with cement brings the first sitting to a close. Make an amalgam die in the modeling compound impression which was taken in the band. For convenience this die may be set in a plaster base. Using the same measurement wire from which the copper or nickel silver band was made, cut a triangular piece of 1/1000 platinum foil about 2 mm. larger than the length of the wire. This foil is swaged or burnished to the die. The lateral portions of the foil are brought together flatly, so as to fold into a "stovepipe joint" on the lingual surface of the die. The foil is removed from the die, while the die is placed in the plaster impression, of which a plaster cast is run. The bite is applied and the whole placed in an articulator. On separation the platinum foil matrix is replaced on the die, and upon it is built up the desired shade of high-fusing body. This is carved, fused, retouched, and re-fused. The foil is removed, and the jacket crown is ready for cementation in place upon the second visit of the patient. [American Journal of Surgery, New York City, January 1918.] Technique of Wiring Corresponding Teeth of Superior and Inferior Maxilla in Fracture of Inferior Maxilla. BY EDMUND BUTLER. Reduce the fracture, judging the results by the occlusion of the teeth. If a tooth is loose in the line of fracture and prevents correction of the position of the fragments, remove it. When the occlusion is correct select the teeth to be wired, usually the first molars on the sound side, the second incisors anterior to the line of fracture, and the first sound tooth posterior to the line of fracture, on the fractured side. If the line of fracture be posterior to the teeth in the region of the angle of the mandible, the inclusion of the first molars on both sides is sufficient. When the fracture is double, only individual judgment will map out a correct procedure. After the teeth have been chosen as suggested above, separate the jaws. Six cm. length of copper wire, No. 26 or smaller, are cut from a spool such as is used by an electrician. The maxillary teeth are first pre VOL. LX.-18 pared. Slip the end of the wire through the distal interspace, with a curved hemostatic clamp direct the wire around the lingual surface, and out through the approximal interdental space. Now grasp each end with a clamp and twist the protruding ends, the first twist fixing the wire around the tooth, and continue to twist until about six twists are made, the remaining twists falling into space distally-the wire must be proximal to the surface of approximal contact-and take the shape of the cervical circumference. If these details are fulfilled the wires do not slip, and future adjustments are not needed. The remaining selected teeth of the maxillæ and the corresponding teeth of the mandible are now prepared in the same manner. Having the wires in place, force the mandible into correct occlusion, twist or hook wires of corresponding teeth together, cut off superfluous ends, turn the rough ends against the teeth and guard each with dental wax or soft vulcanizable rubber. The patient is nourished by crushed, scraped, or liquid food forced through a catheter passed posterior to the last molar or through the space of an absent tooth. If unable to use the corresponding teeth, an oblique position of the wires is permissible, so long as the obliquity is in the direction which prevents the deformity from recurring. The wires may be removed from the fourteenth to the twenty-first day. The longer period is usually advisable. [Annali di Odontologia, Rome, January 1918.] Three Rare Cases of Replantation of the Teeth. BY ANGELO CHIAVARO. It is of interest to consider Chiavaro's article in connection with the view advanced by John S. Marshall (see DENTAL COSMOS, February 1918, p. 169). Marshall has for a long time advocated the extraction of teeth affected with persistent chronic apical inflammation, their extra-oral treatment and eventually their replantation. In this way Marshall assures us that clinically a large majority of teeth can be saved and made useful members of the dental economy. Most pertinent confirmation of this attitude is afforded by Chiavaro's paper. Chiavaro has earned the right to be heard with attention, and his statements must be taken at their face value. The first case concerns that of a young woman whose four mandibular incisors contained gangrenous pulps. The condition had even progressed to the appearance of a mental fistula. The teeth were extracted, disinfected, the radicular apices were rounded off (to remove the necrosed cementum), and the pulpal cavities were filled with gutta-percha. The fistula was healed, and one week after extraction the teeth were replanted. In about six weeks they became firm, and after almost eleven years they are still firmly in place. The second case concerns a young lady whose right maxillary second incisor had a chronic abscess. The external plate of the alveolus was destroyed for about one-third of its length, and on the labial surface of the root there was a large cavity communicating with the pulp chamber. The tooth was extracted; a large porcelain inlay was inserted in the cavity, and