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Transplantation of teeth into artificial
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THE LIBRARIES
iHetical 1librarj>
Transplantation of Teeth , ^ ^ C^uM^^.
INTd
Artificial Sockets
BY
\Vm. J. VOUNGEK, XI. \J.
KX'I'i-nilclcDC or (he C'liMfomla State UuntM AsHoclAtloD.
Ex-ProsKlent Sail FraiK'laco Dental AsaocUtloii.
SAN PBANCISCO, CAL.
REPBlfT FBOM
"Pacific Medical and SurgicalJournal and Western Lancet"
JaXUAKY, 1886.
With Addenda.
Transplantation of Teeth
INTO
Artificeil Sockets
BY
WM. J. YOUXGER, M. D.
Ex-Presidint of the California State Dental Association.
Ex-President San Francisco Dental Association.
SAN FRANCISCO, CAL.
Reprint from
"^ Pacific Medical and Surgical Journal and IVestern Lancet,'
January, i886.
With Addenda.
SA.V FRANCISCO:
IV'm. S. Duncombe «&* Co., Publishers,
211 Post Street.
TRANSPLANTATION OF TEETH
INTO
Artificial Sockets.
Transplantation of teeth from one mouth to another is not, by
any means, a new operation, as it was done many years ago for
the noble and the ojjulent of the old world. li. is not only
mentioned in some of the very old works on surgery, but even
by writers of fiction. Not only did the poor mar their mouths
to sell their teeth, but even the freshly dead were disfigured for
this purpose. Victor Hugo, himself, utilizes a knowledge of
this operation in " Les Miserables," and makes one of his her-
oines, Fanchon, sell two of her front teeth in order to procure
food for her starving child. But so many disastrous conse-
quences occurred, so many painful effects followed, and so
many failures happened, that the operation fell into disrepute
and was abandoned as soon as artificial substitutes were invented
that approached, in some measure, a natural appearance and
in some degree served the purpose of mastication.
Not until I was in Paris in 1877, however, did I learn how
the operation of transplantation was effected, and in learning
that, I acquired an insight into the causes of the many disas-
trous, painful and futile results.
I will let Dr. Thomas W. Evans, the famous dentist of the Em-
pire, and intimate friend of Napoleon III, explain, in his own
language — during a conversation on professional topics — as
nearly as I can recollect it, the modas operandi of transplanta-
tion, and the reason of his abandonment of it, as it was the
narration of this incident in his practice that revealed to me the
method pursued in transplanting teeth, and awoke the sugges-
tions in my mind, that have made this operation, in my hands,
the reverse of what it has been. But I wish it to be distinctly
understood, that in whatever strictures I may make on the oper-
ation as illustrated in the ease related by Dr. Evans, I do not,
in the least, intend to reflect on him, for I have the highest
esteem and respect for the professional skill and attainments,
erudition and private worth that have gained for this distinguished
gentleman, a social position that has contributed immensely in
elevating the status of dental professional life abroad. Dr. Evans
simply followed the beaten path, and was therefore not respon-
sible for it. But to return to the subject.
" The last operation of this kind that I ever attempted," said
he, " was that on a certain Marquise, who shall be nameless in
consequence of the unfortunate results that followed the oper-
ation. She was a young, rich and lovely woman, but whose
beauty was marred by the presence of four dead, black, badly
decayed front teeth, which were a constant source of mortifica-
tion to her. She had such an aversion to wearing false teeth
that she would not consent to an artificial substitute; so the op-
eration of transplantation was decided on. One of her maids
was thereupon commissioned to search among her friends and
acquaintances for a woman whose teeth would in size, contour and
color suit the requirements of the case. At last one was found
whose teeth seemed in every way suitable, and the consideration
for them agreed upon. As it was not desirable that the parties
should know or afterwards recognize one another, the utmost
secresy had been preserved, and was carried out to the end, in
thiswise: Two chairs were placed back to back. The Marquise,
heavily veiled, was seated in one, and the woman, also heavily
veiled, was then brought in and placed in the other. The lady's
teeth were then drawn and laid aside, and then the woman's,
which were immediately fitted into the gaping sockets of the
Marquise's, and tied in by ligatures to the adjoining teeth. The
woman was then led out, paid, and all further interest in her, I
supposed, ended. Not so, however, for, as it afterwards trans-
pired, this woman had been leading an immoral life, had con-
tracted a loathsome disease, which was, unfortunately, commu-
nicated to the Marquise, and produced in her great anguish of
mind and body, and the subsequent loss of the teeth. I came
in for a share in the blame, for not having sufficiently examined
the woman as to her health and moral status. I then determined
never to perform the operation of transplantation again; it was
fraught with too much danger."
