ORTHODONTIA, 
 
 MALPOSITION OF THE HUMAN TEETH; 
 ITS PREVENTION AND REMEDY. 
 
 BY 
 
 S. H. GUILFORD, A.M., D.D.S., Ph.D., , 
 
 Professor ok Opekativf. anh Pkostheth Dentistry in the Philadelphia Dental 
 College; Author of "Nitrous Oxide," &c. 
 
 Approved hy the Xatioiial A^sot-iation of Dental Faeulties as a text 
 book for use in the schools of its re])reseutatiou. 
 
 nn i,Ai)K),riii.A^ : 
 
 I'KKSS OF SPANtiLKR it OAVIS, 
 
 529 COMMRItCK STUKKT. 
 

 Eutered according- to Act ol' Congress, in the year 1889, by 
 
 S. H. GUILFORD, 
 
 In the Office of the Lil^rariau of Congress, at Washington, D. C. 
 
To My Father, 
 
 SIMEON GUILFORD, 
 
 this work is 
 
 Affectionately Inscribed. 
 
Digitized by tine Internet Arciiive 
 
 in 2010 witii funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/orthodontiaormal1889guil 
 
PREFACE. 
 
 Tliis^ work has been written at the rcMjuest of the Na- 
 tional Association of Dental Faculties in furtherance of its 
 plan to secure the preparation of a series of text-books for 
 use in American Dental Colleges. After its completion and 
 examination, it was aece])ted and endorsed by the Asso- 
 ciation at its meeting in Saratoga, August, 1889. 
 
 The impartment of instruction in the simplest and most 
 direct manner being the true province of a text-book, the 
 author has endeavored in the preparation of this work to 
 treat the subject as concisely as possible and to clothe his 
 thoughts and those of others in such language as to be 
 readily comprehended by beginners as well as those some- 
 what advanced in this branch of study. 
 
 In the treatment of the subject, the aim has been to lead 
 the student step by step from the simplest beginnings to 
 the more complicated and difficult work of practical treat- 
 ment. To this end, the underl3dng principles of the art are 
 first elucidated, after which the principal methods employed 
 are explained, and lastly the correlation of principles and 
 methods is shown in their practical application to typical 
 cases. In Part III, the different forms of irregularity, 
 together with a variety of plans for their correction, are 
 arranged under such headings and in such order as to be 
 readily referred to in seeking aid for cases that occur in 
 ofhce practice. 
 
VI PRKFACK. 
 
 Should the work fulfill the object aiiued at in its prei)ar- 
 atiou. the author will feel amply repaid. 
 
 Credit for assistance is most cheerfully given to the 
 twenty-five teachers of this branch in American Dental 
 Colleges who have read this work in manuscript, and by 
 friendly criticism and valuable suggestions added much to 
 its completeness. 
 
 The author would also acknowledge his indebtedness to 
 Prof. W. F. Litcli for valuable services, and to the S. S. 
 White Co., Lea, Brothers & Co., P. Blakiston, Son & Co., 
 and other publishers and authors for the use of certain cuts. 
 
 S. H. G. 
 Philadelphia, Sept., 1889. 
 
CONTENTS. 
 
 PAKT 1. 
 
 PRINCIPLES INVOLVED. 
 
 Chap. I. Definition of Subject, 
 
 " II. ETIOL(KiY, 
 
 ■'' IIL Evii.s Associated with Irekgui.akity, 
 
 " IV. Advisability of Coeuection, .... 
 
 " V. Age at which Cokeection may be begun, 
 
 " VI. Movements to be Produced and Principles 
 
 Governing the Application of Force, 
 " VII. Extraction as Related to Orthodontia, 
 " VIII. Physiology of Tooth-Movement and Char- 
 acter OF Tissues Involved, 
 
 PACE. 
 
 9 
 12 
 26 
 29 
 33 
 
 37 
 42 
 
 49 
 
 PART II. 
 
 MATERIALS AND METHODS. 
 
 Chap. I. Study of Case, 
 " II. Appliances, 
 
 " III. Consideration of Methods 
 Farrar's jNIethod, 
 Patrick's " 
 Byrnes' ■• 
 
 Magill Band, 
 Angle's Method, 
 Coffin's " 
 Talbot's " 
 
 56 
 66 
 
 82 
 84 
 87 
 90 
 93 
 99 
 104 
 
 VU 
 
VI 11 CONTENTS. 
 
 PxVKT III. 
 SPECIFIC FORMS OF IRRE(UTLARITY AND THEIR TJiEATMENT. 
 
 Cpiai*. I. IxcisoK Teeth Erui'tixg Outside ok Inside of 
 THE Arch, ... .... 
 
 " II. Delayed oe Mal-erii'tiox of the 1'ekmanknt 
 
 Cuspids, 
 
 III. In'cisor Teeth Situated Outside or Inside of 
 
 the Arch after Dentition is comvlete, 
 lY. Cuspid Teeth situated Outside or Inside oi 
 
 the Arch, 
 
 A''. Misplaced Bicuspids, 
 
 VI. Torsion, 
 
 VII. Contraction of the Arch, 
 VIII. Protrusion of the Upper Jaw, 
 IX. Protrusion of the Lower .Jaw or I'rognathism, 
 X. Miscellaneous : 
 
 Lack of Anterior Occlusion, 
 
 Reduction of Elongation of the Anterior 
 
 Teeth, 
 
 Assisted Eruption of the Anterior Teeth, 
 Tooth Shaping, 
 
 108 
 114 
 117 
 
 131 
 140 
 145 
 155 
 1(J3 
 172 
 
 179 
 180 
 184 
 
ORTHODONTIA. 
 
 PART I-PRINCIPLES INVOLVED, 
 
 CHAPTER I. 
 
 DEFINITION OF SUBJECT. 
 
 Orthodontia, from un/Yu:: straight, and uoao:; a tooth, is 
 that branch of dental practice which relates to the correction 
 of irregularity of position of the Imman teeth. 
 
 Its recognition as a distinct branch or speciality of gen- 
 eral dental practice has come a1)0ut in recent years, indeed, it 
 attracted so little attention less than a century ago that many 
 of the writers of tliat day entirely omitted it from their Ijooks 
 and writings, while those who did refer to it gave it but little 
 attention and space. Wliether the condition of irregularity 
 was less frequently met Avith then than now we cannot cer- 
 tainly tell, but inasmuch as dentistry was then in its infancy, 
 and as the most pressing demands upon the dentist of that 
 day were for the alleviation of pain, the substitution of arti- 
 ficial dentures to replace lost members, and the checking of 
 the ravages of decay l)y filling, it is but natural to suppose 
 that there was little time or inclination to attempt the relief 
 of so apparently unimportant a condition as mere irregularity 
 of position. Since then, however, with the natural growth 
 of dental science and the enlargement of its sphere, the sub- 
 ject of orthodontia has grown in importance until to-day it 
 
 9 
 
10 ORTHODOXTIA. 
 
 is ensfaffiiio- the attention of some of the best minds of the 
 profession and forms one of the most generally discussed 
 topics of dental gatherings everywhere, l^esides constituting 
 an important part of the study of every dental student. 
 
 With the growth of its interest and importance there has 
 been a corresponding advance in investigation as to the 
 cause and frequency of irregularities, a more exact micro- 
 scopical examination of the tissues concerned and of the 
 physiological changes occurring in them in the process of 
 correcting such conditions : progress has also been marked 
 by the invention of a multiplicity of devices and appliances 
 for the more perfect and easy correction of this class of 
 deformities. 
 
 EEGULARITY AXD lEREGULAEITY DEFINED. 
 
 The teeth of man when normally placed in the alveolar 
 arch describe in outline a parabola or semi-ellipse with a 
 slight flattening of the curve in the region of the incisor 
 teeth, and a consequent tendency to angularity where the 
 cu-spids are placed. The outline of the lower arch differs 
 from the upper principally in the greater divergence of the 
 terminals of the curve. The teeth when thus placed should 
 be in contact, each one touching its neighbors at the mo.st 
 prominent points of its approximal surfaces. When thus 
 arranged the teeth are called regular. 
 
 An irregularity may be defined as any variation from the 
 above order. It may consist in a variation from the normal 
 outline on the part of several or all of the teeth, or in the 
 malposition of one or more individual teeth ; if the latter, 
 the tooth or teeth may be found outside or inside of the reg- 
 ular line of the arch or they may be placed anteriorly or 
 posteriorly to their normal positions, or finally, they may be 
 turned or twisted on their axes. In many cases this torsion 
 is associated with malposition. 
 
 An irregularity being an abnormality, corrective measures, 
 as a rule, .should be re.sorted to, but slight irregularities do 
 not alwavs demand interference. 
 
PRINCIPLES IXVOLVED. 11 
 
 The slight overlapping of the superior centrals by the lat- 
 erals, for instance, is a clear case of irregularity, but it is so 
 slight a one and so commonly found that it has almost ceased 
 to attract attention or to be regarded as an irregularity. 
 Artificial teeth are now made reproducing this condition 
 and in many cases are preferred on account of their " more 
 natural appearance." 
 
 So too, the slight irregularity so commonly found in con- 
 nection with the inferior incisors, where several or all of 
 them are slightly turned and overlapping, is no longer looked 
 upon as inharmonious and is also imitated in the arrange- 
 ment of artificial teeth. 
 
 Again, the slight misplacement of a tooth in the posterior 
 part of the arch, where it is not noticeable, if it does not 
 interfere with proper occlusion or .specially invite decay, may 
 be left without disturbance and no harm result. 
 
 In cases like these, if the slightly altered position of the 
 individual teeth is not likely to result in injury to tooth 
 structure, it is Ijest to omit anv effort toward correction. 
 
CHAPTER II. 
 
 ETIOLOGY. 
 
 Tlie causes rcs])Oiisil)k' for tlio production of irregularity 
 are many and at l)est l>ut imperfectly understood. Some of 
 them are operative l)elore the birth of the individual and 
 others afterward. Tliey may therefore be classed under the 
 two general heads of liereditary and acquired. 
 
 HEREDITARY. 
 
 This class comprises all sucli cases as are evidently due to 
 the inheritance of peculiarities that existed in their near or 
 remote ancestors, or to some of the characteristics of both 
 parents who are themselves free from dental abnormality. 
 
 The well-known l)iological law of transmission of charac- 
 teristics from parent to cliild will readily explain how tlie 
 a))normalities as well as the normalities may be transmitted. 
 The cliild may bear a close resemblance to either }»arent in 
 form and feature, or it may combine some of the peculiarities 
 of both. In other cases it will resemble neither, but be like 
 one of tlie grandparents or other remote relations. 
 
 The evidences of inheritance are perhaps nowhere more 
 clearly expressed than in the dental organs. Not only in 
 these organs as a whole may we see the dental ai)paratus of 
 a progenitor reproduced in entirety, but the resemblance is 
 equally well shown in the inheritance of so slight an abnor- 
 mality as a twisted <<v misplaced tootli. Sometimes such 
 peculi.irity may be inherited by sevei'al children in thesame 
 family. 
 
 Cases of irregulai'ity due to inheritance are oftentimes the 
 most dithcult to correct, for not only must mechanical diffi- 
 culties be overcome, but in addition tlie influence of physi- 
 cal impress, confirmed perluqis l)y repeated transmission, 
 
 12 
 
PRINCIPLES INVOLVED. 13 
 
 must be combattod. Tlie mechanical difficulties in sucli 
 cases are as readily concjuered as in others, but the force of 
 inheritance will show itself in a strono; and stubborn ten- 
 dency of the teeth to return to their former abnormal 
 position. 
 
 The intermarriage of races with widely ditferino- charac- 
 teristics has come to l:)e regarded as one of the most prolific 
 causes of dental irregularity. If l)oth races re])resentcd in tJic 
 marriage possess somewliat similar cliaracteristics as to size, 
 vigor and feature, no dental peculiarity will usually l)e found 
 in the offspring; l)ut wliere the differences are marked, 
 irregularity of the teeth will often be the resulf. 
 
 When one parent possesses a large frame with full-sized 
 teeth set in large jaws and the other a small frame with cor- 
 respondingly small jaws and small teeth, the child may 
 inlierit the large teeth of one parent and the small jaws of 
 the other. The small jaws cannot accommodate tlie full com- 
 plement of the larger teeth and hence a crowded and irreg- 
 ular dental arch will be the result. 
 
 \Miere the small teeth of one parent and the large jaws of 
 the other are found united in the offs})ring, aljuormal inter- 
 dental spaces will fre(piently be the result. These spaces 
 may exist between all of the teeth, or, as in some cases, the 
 deformity will only be found in connection with the anterior 
 ones. ■ Cases of this character, fortunately, are infre(juently 
 met with, Ijut when they occur they present an unsightly 
 appearance and generally result in an earlier loss of the teeth 
 from that lack of contact and mutual support so necessary 
 to their longest retention and usefulness. 
 
 ACQUIEED. 
 
 The causes productive of irregularity during dentition or 
 subsequent to it far exceed in num])er those due to here- 
 ditv. 
 
 LONG RETENTION OF DECIDUOUS TEETH. 
 
 In accordance with physiological law, the deciduous teeth 
 are intended to subserve the wants of the child until they 
 
14 ORTHODONTIA. 
 
 are replaced by the permanent set. The crown of the per- 
 manent tooth should occupy a position beneath or adjacent 
 to the root of the deciduous one which it is intended to sup- 
 })lant. Then, as the root of the temporary tooth is gradu- 
 ally removed, the permanent tooth advances and finally occu- 
 pies the position previou,sly occupied by its predecessor. 
 
 It frequently happens, however, that the crypt of the per- 
 manent tooth is situated at some little distance from the root 
 of its corresponding deciduous one, and as the new tooth 
 makes its way into place it assumes a position to the side of 
 the deciduous root. As usually that part of the root is 
 absorbed which is in contact with the vascular covering of 
 the advancing crown, a portion of the length of the root 
 remains unabsorbed and the new crown is, in consequence, 
 compelled to advance by the side of the root instead of 
 l)eneath it. The deciduous tooth as a result of its only par- 
 tially absorbed root, remains firmly in place and the new 
 one is erupted out of its proper position. Had the condition 
 been brought to the knowledge of the dentist before the new 
 crown appeared, the extraction of the deciduous tooth would 
 have permitted the advancing tooth to assume its proper 
 position in the arch and irregularity have been prevented. 
 When the permanent tooth is advancing out of position the 
 fact may be recognized by the unusual distension of the gum 
 and alveolar plate beneath, and the deciduous tooth, no mat- 
 ter how firmly set, should at once be removed. Even the 
 spicula of a deciduous root has been found sufficient to 
 deflect a permanent tooth from its course during eruption. 
 
 EARLY EXTRACTION OF DECIDUOUS TEETH. 
 
 That tlie premature extraction of deciduous teeth often 
 prepares the way for irregularity of the permanent set is 
 generally recognized, but the extent of its importance and 
 the manner in which it operates can best be understood by 
 considering the |»hysiological facts in the case. 
 
PRINCIPLES INVOLVED. 15 
 
 Irregularity of the deciduous teeth is a condition very 
 seldom met with. As a rule they occupy their normal ]^osi- 
 tions in an alveolar arch of proper size to accommodate 
 them, and this again rests upon a jaw l)one of suitable 
 amplitude. Thus jaw, jn'ocess and teeth are harmoniously 
 correlated. As each deciduous tooth is lost it is succeeded 
 by the corresponding permanent one, whicli. under normal 
 conditions, will occupy the space made vacant by the removal 
 of its predecessor. In this way, one by one, the permanent 
 set should make its appearance until all of the deciduous 
 teeth have been supplanted by their permanent successors. 
 
 The permanent teeth are all larger than the corresponding 
 ones of the deciduous set, with one exception, — the second 
 bicuspid. This being the case, they require a larger alveo- 
 lar arch and a correspondingly larger jaw bone for their 
 accommodation. This nature furnishes by the slow pro- 
 cess of enlargement bv interstitial groAvth, wliich is hastened 
 and stimulated by the lateral pressure of the teeth as they 
 make tlieir way into j)lace, and afterward. When the first 
 permanent molar makes its appearance it is obliged to 
 provide sufficient accommodation for itself by forcing its 
 way between the deciduous second molar and the strong 
 maxillary tuberosity above or the equally resistant ramus 
 below. This pressure is felt by all the other teeth in the 
 arch. If, therefore, any of the deciduous molars shovild be 
 extracted about the fifth or sixth year, for instance, as they 
 too often are after having been impaired by disease, the 
 permanent molar will move forward and occupy part of 
 the space intended for the bicuspids. 
 
 When the permanent lower central incisors erupt they 
 make their appearance inside of the deciduous ones, which 
 soon loosen and drop out. Owing to the fact that the width 
 of these new teeth is considerably greater than the space 
 occupied by their ^predecessors, they naturally overlap to a 
 certain extent the adjoining deciduous laterals. This over- 
 lapping prevents the centrals from moving forward into 
 
16 (MrnioDoxTiA. 
 
 line in the arcli. \\'hcn tlie permanent laterals ernpt they 
 assnme a position hy the side of the centrals, and to find 
 accommodation in tliis contracted space inside of the arch 
 several or all of them are apt to he crowded into irregular 
 positions. 
 
 This condition, while perfectly natural, from the fact 
 that these teeth have erupted too rapidly to admit of a cor- 
 responding increase in size of the alveolar arch, is often 
 regarded as a serious evil, and to correct it, the inexpe- 
 rienced practitioner will in many cases extract the tempo- 
 rary cuspids Mdiich are designed for retention initil years 
 afterward. This additional space having l)een thus fur- 
 nished, the permanent incisors will move forward into line 
 and assume a regular position. 
 
 Later, when the hicuspids appear, they will usually find 
 no difficulty in assuming places in the arch, l)ecause their 
 predecessors occupied a larger space andl)ccause the cuspids 
 are missing, hut from the very ahundance of the space and 
 the pressure of the first molar from behind, the bicuspids 
 will very soon, if not at once, be so pressed forward that the 
 first bicuspid will be. in contact with the lateral, leaving no 
 space for the accommodation of the cusj)id when it makes its 
 appearance at about the eleventh or twelfth year. 
 
 Such being the case the cuspid mnst of necessity erupt 
 outside or inside of the arch, and prodneo a deformity both 
 unsiglitly and hard to correct. 
 
 Had the temporai-y cuspids not been extracted they 
 would have jn-eserved space for their successors, and the 
 inlocked and irregular incisors, in the course of time, by 
 the normal enlargement of the arcii, and the excess provided 
 by the removal of the deciduous molars, would have had 
 space sufficient, Avhich nature, assisted by the ])ressure of the 
 tongue, would aid them in occupying. 
 
 The same coiulition is met with in the superior arch, per- 
 haj)s more freijuentiy than in the iid'erior. Here the incis- 
 ors erupt outside of tlie deciduous ones, and sometimes a})pear 
 
PRIXCIPLKS IXVOLVKD. 17 
 
 in an irreo-ular and crowded position, to correct wliicli tlie 
 tenii)orary cuspids are often needlessly sacrificed, and the 
 same train of evils follows. 
 
 It will thus be seen that the premature extraction of any 
 of the temporary teeth, especially the cuspids, cannot well 
 result in other than harm to the permanent ones, so far as 
 regularity is concerned. 
 
 Sir John Tomes relates a case in which he extracted for 
 cause all of the deciduous teeth of a child, and yet when 
 the })ermanent ones a])})eared they assunuMl their i)ro})er 
 positions in the arch without any resultant irregularity. 
 
 This one case, however, the only one of the kind on 
 record, does not disprove the facts as noticed in tliousands 
 of cases of opposite character, nor does it confute the plainly 
 api)arent workings of physiological law. It simply illus- 
 trates what nature may do in a single case under conditions 
 exceptionally favorahle. 
 
 INJUDICIOUS EXTRACTION OF PERMANENT TEETH. 
 
 A condition frequently met with after all the })crmanent 
 teeth have l)een erupted, is one where in the u})per jaw the 
 centrals, l.)icus})ids and molars are all harmoniously 
 arranged, while the laterals occupy a position inside of the 
 arch and the cuspids lie .outside of it. The condition is 
 most frec{uently brought about l)y the premature extraction 
 of one or more members of the temporary set, as descril»ed 
 under the last heading. 
 
 To remedy the difficulty in the easiest manner, some 
 practitioners have at times extracted the laterals and 
 on other occasions the cuspids. Tlie result has been in each 
 case an almost hopeless deformity. The cuspids l)rought 
 next to the centrals oftentimes gives to the face a canine 
 appearance, while Avith cuspids lacking the countenance is 
 robbed of that prominence near the angles of the mouth so 
 necessary to harmonious expression. 
 
 Again, the first permanent molars of one of the jaws are 
 
18 ORTHODONTIA. 
 
 often neglected until caries has made serious inroads upon 
 them, when they are extracted as offending members. The 
 result is that the lateral pressure, so necessar}^ to proper 
 expansion of the process is lacking in one jaw, while in the 
 other the normal enlargement continues. As a consequence 
 there is disparity of proportion between the two jaws, and 
 the appearance of the individual is perhaps permanently 
 marred. 
 
 DELAYED ERUPTION OF PERMANENT TEETH. 
 
 It sometimes happens, from causes not easily definable, 
 that the eruption of one or more of the permanent teeth is 
 retarded to sucli a degree that the rest of the set take posi- 
 tions in the arch and occupy all the space. When the 
 tardy member is ready to erupt there is no place for it, and 
 it is compelled to take a position outside or inside of the 
 line. This is apt to occur more frequently with the cuspids 
 than any of the other teeth, although it is occasionally met 
 with in the case of the laterals and bicuspids. 
 
 ACCIDENTS. 
 
 An accidental injury to one or more of the teeth of either 
 set, whether resulting in their loss or not, is often respon- 
 sible for an irregular condition. Should a deciduous tooth 
 become devitalized, as the result of an accident or otlier 
 cause, and alveolar abscess su})ervene, the physiological act 
 of ab.sorption will be suspended, and the succeeding tooth 
 in the course of its eruj)tion will naturally be deflected from 
 its course and erupt in an al)normal position. 
 
 So, also, it has hap]»ened that a deciduous incisor, through 
 a fall, has been driven up into the j^rocess. Such a mis- 
 fortune can hardly fail to cause an injury to the partially 
 formed iiernianciit tootli lying Ix'ncath it. Should no more 
 serious result follow it will jtrobably at least divert the course 
 of the new tooth and be productive of an irregularity. 
 
 The author had one such case in his practice with an 
 irregularly ]»lacetl [termaiient t(»oth as the result. 
 
rRINCIPLES INVOLVED. 19 
 
 HABITS. 
 
 The bad habits which young children are apt to acquire 
 after they are weaned, such as thumb-, lip- or tongue-sucking 
 are important factors in bringing about an irregular align- 
 ment of the teeth in one or more portions of the arch. 
 Acquired early, while the temporary teeth are in position 
 and firmly set, the habit will usually make no inqu'ession 
 upon them, but if not checked and allowed to continue up 
 to the time of the coming of the permanent set, as is 
 frequently the case, these will generally be thrown out of 
 position or be so altered in their relationship as to cause a 
 serious deformity. 
 
 This is readily accounted for when we consider that the 
 erupting teeth, seeking their position in the arch and sur- 
 rounded by newly formed and pliable alveolar tissue, are 
 easily turned out of their course by any extraneous force 
 exerted upon them. 
 
 The general results of the triple habit are the same, 
 although they vary in particulars. In thumb-sucking, 
 usually only two or three of the incisors are pressed out of 
 place, and the ones affected are determined by the hand 
 used and the position of the thumb in the mouth. In lip- 
 and tongue-sucking, owing to the larger surface of the organ 
 employed, all of the incisors will be affected. 
 
 Not only has the point of introduction of the thumb to be 
 considered in relation to its effects, but also the angle at 
 which it is held. When the position of the thumb in rela- 
 tion to the teeth, forms less tlian a right angle, the upper 
 teeth will be thrown out and the lower ones in ; but when 
 held in a horizontal position, the upper and lower teeth are 
 not displaced but sinq)ly lield apart. As a result of this 
 latter position the first molars are kept from present contact 
 and naturally elongate until in time they come together. 
 The mouth is thus permanently propped apart in front 
 and when the second molars erupt and come into occlusion 
 the ill-condition is confirmed. With these ei2:ht firm teeth 
 
20 
 
 ORTHODONTIA. 
 
 in contact, there is no longer any liope of the ten anterior 
 ones elongating sufficiently to meet, and we have the 
 deformity known as " lack of anterior occlusion,"' which is 
 not only a disfigurement but a serious disadvantage to the 
 individual in mastication. This lack of anterior occlusion 
 is not always due to the habit of thumlj-sucking, for it may 
 be Ijrought al:)Out by physical peculiarities, as noticed in 
 Part III., Chapter X. 
 
 In lip-sucking the lower lij) is drawn into the mouth 
 over the lower teeth, and held there for varying periods 
 both day and night. The result is that by the force 
 thus exerted the lower teeth are thrown in and the upper 
 ones out to .such an extent as to give them an unnatural 
 jDrominence, and to cause spaces to exist between them. 
 
 Fig. 1 illustrates this condition. The chil<l. v/hen 
 brought to the author Fig. 1. 
 
 for c o n suit a.t ion, was 
 twelve years of age and 
 a confirmed victim in 
 the habit of lip-sucking. 
 All of tiie fourteen teeth in 
 e a c h j a w w e r e f u 1 1 y 
 erupte.l and nicely in line, ^ 
 
 except the eversion and introversion of the upper and lower 
 incisor teeth respectively. The teeth were brought into 
 i:)roper position and the habit, by Ijeing thus made impos- 
 ed )le, was broken up. 
 
 But the displacement and failure of occlusion of teeth in 
 tlie anterior part of the mouth are, hoAvever, not the only evils 
 a.ssociated Avith this habit in its three forms. In each case 
 the jaws are held temporarily a})art so that there could l)e no 
 occlusion of the teeth even thougli they occluded normally 
 when the jaws were closed. This leaves the side teeth free 
 to change their position if any iidhience is exerted to pro- 
 duce that result. In the act of sucking, the checks are drawn 
 in and the strong j)ressure thus In-ought to l)ear upon the 
 
PRINCIPLES INVOLVED. 
 
 21 
 
 Fig. 
 
 bicuspids and (occasionally) the first molars, causes them to 
 
 be bent inward. In this mal-position they are frequently 
 
 confirmed by the opportunity thus given the other molar 
 
 teeth to move forward, 
 
 of which they are not 
 
 slow to take advant- 
 
 ao-e. The rt^sult is the 
 
 deformity known as 
 
 the " saddle-shaped " 
 
 jaw, as shown in 
 
 Fig-. 2. 
 
 This deformity, pro- 
 duced l)y the same 
 causes, may be pres- 
 ent in the lower jaw, 
 but it is much less i^ 
 frequently met with » 
 tliere than in the 
 
 \ip"[)ei'. Saddle-sliaped .\reh, (after Coleman.) 
 
 The condition may also be, and undoubtedly frequently 
 is, due to other causes or conditions. 
 
 Mr. Charles Tomes ascribes the cause of this defurmit}^ as 
 well as that known as the " V-shaped arch," to enlarged ton- 
 sils, which by partially closing the posterior nares necessi- 
 tates breathing with the mouth open. In this case as in 
 lip-sucking, the .jaws are kept apart and the contraction of 
 the muscles of the cheeks lias in consequence a tendency to 
 deflect the Ijicuspids inward. 
 
 Irregular eruption of tlie permanent teeth is also a cause 
 tendino- to l)rino; al)out this condition. In some cases the 
 cuspids erupt and assume their positions in the arch before 
 one or both of the bicuspids make their appearance. When 
 the latter erupt, there is insufficient space for their accom- 
 modation. Their effort to force themselves into position is 
 met and opposed by the more firmly set cuspids and first 
 molars, and in consequence they are forced to take a position 
 
22 ORTHODONTIA. 
 
 inside of the arch, making the diameter of the mouth at this 
 point less than anywhere else, thus constituting a true saddle- 
 shaped condition. 
 
 This deformity, according to the author's observation, is 
 never inherited, l)ut always acquired. 
 
 IRREGULAEITIES OR DEFORMITIES WITH MIXED ETIOLOGICAL 
 CHARACTERISTICS. 
 
 There are some typical malformations of the teeth and jaws 
 the causes of which cannot be classed under either the 
 hereditary or the acquired form, but combine certain features 
 of both. 
 
 Among the more prominent of these are, protrusion of the 
 upper jaw, prognathism, and the " V-shaped " arch. 
 
 SUPERIOR PROTRUSION. 
 
 In this condition the lower anterior teeth may be some- 
 what introverted or they may be in line forming their por- 
 tion of a normal arch, while the superior ones project forward 
 and outward to such an extent as to leave a space, more or 
 less great, between their cutting edges and those of the lower, 
 thus producing a marked deformity and giving to the in- 
 dividual a slightly imbecile exi:)ression. The lower 
 anterior teeth, when the jaws are closed, may not occlude 
 with their fellows above or they may rest in contact with 
 the bases of their crowns instead of touching nearer the 
 cutting edges. 
 
 In most cases this deformity is Ijut the e'xpression of a 
 tendency inherited from a progenitor under conditions favor- 
 able to reproduction. It may also be, and in many cases 
 doubtless is, the result of meclianical causes finding mani- 
 festation in the individual alone. Even if inherited it must 
 have l)een the result of such causes in the individual with 
 whom it originated. 
 
 In some instances we find it associated with abnormally 
 large incisors, especially the centrals, which could find accom- 
 
PRINOIPLKS INVOLVED. 
 
 23 
 
 modation only by enlargement of the arch, while in others 
 it bears evidence of being the result of an over-develoi:)nient 
 of the superior or an under-development of the inferior arch. 
 
 It may also be caused by the mal-eruption of certain of 
 tlie posterior teeth, permitting them to assume a position 
 one tooth in advance of, or posterior to their normal place ; 
 such a condition would tend to restrain the lower teeth 
 from pressing forward and cause the upper ones to advance 
 unnaturally. 
 
 The condition also may appear exaggerated in cases where 
 from some cause the lower incisors are inclined inward, thus 
 causing the upper ones to seem more protruded than they 
 reallv are. 
 
 PROGNATHISM. 
 
