. The apparatus was then placed in position,
and a long screw, with a square head, was passed
through the stud into the fixed nut, and screwed
up. A key fitting the head of the screw was then
given to the father of the young lady, with instruc-
IRREGULARITIES.
99
tions to turn the screw ever}^ day as much as she
could bear, and to see that the gums and teeth were
sponged twice a day with a weak solution of carbolic
acid, letting me see the case once a week, to take
the plate off and clean it thoroughly. This treat-
ment soon moved the bicuspids back. Then another
plate, with a clasp fitted around the mesial surface
Figure 50. ā Showiug the position of tlie bicuspids aftcv moving them.
Figure 51. ā Side view of the upper teetii at this stage.
of the first bicuspid, held them there, until the new
alveoli were properly formed around them, as I
thought it best to let these teeth get well established
before I moved the others. Figs. 50 and 51. The
100
DENTAL PEACTICE.
plate for moving the front teeth was fitted over the
molars and bicuspids. The fixed nut was placed
opposite the first bicuspid, and, of course, the plate
had to be kept well back in the palate, allowing
fully half an inch between its anterior edge and the
lingual necks of the front teeth. A long strip of
thin gold was cut in the shape of Fig. 52, the
Figure 52. ā Showing the form of the strip of gold that was used for
moving the front teeth.
lips being intended to be bent over the cutting
edge of the central incisors to keep the band
from slipping up on to the gum, and studs were
soldered to the ends for the screws to pass
through. The canines being always rather difficult
teeth to move, I made a separate
loop for each of them, thus ā
Fig. 53 ā having holes through
the ends, which were bent so that
the holes would come opposite
the holes in the studs at the ends
of the long strip that went round the front teeth,
allowing the screw to pass through both ends of the
loop, as well as through the stud. Fig. 54. This
soon forced all the teeth back to the required
position. Another plate, with a plain band fixed in
the vulcanite, passing around the front or labial
surface of all the teeth, with hooks, as before, bent
over the cutting edge of the central incisors, to keep
Figure 53. ā Showingthe
form of loop used for
the canines.
IRREGULARITIES.
101
it from slipping, kept all these teeth in position
until the alveoli were properly formed and the teeth
quite firm in their new position. The process of
Figure 54. ā Showing the regulating apparatus in position, with the loops for
canines omitted.
moving all these teeth to the extent necessary
caused a great deal of imflammation and swelling of
the gums on the lingual side. Fig. 55 is from a
model, taken when first the teeth were in a satisfac-
tory position. Great care was taken to syringe the
gums well, in order to remove all lodgments from
around the necks of the teeth, and they were also
constantly sponged with the carbolic lotion, so that
the swelling soon went down without any disagree-
able results. I saw the young lady about six
months after she had left off the retaining plate,
and the teeth were quite firm in their sockets, and
there was no appearance of the old unnatural pro-
jection. This was an operation that would have
102
DENTAL PRACTICE.
been impossible without the aid of home influence
and assistance, and the work, extending over a
period of eighteen months, was a pretty severe trial
fA, ā¬^_ J^ ^
Figure 55. ā Showing the condition of the gums immediately after the teeth
had been moved into the desired position.
of patience for a young girl ; but she bore it ex-
tremely well, and assisted me in every way that she
could.
Another case of projecting upper teeth was
Figure 56. ā Another case of projecting upper teeth.
much more easily treated, because the back teeth
were of natural length. Fig. 56 will show the
IRREGULARITIES.
103
condition of this month when I first saw it, the
young lady being then about thirteen years of age.
