HEALTH SCIENCES STANDARD 
 
Columbia SBnttier^ftj) 
 
 tnttieCttpofilfttigork 
 
 THE LIBRARIES 
 
 Mttiitai Hibrarp 
 
Cbe 
 
 Tilling of Cectb mitb Porcelain 
 
 Ocnkins's System.) 
 
 J\ text Book Tor Dentists and Students 
 
 With Ii6 Illustrations 
 
 By matter lUclfsang Bruck, D. D. S. 
 
 Instructor in the Dental Institute of the Roval University of Breslau 
 
 Translated From the German by Charles IV. Jejikins, D.D.S., Zurich, Germany. 
 "Translation Copyright 1902, by Consolidated Dental Mfg. Co. 
 
 new Verk 
 Consolidated Dental m'fg. €o. 
 
 11$ Ulest 42d Street 
 


 (To 
 
 Bv, "X. :S. Jfcntuns 
 
 Bfil. Sarijs. l^ofrati) 
 lHj&ittf Sincere lEsteem 
 
 3ri)e lluti)or 
 
Contents. 
 
 Tirst Division. 
 
 Introduction ^ 
 
 Historical Development of Methods of Porcelain Filling .... 10 
 
 Second Division. 
 
 Dr. Jenkins's Method of Making Porcelain Fillings. 
 
 Chapter I. — Indication and Contraindication of Porcelain Fillings . . 15 
 
 Chapter II. — The Preparation of the Cavity 17 
 
 Chapter III. — Taking Impressions 24 
 
 Chapter IV. — Investment of the Impression and the Melting Process . 36 
 Chapter V. — The Preparation of Cavities and of the Completed Filling for 
 
 Insertion and Fastening in Position 47 
 
 Chapter VI. — Application of the "Porcelain Enamel" of Dr. Jenkins to the 
 
 Restoration of the Larger Defects in Teeth ... 52 
 
 Conclusion 58 
 
 Appendix. 
 
 Porcelain Inlays 61 
 
 Dall's System - 63 
 
 Literature o6 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 Columbia University Libraries 
 
 http://www.archive.org/details/fillingofteethwiOObruc 
 
Preface. 
 
 The gratifying- fact that the use of porcelain as a material for filling 
 teeth is constantly growing, and that in consequence of the good results 
 achieved the number of those who have in view the adoption of the new 
 method is steadily increasing, has prompted me to undertake a detailed 
 description of this innovation which undoubtedly has a weighty signifi- 
 cance for the future of operative dentistry. 
 
 The present work is intended to afford to the beginner who is unac- 
 quainted with this method of filling, a knowledge of it in all its scientific 
 bearings, and to be a faithful guide and adviser during his practical study 
 of it ; but I hope it may also give to those who are already skilled, various 
 information hitherto unknown to them and much that will stimulate them 
 to independent work in this field. 
 
 The preparation of porcelain fillings is a labor demanding much 
 endurance and patience, and not a small degree of accuracy and skill. It 
 requires a willing thoroughness devoted to apparently unimportant de- 
 tails, and it should not be supposed that it makes less claims on the 
 operator than filling with gold. Yet, since porcelain fillings will in course 
 of time become indispensable to every dentist, the sooner a good degree 
 of skill can be attained in their use the greater will be the sucesses 
 achieved. 
 
 In the June number, 1898, of the Deutsche Moiiatsschriff fi'ir Zaliii- 
 hcilkundc, I published an article on the new Porcelain Enamel of Dr. 
 Jenkins, which was the first German publication of the new method. Al- 
 though I could then only report the result of trials and observations which 
 I had collected in a few weeks, I wrote that this new material provided 
 by Dr. Jenkins seemed destined to contest rank with gold in many cases, 
 since we were now able to insert fillings scarcely visible to the naked eye 
 in place of those which were objectionable to many patients on account 
 of being too conspicuous. The hope based on the new material at that 
 time has been fulfilled completely and beyond expectation. 
 
 It is now nearly four years that I have been using the Jenkins Porce- 
 lain Enamel, during which time I have made many hundreds of fillings 
 with it for all kinds of cavities. This Porcelain Enamel, which by the 
 way has in the meantime undergone various improvements, more espe- 
 cially in color resistance to heat, is so excellent a composition that I have 
 had almost invariable results and verv few mischances in working it. 
 
PREFACE. 
 
 Since T adopted tliis nictliDd in my praoiice. 1 have- had opportunit}' to 
 show the method of woridng" tlie Porcelain l^namel to a not inconsider- 
 able number of colleaj^ues as well as to the students of dentistry in the 
 Dental Institute (where the Jenkins apparatus was installed in the Ope- 
 rative Department 1 and it is now my wish to make my collected experi- 
 ences accessible to a wider circle of present and future colleagues. 
 
 In the original illustrations prepared expressly for this work I have 
 attached especial importance to clearness, as I am well aware of the diffi- 
 culty of setting forth vividly by theoretical explanation a purely prac- 
 tical subject. I therefore regard the illustrations as a most valua1)k' aid 
 to the understanding of the text. 
 
 In a special division of this book I have added a description of the 
 Dall method of inserting already prepared porcelain inlays, because there 
 are many cases in which it is to be preferred to the entire j^reparation 1)y 
 the operator of the required fillings. 
 
 In conclusion I would not fail to express in this ])lace my heartiest 
 thanks to Hofrath Dr. Jenkins of Dresden, whose various suggestions 
 have aided me in this work : Prof. Dr. Ladenburg, Privy Councilor and 
 Director of the Chemical Institute, and Prof. Dr. Meyer. Privv Coun- 
 cillor and Director of the Cabinet of Phvsics in the Universitv of 
 I:>reslau, also deserve warmest recognition for seconding me in my labors. 
 
 To the S. S. White Manufacturing Company, and to Messrs. Ash 
 & Sons I am greatly indebted for the kind loan of stereotype plates. 
 
 I so much the more indulge the hope that this book may be favor- 
 ably received by my dental colleagues because, while isolated articles 
 on the subject have already a]:)]:)eared, there has been as yet nothing so 
 comprehensive as this. And 1 further hope that by means of this work, 
 which owes its existence to years of conscientious striving in a sphere of 
 labor most promising and fruitful in its relation to dentistry, I may suc- 
 ceed in contributing something to the more extended use of the valuable 
 systems of Jenkins and Dall. 
 
 \\'.\LrKK \\'oi.ic, anm; Rri'ck. 
 
 lireslau. ( )ctober. i(;oi. 
 
Cbe Tilling of Cectb with Porcelain. 
 
 Bv Walter Wolfgaxg Brick, D.D.S. 
 
 Translated from the Gcriiian by Charles W. Jeukiiis. D.D.S. , Zurich. Germany. 
 
 Tntroducticn. 
 
 Although the number of preparations used m the fiUing of teeth 
 attacked by caries is constantly increasing, and although, owing to their 
 varied qualities, we are able to select from them in each instance the one 
 best suited to the individual case, yet until now we have never had a 
 filling material that could without qualifications be described as "ideal." 
 
 Prof. Miller, in his book on "Conservative Den- 
 tbe Ideal Tilling. tistry,'" has summed up the qualities which the ideal 
 filling material should possess as follows : 
 (i) Sufficient strength: that it may neither break nor wear away 
 under the stress of mastication. 
 
 (2) Chemical indestructibility: that it may remain unaftected by the 
 fluids of the mouth, or by any food or drink. 
 
 (3) Permanence of form and volume in the mouth. 
 
 (4) Thermal nonconductivity : that changes of temperature in tlie 
 mouth may not be conveyed to the pulp. 
 
 (5) A high degree of adaptability: that it may be made to fit the 
 walls of the cavity so closely as to exclude moisture. 
 
 (6) Color resembling as nearly as possible the color of the tooth 
 to be filled. 
 
 (7) Absence of every quality injurious to the substance of the tooth, 
 including the pulp, or to the mucous membrane, or to the general health 
 of the patient. 
 
 (8) Ease of insertion. 
 
 (9) The least possible susceptibility to moisture. 
 
 Among filling materials we indeed possess some upon which we can 
 depend for good results — for example, gold — and. thanks to the thorough- 
 ness with which Dr. W'itzel has developed the uses of aiiialgain. we en- 
 
10 
 
 able with this material to save teeth which formerly could not be preserved. 
 Other preparations, the cements and giitta percha, often render us good 
 service; but there is no one of these which unites in itself all the require- 
 ments, none in which we may absolutely trust, none which deserves to be 
 extolled as the "ideal tilling- material."" 
 
 On account of its durability gold must always stand in the first rank, 
 but gold fillings in the front teeth are certainly not beautiful. Amalgam 
 cannot be considered in such cases, both on account of its dark color and 
 because it often causes discoloration of the tooth; therefore our only 
 choice has been gold with its shimmering lustre, or one of the plastics 
 like cement, which disintegrates in a comparatively short time. For 
 defective front teeth we need a material that shall be at least as durable 
 as gold and more sightly. 
 
 As I shall take the opportunity to show, for many decades dentists 
 have been striving to find such a material. In earlier times it was naturally 
 more difficult to attain this end, for the dental instruments and appliances 
 with which dentists worked left much to be desired, and the manufacture 
 of artificial teeth, which has furnished incentive for many attempts in this 
 direction, had not reached the perfection of today. 
 
 With the increasing perfection of tools and especially of dental 
 appliances we are now in a position to employ a method of filling that 
 fairly represents the most perfect dental achievement. 
 
 The porcelain filling is very nearly the ideal filling, and when we 
 consider one by one Prof. Miller's requirements for an ideal filling ma- 
 terial, we shall find that porcelain meets most of these demands. If there 
 be still some minor defects in the methods employed in the use of porce- 
 lain, we may hope that they will be remedied in the not too distant future ; 
 in any case a field of experiment is offered in which we can expect bril- 
 liant and useful results. 
 
 l)i$torical Development of methods of Porcelain Tilling. 
 
 In turning over the leaves of the dental literature of past decades, 
 when the science was still in its cradle, and there was not even one 
 trustworthy material for filling in use, it is interesting to note the wish, 
 often expressed, of finding a material that should satisfy the aesthetic 
 sense by approaching the color of the teeth. I regard these writers as 
 the intellectual originators of a method of filling which is not only suited 
 to bring about a revolution in this department in our time, but is also 
 destined to have an important influence on the future of operative den- 
 tistry. 
 
 The first to take up this kind of work was C. J. Linderer. who in 
 
11 
 
 ]820 described processes which he named "founiieroi" and " plattieren" 
 (inlaying and veneering) of the teeth. His son, Joseph Linderer, 
 improved on his methods and published a book describing them in 1834. 
 
 The plattieren of teeth succeeded best with shallow cavities, for which 
 were used small flat pieces of walrus or rhinoceros tooth, shaped to fit the 
 cavity. If the depth of the cavity allowed, small pins were set in the piece 
 to give it a better hold. 
 
 For the ''foiiniicren" which Linderer resorted to in the case of deep 
 cavities, he prepared rods made from the teeth of animals. He made the 
 cavity circular, tapping the section to place with light blows of the mallet, 
 or, after cutting a thread on the under part of it, screwed it into place. 
 These inlays swelled in contact with the moisture of the mouth and per- 
 fectly sealed the cavity. Linderer relates that he had to meet with violent 
 opposition among his colleagues, who often condemned his method with- 
 out trying it. Thus B. Oenicke in 1847 condemned Linderer's method 
 because "a boring out of the cavity would be necessary which would 
 needlessly injure the defective tooth." Bruck, too, in his textbook on 
 dentistry, finds this method "altogether inadmissible." 
 
 The results attained with "plattieren/' and still more with "foiir- 
 niereii," were most excellent. The only reason why in time this method 
 fell into disuse was the discoloration of the inlays, doubtless the result 
 of the absorption of the debris of food.''' 
 
 Three years after Linderer's publication of his methods, in 1837, 
 glass was first actually used as a filling material. Dr. Murphy stated in 
 London that he had used glass for the labial surfaces of front teeth bv 
 melting it upon a piece of platinum that exactly fitted the cavity. The 
 inlay was secured in place with amalgam. 
 
 Probably the results reached were not very good, since many years 
 passed without any improvements in this line of work. Xot until 1857 
 was any progress made, when A. J. \'olck published an article on "The 
 L'se of Porcelain in Filling Cavities in Front Teeth," in the American 
 Journal of Dental Science. B. Wood followed in 1862. recommending the 
 use of porcelain in pieces shaped to the cavity of decay. ]\Iarshall H. 
 Webb states that the American, Hickman, made use. in 1870, of pieces 
 of artificial porcelain crowns for filling buccal and crown cavities n"" 
 molars. He was followed by E. T. A. Starr, who had such pieces of 
 porcelain prepared of different shapes and provided with platinum pins. 
 These pieces needed only a slight preparation of the edges to be ready 
 for use. 
 
 A great step forward in the development of this method must be 
 
 *In 1891 Dr. Fenthol of Leif'zig reported tlir -jse of ivory for inlays; he used it. like Lin- 
 derer. in the form of rods. 
 
12 
 
 ascribed to Dr. Land, of Detroit, who, in 1870, made the experiment ui 
 fusing pieces of artificial teeth in a platinum impression of the outer 
 borders of the cavity. The higli point of fusion of the material as well 
 as the elaborateness of the process prevented the general adoption of 
 this method. 
 
