We now come to the use of cements as anchorage for gold. With this material it has a smaller field of application, and in my hands does not yield as good results as in the use of amalgam. I believe that Dr. F. D. Nellis, of Syracuse, New York, was the first to conceive the idea and use the cement as an anchorage for gold. It is useful in teeth having very shallow cavities, and in those cases where, while it is desirable to use gold, the edges chip or shale off at every attempt to make the cavity retentive. The method of use is as follows: The rubber dam, of course, is used. The cavity being ready, a small amount of cement is mixed and placed in it. On the cement put a cylinder of gold large enough to cover the floor of the cavity. Work the gold into the cement, at the same time working the latter all over the cavity. Trim cement from edges and proceed with the filling, making a mechanical anchorage of the gold with that anchored by the cement. Foil or pellet may be used in place of cylinder, and it may be cohesive or not, and the filling finished with soft or cohesive gold, but I think the best results are obtained by using soft cylinder over the cement, continuing with the same and finishing with a few strips of annealed foil. A very good way is to proceed to fill the cavity with gold the same as if cement were not to be used for anchorage, holding the gold in place with another instrument, and when sufficient has been inserted to nicely take the form of the cavity, to take out, place a little cement in the cavity, then force the gold back to place, and after waiting a minute or two for the setting, go on and finish the filling. It is not necessary in this work to confine oneself to the use of the phosphate of zinc cement. In restoring color to very dark pulpless teeth, and wherever extra whiteness is desired, the oxychloride may be used with advantage, but must not be relied upon for strength like the oxyphosphate. In shading, I get the best general results from the yellow shade of the latter. Pulpless teeth generally have a bluish tinge, and yellow seems to neutralize it very effectually. In regard to the effect of oxyphosphate in deep cavities in teeth with living pulps, it does not seem necessary for me to say much here, since the subject has long been worn threadbare by the profession. However, it must be borne in mind that here is a difference. The cement in use I have described is sealed away from the fluids of the mouth and does not have the same effect as when being disintegrated by those fluids. It remains a perfectly inert substance so long as moisture is kept from it, and has the same use in the floor of the cavity as the varnish so often recommended for closing the tubuli of the dentine to prevent ingress of moisture from that direction. In such cases it is a very simple matter to touch the bottom of the cavity with liquid gutta percha before using the cement. In cases of exposure where capping is desired, cap according to your custom and then proceed as described. When extirpation is resorted to, I fill root and pulp chamber with gutta percha.
CAPPING EXPOSED PULPS.[3]
BY A. H. FULLER, M.D., D.D.S., ST. LOUIS, MO.
I will, in a brief manner, give something of a history of the practice of capping the exposed pulps of teeth, with a view of rendering the teeth comfortable and useful, and at the same time preserving the vitality of the capped pulp.
In the early days of the profession, up to and including the time of Hunter, Fox and Bell, the exposure of the pulp was almost equivalent to the absolute loss of the tooth; not from the fact that dentists were ignorant of the conditions necessary for its retention, but from the want of instruments and appliances with which to perform operations for its preservation.
We find them attempting in various ways to overcome the difficulties with which they were surrounded. They attempted to shrink the pulp and render it less sensitive, that they might fill over without wounding or pressing upon it. To accomplish this, astringents and opiates were resorted to; again, acids, alkalies, or the actual cautery were used to destroy it. Any of the above operations were rarely possible, and when possible, still more rarely successful. The extraction and replantation of the aching tooth was resorted to, the pulp removed and the root canals filled in cases where the means at hand would admit. Cleansing the tooth by boiling before replanting, was suggested by Hunter.
Following the above methods, the operation of excision had its day, its advocates and its opponents. This consisted in removing the crown and as much of the root and pulp as possible with cutting forceps, adapted to the different teeth.
The following from "Waite" would lead us to infer that there were those in his day, as well as at present, who would mount a hobby and attempt to ride into prominence by so doing. In discussing this operation of excision, he says: "At the present period, nothing is aimed at but novelty; nor do many productions succeed that follow the regular line of going on; and while men of science pursue honorable and just means to bring themselves into notice, their reputation is frequently surpassed by cotemporaries, brought forward by some lucky coincidence."
This digression may possibly be excused, as it was, in a measure, necessary, in order to continue the history of attempts at conservation of the dental pulp. I will copy from a few of the earlier writers on dental subjects, to show methods of practice, together with results as given: