James Harrison Prothero.

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THE MORRISON CROWN

In 1869, Dr. W. N. Morrison described in the May number
of Missouri Dental Journal a gold shell, two-piece crown. This




GOLD SHELL CliOWX CONSIIHlllD \M>
DESCniBED P.V DR. W. \ MOUniSO%

IN ISGO



crown was substantially the same as is constructed to-day
and is quite generally known as the "Morrison Crown."

THE BLACK CROWN

In the June nuuilicr of the same journal. Dr. G. V. Black
described and illustrated the construction of a porcelain-faced



crown for an anterior tooth, held in place by means of
screw passing into a gold-lined root canal.



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1157

The similarity between tliis and the erown Dr. Richraoiid
patented years afterward is obvions.

THE BEAN CROWN

In the duly nuniher, IS*)!), of the American donnial of
Dental Science, Dr. J. B. Bean described a porcelain-faced re-



CROViT^' rONSTRU('TED
AKD DESCKIBED BY

DR. J. B. BEAN IN
18G9



mo\able crown tlie dowel of which was split and received
within a permanently fixed tube in the root canal.



THE MACK CROWN



In 1S72, Dr. (Hias. If. Mack designed a pivot tooth liaving
a dovetailed depression in the base of the crown.




THE MAIK c'li<>\V>



Metal i)in"s, roughened, were first fixed in the root
of the tooth and the crown attached with cement or amal-
gam.



1158 A BRIEF HISTORY OF PROSTHETIC DENTISTRY

THE BEERS CROWN

In 1873, Dr. J, B. Beei-s of Oalifoniia patented a gold cap
crown practically the same as described some four years pre-
viously bv Dr. Morrison.




Till! BEERS CKOWN



THE GATES CROWN



In 1875, Dr. W. H. Gates devised a "vertically open con-
tour crown," composed of metal and porcelain, designed to
be held in place with cement. In this, as in the Mack crown,




THE GATES CHOWN'



the dowel was first permanently set in the root canal and
the crown adjusted and attached later. Manufacturing diffi-
culties, however, prevented its introduction and use.



THE RICHMOND CROWN

In 1880, Dr. C. M. Bichmond designed a porcelain-faced
crown backed with metal and held in place on the root by
means of a screw similar to the crown designed by Dr. Black.

An internally and externally threaded tube was fixed in
the root canal, the crown formed with a groove in its lingual
surface for the passage of a screw which entered the tube
within the root, and by means of which it was lield in place.



A BRIEF HISTORY OF PROSTHETIC DENTISTRY lloO




THE mcllMOND CROWN




THE IMI'HOVEI) RICHMOND CROWN



A cap diaphragm rested upon the root end and over this
the crown hase, also of ca]i form, telescoped.



THE GATES-BONWILL CROWN

In 1881, Dr. W. CI. A. Boiiwill desiiined a crown wholly
of porcelain having a central opening- slightly enlarged at
either end fonr the reception of metal dowel.



/\mm




THE OATES-BONWILIi CROWN



These crowns were set with an amalgam specially pre-
pared by Dr. Bonwill. Both three-sided and triangular metal
dowels were iised.

The specifications of the Mack patents, issued six years
previously, were so broad that they covered the principle of
this crown. Therefore, when placed upon the market it was
given the name of the "Gates-Bonwill Crown."



1160 A BRUOP" HISTORY OF PROSTHETIC DENTISTRY

THE BUTTNER CROWN

Til 1SS1, "Or. W. II. r.iiltiici- pntcnlcd a scf of appliances
i'oi- rcdiiciinj;- the mmiI iH'ii|ilici'\ (if a Idtith \u a iiniroi'in cylin-






||1 111



I ji



TUB BUTTNKIl SYSTEM OF CROWN CONSTRUCTION

dor. fitting a doep-sided doTvel cap to same and root canal and
attaching a porcelain facing to tlie base so formed.