 In 1885 we hear of a new development through an article published 
 by \\ . H. Rollins in the Archives of Dentistry, in which he describes a 
 method of preparing porcelain fillings used by him^ince 1879. He shapes 
 the walls of the cavity so that they stand perpendicular to its floor, and 
 with a material composed of two parts mastic, one part parafifine and one 
 part graphite takes an impression of the cavity, which has previously been 
 painted over with vaseline. This is placed in a bath of sulphate of copper 
 connected with a battery, and the plating with copper requires three days ! 
 He now removes by heat the impression material from the copper mould, 
 which is about i>4 mm. thick, and bores a hole at the bottom of it. Into 
 this mould he presses a piece of gold foil Xo. 30, with a ball of cotton, 
 fills the gold foil with enamel powder, and fuses in a gas muffle furnace. 
 Before the fused mass hardens it is pressed into the mould with a platinum 
 instrument. After cooling, the enamel is removed from the mould by 
 thrusting an instrument through the hole previously made, and the gold 
 is drawn oflf from the piece. The fastening in place is eflfected with a 
 mixture of zinc oxide and gutta perclia, the excess which oozes out being 
 removed with chloroform. This method approaches in many particulars 
 that now in use. but is so tedious that it has not found general favor. 
 
 In some sort as a reply to Dr. Rollins. C. W. Dunn reported in the 
 same year in the British Journal of Dental Science a method practiced 
 successfully by himself since the year 1868. which had the advantage of 
 greater simplicity. He took the impression with wax attached to a bit 
 of sheet lead, made the model in plaster, which he then painted over with 
 a mixture of wax and rosin to make the edges less friable, and ground to 
 fit pieces of mineral or of natural teeth, sometimes using those of cattle 
 or lambs. 
 
 In the year 1887 J. L. Stokes published in the Southern Dental Journal 
 a method very similar to the above, the only variation being that he 
 shaped the cavity of decay to the ground inlay. After insertion and the 
 hardening of the cement, he followed the method already practiced in 
 the seventies by Prof. Essig of Philadelphia, viz.. removing the cement 
 from the interstice at the edges and filling it with gold. 
 
 In 1889 W. Storer-How. in an article in the Dental Cosmos, described 
 in minute detail the process, which is now tolerably well known, of making 
 inlays by grinding pieces of artificial teeth. 
 
 In the same year, after several years of experiment. Wilhclni Herbst 
 
13 
 
 put torth a new and much simplified method of making glass fillings. 
 Having prepared the cavity without undercuts, he took the impression 
 with Stent's Composition, made a model in plaster, removed the wax with 
 boiling water, and filled the wet cavity of the model to about three- fourths 
 of its capacity with powdered glass moistened with water. Then he 
 absorbed the moisture from the glass with a bit of linen, dried the model, 
 placed it on a piece of charcoal, and melted the mass wdth the clear flame 
 of a Bunsen burner directed by the blowpipe. This melting was repeated 
 with the addition of glass powder until the mass filled the cavity to the 
 edges. In order to make the under surface of the filling rough, he placed 
 grains of sand in the bottom of the cavity, which united without melting 
 with the glass and furnished good retention.* Herbst's invention 
 awakened much interest both in Germany and in foreign countries, and 
 it is not to be denied that by the introduction of the glass filling he ren- 
 dered great service to the development of the methods now used for 
 porcelain fillings. Xot only did there follow a great number of publica- 
 tions in the dental journals, but distinguished practical workers set them- 
 selves to improve and complete the process. 
 
 Thus in 1890 Prof. Sachs recommended taking the impression with 
 Williams's gold foil and platinum foil No. 60, instead of Stent's Com- 
 position, and bv means of this mould, obtained direct from the cavity 
 itself, secured superior exactness at the margins. After Herbst, several 
 others gave their attention to the production and use of glasslike sub- 
 stances for fillings, among them Schlitsky, ]\Ieyer, Reisert and Robert 
 Richter. None of these glass preparations, however, have maintained 
 their place in practice, for the following reasons : In the first place glass 
 is not homogeneous, and the fillings are consequently porous and do not 
 allow of grmding and polishing after insertion. Glass also changes color, 
 owing to the lead to be found in most kinds of it, while it also crumbles 
 at the edges. Consequently the hope that glass would prove to be for 
 many cases pre-eminenth' a useful material has been disappointing. 
 
 There was now a return to the earlier practice of utilizing artificial 
 teeth by grinding, and tlie inventions of means by which this difificult 
 process is made practically useful was accomplished by the dentist Dali, 
 of Glasgow, whose most excellent system will be described in a special 
 division of this work. 
 
 Heitmiiller. of Gottingen. also did much to promote the use of 
 sections of artificial teeth in filling. 
 
 The want of a fillirig material which should be suited to remedv 
 
 *For this purpose Hartman puts dry plaster at the bottom of the gold impression, as it does 
 not unite with the melting glass. 
 
14 
 
 carious defects in leeth. without lacking the quahties of permanence ana 
 beauty, induced Dr. Jenkins, of Dresden, to make experiments in this line, 
 wiiich he began about the year 189 1 and continued till 1898. the date of 
 his first publication regarding his methods of filling. He has succeeded 
 in inventing a combination and producing a substance which in many 
 respects may be called "ideal." Apropos of the success which Dr. Jenkins 
 has achieved with this fusil)le composition, it may be mentioned that the 
 famous manufacturies of porcelain which flourish in the neighborhood 
 of his residence gave him incentive and practical support in the production 
 of his porcelain enamel. 
 
 After Jenkins had introduced his material to the profession, Dentist 
 Moser, of Frankfurt, also came out with a porcelain preparation. It was 
 claimed by the inventor that it had the advantage over the Jenkins enamel. 
 which is a powder, of being furnished in small pieces which would ensure 
 greater homogeneousness on melting. In my opinion, however, it is just 
 this form of the Moser composition which makes it objectionable, since by 
 using the Jenkins powder the melting mass can be easily directed to every 
 part of the mould and the exact quantity needed can be applied, while in 
 the use of pieces the flow of the melting mass is a matter of chance, and 
 the resulting height of the filling is uncertain. Nor does the manner of 
 working ^iloser's material, which is melted over a Bunsen burner without 
 investment, easily admit of a correction of the contour. However, in 
 certain cases this substance, which in composition is nmch like that of 
 Jenkins, can be used with good results. 
 
 Following Aloser, Dentist Glogavi invented a preparation called 
 "Kaolith." which he believed to be far superior to the Jenkins porcelain 
 enamel, but it does not entirely fulfil the expectations wdiich its discoverer 
 entertained for it. 
 
 The coloring matter of fillings made of this material is a pulverized 
 enamel, which is melted upon the floor of the impression and gives the 
 required color by shining through the stratum of Kaolith that is made to 
 flow over it. It frequently happens that the powdered enamel does not 
 confine itself to the base of the filling, but mixes with the general mass. 
 Moreover, the finished filling has the disadvantage of a glassv lustre. 
 rather than a uniform shade of color. 
 
 Dr. Jenkins has certainly rendered operative dentistry a great service. 
 At all events, his porcelain enamel has been crowned with the highest 
 success. As his discovery was made in Germany, it naturally awakened 
 the greatest interest among German dentists, which is shown bv the fact 
 that there is scarcely a dental meeting in which either a paper treating of 
 the Jenkins System or a demonstration is not on the programme. 
 
 With few exceptions reports on the use of the lenkins method have 
 
15 
 
 been most favorable. It is natural that in judging of an innovation of 
 this kind mischances that are unavoidable in the beginning should make 
 a great impression. Discouraged by such causes, many give up further 
 trials as useless and become opponents of a system which, pursued with 
 patience and persistence, is destined to be of immense value in practice. 
 
 Being of the opinion that one ought not under any circumstances to 
 exclude from examination any improvements that seem to have actual 
 value. I have tested all the glass and porcelain preparations obtainable, 
 and have come to the conclusion that there is no other material with 
 which w^e can make better porcelain fillings than with the Jenkins porce- 
 lain enamel. 
 
 Not only in Germany, but also in America, has this method received 
 deserved attention, and its invaluable qualities are being recognized there. 
 At a meeting of the Xew York Odontological Society, the President, Dr. 
 S. G. Perry, said : "AXe are standing at the beginning of a new era of 
 great significance. The time appears to be approaching when gold fillings 
 in front teeth will be regarded as a relic of a forgotten and barbaric age/' 
 
 It is not impossible that a better substance than this may come into 
 use : yet I think that for a probably long period we shall find in porcelain 
 enamel a material not to be surpassed : a material by means of which 
 we can render both our patients and ourselves distinguished and satis- 
 factory service. 
 
 Tndication and Contra -indication of Porcelain Tillings. 
 
 The position of teeth in the mouth, tlie quality of tooth structure, 
 and the size of the cavity of decav are the conditions upon which the 
 adaptability of porcelain fiUir.gs depends. 
 
 Moreover, it is wise for such as have but recently begun to practice 
 this method to let the choice be governed by the extent of proficiency 
 already acquired. If one has not yet become thoroughly familiar with 
 the preparation of cavities, the taking of impressions and the melting 
 process, it is better to confine oneself in the use of porcelain to laliial and 
 cervical cavities and cuneiform defects. 
 
 For such cavities we always prefer a material which restores as far 
 as possible the original appearance. The taking of impressions from these 
 accessible cavities is comparatively easy, and the melting does not makv 
 excessive demands on the operator. 
 
 But before one proceeds to fill teeth for patients he should acquire 
 facility by experiments out of the mouth, since just in the proportion 
 
16 
 
 that a successful tilliug of this kind coutributcs to the preservatiou of the 
 tooth, in just that (proportion docs a filling fail of doing so if it is in any 
 respect imperfect. 
 
 The employment of porcelain tillings has the great advantage over the 
 use of other materials that it is seldom followed by secondary decay. 
 Ex'en those zvho have entircl\ mastered this method should use their best 
 discretio)i in the choice of cases. 
 
 As 1 have already mentioned, porcelain fillings are indicated: 
 
 (i) For labial cavities. 
 
 (2) For cervical cavities and cuneiform defects. 
 
 ( Ti) Tor buccal cavities in molars. 
 
 (4) For all approximal cavities where the piece to be inserted will 
 not upon occlusion be touched by the antagonizing tooth. 
 
 (5) For large defects caused by caries or fracture. 
 
 As above noted, the restoration with porcelain of defects cited in 
 I, 2 and 3 is desirable on account of the conspicuousness of the positions, 
 where we should aim to avoid attracting attention to the repair. 
 
 Buccal cavities in molars which often extend under the gum margin, 
 are suited to this method, because by its aid we can make a better joint 
 than with any other material. 
 
 F(»r approximal cavities in incisors, cuspids and bicuspids, porcelain 
 is always to be preferred on aesthetic grounds in cases w'here the position 
 and play of the lips make these teeth visible in speaking, so that the gold 
 or amalgam fillings would appear unsightly. Further, porcelain fillings 
 are to be recommended for all cases of extensive decay where enough of 
 the tooth is left to give a strong attachment and an entire crown is not 
 absolutely required. 
 
 Porcelain fillings are contraindicated: 
 
 ( 1 ) For crown cavities in l:)icuspids and molars where severe usage 
 in masticating may readily occasion fracture. 
 
 (2) For approximal cavities where the force of mastication is likely 
 to dislodge the filling. 
 
 (3) In all those smaller visible cavities where gold is not strikingly 
 noticeable. 
 
 (4) For small circular cavities which can be more readily filled by 
 using DalTs prepared inlays. 
 
 (5) For those shallow cavities where sufficient depth cannot be 
 secured without too great sacrifice of sound dentine. 
 
 (6) In the case of all cavities where it is impossible to get a perfect 
 impression. 
 
 From the examples given we learn to what cases this method applies 
 and to what others it is unsuited. In any case it is better to judge care- 
 
17 
 
 fully beforehand than to discover a mistake only on the completion of the 
 filling. 
 
 Especially would I discourage any blind, excessive application of 
 this method. Porcelain inlay work requires no less skill and persistence 
 than filling with gold, and there are many cases where a gold filling guar- 
 antees a surer success. Particularly is one tempted at first, having been 
 successful with a few fillings, to throw overboard the old ways because of 
 admiration for the new. That is indeed a great mistake, which can only 
 lead to disaster. 
 
 By using the greatest possible deliberation as to the cases in which 
 one may employ porcelain to real advantage, one will learn to save time 
 and labor and to avoid those unhappy failures which tend to bring the 
 method into disfavor with the public. 
 
 In the preparation and insertion of porcelain fillings the dentist 
 should subject himself to the severest self-criticism and be content only 
 with absolutely perfect fillings, since any tilling of whatever material is 
 to be preferred to a porcelain filling ivhich is not in every respect excellent. 
 
 II. 
 
 Cbc Preparation of tbe ^mvi. 
 
 In porcelain inlay work the preparation of the cavity is of the utmost 
 importance. There are three rules which must be observed under all 
 circumstances, viz. : 
 
 I. The cavity must be prepared ivithont undercuts. 
 
 II. Tlie margins must be sharply defined, strong and perfectly 
 smooth, but not beveled. 
 
 III. The cavity must not be so shallozv that the tilling cannot be 
 secured in place. 
 
 The neglect of even one of these precautions absolutely excludes the 
 possibility of success. It is impossible to promote the preservation of the 
 tooth in the smallest degree with an imperfect porcelain filling, while with 
 a perfect one we can prolong the life of a carious tooth and essentially 
 heighten its fimctional capacity. 
 