 This deformity, consisting in the abnormal protrusion of 
 the inferior teeth and jaw, is one very frequently met with ; 
 it gives to the individual somewhat of a canine expression, 
 and for this reason is very aptly designated by the Germans 
 as Hundemaul. In some cases the lower anterior teeth an- 
 tagonize with the superior ones but pass just outside of them, 
 while in others the lower jaw and teeth are protruded to such 
 an extent as to make the occlusion of the lower anterior and 
 side teeth a physical 
 impossibility. Fig. 3 
 represents an extreme 
 case of this character. 
 The deformity is not 
 only very unsightly, 
 but interferes serious- 
 ly with mastication. 
 It may be induced by 
 any cause or causes 
 
 that tend to lessen the Excessive protrusion. 
 
 extent of contact in occlusion. That the lower jaw possesses 
 an inherent tendency to move forward when occlusion does 
 not prevent is abundantly shown in cases where the 
 
 Fig. 3. 
 
24 
 
 OKTHODOXTIA. 
 
 individual lias become edentulous and no artificial teeth 
 are Avorn. Even the occlusion of artificial teeth will lessen 
 or check this tendency. 
 
 In many cases it is an undoul)ted iidieritance, while in 
 others it may 1)e 1)rou,<j,ht al)Out by local conditions. It is 
 liable to occur in all cases where it is not prevented by me- 
 chanical influences. 
 
 y-SHAPED AECH. 
 
 The angular or A'-sliaped arch is not an uncommon one. 
 In a typical arch of this character, tlie teeth instead of form- 
 mg an arch, are arranged in two straight but divergent lines, 
 which meet at an angle where the central incisors join each 
 other. The molars, bicuspids and cuspids are usually proper- 
 ly related to one another, but simply thrown inward, forming- 
 straight lines instead of curves. Tlie incisors, liowever, by 
 this contraction of the space are not only thrown forward 
 but turned upon their axes so tliat their lingual surfaces 
 present toward each other. Fig. 4. 
 
 Fig. 4 ^' represents thisform 
 of irregularity. It is in 
 all cases confined to the 
 superior maxilla, the lower 
 one being usually harmo- 
 nious in outline. T h e 
 pressing forward of the in- 
 cisor teeth and their tor- 
 sion often gives such prom- 
 inence to the lip that the 
 teeth remain exposed even 
 
 when the jaws are closed. v-siiaped aicIi. 
 
 In addition to this unsightliness, the speech is often seriously 
 affected by the free and uneonti-ollable escape of air when 
 articulation is attempted. 
 
 The causes responsible for this condition are i)robal»ly 
 
 *Froiii a model in tlie collection of Dr. W. F. Fundeuberg. 
 
rUTXCIPLES INVOLVED. 25 
 
 shrouded in greater obscurity tlian tliose of any other form 
 of irregularity. 
 
 The crowding of teeth during ei'U})tion ; dehiyed eruption ; 
 imperfect or excessive maxillary development or mal-occlu- 
 sion ; some of which are evidently responsible for many forms 
 of irregularity, cannot be called to account for this condition, 
 for none of tliem could press the teeth into such symmetri- 
 cally straight lines. The most plausible hypothesis which 
 has yet been advanced in regard to it is that of Mr. Charles 
 Tomes, who believes that it is brought about by the pressure 
 of the muscles of the cheeks upon the sides of the arch while 
 sleeping with the mouth open, and that this habit is due to 
 enlargement of the tonsils, which prevents full breathing 
 through the nose. 
 
 The pressure of the cheeks covering so large a surface 
 would l)e just the kind of force that would be likely to pro- 
 duce this symmetrical contraction of the arch, l)ut the author's 
 observation does not lead him to coincide with Mr. Tomes 
 in the belief that it is usually associated with enlarged ton- 
 sils. Many persons breathe with their mouths open, and this 
 habit, which may be due to a variety of causes, seems likely 
 to be a factor in producing this peculiar condition ; but the 
 author Ijelieves that the deformity is one, the tendency to 
 which is usuallv inherited. 
 
CHAPTER III. 
 
 EVILS ASSOCIATED WITH IRREGULAEITY. 
 
 Ill order to properly appreciate the importance of the cor- 
 rection of irregularity of the teeth, it will be well to consider 
 in brief detail some of the more prominent evils associated 
 with the condition. 
 
 APPEARANCE MARRED. 
 
 While this result is usually not the most important of those 
 connected with irregularity, it is the one which most gener- 
 ally induces tlie patient to apply for remedial treatment. 
 The other evils may not be recognized or may l)e considered 
 of minor importance by the parent, but the ill-appearance 
 of the child both attracts the attention and enlists the 
 sympatliy to such an extent as to create a desire for its 
 improvement. 
 
 The external deformity caused by an irregularity will be 
 greater or less according to its extent and location. If it be 
 slight in character and located l)ack of the cuspid teeth it 
 will usually give no external evidence of its existence, but 
 if kjcated in the anterior part of the mouth, it will, even if 
 slight, be very noticeable and in consequence constitute a 
 source of annoyance to the individual throughout life. 
 
 The class of irregularities most noticealde under all con- 
 ditions is that where the form of the arch is altc>red, thus 
 changing in a marked degree the entire facial expression. 
 Such deformity cannot be masked. It mu.st either be 
 mechanically reduced or stoically endured. 
 
 SPEECH AFFECTED. 
 
 This re.suh like tlic preceding one will be slight or aggra- 
 vated according to circniiistaiices, l»iit when at all consider- 
 able it |ii-oclaiiiis itself to the world with every attempt at 
 
 2(i 
 
I'RlNCirLES INVOLVED. 27 
 
 speech in so iiiij)lcasaiit a manner as to be a painful annoy- 
 ance to both speaker and listener. 
 
 It may be due to the restriction of the movements of the 
 tongue as in a narrow or contracted arch, to alteration of 
 tlie form of the roof or vault of the mouth where the sides 
 of the latter have assumed a deep pitch resulting in the 
 formation of a sharp angle along the median line of the 
 palate, or, it may be, and most usually is, due to the uncon- 
 trollable escape of air between the teeth in the anterior part 
 of the mouth by virtue of the non-apj^roximation of those 
 teeth and the change of form in that part of the alveolar 
 ridge which aids the tongue in the production of perfect 
 sounds. 
 
 MASTICATION IMPAIRED. 
 
 In most cases of irregularity, either simple or complicated, 
 there is a corresponding degree of either mal-occlusion 
 or lack of occhision. In simple cases, or where but few teeth 
 are throwm out of occlusion it may not occasion any incon- 
 venience to the individual, Init where the irregularity is at 
 all extensive so many teeth are usually lacking in occlusion 
 as to seriously impair the power of mastication. 
 
 When this latter condition prevails it is most likely to 
 result, sooner or later, in injury to other organs, for where 
 mastication is imperfectly performed greater demand is made 
 upon the stomach to prepare the food for digestion and 
 assimilation. The stomach soon feels the effect of this 
 over-taxation and becomes weakened in tone, which may 
 finally result in incapacitating it for the performance of its 
 normal functions. 
 
 Teeth that do not occlude are of no use to the individual 
 for purposes of mastication, and those that occlude but 
 slightly or imperfectly possess very slight value. 
 
 As one of the principal functions of the teeth is mastica- 
 tion, and as all the teeth are needed to perform this work 
 satisfactorily, it naturally follows that any interference with 
 this function, through irregular position or otherwise, must 
 
28 ORTIIODOXTIA. 
 
 be (Ictrimontal to the individual and fiv(|ueiitly result in 
 partial or eoni})le(e loss of lu^altli. 
 
 CARIES INDUCED. 
 
 The human teeth are arranged in the jaws in such man- 
 ner as to best subserve the wants of the individual, and their 
 form and location are also such as to conduce to the greatest 
 immunity from caries and their consequent longest endur- 
 ance. 
 
 Their rounded approximal surfaces and the constriction 
 of their necks reduces the point of contact with their fellows 
 to the minimum. As their liability to approximal decay 
 is in proportion to the amount of surface in contact, it wdll 
 be seen that tliose normally placed are likely to be freest 
 from the ravages of caries. 
 
 Wlien, therefore, the teeth occupy irregular positions, 
 especially where the}' are crowded, more of the surface of 
 each tooth is in contact, and the liability to decay is corres- 
 pondingly increased. This is true of irregularly placed 
 teeth in any part of the arch, but the liability is greatly in- 
 creased where crowding or overlapping exists among the 
 incisor teeth, for owing to their flattened form it is possible 
 for more of their surface to be in contact with their fellows 
 than would be possiljle with any of the other teeth. 
 
 In such cases, with the condition uncorrected, teeth decay 
 and re-decay in spite of the most faithful efforts of the dentist 
 until tliev are finallv lost. 
 
CHAPTER IV. 
 
 ADVISABILITY OF CORRECTION. 
 
 With our advanced knowledge in regard to the teeth and 
 their surrounding tissues, and the advancement made of 
 recent years in the muhiplication and perfection of mechan- 
 ical appliances, scarcely any deformity of the mouth and 
 teeth is beyond mechanical remedy. ^Mth possibility assured, 
 however, it is most important that we should consider care- 
 fully the (piestion of advisability, for what is possible may 
 not always be advisable. There are several considerations 
 that enter into this question of advisability. 
 
 AGE. 
 
 The age of tlie patient lias much to do with the advisa- 
 l)ility of any pr()})0sed operation for correction. Early in 
 life, when the alveolar tissues have not yet reached the hard- 
 ness and density of structure which they will attain at a 
 later period, they are more easily operated upon. They are 
 elastic and readily yield to pressure, and at tlie same time 
 under the influence of this pressure they are more quickly 
 resorbed and thus give way to the tooth that is being 
 moved. This feature of early youth is an important and 
 valuable one in that it renders an operation for correction 
 more easy of accomplishment, but with it is also linked an 
 element of adverse influence which must not be overlooked. 
 
 While the soft and easily yielding process favors the 
 operation, it is at the same time a tissue poorly fitted to resist 
 the influences which often operate to again displace the 
 tooth. For this reason, a tooth moved at an early age is 
 often liable to subsequent displacement when the ])ressure 
 caused by the eruption of the succeeding teeth is brought to 
 bear upon it. 
 
 29 
 
30 OKTIIODONTIA. 
 
 After maturity, we have the conditions exactly reversed. 
 The densei" and more perfectly cakitied process yields less 
 readily to pressure and absorption, l)ut \\'hen the tooth has 
 once been moved into proper position it is more easily and 
 firmly held there by the surrouiidino' tissues. 
 
 In view of these facts it will readily be seen that in many 
 cases, especially where the proposed operation is simple in 
 character, and where the result ol)tained is not likely to be 
 nullified by subsequent events, interference early in life is 
 advisable, but where the operation is to be extensive in 
 character and tlie result difficult to secure against subsequent 
 adverse influences (such as the eruption of the later teeth) 
 2:)rudence would suggest non-interference until all of the 
 fourteen teeth of the involved jaw have eru2:)ted. 
 
 HEALTH. 
 
 The health and strength of the patient at the time of any 
 proposed operation for irregularity is so important a consid- 
 eration that it must not be disregarded. The time that is 
 generally considered most favoral^le for correction (between 
 the ages of thirteen and eighteen years) is also a period 
 when important changes are going on in the entire economy. 
 The individual is passing from the stage of childhood into 
 that of manhood or womanhood, and in this change, 
 especially in tlie case of the female, the life-forces are taxed 
 to the utmost. At this time also the mental faculties are 
 being sev(^rely strained by study, in consequence of which, if 
 the i)hysi('al culture of the individual be neglected, as it too 
 often is, the nervous .system becomes unduly exalted. 
 
 To meet and partially compensate for these drains upon 
 the system it is mo.st important that full luitrition be sus- 
 tained. To do this with teeth that are sore or tender to the 
 touch fi'oiii being moved is impos.sible, and hence the system 
 will be still further weakened 1)V lack of nourishment if any 
 severe operation be undcilakcii. 
 
 .\t this jx'riod (tf life, tlMTcfoi'c, uuless the patient i»oss('sses 
 
PRINCIPLES INVOLVED. 31 
 
 vital powers of a lii<ih order, it might V)e unwise to further 
 tax his or her system by any extensive operation for cor- 
 rection that would involve the intliction of much })ain, 
 discomfort or annoyance. Should tlie vitality of the patient 
 be below the average, no dithcult or protracted operation for 
 correction should l)e undertaken, for it might result in per- 
 manent impairment of the health. 
 
 It is much better to postpone the operation until a time 
 when the vital powers can stand the strain, or if necessary 
 abandon it altogether, for the loss of healtli can never be 
 compensated for by any benefit conferred u})on the dental 
 
 organs. 
 
 SEX. 
 
 The sex of the in<lividual must also be considered in con- 
 nection with this subject. The consideration of sex may be 
 disregarded so tar as the desirability of an operation is con- 
 cerned — for if the results of neglected irregularity are harm- 
 ful in respect to one sex, they are certainly equally so in 
 regard to the other — but as regards the necessity for inter- 
 ference the question of sex is an important one. Correct 
 facial expression and harmony of feature are far more im- 
 portant to the female than to tlie male ; for, Ijeing endowed 
 by Nature with greater beauty of form and feature than man, 
 its absence in any part is more noticeable than it would be 
 in the sterner sex. Besides this, after youth is passed, man 
 has in the hairy covering of the lip a means of concealing 
 most deformities of the dental arch, while woman is entirely 
 without this advantage. For these reasons the necessity for 
 the correction of any irregularity of the teeth seems more 
 imperative in woman than in man. 
 
 POWER OF APPRECIATION. 
 
 The intelligence of the patient and his ability to })roperly 
 appreciate any benefit conferred, are important considerations 
 in enabling us to determine whether or not to undertake any 
 considerable operation for the correction of irregularity. 
 
o2 OKTHODONTIA. 
 
 Orthodontia, at best, is a most dififtcult undertaking, and 
 frequently lacking in suitable pecuniary reward, so that the 
 lover of the art must nearly always depend upon apprecia- 
 tion for part of his compensation. If this be wanting, the 
 operation is robbed of nearly or quite all of its attractive- 
 ness, and the stimulus to success is absent. 
 
 There are those whose want of intelligence or lack of cul- 
 ture ^vould lead them to regard with much indifference any 
 irregularity of their teeth, and who if they were beneiited 
 b}" our efforts for correction would fail to appreciate the ben- 
 efit conferred. For such it would be manifestly unwise to 
 urge or encourage any difficult or extensive operation for 
 correction even though they might be able to compen- 
 sate us pecuniarily for our labor, for they would be likely 
 either to give up the operation when partially completed or 
 fail to wear any appliance for retention, and thus permit fail- 
 ure to follow success. 
 
 FAMILY TYPE. 
 
 A^^len any great deformity of the teeth and jaws, such as 
 anterior protrusion of either jaw or a ^^-shaped arch is shown 
 to be hereditary, it is well to take into consideration the 
 hereditary feature of the case before beginning any opera- 
 tion for correction. Where the irregularity is known to have 
 been acquired in the parent of the child and thus to have 
 been transmitted but once, the difficulties in the case are not 
 so marked because the type has scarcely been confirmed ; but 
 where it has been transmitted througli two or more genera- 
 tions the impress is strong and difficult to overcome. 
 
 In the latter case tlie correction of the deformity will not 
 be more difficuH than usual, l)ut after correction the ten- 
 dency of perverted nature to cause a return to the family 
 type will be so strong as to almost baffle us in our attempts 
 to preserve the advantage we have gained. Under such cir- 
 cumstances the retaining a]>])liance will have to be worn a 
 very long time, and a constant watch kept over the case 
 until we are sure that the result will be permanent. 
 
CHAPTER A'. 
 
 AGE AT WHICH CORRECTION MAY BE BEGUN. 
 
 The correction of invn'ularities. under favoring conditions, 
 may be begun and carried forward successfully through a 
 wide range of years. 
 
 It may be undertaken as early as the eighth or ninth year, 
 and again may yield successful results as late as the thirty- 
 fifth year or later. The operation is one largely dependent 
 upon the absorption and re-formation of bone, and as new 
 bone will form at almost any period of life, as evidenced by 
 the reunion of a fracture, so the correction of an irregularity 
 is possible at quite a late period. 
 
 The correction of irregularity, however, would usually 
 prove so slow and tedious an operation after the maximum 
 of density had been attained in the })rocess, and the neces- 
 sity for it be so much lessened by advancing age, that the 
 advisability of undertaking it would be (juestionable. 
 
 The most favorable time for correction in cases as they 
 usually present is between the ages of thirteen and eighteen. 
 Earlier tlian this the operation is advisable under certain 
 circumstances, and later the difficulties increase with the 
 years. 
 
 WHEN EARLY INTERFERENCE IS JUSTIFIABLE AND 
 ADVISABLE. 
 
 Any of the |)ermanent teeth may erupt outside or inside 
 of the areh. If allowed to remain in such i)Osition for any 
 length of time, the space intended for their accommodation 
 will soon be partly occujiied by the adjoining teeth, and 
 the subsequent correction of the irregularity rendered more 
 difficult. So also a central or lateral incisor often erupts in 
 such manner that its cutting edge, instead of being in lino 
 with the curve of the arch, forms an angle witli it. 
 
ORTHODONTIA. 
 
 Fig. 5. 
 
 Torsion and Overlapping. 
 Fig. 6. 
 
 Torsion \\ith Space. 
 
 This tor.'^iou may l)e as.sociated with an overhipping of tlie 
 adjacent tooth as shown in Fig. o, or there niay be a space 
 between the two as shown in Fig. (i. 
 
 In eithei" case tlie twisted tooth 
 occupies a less space at the line of the 
 cutting edge than it should. By al- 
 lowing this condition to remain, when 
 the pressure of the later erupting 
 teeth begins to be felt, these teeth 
 will be pressed still closer togetlier 
 and the irregularity be confirmed. 
 >Subsec][uent]y, Avhen the correction 
 of the condition is attemjDted, there 
 will not l)e sutticient room to accommodate the tooth in its 
 wider aspect and the adjoining teeth will have to be pressed 
 apart or the arch expanded to obtain the necessary room; 
 while, if the tooth had been turned in its socket before the 
 eruj)tion of the other teeth the operation would have been a 
 very simple one. 
 
 Again, when an incisor erupts so as to occupy a position 
 inside of the arcli in the upper jaw, or outside of it in the 
 lower, and tlie tooth he held in such |)Osition by the antag- 
 onizing teetli, immediate interference and correction is 
 demanded in order to prevent the complications that would 
 result from the partial or complete closure of the si)ace 
 intended for the accommodation of the malposed tooth. 
 The su]ierior central incisors sometimes erupt in such 
 a niannci' that their cutting edges form an angle at the 
 median line. To neglect tlic condition or to postpone its 
 correction will not only result in its confirmation and prob- 
 able aggravation, l)ut may also ojx-n the way for a complete 
 change in the slia]:)e of the arch. 
 
 It is entirely jirobable that certain arches of a modified 
 Y-sha])e have Ix'cn formed in this way. In cases such as 
 those just mentioned, early interference is the wiser plan, but 
 it is equally im})ortant that after they have been j)laced 
 
PinXCII'LKS IXVOLVKD. 35 
 
 propoi'ly ill lino tlicy should he tirnily held, not only until 
 new bony tissue has hirii fonncd around them, Init until the 
 lateral pressure of the neii>h1)C)rin2; teeth coming into place 
 has spent itself. 
 
 How this may be readily and successfully done will ai)[)ear 
 in the consideration of practical cases in Part III. 
 
 In the lower jaw the conditions are somewhat (Uflerent. 
 The incisors, u})on eruption, generally })resent a somewhat 
 crowded and irregular condition, which is ])artly or entirely 
 corrected by nature in the enlargement of the arch and the 
 influence of the lip and tongue in l)ringing them into a more 
 harmonious outline. 
 
 Interference with them is not called for, if at all, until a 
 hiter period. 
 
 At best, the attempt to correct an irregularity during the 
 earlier period of permanent dentition should usually be con- 
 fined to one or two teeth ; if anything more extensive is 
 called for, it should be delayed. 
 
 WHEN CORRECTION SHOULD BE DELAYED UNTIL DENTITION 
 IS COMPLETE. 
 
 xVs a rule, any extensive o})eration for the correction of 
 irregularity involving a number of teeth, should not be 
 undertaken until all of the permanent teeth (excepting the 
 third molars) are fully erupted. When a single incisor is 
 malposed with no prospect of its being able to take its place 
 in the arch unaided, and every prospect of its being confirmed 
 in its malposition, the necessity for immediate interference 
 is plainly evident ; l)ut, where a numl^er of teeth are mal- 
 posed it is not so ea.sy to prognosticate what effect their cor- 
 rection may have when considered in relation to tlie teeth 
 still to be erupted. The result is naturally involved in some 
 doubt. Even if the necessity for correction a})])ears evi- 
 dent to us and we should acc()m})lish it, the result may be 
 wholly undone by later influences which could not have 
 been foreseen. 
 
36 ORTHODONTIA. 
 
 Under sucli circumstances it is wise to delay interference 
 until tlie permanent teeth are in place and the arch fully 
 expanded, when by a careful examination of all tlie condi- 
 tions we can easily foresee the result of any proposed opera- 
 tion and decide intelligently not only what needs to be done, 
 but also the best way of accomplishing the desired result. 
 Oftentimes this later examination will show that the irregu- 
 larity has much improved and the necessity for interference 
 is consequently lessened. 
 
 The line of distinction between the advisability of early 
 and late interference is plainly marked and slioiild not be 
 lost sight of, for a mistake in either case would necessarily 
 bring about unfortunate results. 
 
CHAPTER VI. 
 
 MOVEMENTS TO BE PRODUCED AND PRINCIPLES GOVERNING 
 THE APPLICATION OF FORCE. 
 
 In causing mal})osc<l teetli to assume their proper positions 
 in the arch certain movements are necessary, and to pro])erly 
 accompHsli tliem forces must l)e In'oug'lit to l)ear in a manner 
 best calculated to i)roduce the desired result. Tlie usual 
 movements that teeth undergo in being forced into position, 
 are outward, inward, forward, l)ackward and rotary. Some- 
 times but one movement is necessary in the case of a single 
 tooth, but more frequently several are required before proper 
 alignment is secured. 
 
 The application and regulation of force in producing 
 movements of the teeth are governed largely by the general 
 principles of applied mechanics. 
 
 TJie greatest f/ood can he obtained from any force oidy ivJioi if is 
 exerted in a direct litie with the movement desired. 
 
 To this end, in the selection or application of any devices 
 for the moving of teeth, preference should be given, caeteris 
 parihna, to those that are most direct in their action. 
 
 The application of direct force, however, is not always 
 possible owing to the position the power-producing instru- 
 ment would have to occupy in the mouth, and tlie conseijuent 
 interference (as in the loAver jaw) it would cause in limiting 
 the movements of the surrounding or adjacent organs. P^)r 
 this reason we very frequently have to consent to the use of 
 some form of appliance that will yield power in a line that 
 is not direct, but still effective. 
 
 The force used mast he snfficiod, hnt not excessive, and not too 
 ahmptJj/ applied. 
 
 If the force Ije insufficient to accomplish the desired object 
 the result would not only be a failure but it would also 
 
 37 
 
38 OUTIIODOXTIA. 
 
 involve a serious waste of the time of bi)tli })atieiit and oper- 
 ator ; whereas, if it were more than suttieient it mi^lit cause 
 a fracture of one of the alveolar plates, a ru})ture of a blood- 
 vessel at the apical foramen, or a constriction of the entire 
 ])ul}) at tlie same point, resulting in its devitalization. 
 
 !So, also, in the widening of the arch ; if the force be too 
 great or too suddenly applied it is liable to result in the sepa- 
 ration of the superior maxillary bones at the palatal suture. 
 The greatest 23rudence an.d care are necessary in the ai)plica- 
 tion of force- to the teeth. 
 
 Hie jjoiids of resistance and deViverij of tlie force must he fixecl 
 
 points. 
 
 The point of resistance, or in other words the point selected 
 to resist the strain of an appliance while it is being exerted 
 to cause movement at some other point, must necessarily bo 
 fixed and immovable, for if it be not so, fully one half or 
 more of the force expended will be lost. Xot only this, but 
 if the anchor tooth or teeth should yield at all to the pres- 
 sure they would be ])ressed out of place and thus one irregu- 
 larity would be created in our attempt to correct another. 
 
 No factor in orthodontia is more important than this. 
 
 So, also, the point of delivery must be a fixed point. B}^ 
 a fixed point in this sense, is meant one that will receive the 
 force in such a way that none of it will 1)e lost. As the 
 intended tooth is moved, the jjoint on its surface where the 
 force is delivered will necessarily move with it, but it should 
 be so arranged that in this movement the i;()int of delivery 
 be not changed. A change at this point will be as disas- 
 trous, and frefjuently more so, than at the point of resistance, 
 for if tlie ai>i)liance slij) or change its position, the force will 
 be exerted in a line different from that inteiidi'd and harm 
 will always result. 
 
 (ireat difficulty was formerly experienced in making 
 attachments for ajipliances so that they might be innuovably 
 
pi;tx('ti'[-i:s txvolved. 30 
 
 ]\v\(\ wIktc placed, l)ut since tlie introduction of tlie platinnni 
 band by 1 )v. Abi^iH, difficulty of this character has been 
 overcome. 
 
 The reiiistaiicc at the poi id from which we exert pressure, must Ix- 
 f/rcc(ter ilmn fJic ir.sisfdnce to be overcome by the pressure. 
 
 The truth and inij)ortance of this statement would seem 
 to be self-evident. 
 
 Our points of resistance usually consist of one or more 
 teeth situated at some distance from the one intended to be 
 moved. (Jccasionally, a single tooth, if it l)e multi-rooted 
 or one with a long root firmly implanted, will be sufficient 
 for our anchorage, provided the tooth to be moved be single- 
 rooted and of not too great resisting power; l)uta tooth with 
 a single root will seldom l)e sufficient for anchorage in mov- 
 ing any other tooth. A single molar, firmly implanted,, 
 may sometimes be sufficient to offer resistance in the moving 
 of a bicuspid or incisor, but it is always better, if jiossible,, 
 to have the resistance divided among several teeth. 
 
 A cuspid should never be depended upon to' resist alone 
 the force needed to move another cus})id, for it is as likely 
 that the one will be moved out of as the other into place. 
 The force of resistance should always be as much distributed 
 as possible, for the sake of safety. 
 
 It should at ways be seen to, in adronrc, tliat tliere is xiifficicid space 
 to accomniod(de tlie tooth in the ucw jtosition it is to occupy. 
 
 The importance of this precautionary measure will be 
 readily seen. Unless there be room to accommodate a tooth 
 we will either fail in our efforts to move it or succeed only 
 by the expenditure of an amount of force out of all propor- 
 tion to the reciuirements of the case. Instead of moving one 
 tooth we may under such circumstances have to move sev- 
 eral at the same time, a difficult and oftentimes unnecessary 
 undertaking. 
 
 If sufficient room does not exist naturallv, we can increase 
 
40 ORTHODONTIA. 
 
 it by .-separating tlie adjoining- teeth. If tlie .space alread}' 
 existing be too great to admit of the use of rubber wedges, 
 the object can be accomplished by the use of wood, or other 
 suitable substance. 
 
 The method advocated 1;)y one writer to accomplisli tliis 
 result by means of a double-ended screw with face-clamps, 
 is lK)tli uiniecessarily complicated and less efficient. 
 
 In many cases where a tooth is locked out of place the jaAV 
 needs or will bear expansion as well. In such cases, of 
 course, we expand the arch first, and this will afford us room 
 to bring the tooth into position. 
 
 An exception to this rule is sometimes found in the case 
 of a lower incisor placed slightly within the arch and held 
 there by the adjoining teeth. As these teeth are usually 
 easily moved it will not be necessary to provide room in 
 advance, for, if our point of resistance be sufficient, we can, 
 by the use of a jack-screw, readily force the tooth into line, 
 notwithstanding the overlapping of adjoining teeth. An 
 illu.stration of this method is shown in Fig. 11. p. (J4. 
 
 Pressure may be either constant or interrupted. 
 
 The question of the use of either constant or interrupted 
 pres.sure in the regulation of teeth did not arise until Dr. 
 Farrar declared, a numl»er of years ago, that, according to 
 physiological law, direct and intermittent pressure was the 
 only kind suitable to be applied in the moving of teeth. 
 
 The only way in which direct and intermittent force can 
 be applied is by the use of the screw in one of its various 
 forms. Continuous pressure is that which we obtain from 
 the elasticity of the metals, from rubber, either partially or 
 fully vulcanized, and from the expansion of wood, sea-tangle 
 or other like substances. The action of these substances 
 cannot well be interrupted to provide a period of rest, but 
 they continue their action until the force they are designed 
 to exert has been spent. 
 
 Tho screw is. in manv cases, one f»f the Itcsf methods l)y 
 
rRiN'cirr.Ks jnvolvkd. 41 
 
 wliicli to exert pressure, but it eaunot be ai)[)lie(l to advan- 
 tage ill all eases. To limit ourselves tberelbre to its use, 
 would be to deny ourselves the advantage to be gained by 
 the employment of the various substances previously 
 enumerated. 
 
 So far as the author is aware no one has advocated the 
 exclusive use of constant i)ressure, but those who believe in 
 and make use of it, also use the interrupted pressure in the 
 form of the screw, not because of its interrui)tability but 
 because of its directness and power. 
 
 Experience has shown that by continuous ])ressure equally 
 good results have been produced as by uninterrupted pres- 
 sure and witli as little harm. Those who, like tlie author, 
 have used both kinds according to the seeming requirements 
 of the case in hand, have been uiudde to notice any advant- 
 age in the one over the other as viewed from a physiologi- 
 cal standpoint. 
 
 Dr. Atkinson has recently exjiressed liis belief that continu- 
 ous pressure in regulating most fully stimulates tlie action 
 of the osteoclasts in the absorption of alveolar tissue. 
 
 Pressure sltould be exerted as nearhj as possible in a line at right 
 angles to the long axis of the tooth. 
 
 By the application of power in this way the best results 
 are accomplished. If the power be applied at a slight angle 
 from above, no harm will result, as it will only serve to keep 
 the tooth in its socket while it is being moved, but if applied 
 at an angle from below, the tendency will be to lift the tooth 
 from its socket and serious complications may ensue. 
 
 This last result is most liable to follow the use of a jack- 
 screw applied at an improper angle, when by its direct 
 and excessive power the tooth may be lifted up and par- 
 tially dislodged. 
 
CHAPTER Vir. 
 
 EXTRACTION AS RELATED TO ORTHODONTIA. 
 
