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SOME OF THE ABUSES OF CROWN AND
BRIDGE WORK.
BY WALTER M. BARTLETT, D.D.S., ST. LOUIS, MO.
There are many points in crown and bridge work requiring particular attention which many operators seem entirely to overlook in the construction of this special class of work. It might be of interest to you to turn your attention in this direction.
In the first place, the use of crowns has been abused to a great extent by the crowning of all class of roots, some of which are only fit to be crowned by a good, strong pair of forceps. These roots may be divided into three classes: first, those that have been in a diseased condition for years and have been a source of constant irritation to their owners; second, those that are only held in by their gum attachments; third, those whose walls have been fractured, said fracture only extending down as far as the process.
As the result of many inquiries in regard to the class first mentioned, I find that the majority of operators after spending weeks and even months in careful preparatory treatment, have met with very little success in crowning such cases. They invariably cause some annoyance to the patient. In the majority of cases the trouble is that of inflammation of the surrounding tissues, caused by the constant moving of the root during the process of mastication. After a root has been in a diseased condition for a year or more, it is questionable whether treatment, however carefully given, will place that root in a condition to be crowned and do the work of the original tooth.
The second class is beyond the bounds of practical dentistry, and no operator who has any regard for his reputation will attempt this class of crown work, unless he has a mercenary object in view.
All who have attempted the third class have made many failures. When there is a fracture extending from the centre of the root, running down to the process border in a slant, no crown can with any satisfaction be properly adjusted, owing to this movable portion of the root. Were this portion removed, the root would be placed in a position impossible to crown. Then again, in case the crown is successfully placed, how long will it last? Probably not more than a year. There is bound to be a decaying of the root at the site of the fracture. From decay, that fractured piece will soon become loosened, and the chances are that it will in some way work its way out, and as a result, there is a cup to accumulate food, which will cause, later on, a very offensive odor. A case of this kind cannot be ferrelled without the results already mentioned. Should the root be split down through its centre, then a crown could be used without fear of any bad results, by bracing the root with a strong ferrell made of platinum, letting it extend down to the process border, thus avoiding the possibility of any secretions getting in between the fractured parts. The difference between the two cases can very readily be seen. In one case, there is a loose, disconnected piece of tooth structure only held in place by the membrane surrounding it. In the other case, there are two firm parts which are firmly held in place by their bony socket.
These three classes of roots are being crowned day after day by men who are considered competent practitioners, and their only success is the satisfaction of knowing that they retained the root, or roots, for six months or a year's time.