 As mentioned previously, almost all cavities are suited to receive por- 
 celain fillings. Init I will enumerate here once more such as are to be 
 considered, that I may describe their preparation in due order. 
 
 The simpler cases are those presenting on : 
 
 ( 1 ) Labial surfaces of incisors and cuspids. 
 
 (2) Cervical surfaces and in wedge shaped defects amounting to 
 deformity. 
 
 (3) Buccal surfaces of molars. 
 
18 
 
 More difficult arc those occurring on: 
 
 (4) Approximal surfaces of incisors and cuspids. 
 
 (5) Approximal surfaces of bicuspids and molars. 
 
 (6) Where fracture or caries has caused great loss of substance in 
 front teeth. 
 
 In the cases scheduled in i, 2 and 3, we excavate thoroughly and 
 deepen the cavity, taking care not to injure the pulp. When it is not 
 possible to obtain sufficient depth by removing the carious dentine without 
 disturbing the pulp, we resort to a slight hollowing out either in the direc- 
 tion of the neck or of the cutting edge (avoiding undercut!) which will 
 give the filling a good hold (Figs, i and 2). 
 
 It is better to devitalize exposed pulps than to cap them. After 
 removal of the dead pulp, this hollowing out is of course not necessary, 
 
 Fig. 1. 
 
 for we can then deepen the cavity to our liking and ensure a tirm hold. 
 It is better to use rose burs adapted to the size of the cavity. With the 
 larger ones we can almost completely give the right shape to a large 
 cavity. 
 
 Owing to their favoring position cavities i. 2 and 3 are more easily 
 prepared than those on the approximal surfaces of incisors, cuspids, 
 bicuspids and molars. 
 
 In these latter cases it will generally be neces- 
 sary to separate the teeth in order to get a good 
 impression, which is best done liefore beginning the 
 excavation, as one thereby gets a better view of all 
 therefore a few words here as to separation. 
 The relatively simplest means of securing sufficient interproximal 
 space is the wedging of absorbent cotton between the teeth and letting it 
 
 Separation of 
 the teeth. 
 
 parts of the cavity 
 
19 
 
 remain a day or two. Press into the space a dry piece and follow it with 
 one dipped in mastic. The dry piece will swell on absorbing moisture, 
 while the mastic will prevent the wedge from falling out. 
 
 This way of separation has the disadvantage that it must sometimes 
 be repeated, which requires time not always at command in the case of 
 patients coming from a distance, and also that patients are annoyed by 
 the soreness occasioned by prolonged pressure. 
 
 Therefore it is better when practicable to undertake immediate sepa- 
 ration. 
 
 This is to be accomplished by the customary filing with separating 
 files (Fig. 3). In order not to sacrifice more of the enamel than is abso- 
 
 Fig. 
 
 lutely necessary, we emplo}', after usmg the lowest number of file (000-0), 
 some of the many separators, of which the Ivory and the so-called "Little 
 Giant'^ may be noted. 
 
 Ivory's separator (Fig. 4) consists of two wedge shaped spurs filed 
 to a point, one of which is fastened to a small hoop, while the other is 
 attached to a screw, which being turned pushes this movable wedge 
 towards the fixed one. The stationary spur is placed at the approximal 
 space on the palatal or lingual side of the teeth ; the movable one on the 
 labial or buccal. As the wedges are made to approach each other by slow 
 turning of the screw, the space between the teeth constantly increases. 
 On the first introduction of this instrument we should only screw the 
 wedges towards each other sufficiently to hold it in place and afterwards 
 
20 
 
 proceed by slow stages, since the pressure is unpleasant for the patient 
 and too quick or violent wedging may occasion periostitis. It is a pity 
 that this separator is made in one size only, which does not apply to all 
 cases. The spurs should have differing shapes and be interchangeable. 
 
 "'jMBil 
 
 Fig. 6. 
 
 The "Little Giant" separator, which is to be had in three different 
 sizes (Fig. 5), consists of a fine threaded screw, at one end of which a 
 wedge is fastened, with a second of similar shape sliding upon it and 
 moved by means of a nut, which is turned up with a key (Fig. 6), thus 
 pushing the two points together. The principle of this device, like that 
 of the Ivory, is pressure from two wedges approaching each other. Fig. 7 
 shows the instrument in position. 
 
 Am 
 
 Fig. 7. 
 
 Wedging with wood is unpleasant for the patient, yet is 
 to be recommended for many cases, that is to say, when the 
 space to be gained is small. The sharpened hickory wood'''' 
 should be spear shaped (Fig. 8). Drive in with light taps of 
 the mallet or by hand pressure as far as (a) of the spearhead. 
 The wedge should remain in position without slipping until 
 the operation is completed. Improperly shaped wedges will 
 loosen and fall out. Fig. s. 
 
 In most cases that present, themselves some one of these 
 methods will suffice ; but in cavities that extend under the gum the use 
 of cotton as above described is imperative in order to force the gum which 
 intrudes upon the cavity as much as possible away from the tooth. 
 
 "The orangewood o{ the depots is unsuited to this purpose because it is often pithy inside. 
 
21 
 
 In Fig. 9 I present a method which I practice now and then of 
 placing an underlay of amalgam at the bottom of cavities that extend very 
 far under the gum. This essentially facilitates the taking of the impression. 
 
 We may now take up the preparation of approxi- 
 
 flpproximal mal cavities. If the labial, palatal or lingual wall of 
 
 Cavities. a cavity be especially weak ; if, as often occurs, there 
 
 is onlv a stratum of enamel, it should be removed 
 
 Fig. 11. 
 
 Fig. 12. 
 
 Fig. 13. 
 
 ^ 
 
 Fig. 14. 
 
 Fig. 15. 
 
 with an enamel chisel, since it is easily fractured, and the success of the 
 filling is only apparent. In any case one should provide broad access to 
 approximal cavities, for weak walls can be most effectually restored by a 
 porcelain filling. As before remarked, teeth which have suffered great loss 
 of substance can often be strengthened and made useful by this new 
 agency. In Fig. lo. I illustrate the preparation of an approximal cavity 
 
22 
 
 in a bicuspid ; (/ sliows the mesial surface attacked by caries, b the exca- 
 vated cavity which extends to the fissure, c the shape of the cavity at the 
 coronal edge. 
 
 When one has secured the space necessary for the withdrawal of the 
 impression, and completely removed the weak walls and softened dentine, 
 he begins with the special preparation of the cavity. 
 
 i i i 
 
 i 1 I 
 
 
 Fig. 16. 
 
 The hollowing out, represented in Fig. ii, is also to be recommended 
 for approximal cases. It is better in such instances to make it near the 
 cervical edge, though a weakening of the wall is of course to be avoided. 
 If the loss of tooth structure in an incisor is so great as to include a 
 ]iortion of the biting edge, as shown in Fig. ii, there is one important 
 item wliich in excavating we must not leave out of our reckonine. If we 
 
 Fig. 17. 
 
 give the cavity the shape indicated by the dotted line, the frail corner of 
 the inserted filling at the biting edge will break away in a short time and 
 present the appearance shown in Fig. 12. We must seek to prevent this 
 by cutting a semi-circular groove on this edge, as in Fig. 13; l)y this 
 means such an accident is rendered impossible. 
 
 For the preparation of cavities where great loss of substance does not 
 permit of a prescribed rule, we must of course treat each case differently, 
 observing all established points of procedure. Some such cases are 
 described in the last chapter of this division. 
 
23 
 
 The shape which the operator must give to all the cavities 
 mentioned is that of a trough. One should avoid a perfectly round 
 since thereby the trial and final setting of the inlay is made 
 more difficult. Altogether the most important part of the 
 preparation is the finishing of the margins. I have set forth 
 as the second rule of importance that they should be sharply 
 defined, strong and perfectly smooth, but not beveled. What 
 I intend by this is made clear by Fig. 14a and b, and 15c 
 and d. While 14a represents the section of a properly pre- 
 
 above 
 shape, 
 
 f f f f 99f # # 
 
 Fig. 19. 
 
 pared cavity whose margins are sharp and show^ no bevel, 
 Fig. 15c gives the section of one improperly prepared. The 
 margins in 14a are sharp, those in 15c rounded oft". If w^e 
 put a filling in the properly shaped cavity 14b, an injury 
 under stress of mastication is not likely to occur. But if 
 as in Fig. I5d thin portions of the filling overlap the edges, 
 they will split oft' at the points indicated by the arrows. 
 
 5 
 
 rr 
 
 Fig. 20. 
 
 For grinding and polishing the margins we use pear 
 shaped, barrel shaped and round finishing burs (Fig. 16). 
 We must confine their use, however, to the inner walls of 
 the cavity, never allowing them to slip over the margins 
 (Fig. 17), or we shall bring about the wrong condition 
 censured in Fig. 15c. 
 
 Fis. 1! 
 
24 
 
 If we examine with a lens (Fig. i8) a cavity prepared in conformity 
 to the conditions, the edges which seem smooth to the naked eye will 
 exliibit many inequalities. To remove these we use pear shaped and round 
 finishing burs coated with diamond dust (Fig. 19). More recently the 
 small Arkansas stone points suggested by Dr. Jenkins have come mto 
 favor for this purpose (Fig. 20). 
 
 Only by closely following (/// the directions given in this division shall 
 we be able to obtain faultless impressions from the prepared cavity and 
 with these reach good results in porcelain filling. 
 
 III. 
 
 Cakiiid Tmpmslons. 
 
 As I have taken frequent occasion to emphasize the fact that in order 
 to obtain satisfactory results especial care must be taken in the prepara- 
 tion of cavities, so at once I wish to point out that the getting a good 
 impression is of equal importance to the success of porcelain fillings. 
 
 Unless the iiiipressio)i be perfect if is impossible that the tilling shonhi 
 serve in the least degree to preserve the tooth. 
 
 It cannot therefore be too often emphasized that taking the impres- 
 sion is at the same time the most important and the most difficult pari 
 of the procedure. Not until by continued practice one has acquired great 
 skill in taking impressions of all sorts is he qualified to use this method 
 with success. This or that difficulty which one meets at the beginning he 
 must learn with patience to surmount, since it is only by the study of 
 failures that we learn to avoid them. 
 
 Whenever the situation of the cavity renders it 
 Rubber possible it is advisable in taking an impression to 
 
 Dsm. adjust the rubber dum. For example, in labial cavi- 
 
 ties in the front teeth, where the Ivory clanq) holds 
 the dam well away from the field of operation. The two neighboring 
 teeth must also be included in the isolation, in order that the rubber may 
 not interfere with the gold foil of the impression and perhaps alter itb 
 position. 
 
 Should it be impossible to use the rul)ber dam and clamp — if, for 
 instance, the cavity extends beneath the gum, tliere remain two methods 
 of procedure by means of which we may keep the region perfectly drv. 
 
 The napkins, of linen, about 20 cm. square, 
 
 Dental napkins. should be folded triangularly. For cavities in the 
 
 front teeth the point of the triangle will be placed 
 
 under the lip (Fig. 22) ; in the case of cavities farther l)ack in the mouth, 
 
 pressed against the cheek, and, as shown in Figs. 22. 23, vvill be held in 
 
25 
 
 place against the alveolar process by the lip or cheek and the help of a 
 finger. The broader portion of the napkin may be pushed into the month 
 to form for a time an effectual protection against saliva. 
 
 This is an instrument which 1 constructed sev 
 Saliva Clamp. eral years ago for use in crown and bridgework and 
 also in oth.er cases not admitting the use of the rubber 
 dam, to avoid disturbance from the flow of saliva. It is made in two 
 
 forms, one for use on the right and one for the left side, and serves to 
 exclude during the operation the flow from the parotid gland through the 
 duct of Steno. As seen in Fig. 24. this instrument is in the form of a 
 
26 
 
 pair ui scissors, one arm of which ends in a flat ball designed to cover the 
 duct of Steno, while the other is shaped as a ring that presses against the 
 
 Fig. 23. 
 
 outside of the cheek. The two arms are held together by a spring attached 
 quite sufficient to fix the instruments to the handles. Light pressure is 
 in place, and in the case of sensitive 
 patients cotton can be placed over 
 the ends. As I have already made 
 clear in the September, 1900, num- 
 ber of the Deufschen Monatschrift 
 fiir Zahnheilkundc, in which I de- 
 scribed this device, no evil conse- 
 quences from this confinement of 
 the saliva have been observed. Fig. 
 25 shows the instrument in position. 
 
 For e X- 
 tbe Raruard Clamp, eluding saliva 
 I have also 
 used the Harvard clamp (Fig. 20) 
 in many cases, applying it to one 
 of the adjoining teeth. By means 
 of the two arms which carry ab- 
 sorbent cotton rolls we can keep 
 the field of operation a long time 
 free from saliva. This clamp is 
 made for bicuspids and molars. 
 
 '"ig. 24. 
 
27 
 
 After the tooth and neighboring parts have been 
 taking dried, the tooth should be painted over with some 
 
 the Impression. fatty substance, in order to make the withdrawal of 
 the gold foil impression easier. Jenkins uses vase- 
 line for this purpose. I have used with the best results fine olive oil 
 applied thinly with a brush. 
 
 Fig. 25. 
 
 V'arious aids have been presented to render the taking of impressions 
 easier. It has been proposed to take first an impression of the cavity with 
 Stents's Composition or wax, prepare a model, and then press the gold 
 foil into the mould. There has l)een a special swaging apparatus made 
 for this purpose, but none of these aids are suited to give up such an 
 impression as we can obtain by following the method which I am about 
 to describe, and which ensures a representation of the cavity which is in 
 all respects accurate. 
 