 Probabl}' no feature in the practice of Orthodontia is more 
 important, or has associated with it greater possibilities for 
 good or evil to the patient than that of extraction. 
 
 As related to the prevention or correction of irregularity, 
 extraction on the one hand may l)e of the greatest possible 
 benefit or on the other it may result in irreparal)le injury. 
 
 Judicious extraction, if undertaken in time, will often 
 forestall or prevent an irregular condition of the teeth, and 
 in other cases it will assist greatly in simplifying the opera- 
 tion of correction. Occasionally, it is all that is called 
 for on our part, nature performing the rest of the operation 
 unaided. 
 
 Injudicious or ill-advised extraction, however, may com- 
 plicate and render most difficult the correction of cases 
 which in themselves were not difhcult, or it may even be the 
 immediate cause of a deformity which would not otherwise 
 have existed. 
 
 The paramount importance, therefore, of knowing when 
 to extract, and when not, will l)e readily recognized. 
 
 To properly convey to the student a fair understanding 
 of these circumstances, in as concise and comprehensive a 
 manner as possible, it lias 1)een thought best to formulate the 
 following rules : 
 
 Always avoid, if possible, extracting o.nij of tlie six anterior teetJt, 
 in the superior arch. 
 
 We would iiigc Ibis, ])ecause it is nearly always unneces- 
 sary to cxtracl lliciii, and because their absence, owing to 
 tbeir promiiieiit position, would be more noticeable than 
 that (jf oflier teelh in tlie nioulh. If tlie anterior teeth 
 
 42 
 
I'KINCIPLKS INVOLVED. 43 
 
 bo sound and only irregular in position, the extraction of a 
 bicuspid from one or both sides will usually give us sufficient 
 room for spreading the anterior teeth and moving them into 
 their proper })ositions. 
 
 It has happened, however, to the author and others, to 
 meet with eases where the superior laterals were locked inside 
 of the arch by the close approximation of centrals and cus- 
 pids, and where the laterals were withal so badly injured 
 by decay and disease as to render their usefulness doubtful 
 if brought into line. In such few cases it was deemed best 
 to extract the laterals, especially as their absence would not 
 be more noticeal)le afterward than before, and because there 
 was good occlusion between the rest of the teeth in the 
 mouth. 
 
 The author ha<l two cases in one year present to him for 
 the reduction of protrusion in the anterior superior teeth. In 
 each case there was a broken or badly diseased right cen- 
 tral incisor that was beyond hope of preservation. In these 
 cases it did not ha}){)en [)articularly amiss, for the extraction 
 of the roots attbrded room for drawing in the remaining five 
 teeth, thus easily reducing the deformity and at the same 
 time closing the space. The appearance of the patient in 
 each instance was greatly improved, and the absence of even 
 so large a tooth as the central was scarcely noticeable. 
 
 In the cases just mentioned it must be borne in mind that 
 advantage was simply taken of an existing condition to sim- 
 plify an operation. Had the teeth been good, it would have 
 been criminal to extract them. 
 
 In another case, a girl eleven years of age had lost a right 
 superior central incisor through a fall from a swing. Two 
 days after the accident, and when the tooth had been mislaid 
 or thrown away, she was })rought for treatment. Only two 
 methods of remedying the difficulty suggested themselves. 
 One was the wearing of an artificial tooth ; the other, draw- 
 ing the teeth together to close the space. The latter plan 
 was decided upon, and successfull}'^ carried into effect ; but, 
 
44 ORTHODOXTTA. 
 
 unfortunately, as there had been no protrusion before and 
 there was contraction afterward, the superior teeth no longer 
 overla[)pcd the lower ones, Init met them edge to edge, thus 
 giving the upper jaw a flattened ai)pearance, which was in 
 itself a deformity. The patient was saved the annoyance of 
 wearing an artiticial tooth, but her facial expression was 
 injured in consequence. 
 
 Such cases as those just alluded to are exceedingly rare, 
 and are only mentioned as extraordinary exceptions to a 
 very good rule. Aside from the centrals, there is probably 
 less excuse for the extraction of the cuspids, than any of 
 the anterior teeth, and yet it is, unfortunately, too often re- 
 sorted to. 
 
 If for any cause, the cuspids erupt al)normally, and there 
 is no room for them in the arcli, if it be not advisable to 
 expand the arch, one of the bicuspids on each side should 
 be extracted to make room for them. The cuspid being the 
 stronger and more durable tooth of the two, it should be 
 given the preference in the struggle for existence. More than 
 this, owing to its long and prominent root it gives a char- 
 acteristic expres.sion to the face, and if it be lost the expres- 
 sion will be irretrievably lost with it. The first bicuspid 
 proves a very poor substitute for it in every way. 
 
 Ill tJie lower jaw one of the incisors hkhj sometimes he 
 extracted to f/aia space. 
 
 Slight irregularity or crowding of the inferior incisors is 
 of such common occurrence as to have almost become the 
 rule in.stead of the exception. Their partial concealment, 
 together witli the usual freedom of the condition from ill 
 results, causes any interference to seem meddlesome rather 
 than otherwise, if the irregularity be trifling. In cases, how- 
 ever, where the crowding is excessive and calls for correc- 
 tion, it is usually tlie easier and better plan to extract one 
 of the implicated teeth and bring the others together into 
 line. The four teeth are so nearly alike in size and charac- 
 
PRINCIPLES INVOLVED. 45 
 
 ter, that the loss is not usually noticed when one has been 
 removed. It is sometimes perplexing to decide which of the 
 four to extract, but the one most out of line, and in conse- 
 quence the one that will create the least sj)a('(> by its removal, 
 shoultl usually be selected. 
 
 Ill respect to the loss of the inferior cuspid, the same re- 
 marks apply as to its fellow in tin> ()p})osite jaw. 
 
 Bacl: of tJte anterior teeth, if all are eqiiolli/ gond and one invst 
 
 he rcmoinK ^ehrt the one nearest (nid posterior to the 
 
 one out of position. 
 
 As so large a proportion of the irregularities we are called 
 upon to correct })ertain to the anterior teeth, and as it is so 
 advisable to retain these, extraction for room, when neces- 
 sary, generally falls upon one of the teeth posterior to the 
 cuspids. Which of these it is best to extract, to make room 
 for a malposed cuspid or incisor, has been a sul)ject of con- 
 troversy among })ractitioners for many years. 
 
 Some have claimed that as the statistical tables show the 
 first molar to be by far the least durable of all the permanent 
 teeth, it should generally be selected as the one to be sacri- 
 ficed. Others, on the contrary, have contended that as the 
 first and second bicuspids are both frail teeth, and are often 
 lost early in life, and as from its greater size the first molar 
 is so much more valuable in mastication, it should be 
 preserved and one of the l)icuspids removed. 
 
 There is truth in botli of these arguments, l)ut we feel 
 satisfied that under the conditions named, all e(iually good 
 at the time, wisdom will dictate the removal of the one near- 
 est the point of ditficulty, for in so doing we greatly simplify 
 the operation for correction and effect a saving all around. 
 Simplicity in surgical as well as mechanical matters is a 
 great desideratum. Indeed, it not infrequently happens that 
 where a cuspid is out of line the first bicuspid assumes its 
 place in the arch, so that if we were to extract the first 
 molar, both first and second bicuspids would have to be 
 
46 ORTHODONTIA. 
 
 moved out of their position of good occlusion into a space 
 further back, a feat very difficult and oftentimes well-nigh 
 impossible of accomplishment. By the simple extraction of 
 the first bicuspid in such cases, the cuspid will usually fall 
 into its place without any assistance. 
 
 If a tooth other than the one nearest to that in malposition he 
 
 defective, and not too far distant from point of irregularity, 
 
 extract it instead. 
 
 The second molar, decayed or sound, is usually too far dis- 
 tant to be available by its extraction in furnishing room for 
 the movement of anterior teeth. If the bicuspids be sound 
 and the occlusion does not interfere witli their backward 
 movement, the first molar, if very defective, may be extracted 
 in preference to a sound tooth in advance of it. 
 
 So, too, if the second bicus^Did be carious or defective and 
 the first one healthy, the former should for the same reason 
 be extracted. 
 
 If a tooth must he lost, either to allow a more important one to 
 
 f(dl into line or to create space, it should he done ivithout 
 
 delay to accomplish tJte hest results. 
 
 When a cuspid erupts Avithout room in the arch for its 
 accommodation, and the circumstances of the case point to 
 the extraction of the first bicuspid to make place for it, the 
 sooner the extraction takes place the better. If the opera- 
 tion be delayed, the cuspid in its endeavor to force its way 
 into place will often press so hard upon the lateral as to force 
 it inward, and if possible under the central, thus creating an 
 additional irregularity. Such results have often been noticed . 
 Prompt extraction after it liad become necessary would liave 
 changed the condition. 
 
 In similar manner, when it becomes advisable to extract 
 one or more of the first molars to prevent the further expan- 
 sion of the jaw or to abort a threatened irregularity in the 
 anterior part of the arch, it is best not to delay their extrac- 
 
PRINCIPLES INVOLVED. 47 
 
 tion too loiio-. They sliould not \)v iwtracted before the sec- 
 ond bicuspids arc in })laee, but it they must be lost, they 
 should be removed after the erui)ti()n of the latter teeth and 
 before the second molars ai)})ear, somewhere about the 
 eleventh or twelfth year. If longer delayed the harm we 
 wished to prevent (ex})ansion of the jaw) will have been 
 accomplished and their later extraction will not avail. If 
 extracted about tlie time the second molars are erupting, tlie 
 latter will glide naturally into the s})ace formerly occupied 
 by the extracted teeth ; tliis tliey are not so a[)t to do later 
 on. 
 
 If a tooth must be removed on one side to obtain space it does not 
 
 necessarily folloiv that its mate on the opposite side slundd 
 
 also be extracted. 
 
 If there be the same reason for extracting l)oth, as where 
 the existing evil pertains as much to one .side as to the other, 
 let both be extracted ; but where tlie trouble sought to be 
 remedied is confined to one side, the extraction of a tooth on 
 that side ought not to be supplemented by a useless extraction 
 on the other. Those who favor symmetrical or double 
 extraction claim that it prevents the disturbance of the 
 median line, but it has been our experience that the extrac- 
 tion of a tooth back of the cuspid will not often affect the 
 central line through the moving of the teeth toward the 
 space, and even a slight disturbance of that line is far less 
 objectionable than the sacrifice of a valuable tooth. 
 
 Where there is disparity in size between tlie two jaws, and two 
 teeth need to be extracted from the more prominent one, it 
 would be a serious mistake to extract also the cor- 
 responding teeth in tlie other and 
 smcdler jaw. 
 
 It would seem almost impossible to make such a mistake, 
 and yet that it has been made time and again, the mouths 
 we are called upon to examine often bear sad evidence. It 
 
48 OKTIIODOXTTA. 
 
 occurs through hick of kiiowledgc, want of judgment, or 
 erroneous teaching. 
 
 When those of long practice advise, without qualification, 
 that at eleven years of age the four first molars should be 
 extracted, it is scarcely to be wondered at that some young 
 practitioners sliould lose confidence in their own better judg- 
 ment and be led astray. Harm of this nature, wlien once 
 done, can never be undone, and the patient is injured beyond 
 repair. 
 
 Needless cxtmction should he carefully guarded against. 
 
 It is our ol)ject to save and improve, not to destroy. 
 Extraction should only be resorted to when it appears, after 
 careful consideration, to be the only or best way of accom- 
 plishing the object in view. Ill-advised extraction of the 
 molars or bicuspids has often been the cause of a very serious 
 and irremedial)le form of deformity, namely : — the separation 
 of the anterior teeth from one another, leaving unsightly 
 spaces between them, thus depriving them of their natural 
 support and leading to their earlier loss. 
 
 When teeth, especially the first molars, are extracted at a 
 later period than they sliould l)e, leaving a space tliat the 
 second molars cannot occupy, the teeth anterior to tlie space 
 will fall back unless prevented by the occlusion. If this 
 falling back pertains only to the bicuspids, no harm will 
 usually result, but if it extends to the anterior teeth, as it 
 may and often does, the result will be disastrous. In this 
 connection we cannot help again ,em])hasizing the necessity 
 for the removal of lirst molars (if they ai'e to be removed) 
 before the second molars have assumed their })laces in the 
 arch. 
 
 // a crowded arch calls for or will ad ml f of expavm))! to advan- 
 tage, da this in preference to extracting. 
 
CHAPTER Vlir. 
 
 PHYSIOLOGY (^F TOOTH-MOVEMENT AND CHARACTER OF 
 TISSUES INVOLVED. 
 
 In changing the position of teeth in the act of regiihiting, 
 the ssuiTouiiding tissue?!, both hai\l and soft, ure largely 
 involved. 
 
 In order therefore to properly comprehend the pliilosophy 
 of tooth movement, it is necessary to understand tlie structu- 
 ral character of these tissues and the physiological changes 
 that take place in them while a tooth is ht'ing moved. 
 
 THE ALVEOLAR PROCESS. 
 
 This process, as its name implies, is not a separate and 
 distinct bone, but an outgrowth from another. It is a, pro- 
 visional structure designed to support the teeth in })()sition 
 and atl'ord lodgement for the nutrient vessels leading to them. 
 It is formed upon the body of the bones of the jaw as the 
 teeth are developed, growing with them until they are fully 
 formed and then remaining while they remain. 
 
 When the teeth are lost, there being no longer any special 
 use for it, most of tliis process is absorbed and carried away- 
 In early infancy little alveolar structure exists, but it is 
 formed co-ordinately with the growth of the deciduous teeth 
 and remains during the period of their retention. Should 
 they l)e lost before their successors are ready to appear, the 
 process will b(> entirely removed 1)V abs()r})tion, and a new 
 one be formed for the accommodation of the permanent 
 teeth. Where, however, the deciduous teeth are gradually 
 shed to make way for their successors, the process is not 
 entirely absorbed, the basal and unabsorbed portion serving 
 as a foundation upon which the new structure is formed. 
 
 The alveolar process, being built or formed upon the body 
 of the maxillary bones, conforms to them in outline and 
 
 49 
 
50 ORTHODONTIA. 
 
 describe;- the .same curves. In depth it corres})oiids to the 
 length of the roots of the teeth, while in Avidtli it is sufficient 
 to envelop all of that portion of the teeth located below the 
 gum line. It gradually increases in width as it approaches 
 the body of the bone upon which it rests. 
 
 It consists of an outer and inner plate united at intervals 
 by septa, thus forming the alveoli for the accommodation of 
 the roots of the teeth. In structure, the process is not com- 
 pact, but open and spongy, .somewhat resembling the can- 
 cellated structure of the diploe of the bones of the cranium 
 or the inner portion of the shafts of the long bones. Its 
 outer or cortical layer is denser and harder than the inner 
 portion. Its cellular structure, while giving it sufficient firm- 
 ness to .support the teeth in their position.s, affords opportu- 
 nity for the lodgement and passage of the vessels of nutri- 
 tion Avith which it is .so bountifully supplied. 
 
 Owing to its peculiar .structure and its great vascularity, 
 it is readily resorbed under the stimulus of pres.sure and 
 again readily re2:)roduced behind the moving teeth. 
 
 THE TEETH. 
 
 Of the teeth themselves, liut little need be said. The stu- 
 dent is familiar with their number, .shape, position and 
 structure. Being the hardest structures of the human Ijody, 
 the application of any force necessary to move them will not 
 injuriously affect them so far as their hard tissues are con- 
 cerned. 
 
 A mechanical difficulty associated with their moving con- 
 sists in the fact that their crowns are round and smooth, thus 
 making it somewhat difficult to apply force at a given point. 
 This difficulty, however, has been overcome by the intro- 
 duction of tlie Magill band. 
 
 In considering the moving of teeth, the fact nui.-^t not be 
 overlooked that while the crown may be moved considerably, 
 the movement becomes less and less along the line of the 
 root so that tlie apex is moved but little. This is due to the 
 
PRTNCIPLES INVOLVED. 51 
 
 fact that force can only be applied to the crown, while the 
 apex remains almost a fixed point or fulcrum. In the move- 
 ment of a tooth therefore, whether inw'ard or outward, for- 
 ward or backward, the crown describes the arc of a circle, 
 the centre of wdiich is near the apex of the root. 
 
 Teeth with single and short roots can be moved more 
 readily than those with long and many roots, for the reason 
 that in the former case there will be less resistance to be 
 overcome. 
 
 THE PULP. 
 
 The pulp is the formative organ of the tooth, and after 
 calcification is complete it remains as the principal source of 
 nutrient supply for the dental tissues, especially the dentine. 
 
 It is composed of fibrous connective tissue, containing a 
 delicate system of lymphatics, together with numerous nerve 
 filaments which enter through the apical foramen. Ramifi- 
 cations of minute blood-vessels are noticeable throughout 
 its whole extent, giving color to the organ and constituting 
 its vascular system. 
 
 It bears an important relation to the teetli in their move- 
 ment since it may be readily devitalized through impru- 
 dence or lack of care. Before calcification of the teeth has 
 been completed the apical foramen is large and easily accom- 
 modates the pulp where it enters the tooth. After calcification 
 is complete the apical foramen is small, and the pulp at this 
 j)oint is in consequence greatly reduced in size. In the 
 movement of the teeth there is often a slight mechanical 
 constriction of the pulp at the apex due to the tipping of the 
 tooth in moving. If the movement be rapid in teeth fully 
 calcified (after the sixteenth or eighteenth year) this constric- 
 tion may be so great as to cause the death of tlie pulp through 
 strangulation. Before complete calcification this is not likely 
 to occur, from the fact that when the foramen is large the 
 pulp has more space for its accommodation. 
 
 In the movement of a tooth in the direction of its length 
 the pulp may also become devitalized through excessive 
 
O'l ORTHODONTIA. 
 
 stretching. This has occurred at times in (h'awing down into 
 line a tooth that lias been retarded in eruption. In all such 
 cases care must be exercised and the movement be conducted 
 slowly. 
 
 THE PERICEMENTUM. 
 
 The pericementum or peridental membrane is that tissue 
 which envelops the root of the tooth and tills the space 
 intervening l)etween it and the alveolar wall. It is a tough, 
 strong membrane, composed mainly of fibrous connective 
 tissue, permeated with blood vessels and nerve fibres and 
 containing traces of a lymphatic system. 
 
 It is stronglv adherent to the alveolar wall of the socket 
 on the one hand and to the cementum of the tooth on the 
 other, its adherence being due to the extension of its fibres 
 into both the bone and the cementum. These fibres, 
 according to Prof. Black,* " are wholly of the white or inelastic 
 connective tissue variety," and the apparent elasticity of the 
 membrane is due to tlie passage of mo.st of the fibres from 
 cementum to wall in an oblique direction, in such a way as 
 to "swing the tooth in its socket." 
 
 This membrane is the formative organ of the cementum 
 of the tooth and also a.ssists in building the walls of the 
 alveoli. 
 
 The cells concerned in the building of the bony walls are 
 known as osteoblasts, and those forming the cementum are 
 designated cementoblasts. After these cells have performed 
 their normal function, they become encapsuhMl an<l form 
 part of the tissue tlR\y were instrumental in l)uilding. 
 
 When re-formation of tissue is demanded, as in the thick- 
 ening of the alveolar wall, or in enlarging the normal 
 amount of cementum at various points under certain con- 
 dition.s, new cells are originated to perform the work. In 
 the moving of a tooth the activity of these new cells is at 
 once manifested in the formation of alveolar tissue to fill the 
 space caused by the advancing tooth. 
 
 *Dental Review, vol. I., p. 240. 
 
rKIXCIPLES INVOLVED. 53 
 
 Beside these cells of construction and repair, the perice- 
 mentum also contains cells that might well be called cdl>i of 
 dcsfrudioii. Thcv are the osteoclasts or cementoclasts, and 
 tlicir function is to break down or absorb the cemental or 
 osseous tissues when nature calls for sucli action. 
 
 In tlie correction of irrregularities, these cells perform 
 valual)le service in removing bt)ny tissue in front of the 
 moving tooth. 
 
 The pericementum is thickest in eliildhood, when the 
 sockets or alveoli are of necessity considerably larger than 
 the roots of the teeth which they contain. With advancing 
 age both cementum and the alveolar walls are increased in 
 thickness by slow but continuous growth until the perice- 
 mentum is greatly reduced in thickness, and in consequence 
 the diameter of the roots more nearly approximates that of 
 the alveoli or sockets. 
 
 The pericementum [possesses a variety of function not often 
 met with in any single tissue of the human system. 
 
 It retains the tooth in its socket and acts as a cushion to 
 prevent injury to the adjoining bony structures from hard 
 and violent concussions to which tlie teeth are sometimes 
 subjected. 
 
 It affords accommodation for numerous blood-vessels which 
 supply both the teeth and alveolar tissue with nutrient 
 material, and for the branches of nerves which constitute it 
 the sensory organ of the tooth, so ftir as tactual impress is 
 concerned. 
 
 It is the organ of construction and repair of both cemen- 
 tum and bone, and is also, on occasion, the organ of 
 destruction of either or both of these tissues. 
 
 Its great importance in the moving of teeth is shown in 
 the fact that without its services teeth could not be altered 
 in their positions without serious injury to themselves or ad- 
 joining parts, and if so moved would be useless, because they 
 could not possibly be made firm in their new positions. In 
 
54 Oi;TH()n(')NTIA. 
 
 other words, the regulation of teeth would be a physical im- 
 ])ossibility without the important services rendered by this 
 peridental membrane. 
 
 PHYSIOLOGICAL ACTION IN THE MOVEMENT OF A TOOTH. 
 
 When force is exerted u[)on a tooth for the purpose of 
 niovino it, the first effect produced is the compression of the 
 pericementum between the tooth and alveolar wall on the 
 advancing side, and the stretching of the same membrane 
 on the opposite side. In the compression of the membrane, 
 the blood supply is partly cut off and the nerves, by their 
 irritation, create a sensation of pain, which is soon obliterated 
 by the semi-paralysis brought about by continued pressure. 
 At the same time this irritation stimulates and hastens the 
 development of the osteoclasts which at once begin the work 
 of breaking down and absorbing that portion of the socket 
 pressed upon. 
 
 Bony tissue being thus removed, accommodation is made 
 for the advancement of the tooth, which at once takes place. 
 Under continued pressure this action is renewed again and 
 again until the tooth has reached its intended position. While 
 this is taking place on the advancing side, quite an opposite 
 condition prevails on the side from which advancement has 
 taken place. There the fibrous tissue of the pericementum 
 has been subjected to extreme tension ; greater room has 
 been provided for the accommodation of the nutrient vessels, 
 and osteoblasts have been develo[)e(l for the formation of 
 bony material to add to the alveolar wall and thus close the 
 space caused by the movement of the tooth. While these 
 processes of absorption nnd reproduction on opposite sides 
 of the tooth have been going on coincidently, their results 
 have been very unequal, for the absorption of bone is a far 
 more rapid [)rocess than its formation. 
 
 During the entire time of nujving and for a long time 
 afterward, the tension of the pericementum on the free side of 
 the tooth is kei)t up to such an extent that were the force 
 
rRiNciPLES involvp:d. 55 
 
 of pressure or retention removed, tlie tooth would at once be 
 drawn partly ])ack into the !S[)aee created b}^ its movement. 
 
 The tendency is only tinally overcome after the deposit of 
 ossific matter in the alveolar socket has l)een sufficient to 
 allow the pericementum to resume its normal tliickness on 
 that side of the tooth, when, by virtue of the removal of the 
 tension and the supi)ort of the new bony tissue, the backward 
 movement of the teeth will no longer be possil)le. 
 
 While this process of reparative construction has been 
 going on, the structures about the opposite side of the tooth 
 have been adjusting themselves to the new condition. The 
 pressure upon the tooth having ceased, no more bone is ab- 
 sorbed ; any injury inflicted upon the pericementum by its 
 continued compression is repaired ; the nerves and blood- 
 vessels resume their normal functions and the tooth in its 
 new position becomes a far more useful member of the den- 
 tal ora'anism than it had been. 
 
PART II. 
 
 CHAPTEE I. 
 MATERIALS AND METHODS. 
 
 EXAMINATION (JF THE MOUTH. 
 
 AVhcii a case of irregularity presents lor treatiiierit, the 
 first requirement is a careful examination of the mouth and 
 teeth. 
 
 In conducting tins examination it is necessary to note the 
 position of the teeth; their relation to one another; their 
 occlusion with those of the opposite jaw ; the relative size 
 and shape of both arches ; the size, character and condition 
 of the teeth ; the age and general health of the patient ; 
 the harmony or inliarmony of the features and the facial 
 expression. 
 
 A careful consideration of all tliese points will enable us 
 to decide : — 
 
 1st. AVhat is desiralde. 
 
 2nd. Whether it can Ije done. 
 
 3rd. If possible, how it can best be aecoiii[)lished. 
 
 After this preliminary examination, our opinion of the 
 case should be given the patient or parent, accomi)anied by 
 a j)lain statement of tlie difficulties of the case, if such exist, 
 the probable time tliat will be rc()uir(Ml for correction, and 
 an a[)proximate estimate of the cost. To avoid any possible 
 niisai)prehension, tlic patient should also be informed that 
 
 50 
 
MATKKIALS AND METHODS. 57 
 
 the appliances will cause some annoyance and possibly some 
 pain, and that patience, endurance and ])erseverance will be 
 necessary on his or her {)art to enable us to accomplish a 
 satisfactory result. 
 
 It should also be mutually understood that the parent or 
 patient shall assist in the furtherance of the work by seeing 
 that the appliances are faithfully worn, that all the instruc- 
 tions are carried out, and that the patient shall punctually 
 meet all appointments that may be made. 
 
 Should the prognosis of the case prove satisfactory and all 
 of the above conditions be agreed to, we may at once proceed 
 with the treatment. 
 
 IMPRESSION AND ARTICULATION. 
 
 The first step will be to take impressions of the upper and 
 lower teeth, from which to secure models for the further and 
 more exact study of the case. 
 
 These impressions should be taken with some material that 
 will receive a sharp imprint, and not materially change its 
 shape in removal from the mouth. Either Plaster of Paris or 
 Modelling Composition (Stent's or Godiva) will give satis- 
 factory results, but as the former can only be removed from 
 the mouth by being broken into many pieces the latter is gen- 
 erally preferred. In selecting the impression cups, those 
 known as fiat-bottom cups (Figs. 7 and S) should be chosen, 
 on account of the better accommodation they afford for the 
 crowns of the teeth. The cups should in all cases be large 
 enough to allow for a sufficient quantity of the material 
 along the outer rim to enable a perfect impression to be 
 taken of the labial and buccal surfaces of the teeth, and as 
 much of the gum above them as possible. 
 
 A proper quantity of the composition having been softened 
 by dry heat or in hot water, it is placed and properly shaped 
 in the previously warmed cup and rapidly introduced into 
 the mouth. 
 
 In taking an impression of the upper jaw the mouth 
 
58 oirrHODOXTiA. 
 
 should be kej^t well open so tiiat the teeth may not come in 
 contact with the material before the proper time and thus mar 
 the surface. When tlie eu[) with its contents has been placed 
 Fig. 7. Fig. 8. 
 
 Impression Cups. 
 
 as far back as necessar}^ and immediately beneath the teeth, 
 it should be brought up into position with a straight and 
 steady movement. Once there, it should be firmly held 
 while a finger is introduced to force forward into position 
 that portion of the material which has escaped at the rear 
 of the cup, after which all that portion along the outer rim 
 should be pressed against the teeth and gums from molar 
 to molar. 
 
 In this position it must be tirmly held until it has become 
 so hard that a finger nail will scarcely indent it, when it 
 should be carefully removed. The hardening is best hastened 
 by a stream of cold water from a syringe, or by the renewed 
 application to the cup of small .sponges dipped in cold water 
 as suggested by Prof. Newkirk. 
 
 In taking an impression of the lower jaw, the same gen- 
 eral method is followed, and after the cup is well in place 
 all tlie surplus material around both the outer and inner 
 rims should be pressed into place with the finger. 
 
MATERIALS AND METHODS. 
 
 59 
 
 The models obtained from impressions taken in this man- 
 ner will be sufficiently accurate to give us a good representa- 
 tion of both the buccal and lingual surfaces of the teeth, so 
 necessary to a proper study of the case. 
 
 Impressions taken in plaster are the most accurate in detail, 
 but the composition gives us all the accuracy we need in 
 models for regulating. 
 
 During the same sitting at which the impressions are 
 taken, the manner in which the teeth occlude should be 
 observed and recorded, so as to enable us to place the models 
 in proper relation while being attached to the articulator. 
 This will dispense with the necessity for taking a bite. 
 
 A 11 inex- F^fj 9 
 
 pensive and 
 excellent ar- 
 ticulator, Fig. 
 i), for the 
 mounting of 
 models of ir- 
 regularity, is 
 made from 
 brass w ire. 
 The upper 
 arms and coil 
 are one con- 
 tinuous piece, 
 while the 
 lower arms 
 
 are formed bv "^'^^ Author's wire Arliculator. 
 
 passing another piece of the wire through the coil and bend- 
 ing to shape. 
 
 The articulator is so slender in outline that after the models 
 are attached to it the occlusion of the inner cusps of the 
 teeth may be as readily examined as that of the outer ones. 
 
 With the models properly mounted on the articulator, our 
 second and more deliberate study of the case may be carried 
 forward at our leisure. 
 
GO ORTHODONTIA. 
 
 At the first or personal examination of the case, we are 
 supposed to have decided upon the advisability of an attempt 
 at correction, and also upon the general plan we purpose 
 pursuing. By the study of the articulated models, we will be 
 enabled to decide upon the details of the work, and the kind 
 of appliance that should be used. Both studies are necessary, 
 for witli the patient in the cliair we cannot take the time to 
 map out the proposed work in detail, while an examination 
 of the models alone will leave us without a knowledge of 
 many important characteristics of the ease that can alone 
 be gained from a personal examination. 
 
 STUDY OF CASE FROM ARTICULATED MODELS. 
 
 The study of the case may be either a simple or difficult 
 one, according to the conditions and requirements involved. 
 Thus, the movement of a single tooth will only involve the 
 consideration of providing accommodation for it in the arch 
 and the manner of applying force to bring it into position, 
 whereas when a number of teeth in different locations are 
 to be moved, each perhaps requiring a different form of 
 movement, we will have to decide whether we can and should 
 produce all of these movements with one appliance at one 
 time, or whether it would be best to produce each move- 
 ment separately and possibly with dififerent appliances. If 
 the latter, we will have to determine which should be accom- 
 plished first, which next, and so on. 
 