This then was the method practiced in transplantation. The
subjects were brought together, the fresh, blood covered teeth
of one, with whatever of tartar and filth had accumulated on
them, were immediately transfei-red, into the raw, bleeding and
clotted sockets of the other; each tooth having in its body a
mass of soft tissue, known as the pulp, whose life was ex-
tinguished as soon as rupture of its tissues occurred at the apex
of the root; and which, being deprived of vitality, was bound to
decompose with all the attendant phenomena of putrefaction,
to wit : formation of gases, pus, etc. With this style of
procedure, the wonder to me is, that the operation was ever
successful.
In the first place, the danger of communicating hereditary or
acquired disease, when the blood of one person is placed in con-
tact with a raw surface of another must be evident to all.
Secondly. No thought seems to have been given as to how
the tooth attached itself. It seems to have been put in in a hap-
hazard sort of way, with an indefinite idea that it would grow
into the gum. Now, it is due to the pericementum of the
tooth, which is the analogue of the periosteum of the bones,
that attachment to the walls of the socket is possible. And it is
readily seen, that some of the clot into which the tooth is
thrust, must remain between the root and the socket, preventing
that intimate contact between the pericementum and the alveolar
wall so requisite for union, to say nothing of the septic dangers
attendant upon a decomposing, confined clot. But, supposing
this difficulty and danger to be overcome, and sufficient union
effected, we come to
Thirdly. The pulp or nerve, as it is called by the laity, is the
substance, the death of which, jDroduces that frightful torture
attendant on the formation of what is known as alveolar abscess.
The pulp then in these transplanted teeth, — being devitalized by
the solution of continuity effected in extraction, and being un-
like the pericementum in its power to retain vitaKty, — dies, and
in its death, unless the tooth is secured by ligatures or other-
wise, and the gases evolved are not sufficient, consequently, to
expel it, all the painful train of phenomena attendant on the
formation of alveolar abscess are sure to follow.
Fourthly. If, in spite of all these deterring causes, the tooth
should become fixed in its new habitation, the decomposed pulp
is partly absorbed by the tubuli of the dentine and the tooth
becomes blackened and unsightly.
With the operation performed in this manner, we cannot but
agree with other writers on the subject, that transplantation
of teeth is accompanied with great danger and is bound to be a
failure.
But transplantation can be made a success and void of all danger
and unpleasant consequences, if only common sense, and cleanli-
ness, ordinary skill and care are taken.
It is to prove this and unprejudice the scientific mind, and,
through it, the public, and to do away with the abomination of
false teeth, that I here present to the profession the results of
my experiments and experience in this direction.
I gained courage to try the operation by reflecting on the ex-
periment of John Hunter, who, to test the vitality of the peri-
cementum, planted a tooth in a cock's comb. This tooth at-
tached itself firmly to the crest, and a few mouths afterwards
the cock was killed and a microscopical examination showed that
a living union had taken place, the blood vessels of the comb
and pericementum having established free communications.
I also tried the experiment upon a cock's comb, to further and
personally assure myself of the truth of this statement, and
confirmed, as far as attachment was concerned, the exi^eriment
of the great surgeon. But, in my experiment, I took the pre-
caution of removing the pulp and filling the pulp chamber and
root canal with a preparation of gutta percha, known as "Hill's
stopping," much used by dentists for temporary fillings. This
was in order to avoid any trouble from a decomposing pulp.
The tooth was then well cleansed with warm water and dipped
in a disinfecting solution. The success of this experiment sat-
isfied me that the pericementum would attach itself to any vas-
cular body, and that, if properly planted in a fresh socket, it
would attach itself and form a living union with the surround-
ing tissues, without the production of afterpains or other evil
consequences.