28 
 
 I mention first the invention of Dentist Bruhn, of Uiisseldort, who 
 has devised Trial Dies by which the gold foil may be given a shape 
 approaching that required before it is pressed into the cavity. The appa- 
 ratus consists of a rubber cushion upon which the goldfoil is laid. We 
 then select from the assortment of twenty-five stamped pieces of metal 
 that which conies nearest in shape to the cavity to be filled, screw it upon 
 a handle and press the stamp, as shown in Fig. 27, lightly upon the gold 
 on the rubber cushion. The superfluity of goldfoil which might be in 
 the wav of taking or withdrawing the impression may then be cut away 
 with scissors. I am convinced that this apparatus could render good ser- 
 
 Fig. 26. 
 
 vice to beginners. For the skillful it is not necessary. As 1 have already 
 said, by continued practice one may acquire great skill in the manipulation 
 necessary to take impressions, though at first the difficulties seem great.* 
 
 We attain the end arrived at with Bruhn's Trial Dies in a manner 
 much simpler by shaping the goldfoil to the required form while held 
 in the hand (Fig. 29) with a pear shaped instrument (Fig. 28). 
 
 The goldfoil Nos. 30 and 40, used for impressions, may be kept on 
 hand cut to various sizes, thus avoiding loss of time in this time-consuming 
 work. The foil most to be recommended for this purpose is that of 
 Williams or White. Williams's is somewhat tougher and does not tear 
 so easily. Beware of using foil to which particles of Paris red used for 
 
 'Another apparatus similar to Bruhn's has recently been constructed, which includes a 
 number of circular knives for cutting out round pieces of goldfoil. The high price of this appa- 
 ratus will probably preven': its coming into gereral use, especially in view of the fact already 
 stated that it becomes superfluous on the acquirement of greater skill. 
 
29 
 
 polishing still cling. Fillings melted in such foil often take on a reddish 
 tinge, especially at the edges, which may destroy the success of the filling. 
 For smaller cavities the thinner foil, for larger the thicker is recom- 
 mended. Various materials may be used for pressing the foil against the 
 walls of the cavity, for example, cotton, soft erasing rubber, unvulcanized 
 caoutchouc, soft chamois leather and spunk ; for the most part I use 
 spunk, cut to various sizes, and sometimes small round pieces of chamois 
 leather cut out with a punch (Fig. 30). 
 
 Fig. 29. 
 
 D 
 
 Fig. 30. 
 
 Fig. 2S. 
 
 Place the already partly moulded piece of foil in the cavity with 
 the pliers and hold it steady upon the deepest part with a piece of spunk.* 
 
 To beginners we especially recommend that in taking difficult impres- 
 sions they make sure by the removal of the first piece of spunk that the 
 gold is so placed that the edges will not be drawn into the cavity by the 
 pieces subsequently introduced. This will surely happen if the foil has 
 been cut too small or if it be not properly laid in the cavity. During the 
 ivhole time of taking the impression one holds in place zvith a blunt instru- 
 
 *In cutting up the spunk reject all but the softest pieces. For taking impressions only the 
 softer sorts should be used; a hard piece may render the impression unfit for use. 
 
30 
 
 incut, held in the left hand (Fig. 31), 
 the pieces of spunk already placed in 
 the cavity, taking constant care that 
 the foil does not He pressed upon the 
 edges of the cavity, which would cer- 
 tainly result in its being torn. For 
 putting in the pieces one may use any 
 pliers not too pointed unless one 
 chooses to get those made for this pur- 
 pose by Dr. Keyes (seen in Fig. 32 
 from the front and in Fig. 33 from the 
 side), which is provided with buttons 
 that form a small ball \\hen the instru- 
 ment is closed and which prevent pierc- 
 ing the goldfoil. 
 
 Continue to fill the cavity with 
 spunk without exerting nuich pressure 
 
 Fig. 34. 
 
 near the edges. When the cavity ex- 
 tends far under the gum and especially 
 in approximal cavities it is well to cut 
 the goldfoil in the shape given in 
 Fig. 34. bending the upper edge a 
 and laying a piece of soft chamois 
 leather in the bent edge and placing 
 them together between the teeth (Fig. 
 35). This will prevent the goldfoil 
 from being drawn into the cavity. 
 Now take away the chamois skin to 
 convince yourself that the goldfoil is 
 ill the right position and proceed to fill 
 with spunk as above described. When 
 the cavity is full the next step is to press 
 Fig. 31. Fig. 82. Fig. 33. the Overlapping goldfoil upou the cdges 
 
 of the cavity. On this point I would re- 
 mark that it is of great importance for the melting to retain as much as pos- 
 sible of the foil in order to hair during the melting a good idea of the situa- 
 
31 
 
 tio)i of the caz'ity in tJic tooth. However there must not be retained so broad 
 a margin of foil as to interfere with the removal of the impression from 
 the cavity. For compressing the foil over the edges, which is not to be 
 done until it has been closely pressed against the interior walls by filling 
 the cavity with spunk. I have constructed six instruments which are 
 sufficiently adapted to the requirements of every cavity. 
 
 The cuts give both front and side views of these instruments. That in 
 Fig. 37 is intended for all large labial cavities : 38 for smaller labial cavi- 
 ties ; 39 and 40 for approximal cavities ; 41 for cervical cavities : 42 for 
 pressing the foil into fissures of bicuspids and molars. 
 
 Fig. 35. 
 
 Fig 36. 
 
 These instruments are to be used with a light rocking movement, 
 beginning at the edges of the cavity, until the goldfoil is pressed smoothly 
 upon the tooth. Fig. 43 shows the use of these instruments in taking an 
 impression of an approximal cavity in a bicuspid. The two instruments 
 marked a and b have pressed the foil against the palatal and buccal walls ; 
 the instrument c presses it into the fissure of the tooth. 
 
 We now begin the removal of the spunk. With a pair of sharp pliers 
 we take out one piece after another, those remaining in the cavitv being 
 still held firmly with an intstrument. If in spite of using these instruments 
 
32 
 
 there is any point where the goldfoil does not He close to the tooth, which 
 may sometimes occur near the cervical edge, we must go over this portion 
 either with the ball pliers or with the ball burnisher (Fig. 45), holding 
 the foil meanwhile with a blunt instrument at some 
 other part of the cavity (Fig. 31 ). For an impres- 
 
 Fig. 3'J. 
 
 Fig. 40. 
 
 Fig. 42. 
 
 Fig. 37. Fig. 38. 
 
 sion of a cervical or labial cavity it is sufficient to press with one of the 
 instruments upon the spunk which fills the cavity. The foil is pressed 
 down upon the margins by the elastic rubber, so that further manipulation 
 will be superfluous. If it happens, especially in approximal cavities, that 
 
33 
 
 the foil is too large at the cervical edge, or that in the case of front teeth 
 it extends too far over the palatal wall, so that it would be difficult to 
 remove the impression without bending it. we cut away the 
 
 (superfluous part with a lancet or excavator, taking care to 
 keep the impression in place by holding it with a blunt in- 
 strument. 
 
 Fig. 43. 
 
 If one has even the slightest sus- 
 picion that the goldfoil has altered its posi- 
 tion in any respect, it is well to press it 
 down again with a rather large piece of 
 spunk to make sure that it lies closely 
 against all parts of the cavity. Many rec- 
 ommend taking several impressions of 
 every cavity and the melting of several fillings. Doubtless 
 this is of great value to the beginner, since by this means 
 he obtains a degree of skill in taking impressions and in 
 melting. When, however, one is so far advanced as to 
 succeed with almost every impression, this is unnecessary. 
 Of course it will sometimes occur when the cavity is difficult 
 Fig. 45. q£ access that the first filling may not fit as perfectly as 
 
 desired, but the repetition of the process in such a case will not consume 
 so much time as that required for several impressions and meltings for 
 each case. 
 
34 
 
 Before removing the impression examine care- 
 K*iiO"7al 0-" fully with the lens to make sure that the foil is 
 
 the Impression. lying closely upon all the edges of the cavity. 
 
 To loosen the foil I have for a long time made 
 use of an instrument that suits all cases. It is White's excavator No. 97 
 (Fig. 46). In labial cavities I place the point at the deepest point of 
 the impression, when a light lifting movement is usually enough to remove 
 
 Fig. 46 
 
 it. In approximal cavities in the front teeth 
 
 (Fig. 47) I place the point of the excavator at 
 
 the place marked a and try to draw out the 
 
 impression by a downward motion, as indicated 
 
 by the arrow ; should the foil not loosen at the 
 
 first attempt, I continue by carefully inserting the 
 
 instrument between tooth and foil, beginning at 
 
 the point b, until the loosened condition permits 
 
 withdrawal without difficulty. From approximal 
 
 cavities of molars and bicuspids I loosen the impression both on buccal and 
 
 palatal sides (Fig. 48). The removal of the foil is very difficult only in 
 
 cases where the cavity has not been properly prepared; with patience we 
 
 soon learn what to avoid in order to eflfect the removal easily and without 
 
 bending the foil anywhere. 
 
 Fig. 49. 
 
85 
 
 The method proposed by Robicsek, of blowing the impression out of 
 the cavity with the airblower. is not to be recommended on account of the 
 uncertainty as to where the impression may hght and the danger of its 
 being bent. 
 
 If rents in the goldfoil are present after removal from the cavity, 
 they will not affect the result if they do not reach too near the edges. 
 However, it is well to aim at removing the impression uninjured, since 
 rents in the foil, wherever situated, make bending more possible and 
 require more careful attention during the fusing process. 
 
 The best implement for receiving the impression is the mouth mirror 
 having a high rim, as devised by Prof. Sachs (Fig. 49). If one does not 
 proceed immediatelv to the melting, the celluloid boxes now everywhere 
 to be obtained are useful to protect the impression from injury. 
 
 The color assortment of Dr. Jenkins, selected 
 (Choice of Color. from many hundred shades actually tested by him, 
 should suffice for all cases, but if any other shade be 
 desired, it can be obtained by mixing the powders furnished. 
 
 ^ 
 
 
 ~~^ 
 
 
 
 :,iii 
 
 1 I 
 
 Fig. 50. 
 
 In regard to obtaining good results in color, I would emphasize one- 
 piece of advice that I have already given in my article on "The New 
 Porcelain Enamel of Dr. Jenkins," which appeared in 1898, viz. : to remove 
 the color patterns from the color fans and to replace them by patterns 
 made by oneself, giving each sample a fourfold fusing. The influence 
 of the varying heat of dift'erent furnaces upon the color of the material 
 differs so much that this precaution is much to be recommended. 
 
 In selecting colors take for all labial cavities that which comes nearer 
 to matching the tooth ; for all approximal cavities choose a somewhat 
 lighter shade. When I come to speak of the insertion of the filling I shall 
 take occasion to show what modification of the color is then possible in 
 case that the inlay does not exacth- match the tooth. After matching the 
 color while the tooth is zvet, if the filling is not to be inserted at the same 
 sitting, fill the cavity with gutta-percha, first removing the vaseline or olive 
 oil with carbolized alcohol. 
 
 In melting contour fillings it is advisable to have the desired form 
 constantly before the eyes. Therefore either take an impression of the 
 
36 
 
 oavitv in Stent's conipouiul. make from it a model in tine plaster, or model 
 the contour of the tootli with gutta-percha, harden with cold water and 
 remove. While melting the filling, keep this model before the eyes to 
 show how to build up the powder in order to perfect the contour. 
 
 At the meeting of the Central Union, held at 
 Caking Impression, Easter, 1901, Dr. Sachs described a process of obtain- 
 Dr. Sachs's method, ing a good impression of teeth having defects of 
 contour which I should not leave unmentioned. Dr. 
 Sachs remarked that the difficulty in the case of such teeth was not so 
 much in getting good impressions as in building out the porcelain — 
 usuallv for missing corners — to the proper shape. Even when one is 
 skillful the tooth may not receive the proper slant, and it is difficult to 
 give the corner a perfectly natural look, if the work is guided only by 
 the judgment of the eye. It is therefore desirable to secure beforehand a 
 means of producing accurately the desired form. Warming a piece of 
 Stent's compound the size of a walnut, he presses it from the palatal side 
 upon the tooth, the cavity and defective part, lets it cool, and then cuts 
 away from the Stent's compound imtil only so much is left as represents 
 the portion of the tooth that is to be replaced by porcelain. Then he 
 takes an impression with goldfoil. paints the Stent's compound model over 
 with vaseline and presses it with the foil into the cavity so that the gold- 
 foil outside the cavity lies closely against the Stent's compound. The 
 Stent's compound is then removed, leaving the goldfoil in place, which 
 is easilv done, as the vaseline prevents adhesion. He now fills the hollow 
 in the foil with wax in order to prevent bending the goldfoil on removal, 
 invests in a mixture of plaster and asbestos, washes out the wax and, 
 putting porcelain powder in its place, proceeds with the melting. 
 
 Tnocstmcnt of tbe Tmprcssion ana the mcliittd Process. 
 