 For instance, where the entire upper arch is to be expanded 
 to make room for outstanding cuspids, we will have three 
 different o])erations toj^erform ; the side teeth must be moved 
 laterally, the anterior ones forward and the cuspids inward 
 into line. To produce all of these movements at the same 
 time with one appliance, would be impossible from the 
 nature of the case ; therefore they will have to be performed 
 separately, and usually in the order in which they have been 
 named. In attemi)ting to produce many movements with 
 one a])pliance, we often defeat our object ; although occasion- 
 
MATERIAJ.S AND METHODS. 01 
 
 ally, whore the movements to be i)r()(luce(l are of opposite 
 character, we may advantageously play one against the other. 
 
 Where they are of the same character, or nearly so, too 
 much should not be attempted at one time, for the loosen- 
 ing of many teeth will be liable to make our anchorage 
 unstable, in which case we would have to suspend all opera- 
 tions until some of the teeth again became firm. 
 
 Having decided upon the order in which the movements 
 should take place, we have two other imjjortant points to 
 determine. 
 
 Amoinif of power required. — This will l)e determined largely 
 by the age of the patient and the character of the teeth and 
 process. As previously stated, at an early age, before the 
 process has become fully calcified, the teeth can be moved 
 more rapidly than at a later period, and less power will be 
 required to accomplish it ; so also, in patients of the same 
 age, the teeth of one will be more readily moved than those 
 of the other. This is due both to the relative length of the 
 roots and the resistance of the alveolar walls, and as we can- 
 not judge of the lengths of the roots from the appearance 
 of the crowns alone, we have to form our opinion in the mat- 
 ter from the general conditions. 
 
 Observation has shown that teeth with large crowns, situ- 
 ated in large and firm looking jaws, usually have long roots ; 
 whereas, smaller teeth, associated with thin and more delicate 
 j)rocesses, have shorter roots. 
 
 Therefore, considering the age of the patient and the ap- 
 pearance of the teeth and processes, we can at least decide 
 whether the amount of force to be applied should be great 
 or little. 
 
 Manner of applying power. — Among the many appliances 
 or substances for yielding power in the moving of teeth, the 
 practitioner has a range of choice from the screw with its 
 directness and power, to the silk ligature with its gentle 
 traction. 
 
 Between these two extremes we have materials that will 
 
62 ORTHODONTIA. 
 
 yield us force of any desired degree. Selecting the one which 
 seems best suited to the case, we must next decide upon the 
 most advantageous manner of using or applying it. 
 
 There are two general methods of securing the power- 
 producing appliances in the mouth. One is the use of a 
 plate of some kind to which .attachments can be made, and 
 the other is the plan of attaching the appliances to the 
 natural teeth in such a way as to dispense with tlie Avearing 
 of a plate. 
 
 In certain methods of regulating, .such as Angle's and 
 Patrick's, no plate is used ; while in others, such as 
 Cothn's. a plate- is invariably used for attachment and 
 security. Farrar advocates the use of a plate only in excep- 
 tional cases. Each manner has its advantages and disad- 
 vantages. In the use of a plate, we have as advantages : — 
 
 Its convenience and adapt (ibiJity. — Covering a large surface, 
 it affords opportunity for the attachment of the immediate 
 power-yielding appliance in any position and at any angle, 
 and permits the same to be altered or changed with very 
 little trouble. It also protects the soft tissues from any pos- 
 sible injury whicli might result from the slijiping or impinge- 
 ment of other appliances upon them. Indeed, in many cases, 
 a plain rubber plate covering the roof of the mouth and not 
 having any appliances attached to it, is used simply for the 
 protection of the gums during the operation of regulating. 
 
 Its distrlbntion of the power of resistance. — Touching all or 
 nearly all of tlie teeth not being operated upon, it compels 
 each one to bear its part in offering resistance to the power 
 used for the movement of certain teeth, and in this way 
 brings more teeth into use as points of resistance than can 
 possibly be done by any other metliod. 
 
 Its sirnj/Iicity of constmction and tin faciJitij it affords for ad- 
 justment and altered ioii. 
 
 The disadvantages pertaining to the employment of a 
 plate as an aid in regulating, are : — 
 
 Its uncIeanU)iess. — Ina.smuch as a plate comes in contact 
 with so much tooth .surface at the necks and elsewhere, it 
 
MATERIALS AND METHODS. 63 
 
 offers special ()i)|)()rtunitv for the aeciiniulatioii of deltris. In 
 plates that are removable by the ])atient, this may be largely 
 avoided by frequent eleansino-, but observation has shown 
 that the majority of patients are either so careless or indif- 
 ferent in regard to the matter, that a clean regulating plate is 
 seldom seen. In plates so constructed or arranged that only 
 the dentist can remove them, the uncleanliness of the plate 
 is greatly increased. 
 
 The frequent appoinfDients iiecessary. — In the class of plates 
 last alluded to, it is absolutely important that they be removed 
 and cleansed at least once in every forty-eight hours. This 
 requires such frequent visits on tlie part of. the patient and 
 the expenditure of so much valuable time on the part of the 
 operator, as to constitute a great objection to the use of such 
 plates where they can at all be dispensed with. 
 
 Notwithstanding these disadvantages, however, the employ- 
 ment of plates is necessary in many cases. 
 
 When plates are not used, appliances are usually attached 
 directly to certain teeth which serve as anchorages. Such 
 attachment is generally secured by means of bands or 
 collars encircling the teeth and cemented to them ; or, in 
 other cases, by having the bands simply passed around the 
 teeth of attachment and drawn tight by means of screws 
 or clamps. 
 
 The advantages of appliances attached to the teeth in this 
 w^ay are : — 
 
 1st. The leaving of the roof of the mouth uncovered, thus 
 affording more room for the movements of the tongue. 
 
 2nd. Their greater cleanliness, because they touch the 
 teeth at few points, and thus furnish good opportunity for 
 thorough cleansing with the brush. 
 
 3rd. Not needing to be removed often, fewer visits to the 
 dentist are necessary, thus effecting a great saving in time 
 and labor. 
 
 The disadvantages of this manner of attachment are : — 
 
 1st. The few^er teeth that are brought into service in an- 
 choring the appliance. In any sim})le case of regulating 
 
64 
 
 ORTHODONTIA. 
 
 Fig. 10. 
 
 this objection would luive but little weight, for the amount 
 of resistance needed could readily be obtained ; but in com- 
 plicated cases there would be great likelihood of the anchor- 
 ages proving insufficient to resist tlie great force brought to 
 bear upon them. This objection may be largel,y Overcome 
 by making such extensions or additions to a band as to cause 
 teeth adjoining the banded ones to bear their part in offer- 
 ing resistance. Extensions of this character, as used in the 
 author's practice, may be seen in cuts 10 and 11. 
 
 In Fig. 10, a bicuspid is 
 banded, and to the band 
 on the buccal side is sold- 
 ered a strip of platinized 
 ffold lono- enough to reach 
 to and rest upon the ad- 
 joiningteeth, causing them 
 to bear theii' part in afford- 
 ing the needed resistance. 
 We thus get the resistance 
 of three teeth with the use 
 of a single band. 
 
 In Fig. 11, an extension 
 strip of gold is soldered to 
 a bicuspid band, in order 
 to obtain the additional re- 
 sistance of the adjoining 
 molar. 
 
 Dr. Angle recommends 
 tlie banding of two adjoin- 
 ing teeth and having these 
 Itands united before being 
 l)laced in position. He 
 infieasc-.i Anchoiage. claiuis that by tlus mctliod 
 
 the resistance is greatly increased, for the anchor teeth to 
 move at all would have to move bodily forward in an up- 
 right position instead of ti})ping. So much resistance to this 
 
 Fig. 11. 
 
MATERIALS AND METHODS. 65 
 
 form of movement would be offered by the mass of alveolar 
 tissue involved, as to make it almost impossible of accom- 
 plishment. 
 
 2nd. The injurious effect of bands upon the teeth. When 
 bands are placed around teeth and secured by some mechan- 
 ical device, they never can fit tlie teeth so accurately as to 
 avoid spaces for the accumulation of food and saliva. The 
 fermentation of the particles of food, and the acidity of the 
 saliva in a state of rest, will soon injuriously affect even 
 good tooth structure. 
 
 This can only be prevented by the employment of some 
 material that will perfectly fill the space between the band 
 and the tooth. Exj^erience has abundantly proven that all 
 })ands passing around and encircling the teeth, in order to 
 be harmless, should be cemented in place either with oxy- 
 chloride or phosphate of zinc. 
 
CHAPTER II. 
 APPLIANCES. 
 
 MATERIALS AND THEIR USES. 
 
 During the study of the case, after we have decided upon 
 
 the amount and kind of power we wish to apply in order to 
 
 produce the desired movements, we will have to consider the 
 
 different materials at our disposal in order that we may 
 
 select from them the ones best suited to our purpose for the 
 
 case in hand. 
 
 PLATINUM AND ITS ALLOYS. 
 
 Platinum on account of its tastelessness, its non-oxida- 
 bility and its harmonious color, should constitute it one of 
 the best metals for use in the mouth. Its extreme plia- 
 bility and softness, however, greatly limit its usefulness, so 
 that it can be used only where these latter cjualities do not 
 interfere with its employment. 
 
 It is chiefly used in the construction of bands that are to 
 be cemented to the teeth to serve as anchorage for appli- 
 ances or to form parts of retaining fixtures. 
 
 In combination with other metals, in the form of alloys, 
 its greatest usefulness is develoj^ed. 
 
 IRIDIO-PLATINUM. 
 
 This alloy, combining the color and purity of platinum 
 with the hardness and stiffness of iridium, is useful for bands, 
 bars and wires, in connection with regulating appliances 
 where platinum alone would not be available on account of 
 its softness. 
 
 PLATINIZED GOLD. 
 
 (Jold in ;i pure state, oi- alloyed witli silver or copjicr, does 
 not possess the stifTiiess necessary j'or its use in the form of 
 
 m 
 
MATERIALS AND METHODS. 67 
 
 bars, springs or accessories, where great resistance or elas- 
 ticity is requisite, but when alloyed with about five per cent, 
 of platinum it attains a degree of elasticity second only to 
 steel. In tliis form it is one of our most useful materials, 
 for even the heat of soldering does not rob it of its elastic 
 equality. 
 
 This alloy of gold can be purchased in the dental de2:)ots 
 in plate of any thickness and in wire of any form or size. 
 When used for the construction of screws or supports, its 
 stiffness is the quality taken advantage of, while in the 
 form of levers or bows its elasticity constitutes its chief 
 excellence. 
 
 PLATINIZED SILVER. 
 
 This allov, thouo-h lono- and favorablv known in Eno-land, 
 has never been extensively used in America. It is prepared 
 for the market in tlie form of plate and wire of every gauge. 
 In the form of })late it is largely used abroad as a l)ase for 
 artificial dentures, especially small partial pieces, while the 
 wire is used as a support for the Ash tube-teeth and other 
 j)urposes. 
 
 The alloy is composed of one part of platiniun to two of 
 silver. Its stiflthess and elasticity is but little inferior to 
 platinized gold, while its cost is less than one-third that of 
 gold. It can be rolled, bent or fashioned in any form and 
 may l)e soldered with the highest grades of gold solder. 
 
 In the form of wire the author has found it very useful 
 in the construction of bows for the attachment of rubber 
 bands or ligatures to draw teeth in any direction, and for 
 parts of retaining appliances where inconspicuousness is 
 desirable. 
 
 Its non-oxidability is also a feature of considerable value. 
 
 GERMAN SILVER. 
 
 This improperly named alloy, composed of copper, zinc 
 and nickel, is frequently employed by some practitioners in 
 the construction of regulating appliances, on account of its 
 
68 ORTHODOXTIA. 
 
 stiffness and inexpensiveness. While it may be regarded as 
 a base compound, its baseness is of so high a grade that it 
 may be used ^vithout fear of harm to the soft tissues or the 
 general system. Prof Angle uses it almost exclusively in 
 the construction of his appliances, and the author has made 
 frequent use of it without ever noticing any detrimental 
 effects. Its valuable qualities are too many for us to deprive 
 ourselves of 
 
 GOLD. 
 
 Gold, in its non-elastic condition, has been and probably 
 always will be one of the most useful of the metals for the 
 construction of parts of regulating appliances. Its softness? 
 adaptability and strength are all qualities of the greatest 
 value and render it serviceable in numberless ways. To pre- 
 serve its purity, and as far as possible to prevent oxidation, 
 it should never be used of a carat less than 20 or 22. 
 
 STEEL. 
 
 This metal has the same desirable qualities of firmness 
 and elasticity that are found in platinized gold, and possesses 
 them in a higher degree, so that it is used in preference to 
 the former metal where greater power is needed. 
 
 There are two disadvantages, however, connected with its 
 u.se : — one is, that it cannot be highl}- heated (as in solder- 
 ing) without losing its temper ; and the other, that it oxidizes 
 so readily when in contact with the fluids of the mouth. But 
 for these drawbacks it would be employed more frequently 
 in connection with regulating appliances. It is used prin- 
 cipally in the construction of jack-, and other screws, and as 
 wire in the form of bows, levers and springs. 
 
 In tlie latter form its use Avas first brought prominently 
 before the profession by Mr. Coffln, of England, in connec- 
 tion with his method of regulation. 
 
 VULCANITE. 
 
 Soon after tlie introduction of vulcanite as a base for arti- 
 ficial teeth, its qualities of adaptability, strength and elas- 
 
^rx\.TERIALS AND METHODS. (30 
 
 ticity were recognized and utilized in the construction of 
 appliances for regulating. By its use we secure advantages 
 that could neither be so readily nor so well gained by any 
 other known substance. 
 
 Used either to produce pressure by its own elasticity, or as 
 a medium for the attachment of other power-producing appli- 
 ances, its value cannot well be over-estimated. It has been 
 and is now one of the most commonly employed materials 
 for the construction of regulating appliances. Some of the 
 many ways in which it so admirably serves us are shown in 
 Part III. 
 
 COMPRESSED WOOD. 
 
 The use of this substance is very old. Before the intro- 
 duction of either soft or vulcanized rubber, the quality of the 
 expansion of compressed wood under moisture was employed 
 in lieu of elasticity. 
 
 It was chiefly used in the form of small sections placed 
 between a silver or gold plate and the teeth to be moved, a 
 suitable slot or socket for its retention having been formed 
 in the plate. 
 
 In this way it is no longer used, other materials possessing 
 superior qualities having superceded it. 
 
 The author occasionally finds great advantage from the 
 use of compressed wood in the separation of teeth for the 
 accommodation of some malposed tooth, where the existing 
 space, though not sufficient, is still too great to admit of the 
 use of elastic rubber. 
 
 In such case it is his custom to cut a cross-section from 
 some compressible wood, such as cotton- wood, a little larger 
 than the space it is to occupy. This is compressed in the 
 direction of the length of tlie fibre by means of a hammer, 
 after which it is notched at each end to fit the convex sur- 
 faces of the teeth to be moved. Upon being placed in 
 position its expansion by the absorption of the fluids of the 
 mouth will quickly cause the movement of the teeth. In 
 the course of its expansion it adapts itself accurately to the 
 
70 OETHODOXTIA. 
 
 tooth surfaces and thus does not become dislodged or sUp 
 from its position. 
 
 SEA-TAXGLE. 
 
 This is one of the newer substances introduced into the 
 list of materials that are of service in regulating. The idea 
 of its use was borrowed from the medical fraternity, who 
 first employed it for distention of the cervex uteri. It is a 
 variety of sea-weed roljbed of its moisture and comj^ressed 
 until its density is about equal to that of horn. For medi- 
 cal use it comes in the form of a cylindrical tent about one- 
 fourth of an inch in thickness and two inches in length. 
 
 This is the only form in which it has been placed upon the 
 market. In the presence of moisture it rapidly expands 
 from two to three diameters. As it expands only in the 
 direction of its width, sections from it must be so cut and 
 shaped as to take advantage of this lateral enlargement. 
 
 In regulating it may be employed in place of compressed 
 wood, and like it is used to produce i^ressure between the 
 unyielding plate and the tooth to be moved. A place for it 
 is readily provided by cutting a hole or socket in the rubber 
 plate at the desired point. 
 
 Its advantage over rubber or Avood lies in its greater ex- 
 pansive properties and the ease with which it can be secured 
 in place. A piece of suitable size can be placed in position, 
 and the plate properly secured in the mouth before exjDan- 
 
 sion begins. 
 
 ELASTIC EUBBEE. 
 
 The resilience of elastic rubber was early recognized as a 
 valuable property that might be used to advantage in pro- 
 ducing traction upon teeth to be moved. It was first used 
 in the form of strips attached at either end by ligature, but 
 since the introduction of rubber tubing, rings or bands cut 
 from the .same have been employed instead. Their fir.st em- 
 ployment has been credited to Dr. E. G. Tucker, of Boston, 
 about the vear 1846. 
 
MATERIALS AND METHODS. 71 
 
 These sections, cut from the smaller sizes of French rubber 
 tubing, are now in almost universal use in connection with 
 other appliances for regulating, and their value has been 
 greatly enhanced since the Magill band has furnished a 
 better means for their attachment. 
 
 Their power, though great, is limited, for they cannot 
 exert so great a force as the metals ; but their wide range of 
 applicability and the persistence of their power [)laces them 
 among the most valual)le adjuncts of regulating devices. 
 
 In use, their tendency to slip off the tooth or up under the 
 gum (which constitutes the chief objection to their employ- 
 ment) must be guarded against by so securing them that 
 change of position will be impossible. They should never 
 be permitted to rest upon or touch the soft tissues at any 
 point. 
 
 SILK LIGATURES. 
 
 The contraction of silk, linen or cotton thread in contact 
 with moisture, enables us to make use of it where the 
 gentlest tractile power is desired. Most frequently it is 
 employed simply as a ligature in attaching some appliance 
 to the teeth ; but it has often been used to advantage in cases 
 where teeth were to be moved slowly and a very short dis- 
 tance. Prof. Peirce employs it in this way for the moving of 
 certain single-rooted teeth, as described in Part III. Its 
 gentle power, together with its safety and simplicity, will 
 often prove the very qualities we desire in certain simple 
 operations. 
 
72 ORTHODONTIA. 
 
 QUALITIES AN APPLIANCE SHOULD POSSESS. 
 
 In selecting a form of appliance from among the many 
 that have been devised by writers and workers in this field 
 of practice, or in devising one to suit the demands of the 
 case under consideration, it will be well to consider and bear 
 in mind the (jualities any appliance should possess in order 
 to render it most effective. 
 
 The following are among the most important of such 
 qualities : — 
 
 Efficiency. — The first requirement of any device is, that it 
 shall be able to do the work expected of it. All appliances 
 are, of course, devised with this end in view, but the attain- 
 ment of it is often not as simple a matter as might at first 
 appear. Almost every case has associated with it so many 
 features and peculiarities claiming consideration, that even 
 with the greatest care and thought we often fail to apprehend 
 or grasp each individual complication. Some, indeed, are 
 so little apparent that they can scarcely be recognized in 
 advance. 
 
 For this reason even the most experienced practitioners 
 will at times devise an appliance which, though seemingly 
 meeting all the requirements, will, when brought to a practi- 
 cal test, fail to accomplish the end desired. It will then have 
 to be altered, or perhaps discarded, in favor of some other 
 fixture more perfectly adapted to the requirements of the 
 case. 
 
 An appliance that will not yield the results we desire, or 
 whicli yields them in an imperfect manner, should in all 
 cases be su[)erseded by another. 
 
 Sim]>licltij. — A c(Miiphcated device is in nearly all cases less 
 cfiiciciit than a Hiin])k' one. Simplicity is a cardinal virtue 
 
MATERIALS AND METHODS. 73 
 
 in all matters of construction, and through lack of it about 
 seventy-five per cent, of the patents granted in this country 
 prove unprofitable. 
 
 Far greater mechanical ingenuity is displayed in an effec- 
 tive simple device than in a complicated one. 
 
 Bapidity of action. — In order to lessen the discomfort of the 
 patient, and to conserve the time of both patient and oper- 
 ator, a regulating appliance should be as rapid in its action 
 as is consistent with physiological conditions. Too rapid 
 action may cause suffering to the patient, and possibly bring- 
 about deleterious results ; while too slow action will prolong 
 the treatment unnecessarily, and possibly cause the patient 
 to become disheartened and abandon the treatment. 
 
 Between these two extremes there is a mean in which the 
 best results are accomplished. 
 
 All regulating appliances are at best a source of some dis- 
 comfort to the patient. A foreign body in the mouth, occupy- 
 ing a certain amount of space and thereby interfering more 
 or less with natural functions, cannot fail to be objectionable. 
 In order, therefore, to lessen this discomfort as much as pos- 
 sible, we should try to devise appliances that will occupy no 
 more space than is necessary, and also have them free from 
 all rough projections. Very little is required to cause abra- 
 sion of or injury to the soft tissues of the oral cavity, and 
 when once caused such lesions are the source of much pain. 
 
 Least interference with speech and mastication. — Most patients 
 apply to us for correction of irregularity at a time when their 
 education is in progress. Their lessons must be recited, and 
 their enunciation must be distinct enough to be understood 
 by the teacher. With a large and cumbersome appliance in 
 the mouth it would prove very difficult for them to speak 
 distinctly, and they would thus be placed at a disadvantage. 
 
 They are also in their growing age when the body needs 
 an abundance of nutritious food to supply the demands of 
 the various tissues. If mastication be insufficient through 
 imperfect occlusion or through tenderness of the teeth caused 
 
74 OKTHODONTIA. 
 
 by a bulky fixture, nutrition will be inadequate to the needs 
 of the system. 
 
 Such conditions can and ou(;lit to be avoided by a 
 properh' constructed appHance. 
 
 Clecnilincsfi. — The cleanliness of any appliance will depend 
 both upon tlie method of its construction and the care that 
 is taken of it. If it be removable so that the patient can 
 take it out, cleanse and reinsert it, there ought to be no 
 difficulty aljout its being kept clean. The patient should be 
 instructed to remove it for cleansing at night, in the 
 morning, and after each meal, at the same time giving the 
 natural teeth a thorough brushing. 
 
 A good plan is to supply the patient Avitli a brush, prop- 
 erly marked, to be kept in the office. When the j^atient 
 appears and the appliance is removed, the operator shovild 
 see that ])oth plate and teeth are well cleansed in his pre- 
 sence. This one cleansing he will 1 )e sure of, though he may 
 not be certain of the others. The same plan is pursued with 
 plates or appliances that can only be removed l)y tlie oper- 
 ator. Where appliances are of such character that they 
 seldom need to be disturbed, the patient should be taught to 
 take a quantity of water in the mouth, and then using tlie 
 lips and cheeks bellows-fashion, force the water through every 
 interstice of the. teeth and appliance to flush out accumula- 
 tions. This should l)e done each time after eating, as well as 
 before retiring and after rising. 
 
 Most appliances can be worn a long time without injure- 
 to tooth suljstance, if they are properly constructed and kept 
 scrnjndously clean. 
 
 Without cleanliness, the teetli will soon be injured by the 
 secretions and accumulations, and the Ijreath of the patient, 
 from the same cause, will become so offensive as to disgust 
 all brought within its range. 
 
 Iiicoii^picnoviiiK-fiH. — Annoyance from wearing a conspicu- 
 ous appliance is often added to the other ills which the 
 patient is subjected to diuiiig the process of regulation. An 
 
MATERIALS AND METHODS. 75 
 
 appliance of this character, wliile often producing distortion 
 of the lips, also attracts much attention and compels the 
 wearer to make frequent answer to the same oft-repeated 
 question. 
 
 Young persons attending school, or entering societ}', are 
 naturally very sensitive to the ill-appearance of any conspic- 
 uous device. Whenever the same result can be accomplished 
 by a concealed fixture as by an exposed one, it is better to 
 adopt the former ; but where a better or more satisfactory 
 result can be obtained by the use of a more prominent 
 fixture, appearance will, of course, have to be sul>ordinated 
 to utility. 
 
 Stabilifi/. — The (juality of stability has previously been 
 spoken of, but its real practical importance cannot be too 
 strongly insisted upon. It is a sine qua nan in orthodontic 
 practice. With it, we have a reasonable certainty of results ; 
 without it, all is uncertainty. 
 
 In some cases, as where most or all of the superior teeth 
 are to be drawn backward, we have apparently no point for 
 proper anchorage. Stability or fixedness of position for an 
 appliance, in such cases, not being obtainable within the 
 mouth, some fixture can be devised which will have its point 
 of resistance outside, as on the back of the head. 
 
 This plan of securing resistance outside of the mouth, 
 has been adopted thus far only in a few exceptional cases, 
 but it is hoped that its advantages and importance will lead 
 to its more frequent employment in the future. 
 
 Freedom from injury to tooth ^nhdance. — By this we do not 
 mean chemical injury, for that has already been treated of, 
 but we refer to mechanical injury. Any sharp, hard })oint 
 or roughness of a metallic appliance, will be likely to scratch 
 and mar the surftice of enamel and thus prepare the way for 
 future decay. 
 
 Steel jack-screws of any form, when placed directly against 
 the teeth of anchorage and those to be moved, are liable to 
 work injury to tooth structure. For this reason there should 
 
76 ORTHODONTIA. 
 
 always be interposed between the teeth and screw some 
 material that is non-injurious to the tooth. Besides protect- 
 ing the teeth, such substance will also serve to give greater 
 security to the screw. 
 
 To obtain this same fixedness for the point of a fish-tail 
 jack-screw, or other appliance, some operators have been 
 in the habit of drilling a hole or depression in the tooth to 
 be moved. It is hoped that the introduction of the Magill 
 band has caused the abandonment of this practice, which at 
 best was only justifiable in exceptional cases and in self- 
 cleansing localities. 
 
MATKIJIALS AND METHODS. 77 
 
 RETAINING APPLIANCES. 
 
 Tlie retention in situ of teeth that have been moved, for a 
 time sufficiently long to allow them to become firm, is quite 
 as im})ovtant as the moving of them. As previously explained, 
 teeth become firm in their new jtosition by virtue of a deposit 
 of ossific matter in the space created by their displacement. 
 The formation and })erfect ossification of this new material, 
 is only completed after a lapse of time varying with the age 
 and constitution of the individual. Experience has proven 
 that a less time than six months should never be allowed 
 for it, while in persons of mature age or in those younger 
 where many teeth have been involved, the time will some- 
 times have to be extended to a year or longer. 
 
 The natural tendency of a tooth to return to its former 
 position, aided l)y the tension of the parts that have resisted 
 its movement, will certainly move a tooth from its new 
 position, unless the newly formed process has become 
 thoroughly calcified, and is thus by its strength and density 
 able to resist the opposing forces. Numberless failures to 
 retain the good results of regulation are attributable to this 
 cause alone. 
 
 In certain cases, as where a superior incisor has been 
 occluding inside of the lower ones, or where a lower one has 
 been biting outside of the upper ones, no retaining appliance 
 will be required after they have been brought into proper 
 position, because the natural occlusion of the jaws will 
 prevent the corrected tooth from returning to its former 
 position. 
 
 So also with the bicuspids and molars. Where mal- 
 occlusion has forced them out of their true position, or kept 
 them there, the correction of the occlusion will often tend to 
 retain them in their normal positions without extraneous aid. 
 
 In all other cases, however, mechanical assistance will be 
 necessary until the teeth have become firm. AVhere the arch 
 
78 
 
 ORTHODONTIA. 
 
 or any portion of it has ])een enlarged, or where a number 
 of teetli have been moved from within outward, the simplest 
 and probal)ly the best means of retaining them will be the 
 wearing of a thin rubber plate covering the palatal arch 
 and nicely fitting each tooth at its neck. It may contain a 
 vacuum-chamber or not, as preferred, but in many cases the 
 use of one will greatly assist in keeping the plate in })lace. 
 In addition to its use in preventing teeth from moving- 
 inward, tlie plate may often be advantageously modified by 
 the addition of a gold hook or spur to kee}) rotated teeth in 
 position, or to retain individual teeth that have been moved 
 inward. 
 
 In cases where it is necessary to retain a number of teeth 
 that had formerly occupied positions outside of the arch, or 
 where some had stood outside and some inside, probably no 
 plan yet devised equals in simplicity and efficiency the one 
 suggested many years ago by Dr. Richardson. The accom- 
 panying illustration 
 ^^^- ^~- (Fig. 12) represents its 
 
 general appearance. 
 It consists of two 
 narrow strips of vul- 
 canized rul)]3er aljout 
 one-fourth of an inch 
 in Avidtli, the one 
 fitting tlie gum and 
 necks of teetli on the 
 palatine surface, and 
 the other the same 
 portioiis of the l)uccal or ]al)ial surftice. Tlie two are either 
 continuous around tlie last niolai-s, or tliey are separate there 
 and joined at two otlier points by pieces of fiattened gold 
 wire vulcanized into them. These wires can be placed at 
 points where a tooth is missing or where space exists between 
 the teeth ; or, if the articulation of the teeth be not too close, 
 they can be passed over the depressions between crowns on 
 
 Richardson's Retainer. 
 
MATERIALS AXD METHODS. 
 
 79 
 
 the masticating surface. The appliance is light, occupies 
 little s})ace in the mouth, and is not very noticeahlc. 
 
 While ruhher plates in some form, either hy themselves or 
 in combination with accessories, are the most commonly 
 approved appliances for retaining corrected teeth, their use 
 is, nevertheless, open to certain objections. All ruljber plates 
 used either for correction or retention, must he removed at 
 frequent intervals for cleansing. The very necessity for their 
 removal affords opportunity for the patient to remove them 
 at other times, and possibly forget or willfully neglect to 
 reinsert them for a longer or shorter period, thus causing 
 delay in the reparative process. 
 
 Besides this, also, in the very act of removal and insertion 
 the teeth are slightly moved in their sockets, and this will 
 to a certain dey-ree hinder the re-formation of tissue. 
 
 On account of these objectionable features the author 
 has for many years avoided the use of rubber retaining 
 plates, wherever he could do without them. As a substitute 
 he was led to devise a number of little appliances of gold 
 and platinum, occupying the least possible space, and firmly 
 attached to the teeth 
 for the required time. 
 Fig. 13 shows one of 
 these appliances in its 
 simplest form. It con- 
 sists of a platinum 
 (Magill) band, freely 
 fitted to the tooth , and 
 having a gold bar or 
 spur soldered to it to 
 press or bear against 
 one or more of the 
 adjoining teeth. 
 