the tooth replanted. In about one month it had become firm. After the lapse of four and a half years it is still very firm, the gum has not at all receded, but is perfectly normal, even where it is in contact with the porcelain inlay. The third case is that of a medical student upon whose left mandibular first molar there was a large abscess. It was extracted, and two weeks later it was replanted. Although the socket had been enlarged by Ottolengui's special burs, there was much difficulty in completely reorienting the molar. This was overcome only by the patient strongly occluding his teeth. The replantation was suc cessful. From these three cases Chiavaro draws the following conclusions: (1) If the alveoli are existing, the contemporary replantation of mono-radiculated teeth is successful; (2) there is a possibility of success in the replantation of a single-rooted tooth, even if a large area of the surface of the root be restored with a large inlay and the corresponding alveolar tissue be absent; (3) if there be great resistance offered to the proper reorientation of a molar (multi-radiculated tooth), success may be obtained, better than by any other means, by the strong occluding of the teeth. Nowhere in this paper is it made exactly clear why Chiavaro postpones so relatively long the replantation. Perhaps this delay is to permit time for the eradication of the periapical disease focus. Marshall replants the tooth at the same sitting at which it is extracted. Perhaps it is significant that the three successful cases recorded here were those of relatively young individuals. The vitality of youth is in general a potent factor in facilitating and accelerating reparative processes. Chiavaro mentions a case where replantation failed. The patient was a woman of fortysix years. It is regrettable that the author has not offered radiographic data upon the condition of the teeth and their surrounding parts after the lapse of a number of years. This information would be still further enhanced in value if we could have a radiographic record of the condition of the teeth before replantation was resorted to. [Journal of Parasitology, Urbana, Ill., Endamœba Buccalis: (II) Its Reactions The author reveals some unfamiliarity with practical dentistry, and from this standpoint this paper is open to some unfavorable criticism; but obviously the primary purpose of the work was to investigate the biology of the parasite. This forms an interesting contribution. described by other writers, notably Smith and Barrett, or any solid except bacteria and these in small numbers." This is contrary to the conclusions of Goodey and Wellings. (DENTAL COSMOS, December 1917, p. 1268.) E. gingivalis absorbs its food mainly, taking up by osmosis the fluids of leucocytes or other media on which it rests; stores these colloidal substances in vacuoles, and by secretion of its own enzymes assimilates these as needed. The reasons against believing that large food vacuoles are ingested leucocytes may be summarized thus: (1) There is never but one body to a vacuole, while most leucocytes have a one- to three-lobed nucleus; (2) there is never any granular area around the vacuolar inclusions, as would be expected if the cytoplasm of a leucocyte were ingested; (3) leucocytes have been surrounded by amabæ, but never ingested, according to Nowlin's observations; (4) the whole system of vacuoles can vanish from an E. gingivalis exposed to unfavorable conditions sooner than would be possible if these were solid inclusions; moreover, the leucocytes outside the endamaba are left intact. This method of food-getting by absorption would explain the shrinkage of gums where E. gingivalis is present. There appears to be no evidence that these organisms penetrate epithelial cells, but there is abundant evidence that they draw supplies by applying themselves to the surface of the tissues and by crowding between them. [La Restauration Maxillo-faciale, Paris, November 1917.] The Oculo-cardiac Reflex in Cases of Contractures of the Jaws. By R. DUCHANGE. This reflex is manifested by a diminution of the number of radial pulsations under the influence of pressure on the eyeballs. The reflex has been observed among the wounded affected with traumatic ankylosis of the limbs. For the present purpose two series of individuals were taken, (1) those with fractures without contractures, and (2) those with contractures. In the first series the diminution in the number of pulsations was only by about one-fifth, which is normal. In the second series the mean diminution was by one-half. The figures indicate that among those with maxillary contractures, the oculo-cardiac reflex is positive. Consequently these patients come under the general law. [Journal of the National Dental Association, January 1918.] The Treatment of Root-canals with Putrescent Pulps. BY CARL J. GROVE. The tooth is radiographed to supply data upon which the treatment may be planned. A sterilized rubber dam is applied, including as few teeth as possible, because every tooth is an additional source of contamination. After it has been applied the rubber dam and the isolated teeth are