 1 will now speak of the apparatus used in the preparation of porce- 
 lain fillings. Since cleanliness during the melting process is a chief requi- 
 site, it is advisable to have a special table reserved for porcelain work, 
 which should he covered with sheet tin or iron and upon which all the 
 necessary instruments and apparatus may be always ready for use. The 
 bottles which hold the powder must be kept closed against dust ; the 
 spatula and brushes used for putting the mixed powder into the impression 
 must always be carefully cleaned before using. In the middle of my 
 work table I have an electric furnace upon a stand just high enough to 
 bring the opening of the furnace on a level with the eyes. There is also 
 a hermetically closed vessel containing asbestos powder mixed with alco- 
 
hoi; a bottle of alcohol having a droptube. a 
 number of plates upon which to mix the pow- 
 ders ; pliers, spatula and brush ; several footles? 
 wineglasses for covering the remnants of pow- 
 der after the melting, a pair of colored glasses 
 to shield the eyes from the glow of the furnace, 
 and the box of powders. 
 
 Dr. Jenkins has constructed a small plati- 
 Tnccsting num cup wdth a long handle (Fig. 51) for the 
 
 tbc matrix. imbedding of the impression, which one fills 
 
 with the asbestos mixture, placing the impres- 
 sion in it with the pliers. 
 
 I do not mix the asbestos with water, as Dr. Jenkins recon> 
 mends, but with alcohol ; for it is my experience that unless the 
 greatest care is observed in the drying process the conversion of the 
 water into steam causes the lifting up of the goldfoil, and the 
 impression obtained with so much painstaking is bent and 
 spoiled. 
 
 One must take care in imbedding the impression that the under 
 side next to the asbestos be everywhere supported by the paste, 
 which may be usually brought about by gently tapping the cup on 
 the table, but in manv cases, especially in complicated approximal 
 filings, we must draw some of the paste from the edge of the cup 
 with a spatula (Fig. 52), pushing it under the impression until sure 
 that all hollow places are filled. There is another small aid which 
 we may not despise, since such are often very important for the 
 final success of the filling. In most cases sufficient goldfoil has 
 been retained to show clearly the shape of the tooth and the sur- 
 rounding parts. The superfluous goldfoil having been pressed 
 closelv against the tooth pictures the situation of the cavity. We 
 should imbed the matrix in such a manner that, as far as possible, 
 we may have the cavitv before the eye in the melting cup in the 
 same relative position that it occupies in the tooth ; we shall thus 
 in most cases avoid putting in too much powder. Fig. 53 shows 
 the prepared cavity. In Fig. 54 the foil lies over the edges in such 
 a way that it may be easily removed and will give an almost perfect 
 representation of the tooth. In Fig. 55 the position of the cavity 
 and the shape of the tooth can easily be recognized from the 
 imbedded gold. 
 
 When the impression is properly placed in the asbestos, ignite 
 the alcohol contained in the asbestos paste and let it burn away 
 completely. It will often happen that some of the paste has flowed 
 
 Fig. 51. 
 
38 
 
 into the impression, perhaps through a rent at the bottom, and dried 
 on by the burning out of the alcohol. It can best be removed by a brush 
 wet with alcohol. 
 
 Place the probable quantity of porcelain powder 
 
 Tillins required for the filling upon the agate plate furnished 
 
 the matrix. with the Jenkins apparatus and mix with absolute 
 
 alcohol to a thin paste of cream-like consistency.* 
 In mixing the porcelain powder with alcohol take great care that it 
 be kept free from dust, threads or other impurities, since the smallest 
 particles of dust may afifect unfavorably the color of the filling. After 
 moistening the foil with a drop of alcohol, fill the impression to the edge 
 with the porcelain paste, which may be done with the spatula recom- 
 
 Fig. 53. 
 
 Fig. 54. 
 
 mended by Dr. Jenkins, or, as I prefer after long experience, with a very 
 small, finely pointed camel's hair brush. If the alcohol evaporates before 
 the impression is filled, moisten the paste again. 
 
 The important point in filling the impression is that the paste should 
 fill it perfectly everywhere, so that there be no hollow places beneath which 
 can cause bubbles in the melting. We make sure of this by letting 
 alcohol drop into the impression from the droptube held in the left hand, 
 while with a l)rush in the right hand we gently manipulate the paste 
 until it is thoroughly distributed to every part (Fig. 56). We are also 
 careful not to put too vinch paste at a time into the impression. The 
 asbestos, as well as the porcelain powder, should now be dried by burning 
 out the alcohol before the fusing process begins. 
 
 For this process Dr. Jenkins has constructed two 
 
 Che Turnaccs. similar pieces of apparatus, one for gas and the other 
 
 for alcohol, this latter for the use of those who have 
 
 not at command either gas or electricity. With the introduction of the 
 
 *Dr. Jenkins strongly advises against mixing norcelain-enamel with alcoliol on glass, lest par- 
 ticles of glass become mixed with the powdei. 
 
39 
 
 alcohol furnace the last obstacle has been removed which in some local- 
 ities prevented the introduction of Dr. Jenkins's method. Besides these 
 two, the Mitchell electric furnace (Fig. 57)* can be advantageously used 
 for melting the Jenkins fillings. I have myself used it for two years 
 with the best results. 
 
 The Jenkins gas furnace (Fig. 58) consists of an asbestos lined 
 mufifel, with an adjustable support, open in front and with an opening 
 in the floor through which the flame enters. This is fastened to a base 
 to which are also fixed the pipes for air and gas and the regulating device 
 
 Fig. 55. 
 
 for the latter. To the stand are fixed an arm for supporting the handle 
 of the melting cup and a shield of colored glass for the protection of the 
 eyes. There belongs also to the apparatus a standing IdcHows connected 
 with the blowpipe. 
 
 The alcohol-gas furnace (Fig. 59) varies but little from the one 
 just described, the principal difference being that the gas necessary for 
 use in fusing must first be made in the small retort at the right of the 
 apparatus. 
 
 The process is thus described by Dr. Jenkins: "The alcohol holder 
 after removal of the screw a is filled with absolute alcohol and the screw 
 replaced. The valve b is only a safety valve and the alcohol is on no 
 account to be poured through it. The lamp d is filled with ordinary 
 
 * Unfortunately this electric furnace has the disadvantage of not being durable. Repairs are 
 frequently necessary on account of the burning out of the wires, making it needful to have a 
 duplicate on hand in order not to be left in the lurch. 
 
40 
 
 alcohol through the opening c, behind the holder, which is covered with 
 a cap. Then the lamp d is lighted and the flame regulated by screwing 
 the wick up or down. In a few minutes the absolute alcohol in the 
 
 Fig. 56. 
 
 Fig. 57. 
 
 holder above the lamp will be sufficiently heated and the gas will find 
 its way through the burner e. The products of condensation are carried 
 into the receptacle g. As soon as the first drops fall into it, we can 
 
41 
 
 light the burner e. The contents of g can be used for replenishing the 
 lamp. The standing foot bellows is connected with the tube / and a 
 flame obtained that can only be blown out by a violent use of the bellows. 
 This flame can be regulated as desired bv regulation of the lamp d." 
 
 In using either of these furnaces for fusing fillings, one covers the 
 melting cup with a nickel cap which has an opening through which the 
 melting process can be closely watched (Fig. 51). We note here that 
 the melting requires a longer time in the alcohol gas furnace than in 
 the other. 
 
42 
 
 Mitchell's electric furnace, which i use exclusively in the fusing of 
 porcelain fillings, consists of a small box having an iron support. In 
 the middle of the box is an opening ilA cm. square. The interior of the 
 
 Fig. 59. 
 
 box is filled with an asbestos composition in which platinum wires are 
 imbedded. Through connection with the electric current these wires and 
 the mass of asbestos are brought to a glowing heat. 
 
43 
 
 In order to prevent as far as possible the burning out of the wires, 
 which, as I have already mentioned, often happens in constant use of 
 the furnace, I have had a switch arranged close to my work bench 
 so that when for a moment or two the furnace is not actually in use, as 
 while the filling is cooling or I am adding more powder, I can at once 
 shut ofif the current. By observing this precaution the repairs, so fre- 
 quent previously, have become rarer. 
 
 In the Jenkins gas furnace the regulation of the intensity of the heat 
 is brought about by an adjustment of the valve of the blowpipe to a 
 scale with millimeter divisions ; and in the alcohol furnace by raising 
 
 Fig. 60. 
 
 or lowering the position of the lamp, while in the electric furnace we 
 effect the same object by breaking the current as already mentioned, 
 resulting in the more gradual increase of the heat, or by introducing a 
 rheostat into the circuit. 
 
 The question has lieen much debated whetlier when practicable one 
 should use the electric furnace in preference to the Jenkins furnaces. For 
 my own part, as above stated, I use only Mitcheirs electric furnace, which 
 with a properly regulated current has the same advantages as the two 
 Jenkins furnaces and seems to me to have an essential advantage in 
 respect of uniformity of heat and of the flowang of the porcelain. ]\Iore- 
 over, the fillings can be fused in a shorter time, which to a busy man 
 means a considerable saving. The same results, some say better results, 
 can be obtained with the other two ; in small places, where electricity 
 cannot be had. the question need not come into consideration. 
 
 In using the electric furnace (there are others besides the Mitchell 
 on the market) it is not necessary to cover the impression with the nickel 
 
44 
 
 cap, since no soot is formed in an electric furnace, an advantage deserving 
 consideration. 
 
 A slight change must be made in the shape of the melting cup for 
 use in the electric furnace. Cut ofT the cup and wire from the handle, 
 hammer the wire flat and bend it to the shape shown in Fig. 60. As 
 the cup does not correspond in size with the opening of the furnace, the 
 sides may be bent a little to admit of its being easily passed in and out. 
 
 The process of melting is the same with all these 
 
 methods Of furnaces. Usually three or four fusings are suf^cient, 
 
 fusing. but in making large contour fillings a greater number 
 
 are sometimes necessary. 
 
 For the first melting fill the impression to the edge with the porcelain 
 
 powder (Fig. 61), but do not let it fuse entirely; but as soon as you 
 
 Fig. 61. 
 
 Fig. 62. 
 
 see that the mass has contracted and run together remove from the fur- 
 nace. At this stage the surface of the porcelain is rough and has the 
 appearance of a biscuit ; although the impression was filled to the edges 
 with powder, it has now so contracted that the bottom is scarcely 
 covered (Fig. 62). 
 
 Dip the bottom of the cup in water, to cool it, taking care that no 
 water gets into the cup. 
 
 Then with the drop tube let alcohol flow upon the filling from the 
 edges — not fall directly upon the tilling — and add more powder paste, 
 pushing it with the brush into all the little depressions. For this purpose 
 the consistency of the paste should be very thin. When certain of 
 having filled in the paste wherever needed, we let one drop of alcohol 
 fall directly upon the impression, then fill up to the edges again with 
 paste, burn out the alcohol, and fuse a second time. 
 
45 
 
 We now hold the melting cup so long in the flame that the mass 
 becomes thoroughly fused and the surface smooth and shining. 
 
 Fig. 63 shows the filling after the second fusing. The porcelain 
 enamel has now attached itself to the edges in two places, above and 
 below, but on either side it has drawn away. These places, after cooling 
 the cup, must be filled out as before described.* Now follows the third 
 fusing. By turning the cup during the melting one can direct the flow 
 of the porcelain towards any point desired. In the electric furnace we 
 can set the cup aslant on the wall and attain this end more easily than 
 with the other furnaces, where the cup is held in the hand. 
 
 After the third fusing in most cases, especially after a degree of 
 skill has been acquired, the filling will be finished. It is better in the 
 beginning to use less powder at a time and melt once or twice more 
 
 Fig. 63. 
 
 Fig. 64. 
 
 rather than make the filling too high and be obliged to grind off some- 
 thing from the filling after it is set. 
 
 Fig. 64 shows a perfect filling after three fusings. I could judge 
 just how much powder to put in to obtain the desired height of this 
 filling because I had in the imbedded impression the exact representation 
 of the position of the cavity in the tooth. I would again emphasize this 
 point. Allow so much of the goldfoil to overlap the edges of the cavity 
 that you have this relative position before your eyes while melting and 
 so may be able easily to determine what quantity of powder to add to 
 make a perfect contour. 
 
 I now call attention to another use of the Jenkins 
 
 Us? Of Gum powder. We often have occasion to fill front teeth 
 
 Colored Porcelain, whose defects not only extend under the gum, but 
 
 also, on account of the recession of the gum, 
 
 •Dr. Hirschfeld recommends comparing the chosen sample on the fan with the piece in the 
 melting cup before the third melting, in order, if the match be not perfect, to employ a different 
 shade for the final fusing. 
 
46 
 
 require a more complicated restoration. Fig. 65 shows such a tooth. For 
 that part of the fiUing which is to supply the place of the normal gum 
 tissue we can best use the gum colored porcelain powder supplied in the 
 Jenkins outfit. 
 
 Fig. 66 represents this tooth filled with porcelain enamel, the gum 
 being restored in form and color by the use of th.e rose tinted powder, 
 giving the tooth its natural appearance. 
 
 If in such cases the defects are very small, and yet from their 
 position at the necks of the teeth it is desirable to use the gum color for 
 
 '# 
 
 Fig. 65. 
 
 i-ig. 66. 
 
 Fig. 67. 
 
 appearance sake, it is recommended to make the tirst melting of some 
 other color and flow the gum color over it. 
 
 Although the Jenkins Enamel can be readily ground away and 
 beautifully polished, yet by doing this we sacrifice the original lustre 
 obtained in melting which no polishing can restore. 
 