Some one ā I never ask who does these senseless
things ā had extracted two lower bicuspids ; but
why this had been done it would be impossible to
say, unless it w^as felt that something must be done
to make a charge for, as any man, who thought at
all of what would be best for the patient, would have
seen that the lower jaw was already too small, and
therefore that its growth should be encouraged by
all possible means, and not stopped by extractions on
each side. As it was, the best thing to be done was
to extract the first upper bicuspids and move the
canines and incisors back. I commenced with the
Fifoire 57. ā Showing the form of loop used in moving the canines. The
straight bar projecting from the buccal surface of the plate is intended
to prevent any outward movement of the teeth.
canines, to avoid the excessive amount of inflam-
mation that so often results from moving a number
of teeth at the same time. A frame was made of
vulcanite, covering the two molars and the second
104
DENTAL PRACTICE.
bicuspid on eitiier side with a fixed nut opposite
the bicuspid. Then a loop of thin gold plate, like
that shown in Fig. 57, was fitted to each canine, and
a square-headed screw and key, as before, quickly
accomplished the removal. But they were also
drawn rather out of the arch and elongated, pro-
bably from being moved so rapidly into the spaces
where bicuspids had been recently extracted. To
correct this I made another plate, Fig. 58," with
Figure 58. ā Form of plate for moving canines inwar J, and at the same time
shortening them ; showing lingual surface.
a strong clasp passing round the labial and mesial
surfaces of the canines, and a strip of stiff gold plate
springing from the palate, with the free end resting
on the points of the teeth, thus making an incline
which, as the teeth were pressed inwards by the
clasps, must shorten them by forcing them into the
sockets. I then cut away the vulcanite from
around the necks of the canines to allow them to
move into their proper place in the arch, and
bending the clasps so as to press on the labial
surfaces of the teeth, they were very quickly in the
IRREGULARITIES.
105
position I wished them to be, aud of the right
length. This plate was worn until the canines were
firmly fixed in their sockets, and then I moved the
incisors back with springs of stiff gold wire, fixed in
the buccal surface of another plate shown in
Fig. 59. All this was done without any serious
Figure 59. ā Form of plate for moving all the upper incisors inward ;
showing lingual surface.
Figure 60. ā Retaining plate in position.
inflammation. When the teeth were as far back as
I wanted them, the plate, Fig. 60, held them all in
106 DENTAL PRACTICE.
position for six months, when the casts shown in
Fig. 61 were taken.
Figure 61. ā Showing articulation of teeth at this stage.
Another member of the same family, a younger
sister of ten years of age, also had projecting front
teeth, with the compHcation shown in Fig. 45,
the lower incisors shutting deeply into the palate,
and the projection quite as conspicious as in that
case ; hut she was late in getting her second teeth,
and the canines and second bicuspids were not
erupted. I pressed the incisors back with springs,
as in the last case, and, in making a plate to retain
them in position, the same plan was adopted that I
made use of in that case, strips of thick gold plate
from the palate being bent over the cutting edge of
the front teeth. But in this case I also made the
plate of sufficient thickness, where it would receive
the bite of the lower incisors, to give the back teeth
a chance of elongating as much as was necessary to
keep the lower front teeth from touching the palate ;
thus inverting the process adopted in a former
case, where the lengthening of the back teeth
was the first step in the treatment. But this
patient was so much younger, that I thought I
IRREGULARITIES. 107
might venture to simplify the process. The result
justified my treatment, for there was no swelling of
the gums to prevent her wearing a plate of this
construction after the moving of the front teeth was
accomplished, whereas in the former case, with the
gums swollen, as shown in Fig. 55, this would have
been impossible.
The upper jaw may be too narrow, and from
this cause alone the front teeth may be forced too
far forward. A case of this nature is shown in
Fig. 62. The outer instead of the inner cusp of
Figure 62. ā Showing faulty articulation of all the teeth.
the upper bicuspids is in the sulci of the lower
teeth, thus making the upper jaw too narrow by
exactly the largest diameter of the crown of a
bicuspid, or rather more than a quarter of an inch.
The obvious treatment here is to press the bicuspids
and canines out, in order to give the jaw the proper
width, and thus gain room to press the incisors
inwards ; thus very considerably altering the form
of the upper jaw, as shown by comparison of Fig.
108
DENTAL PRACTICE.
63 with Fig. 64. Fig. 65 shows the articulation