THE HOW CROWN

In 1S83, Dr. W. S. How designed what was called the
"fonr-pin crown." These pins were set within a depression
on the lingual surface of the facing, were folded aronnd a




§



'"'i?



tmi



THE HOW FOUll-I'lN CROWN



threaded dowel fixed in the root canal and tlie lingual con-
tour of the tootVi developed in amalgam.

Dr. How also designed the Dovetail Crown in 1889.



THE WESTON CROWN

Tn 1883, Dr. Henry Weston designed a "porcelain pivot
crown" having two pins located in a depression on its lin-
gual surface for the reception of a cross-head dowel. The
dowel and facing were attached with solder and the crown
attached to the root by gold, cement or amalgam.



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1161

Another form of ci'own devised by Dr. Weston consisted
in a more fnllv contoured iiorcelaiii faciiii;', in wliicli the (hiwel




WESTOXS ntdSS lIKAli DOWLI I'BOWN



WESTON'S FIXED IIOWEI, IROWN



was baked. This crown was secured to the root in the same
manner as was the preceding crown.

THE LOGAN CROWN

In 1885, Dr. ]\I. Ij. I^ogan devised a full contoured porce-
lain crown having a ]ilatinum dowel permanently fixed within
its base.




THE LOiiAX I'liOWN"



This crown has, almost from its introduction, been ex-
tensively employed and has proven most serviceable as a sub-
stitute of the fixed dowel type.



THE BROWN CROWN

In 18!M), Dr. E. Painily T.rown designed a crown very
similar to tlie "Logan," iiut with a convex instead of a con-
cave base.





THE E. PARMf.V P.I'.nWX CIIOWX



AVithin recent years many forms of detached dowel
crowns have l>een introduced, which, because of comparative
ease of adaptation, are fast coming into favor, both as crown



1162 A BRIEF HISTORY OF PROSTHETIC DENTISTRY

rfiplaceinents and lor use in liriilgx' and di-nture work as
well.

Among these may be mentioned the Davis, S. S. White,
Justi, Brewster Twentieth Century, illustrations of which are
found elsewhere.

An analysis of the various means I)y which crowns, Itotli
ancient and modern, are fixed to natural teeth and roots shows
but two general principles of attachment, viz., with dowels,
the telescoping principle, or a comlnnation of tlie two methods.

Much of the material contained in the foregoing history of
crowns has been obtained from a monograph published by
the S. S. White Dental Manufacturing Company, entitled
"Origin and Development of Porcelain Teeth," and from vari-
ous articles which have apjieared from time to time in the
Dental Cosmos.

BRIDGEWORK

Modern bridgework, of a practical character, is of very
recent origin as compared with dental procedures in general.

Dental literature of modern times contains scarcely any
reference to bridgework previous to 1869.

In addition to the three greatly improved crowns pre-
sented by Drs. Morrison, Black and Bean in that year, Dr.
Bennett described, in the Dental Cosmos of October, 1869,
a method of bridging in the space of a single missing tooth as
suggested by Dr. B. J. Bing of Paris.

THE BING BRIDGE

This method consisted in preparing cavities in the teeth
proximating the space, fitting a square bar across the space,
its ends resting within the cavities, and by suitable steps



adapting and soldering a facing to the bar. The appliance
was fixed by packing gold foil into the cavities and around
the bar ends.



A BRIEF HISTORY OF PROSTHRTIC DENTISTRY 11C2

DR. WEBB'S WORK

In 1873, Dr. Marshall II. Webb suggested a modification
of the Bing method, consisting of a flattened "two stop back-
ing and saddle," and in 1879 a "stop post," consisting of a




MODIFICATION OF THE BING BRIDGE (WEBB)

facing attached to a rigid wire staple, the ends of which were
anchored within the root canals of the proximating teeth.

In both cases the stops were surrounded by and anchored
within gold foil filling in the cavities of the adjoining teeth.