 The melting process, represented in Figs. 61 to 
 
 Tusing for 64, is very simple ; it is much more difficult when we 
 
 Contour Tillings. have contour fillings to make. In such cases one 
 
 must take care in flie second melting not to allozv 
 
 the poivder to floiv to the edges. Melt as shown in Fig. 67, by layers, 
 
 in order to prevent the mass from flowing over the edges. First melt in 
 
 the shape of a flat ball at the bottom of the impression, adding successive 
 
 layers : although the cut shows this only schematically, yet it is a plan that 
 
 can be very nearly effected in practice. In melting we build the powder 
 
 up higher than the real contour requires ; it flows in the direction indicated 
 
 by the arrows, so that we obtain just the desired contour. I mentioned 
 
 in describing the taking of the impression that, in order to have, while 
 
 melting, a certain guide as to the form and size of the piece to be built 
 
 out, one should, after removing the goldfoil. model in gutta percha upon 
 
the cavity the desired restoration, harden this model and keep it before 
 him that he may know exactly where to place the porcelain powder during 
 the fusing process. By following this method we avoid building out the 
 contour in a false direction, a misfortune which cannot be remedied after 
 the filling is finished. The more carefully one goes to work at the begin- 
 tiing of the melting process, the more successful he will be. To become 
 thoroughly familiar with all the properties of the material and the several 
 stages of the fusing process by previous practice is of course essential. 
 
 V. 
 
 Cbc Preparation of ;€apitie$ and of the Completed Tillings for Insertion and 
 
 fastening in Position. 
 
 On completion of the melting process we let the porcelain cool off 
 and then dip it in cold water; this last for the purpose of more easily 
 detaching the goldfoil. With the tweezers we cautiously separate the 
 foil from the filling, beginning at the edges, which we must avoid injuring. 
 This can usually be accomplished without difficulty ; if, however, as some- 
 times happens, the foil does not come away in one piece, but remains 
 partially clinging to the reverse of the filling, we remove these bits with 
 an excavator. The filling when ready for insertion should be entirely free 
 from particles of gold. 
 
 If there has been a rent in the impression, we look for the place where 
 the porcelain has united with the asbestos while fusing. This is readily 
 discovered as a rough excrescence which is to be removed with a corundum 
 stone, since otherwise the filling may not fit the cavity. 
 
 We now place the piece in the cavity to ascertain by examination with 
 the lens — in cases where the cavity extends to the palatal surface by help 
 of the mouth mirror — if it fits the margins closely at every point. 
 
 Though we may hold large fillings in the pliers, it is often impossible 
 in the case of small ones. We can manage by using a broken plugger with 
 the rough end dipped in mastic. It is well to lay a saliva apron, or towel, 
 about the patient while handling the filling, to avoid dropping the filling 
 on the floor and thereby losing much time in hunting for it. 
 
 The next item of procedure is to provide the 
 
 Undercuts cavity with undercuts for the retention of the filling. 
 
 in Cavity. Since the making of undercuts, especially in labial 
 
 cavities in front teeth, is often painful, on account 
 
 of the nearness of the pulp, it is well to use an obtundent, such as menthol 
 
 in absolute alcohol, in the proportion of 2 : i, Validol camphoratum or 
 
 pure carbolic acid. 
 
48 
 
 In every case use i-cry sJiarp instntiiieiits and dry out carefully 
 beforeluind with hot air. 
 
 For making undercuts use either rose or wheel hurs. Do not make 
 them too near the margin. l)ut more towards the bottom of the cavity; 
 when the filHng fits well it is enough that it has a good hold at its base. 
 
 The filling must also be furnished with several 
 
 Undercuts undercuts, made to correspond, when practicable, 
 
 in Tillings. with those in the cavity, thus forming a ring which 
 
 filled with cement will surround the filling and give 
 
 secure hold. Fig. 68 shows a section of a tooth filled with ])orcelain 
 
 where the undcrcr.ts correspond as aforesaid. 
 
 oo 
 
 J-ig. 70. 
 
 <2=^ 
 
 Fig. 71. 
 
 Fig. 
 
 For making undercuts in the porcelain, thin nickel disks, of various 
 sizes, covered with diamond dust, are used (Fig. 69). Those made by 
 Ash & Sons are the best for this purpose, being more durable than other 
 makes ; but it is important to keep the disk wet while in use, since other- 
 wise they become useless at once. 
 
 The undercuts in the filling should also not be made too near the 
 edge, or the filling may break under the pressure of forcing it to place, 
 though ever so moderately applied. 
 
 There are three kinds of undercuts used for the filling, the most 
 common being a groove encircling the piece (Figf. 70) ; for specially large 
 
49 
 
 fillings, as in the building out of contours, several parallel grooves 
 (Fig. 71) ; and, lastly, the cutting out the center of the tilling, as shown 
 in Fig. 'J2, a method adopted for flat fillings. 
 
 There are other ways of making retaining points. For example : 
 Erich Schmidt, of Berlin, lays bits of copper wire at the bottom of the 
 impression, melts them into the porcelain and afterwards dissolves out 
 the copper by boiling in nitric acid. 
 
 In my opinion, the cuts made with the diamond disk give greater 
 security to the filling. In order to make them one holds the bit of 
 porcelain with thumb and finger of the left hand, having previously 
 moistened and dipped them in pumice powder to prevent slipping, and cuts 
 the groove with the diamond disk in the engine, using as little pressure as 
 
 possible. In Fig. j^, I have attempted to show the manner of holding 
 filling and disk, the position of course constantly varying with the progress 
 of the cutting. 
 
 After making the undercuts wash the filling carefully, dry with a 
 napkin and hold it over an alcohol flame to make sure that no moisture 
 is left in the undercuts. It may happen that too quick heating of the 
 porcelain may crack it; in which case one can take a new impression of 
 the cavity, lay the broken pieces into it, and remelt. Since some of the 
 material has been cut away in making undercuts, it will be necessarv to 
 add some porcelain powder before melting to ensure the original height 
 of the filling. The advantage of this is that it saves a threefold melting. 
 
 The filling is fastened into the tooth with cement. 
 
 Setting Those cements should be used which have the finest 
 
 the Tillinfl. possible powder and which do not harden too quickly. 
 
 Dr. Jenkins has had a cement made expressly for 
 
 setting his fillings ; it is specially manufactured by the makers of the 
 
 Harvard Cement in Berlin. For a year and a half I have used successfulk 
 
 S. S. White's Alphos Cement. 
 
oil 
 
 If on tryiiii;- in Uk' tilling one tinds it too light ur 
 too dark, it can he partially remedied by using respec- 
 tively a darker or lighter cement, sometimes by mixing 
 the phosphate powders. The mixing of the cement 
 requires the most thorough incorporation of the pow- 
 der and fluid, since the smallest lump in the cement will 
 cause failure. The consistency of the cement must be 
 that of cr-am, but on no account thinner, or it will not 
 harden with sufificient strength for permanency. 
 
 Put a small quantity of cement into the cavity ancl 
 distribute it into the undercuts with a suitable instru- 
 ment. I use for the purpose the one represented in 
 Fig. 74. Then with a small and thin spatula (Fig. 75) 
 fill the undercuts in the porcelain filling with cement 
 and set it in place. I give here a useful hint, and 
 illustrate with the example shown in Fig. 76. Put in 
 first that side of the filling which lies near the cutting 
 edge and press gradually to place, so that the super- 
 fluous cement may be pushed out before the filling 
 in the direction of the arrow. By so doing one pre- 
 vents the lifting of the filling by any air that may have 
 remained in the cavity. 
 
 It is not necessary to use a great quantity of 
 cement in the insertion of a filling. It suffices to fill 
 the undercuts and to have enough that a little overplus 
 be visible, oozing out at the edges of the filling. Thi> 
 overplus is removed with a narrow linen tape (Fig. yy). 
 The filling is then held firmly in place with a fiat piece 
 of hickory wood (Fig. 78) until the cement begins to 
 harden.* 
 
 Dr. Green, of Albany, recommended in the Inter- 
 national Dental Journal, 1896, to warm the filling jusr 
 before insertion. I have tried it several times and 
 cannot too strongly warn against doing so, since it 
 causes the cement to harden before one can bring the 
 filling into the proper position. 
 
 It is best not to remove the rubber dam or moulh 
 napkin until the cement left on the mixing plate is quite 
 hard. If obliged to admit saliva sooner, melt over the 
 filling and margins a thin coat of paraffine under 
 
 
 *A very important requirement, too often not observed. — Editor. 
 
 J 
 
 Fig. 74. 
 
 lig. 75. 
 
51 
 
 which the hardening process will continue undisturbed. I cover all fillings 
 with such a layer of paraffine, which, with the remaining particles of 
 cement, is afterwards removed by the patient in the act of brushing. 
 
 With practice one will rarely make a filling that does not exactly fit 
 the cavity. Should it happen, however, that a filling is too high, or that 
 the porcelain has flowed over the edges, one can remove the superfluous 
 part with corundum stones and sandpaper disks (if one does not prefer 
 to make a new filling) either before or after setting in place ; in the latter 
 case after a day or two. For polishing the surface roughened by this 
 grinding, use sandpaper disks for approximal and Arkansas stones 
 (Fig. 79) for labial and buccal positions. 
 
 Fig. 
 
 In concluding this part of the subject, I must 
 
 Scaling contradict the statement often advanced by opponents 
 
 the Canity. of porcelain fillings, viz. : that a porcelain filling never 
 
 properly seals a cavity, since there is always a space 
 
 of the thickness of the goldfoil between the filling and the walls of the 
 
 cavity ; the cement which fills this space must soon be dissolved by saliva, 
 
 leaving the tooth unprotected from secondary decay, and the earlv falling 
 
 out of the filling is inevitable. Flow mistaken this opinion is I would 
 
 show by means of the three following illustrations: 
 
 Fig. 80 shows a section of a properly prepared cavity. Fig. 81, the' 
 same cavity, in which is laid the filling still enclosed in the goldfoil 
 impression. (The goldfoil is here purposely represented thicker than it 
 
52 
 
 actually is.) In J-'ig. i^j the goldfoil is i-enioved, and the tilling lies in the 
 cavity without it. 
 
 Although on account of the thinness of the goldfoil there is no space 
 left, worth mentioning, betzveen the ivalls of the cavity and the Ming, 
 yet since in the case of properly prepared cavities the tillings, after the 
 goldfoil is removed, sink deeper into the cavity to an extent corresponding 
 to the thickness of the goldfoil, this space consequently disappears entirely 
 and there is barely room left for cement. 
 
 *if--j^' fi-'-i^ 
 
 Fig. 79. 
 
 Fig. 80. 
 
 Fig. 81. 
 
 Fig. 89. 
 
 In order not to kee]j the i:)atient in di.sconifort from the rubber dam 
 while the cement is hardening, one can draw the dam over the tooth, as 
 shown in Fig. 83. By means of this arrangement the patient can wait in 
 a neighboring room while the operator attends to another. 
 
 VI. 
 
 Application of the "Porcelain enamel" of Dr. JenKlns to the Restoration 
 of the Cargcr Defects in Ceetb. 
 
 Beside its use for tillings of ordinary size and form and for restoring 
 the contour, there are many other cases in which porcelain enamel can be 
 employed, such as defects from traumatic causes or where large portions 
 of the tooth have been destroyed by decay. 
 
 In cases where formerly the only method possible was to set a crown, 
 the same or even better results mav now often l)e obtained bv the u.se of 
 
this enamel. Of course in such cases one must carefully take into con- 
 sideration whether the bite may endanger the durability of the work. 
 
 // the bite does not in any zuay interfere, one can replace large 
 portions of teeth with porcelain enamel tmthout anxiety. The patient will 
 not be obliged to take more care in using teeth built out with porcelain 
 enamel than he would of a Richmond crown, which we often use in 
 such cases. 
 
 Before I proceed to the description of these cases, I would call 
 attention to the principle that in this work the depth of the cavity should 
 nearly correspond to the size of the contour to be built out, in order that 
 the porcelain may have a firm hold (Fig. 84). I do not think it absolutely 
 necessary to anchor it with posts or stays; indeed, in many cases, I think 
 their use disadvantageous in relation to durabilit} . 
 
 From the many cases in which I have restored large defects by the 
 use of porcelain enamel in the last few years. I select only the following 
 for description here. 
 
 Fig. 84. 
 
 The locksmith's apprentice, F., fell through a 
 €a$C T. glass roof and broke his right superior incisor. The 
 
 pulp was exposed, and the patient experienced great 
 pain on opening his mouth. He came to the Breslau Dental Institute 
 and was sent to the operative department under my supervision. The 
 fracture ran from the mesial wall rather near the gum obliquely down- 
 ward to the distal wall. The first thought in treating so great an injury 
 was, after destroying and removing the pulp, to set a Richmond crown, 
 but I decided against it, since this kind of fracture did not demand an 
 operation that should remove the whole crown to the root. 
 
 At the first sitting by using Anestile Benguc I removed the pulp, 
 and for several days treated the pulp canal with iodoforni-ether, since 
 the shock had induced a slight irritation of the peridental membrane. 1 
 then filled the root canal and prepared the tooth for the insertion of a 
 large piece of porcelain. This filling has now been in place over a year. 
 
54 
 
 I'ig. 85, from a photograph not retouched, represents tlie outHne of the 
 fining and inchoates how httle it shows in the mcnitli. 
 
 A young girl of 14 came under my care for 
 
 €a$C IT. treatment of the right superior incisor, destroyed by 
 
 decay, as shown in Fig. 86. It was the express wish 
 
 of the parents not to liave a Richmond crown, so I was obliged to see 
 
 what I could do with porcelain enamel, and succeeded extraordinarily 
 
 well, as appears from h'ig. 87. 
 