painted with full strength tincture of iodin, which is shortly washed off with ethyl alcohol. At the first sitting do not attempt to enter the canal to any extent. To do so might force septic material through the apical foramina. Apply chloral hydrate and thymol, equal parts, in a small amount of alcohol, to neutralize the chemical tissue irritants in the canal's putrescent material, and to kill the micro-organisms. This dressing is hermetically sealed in, to be left three or four days, or even for one week with impunity. At the second sitting, after preliminary isolation and attempted sterilization of the teeth-this of course must be done at each sitting an effort is made to cleanse the canals with a sterile barbed broach. No attempt should be made to reach the apex. Grove insists strongly that whatever instruments are needed at this or any other visit must be sterile. After the canals have been fairly well cleaned, flood the chamber with alcohol and dry with hot air. There are three reasons for using alcohol at this time-(1) for further sterilization, (2) desiccation before application of medicaments, and (3) desiccation to inhibit bacterial growth. Grove regards this procedure as a very important step in the treatment of septic root-canals. Into the canals is now sealed a dressing, as at the conclusion of the first sitting. At the patient's third visit a serious effort is made to cleanse thoroughly the canals. The author mentions the use of the sodium-potassium alloy, and of acids, in this connection. The material for the definitive filling, as far as Grove puts himself on record in this paper, is left to the individual practitioner's discretion. The canals should never be filled if the seepage of serum persists in discharging from the apex. There are three salient points to this paper, which while not original, are yet perhaps not as generally appreciated as they deserve: (1) The strictest possible asepsis in all details throughout the whole treatment, (2) The initial treatment, which essentially consists in the application of an antiseptic and neutralizing agent to the putrescent contents of the canal. These contents are disturbed at first as little as possible. This step is a precaution to prevent the mechanical forcing through of toxic material into the periapical tissues. This second point is really only a phase of the third and following point. (3) The most scrupulous care not to irritate the periodontal ligament in any way. Any agent or procedure which would tend to weaken the vitality and health of this structure would expose to defeat the whole purpose of the entire treatment. For this reason, Grove dwells on the dangers of forcing part of the putrid canal contents through the foramina, of allowing any sterilizing or cleans ing agent employed in the canal to extend to the apex (avoid those irritants, e.g. formalin, which are not decidedly self-limiting), or of attempting to enlarge the foramina mechanically. By so doing the periodontal ligament at the orifice will surely be destroyed or injured to such an extent that it may become diseased. [New York Medical Journal, January 12. 1918.] Relation of Chronic Infection to Thyroid Deficiency. BY HARVEY G. BLACK. This report appears to be but a summary of a statistical study, which it is to be hoped will be published in full. There were a hundred patients in his series. Oral sepsis and inflammatory diseases of the gall-bladder and appendix played an important rôle in the relation of chronic focal disease and hypothyroidism, comprising 63 per cent. of the 255 infections present in the series. Oral sepsis, including tonsillitis, root-abscesses, pyorrhea, sinusitis, etc., represented 36 per cent. of the total infections, and occurred in 56 of the cases. PERISCOPE Relief of Post-extraction Pain.-It often happens that extreme pain follows the extraction of a tooth or root. Almost immediate relief may be given the patient by inserting a pellet of cotton wet with chloroform to the full depth of the root-socket, and placing the finger firmly over the mouth of the socket for from ten to twenty seconds; then remove the cotton from the socket. Repeat if necessary.-H. A. CROSS, Dental Review. Veronal and Novocain to be Made in America as Barbital and Procain.-The Federal Trade Commission which has already issued licenses to three manufacturers to make salvarsan in the United States under the name of Arsphenamine, has recently issued a non-exclusive license for the manufacture of veronal to the Abbott Laboratories of Chicago. It is stipulated that the name Barbital shall appear on the package together with the scientific name diethyl-barbituric acid. The name veronal may also be used on the package in an explanatory sense. The com mission has also issued licenses to the Rector Chemical Co. of New York, and to the Farbwerke-Hoechst Co. of New York, for the manufacture of novocain under the German patent, with the stipulation that it shall be designated as Procain. The licensees are required to pay 5 per cent. of their gross receipts to the Federal custodian of alien property. The commission reserves the right to fix the prices on these drugs if it should become necessary. These three synthetics are the first for which licenses to manufacture have been issued under foreign patents by the Federal Trade Commission, and physicians would do well to make a note of the new names assigned to the drug by the commission.