DR. LITCH'S WORK

In 1880, Dr. Wilbur V. Litcli suggested two modifications
of the Bing bridge. The first was called a "wing plate," in
which the backing was extended beyond the dummy so as to
rest upon the lingual surfaces of the proximating teeth. Per-
forations were then made in the wings and corresponding




DK. LITCU'S FIRST MODIFICATION OF THE BING BRIDGE

holes in the teeth, through the enamel, and as deeply in the
dentine as practicable, without endangering the pulp.

Headed platinum pins were passed through the plate
into the holes, the relation between backing and pins secured,
the case invested' and the pins soldered to the wings. The
substitute was set with cement.

The second modification consisted in devitalizing either
one or both teeth and extending dowels through the wings into



11fi4 A BRIEF HISTORY OF PROSTHETIC DENTISTRY

tlic n.ot canals. Ij will he imrM-cd llial holli Di's. \Vel)!> and
l;ilcli increased ilic anclioran'cs of ilic diiiiiniics li\' root dow-




0''''h\^



DR I.ITCirS SECOXI) JIUIUKUATll LN (IF THK lilXG ISl'.IDGE

els, being impelled to do so l)eeanse of failures iu their first
attempts.

DR. WILLIAMS' WORK

In 1884, Dr. J. Leon Williams, in the Dental Cosmos,
called attention to the neeessitv for more sta1)le anchorage for




MODIFIED KICHAEDSOX CROWN (WILLIAMS



bridges and suggested the use of a modified, so-called, Eich-
mond crown, wliich, in a general way, represents a common
type of porcelain-faced crown of to-day.




FOUR-TOOTH ANTERIOR BRIDGE (\VIMiI.\MS)




""'"^ \s.^X^*^-^



This article was followed, the next year, with illustra-
tions and descriptions of two very practical bridges by the
same writer.



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1165

Dr. Williams remarks, in Jamiarv Cosmos, 1884: "As
the single crown is the beginning and the end of all bridge-
work, a description of that particular form, which is of the
greatest practical value, will be necessary. This is known as
the Richmond crown, though not the crown he claims as his
invention. It consists essentially of three parts — a pin
[post .n which enters the root canal; a root cap of gold; and
a porcelain face, which is the ordinary plate tooth."

It is evident that our modern system of bridgework could
not have been possible without the evolution of suitable crowns
for supporting the same.



DR. STARR'S WORK

In the Dental Cosmos, 188(i, Dr. R. Walter Starr de-
scribed a difficult case of restoration in which two removable
l)ridges were successfully applied. The telescoping crown
])rinci]ile is here mentioned for the first time.




EEMOVABLE BRIDGES BY DB. STARB. ISSi;

In 1887, Dr. Starr suggested a modification of the Bing
bridge tooth, consisting of a porcelain tooth with two parallel
bars extending through it by means of which the projecting
ends of the substitute were anchored within fillings placed in
the proximal ing teeth.

The names of Drs. Cryer, Starr, Ilodgkin, E. Parmly
Brown, EoUo Knapp, Stowell, and Rhein are associated with



1166 A BRIEF HISTORY 0I<" PROSTHETIC DENTISTRY

the early history of recent bridge methods, nearly all of
whom presented modilications of the Bing bridge.

Drs. Williams, Eichmond and Knapp seem to have been
among the first to reeognize the necessity for the use of




STARR'S MODIFICATION OF THE
BING BRIDGE. 1887



stronger and more hygienic abutments in bridge appliance,
although no doubt many others were coming to recognize the
same fact.

In 1888 Dr. Sidney S. Stowell described an extension
stop-supported bridge, similar to those frequently constructed




TWO-TOOXn STOP AND SADDLE BRIDGE



to-day, except that with present methods the stop rests in a
depression within an inlay instead of being enclosed within a
filling, as described by Dr. Stowell.



BASIS OF OUR PRESENT SYSTEM OF BRIDGEWORK

The crowns of "Wood and Dwinelle in the "50's" formed
the basis. The great improvements by Morrison, Black and



A BRIEF HISTORY OP PROSTHETIC DENTISTRY 1167

Bean, in crowns, and the appearance of the Biug bridge tooth,
all of which were presented in 1869, although crude, furnished
the necessary elements which had previously been lacking.