 Fig. 85. 
 
 ]"ig. SG. 
 
 Fig. 87. 
 
 This case needed the restoration of a front tooth. 
 6asc TTT. Jt had been filled with cement and became discolored. 
 
 After excavation there was scarcely anything left of 
 the labial wall but the enamel. When the porcelain filling had been set, 
 the original form and color were restored, and the patient is able to use 
 the tooth as formerly. I'ig. 88 and 89 show^ the tooth before and after 
 treatment. 
 
 This patient came to have an artificial piece 
 
 Case lU. made. The incisors were all gone; both cuspids were 
 
 l)artially destroyed by decay proceeding from the 
 
 points and had been filled with gold. The plate which the patient was 
 
 wearing had been constructed in relation to these shortened cuspids, and 
 
the appearance of the short teeth was unpleasing. On touching the gold 
 finings with an excavator, I found them ready to fall out, and therefore 
 removed them and restored hoth cuspids with large and deeply seated 
 porcelain fillings. Now that the cuspids had their original form, I could 
 use teeth of normal size in making the new denture. In this case I had 
 also the opportunity to use porcelain enamel in another way. In trying 
 in the piece I observed that the root of the left upper incisor (that of 
 the right was absent) had altered its position in the course of time and 
 lay inclined towards the cuspid in such a way that a part of it came into 
 view between the incisors of the artificial piece. In order to get rid of 
 (his lilemish, I fused some porcelain enamel No. 18 (gum color) into the 
 
 t 
 
 
 Fig. 88. Fig. 89. 
 
 
 Fig 90 
 
 
 space between the two artificial incisors, and thus concealed the root from 
 view (Fig. 91). 
 
 1 could describe many such cases, but these may be sufficient to show 
 tliat porcelain enamel can be used to advantage for large defects. 
 
 In making pivot teeth and croivns I have also 
 Crowns. had good results with the Jenkins enamel. 
 
 For a pivot tooth select first a platinum pivot that 
 fits the root well and cut several retaining notches in it with an Arthur 
 disk. Take an impression of the root and grind a tooth to fit. Bend the 
 pins around the pivot, as seen in Fig. 92, and try pivot and crown thus 
 joined in the root. If the tooth has been ground to fit perfectly, remove, 
 and with a Herbst polisher burnish a piece of platinum foil upon the face 
 
56 
 
 cf the root prLijcciiUi^ noiii Uie gum. The positiuii ut the root canal 
 will be plainly marked. Ptitting some wax upon the artificial crown, 
 push to place in the canal and. making sure that the crown has the proper 
 position, withdraw carefully; the foil will cling to the wax (Fig. 93). 
 Then imbed in a melting cup which Dr. Jenkins has devised for thi^ 
 special purpose and which has a platinum spiral to receive the pivot 
 (Fig. 94). Fuse porcelain enamel upon the reverse of the crown until 
 you have it as seen in Fig. 95. The enamel will unite so closely with the 
 artificial tooth that if the bite requires it it can l)e cut down nearly to the 
 pins without impairing the durability of the tooth. 
 
 In constructing these pivot teeth we must beware of cooling them ott 
 too quickly, since artificial teeth crack more easily than the fused porcelain 
 enamel. 
 
 X'- 
 
 ( 
 
 f 
 
 Fig. 91. 
 
 Fig. 92. 
 
 Fig. 'A?.. 
 
 The Jenkins powder can also be used for crowns with success. In 
 Fig. 96 is shown the root of a molar with a ring of gold fastened with 
 cement. After removing the superfluous cement take an impression with 
 goldfoil and fuse porcelain into it. Form tlie fissures with an instrument 
 before the mass hardens. 
 
 Dr. Jenkins, following an idea of Fenchel's, 
 Sachet Crown. uses porcelain enamel in making the so-called "jacket 
 crown." Fenchel puts a platinum ring on the root, 
 which after trying in he gives the form shown in Fig. 97. Then he makes 
 little cuts in the upper rim and bends as seen in Fig. 98. The ring can 
 then be imbedded in asbestos and porcelain enamel fused in it. \\\ means 
 of the platinum cut in ])arapet shape and bent inwards the porcelain is held 
 so securely that whole crowns can be built u]) with safety ( Fig. 99). 
 
 In regard to this Dr. Jenkins writes as follows: "In many cases of 
 a close bite, or for the restoration of fractured or undeveloped teeth where 
 the pulp is still alive, this jacket crown can be used with success. It 
 makes a very strong crown.'" 
 
 Dr. Jenkins is well .satisfied with results ()l)tained by the hYMichel 
 method, both in res])ect to durability and ])eauty. and uses it in lii'^ practice. 
 
Dr. George Evans, of New York, has also used 
 
 methods Of the Jenkins enamel for other operations than filling. 
 
 Dr. Geo. €oan$. He employs it for covering gold or platinum crowns 
 
 with a layer of sightly material. 
 
 He sometimes cuts off the pins from an artificial tooth and grinds it 
 
 so thin that only the outside labial surface remains ; he then fuses this 
 
 facing upon a gold crown, using porcelain enamel with marked success. 
 
 Fig. 94. 
 
 Fig. 95. 
 
 "vTL- 
 
 Fig. 97 
 
 Fig. 98. 
 
 Fig. 99. 
 
 1 have seen Dr. Jenkins make another interesting 
 molar Crowns. use of the enamel in preparing a crown for a lower 
 molar. He made a platinum ring to fit perfectly the 
 edges of the root ; regulated the height of the ring, and took an impression 
 of the ring and root ; then soldered platinum upon the ring, making a cai) 
 that perfectly embraced the surface of the root. From the part of the 
 ring above the cap a piece was cut out on the buccal side and a half molar, 
 provided with a backing, was soldered on. Then, in order to make certain 
 of correct articulation, the cap was tried again in the mouth. 
 
 The ring was now filled with porcelain enamel powder and the fusing 
 continued until the occlusion with the antagonist was perfect. The 
 porcelain united with the tooth most compactly. After another trial in 
 the mouth, the platinum ring visible above the gum was covered with 
 gum porcelain enamel. Dr. Jenkins believes that he can make no stronger 
 nor more durahle crown than this. 
 
58 
 
 I have also made a crown after this nietliod. and in order to give the 
 ring a still firmer hold on the porcelain I cut and bent the jilatinum after 
 Fenchel's method (Fig. 98). 
 
 From the variety of examples alread} given it ma\ be seen how great 
 a field of usefulness opens out for the extended use of porcelain enamel, 
 especially if one most carefully takes into consideration all circumstances 
 in making choice of it for each particular case. 
 
 Having come now to the conclusion of my descriptions of Dr. Jen- 
 kins's method. I would once more point out how valuable, when properly 
 and conscientiously used, this process is. both to our ])atients and to 
 ourselves. 
 
 Its introduction constitutes for the dental profession an event of far 
 reaching significance, and ensures for the discoverer the gratitude of all 
 who regard dentistry not merely as a scientific handicraft, but rather as 
 calling for the exercise of aesthetic and artistic judgment and .skill. 
 
 Conclusion. 
 
 When we take into consideration the difificulty wiib. which nearly all 
 our most useful filling materials were introduced into use, and read in 
 the journals of earlier decades of the bitter contests waged, for example, 
 against amalgam, a material which no dentist today could spare, w^e can 
 understand that there is likelv to be much opposition to the filling of teeth 
 with porcelain. 
 
 The mistrust of new discoveries and methods is to a certain degree 
 excusable, since it often occurs that quite useless innovations (I recall 
 especially many of the preparations for treating the pulp) are extrava- 
 gantly praised. It is certainly desirable that warnings founded on experi- 
 ence should be published in the case of useless and worthless things. 
 
 When Dr. Jenkins, whose standing as a practitioner I have no need 
 to certify, made known ' his method, after years of experiment, he not 
 only explained it theoretically in a manner worthy of admiration, but also 
 exhibited it practically in the mouths of his patients with brilliant and 
 almost never failing success. Stich a discovery, thus announced, may be 
 received at once with a good degree of confidence. That in this case 
 confidence was completely justified is proven by the many satisfactory 
 trials of this method made by German dentists and reported by them both 
 verbally and in writing. So much the more astonishing is it that such 
 really useful discoveries are often subjected to unreasonable criticism. 
 
 Although I have already emphasized the excellence of the Jenkins 
 method and of the porcelain enamel. I wish in conclusion to combat some 
 <>f these unfounded criticisms. 
 
59 
 
 In describing- the setting of the porcelain hUing, I took occasion to 
 deny the assertion that the cavity was not perfectly closed by such fillings. 
 I will now adduce other examples showing how unjustifiable are some of 
 the objections urged against this method. 
 
 It has been claimed that the Jenkins material 
 Jenkins's Porcelain does not differ essentially in composition from the 
 not Glass. glass powders previously in use, and that it melts- 
 
 over a Bunseii burner, ivhich fact justifies the sus- 
 picio)i that it is nothing more than a glass compound. Since I have 
 busied myself in these last years not only with making fillings after 
 the Jenkins system, but have also been interested in studying the com- 
 position and the fusing point of the porcelain enamel and of other com- 
 pounds of like nature, I am prepared to give some particulars upon both 
 these points, viz. : that the Jenkins material is believed to be a purely 
 glass mixture and that it melts easily over a Bunsen burner. 
 
 I had some of the porcelain mixtures which have come most into 
 use analyzed in the Chemical Institute of the Breslau University, the 
 result being that the Jenkins powder is shozvn to be almost identical in 
 composition — the "variation being very slight — ivith the so-called "high 
 fusing porcelain" as zcell as zcitJi the hard German porcelain tested by 
 H. Seger but not more exactly designated."^' 
 
 As to the fusing of the Jenkins powder over a Bunsen burner, I 
 am not surprised at it. since the flame of the Bimsen burner has a heat 
 of more than 1.300 degrees in its hottest part, in which heat all the com- 
 pounds used for porcelain fillings, including even the high and low fusing 
 materials used by Ash in liis artificial teeth, may be melted. 
 
 In order to be sure of this I made, last summer, a series of experi- 
 ments in the Physical Laboratory of the University, and noted the melting 
 ]ioints with the scientific instruments in use there. 
 
 Begins to melt. Melting process completed. 
 
 Kaolith (Glogau) At 693 degrees At 870 degrees 
 
 Glass powder (Herbst) '" 790 " "" 894 
 
 Composition (Moser) " 810 '" "" 890 
 
 Porcelain enamel (Jenkins ) " 850 " "" 910 
 
 Ash's "lowfusing." " 865 " "" 1.000 
 
 The figures marking the beginning of the melting are given here with 
 addition of 20 degrees, because this was the temperature of the room. 
 
 From this table it clearly appears that materials having a still higher 
 meltitig point than any of these can be melted over a Bimsen luirner. 
 
 *Von Wagner. Hamlbuch der Chcniisclien Technologie. I.eipsig, Otto Wiegand, 188t, 
 
60 
 
 Ai a lueetiiig- of the Brandenburg" Society of 
 Grinding Dentists, Feb. 3 and 4, 1900, the Jenkins compound 
 
 and Polishing. was charged with two other defects. It was main- 
 
 tained in a paper read on that occasion that the 
 Jenkins enamel could not be ground and polished without losing its 
 transparency, and it was asserted by another speaker that fillings of 
 porcelain enamel became dark, indeed almost black, in the mouth. 
 
 As to the first assertion. I refer to my remarks on the sub- 
 ject of grinding away too high porcelain fillings. The other charge 
 has been refuted by Torger in the Zahiiarstliche Rundschau in these 
 words : "A discoloration or blackening of these fillings is out of the 
 range of possibility. "" 
 
 I have myself never yet found one among the large number of fillings 
 that I have made with the Jenkins material which had changed color, 
 hot even at the points where the tooth had been ground and polished. Nor 
 have I seen any sign of the porousness of which the material has been 
 accused by some. 
 
 Prof. Hesse, in his last lecture on the Jenkins 
 Retention porcelain tilling before the Central Society (1901) 
 
 by Cement. mentioned the mistrust so often expressed by oppo- 
 
 nents of this method in regard to the retentive 
 power of the cement. He is of the opinion that since the old glass and 
 porcelain fillings have stood the test for years though held in place only 
 by cement, it was not the lack of durability in the cement but of the 
 material of which the fillings were composed that gave cause for com- 
 plaint. So long as we have no more trustworthy material for fastening 
 inlays in place, w'e must let wdiat we have suflfice. The most of the 
 attacks on the Jenkins method are based on an insufficient freedom from 
 prejudice or on an inadequate experience in the use of the material. 
 Whoever will make hiniself acquainted with the brilliant results thai. 
 have been attained will gladly enroll himself among the great number 
 of the followers of this system. Only years of practice with a new filling 
 material can qualify us to give a final judgment upon its capabilities and 
 durability. One should not allow himself to be led to a premature 
 condemnation on account of failures at the beginning. 
 
 Undoubtedly the future of operative dentistry is to be in large 
 measure concerned \\ith the employment of porcelain as a filling material, 
 and we may expect with increasing perfection in the methods and materials 
 that we shall in time possess that which is so much needed — a compoimd 
 that shall meet all the ref|uirements that we must flemand of an "ideal" 
 filling material. 
 
61 
 
 Jlppcndix. 
 
 Porcelain Inlays. 
 