 When properly adjusted, it is secured to the corrected tooth 
 by means of phosphate of zinc. 
 
 As will readily be seen, its advantages consist in its small 
 
 Fig. 13. 
 
 The Author's Band and Bar Retainer. 
 
80 
 
 ORTTIODOXTIA. 
 
 Fig. 14. 
 
 Retainer. 
 
 Fk;. 1.5 
 
 Ketuiuer. 
 
 size, its .slight contact witli teeth other tlian the one upon 
 which it i.s i)hice(l,its cleanliness, its fixedness, and the firm- 
 ne.ss with which it liolds the corrected tooth in plaee. 
 
 The latter is its most ini})ortant feature, for it is a well recog- 
 nized fact in surgical practice that, other things being equal, 
 reunion of bony tissue or new formation of the same will 
 progress in rapidity proportionate to the stability of the parts. 
 Fig. 14 shows a modification where two 
 teeth are thus to be retained, with the exten- 
 sion bar long enough to include more dis- 
 tant teeth. Fig. 15 represents two bands 
 joined at their borders, for the retention of 
 two teeth tliat have been rotated. 
 
 Still another modification is shown in Fig. 
 in. In this case the two bands on the cus- 
 ]»ids are united by a thin gold or })latinum 
 wire passing along and conforming in the 
 Fk;. in. outline to the labial sur- 
 
 faces of the intervening 
 teeth. It was used to re- 
 tain tliree incisor teeth 
 that had been drawn in- 
 ward. 
 
 Retaining appliances of 
 this character cannot, of 
 course, be used to advan- 
 tage in all cases ; but Avhere 
 they can they will be 
 found to 1)0 most satisfactory. 
 
 Prof Angle uses a retaining appli- 
 ance differing from the foregoing in 
 having a tube soldered horizontally 
 to the band that encircles the tooth. 
 The tooth once in position a wire is 
 passed through the tube and made to restu])on the adjoin- 
 ing teeth, after Avhich a hole is drilled through both tube 
 
 Band and Wire Retainer. 
 
 Fk;. 17. 
 
 Angle's Retainer. 
 
MATERIALS AND METHODS. 
 
 81 
 
 Fig. Ifi. 
 
 Tal 
 
 Fig. 19. 
 
 and wire and a short pin inserted to prevent the; wire from 
 shifting its position. See Fig. 17. Dr. Talhot uses an 
 appliance closely resembling that of Prof. Angle. See 
 Fig. 18. 
 
 Another simple and ingen- 
 ious device for retaining teeth 
 after they have been moved, 
 especially after rotation, was 
 shown the author by Dr. H. L. /-^^ 
 Baker. It consists of a gold 
 screw cemented into some con- 
 veniently located 
 cavity in sucli a 
 way that the pro- 
 truding portion 
 shall rest against 
 an adjoining 
 tooth, and tiius 
 prevent the tooth 
 o p e r a t c d u }> o n 
 from changing its 
 new 1^ o s i t i o n . 
 Such device could, 
 of course, only be 
 used in rare and 
 exceptional cases ; but where ap})licable, it possesses the 
 advantages of simplicity, inconspicuousness and efficiency. 
 Fig. 19 represents a case in which a rotated incisor was thus 
 retained. 
 
 Baker's IJatainer. 
 
CHAPTER III. 
 CONSIDERATION OF METHODS. 
 
 FAERAR'S METHOD. 
 
 In 1876 Dr. J. N. Farrar began publishing a series of 
 articles in the Dental Cosmos, descriptive of a method he had 
 devised for the regulation of teeth. Reading and observa- 
 tion, lie said, had satisfied him that the various plans 
 suggested up to that time for the correction of irregularity, 
 "vvere lacking both in system and principle. He claimed that 
 the performance of so important an operation as regulation 
 should be based upon a correct knowledge of Ijoth mechan- 
 ical and i:)hysiological law. 
 
 Experience had convinced hiin that the character of force 
 a})])lied to the teeth sliould l)e positive, and that it should be 
 intermittent — a })eriod of rest following a period of motion. 
 
 The best instrument for applying a force that is positive 
 and may be intermittent, he stiid, was the screw in one of its 
 various forms. 
 
 Experimenting with appliances constructed u])on the screw 
 principle, convinced him that this method of delivering 
 force was not only positive and direct, but also that its range 
 of applicability was so great that it might be used to the best 
 advantage in nearly all cases of regulating. He claimed, 
 also, lliat it was tlie only instrument wliose force could be 
 controlled at will, and thus be made to exert power u])on or 
 retain in a state of re])0se the tooth or teeth operated upon. 
 
 This alteniiilion of motion and rest in changing the posi- 
 ti<Mi of tcctli, was as important as in other organs of the 
 b(j<iy, and was in strict accord with physiological law. In 
 his experiments he found that intermittent force was pro- 
 
 (82) 
 
MATERIALS A.XI) MrCTiroDS. 83 
 
 ductiveof less i^ain to the i)ati('iit tliaii coiitimious forco, and 
 might be so skilfully a})plied as to prevent all i)aiii. 
 
 Pain, he said, was an expression of a patholooieal eondi- 
 tion, and l)v its avoidance we kept within the boundary 
 separating the physiological from the pathological state. 
 With screws of known pitch and nundjer of threads, he 
 found that he could move a tooth painlessly, and therefore 
 safely, from 2fi7 to Y^o^ of an inch every tweidy-four hours. 
 His experiments led him to the following conclusions : — * 
 
 " Id. That in regulating teeth, the traction must be inter- 
 mittent, and nuist not exceed certain fixed limits. 
 
 " 2nd. That while the system of moving teeth l)y elastic 
 rubber apparatus is unscientific, leads to ])ain and inflamma- 
 tion, and is dangerous to the future usefulness of the teeth 
 operated ui)on, a properly constructed metallic ap})aratus, 
 operated by screws and nuts, produces happy results, without 
 pain or nervous exhaustion. 
 
 " Srd. That if teeth are moved through the gums and 
 alveolar ])rocess about -ji^ of an inch every morning, and 
 the same in the evening, no \)\\\n or nervous exhaustion 
 follows. 
 
 "4-fli. That while these tissues will allow an advancement 
 of a tooth at this rate (2!^ of an inch), twice in twenty-four 
 hours, the changes being ])hysiological, yet, if a nnich 
 greater pressure be made, the tissue changes will l)ecome 
 pathological." 
 
 The above conclusions were epitomized by him into the 
 following Law: — "In regulating teeth, the dividing line 
 between the [)roduction of physiological and ])athological 
 changes in the tissues of the jaw is found to lie within a 
 movement of the teeth acted u})on, allowing a variation which 
 will cover all cases, not exceeding o-iir or y-^-jj of an inch every 
 twelve hours." 
 
 A full elaboration of his theories, together with a descrip- 
 
 * Dental Cosmos, Vol. XVIII, p. 23. 
 
84 oirriioDoNTiA. 
 
 tion of methods, illustrated by engravings of numerous 
 appliances devised by him, may be found in the Doifal Cos- 
 onos, extending from Vol. XVTII to XXR". 
 
 Although tlie screw princi}>le Avas the one wliieh he ])rin- 
 cipally used, and the only one which he considered scientifi- 
 cally and pliysiologically correct, he at times availed himself 
 of the use of some of the continuous-force a|)pliances, such 
 as rubber bands,* silk or fibre ligatures,t and for the 
 attachment of appliances, vulcanite plates.| 
 
 So far as the principles upon Avhich Dr. Farrar's system is 
 based are concerned, tliev have received but limited public 
 approval on the part of the profession ; but the multiplicity 
 and variety of his appliances and the ingenuity displayed 
 in their devising, have commanded the admiration of all 
 and been of great value to lal)orers in this field. Most of his 
 appliances are original in design, Ijeautiful in construction, 
 and well calculated to perform the work intended ; l)ut in 
 confining himself so largely to the use of one form of power- 
 producing instrument, his apparatus is in many cases very 
 elaborate and complicated. The same end could often be 
 accomplished by much simpler means. 
 
 Dr. Farrar's appliances are so numerous that illustrations 
 of all of them could not l)e introduced into a text book, nor 
 could they well be selected fi-om to illustrate his ])rinciples, 
 but some of them may be found in Fart III, wliere the prac- 
 tical treatment of various forms of irregularity is considered. 
 
 PATRICK ',S METHOD. 
 
 In FS82, Dr. Fatrick brought forward his method of regu- 
 lating. His appliance is made of gold, and designed to be 
 attached directly to the teeth on presentation of patient, 
 without the usual jireliminaries of taking an impression and 
 makiuii' a model. 
 
 * Co»mo8, Vol. XIX, p. 520. 
 t " " XXI, " 306. 
 
 t " " XXI, " 305. 
 
MATERIALS AND METHODS. 
 
 85 
 
 Fig. 20. 
 
 The appliance with its appurtenances, all beautifully con- 
 structed and ready for use, may be purchased from the 
 inventor or through the dental depots. 
 
 The essential parts consist of a bow-spring, adjustable 
 anchor bands, and numerous devices for engaging with the 
 teeth to be moved. 
 Fig. 20 represents 
 the appliance with 
 many of the acces- 
 sories in position. 
 The bow-spring 
 "A" consists of a 
 half-round bar or 
 wire of platinized 
 gold, bent in horse- 
 shoe form to ap- Patrick's Regulating Appliance. 
 
 proximately conform to the shape of the arch. "BB" are 
 the adjustable loop-bands, made of thin gold plate, the free 
 ends of which, on their palatine surfaces, are connected with 
 a screw and fixed nut (C), for bringing the band in close 
 contact with the tooth to which it is applied. On the buccal 
 surfaces of these bands are soldered sections of half-round 
 tubing, accurately fitting the bow-spring which plays through 
 them. Outside of this tubing is soldered a nut threaded to 
 receive the long buccal screw (D) intended to tighten the bow 
 spring after it is in position, or to take up the slack caused 
 by the moving teeth. The head of this screw passes through 
 and operates against a smooth nut soldered to a section of the 
 tubing which is temporarily attached to the bow-spring at 
 any point by means of an adjustable double wedge. 
 
 Of the accessory appliances shown, " E " is a hook intended 
 to rest against the mesial or distal (by reversing) surfaces of 
 a tooth intended to be moved in an anterior or posterior 
 direction. It is secured in the desired position by a wedge 
 placed between the inner flat surface of the spring and the 
 adjoining surface of the slide to which the hook is attached. 
 
86 ORTHODONTIA. 
 
 The tooth is moved anteriorly or posteriorly by loosening 
 the Iniccal screw on one side and tiohtening it on the other 
 toward wliieli the tooth is intended to be moved. " F" is a 
 liook to catch over the cuttinp; edges of incisors, when it is 
 desired to move them from within outward. When in posi- 
 tion the tension of the bow-spring is increased from time to 
 time, by unscrewing the buccal screws. " H " is a slide, or 
 section of the half-round tubing, reinforced on its palatine 
 surface by additional gold, and intended to be used as a stud 
 to prevent one portion of the tooth from moving while the 
 opposite one is being moved, as in rotating an incisor. It is 
 also used to press against any tooth as a wedge in moving 
 it inward. 
 
 " G " is a T-bar for producing double rotation of the inci- 
 sors. "I " is a hook set vertically to engage with the cutting 
 edge of ail incisor, to prevent the bow-spring from slipping 
 up toward the gum. 
 
 " J " is a Infurcated hook, to grasp a cuspid tootli intended 
 to be moved outM'ard. 
 
 Each of these appurtenances is soldered to a section of the 
 half-round tubing, which allows it to be moved to any desired 
 position on the bow-spring. Wlien in position, they are 
 retained Ijy means of the wedge already referred to. 
 
 xVs will readily be seen, the power obtained by this appli- 
 ance consists partly in the elasticity of tlie bow-spring and 
 partly in the direct action of the tightening screws. 
 
 The ingenuity displayed in the devising of this method is 
 certainly very great, and the delicacy and accuracy of con- 
 struction of the various parts all that could be desired. The 
 combination of the principles of the spring and screw bring 
 into play two of the most important ])owers available in 
 regulation, and tlicii- correlation in tliis method is very 
 hapjtily ])rought al)out. 
 
 Like all other methods, however, a few objections stand in 
 the way of its Ix'ing as ])erfect as we could desire: — 
 
 1. All uiicenicnicd bands ])lac('(l ai'ound teeth and kept 
 
ISfATERIALS AND METHOD!=?. 
 
 87 
 
 there for considerable time, are likely to work injury to the 
 underlying tooth substance, unless the tooth-structure be of 
 the densest variety. Cementing the bands to the teeth, accord- 
 ing to the Magill method, will obviate this trouble and attach 
 the bands to the teeth more firmly. 
 
 2. Dr. Patrick usually attaches a single band to a tooth 
 on each side of tlie mouth to obtain resistance. When 
 several teeth are firmly implanted in front of the banded 
 teeth, they all add to the resisting power ; but where there 
 are none, or only one in front of them, the resisting power 
 would seem to be too slight to move several teeth at once. 
 Where two adjoining teeth are available for banding, it would 
 be better to band both of them, and thus add to the stability 
 of the anchorage. 
 
 3. The conspicuousness of the gold bar and its append- 
 ages, is another objection. Where exposure of gold or other 
 materials cannot well l)e avoided, it becomes a minor con- 
 sideration; but where it can be obviated, without impair- 
 ing the efficiency of the appliance, it certainly should be. 
 Dr. Patrick has also devised two additional ap})lianees for 
 moving individual teeth, where the irregularity is confined 
 to one side of the arch, and where the bow-spring would 
 b e unnecessarily conspicuous 
 and cumbersome. In these cases 
 the power is obtained from the 
 direct action of the screw alone. 
 
 Fig. 21 represents the device 
 for moving a bicuspid either 
 forward or l)ackward in the 
 arch; while Fig. 22 illustrates 
 the same appliance modified 
 for use in drawing a cuspid backward. 
 
 Fig. 21 
 
 Patrick' 
 
 Modification for Cuspids and 
 Bicuspids. 
 
 BYENES' METHOD. 
 
 Dr. B. S. Byrnes has devised a method for regulating teeth 
 by the use of narrow strips of fine gold variously shaped and 
 bent to produce tension upon the malposed teeth. The 
 
88 ORTHODONTIA. 
 
 method is an exceedingly novel and ingenious one, and while 
 it could not be used to advantage in all cases, still contains 
 elements of merit that will be of value to the practitioner. 
 His power is derived from the elasticity of the metal, which 
 is corrugated in such a manner as to develop this quality in 
 the highest degree. . 
 
 His bands are made Irom gold plate of 20 to 22 k. fine- 
 ness, rolled very thin, and when greater power is needed the 
 bands are doubled in thickness. He uses no plates, but 
 anchors liis appliances by means of bands to suitable teeth, 
 ^situated at some distance from the ones to be moved. 
 
 * The method of application, in a general way, is as fol- 
 lows.: — The fixed points having been determined upon, the 
 tooth or teeth to be regulated are connected with them by 
 means of a thin gold band. The band is manipulated 
 so as to form it into a spring, or series of springs, so adjusted 
 as to bear most powerfully on the misplaced tooth. Thus, 
 supposing that a projecting superior central incisor is to be 
 drawn inward to align properly with the remainder of the 
 teeth in the arch, a continuous gold band embracing the 
 first molars on both sides is fitted around the outside of the 
 arch. 
 
 With a dull pointed instrument, like a burnisher, the 
 ribbon is then pressed into the interstices of the teeth 
 over which it passes, thus forming it into a series of small 
 springs. The incisor being the most prominent point will 
 naturally 1)e most attected by the pressure exerted by the 
 springs, and in a short time it will be found to have moved 
 away from the band, so that it is no longer affected by its 
 tension. As soon as this occurs the apparatus is removed, 
 the ribbon annealed and straightened, and a small portion, 
 say a thirty-second to a sixteenth of an inch, as may be 
 required, is cut out of it. The ends are then soldered and 
 the appliance replaced upon the teeth, the connecting band 
 being formed into a spring as before. Tension is thus kept 
 
 * Dental Cosmos, Vol. XXVIII, pp. 278-284. 
 
MATKlilALS AND METHODS. 
 
 80 
 
 Up until the tootli has assuiiu'd tlic dcsirt'd i)()siti()ii. Some- 
 times the spring of the l)au<l may be advantageously siii)ple- 
 mented by other aids, as the insertion of a rubber wedge 
 (under the band) at points were a partieular gain is desired. 
 
 Fid. 
 
 Figs. 23. 24 and -J.") illus- 
 trate the general api)ear- 
 anoe of the applianee in 
 some of its forms. 
 
 Figs. 23 and 24 were used 
 to draw in })rojecting in- 
 cisors in the ease of a 
 young lady, aged 18. The 
 movement was assisted by 
 rubber wedges placed be- 
 tween the band and the 
 labial surfaces of the teeth. 
 " The connecting band was 
 cut and shortened every 
 other day, the patient 
 having a sitting every day 
 to allow the band to be 
 sprung more as the teeth 
 moved away from it." 
 
 Fig. 25 represents the 
 form of appliance used by 
 Dr. Byrnes in drawing for- 
 ward the lower incisors, Byrnes' Band Regulators. 
 
 and pressing back the cuspids at the same time. The 
 band clasped the first molars of each side and passed around 
 the cuspids and back of the incisors. By cutting and shorten- 
 ing the l:)and from time to time as the teeth yielded to the 
 j)ressure, the irregularity was easily and quickly corrected. 
 Fig. 26 shows the form of a corrugated band used to draw' 
 inward an outstanding central incisor in the up})er jaw. Two 
 teeth are here used as anchorages, being connected by a 
 sinole continuous band. 
 
90 
 
 ORTHODOXTIA. 
 
 Fig. 27 sliows a more complicated apparatus tliau any 
 of those i)revioiisly described. It was used in a case where 
 Fi(i. 2n. a riglit central over- 
 
 lapped the lateral. 
 It illustrates how the 
 method may be ap- 
 plied to turn a tooth 
 where the force must 
 l)e applied directly 
 across the mouth. 
 
 After the necessary 
 
 room was provided;, 
 
 this fixture was aj)- 
 
 'ied. It accom- 
 
 ])lished its work in 
 
 four days, after which 
 
 device was 
 
 c o n s i s t i n p- of a 
 
 Byrnes' Corrugated Baad. 
 
 Fig 
 
 retaining 
 
 Appliance for Rotation 
 
 a 
 
 used, 
 
 simple band clasped 
 tightly around the central 
 which had been rotated, 
 and provided with wings 
 ti})ping on the left central 
 and under the right 
 ateral. 
 
 THE MAGILL BAND. 
 
 This device, while not ])roperly constituting a method, is 
 considered here, because through its great value it has come 
 to be an important factor in several methods of regulating- 
 devised since its introduction. Dr. W. E. Magill, having in 
 common with other practitioners experienced the difficulty 
 of attaching regulating appliances to the natural teeth in 
 such a Avay that they would have a firm hold and not slip, 
 devised the following }dan of meeting and overcoming the 
 difficult v.— 
 
MATERIALS AND METHODS. 91 
 
 From a piece of ])latiiuini plate. X(». 2S. Anieriean .uaiige 
 in thiekiiess. he cut a strip about a line in width, and bend- 
 it to conform to the s]iai)e of the tooth, soldered it at the 
 point where the ends overlapped, thus convertino- it into a 
 band or collar. After attacliing to this band any studs, pins 
 or hooks tliat the case demanded, it was lined with oxy- 
 chloride of zinc and slipped over the dried tooth to a point 
 about midway between the cutting- edge and neck. 
 
 Since the introduction of phosphate of zinc, it has been 
 found to be a far better medium for the attachment of the 
 band to the tooth than the oxy-chloride of zinc-, formerly 
 used. Once in position, the cement will harden in about 
 five minutes, after which no ordinary force will be able to 
 dislodge it. If a wire spring is intended to rest again.'^t and 
 press upon a banded tooth, a hole or pit should be drilled in 
 the band at a suitable point, before it is cemented in place. 
 If rubber bands or ligatures are to be employed, suitable 
 provision for their easy attachment may l)e made by pre- 
 A'iously soldering to the band a small gold hook, or a headed 
 platinum pin taken from a vulcanite tooth. Where a jack- 
 screw is to be used in the moving of a tooth, an abutment 
 of platinum should be soldered to the band encircling the 
 resisting tooth, and then be slotted to receive one end of the 
 screw. The band of the tooth to be moved should also 
 be re-enforced and drilled to accommodate the point of the 
 screw. 
 
 When the operation is completed, or for any cause it may 
 be desirable to remove the band, it is easily accomplished 
 by protecting the enamel at the cutting edge of the tooth 
 with a folded napkin or piece of chamois skin, and placing 
 one beak of a pair of pliers upon it and the other upon the 
 upper edge of the band, the closure of the hand will dis- 
 lodge the appliance without in the least marring or altering 
 its form. By this simple invention, one of the greatest diffi- 
 culties hitherto experienced in regulating has been overcome, 
 and its devising has almost introduced a new era in regu- 
 
92 ORTHODONTIA. 
 
 luting. For tlio purpose intended, there is nothing that- 
 jipproaclies it in etiieiency. 
 
 Before its introduction, attachment to tlie tootli to be 
 moved was usually eflfected hy means of a ligature ingeni- 
 ously a]>})lied and made fast by some form of knot, or a pit 
 or hole was tlrilled into the substance of tlie tooth to receive 
 the point of a scre^v or other device and prevent it from. 
 sli})ping. The knots would often sli}), and the drilling of 
 l)its was ol:)jectionable, so that the difficulties of securement 
 Averc not overcome until the invention of this band. 
 
 By its use al)solutely secure attachment and anchorage are 
 obtained, and the moving of teeth is accom|)lished with far 
 greater exactness than had previously been possil)le. When 
 attachment was made by ligature, it was often necessary 
 that the ligature should encircle the tooth at its neck, and 
 when not necessary to place it there it would often slip into 
 that position, ow^ng to the shape of the tooth. The irrita- 
 tion of the soft tissues thus produced, was frequently the 
 cause of much pain to the patient. The Magill band obviates 
 this by preventing any fixtures attached to it from coming- 
 in contact with the delicate and sensitive mucous membrane 
 of the gum. 
 
 Indeed, the author has found that by its use nearly all the 
 pain of regulating has been done away with, for the pain 
 attendant upon regulating by the old methods, was caused 
 not so much by the slight irritation induced by the moving- 
 tooth, as by the impingement of ligatures, rubber bands and 
 other appliances upon the soft tissues. The Magill band may 
 therefore, we think, be credited with having done more to 
 modify the pain accompanying regulation than any other 
 device ever introduced. 
 
 In some methods of regulating, such as Farrar's and Pat- 
 rick's, attachment is made to the teeth by means of an open 
 band of gold, secured to the teeth l)y a nut and bolt operat- 
 ing u})on the free ends of the band. Such device, while 
 valuable, is more complicated, cumbersome and less cleanly 
 
MATEKIALS AND METHODS. \l.j 
 
 tliaii tlic Mau'ill l)an(l. It is also opL'ii to the objection pre- 
 viously noted, that of allowing the secretions to remain 
 between the tooth and l)and. 
 
 Several of the autlior's methods of modifying the form of 
 tlie band by means of attachments to increase its usefulness, 
 will be illustrated hi Part III. 
 
 ANGLE'S METHOD. 
 
 This method of regulating was first brought to the notice 
 of the profession by its originator, Prof. Edward H. Angle, 
 in a paper read before the dental section of the Ninth Inter- 
 national Medical Congress, held at Washington, D. C, Sep- 
 tember, 1887. 
 
 The appliances used in this method are composed entirely 
 of metal. Power is obtained by the well known mechanical 
 forces of the screw and lever, the latter always being made 
 of piano wire, in order to obtain the greatest amount of 
 po^v■er. 
 
 Support of the appliances or resistance, is gained by firmly 
 attaching the parts to the teeth by the Magill band, which 
 is always cemented in place. 
 
 The appliances are few in number, simple in design, and 
 easily applied ; qualities that add materially to the value of 
 any device for general use. Prof. Angle, in describing his 
 method, says: — 
 
 " Fig. 28 shows the simple appliances from which all the 
 various combinations used in the method may be made. 
 ''A" is a large traction screw encased in its accompanying 
 tube, and used for pulling where the resistance is great. 
 " B" is a smaller traction screw, used in the same way where 
 the resistance is slight, or where from any reason a delicate 
 appliance is desired. " C " and " D " are tubes which are 
 soldered to bands placed upon the teeth to be moved, into 
 which the ends of the traction screws are hooked. "J" is a 
 jack-screw, used for pushing, the end of which is beaten flat. 
 " E " is an extra piece of tubing, by means of which a longer 
 
94 
 
 ORTHODOXTIA. 
 
 jack-screw can be made. " FF" are coils of l)and material. 
 "G" is a gold wire ased in retaining, and "RR" are small 
 
 Fig. 28. 
 
 Angle's Appliances. 
 
 retaining tubes designed to be soldered to bands, into which 
 the retaining wire accurately fits. "LL" are piano wire 
 levers of varying sizes, giving different degrees of power. 
 
 "Aside from the advantages of simplicity, efficiency and 
 cleanliness, which are insured b}^ these appliances, a still 
 greater desideratum is gained by means of the mechanical 
 principles observed in their construction. Stationary anchor- 
 age and non-relinquishment of pressure are prominent 
 features of this method, and are certainly secured almost to 
 perfection. 
 
 " The means by wliich one or more teeth are held perfectly 
 
 Fjq 29. stationary, while serving as an 
 
 anchorage or l)ase of resistance for 
 
 the application of force is quite 
 
 simj)le, and peculiar to this method. 
 
 " One or more teeth are banded, 
 
 V, as shown in Fig. 29. Soldered to 
 
 •^ the bands is a tube of some length. 
 
 Through this tube a rigid shaft, 
 
 threaded at one end and bent to a right angle at the other, is 
 
MATERIALS AND METHODS. 
 
 95 
 
 Fk;. ;?(). 
 
 passed to a tooth to l^e moved. On turning the nut the 
 natural tendency would be to tip the anchor teeth forward in 
 their sockets ; but they cannot tip thus, l)ecause of their rigid 
 connection, and the length of tube surrounding the shaft. 
 It is evident that two teeth thus connected cannot move, 
 except as they move together. The apices of the roots 
 must move the same distance as the crowns, if any move- 
 ment at all occurs, and this is well nigh impossibl(\ The 
 tooth to be moved is connected 
 with the shaft in such manner 
 that it may tip, and responds 
 l^y moving according to the 
 force applied. The dotted lines 
 of the diagram show the direc- 
 tion of any movement that oc- 
 curs. Fig. 30 shows the same 
 where the motion is pushing 
 instead of pulling. 
 
 "The base of the jack-screw 
 in this case is soldered to the band. Retention of the tooth 
 is always anticipated, and in nearly every instance retaining 
 tubes are soldered in position at the beginning of an 
 operation, so that all tliat is necessary when the tooth is 
 in place, is to insert the gold retaining wire and remove 
 the power. 
 
 "A few of the principal movements are selected for illus- 
 tration from the many modifications of which the appliances 
 are capable. 
 
 "The application and operation of the direct screw is 
 shown in Fig. 31. A firm anchorage for the resistance of 
 the screw is obtained by banding and tubing the left cuspid, 
 and passing through the tube a piece of gold wire long- 
 enough to extend to and rest against adjoining teeth. The 
 opposite cuspid is banded, and a retaining tube soldered 
 to the labial surface. The linsual surface has a slot cut 
 
 Lateral Jloveinent. 
 
96 
 
 ORTITODONTIA. 
 
 Fl(i. 31. 
 
 in it to receive tlie flat end of the jack-screw. The other en(i 
 of the tnhe, in whicli the screw plays, is so tiled that it rests 
 
 securely against 
 the re-enforcement 
 wire and the tuhe 
 upon the lingual 
 surface of tlie cus- 
 ]^id band. After 
 l)eing brought into 
 position, the tooth 
 is held in place by 
 passing a short 
 piece of gold wire 
 through the re- 
 taining tube on 
 
 Re-enforoed Anchorage. 
 
 the labial surface, which is left in place until the tooth is 
 
 firmly set in its new position. 
 
 "The backward movement of teeth in the line of the 
 
 arch is accomplished by 
 the appliance shown in 
 Fig. 32. The second bi- 
 cuspid and first molar are 
 banded, and the tube of 
 the heavy traction screw 
 rigidly soldered to the 
 bands. The cuspid to ])e 
 moved is banded, and a 
 short section of tubing 
 soldered to it to receive the 
 end of i\\c traction screw. 
 On turning the nut^ 
 
 lietraction ofCiispif 
 
 traction is produced, iind the cuspid ])ulled into place. 
 The cuspid is kepi from being rolatcd, wliilc it is being- 
 moved backward, by iiiciins of the short tube accurately 
 fitting the right angled end of the traction screw. 
 
MATERIALS AND METHODS. 
 
 97 
 
 Fi(i. :^3. 
 
 Increased Anehoraae. 
 
 Fro. 31. 
 
 "Another outward movenu'iit of a tootli by means of the 
 jack-screw, is, shown hi Flo-. 
 33. The second bicuspid 
 is made the principal an- 
 cliorage, apiinst which the 
 base of t h e t ube rests. Tl i e 
 band encirchni;- the hiteral 
 incisor has a slot cut in it to 
 receive the end of the jack- 
 screw. The anchorage is 
 re-enforced by means of a 
 wire loop, which hooks 
 into tubes upon the ad- 
 joining central and cus})id, and is looped over a spur uj)on 
 the body of the jack-screw tube. The central and cuspid 
 cannot l)e pushed outward on account of this re-enforcement, 
 and three teeth constitute the 
 anchorage instead of one. The 
 several parts of this appliance 
 are shown in Fig. 34. 
 
 " Outward movement, as ac- 
 complished by anotlier simple 
 
 means, is as follows: A thin strip of band material is looped 
 about the malposed tooth, the ends resting upon the labial 
 surfaces of the adjoining teeth. To one end of this strip is 
 soldered a tube placed vertically, while to the other end a 
 similar tube is attached horizontally. Into these tubes the 
 small traction screw is placed, being bent to Fig. 35. 
 conform to the shape of the arch, and being- 
 used in this case to push instead of pull. 
 The parts of this device are shown separately 
 in Fig. 35. The manner of retaining the """''ZyemelT"^ 
 teeth in position, after correction, is shown 
 in Fig. 3(3. 
 