Further improvements in crowns, the development of
various forms of dummies, together with simplitied' technical
procedure, gradually followed, but only after many failures
and a considerable lapse of time.

It is singular to note that practically all of the pioneers
in bridgework failed to recognize the heavy stress in mas-
ticatory effort delivered against bridge replacements. Neither
were the limitations in regard to resistance of stress of the
materials employed well understood.

This lack of knowledge of the strength of materials used,
together with an indefinite or exaggerated idea of the ca])acity
of natural teeth or roots for performing their own work and
carrying the additional burden imposed by the replaced teeth
were some of the discouraging features.

Peridental troubles, the splitting of roots and recurrent
decay of the abutment and pier teeth and roots were of fre-
quent occurrence.

A recognition of these facts, which could only be gained
by experience, led to further improvements in crowns of
greater strength and of more hygienic form and in more judi-
cious selection of cases for substitutes of this type.

PORCELAIN BRIDGE

Baked porcelain crown and bridge work went through a
similar jn'ocess of trial, failure and development before the
limitations in this field were finally determined. The principal




PLATINUM FRAMEWORK FOR PORCELAIN
BRIDGE (SCHWARTZ. 1902)



failures were due to insufficient strength to the metal sub-
structure and deficient bulk of porcelain. One of the pioneers
in this field was Dr. G. W. Schwartz of Chicago, who was en-
gaged in the production of porcelain crowns, bridges and in-
lays as early as 1893.



1168 A BRIEF HISTORY OF PROSTHETIC DENTISTRY

While to-day, tlie application of fixed bridgework is not
as extensive, the results of such application at the ])resent
time are generally far more satisfactory than in the past.

REMOVABLE BRIDGES

Bridges of the remo\'able type, and partial dentures sup-
ported by saddles resting upon the alveolar process, retained
in position by some of the various forms of fractional appli-
ances, are now introduced in many cases where formerly
bridges of the fixed type were a])pli('d.



INLAYS

An inlay, in its dental meaning, refers to a filling com-
posed of some dense material, constructed outside the tooth
cavity, and which is held in position in the cavity by some
adhesive medium.

FIRST RECORDED ATTEMPTS IN FILLING TEETH

The first attemi)ts at filling teeth must naturally have
been extremely crude, and the results of the ])ioneer efforts
in this field have ])roved but temporary in character. Be-
cause of the difficulty in adapting dense materials, the first
fillings were undoubtedly of the ])asty, plastic or pitchy class.

Mastic and alum, a substance of this class, was recom-
mended for filling carious cavities, by Rhazes, a Persian phys-
ician, about 850 A. D. (Guerini). Frequently medicinal agents
were incorporated with the mastic base for the purpose of
arresting the progress of decay, myrrh, sulphur and tur-
pentine being mentioned in this connection. The comfort
derived from the use of such stoppings, although only of tem-
porary nature, gradually led to the general practice of filling,
and the use of more permanent materials.

Mesu, an Arab surgeon, in the latter part of the eighth
century recommended the use of gold foil for filling teeth,
while from the thirteenth century on various writers mention
the use of both gold and lead for this purpose.

FIRST MENTION OF INLAYS IN DENTAL LITERATURE

In 1()90, Pierre Dionis, a surgeon of Paris, in discussing
the filling of teeth, says: "For this purpose, gold or silver
leaf is made use of; but this method of stopping is not dur-



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1169

able, liecaiise gold or silver leaf is apt to become loosened
and fall out. It is tberefore preferable to make a stopping
with a piece of gold or silver corresponding in size and shape
to the cavity. Many prefer lead on account of its softness,
while others simply use wax." (Guerini.) This is the first
definite reference to the inlay method of filling teeth, so far
as the writer knows, in any of the old-time treaties on dental
procedures.

In 1718, Lorenz Heister, a German surgeon recommended
the filling of teeth with various substances. In reference to
crown cavities in molar teeth he recommends gold or lead leaf,
or a piece of the latter fitting into the cavity. (Guerini.)