My first experiment January 24:th, 1881, was on a Mrs. H., a
lady of about 36, who had nursed a badly diseased root of a left
superior lateral incisor for fifteen years, in order to maintain
the contour of the gum, while wearing a plate with an artificial
8
crown resting on it. Whilst waiting for a lateral, I cured the
diseased root, but kept its shattered parts together, in order to
presei*ve the socket intact. There had been so much disease in
this socket that the gum was covered with cicatrices, the sequel-
Ise of different discharges. At last I procured the tooth needed
from a lady of about forty, and prepared it in the manner
already described for the cock's comb. Before doing so, I
extracted the root, in order to allow the patulous vessels to close
of their own accord. "When the tooth was ready, I carefully
wiped out the clots, rinsed the socket with a disinfecting solu-
tion and put in the tooth. Finding the root a little too long,
Ij cut off the excessive portion of the apex, cleansed the
socket again, pressed the tooth into position and held it in
place by delicate silk ligatures. No pain ensued, no swelling,
and no unpleasant symptoms, of any kind whatever, developed.
Four days after, the ligatures were removed and I was gratified
to find the tooth well attached and resisting gentle traction
made with the fingers. The ligatures were again replaced, in
order to hold the tooth firmly in position until the attachments
had acquired sufficient strength. In four weeks they were
removed. The tooth has now been in its new home, nearly five
years and is as firm in its place, and light in color, as any tooth
in the delighted lady's mouth.
I have now had between thirty and forty cases of transplant-
ation into sockets already formed, and have to report but two
failures. One due to the patient's own neglect, in leaving for
foreign parts too soon after the operation, and not allowing
me to place the ligatures necessary to retain the tooth in a fixed
position, until sufficiently strong attachments could take place,
and the other, to my own inexperience. In the latter case, there
was a diseased root of fourteen years standing. The attach-
ments all around the root had been destroyed and the tooth
hung but by a pedicle at tlie apex. I bad not bad time to cure
the root, and so I. drilled tbrougb tbe crown of the new tooth
into the pulp chamber, forming a canal through to the end, for
drainage, and to treat the diseased socket. Unfortunately, I
did not scrape away sufficiently the healed walls of the socket,
and, therefore, attachment did not take place along the sides of
the root. The tooth, not tightening, became a nuisance to the
lady, who was of a highly nei-vous temperament, and three
months after its insertion it was removed.
One case, where I had but little hope of success, turned out a
decided one. At the time, I was surprised, but since I have
discovered the wonderful gi'ip a little pericementum has, I am no
longer surprised at anything this remarkable membrane will do.
As there was a little sentiment, besides cold science, connected
with this case, I take a special pleasure in narrating it. Two
young girls of sixteen, merry, laughing, loving little friends,
came to me, one had an upper bicuspid that was overcrowding
her otherwise lovely mouth; the other a badly formed, worse
decayed and painful lower one in hers, and they asked me if I
would not please take the one out and insert the other in its
place. But as the root of the upper was considerably wider than
the lower, and would necessitate, to fit the tooth properly, the re-
duction of the diameter of the root, and thereby involve the de-
struction of considerable pericementum, I did not consider it
practicable. Nevertheless, as they seemed to have set their
hearts upon it, evidently believing that this transfer of tooth,
would, in some subtle manner, unite them more closely, and the
one declaring her. willingness to suffer any pain, even with the
slight chance of success promised, to have her wish consummated,
I yielded. In this operation I had to grind away the labio-lin-
gual aspects of the root, thus denuding the whole of these sur-
faces of pericementum, and leaving but two strips of this mem-
10
brane, one anteriorly, and the other posteriorly, with which to
form attachments. Nevertheless, it did so, and it is now one of
the best and firmest teeth the young lady has in her head. This
operation was ijerformed Feb. 21st, 1881, but a month later than
the one previously rei^orted.
The great and only difficulty I had to contend with, was the
procurement of teeth at the time they were needed. At last a
way suggested itself. I applied to my dental friends for what-
ever good teeth or roots the exigencies of cases required them to
extract. The experiment of Hunter and my own experience
had taught me that teeth could be kept alive, indefinitely, in
cocks' combs. But could they be transferred to the human
mouth again and made to grow there ? I concluded they could,
and my first experiment verified my conclusion.