 " Rotation by this method, as in most 
 others, is accomplished by the leverage and 
 elasticitv of a metallic bar or wire attached Retention 
 
 Fio. 36. 
 
98 
 
 ORTlK^nOXTIA. 
 
 Fig. 38. 
 
 to the tooth to he rotated, and then sprung around to some 
 firmer tooth or teeth at a distance. Fig. 37 shows a lateral 
 to be rotated, and the appliance in position by which it 
 Fig. 37. may be accomplished. The lateral 
 
 is banded and tubed as shown in the 
 cut. The second bicuspid is also ban- 
 ded, and to secure greater resistance, 
 the two adjoining teeth are made to 
 assist by means of a wire which 
 passes througli a tube on the pala- 
 tine surface and rests against the first 
 bicuspid and first molar. On the buc- 
 cal side of this same band, the ends 
 of the band material are 
 shaped into a latch or hook, 
 Avitli which the rotating 
 lever engages when it is 
 sprung around. The sev- 
 eral parts of this appliance 
 are shown in Fig. 38. 
 Fig. 39.^ After the tooth is in position, it is retained by 
 ^^^^^. means of a short wire passing through the tube, 
 .™ and extending upon the central, as seen in Fig. 
 yP 30. Tliis wire is kept in place by a small pin, 
 Retainer. ^y]^\^.\^ iy tightly fitted in a small hole drilled 
 through botli tube and wire, as shown. 
 
 "When two teetli are to be rotated in opposite directions 
 p,(, 4^J at the same time, as the central in- 
 
 cisors, double rotation may be accom- 
 plished l)y one appliance, as shown 
 in Fig. 40. Botli teeth are banded, 
 and a tube soldered to each band, 
 i».,uM« Rotation. one being horizontal and the other, 
 
 vertical. A |)i(('c of j)ian() wire is bent to a right angle at 
 one end, and IIk^u placed in jjosition as seen in Fig. 41. 
 The tendency of the wire to straighten itself, will rotate both 
 
MATKKIALS AND METHOD!^. 
 
 99 
 
 Double lioialion. 
 
 Fig. 42. 
 
 teeth at once. When in position they are retained by sub- 
 stituting a non-ehistic gohl wire pf,;. 41. 
 for the piano wire. 
 
 " Exj)ansion of the arch is ac- 
 coniphshed by banding and 
 tubing the first and hist teeth of 
 those to be moved, on each side, 
 and connecting them by means of a wire passed through 
 the tubes. The jack-screM' is then pLaced in position across 
 tlie arch from wire to wire. CoRars, or short tubes, are sold- 
 ered to the wires at intervals to kee[) the screw in ])roper 
 position. The j a c k - 
 screw may Ijc moved 
 forward or ])ackward 
 according to the varying 
 requirements of the case. 
 This appliance in posi- 
 tion is clearly shown in 
 Fig. 42." 
 
 Retention is always 
 anticipated and p r o - 
 vided for, by means of 
 the tul)ed band, wliile 
 the ijin device for lock- 
 ins; lever and tube to- 
 
 for Expansion. 
 
 ill 
 Aiisile Devif 
 
 gether, is both novel and ingenious. Aside Irom these, the 
 method contains so many ingenious modifications of pre- 
 viously known devices (as the screw and band), and is com- 
 posed of parts so simple and direct in their action, that it 
 must necessarily commend itself to all engaged in this line 
 of practice. 
 
 The various parts of the Angle appliances may be obtained 
 from the inventor, or from the dental supply houses. 
 
 COFFIN'S METHOD. 
 
 In a paper read before the Dental Section of the Inter- 
 national Medical Congress, held in London, in August, 1881, 
 
100 oirnioDoxTiA. 
 
 Mv. Wnltcr IT. Coffin explained his metliod of correcting 
 irregularity <if the teetli. The method was devised by his 
 father, and had l)een in use by fathei' and son for twenty- 
 five years. It was termed the " Expansion Method," because 
 in nearly all eases coming' under their care, a certain amount 
 of expansion had been found necessary in connection with 
 other desired movements. 
 
 The construction of the appliance, and the principle upon 
 which it acts, are exceedingly simple. The power is derived 
 from the elasticity of piano-forte wire, attached in various 
 ways to a vulcanite plate which covers the arch (in an upper 
 case) and envelopes the posterior teeth on either side to give 
 it firmness and fixedness in position. AVhen it is desired 
 to expand the superior arch, the wire is l)ent into the fol- 
 lowing form iSlS , lyiiig on top of the plate ^\'ith the ends 
 embedded in it. 
 
 To produce lateral expansion in the lower jaw, the form 
 of the appliance is necessarily different. A simple vulcanite 
 plate is made in horse-shoe form, fitting the gum and lingual 
 surfaces of the teeth, and capping the molars and bicus- 
 pids. On the lingual surface of this plate, lie two pieces of 
 piano wire suitably curved, with their ends imbedded in the 
 rublier. 
 
 Each of these plates wlien completed, is sawn in two along 
 the median line, thus allowing the tension of the wire to be 
 increased from time to time, by spreading apart the sections 
 of the plate. 
 
 The piano-forte wire used may be obtained from piano 
 factories or from dealers in dental supplies. It is sim])ly 
 wire made from the best quality of steel, drawn to size 
 through draw-plates. The (juality of tlu> steel, as well as 
 the toughness of the wire, is greatly iin])roved l)y the suc- 
 cessive drawings to which it has been subjected. For ordi- 
 nary cases Mr. Cotlin reeoiiiniends lliat the dinincter (»f tlie 
 wii-e be between three and foui' one-hundredths of an inch. 
 A lighter or heavier number will \'ield respectively less or 
 greater pressure. 
 
MATKUIALS AND ^fETHODS. 101 
 
 In iisL' it .should not be aniu'aled, but V)cnt to shape as it 
 comes. Mr. Cofiiii recommeiuls tliat the wire be tinned after 
 l)ein.ii- l)ent to sha])e, to prevent oxidation in the moutli, but 
 this does not appear to be necessary. 
 
 A wire suitaldy l)ent to pro(hice 
 ex})ansion of the su])erior arch is 
 represented by Fi^-. 43. 
 ■ Tlie details of tlie construction of 
 an expansion plate for the superior 
 jaw. are as follows : From an accurate ^ cottin spring. 
 impression of the jaw and teeth, taken with plasterer model- 
 ling compound, a pla.ster model is ol)tained. I'pon this a 
 wax base-})late is fashioned, to cover all parts intended to l)e 
 covered l)y the com})leted plate. The suitaldy lient wire is 
 now further shaped so that it shall lie upon the exposed 
 surface of the base-plate, and conform to it as closely as 
 possible in outline. After the ends of the wire are attached 
 to the base-plate by means of additional wax, a piece of tin- 
 foil (No. ()0) is slipped between the wire and the plate and 
 its corners bent, so that the plaster when jjoured into the 
 flask will grasp and remove it with tlie wire. The foil is 
 placed there so tliat the plate will have a polished surface 
 under tlie wire after vulcanization. The wax base-plate 
 should now be smoothed with a s|)atula and flasked in the 
 usual manner. In .separating the flask, the wire and tin-foil 
 will come away with the upper half, while the model will 
 remain in the lower. After removing the wax and packing 
 the ru]d)er, the case is vulcanized, after which it is polished. 
 The completed piece should now be properly fitted to the 
 patient's mouth, and the rubber covering the masticating 
 surfaces of the po.sterior teeth so filed and dressed that the 
 cusps of the occluding teeth will all .strike the rubber at the 
 same time. 
 
 However many or few of the natural teeth be covered, the 
 last ones in the arch must always be included, as otherwise 
 they would elongate through non-occlusion, and thus seri- 
 ously impair the usefulness of the masticatory apparatus. 
 
102 
 
 ORTIIQDONTIA. 
 
 Fig. 44. 
 
 After tlie plate has been fitted, it ^liould Ije .•<awn in two with 
 a jeweler's fine saw, the edges made smooth and slightly 
 rounded, and the case introduced into the mouth. 
 
 It is desirable to have the patient Avear the plate for a day 
 without eidargemeiit. after Avhich, at intervals of a day 
 or two, the tension of the wires should be increased by 
 pulling the halves of the plate apart sufficiently to slightly 
 increase the space between them. Only the fingers should 
 be used in thus spreading the plate, for if pliers be used 
 upon the wire for this purpose, the relation between the two 
 halves may be so disturbed as to destroy the usefulness of the 
 plate. The construction of the lower plate is substantially 
 the same, only the wires lie against the plate in a continuous 
 smooth curve, instead of being corrugated. 
 
 Figs. 44 and 45 represent an upjjer and lower cxj)ansion 
 
 plate as described. 
 For cases where 
 expansion is not 
 needed, but simply 
 the moving of one 
 or more teeth, Mr. 
 Coffin uses a solid 
 rubber plate, with 
 wires so placed as 
 to produce the de- 
 sired movements. 
 The construction 
 of this form of 
 plate is the same 
 as those just de- 
 scribed, with the 
 exception of the 
 shajje and arrange- 
 ment of the wires 
 and the non-sepa- 
 
 Coffin'B Expansion Plates. ratioU of the plate. 
 
 A single long piece of wire, bent at right angles near one 
 
 FUi. 45. 
 
MATERIALS AND METHODS. 103 
 
 end and flattened at tlio other, is embedded at its flattened 
 end into tlie plate; wliile the other end, and a long i)ortion 
 besides is free and lies in close apposition to the plate. Be- 
 fore the wire is attached to the wax base-plate, the plaster 
 tooth representing tlie one to be moA^ed should l)e ent away 
 close to its neck and the l)ent end of the wire laid ni)on it 
 so as to cover the entire diameter of the stub tooth. In this 
 position it is vulcanized to the plate. 
 
 When the plate is introduced, the wire will have to be 
 drawn back with an instrument or string, before the plate 
 Avill go into j)osition. Once in place, and the wire released, 
 continuous pressure will be exerted on the malposed tooth. 
 After the tension of the wire has been lessened l)y the moving 
 of the tooth, it may be increased either by Ijending tlie wire 
 where it enters the plate or by cutting it out and re-setting 
 in a different position. 
 
 Another and very convenient way of lengthening the 
 wires to follow the moving tooth, is to slip a section of plati- 
 num or German silver tubing over the end of the wire and 
 soft-solder it in position. 
 
 AVhere a tooth is to be pressed outward, the wire is anchored 
 in the palatal portion of the plate; but where a tooth is to 
 be moved from witliout inward, the wire should be attached 
 to that portion of the plate covering the buccal surfaces of 
 the molars. 
 
 Rotation is accomplished l)y combining the two move- 
 ments ; that is, by having one wire on the palatine surface 
 to press against one angle of the tooth, and another on the 
 buccal surface to press against the opposite angle. 
 
 Two wires can be inserted to operate on two teeth at the 
 same time, either in similar or opposite directions. Fig. 46 
 represents a plate made to press outward two lateral incisors. 
 
 Many modiflcations of the Coffin plate have been devised 
 by different practitioners, some of which are shown in 
 Part TIL 
 
104 
 
 ORTITODONTIA. 
 
 Fig. 46. 
 
 Tlie originator claims for his iiiethod and appliances, sim- 
 plicity, ease of construction and inexpensiveness, almost 
 universal range of application, perfect control of force applied 
 
 and direct action, com- 
 parative painlessness from 
 non-irritation of the soft 
 tissues, perfect fixedness 
 and least unsightliness, 
 ease of removal for cleans- 
 ing, and little interference 
 with speech and mastica- 
 tion. All these claims 
 must, we think, be granted; 
 Coffin Solid Plate. and lu doiug so, we prob- 
 
 ably accord it the highest place among the methods devised 
 for the correction of dental irregularities. 
 
 TALBOT'S METHOD. 
 
 Dr. E. S. Talbot* has designed a modification of the Coffin 
 piano-wire spring, which consists in converting it into a coil 
 at some point of its length, thus adding, it is claimed, greater 
 •elasticity and a wider range of applicability. Unlike the 
 Coffin spring it may be used without a rubber plate and 
 without being permanently attached to any appliance. The 
 €oil is formed by bending the wire around a mandril firmly 
 driven into the bench or properly secured in a vise. 
 
 The arms may be bent or cut to any length to suit the 
 case in hand. They may be used in connection with a 
 ruljl)er })latc, oy Avith bands of gold or platinum fastened to 
 the teeth with zinc-})liospliate. With holes properly drilled 
 in the bands or j^late and the arms fitted into them, the 
 spring will stay in position. When the s[)riiig is used with- 
 out a plate it may be well to fasten the wire to some of the 
 
 *Ta]l)ot'.s "Irregularities of the Teetli," page 126. 
 
MATERIALS AND METHODS. 
 
 105 
 
 teeth to ])ixvt'iit its being swallowed. Fig. 47 illustrates 
 
 the coil Fic^. 47. 
 
 spring in 
 
 sonic of its 
 
 forms. To 
 
 prevent t li e 
 
 spring from 
 
 rocking i n 
 
 the mouth 
 
 the coil is Talbot Colled springs. 
 
 usually made to press over a button or Y)o^{ suitalily placed 
 on the plate for that purpose. 
 
 Fig. 48 shows a case Fi«- ^^■ 
 
 treated by Dr. .J. F. 
 Austin, in which tlie 
 Talbot spring in a small 
 form was made use of 
 to press apart adjoining- 
 teeth to make room for 
 rotating and bringing 
 into place a lateral 
 incisor that was mal- 
 posed. 
 
 Fig. 49 represents the application 
 and use of the coil spring in widen- 
 ing the lower arch. The plate is 
 slotted after the Kingsley plan, in 
 such a way that the partly separated 
 portions may move independently 
 of the rest of the plate. Near the 
 free extremities of each of these 
 
 tongues a hole is drilled to receive slotted vuieanite piate ana 
 the ends of the coil spring, the coiled 
 
 portion resting against the anterior 2:)ortion of the plate. In 
 this way the bicuspid teeth will be moved more rapidly 
 than the molars. 
 
 Coiled Spring in Position. 
 Fig. 49. 
 
106 
 
 ORTHODONTIA. 
 
 An illustration of the 
 use of the coil spring with- 
 out a rubber plate is given 
 in Fig. 50. In this case 
 p 1 a t i n u m b a n d s w e r e 
 cemented to the laterals 
 ., -v/. / 4%»aas»i^and the ends of the coil 
 spring rested in small holes 
 drilled in the bands for 
 the purpose. The action of the .spring forced the laterals 
 out of lock, after which they were brought into proper 
 position by means of other appliances. 
 
 The coiled .spring, in many cases, possesses advantages 
 over the plain spring because it can be effectively used 
 where the other cannot. It is also more easily regulated as 
 to tension, and can be readily replaced by a weaker or 
 stronger one should the case require it. 
 
 Coiled Spring aud Platinum Bands. 
 
PART III. 
 
 SPECIFIC FORMS OF IRREGULARITY AND THEIR 
 TREATMENT. 
 
 While principles and methods may be well understood, 
 illustrations of their application in certain forms of irregu- 
 larity will be necessary in order that the student may 
 properly comprehend their practical relationship. 
 
 So far as ease or difhculty of treatment is concerned, cases 
 of irregularity are naturally divided into two general classes ; 
 in one the cases are brought to our notice as soon as the 
 irregularity begins to manifest itself, while in the other the 
 deformity is fully established and confirmed before presenta- 
 tion for treatment. In the first class, occurring usually in 
 children, we have the advantages of easy movement and 
 freedom from complications ; while in the second, we have 
 to contend with slow and difficult movement and a variety 
 of unfavoring conditions. 
 
 For these reasons it is deemed advisable to treat of certain 
 forms of irregularity, especiall}' those involving the six 
 anterior teeth of each jaw, under separate heads, according 
 as they present before or after dentition is complete, for the 
 treatment in one case will vary considerably from that 
 required in the other. 
 
 (107) 
 
CHAPTER I. 
 
 INCISOR TEETH ERUPTING OUTSIDE OK INSIDE OF THE ARCH. 
 
 Reference has already been made to the fact that normally 
 the permanent inferior incisors erupt inside of the arch 
 and posteriorly to the deciduous ones, wliile the permanent 
 superior incisors erupt outside of their deciduous prede- 
 cessors. From the limited space allotted to them, there 
 is a stronger tendency to irregularity on the part of the 
 lower incisors than tliere is on the part of the more favor- 
 ably located superior ones, although tlie latter are also often 
 found in a crowded condition, sometimes complicated with 
 torsion. 
 
 So long as the inferior ones are within the arch, even 
 though irregularly arranged, they will usually need no atten- 
 tion on our part until dentition is com[»lete ; and wliou tliat 
 time arrives it will generally be found tliat nature lias al- 
 most, if not entirely, corrected the condition. 
 
 So, also, where some of tlie su}»('rior incisors erupt slightly 
 outside of the arcli, tliey Ijcing still in line, with spaces 
 between tliem, we need nut interfere, fur in most cases the 
 force exerted by the lips and the erupting cuspids will bring 
 them into normal pf)sition and relationship. 
 
 It not unfrequently happens, however, that from some 
 cau.se a superior incisor is deflected in its eruption and 
 appears inside of the arch, or that an inferior incisor is found 
 to eru[)t outside of the arch. In either case, treatment is 
 indicated as soon as the irregular tooth or teeth are sufR- 
 ciently erupted to enable us to bring the ]»i'oj»c'r force to bear 
 upon them. 
 
 (108) 
 
PRACTICAL TREATMENT. 109 
 
 Where one or two of the su])eri(jr incisors erupt inside of 
 the arch, a very ready manner of bring- 
 ing them out into line is by tlie use of 
 the "saddle and inclined plane," as sh()\vii 
 in Fig. 51. 
 
 It is commonly made of silver })late, in.iined piane, 
 gauge 26, swaged in a single piece to cover all of the crowns 
 of the inferior incisors and cuspids. At a point where the 
 introverted upper tooth touches this plate, a piece of heavy 
 silver, gauge 22, is soldered in an inclined position to the 
 ridge of the saddle. With this appliance in position, the 
 malposed tooth is readily brought forward into line, 
 through the force exerted upon it in mastication. Where 
 more than one tooth is to be moved, corresponding inclined 
 planes are attached to the saddle for each one. 
 
 To insure a close fit and stability for the piece, it is well 
 to scrape slightly the neck of each plaster tooth on the 
 model, both on the lingual and labial aspect, before casting 
 the die. With the appliance properly constructed, so as to 
 bind upon each tooth at its neck, it will usually retain its 
 position during the ten or fifteen days necessary for bringing 
 one or two teeth into place. 
 
 To avoid the necessity of removal for cleansing and the 
 possible non-replacement of the a]i)pliancc l^y the patient, as 
 well as to secure it in position more effectually, the writer has 
 been in the habit of cementing it to the teeth with phos- 
 phate of zinc cement, in the same manner as crown and 
 bridge-work is attached. 
 
 Two principal objections have been urged against this 
 appliance : one, that by thus opening the bite, the posterior 
 teeth will elongate ; the other, that the patient may avoid 
 biting upon the plane. These objections have no real valid- 
 ity, as is shown by actual experience. 
 
 The short time that the bite is kept open is not long 
 enough to permit of any perceptible elongation, and the 
 patient must and does bite upon the plane in mastication, 
 because it is the only point where occlusion is possible. 
 
110 ORTHODONTIA. 
 
 In cases where a lower incisor is locked out of the arch by 
 a superior one biting inside of it, both teeth can be moved 
 in opposite directions and brought into line bj' means of an 
 appliance devised by the author many years ago. It is con- 
 structed as follows : A band of thin platinum plate (No. 29, 
 Am. gauge) is bent to encircle and fit the protruding lower 
 incisor, and the ends soldered. A piece of ordinary gold 
 plate is then bent double to form the plane, and spread apart 
 at its ends to grasp tlie band on the lingual and labial sur- 
 faces, to which it is soldered. It is next placed upon the 
 tooth to see that the adjustment is correct, removed, lined 
 with phosphate of zinc, and pressed permanently into posi- 
 tion. If the. teeth are in close contact it is well to allow the 
 fixture to be worn a day previous to cementing, for then the 
 teeth will have been pressed apart and the replacement with 
 cement will be more easily accomplished. The cement not 
 only lines the band. l)ut fills up all the space between the 
 plane and the tooth, thus giving greater resist- 
 ance and strength in biting. It is sho^'n in 
 position and separately, in Fig. 52. Its ad- 
 vantages are its small size and absolute 
 fixedness. When the correction has been 
 accomplished, it will be necessary to cut the 
 band in order to remove it. 
 Fixed Plane. Auothcr plan of accomjDlishing the same end 
 is that devised by Prof. C. N. Peirce. He simply attaches 
 ligatures to several or all of the lower incisors, and makes 
 these fast to the molars on either side. The ligatures being 
 attached and drawn tight while dry, will, under moisture, 
 contract and draw the incisors inward. This operation is 
 continued until the lower incisors reach a po.sition inside or 
 back of the malposed superior ones. The ligatures are then 
 removed, and the lower teeth, in gradually resuming the 
 position they formerly occupied, will carry the inlocked 
 superior ones with them. 
 Where, for any cause, it is desirable to confine the means 
 
PRACTICAL TREATMENT. 
 
 Ill 
 
 of correction to the jaw in which the irregnlai'ity exists, as 
 for instance where the superior hiterals are inlocked, a sim- 
 ple plan is to take a piece of platinized gold, about one- 
 eighth of an inch in width and long enough to more tlian 
 cover the four incisors, and punch or drill four lioles in it, 
 two opposite each of tlie laterals. The bar being laid in 
 position on the labial surfaces of the centrals, the laterals 
 are securely ligated to it, the thread passing through the 
 holes. The spring of the bar and the contraction of the 
 moist ligatures, will move the laterals into position in a 
 short time, the ligatures being renewed ever}^ two or three 
 days. 
 
 A more satisfactory way of performing this operation, is 
 to solder one end of the bar to a platinum band made to 
 encircle one of the laterals and attached to it by zinc cement. 
 Arranged in this way, the bar has but one free end, which 
 is the more readily ligated to the other lateral. 
 
 Fig. 53 illustrates an appliance of this character, that was 
 used to bring out into posi- pj^, 53 
 
 tion two superior laterals in 
 the mouth of a girl ten years 
 of age. The case was compli- 
 cated by one of the centrals 
 being slightly turned upon 
 its axis. 
 
 A platinum band or collar 
 was made to fit the right lat- 
 eral, and to its laV)ial surface spring Bar. 
 was soldered one end of a ])ar of spring gold, long enough to 
 extend over the centrals and cover the opposite lateral. 
 The bar was converted into a hook at its free end, and w\as 
 so shaped that in its course it touched only the prominent 
 edge of the twisted central. The band was then cemented 
 to the right lateral, and a section of small rubber tubing 
 passed under the left lateral and caught in the hook. The 
 appliance thus operated in two ways : First, to bring the 
 
112 
 
 ORTHODONTIA. 
 
 Fig. 54. 
 
 laterals out into line ; and next, to press backward and 
 inward the protruding corner of the central. 
 
 Another way of securing the same result is by the use of a 
 
 Coffin plate and suita- 
 bl}'' shaped extension 
 wires, as shown in Fig. 
 54. 
 
 The rubber plate is 
 made to cover the arch 
 and enclose several bi- 
 cuspids or molars on 
 each side. In each of 
 the buccal portions of 
 the plate a piece of piano 
 wire is imbedded, which 
 extends forward clear of the teeth and terminates in a curve 
 or hook opposite the tooth to be moved outward. A section 
 of rubber tubing is slipped over the tooth and caught upon 
 the hook. The elasticity of the rubber, added to the spring 
 of the metal, will rapidly draw the tooth outward provided 
 there is sufficient space in the arch to accommodate it. 
 
 As already stated, slight spaces existing between the 
 superior incisors when recently erupted need give us no 
 concern, provided they are in the nor- 
 mal line of the arch ; but it often hap- 
 pens that in addition to the spacing, 
 one or more of them is, to a greater or 
 less extent, turned upon its axis, as 
 shown in Fig. oo. 
 
 In other cases the teeth may be in 
 contact, while one of them is twisted 
 and overlapping its neighbor, as shown 
 in Fig. 56. In either case it is quite 
 probable that the cutting edge of the 
 Torsion with Overlapping. ^^^,j^^,j ^^^^j^ ^^,-^^ occludc with the Cor- 
 responding surface of the one in the opposite jaw at an 
 
 Fig. 55. 
 
 Torsion with Space. 
 
 Fig. .)«. 
 
PRACTICAL TREAT^FEXT. 113 
 
 angle, and thus either prevent full eruption of one or the 
 other of the teeth, or temporarily open the bite and favor 
 undue elongation of posterior teeth. 
 
 Both of these forms of irregularity should receive im- 
 mediate attention, for at an early age correction is easily 
 accomplished. AVere the conditon to remain unchanged, 
 it would necessarily become more complicated from partial 
 closure of the space caused by the lateral pressure that 
 would be exerted during the eruption of neighboring teeth. 
 
 Rotation of these teeth, as well as of others, may be 
 accom})lished l)y one of the many methods described in 
 C'ha])ter XL 
 
CHAPTER II. 
 
 DELAYED OR MAI^ERUPTIOX OF THE PERMAXEXT CUSPIDS. 
 
 The third molars excepted, the cuspids are usually the last 
 teeth of the permanent set to erupt, and they almost invaria- 
 bly make their appearance outside of the arch. When there 
 is room in the arch for their accommodation and they erupt 
 directly outside of it, we may feel assured that in due time 
 they will find their way into place unaided. Where, however, 
 they erupt over the lateral incisors, as is sometimes the case, 
 and these incisors are in consequence being forced inward 
 from their true position, it becomes necessary for us to inter- 
 fere and endeavor to draw the cuspids toward their proper 
 places. This is usually not a difficult matter when the cus- 
 pid crown is far enough erupted to enable us to apply pres- 
 sure upon it. In such a case, by cementing a Magill band 
 to the cuspid and another to the second bicuspid or first 
 molar, each having a pin or hook attached to its buccal sur- 
 face, a rubber ring extending from hook to hook will, in a 
 short time, draw the cuspid back to a position opposite the 
 space it is to occupy as illustrated in Fig. 78. 
 
 It sometimes happens, however, that the cuspids are tard}" 
 in their eruption and fail to assume their positions in the 
 arch at the time they are needed to complete the row and 
 prevent the incisors and bicuspids from encroaching upon 
 the space the cuspids are to occupy. In such cases it is gen- 
 erally advisable to hasten their eruption by the application 
 of tractile force in some manner. AVhere one-half of tlie 
 crown is through the gum we can attach to it a Magill band 
 witli a pin, hook or other projection upon it, and Ijy its 
 as.sistance readily apply power to the tooth. 
 
 The author lias had several cases where elongation of the 
 
 (114) 
 
PRACTICAL trp:atment. 115 
 
 cuspid was called for, when only the cusp of the tooth was 
 visible through the gum. Here, the application of a cemented 
 band was out of the question, and attachment to the tooth 
 had to be gained in another way. The difficulty was solved 
 by tying a silk ligature in a half knot, passing it over the 
 projecting cusp, and then with a small, flat plugger, forc- 
 ing this ligature up under both gum and alveolus until 
 it encircled the neck of the tooth, when it was drawn tight 
 and made fast with a surgeon's knot. A very small gold 
 ring, with a centre only large enough to admit of the passage 
 of silk floss, was then slipped over one of the ends of the 
 ligature and tied so that it would lie upon the labial face of 
 the tooth near the gum. This ring was allowed to remain 
 without change until the tooth was drawn into position. A 
 delicate vulcanite plate was constructed to fit the arch, and 
 extend into the space between the lateral and first bicuspid. 
 At this latter point the plate was thickened until it was 
 nearly on a level with the cutting edges of the adjoining 
 teeth, and made concave on its most prominent part. A 
 rubber spur was also formed on the plate, in a line with the 
 cuspid and space. The plate being in position, a rubber 
 band was passed over the spur and drawn tight to the ring 
 on the tooth by means of a ligature, the band in its course 
 resting in the notch of the elevation on the plate. By this 
 arrangement no pain was infiicted except that incident to 
 forcing the ligature into position under the gum, while power 
 was exerted in a nearly direct line with the long axis of the 
 tooth, and in a gentle, continuous manner. 
 
 Another and most excellent plan of securing attachment 
 to a partially erupted cuspid, is that devised by Prof. J. F. 
 Flagg. It consists in screwing a gold ring-bolt or screw-eye 
 into the point of the cusp. The screw-eye can be made by 
 soldering a small gold ring to the end of a section of threaded 
 gold wire. After the correction is accomplished, the screw 
 is removed and the hole filled with gold. 
 
 If mal-position of an erupting cuspid should be compli- 
 
116 ORTHODONTIA. 
 
 cated with more or less torsion, the correction of the hitter 
 will be best accomplished after the tooth is nearly or quite 
 in position. 
 
 When a superior cuspid eru})ts inside of the arch, it may 
 either be forced outward by a Coffin plate and spring, or it 
 may be drawn outward by one of the several methods men- 
 tioned for similar operation upon the incisor teeth. 
 
 The difficulty of gaining a firm hold upon a cuspid tooth, 
 owing to its round and conical form, may be overcome by 
 encircling it with a Magill band. To this any desired at- 
 tachment can be made. 
 
CHAPTER III. 
 
 INCISOK TEETH SITUATED OUTSIDE OR INSIDE OF THE ARCH 
 AFTER DENTITION IS COMPLETE. 
 
 Irregularities of this character will require much the same 
 treatment as is given to similar cases occurring during den- 
 tition, but the attendant difficulties will be greater, owing to 
 the greater density of the alveolar structure and the pres- 
 ence of all the teeth, making the obtaining of space more 
 difficult. In the lower jaw, the irregularity in most cases is 
 confined to one or two teeth, standing either anteriorly or 
 posteriorly to the line of the arch. If they are located pos- 
 teriorly, and the extraction of one of them be not indicated, 
 room should be made (if it p^^, ^^ 
 
 does not exist) by pressing 
 apart the neighboring teeth. 
 After this is done they may 
 be conveniently forced into 
 place by means of a C'offin 
 plate, constructed as shown 
 in Fig. 57. 
 