-N. Y. Med. Journal. Tempering Small Tools.-Fill the tin top of a catsup bottle with melted beeswax, and place conveniently on the work-bench. When tempering hold the instrument-as a chiselabove and near the wax; with the blowpipe heat to a dull red, and quickly push the instrument into the wax. The degree of hardness depends on how rapidly the instrument is pushed into the cold wax.-J. T. SEARCH, Dental Review. An Aid in Crown and Bridge Soldering. -The Richmond crown and certain parts of bridge work present difficulties in the soldering technique, due to the fact that the solder refuses to flow into those V-shaped spaces at the gingival portion over the facing. This may be overcome by clipping up some scrap 22-k. plate, fluxing it, and partly filling the space with this scrap; then continue in the usual manner. These bits of scrap also serve to advantage in preventing the solder from reducing the karat of the cap and backing.-Pacific Dental Gazette. To Hold Cotton Rolls in Place While Operating. Frequently a cavity may be kept dry long enough for a treatment or for the placing of an amalgam filling by the use of cotton rolls without the rubber dam. The problem is to keep the rolls in place, particularly in the lower jaw, where the tongue always has a tendency to toss them out of position. This may be obviated by slipping an ordinary rubber dam clamp over the tooth after the rolls are in place, allowing the beaks of the clamp to grasp a small portion of the roll between the clamp and the tooth. This will hold the roll securely, and will also prevent the clamp from hurting.-Dental Re view. How to Get the Best Results in Casting Watt's Metal Plates with Porcelain Teeth. After the wax model has been properly invested in a casting flask allow the investing material to dry for one hour. Then place it on a low flame for forty-five minutes, and on a high flame until the whole investment block is red-hot. In order to prevent the checking of teeth which is likely to occur by the difference in the expansion or contraction of Watt's metal and porcelain, the flask should be allowed to cool for thirty minutes. Melt the Watt's metal, pour it in the flask, and allow it to cool. As I have cast Watt's metal for a number of years with the best results, I am positive that some fellow dentist will profit by adopting this method.JOHN V. AMENTA, Dental Review. Free Dentistry in New Zealand.—The Auckland Hospital and Charitable Aid Board established in 1909 a free dental department for the benefit and accommodation of those who are not able to have their teeth properly taken care of in the community, since which time 23,555 persons have made application for treatment. During the time which has elapsed 18,530 teeth have been extracted, 11,919 fillings put in, and 1264 vulcanite dentures made. The staff at present comprises two dental surgeons and two attendants, besides a number of honorary members of the staff who have given their services free of charge. In return for this free service the hospital board has given the dental association free use of a portion of the hospital for housing a valuable dental museum presented by a prominent individual of the city of Auckland. It seems that at present there is no very marked shortage of dentists in this part of New Zealand at least, but owing to the additional year added to the course of study, making it four years before graduation, there are but few young men willing to give that time to enter the profession.-CONSUL-GENERAL ALFRED A. WINSLOW, Auckland. Should the X-Ray Diagnosis Supplement or Supersede the Clinical?—In a broad sense, and generally speaking, the Xray should be used to substantiate, supplement, and amplify the clinical diagnosis. By following this plan one's skill in clinical diag nosis may be very highly developed, while if the reverse order were adopted the clinical art would be lost. The use of the X-ray tends strongly to lead one away from a clinical study of his problems. Exceptionally the clinical picture is so obscure that it becomes necessary to depend almost entirely on the X-ray findings for a diagnosis. This is especially true where there are no local subjective symptoms, and where the objective and remote symptoms are poorly defined. This type of cases is to be found among the chronic apical infections, supernumerary, unerupted, and deeply buried teeth, etc. With these exceptions we still have the majority of cases in which a clinical diagnosis may and should precede the X-ray study. On the other hand, especially in acute pathology, the clinical manifestations may be the only dependence in making a diagnosis. In the early stages of acute inflammation, before any gross destruction of tissue has taken place, the Xray findings are unsatisfactory. This is likewise true in acute extensions of pathologic conditions surrounding chronic foci.-R. J. WENKER, Dental Review. |