On November 28th, 1882, a bicuspid that had been in a cock's
comb for ten days, was transferred to the mouth of a gentleman,
where it fastened itself, as if there had been no gallinaceous
period in its existence.
Where I have not been able to procure a suitable tooth, I have
taken a root, and mounted an artificial crown on it. Sometimes
I use the natural crown of a tooth that has been irretrievably
loosened by incrustation of tartar on its root. In this case I
simply saw off the bad root and attach a good one to the crown
by means of one or more gold screws and cement. In these cases
the patient simply changes roots. I have also discovered that
the pericementum can be kept alive for, certainly, two days, in
warm water, temperature 100^ to 110^ Fahrenheit. I have in two
cases transj)lanted teeth successfully that had been so kept for
fifty hours.
My former practice when I found a root was too long or too
wide for 9, socket, was to cut off from the apical extremity, or
shave off from the surface of the root, the necessary quantity to
11
insure a fit: but so often the best portion of the pericementum
was in that way removed, that I tried deepening or widening
the cavity as the case required, often cutting freely into the bone
in order to save all possible of this valuable tissue. I found that
adhesion took place in this' portion as perfectly as in the un-
broached. The consideration of this, led me to the grand con-
clusion, that artificial sockets could be drilled into the bone ilaelf
and teeth planted therein as successfully as into the natural cavities.
My first operation of this nature was reported to the Califor-
nia State Dental Association in August last, and its success was
witnessed by them seven weeks after its j)erformance. But as
the transactions of this society for this year, will not be pub-
lished for some time, I will incorporate that report in this article.
On the 17th of June last, Miss Ward, a young lady of 24,
presented herself. She had lost the left superior lateral incisor,
root and all, four years previously, and had been wearing, as a
substitute, an artificial tooth on a rubber plate. The collapse
of the gum, consequent on the absorption of the alveolus, was
so great, and the exposure of gum so much, in conversation,
and especially in smiling, that the falsity of the denture was im-
mediately recognized, and was an object of great distress to her.
As it was impossible, for the reasons just given, to produce an
artificial substitute that would look natural, I determined ujjon
the following operation, — one that I had for a long time contem-
plated, and which, though satisfied in my mind, in consequence
of certain obseiwations and experiments, would be successful,
seemed so opposed to scientific thought and the established rules
of surgery, that I had not before screwed up my courage suffi-
ciently to attempt it. I took a corresponding lateral from a
young man, which, from its awkward position, was disfiguring
12
his mouth, and prepared it as I do all teeth I use in transplanta-
tion, viz. : removed the pulp, filled the pulp chamber and root
canal with Hill's stojjping, and finished the apex with gold.
The tooth was then placed in water of the temperature 100° to
110° Fahrenheit, to cleanse it of all blood and impurities, and
allowed to remain for about one hour. It was then placed in a
bath of bi-chloride of mercury, 2 parts to 1,000 water, for about
fifteen minutes, to disinfect it. The tooth being now ready, I
turned my attention to the patient. I cut a hole in the gum a
little less than the diameter of the root to be inserted. I then
took an ordinary flat, angular-edged drill, and drilled into the
bone in the line of direction the tooth was to occupy. When
fully deep enough, I widened the cavity and formed the socket
with a cone-shaped burr. When I found by trial that the cavity
would receive the tooth perfectly, I carefully washed and sponged
it out, in order to remove eveiy particle of detached bone, first
with warm water, then with cold, and lastly with the bi-chloride
solution already referred to, and when the bleeding had ceased,
I introduced the tooth, and kept it in position by delicate silk
ligatures attached to the central incisor on the right and to the
canine on the left. There resulted a little swelling over the root,
which remained a few days and then gradually disappeared.
An accident to the gum occurred during the development of
its socket. Just as the drill touched the surface of the bone
the young lady jerked her head back, which caused the instru-
ment to slip forward and through the gum, making a triangular
shajDed gash of fully an eighth of an inch in length. Before
the tooth was inserted the edge of this cut was brought care-
fully together and retained in contact by delicate silk sutures.