 Or, if it be desired to in- 
 terfere less with the tongue Comn Plute tor Lower Incisors. 
 
 in speech, the wires, made to describe a slight curve and 
 W' ithout angles, may be anchored in the plate on the outside. 
 Their free ends may then be drawn down and made fast to 
 the in-lying teeth, eitlier l)y means of a silk ligature or rub- 
 ber ring, as shown in Fig. 54. 
 
 Where it is desired to move outward a single incisor, and 
 at the same time create space for its accommodation, an 
 excellent method for its accomplishment is that devised by 
 Dr. A. E. Matteson.* 
 
 * Dental Cosmos, Vol. XXX, p. 6S. 
 
 (117) 
 
lis 
 
 OETHODONTIA. 
 
 Fig. 
 
 Mattesoii Coiled 
 Spring. 
 
 The apparatus con.sists of two separate parts, a narroAV 
 
 ribbon of thin gold or platinum, and a coiled spring of piano 
 
 wire. The ribl)on is cut of sufficient length to pass around 
 
 tlie in-lying tooth, and over tlie labial sur- 
 
 iP (s^ faces of the two adjoining ones. The spring 
 
 (g/ %) is made from piano wire, Xo. 14 or 16, and 
 
 bent to the shape shown in Fig. 58. 
 
 After the spring is constructed, the ribbon 
 is placed in position and the spring, with its 
 ends drawn closer together by means of a 
 ligature, is laid upon it, and the points where 
 the ends of the spring touch the ribbon 
 marked with a pencil or sharp instrument. The ribbon is 
 then removed and a hole punched near each end oj^posite 
 the marks, after which it is again properly placed upon the 
 teeth, the ends of the spring placed in the holes, and the 
 restraining ligature severed. Pressure begins at once and 
 
 continues uninterrupt- 
 edly until the tension 
 is spent and the teeth 
 moved. The ai3i")liance 
 in position is shown in 
 ^ig. 59. 
 
 Should the tension of 
 the spring not be suffi- 
 cient to move the tooth 
 entirely into place, the appliance should be removed, new 
 holes punched in the ribbon nearer its centre, and reapplied. 
 The case of irregularity shown, was corrected by the use of 
 this appliance in ten daj's. 
 
 Where a ribV:)on is inadmissable on account of a close bite, 
 Dr. Matteson sulj.stitutes a piece of gilling twine, one end of 
 which he fastens to one eye of the spring by means of a 
 slip-knot, and the other, after passing around the tooth to be 
 moved, is secured to the other eye. The ligature is now cut, 
 and the spring operates as in the previous instance. Dr. 
 
 Fig. 59. 
 
 Matteson Appliance in Position. 
 
PRACTICAL TREATMENT. 119 
 
 Matteson says : " By the use of a longer compound spring, 
 several teeth may be brought into line at the same time. 
 For example, where the lower incisors are in a 'jumbled' 
 condition, the ribbon or ligature may be woven in and out 
 among the proper teeth in such a way that when the power 
 of the spring is exerted some teeth will be pushed apart to 
 make room for others which are being pulled into place." 
 
 Another manner of using the metal ribbon for drawing- 
 outward an inlocked incisor, and at the same time creating 
 space for its accommodation by pressing apart the adjoining 
 teeth, is that suggested by Prof. Angle and noticed in the 
 description of his method. The ribbon being of suthcient 
 length to pass Ijack of the inlocked tootli and rest slightly 
 upon the labial surfaces of the adjoining teeth, two short 
 tubes are soldered to it, one at each end. One of these tubes 
 is set vertically and the other horizontally. A piece of steel 
 wire, bent at a right angle at one end, and thread-cut and 
 provided with a nut at the other, is made to engage with the 
 tubes, the bent end slipping into the vertical tube and the 
 other passing into the horizontal one, with the nut resting 
 against its inner end. By unscrewing the nut the ends of 
 the ribbon are forced apart and the desired movements 
 accomplished. Fig. GO represents the Fig. 60. 
 
 appliance in position, and Fig. 61 the 
 separate parts of which it is con- 
 structed. In this device the direct 
 power of the screw is used to furnish 
 the necessary pressure. Fig. 61. 
 
 The credit for first devising an ap- <mmm.,mm^ 
 pliance that would draw a tootli out- 
 ward into line and at the same time 
 create space for it b}^ pressing apart the 
 adjoining teeth, is probably due to Dr. J. N. Farrar, whose 
 device and description may l^e found in the Dental Cosmos, 
 Vol. xxvi, page 072. 
 
 A lower incisor, Avhen locked inside of the arch by the 
 
120 
 
 OKTHODONTIA. 
 
 Fk;. G2. 
 
 over-lapping of its neighbors, is often so firmly held in its 
 mal-position that all ordinary means will fail to move it 
 unless space is first in'ovided for it by lateral pressure. This 
 
 being sometimes difficult 
 of accomplishment, the 
 direct power of the jack- 
 screw may be taken ad- 
 vantage of in such cases 
 to overcome the difficultv, 
 
 Jack-Sciew Forcing Out Inferior Lateral. 
 
 as shown in Fig. &2. 
 
 The patient in this case 
 was at least twenty-five 
 years of age and the lat- 
 eral incisor tightly in- 
 locked. A platinum band 
 was constructed to fit the lateral, and on its lingual .surface 
 was soldered a tongue of heavy platinum, so formed that it 
 would lie in contact with the tooth when the band was in 
 position. Into this tongue, near its free end, was drilled a 
 counter-suidc hole nearly deep enough to pass through the 
 metal. On the opposite side of the mouth the second bicus- 
 pid was similarly fitted with a band, to wliich was soldered 
 a strijD of platinized gold long enough to cover the lingual 
 surface of the adjoining molar. By this means the molar 
 was made to assist in resisting the force to be applied to the 
 lateral. The bicuspid band was also re-enforced by an 
 additional piece of heavy 2:»latinum .soldered to it at a point 
 diagonally opposite to the lateral. Into this latter piece a 
 horizontal slot was drilled with an engine-bur, sufficiently 
 deep and long to receive the fish-tail end of an ordinary 
 nickeled-steel jack-screw. After both l)ands were cemented 
 in place, the jack-screw was placed between them with the 
 flat end in the l)icuspid band and the point resting in the 
 counter-sunk hole of the lateral band. The ])atient increased 
 the tension of the screw from day to day by turning, and in 
 two weeks time the tooth was in line. It was held there 
 
PKACTICAL TREATJ[ENT. 
 
 121 
 
 until it became firm by means of platinum Ijinding wire 
 woven about it and its neighbors. 
 
 In the u])})er jaw, where single incisors stand within the 
 arch, they may be forced forward into line by some of the 
 appliances just described for use in the lower jaw, such as 
 the Matteson spring and tlie jack-screw, or by those referred 
 to for bringing out into line upper teeth during eru])tion, 
 such as tlie inclined plane, and the l)and and bar. 
 
 There are methods, however, of dealing with cases of this 
 character in adult life, that are preferable to those already 
 described. 
 
 One is by means of the Coffin plate as shown in Fig. 03, 
 and constructed as de- yiu. 6:i 
 
 scribed on page 103. The 
 advantages of a plate of 
 this character, are its in- 
 conspicuousness and great 
 power. if Ml iWUKKIKKKIUM v)^ 
 
 The only difficulty in 
 the use of this form of 
 Coffin plate, met with by 
 the author, has been where 
 the teeth to be moved, 
 although inside of the arch, stand perpendicularly or 
 incline slightly forward. In these cases the free ends of 
 the wires, after being pressed up into position on the teeth, 
 are frequently thrown down toward the cutting edge by the 
 force of the spring operating upon an inclined surface. 
 Where great inconvenience arises from this cause it may be 
 remedied by cementing a narrow platinum band about mid- 
 way of the crown of the tooth to be moved, and placing the 
 end of the wire spring above it. 
 
 Another plan of moving outward any or all of the supe- 
 rior incisors, is by means of a plate constructed after the 
 pattern of Fig. 64. 
 
 It is made of rubber, and has inserted in it a half-round 
 
 Curtii) Solid Plate. 
 
1-2 -2 
 
 ORTIIODOXTIA. 
 
 gokl wire, with the Hat side toward tlie teeth. The wire 
 Fig. 64. passes out from the plate on one 
 
 side at any point where there 
 may be space for it. and following 
 the outline of the teeth, but sepa- 
 rated from them by a space of an 
 eighth of an inch or more, re-enters 
 tlie plate at some convenient point 
 opposite. When in position, pres- 
 sure is Ijrought to l)ear upon the 
 teeth to be moved by means of rulj- 
 l>er bands passing over the gold 
 
 Plate and Bar «itli Rubber Rings. ^yirC and arOUud .SUCll teeth. 
 
 The cut shows the manner in which these l)ands are ap- 
 plied. The one with the single fold to encircle the tooth, is 
 used where less traction is desired ; and the other, with the 
 double fold, will have to be used to bring the tooth entirely 
 into contact with the wire. To prevent, as far as possible, 
 the bands from slipping off over the cutting edges of the 
 teeth, the wire should be so arranged in relation to the 
 plate that wlien in po.sition it will be on a line with the necks 
 of tlie teetlj, thus enabling the l)ands to pull u})ward as well 
 as outward. Should tlie rul)ljer bands still show a disinclina- 
 tion to remain on the teeth, the}' may be held in place by 
 ligatures tied around their necks and secured to the rubber 
 on the i^alatine side. 
 
 The jDlate is secured in position by beirfg ligated to a 
 posterior tooth on each side, holes being drilled through the 
 plate at points suitable for the purpose. If, after the teeth 
 are moved out far enough to touch the wire, it be desired to 
 move them still farther, the bar can be stretched by beating 
 it with a riveting liammer over the horn of a small anvil. 
 Or, the wire may he removed from the plate and a longer 
 one inserted. 
 
 The appliance is e(jually effective in drawing forward 
 either one, two or all of the incisor teeth at the same time. 
 
PRACTICAL TREATMENT. 
 
 123 
 
 Fig. 65. 
 
 Prof. R. B. Winder suggests the soldering of small pieces of 
 gold to the how wire directly opposite each tooth to be moved, 
 and occasionally at intermediate points. By the aid of such 
 cleats, he says, the rubber ])ands are more easily attached 
 and removed, and traction can be made in an ol)lique direc- 
 tion as well as forward. 
 
 Still another method, both simple and effective, of moving 
 an incisor outward into line, is by a combination of metallic 
 screws and a v u 1 - 
 canite plate, as shown 
 in Fig. 65. 
 
 A thin vulcanite 
 plate is constructed 
 to cover the roof of 
 the mouth and ca}) 
 the bic u s p i d s and 
 molars ; opposite the 
 tooth or teeth to hv 
 moved, tlio plate is 
 a 1 1 w e d to c o m e 
 down to their cutting- 
 edges. Directly opposite the centre of each of these teeth, 
 a hole is drilled entirely through the plate to receive a 
 piece of screw wire long enough to pass through and 
 project a little beyond it. In springing the! plate into 
 position the slightly projecting ends of the screws will press 
 against the teeth and they will be moved forward. A half 
 turn of the screws every day will soon force the teeth into 
 position. 
 
 The originator of this device is unknow^n, but it was first 
 brought to the notice of the author by Prof. Thos. Fillebrown. 
 
 Where a single incisor in the upper or lower jaw is 
 situated either inside or outside of the arch, and where there 
 is room for its accommodation and no obstacle exists to 
 prevent it from occupying its normal position, it may some- 
 times be brought into place by the simplest of all means 
 
 \'ulc;vnite Plate with Screws. 
 
124 OETIIODONTIA. 
 
 and without the making ov wearing of any appliance 
 whatever. 
 
 All tliat is needed is to instruct the patient to exert 
 pressure upon the tooth, with one of his lingers or thumbs, 
 in the direction in which it needs to go. The pressure thus 
 exerted should be great enough and continued sufficiently 
 long to cause the tooth to feel uncomfortable and be 
 re{)eated a half dozen or more times daily. The method is 
 a slow one and somewhat uncertain as the result will 
 depend entirely upon the zeal and faithfulness of the 
 patient, but notwithstanding these limitations, it has been 
 found thoroughly efficient in numl^erless cases, as many 
 practitioners can testify. The author has adopted the plan 
 frequently with charity patients and in most cases with 
 satisfactory results. 
 
 AVhen an incisor tootli in the loAver jaAv stands outside of 
 the arch, the malposition is usually due either to its having 
 been forced out of place by a superior one occluding back 
 of it, or to unusual crowding on the part of its neighbors. 
 In tlie first instance, the correction of tlie occlusion of the 
 superior tooth will usually press the lower one into its 
 proper place, while in the second instance, it will be nec- 
 essary to consider the advisal>ility of extracting one of 
 the crowded teeth to aftbrd room. If such an extraction 
 be deemed best, the case will be greatly simplified and 
 the mal-posed tooth can l)e brought into line by some one 
 of the means shortly to l)e descril)ed for di-awing inward the 
 superior incisors. 
 
 If it l)e deemed inex2:)edient to extract one of the crowded 
 teeth, room will have to be provided either by expanding 
 the arch or by extracting a tooth or teetli back of the 
 cuspids. 
 
 In considering the matter of ex])ansion of the arch, it 
 should be borne in mind that tlie enlargement of one arch 
 may also necessitate the expansion of tlie other in order to 
 preserve the normal occlusion. If both jaws will admit of 
 
PRACTICAL TREATMENT. 
 
 125 
 
 Fig. G6. 
 
 it to advantage, it may l)e the best plan to pursiu', altlioiigh 
 it will necessarily increase the labor and difticulty of the 
 operation. Generally, if the occlusion and facial expression 
 be satisfactory, it will hv far better not to disturV) the general 
 relation of the teetli, but rather to extract one or more of 
 the ].)icuspids or molars. After any of tlie posterior teeth 
 have been extracted, the anterior ones can be moved apart 
 or backward and the irregular tooth brought into place. A 
 simple and excellent way of moving l)ackward one or more 
 incisors, especially in the lower jaw, 
 is that devised by Dr. Kingsley and 
 shown in Fig. 66. 
 
 The appliance is a simple \u\- 
 canite plate made to fit the lingual 
 surfaces of the ten anterior teeth and 
 the adjacent gum. A portion of the 
 plate lying immediately back of the 
 tooth or teeth to be moved is cut 
 aw^ay to make room, and then slotted 
 to accommodate the rubber rings 
 that are to act upon the teeth. By adapting the diameter 
 and width of the rings to the force desired, any degree of 
 tension can l;)e Vjrought to bear upon the outstanding teeth. 
 Any of the inferior incisors, after being brought into line, 
 will usually be retained in place bj^ the occlusion of the 
 superior teeth, Init wliere this is not the case, they may be 
 retained by means of platinum binding wire woven about 
 all of the incisors at or near their necks, or they may be 
 securely held ])y means of a ribbon of tldn gold fitting the 
 lingual surfaces of the incisors, to which is soldered a 
 platinum fmnd to encircle each tooth that has been cor- 
 rected. The piece is set with phosphate of zinc as a lining 
 to the bands. 
 
 For drawing or forcing into line any of the superior 
 incisors standing outside of the arch, a variety of methods is 
 at our disposal. In the upper jaw the extraction of one 
 
 Kingsley's Vuloauite Plate 
 and RubbLT Bands. 
 
126 ORTHODONTIA. 
 
 or more incisors to provide room for other outstanding ones 
 is, except in rare cases, not to be thought of, aUiiough, as 
 just stated, in the lower jaw extraction may often be advan- 
 tageously resorted to. Tlic greater conspicuousness of the 
 superior incisors, and the difference in size between the 
 centrals and laterals would cause the absence of any one of 
 them to be most noticeable. Rare cases occur, however, in 
 Avliich such extraction is justifiable, as described on page 
 43, but a wise discrimination must be exercised in regard 
 to the matter, as otherwise a greater deformity is likely to be 
 created than the one already existing. Where space is 
 needed in the arch for the outstanding tooth or teeth and 
 expansion of the arch is not indicated, w^e may obtain it by 
 extraction back of the cuspids, or where the lack of space is 
 slight in amount it may be secured by simply exerting 
 pressure upon the adjoining anterior teeth. A simple way 
 of producing this pressure is by the use of compressed wood, 
 as described on page 69. 
 
 Another plan is by means of a vulcanite plate to which 
 are attached gold or steel wires so arranged that their free 
 ends, when drawn together and inserted in the space 
 intended to be widened, will press the adjoining teeth farther 
 apart. 
 
 Still another, without the use of a plate, wliich tlie author 
 has found very effective, consisting of platinum bands 
 attached to the teeth to be moved, with a piano-wire spring 
 acting between them, is described and illustrated on p. 161. 
 
 Dr. Farrar recommends for the same purpose a delicate 
 jack-screw with crutch ends to fit the teeth to be separated. 
 
 Other ways of accomplishing the separation Avill suggest 
 themselves to an inventive mind. 
 
 After the desired space has been obtained, the tooth may 
 be brought into place by means of a Coffin plate Avitli a 
 wire attached to its buccal portion, extending forward in a 
 curved line and resting near its free end upon the })roject- 
 ing toot) I. Bending the wire inward from time to time 
 will k('(!j) uj> the ])ressui'(' uj)i)ii the moving tooth. 
 
PRACTICAL TREATMENT. 127 
 
 To secure additional power in such cases, Dr. V. H. Jack- 
 son* has modified the above appHance by inserting two wires 
 in the plate, one on eitlier i^ide, and allowing the free ends 
 of each to rest upon the tooth to he moved as illustrated in 
 Fig. 67. Dr. B. 8. Byrnesf presents two methods, both 
 simple and ingenious, for bringing into line an outstanding 
 
 Fig. 68. 
 
 Fig. 67 
 
 Jackson's Modification of Cottin Plate. Byrnes' Baud Regulator. 
 
 incisor tooth. One, as shown in Fig. 68, consists of two gold 
 or platinum bands made to fit suitable posterior teeth intended 
 for anchorages, and connecting tliem with a gold ribbon, 
 nearly long enough to extend around the labial surfaces of 
 the intervening teeth. At some point in the length of this 
 ribbon a gold hook is soldered to engage with the cutting 
 edge of one of the anterior teeth and thus prevent it from 
 slipping up on the gum. By forcing the bands over the 
 teeth intended to receive them pressure is at once brought 
 to bear upon the tooth to be moved. When the elasticity 
 of the wire has spent itself, it should be removed, a small 
 piece cut from its length, soldered and re-inserted. This 
 may be done as often as necessary until the tooth is brought 
 into position. Additional pressure may also be obtained by 
 placing pieces of elastic rubber between the ribbon and the 
 moving tooth. 
 
 The second method consists in making a band to fit the 
 outstanding tooth and another for some posterior anchor 
 tooth. These bands are connected by a strip of thin cor- 
 
 * DenM Cosmos, Vol. XXX, p. 510. 
 
 t DenM Cosmos, Vol. XXVIII, p. 278. 
 
128 
 
 OETHODOXTIA. 
 
 nigated gold plate. When ready for use the hands are 
 slipped over their respective teeth and traction is exerted 
 by the elasticity of the corrugated metal. Tlie closeness of 
 the corrugations will regulate the force desired, which may 
 be increased at will by pressing the folds closer together. 
 Fig. 69 shows the appliance in position. 
 
 The author's usual plan in such cases is to solder pins or 
 
 hooks at suitable points on the two bands and cement the.se in 
 
 position. They are then connected by means of a rubber band 
 
 Fig. 69. extending from 
 
 tooth to tooth and 
 caught over the 
 projections on the 
 bands as shown in 
 Fig. 70. 
 
 By cutting the 
 rubber Ijands from 
 French rubber 
 tubing of different 
 dia meters, any 
 amount of tension 
 may be produced. 
 Dr. Kingsley* 
 has suggested 
 another method 
 of producing the 
 same result by the 
 combination of 
 gold wires with a 
 rubber plate as 
 shown in Fig. 71. 
 One end of the 
 long wire is im- 
 
 Magill B.inds and Rubber Riugs lor drawing in Central. 1 ) C d d C d in t ll C 
 
 plate while the other is converted into a hook. A short 
 wire similarly shaped and secured passes between certain 
 
 * Oral Deformiti&s, p. 87. 
 
 Bvm.>.'s' Cornigated B:uid. 
 
PltACTlCAL Ti; KATM KXT. 
 
 129 
 
 Fiu. 71. 
 
 posterior teeth on the opposite side and eonies forward to 
 nearly meet the first one. By connecting;- the two with a 
 rubber l)an(b ])ressure is bronolit to l)eai' upon the ])ro]n- 
 inent tooth wliich is oraihially forced inward into hue. 
 
 .\nother method of ])r. I\in,ijjsh\y's foi' ])rcssin<;- in one or 
 more of the anterior teeth is shown in Fig. 72. It consists of a 
 rul)ber phite with gohl 1)ow- 
 spring attaclied. 
 
 He says :* " The })hite was 
 accurately adjusted to fit and 
 catch between the bicuspids 
 and molars. The gold wire 
 in front was elastic a n d 
 springy. It was l^ent so as 
 to impinge upon the incisors 
 (or incisor), then cauglit in 
 front of them, pulled back, 
 and sprung into place. As 
 fast as the reduction '\\'as 
 accomplished, the wire 
 was bent at the sides 
 where the teetii had 
 been extracted, and also 
 contracted." 
 
 Protrusion of a single 
 incisor or more may 
 also be corrected by 
 means of a fixed ap- 
 pliance with the screw 
 as the operating prin- 
 ciple, as in the methods 
 of Drs. Patrick and 
 Farrar. 
 
 In using 'the Patrick 
 appliance for irregu- 
 larities of this character, 
 
 Kingsley Plate. 
 
 Fro. 
 
 Kingsley Plate. 
 
 Idem, p. 109. 
 
130 ORTHODONTIA. 
 
 the adjustable loop-bands and bow-spring are placed in 
 position and properly secured. The slide " H " is then 
 made to rest against the projecting tooth, the hook "' I "' 
 is caught over the cutting edge of some adjoining tooth 
 and tension is produced bv turnino; the screws '' D." (See 
 p. 85.) 
 
 Superior incisor teeth, after being forced backward into 
 line, may be retained most simply by means of the platinum 
 band and gold bar as shown in Figs. 13 and 14. (pp. 79 
 and 80.) 
 
 It is inconspicuous, occupies little space, and holds the 
 tooth or teeth immovably. 
 
 When sufficient time has been allowed for the tooth to 
 become firm, (never less than six months) the retainer should 
 be carefully removed as described on i:)age 91. For a few 
 months afterward the patient should be seen once a week, 
 in order to ascertain whether the tooth is remaining in its 
 new position. Should it manifest a tendency to recede, the 
 retainer must again be placed in position and kept there for 
 a further j^eriod of three months or more. 
 
 By thus carefully watching a case after its .supposed com- 
 pletion, we may often avoid the loss of some of the ground 
 we have gained. 
 
CHAPTER IV. 
 
 CUSPID TEETH SITUATED OUTSIDE OR INSIDE OF THE ARCH. 
 
 Of the various forms of irregularity tliat present for treat- 
 ment, none perhaps is more common than that in which the 
 cuspid teeth are located outside of the arch. The cause 
 most frequently responsible for this condition is the prema- 
 ture extraction of the temporary cuspids, altliough it is often 
 caused by delayed eru])tion of the permanent ones, and by 
 the lack of accommodation a small arch sometimes affords 
 for the full complement of teeth. The cuspids (superior) 
 being among the later teeth to a})pear, often find their terri- 
 tory pre-occupied by the earlier arrivals. Frequently, though 
 not always, the mal-position of the cu.spids is associated with 
 like mal-position of certain neighbors, usually the central 
 and lateral incisors. The irregularity of these adjoining 
 teeth is, in most cases, brought about by the pressure of the 
 cuspids in their attempt to occupy their places ; for, previous 
 to their appearance there is no inducement, if the occlusion 
 be normal, for the incisors to vary much from their true 
 positions. The fact should not be overlooked that all teeth 
 in erupting, are impelled by a strong hidden force to seek 
 their proper positions in the line of the arch, and in no 
 teeth is this persistence more plainly or powerfully exhibited 
 than in the cuspids. 
 
 The conditions being favorable each tooth will naturally 
 assume its place in line, and should obstructions interfere 
 it will strive to overcome them ; but the cuspid teeth will, if 
 necessary, exert a power far exceeding that of any of the 
 other teeth in their efforts to gain their proper positions in the 
 arch. To this end incisors are often disarranged, and bi- 
 cuspids forced inward or outward. This wonderful force 
 
 (131) 
 
132 oirrnoDOXTiA. 
 
 exerted by tlie cuspids, may well be illustrated by a case 
 which occurred in the practice of the author many years 
 ago :— 
 
 The patient was a young lady about fifteen years of age, 
 in whose upper jaw a cuspid had erupted outside of the arch, 
 causing projection of the lip. All of the other teeth were 
 regular, ])ut the Ijieuspids and molars on the affected side 
 were somewhat in advance of their true positions, and there 
 was eonse(|uently very little space in the arch for the accom- 
 modation of this cuspid. The first molar on the same side 
 was badly decayed, so it was decided to extract it as a pre- 
 liminary to making room for the cus})id. An appliance was 
 then attached to the second molar and second bicuspid, in- 
 tended to draw the latter tooth l^ackAvard. The patient left 
 wath this fixture in position and did not return until eight- 
 een months later, when it was noticed that both bicuspids 
 had moved backward and the cuspid occupied its normal 
 position in the arch. It transpired that the appliance, having 
 caused some pain, was removed by the patient two days after 
 it had Ijeen placed in })osition. The correction of the irregu- 
 larity had been entirely accomplished by the cuspid forcing- 
 its way into place and crowding the bicuspids backward in 
 the effort. 
 
 To obtain space for the accommodation of the cuspids when 
 they are situated outside of the arch, we usually have to 
 decide between the enlargement of the arch and the extrac- 
 tion of one or two teeth posterior to them. If the upper 
 arch is contracted and will admit of expansion to advan- 
 tage, it may be done by one of the methods described in 
 Chapter A^IT. of this part; l)ut if this l»e not indicated, we 
 will have to decide upon the extraction of a bicus])id or 
 molar in order to obtain space. 
 
 A careful consideration of tlic rules governing extraction, 
 on pages 45 and 46, will greatly assist tlie ()})erator in 
 deciding which tooth to extract. 
 
 It very frequently happens that the space in the arcli in- 
 
PRACTICAL TKEAT.M ENT. 
 
 Fig. 73. 
 
 tended to accommodate the cuspid is nearly, but not quite, 
 sufhcient. In such cases, slight additional space may gen- 
 erally be gained l)y pressing apart the adjoining teetli with 
 the tixture shown on page lOl. 
 
 Room having been provided, the cus})id tooth may be 
 l)rought into place by one of several methods that are equally 
 effective in the ui)per and lower jaws. Outstanding cuspids 
 are usually- situated a little in advance of their normal posi- 
 tions, so that in bringing them to place we must exert force 
 in a backward as 
 well as inward direc- 
 tion. Dr. Kingsley, 
 in his work,* shows 
 a neat and etfective 
 appliance for l)ring- 
 ing inferior cuspids 
 into line. It is illus- 
 trated in Fig. 73. 
 
 It consists of a nar- 
 row vulcanite })late, 
 fitted to the lingual 
 surftices of the teeth 
 
 and the adiacent DOr- Klngsley's vulcanite Plate and Rubber Bands. 
 
 tion of the ridge. In the posterior portion of the plate, gold 
 hooks are inserted over which rubber rings are caught, 
 drawn forward and tied to the cuspids. 
 
 Another simple way of bringing about the same move- 
 ment, is by means of the Coffin plate with the wire or wires 
 attached to the buccal portion and extending forward until 
 their free ends rest upon the teeth to be moved. Ordinarily^ 
 the pressure to be exerted by them would be inward only ; 
 but by bending their ends into the form of partial hooks, so as 
 to engage with the mesial surfaces of the teeth, an additional 
 backw^ard pressure is obtained. 
 
 Sometimes a cuspid may be drawn into position by so 
 simple a means as that shown in Fig. 74. 
 
 *Loc. cit. 
 
134 
 
 ORTHODONTIA. 
 
 Incieaseil \ui liuiasre 
 
 In this case a platinum band, with a pin on its labial face, 
 was cemented to the outstanding cuspid. To the iirst bicus- 
 FiG 74. i^id on the opposite side 
 
 was fitted a similar band 
 with a small gold hook on 
 the palatine surface and 
 a bar of platinized gold on 
 the buccal surface long- 
 enough to extend to and 
 rest upon the adjoining- 
 cuspid and second bicus- 
 pid. This provided the 
 resistance of three teeth, 
 whilst attachment was made to but one. A light vulcanite 
 plate was made to cover the arch, so as to protect it from 
 the irritation of the rubber ring, which was stretched from 
 band to band. The operation of bringing the tooth into 
 line was somewhat slow, occupying- some four or five weeks 
 time, but the object was satisfactorily accomplished. 
 
 In- most cases, however, greater force than that exerted by 
 a rul)ber band will Ije necessar}^ to draw a cuspid into place, 
 especially if it be large and firmly implanted. In such 
 event the power exerted by a screw, in some form, will prob- 
 ably yield the best results. 
 
 Fig. To rei^resents a case of this character, where, in addi- 
 tion to the firmness of 
 the tooth, the patient re- 
 sided at such distance 
 from the dentist that a 
 visit to him could be 
 made only at intervals of 
 two or tlu'ee weeks. It 
 ^vas tlierefore necessary 
 t(j devise an appliance of 
 such character that it 
 could not be removed or 
 
 Gold Box and Screw L'rawint; in Cuspid. misplaCCd, and witll a 
 
I'RACTICAL TREATMF:NT. 
 
 135 
 
 sufficiency of power that might l)o regulated by the patient 
 herself. The a})pliance sliowu in cut, consists of two plati- 
 num l)an(ls made to tit the misplaced cuspid and opposite 
 molar respectively, and cemented to these teeth. To the 
 palatine surface of each of these bands was soldered a gold 
 ring, which served as point of attachment for the gold box 
 and screw, which operated between them. 
 
 One end of the gold Ixjx was l)ushed and thread-cut to 
 receive the gold screw, which at the opposite end was bent 
 into the form of a hook to engage with the ring on the cus- 
 pid band. The other end of the box was fitted with a smooth 
 gold wire, with a head on one end to serve as a swdvel, 
 and a hook on the other to attach to the ring on the molar 
 band. Turning the box with a wrench drew the screw in- 
 w^ard, and with it the cuspid tooth. Using a single molar 
 as anchorage in the movement of a cuspid was scarcely in 
 accord with correct practice, but in this case there was no 
 alternative. In drawing the cuspid to place the molar was 
 also moved somewhat inward and forward, l)ut it soon 
 resumed its former j^osition after l^eing relieved from duty. 
 The corrected tooth was 
 retained in place by 
 having cemented to it 
 the small band and bar 
 appliance shown in 
 position and separate in 
 Fig. 76. 
 