Unfortunately, few specimens of ancient inlay work are
in existence, and the genuineness of such as are preserved is
questionable.

PREHISTORIC INLAY WORK

In the Peabody Museum of. Harvard University is a pre-
historic skull, in the central incisors of which are inlays of
green stone. This specimen was found a few years ago
among the Aztec or Toltec ruins, near Copan, Honduras, by
Professor Owen. Whether these inlays were placed in the
teeth to correct the ravages of decay or merely for ornamental
purposes cannot, of course, be determined.

THE BEGINNING OF MODERN INLAY METHODS

Authentic records of inlay work in modern times date
back only about one hundred years. At the beginning of this
period, tin, lead and gold, in the form of foil, were the only
metallic fillings in use. Amalgam had not yet been introduced.
It came into vogue as a filling material, under the name of
"silver paste," about 1825, but for years was looked upon
with disfavor and used to a very limited extent. Cohesive
gold was not introduced until 1855, and therefore, since none
of the foils were cohesive, extensive contour restorations
were impossible. Added to these difficulties, the general dis-
like on the part of patients to the display of metals in the
mouth, rendered the filling of teeth a discouraging and often-
times unsatisfactory, jirocedure.

It is not surprising, therefore, that efforts were early
made to find a material for filling operations less obiection-
able in appearance, and easier to manipulate than the metals.
The records of these attempts are scattering and difficult to



1170 A BRIF^P" HISTORY OF PROSTHETIC DENTISTRY

find. Many efforts in inlay work, and probably some reason-
ably successful results, were without doubt never disclosed,
because, as a rule, the pioneer practitioner kept his methods
a secret.

Such early records as are available are usually found in
little handbooks, published in the early days by the prac-
titioner, and intended for circulation among prospective pa-
tients. Later on, the dental journals from time to time con-
tained descriptions of inlay methods, as they developed.

BRIEF SUMMARY OF INLAY WORK, BEGINNING WITH 1820

In 1902, Dr. Walter W. Bruck of Breslau, Germany, in
the Items of Interest, presented an outline of the history of
inlay work, gathered from common and obscure sources. A
portion of the following brief description of the progress of
this work is based upon tlio article mentioned.

In 1820, C. J. Linderer filled teeth by the "fournieren''
(inlaying) method and the "plattieren" (veneering) method.
The first procedure consisted in i)reparing a cavity in circu-
lar form, and from the tooth of some animal shaping a cylin-
drical rod to fit. This was driven into the cavity, the project-
ing portion cut off and polished even with the tooth surface.
The expansion of the inlay, due to absorption of the oral
fluids, caused it to swell and thereby furnish retention. Some-
times both inlay rod and cavity walls were threaded to fur-
nish positive mechanical retention.

The plattieren method was adapted to shallow cavities
and consisted in shaping small, flat pieces of rhinoceros teeth
to fit the prepared cavity. These veneers were usually held in
place with dowels of the same material. Difficulty in
matching the shades of the natural teeth, discoloration from
use and general lack of permanency, were the principal objec-
tions to the Linderer inlays.

In 1837, Dr. Murphy of London conformed a platinum
matrix to the prepared cavity, and in this matrix a glass in-
lay was fused, which was held in place with amalgam.

In 1857, Dr. A. J. Volck recommended the use of porce-
lain for filling cavities in the front teeth. The inlays so
formed were held in place by packing ropes of gold foil around
their peripheries.

In 1862, Dr. B. Wood shaped porcelain blocks to tooth
cavities by grinding to form.



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1171

In 1870, Dr. Hickman formed inlays from sections of
porcelain teeth, shaping the pieces to fit the cavities by
grinding.




In 1870, Dr. Starr designed "cavity stoppers," small
pieces of porcelain of various shapes and sizes, which were
fitted to cavities by grinding. The pieces were provided with
platinum pins for retention purposes.