On the fourth day the sutures were removed and no mark was
apparent to tell of the lesion that had existed. In twelve days
I removed the ligatures from the tooth and found it well at-
13
tached. I then removed the threads to fix the tooth while the
callus foiiued I'ound the root. About three weeks afterwards,
the gum being free from every sign of irritation and the tooth
comparatively firm, and desiring to improve the position of the
right superior central and lateral, I had to pass the ligatures around
the new tooth. This, unfortunately, set up a slight inflamma-
tory action, and an epulis formed a few days after, and a little
discharge of matter took place. I thereupon removed the liga-
tures and treated with injections of iodine. When last seen
the epulis had nearly disappeared, the surrounding gum had
resumed its normal look, the tooth become firm in its position
and performing its functions in common with its fellow teeth as
though it had never been a stranger in the mouth.
This case was examined by several physicians, and by the
members of the California State Dental Association, who, with
the exception of two, pronounced the operation a great success.
These two gentlemen were not thoroughly satisfied with its
stability because, only, of the epulis that had formed.
CASE TWO.
On the 15th of August and the 5th of September, similar
operations were performed on Mrs. C. , set. 35. In Mrs. C. 's case,
however, the teeth (superior bicuspids) had been absent for
twenty years, and during this time she had worn an artificial
plate.
On the first date mentioned, a socket was drilled out immed-
iately on the right of the right superior canine, and a bicuspid
inserted. It was held in position by a silk thread attached to
the canine and lateral in front, and a molar a little distance in
the rear, the thread simply passing over the crown between the
cusps like a tight-rope.
On the 5th of September, Mrs. C. , being satisfied of the success
14
of the operation, bad two bicuspids inserted in the left side in a
similar manner. In this case, however, there was no molar to
attach a thread to and so a little loose, diseased root of a second
molar had to be brought in requisition. Into this root a fine
gold wire was inserted to which the distal end of the string was
attached, the string brought taut over the crowns and between
the cusps and fastened to the canine and lateral in front. After
the insertion of these teeth the face swelled slightly, but there
was no tendency to expel the teeth, nor was there any pain con-
nected with them. The face was washed with the ordinary solu-
tion of muriate of ammonia in water and alcohol, and the gum
painted with iodine. In four days the swelling subsided. The
gums have now been for over two months without the slightest
mark of irritation. The teeth have become quite firm, and the
lady is now using them in mastication, There are three more
teeth yet to be inserted, — one right bicuspid and two left
superior molars, — which will be done as soon as the proper teeth
are procured.
Among the many medical and dental gentlemen who have
critically examined this case, and expressed themselves fully
satisfied with the success and utility of this operation, are:
Prof. E. Beverly Cole, A. M., M. D., M. E. C. S., Medical
Department, University of California.
Prof. F. H. Terrill, M. D., Medical Department, University of
California.
Wm. S. Whitwell, A.M., M. D., Editor Pacific Medical and
Surgical Journal.
"Wm. T. Grarwood, M. D., former Eesident Physician City and
County Hospital.
A. F. Sawyer, A.M., M. D.
C. M. Eichter, M. D., late Chief Surgeon of the G-erman
Hospital,
15
J. A. W. Lundborg, President California State Dental Asso-
ciation.
S. E. Knowles, M. D., D. D. S., President San Francisco
Dental Association.
"NVm. A. Knowles, M. D., D. D. S., Vice-President California
State Dental Association.
Alex. "Warner, D. D. S., late President California State Den-
tal Association.
So perfectly natural is the appearance of these teeth in the
mouth, so firm and so normal the surrounding gum, that the
great majority of these, as well as of other gentlemen who have
seen the case, were unable, when put to the test, to distinguish
the transplanted teeth from those that were " native and to the
manor born." Many mistook some of the old teeth for the new,
and the three or four who did point out the right teeth acknowl-
edged that they merely guessed them, in consequence of their
being handsomer and better than the other teeth.
Mrs. C. herself says: ''"When I think that for twenty long
years I have had to wear a nasty, old i^late, and now I have in-
stead natural teeth growing in my mouth, I feel so hapjDy that I
cannot express myself."
Practical experiments have convinced me that the views
expressed, of the formation of the socket, and method of attach-