 In the section devoted to the historical development of the method 
 of filling teeth with porcelain. I have mentioned the use of pieces of 
 artificial teeth as inlays. I can therefore restrict myself here to a few 
 remarks which may give a better idea of these fillings. There have been 
 several ways in use of making porcelain inlays. The simplest, it seems 
 to me, is that recommended by Prof. Sachs. He selects a front tooth of 
 
 
 fSHHHMKl 
 
 
 Fig. 101. 
 
 u 
 
 i 
 
 Fior. 102. 
 
 • i u 
 
 White's manufacture which matches in color the tooth to be filled and 
 cuts out of it a round piece w^hich nearly corresponds in size to that of 
 the cavity. Fastening this with shellac to the end of a burr, he lets the 
 engine revolve to the right while he holds the porcelain against a fine 
 grained wheel of the lathe revolving in the opposite direction. One can 
 also, in order to obtain a more perfect joint, fill the cavity with wet 
 pumice or emery powder and thus polish to a nicety in the cavity itself. 
 
 The pieces are given a somewhat conical form, so that if they do not 
 at the first trial exactly fit the cavity the small end can be cut away and 
 the piece sunk deeper into the cavity. The lower part is grooved 
 (Fig. lOo), and a groove is also made in the tooth. Later, in order not 
 to consume too much time in preparing an inlay for each case, Sachs made 
 out of artificial teeth which had been discarded for other uses a large 
 number of porcelain inlays of various sizes. 
 
 Another method is (by means of one of White's trephines (Fig. loi ), 
 
which arc made of copper charged witli tHam.nd dust, and can be had 
 in several sizes) to cut from the selected tooth a piece of the required 
 size. This method has the advantage that one can cut out from the 
 artificial tooth the piece which best matches the shading of the natural 
 one and will render the defect least visible. There are also to be had for 
 this work cylindrical burs having the same diameters as the trephines 
 (Fig. 102). 
 
 For holding these small porcelain inlays while being ground. How 
 has made some metallic rods (Fig. 103), which are to be set in a mandrel 
 
 I 
 
 Fig. 103. 
 
 •ig. 104. 
 
 Fig. 105. 
 
 mm 
 
 Fig. lOG. 
 
 l"ig. 107. 
 
 as shown in Fig. 104, for use on the engine. By this means the inlay 
 can be given the desired shape by holding it against fine grained corundum 
 or emery. 
 
 White and Ash have also prepared for porcelain inlay work, from 
 the same substance as their mineral teeth, small rods of various shapes 
 and colors from which the piece required can be cut ofif (Figs. 105 
 and 106). Finally I would mention the inlays manufactured by Aslj for 
 large cavities, some of them provided with platinum pins for molar 
 teeth (Fig. T07). 
 
63 
 
 All these methods have been superseded by Ball's system, which has 
 greatly simplified the work and essentially shortened the time necessary 
 to prepare such fillings. 
 
 Dall's System. 
 
 Dall engaged the firm Ash & Sons to furnish so-called "ground 
 inlays/" made of the same material as their artificial teeth, in sizes cor- 
 responding to a steel gauge (Fig. io8). These inlays are of two thick- 
 
 DALL' s 
 INLAY GAUGE 
 
 Dalls 
 Ground Inlays 
 
 Deep Shallow 
 
 I'lg. 1U9. 
 
 Bur 
 
 Fig. no. 
 
 C.ASHlSONS 
 ENGLAND. 
 
 oooO 
 
 li 
 
 Z7 
 
 Li 
 
 Fig. ni. 
 
 Fig. 112. 
 
 Fig. 108. 
 
 nesses (Fig. 109 j ; both have grooves on the under side, and on the outer 
 a little button by which the inlay may be seized with the pliers, which 
 makes the trying in and setting much easier. The thicker inlays have a 
 retaining groove. There are twenty-five sizes of inlay corresponding to 
 the same number of holes in the gauge, and also twenty-five large burs 
 
H4 
 
 marked on tlie shaft w itli the lUimbcr corresponding to the gauge 
 (Fig. no). Tliese burs are sHghtly conical in shai)e and give the cavity 
 tlie exact form of the inlay selected. 
 
 Dall has also constructed four inlay holders (Fig. iii) for use 
 when the inlav has to be ground away on the under side. The top of 
 the inlay with the button is fastened into the holder with shellac. 
 
 The process of setting such inlays on labial surfaces is as follows: 
 Remove all decay from the cavity with a rose bur, and with the burs 
 above described give it a circular shape : in doing this take great care 
 to hold the bur jierpendicular to the required plane of the filling and that 
 the bur runs true in the handpiece, or tlie desired form will not be 
 obtained. 
 
 Pis. n;:. 
 
 Fig. 114. 
 
 iMg. 115. 
 
 Fig. 110. 
 
 When the cavity has sufficient depth, make an undercut with Ball's 
 undercut bur (Fig. 1 12). With the pliers take the inlay which corresponds 
 with the size of the bur and place it in the cavity. If it is too high, the 
 lower surface may be ground away until it corresj^onds with the edges 
 of the cavity, but there must never be so much taken away that the edge 
 of the cavity is above the inlay, but the edge of the inlay must always 
 stand a trifle above the edge of the cavity wall. If there is no retaining 
 groove in the piece selected, one is easily made with the diamond wheel 
 (Fig. 113), always kept wet. 
 
 After putting a little cement of the consistency of cream into the 
 retaining grooves in both inlay and tooth, set the piece with a small 
 surplus of cement. The little button is to be nicked with the diamond 
 wheel and excised. When the cement is hard, remove the extra portion 
 with a corundum disk and polish the surface of the porcelain inlay with 
 an Arkansas stone. 
 
 We prefer these inlays to melted fillings for small, round cavities. 
 The cuts 114 to it6 show cases in which the use of the Dall system is 
 advantagreous. 
 
65 
 
 For all irregularly shaped cavities, or when to make a round cavity 
 would involve too much destruction of tooth substance, we prefer the 
 Jenkins method. This only requires that we remove the decav and enough 
 tooth substance to prevent secondary caries.* 
 
 *It should be said that Dall has in view the preparation of inlays of irregular shape, but 1 
 maintain that for such cases fillings melted in an exact impression of the cavity more completely 
 fulfill the purpose sought. 
 
Citerature. 
 
 Bkuck, J. — Lclirhuch der Znlinheilkumic. Berlin. A. Fiirstncr, 18o(). 
 
 CoMEGYS. — Zalintlcisclifaiiiigc Porzollanfullungen (Gum-colored porcelain fillings). 
 Dental Cosmo?. March. 1889. 
 
 D.\Ki!v, E. T. — Remarks liefore the National Dental .Association. Dental Cosmos, 
 189fl. p. 1188. 
 
 Drx.v. C. W. — Enamel Fillings. British Journal of Dental Science. 1885. 
 
 Ekx-SMEre, J. B. — Porcelain Dental Work. Dental Cosmos. February. liHiu. 
 
 Ev.\xs, Geo. — Remarks before the Xat. Dental .\ssn.. Dental Cosmos. 18911. p. 1171. 
 
 Ev.\xs. Geo. — Remarks before the X. Y. Odontological Society. Dental Cosmos, 
 1900, p. 183. 
 
 Fexthol.— Die neueren Fullungsmaterialen. Deutsche Monatsschrift fur Zahnheil- 
 kunde. Jan., 1892. 
 
 Gi.oG.vu. — Kaolith. eine neue Porzellanemaille, Zahnarztliche Rundschau. 1900. 
 
 Hesse. — Porzellanfullungen nach Jenkins. Deutsche Mcnat^schrifi fur Zahnheil- 
 kunde, 19nl. 
 
 HiKscHFEi.i), W. — How to Overcome the Dit^cullie- in Dr. Jenkins's System of 
 Inlays. Dental Cosmos. 1899, p. 489. 
 
 HoLxnuEK. — Erfahrungen niit Glasfiillungen. Deutsche ^[on. fitr Zahnheilkunde, 
 Mai. 189-2. 
 
 H.\KT.M.\x.\. .AxTox Jllils. — Einigcs iiber Gla.sfiillungen. Deutsche Mon. fiir Zahn- 
 heilkunde. .Aug.. 18911. 
 
 He.\d, J. — The Shadow Problems of Porcelain Inlays, Dental Cosmos, June. 1900. 
 
 He.xd. J. — Remarks in the Xat. Dental Association, Dental Cosines, 1899. p. 1170. 
 
 He.\I). J. — The Status of the Inlay as Compared With Other Fillings. Dental 
 Cosmos. 1900. 
 
 How. W. Stoker. — Porzellanfiillungen. Correspondenzblatt fiir Zahnarzte. 1889. 
 
 Herbst. W. — Glas als Fiillmaterial. Correspondenzblatt fiir Zahnarzte. 1889. April- 
 heft. 
 
 Jexkixs. X. S. — Porcelain Inlays. The Dental Register. Vol. ol. June. 1897. 
 
 Jenkixs. X. S. — Porcelain Enamel for Inlays and Pivot Teeth. Dental Record. 
 Aug.. 1898. 
 
LITERATURE. 67 
 
 Jexkixs. X. S. — Porcelain Enamel Inlays. Dental Cosmos, 1898, p. 633. 
 
 Jenkins. X. S. — The Perfected Porcelain Enamel, Dental Cosmos. 1899. p. 84. 
 
 Land. — A Xew System of Restoring Badly Decayed Teeth by Means of an 
 Enamelled ^^letallic Coating. The Independent Practitioner, Aug.. 188G. 
 
 Lanu. — Metallic Enamel Sections: a Xew System for Filling Teeth, in the same. 
 Feb., 1887. 
 
 LiNDEREK. J. — Handbuch der Zahnheilkunde. Bd. II, 1847. 
 
 LiNUEKEK, J. — Fournieren nnd Plattiertn der Zahne, Deutsche Vierteljahrsschrift fiir 
 Zahnheilkunde, 1874. 
 
 Miller. \V. D. — Lehrbuch der conservierenden Zahnheilkunde. Leipzig. Geo. 
 Thieme. 189G. 
 
 Miller. \V. D. — Wiederherstellung der Contur carios gewordener Zahne durch 
 Porzellanstiickchen. Osterr.-Ungarische \'ierteliahrsschrift fiir Zahnheilkunde 
 Jan., 1887. 
 
 Mu.i.EK, W. D. — Die Ausgleichung von Zahndefecten mittels Porzellaneinlagen, 
 Odontologische Blatter. Mai. 1899. 
 
 MoESEK, Ernst. — Homogene Email-Einlagen. Odontologische Blatter, 1899. S. 120. 
 
 MoESER. — Durchsichtige Glasfiillungen. Deutsche Monatsschrift fiir Zahnheilkunde, 
 Xov.. 1897. 
 
 MoESER. — Die Herstellung homogener Einlagen zu Zahnfiillungen ohne Brennofen, 
 
 Deut.sche Monatsschr. fiir Zahnheilkunde, Juli. 1899. 
 Murphy. — Popular Treatise on the Structure. Diseases and Treatment of the 
 
 Human Teeth. London, 1837. 
 Oenicke, G. a. — L'eber das Ausfiillen cario-^er Zahne mit Riicksicht auf das Plat- 
 
 tieren und Fournieren derselben. "Der Zahnarzt." 1847. 
 Rollins. W. H. — Enamel Fillings, Archives of Dentistry, 1835. 
 Sachs. W. — Die Technik in der conservativen Zahnheilkunde, Deutsche ^lonat. fiir 
 
 Zahnheilkunde. Juni, 1889. 
 Sachs. W. — Discussionsbemerkungen zu dem Vortrag des Prof. Hesse: "Por- 
 
 zellanfiillungen nach Jenkins." Correspondenzblatt fiir Zahnjirzte, April, 1901. 
 Sachs. W. — Glasfiillungen. Deutsche Monat. fiir Zahnheilkunde. June, 1890. 
 
 Sachs, \V. — Das Fiillen der Zahne. "Handbuch der Zahnheilkunde" von Scheff, 
 
 Wien 189-2. A. Holder. 
 SiFFRE, A. — Les procedes de vitrification appliques a I'obturation des dents, Revue 
 
 Odontologique. 1899. 
 Smreker, Ernst. — Einige Kunstgriffe beim Fiillen der Ziihne. Wiener Zahnarzt- 
 
 liche, Monatsschrift. Mai, 1901. 
 
68 
 
 LiriiRAri'Rii. 
 
 Stokes. J. L. — Porcelain Filling.s, SoutlRrn IXntal Journal, 1887. 
 
 Thompson. A. H.— Gum-colored Porcelain Fillings, Dental Cosmos, Mar., 1889. 
 
 VoLCK, A. J.— Am. Journal dt Denial Science. July. 1857. 
 
 Webb, M.\rsh.\li. H. — Ueber die Verwendung von I'orcellanstucken zur Fullung 
 von Cavitiiten. Correspondenzhlatt fiir Zahniuzie, 188_'. 
 
 Brixk. \\ . — Leber die neuen Jenkins'scben l^'orzellanemaillen. Deutsclie Monat. 
 fiir Zabnbeilkunde. 18!I8. 
 
 Bruck. \V.- — Die Thatigkcil der Abteilung fiir conservirende Zahnheilkunde am zabn- 
 arztlichen Institut der k(")niglicben Universitiii P>re>-lau w.ibrend des Snnnner-e- 
 mesters, IfKXi. Deutsche Monat. fur Zabnbeilkunde. Heft 9. lOUO. 
 
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 The filling of teeth with 
 
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 porcelain (Jen 
 
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 2002399130