DR. C. H. LAND'S METHOD OF PORCELAIN INLAY WORK

In 1870, Dr. C. H. Laud constructed inlays by "fusing
pieces of artificial teeth in a platinum impression of the outer
borders of the cavity." This method, as he later on modified
it by pulverizing the teeth before fusing, represents the basic
principle of our porcelain inlay system of to-day.




In 1876, Dr. Bogue described a method suggested liy Dr.
Fisk of veneering a carious tooth with small gold caps, which
he likened to "little gold toadstools, set with gutta percha,
somewhat resembling an umbrella."



DR. BING'S METALLIC
FACING



DR. BING'S METALLIC FACING

In 1877, Dr. B. J. Bing recommended the use of "metallic
facings" for protecting fillings of cement or gutta-percha.
These facings were usually made of pure gold or platinum.



1172 A BRIEF HISTORY OF PROSTHETIC DENTISTRY

and when set very much resembled in ;i}»i>eariiuce tlic metallic
inlays of the present time.

Dr. Wilber F. Liteli describes llicsc J'ac^ings quite fully in
the American System of Dentistr}-, p. IMU. Of their practica-
bility, he says: "In large crown cavities they have an in-
definite durability, and in the writer's practice large numbers
of proximal facings have been in use for three and four years
and still give no sign of failure." This system, although
crude, proved an incentive to many to attempt the restoration
of badly decayed bicuspids and molars by these or similar
means. The writer constructed and placed a number of fac-
ings of this type for patients in the clinic of Washington
University Dental School in 1891. (Mo. Dental College.)

ROLLINS' METHOD OF INLAY WORK

In 1885; Dr. W. Rollins, in the Archives of Dentistry, de-
scribed as follows a method of inlay work employed by him-
self for a number of years previous to the date mentioned.
An impression of the tooth with cavity prepared is taken in
a material composed of two parts mastic, one part paraffin,
and one part graphite. The tooth and cavity surfaces should
be previously oiled with vaseline. When secured, the im-
jaression should be i^laced in a bath of copper sulphate, and
a film of copper deposited by electrolysis, the process usually
requiring from two to three days to develop a sheet about
11/2 m.m. thick, or sufficiently rigid to obviate distortion in
handling. The impression was then removed, and a hole bored
in the bottom of the cavity in the copper reproduction of the
tooth, to facilitate the removal of the matrix. Into the cavity
a piece of No. .30 gold foil was adapted with pellets of cot-
ton. The matrix thus formed was filled with enamel powder
and fused in a gas muffle furnace. Before the mass hardened
it was pressed into the copper mold with a platinum instru-
ment. After cooling, the enamel was removed from the mold
by pressure through the opening in the base of the copper
pattern, and the gold matrix peeled off. It was set with a
mixture of zinc oxide and gutta-percha, the excess being re-
moved with chloroform.

DR. DUNN'S METHOD OF INLAY WORK

In 1885, Dr. C. W. Dunn, in the British Journal of Den-
tal Science, described a method practiced by himself since
1868, of taking a wax impression of the tooth, and cavity,



A BRIEF HISTORY OF PROSTHETIC DENTISTRY 1173

from whicli a modrl iii plaster was secured. This was painted
with a mixture of wax and rosin, to prevent friability of the
cavity margins. Into the cavity a filling was tittecl by re-
peated grinding and trial, until satisfactory adaptation had
been secured, after which it was set with cement Various sub-
stances were used by him for inlays, such as mineral and
natural teeth, as well as the teeth of cattle and lambs.

DR. STOKES' METHOD

In 1887, Dr. J. L. Stokes, in the Southern Dental Journal,
described a method of first making the inlay, and shaping
the cavity to receive it. After setting, he removed the hard-
ened cement, from the joint to a slight depth, and tilled be-
tween the cavity walls and inlay with gold. A similar method
of retention had been previously introduced by Dr. Essig of
Philadelphia some time in the seventies.

DR. AMES' METHOD OF GOLD INLAY WORK

In 1888, Dr. W. V. B. Ames of Chicago constructed gold



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