 The tooth in the })re- 
 ceding case was retained 
 in the same manner. 
 Six months sufficed for 
 
 each tooth to o'rO^\' firm completed case with Retaiuing Appliance. 
 
 in place. Quite frequently a cuspid tooth is located so far 
 anteriorly to its proper place that the principal movement 
 required of it is in a backward direction. To effect this move- 
 ment Dr. Farrar makes use of his device, as illustrated in 
 
 Fig. 76. 
 
13G 
 
 OKTIIODUNTIA. 
 
 Farrai's Tractimi Apparatus. 
 
 Fig. 77. It consists of a narrow ribbon of ,ii,'ol(l, lon<>; enough 
 to enclose the cuspid tooth and some tootli l.)ack of tlie space 
 
 it is to occui)v. 
 The ends of this 
 ribbon n e a r 1 y 
 meet on the buccal 
 side of the teeth, 
 and after being re- 
 enforced with 
 studs of heavy 
 gold, the anterior 
 one Ijeing simply 
 drilled and the 
 posterior one drill- 
 L'(l and threaded, 
 tliey are connected 
 1 )y means of a gold 
 screw. The turn- 
 ing of tlie screw brings the ribbon ends nearer together, and 
 causes corresponding traction on the misplaced tooth. The 
 ribbon, at suitable places, has ears or tips attached to it, in- 
 tended to rest upon the masticating or inclined surfaces of the 
 enclosed teetli and prevent the band from slipiiing u}) and 
 irritating tlie gum. Dr. Patrick's ai)pliance, as shown in 
 Fig. 22, is also well adapted to produce backward movement 
 
 of a cuspid or other tooth. 
 Prof. Angle a c c o m - 
 plishes the same result 
 by means of bands, tubes, 
 traction screw and nut, as 
 described and illustrated 
 on ])age iXJ. 
 
 The author's device for 
 the backward movement 
 of teeth is shown in Fig. 
 7'S. It does not involve 
 
 AiUhor-8 Appliance lor Retrnctioii. ,],,, niakin!'- or USe of a 
 
rRACTICAl. TRKATMENT. 
 
 137 
 
 Fiff. 79. 
 
 plate, screws or nuts, and is very simple in design and con- 
 strnction. A platinum band, with short gold wires soldered 
 to the buccal and lingual surfaces, is cemented to the 
 tooth to be moved, while a similar one is attached to a 
 molar or other anchor tooth. The wires on the anterior 
 band are bent forward, and those on the posterior one 
 are curved backward. Two rubber rings, cauglit over 
 the gold hooks, connect the two bands and vield the tractile 
 power recpiired. These rubber rings can be removed and 
 replaced for cleansing the teeth, or can be renewed at will 
 by the patient. Two rings can be attached to each pair of 
 hooks, if greater power be retpiired, or the same object can. 
 be attained by cutting wider rings from thicker tubing. 
 
 Prof. E. T. Darby's plan for producing the same movement 
 is by the use of 
 a rubber plate, 
 a gold encase- 
 ment for the 
 cuspid, and a 
 gold screw for 
 connecting the 
 two and produc- 
 ing the required 
 tension. Fig. 79 
 is drawn from 
 one of his 
 models, and re- '''''''''' ^■"''""'" '"' R*^"-*^«°"- 
 
 presents the fixture in position. The case was that of a 
 young lady, fourteen years of age, who applied for the cor- 
 rection of irregularity of the anterior teeth. As will be 
 noticed in the illustration, both laterals and the right cen- 
 tral were inside of the proper line of the arch, while the left 
 central was outside of it. Space was needed to bring these 
 teeth into position, and to obtain it the left cuspid had to be 
 moved backward in the arch. Op})ortunity for so doing was 
 afforded by the absence of the first bicuspid. 
 
138 
 
 ORTllorx^XTIA. 
 
 To move tlie cuspid backward, and to assist in accomplish- 
 ing other movements, a rub])er plate covering the arch and 
 capping the molar teeth was constructed, and into it on the 
 buccal surface was inserted a gold stud or ear, drilled and 
 tapped. A gold helmet, to cover the entire crown of 
 the cuspid was then constructed, with a i^rojection on the 
 labial .surface drilled for the passage of the traction screw. 
 After this helmet was cemented in place with phosphate of 
 zinc, and the plate inserted, the two were connected by means 
 of a long gold screw. Twice each day this screw was turned, 
 until the cuspid was brouglit almost in contact witli the 
 second bicuspid. 
 
 While this movement was j^rogressing, other objects were 
 being accomplished. The rubber plate when first inserted, 
 had a piano wire spring attached to its palatine surface, to 
 force forward the right central. This accomplished, the 
 spring was removed and rubber added to the plate, to keep 
 this tooth in its new position. Two new piano wire springs 
 were next inserted, to spread apart and press forward the 
 laterals, as shown in cut. They were brought into posi- 
 FiG. 80. tion by the time 
 
 the cuspid had 
 been drawn suffi- 
 ciently backward. 
 J \ The helmet and 
 
 ^ screw were now re- 
 
 z.^ moved and a piece 
 
 of piano wire, 
 doubled and bent 
 to proper shape, 
 ( was inserted in the 
 ''N:Ti?r^/ hole of the gold 
 stud in the rubber 
 plate, in such a way that the folded end would rest upon the 
 outstanding central and force it into line. 
 
 The case as corrected is .shown in Fig. 80. The entire 
 
 \ 
 
 Corrected Case. 
 
TRACTICAL TREATMENT. 139 
 
 Avork of cori'ec'tioii, with its varied movements occupied 
 but five montlis time, and was accomplished by the use of 
 a single plate with it^ different attachments. To retain the 
 teeth in position, a rul>l)er }>late was worn, covering the 
 arch and having a gold T inserted to pass between the 
 centrals. 
 
 When a su})erior cuspid erupts inside of the arch, the 
 difficulties attending its being brought into position are far 
 greater than when it eruj^ts externally. This is partly due 
 to the fact that the space between it and the opposite side of 
 the arch is sometimes too limited to admit of the use of 
 some of our best power-producing appliances, and partly 
 also to the amount of alveolar process that will have to be 
 resorbed before the tooth can assume its i)roper position. 
 
 The power to be applied to an in-lying cuspid to force it 
 outward must necessarily l)e very great to carry with it an}^ 
 prospect of success. A solid Coffin plate with a very stiff 
 piano wire imbedded in it will yield the greatest amount of 
 spring power, and where this proves insufficient, we must 
 needs resort to the jack-screw in some of its forms. The 
 ordinary jack-screw, applied between Magill ])ands, some- 
 what after the manner illustrated in Fig. 62, has, in the au- 
 thor's hands, accomplished the best results in such cases. 
 
CHAPTER V. 
 
 MISPLACED BICUSPIDS. 
 
 The bicuspid teeth, both superior and inferior, are often 
 found located outside or inside of the normal arch line, but 
 their mal-position is not of as frequent occurrence as that of 
 the anterior teeth. 
 
 Their position out of line, as in the case of most forms of 
 individual irregularity, is due to lack of space, or the crowd- 
 ing of other teeth. Sometimes, through tardy eruption, their 
 space in the arch has been encroached upon by the pressure 
 of the erupting cuspids in front, as well as the forward-moving 
 tendency of the molars. In such cases, one or both of the 
 bicuspids are compelled to assume a position outside or 
 inside of the arch, the latter being the one they most com- 
 monly take. 
 
 Again, their predecessors, the deciduous molars, frequently 
 have their crowns destroyed by caries long l^efore the time 
 for their natural removal, while their roots remain. Induce- 
 ment is thus offered to the adjoining teeth to occupy part of 
 the space, and the l)icuspids are forced to erupt in an abnor- 
 mal position. 
 
 In other cases, they may have taken their places in line, 
 f)r nearly so, and are sul)se(|uently forced out of place by the 
 effort of the cuspids to occui)y their places in the arch. Tlio 
 ease with which they may be forced out of position is readily 
 understood when we consider that their roots are conical and 
 rather short, and that they are i)laced between teeth that are 
 firmly set and have either a single long root firmly implanted, 
 like the cuspids, or several roots, like the molars. Their dis- 
 
 (140) 
 
PRACTICAL TREATMENT. 141 
 
 tinctly convex approxinial surfaces also greatly favor their 
 displacement. 
 
 The second bicusjdd is more frequently found out of line 
 than the iirst, probably because of its later erui)tion. 
 
 The lack of alignment of one or both bicuspids is some- 
 times associated with a greater or less degree of torsion ; but 
 this is not of common occurrence, and when met with is 
 either corrected in the act of bringing the tooth into line, or 
 will have to be remedied by a separate operation afterward. 
 
 The greater or less difficulty of bringing into line one or 
 more bicusi)id8 situated inside of the arch, will usually be 
 entirely dependent upon the amount of space existing for 
 their accommodation. If much of their space in the arch 
 has been pre-occupied by adjacent teeth, these will first have 
 to be pressed apart to afford accommodation. Should full 
 or nearly full space exist for them in the arch, they may 
 "usually be forced into line by the elasticity of a vulcanite 
 plate, or of metal in some form of spring. Where it is de- 
 signed that the moving tooth shall make room for itself 
 as it advances, the greater power of the jack-screw will be 
 required. 
 
 A simple method of moving a bicuspid, either upper or 
 lowTr, outward into line, is to obtain a |)laster model of the 
 jaw. The plaster tooth representing the one to be moved, 
 should then be cut away on its 2>alatine or lingual surface, 
 until this portion of it is in line with the same surfaces of 
 the adjoining teeth. A vulcanite plate made upon this 
 model, w4th a piece of piailo wire imbedded in its central 
 portion, if it be for the lower jaw, will, by its elasticity, soon 
 bring the tooth into position. Or, we may make the plate 
 upon the unaltered model, and then insert a wooden peg in 
 a hole drilled in the plate opposite the tooth to be operated 
 upon. Or, instead of the wooden })eg, a metal screw may be 
 inserted so as to act upon the tooth. By setting the screw 
 well into the rubber plate, it may be elongated by turning 
 from time to time until the object is attained. 
 
142 
 
 OETHODONTIA. 
 
 Fig. 81. 
 
 Talbot's Vulcanite Plate and Coiled Spring 
 
 Fig. 82. 
 A 
 
 Dr. Talbot lias devised an excellent method of forcing one 
 or more bicuspids into line by means of a coiled spring of 
 
 piano Mire, in connec- 
 tion with a rubber plate 
 to hold it in po.sition 
 and properly direct its 
 action. Fig. 81 repre- 
 sents the appliance in 
 position. Dr. Talbot 
 says : * "A thin, narrow, 
 close-fitting vulcanite 
 plate was made, and a 
 hole drilled through the 
 middle of it, opposite the centre of the tooth to be moved. 
 In the other side, another hole was drilled, but not quite 
 
 through the plate. A suitable spring, 
 Fig. 82, was then made of piano wire, 
 having a single coil A, and the ends 
 of its arms bent at about a right an- 
 gle. One of these ends, C, was cut 
 short to enter the corresponding hole 
 in the plate, and the other end, B, 
 left long enough to go through the plate and impinge on the 
 lingual surface of the bicuspid, leaving a full eighth of an 
 incli between that arm of the spring and the plate, as is 
 clearl}'^ shown by Fig. 81, where the .spring is in position to 
 act upon the tooth to be moved. Both the .spring and the 
 plate may be removed instantly, either for cleansing pur- 
 poses or to increase the power of the spring by spreading its 
 Pj^ ^ arms, or to open the coil so that the 
 
 tooth may be held steady at the 
 point to which it may have been 
 moved. Fig. 83 .shows a spring 
 having two long ends, B B, which 
 coikd Spring. |^ dcsigucd for a case in which 
 
 two such teeth are to be moved in opposite directions." 
 
 * Dental Cosmon, Vol. XX VIII, pp. S-fi-T. 
 
 ../\.. 
 
 Coiled Spring. 
 
PEACTICAL TRKATM KXT. 
 
 143 
 
 In eases wliere the .suj)erior power of the jack-screw is to 
 
 be taken advantage of, Dr. Kingsley's method of using it in 
 
 combination with a 
 
 1 , , 1 1 • , Fig. 84. 
 
 slotted V n 1 c a n 1 1 e 
 
 plate, is certainly one 
 
 of the best. 
 
 The accompanying 
 
 illustrations. Figs. 84, 
 
 85 and 86, c o p i e d 
 
 from Dr. Kingsley's 
 
 work,* represent 
 
 some of the ways in 
 
 which he a c c o m - 
 
 plishes movements, slightly varying in character. Fig. 84 
 
 was used to move outw^ard a left superior second bicuspid ; 
 
 Fig. 85 operated to move outward both bicuspids of the left 
 
 Fig. 86. 
 
 Fig. 85. 
 
 Kingsley's Slotted Vulcanite Plates with Jaok-Screw. 
 
 side inferior, the first more than the second ; while Fig. 86 
 moved all four of the inferior bicuspids. 
 
 A jack-screw should not rest against and operate upon 
 naked teeth for evident reasons, but Avhere it is desired to 
 avoid the use of a plate, Magill bands, re-enforced, drilled 
 and counter-sunk, may be cemented to the teeth to be moved 
 and the jack-screw inserted between them. Prof. Angle's 
 
 * Loc. cit. 
 
144 ORTHODONTIA. 
 
 device for expanding the arch, as shown and described on 
 page 99, may also be advantageously used for moving out- 
 ward one or more of the bicuspids. It will be noticed that 
 in the operation of this appliance any instanding teeth are 
 moved outward into line before real expansion of the arch 
 begins: if therefore, the moving of individual teeth is alone 
 desired, operations can be suspended as soon as that object 
 is accomplished. 
 
 The small size of the jack-screw in the Angle device is 
 also an element in its favor, since it will interfere less with 
 the movements of the tongue than the larger ones commonly 
 used. 
 
 In addition to the power of the jack-screw, it has the 
 further advantage of rapidity of action ; so that, if its posi- 
 tion in the mouth should somewhat inconvenience the 
 patient, it would do so only for a very short time. 
 
CHAPTER VI. 
 
 TORSION. 
 
 The term torsion, as applied to the teeth, signifies that 
 condition in which a tooth is found to be turned upon its 
 axis. Rotation refers to the act of twisting or turning a 
 tooth so as to bring it into normal position. Torsion, there- 
 fore, describes the condition, and rotation the operation. 
 
 Torsion is usually due to some abnormal influence opera- 
 tive before or during eruption. Lack of space will often 
 impel a tooth during eruption to turn in such a way as to 
 present its smaller diameter toward the space intended 
 for its accommodation, in order to occupy that space at 
 all. A root, or even a portion of one, will also often cause 
 a tooth to partly turn in its socket while seeking its position 
 in the arcli. Torsion of the superior central incisors, so often 
 met with, is doubtless due in the majority of cases to undue 
 thickness of the median alveolar septum. The condition is 
 also produced after eruption by the crowding of adjoining 
 teeth, induced by some unusual pressure, such as the effort 
 of a later erupting tooth to occupy its place in the arch. 
 
 Torsion is met with in all degrees of extent, from the 
 slightest prominence of one corner of a tooth to a complete 
 half-turn. 
 
 It occurs, generally, in single rooted teeth, or in those with 
 a slightly bifurcated root ; and among these, those with roots 
 most nearly round are the ones commonly affected on 
 account of the ease with which they can be made to turn 
 upon their axes. 
 
 At times cases are met with in wdiich two adjoining teeth 
 are thus affected, usually each in like degree, this variety of 
 the condition being known as Douljle Torsion. 
 
 (145) 
 
140 ORTHODONTIA. 
 
 Rotation is usually not a very diflieult ()i)ei'ation in itself, 
 but when complicated liy the crowd iiii:; or disarrangement 
 of adjoining teeth it sometimes proves (juitc troublesome. 
 
 Where there is sufficient space m the arch to accommodate 
 the tooth after it has been turned, we have simply the mat- 
 ter of rotation to deal with : but when such is not the case, 
 our first efforts must be directed toward providing space. 
 This may be done, if the deficiency be slight, by pressing 
 apart the impinging teeth by some of the means described 
 on page 40 ; but where great space needs to be provided, and 
 expansion of the arch is not indicated, it will be necessary 
 to extract some less important tooth to afford opportunity 
 for bringing the turned tooth into line. In the case of teeth 
 with flat crowns, as the incisors, we may adopt either of two 
 plans for turning the tooth, viz.: grasping the crown through- 
 out its entire circumference and applying suitable power, or 
 by direct pressure upon one or both of the angles that are 
 out of line. With teeth having round crowns, such as the 
 cuspids, we are limited to the plan of making attachment to 
 the periphery of the crown. 
 
 At one time it was difficult if not almost impossible to 
 grasjj a tooth so securely as to have the attachment resist tlie 
 strain of the applied power, but since the introduction of 
 the Magill band this greatest of all difficulties associated 
 with rotation has been overcome. 
 
 One of the simplest and most eff'ectual methods of rota- 
 ting a flat-crowned tooth is by the use of a rubber plate 
 made to cover the palate and envelope the posterior teeth on 
 either side, according to the CoHin plan. To the palatine 
 portion of the plate a piano Avirc is attached in sucli a way 
 as to bear upon the inner corner of tlie tooth to be turned, 
 while a similar wire imbedded in tlie buccal portion of the 
 plate, is arranged to press u]»oii tlie corner that projects. The 
 bending of the wires from time to time, to increase the ten- 
 sion, will speedily accomplish the desired result. 
 
 Where only one corner of a tooth stands out of line, the 
 plate just descrilxHl may l)e modifi(Hl by having l)Ut a single 
 
PEACTICAL TKKATMENT. 147 
 
 wire to press inward the outstanding corner, and allowing the 
 rubber plate to rest firmly against the corner that is in line, 
 to prevent it from turning. 
 
 Opportunity for the projecting portion of the tooth to 
 move inward, must of course be provided by cutting away 
 the rubber plate at this [)oint. 
 
 Another way of rotating a tooth, is to fit a band or ferrule 
 of gold or platinum to it, with a headed i)latinum tooth-pin 
 soldered to its labial face near the angle that is out of line. 
 A delicate vulcanite plate is then made to fit the roof of the 
 mouth, and into it at a suitable point is screwed a threaded 
 gold wire with a slight curve or hook on its end. After the 
 band is cemented to the tooth, it is connected with the gold 
 hook in the plate by means of a rubber ring. Should it be 
 desirable to change the point of attachment on the plate, it 
 can be done by drilling a new hole at the desired point, and 
 screwing a hook into it. The plate can be removed for 
 cleansing and new rubber rings applied by the patient. 
 
 To avoid the inconvenience of wearing a plate during 
 the school-age, the author many years ago devised a small 
 and inconspicuous appliance for rotating a sin- pj,-, g?. 
 gle incisor. It is shown in outline in- Fig. 87, -^ 
 and is constructed as follows : ^^^^^>^^y 
 
 A strip of platinized gold about an eighth of -riie aiuIioi-s 
 an inch in width, and gauge Xo. 24 in tldck- ^^^^^^^^ D^^i^e. 
 ness, is bent to conform to the outline that we wish the 
 turned tooth and its neighbor to describe when in normal 
 position. Each end of this strip is bent to partly encircle 
 the di.sto-palatine angle of each tooth, after which another 
 strip of gold, of similar width but thinner, is soldered to the 
 centre of the first piece. This last piece should be long 
 enough to extend between the teeth and embrace the pro- 
 truding edge of the tooth to be turned. 
 
 By bending this arm so short that the ai)plianceAvill have 
 to be sprung into place, pressure is brought to bear upon the 
 tooth that \\\\\ cause it to rotate in its socket. The appliance 
 
148 ORTHODONTIA. 
 
 should be removed each day, tlie length of the arm shortened 
 by bending, and replaced. To guard against loss or accident, 
 a ligature of sewing silk should be tied around the neck of 
 one of the teeth and made fast to the appliance. About 
 ten days will usually suffice to bring the tooth into proper 
 position. 
 
 Tlie teeth, once in place, are readily retained by means of 
 the small retainer shown in Fig. 88. In its Fig. 88. 
 construction, .similar bands are made to fit 
 both the corrected tooth and its neighbor, 
 
 n, i-1ji --ti 11 1 The Author's 
 
 after which they are jomed by solder at the Retaining Fixture, 
 point where they touched when in place. To add stifiness, 
 another strip of gold should be soldered to the palatine sur- 
 face of the fixture. When completed and polished, it is 
 lined TNdth phosphate of zinc, and placed in position upon 
 the teeth. 
 
 By the use of this retainer, which occupies but little space, 
 the tooth is held so rigidly in its new position that it becomes 
 firm much more rapidly than it would under other circum- 
 stances. Should the force exerted by the effort of the cor- 
 rected tooth to return to its former mal-position be so great 
 as to affect the tooth used as anchorage, this tendency may 
 be jDrevented by soldering a spur of gold to the appliance at 
 a suitable point, and allowing this to rest against some firm 
 tooth near by. 
 
 A case in the practice of the author will illustrate a ready 
 
 means of correcting an extreme case of torsion. The patient 
 
 was a Japanese bov, nine 
 Fig. 89. ,. , *' 
 
 years oi age, whose upper 
 
 denture, when he applied 
 for treatment, presented 
 the appearance shown in 
 Fig. 89. The left decidu- 
 ous lateral was .still in 
 place, while the right per- 
 manent lateral was just 
 
 Torsion caused by Supernumeran-. appearing thrOUgh the 
 
PRACTICAL TREATMENT. 
 
 149 
 
 Fm 
 
 Bands and Rubber Ring for Rotation. 
 
 gum. Both permanent centrals were fully erupted, but 
 owing to the presence of a supernunierarv tooth in the centre 
 of the areli the right central Avas crowded far out of its 
 place and turned on its axis. 
 
 After extracting the supernumerary and the deciduous 
 lateral, platinum bands were fitted to the centrals, with a gold 
 hook soldered to each at points that would furnish the great- 
 est amount of tractile power. 
 After the bands were cemented 
 in place a rubber ring was 
 stretched from tooth to tooth, in 
 the manner shown in Fig. 00. 
 
 The malposed tooth was thus 
 readily brought into contact 
 with its fellow, and at the same time considerably straight- 
 ened. Its further and complete rotation was then accom- 
 plished by an appliance somewhat similar to that shown in 
 Fig. 87, after which it was retained h\ the retainer sliown in 
 Fig. 88. As the left central had been somewhat loosened in 
 the act of rotating its fellow, it was found necessary, in order 
 to secure stable anchorage, to attach a spur to the appliance 
 and have this rest against the palatine surface of the right 
 lateral, which was by this time almost fully erupted. In 
 six months the teeth were firm in their new position, as 
 shown in Fig. 91. 
 
 A simple and very effectual method of accomplishing the 
 rotation of any tooth, without regard to the form of the 
 crown, and one too, in which the use of a plate is dispensed 
 with, is illustrated in Fig. 92. 
 
 It consists of a platinum or gold l^and made to fit the 
 tooth to be rotated, and having Fig. 91. 
 
 an extension bar of heavy plat- 
 inized gold soldered to its labial 
 surface. The free end of the bar 
 is perforated by two holes for 
 
 ligation to some firm tooth, corrected case. 
 
 usually a molar. In use, the band is cemented to the tooth 
 
150 
 
 ORTHODONTIA. 
 
 and the bar sprung down and ligated to the tooth selected 
 for anchorage. The immense leverage of this l)ar will 
 
 quickly compel the 
 
 Fig. 92. 
 
 tooth 
 socket, 
 becomes 
 time to 
 can l)e 
 
 to turn in its 
 
 As its force 
 
 spent from 
 
 time the bar 
 
 bent outward 
 
 Spring Bar and Band for Rotation. 
 
 with pliers, without re- 
 moving it from the 
 tooth. After the tooth 
 has been brought into 
 proper alignment, it is 
 most conveniently held 
 in position Ijy means of the retainer shown in Fig. 13. It 
 may also l^e retained by a rubljer plate having a gold spur 
 to pass between the teeth and rest upon the portion of the 
 tooth that has been moved inw^ard. 
 
 Prof. Angle has improved this a})pliance by making the 
 band and bar detachable. 
 
 The band is fitted wath a section of German-silver tubing 
 soldered to its labial surface, parallel with the cutting edge 
 of the tooth. Another band, with a hook or catch soldered 
 to its buccal surface, is fitted to a bicuspid or molar. This 
 latter Ijand also has a piece of tubing, soldered horizontally 
 to its palatine surface, through which is passed a piece of 
 wire intended to rest against the two teeth adjacent to the 
 one banded and thus afford greater resistance. After both 
 of these bands are cemented to their respective teeth, a 
 straight piece of piano wire is inserted in the tube of the 
 tooth to be turned, and bent down and caught in the catch 
 on the other tooth. The advantage of this modification is, 
 that a weaker or stronger wire can be substituted at will, and 
 the power be tlius readily controlled. When the tooth is in 
 proper Hue, the wire is removed and replaced by a shorter 
 one resting upon an adjoining tooth. This acts as a retainer 
 
JM; ATTICA I. TREATMENT. 
 
 151 
 
 Fig. 93. 
 
 This wire 
 Fig. !)4. 
 
 by keejtiii^ii,- tlic tootli in position until it lias grown firm. 
 
 The retaining wire is 
 
 secured ])y means of a 
 
 pin, inserted in a hole 
 
 drilled through l)oth 
 
 tuhe and wire. Dr. Far- 
 
 rar's [)lan of })rocUu'ing 
 
 single rotation is shown 
 
 in Fig. 1)3. 
 
 . A shp-noose, made of 
 
 Tery thin gold or l^Iati- Farmr's Appli^mee for Rotation. 
 
 iium about one-twelfth of an inch in width, has a threaded 
 gold wire and nut soldered to its free end 
 and nut engage with a stri}) of gold plate, 
 bent to conform to the lingual surfaces of at 
 least two teeth on either side of the tooth to 
 be operated upon, as shown in the illustra- 
 tion. The turning of the nut draws the 
 protruding angle of the tooth inward. The noose and bar 
 are shown separately in Fig. 94. 
 
 DOUBLE TORSION. 
 
 Where two adjoining teeth, as the superior centrals, are to 
 be rotated in opposite directions, a single appliance will often 
 accomplish both movements at the same 
 time. The appliance devised by the author 
 for this purpose is shown in Fig. 95, and the 
 details of construction in Fig. 96. It is a 
 modification of the appliance for single rota- 
 tion shown on p. 147. To adapt it for duty 
 in turning two teeth, instead of the single 
 strip of gold passing between the teeth, 
 two strips are bent in the form of " b " 
 and " c." These are made long enough 
 to be bent slightly over the labial surfaces 
 of the teeth to be turned, extend along the mesial surface to 
 
 Fig. 95. 
 
 The Author's Device 
 for Double Rotation. 
 
 Fig 
 
152 OKTIIODONTIA. 
 
 the palatine, and then along this latter almost to the distal 
 angle. After being properly shaped aeeording to the model, 
 they are clamped together and soldered along their contigu- 
 ous surfaces. This part is then placed in position on the 
 model, and the long arms bent to conform to the inner sur- 
 face of the bar " a," after which it is removed, soldered to 
 " a," and the part " b " " c " reduced in thickness by filing, so 
 as to occupy as little space between the teeth as possible. 
 When properly constructed the labial part of the appliance 
 will rest against the teeth just at or slightly above the most 
 prominent part of their convexity, wliile the lingual por- 
 tion will be near the gum but not quite touching it, and the 
 slightly curved ends of this part will catch just above the 
 little prominence usually found at the disto-palatine angle 
 near the gum. 
 
 Thus made and placed, the piece cannot become displaced 
 by the lip or tongue, except when it has become loosened 
 by the moving of the teeth. As will readily be seen, by 
 its use force is brought to bear upon four points of the 
 two teeth at one time, acting as a double lever upon each 
 tooth. 
 
 A valuable feature of the appliance, had in view in its 
 devising, is that it occupies but one interdental space, and 
 thus more readily favors the turning of teeth that are more 
 or less crowded. 
 
 In use, the patient should l;e seen each day, the fixture 
 removed and tightened by bending the long arms slightly 
 toward the smaller ones and sprung into place. 
 
 To facilitate its introduction in the first instance, a piece 
 of rubber should be placerl between the teeth one day pre- 
 vious to the insertion of the appliance. 
 
 As in the case of the appliance for single rotation, a thread 
 should be tied around one of the teeth and attaclied to the 
 front bar to guard against the swallowing or lo.ss of the 
 piece. Fig. 07 rej)resents a case of double torsion which was 
 corrected in ten days time by the use of the appliance just 
 
PRACTICAL TKEATM ICXT. 
 
 153 
 
 described, the patient l)eiiig seen every <]ay ; while Fio;. 98 
 shows the completed operation. After tlie teeth are in posi- 
 
 Fio. 97. Fio. 98. 
 
 Corrected Case. 
 
 Fig. 99. 
 
 Double Rotation. 
 
 tion, they may be retained by 
 means of the retainer shown on 
 p. 80, Fig. 15, or a vulcanite plate 
 with gold " T " inserted (Fig. 99), 
 may be used instead. The for- 
 mer has the advantage of hold- 
 ing the teeth more firmly, while 
 the latter occupies but one in- 
 terdental space. 
 
 When the distal corners of 
 the teeth project instead of the 
 mesial, the appliance described Retaining piute. 
 
 is rendered equally serviceable by reversing its position and 
 placing the long arm on the laljial surface. Fig. 100 repre- 
 sents a case of this character, while Fig. 101 shows the rub- 
 ber plate with gold wire bow that was used to retain the 
 teeth after correction. 
 
 Prof. Angle has devised a very sim})le and effectual 
 method of accomplishing double rotation, where the mesial 
 angles protrude. Upon each of the teeth to be rotated he 
 places Magill bands with tubes soldered to their labial faces 
 near the distal angles. One tube is set vertic-ally and the 
 
154 
 
 OKTIIODONTIA. 
 
 other liori/.ontall y. A sliort piece of piano or German silver 
 wire, l)ent to a right angle at one end, is inserted into these 
 
 Fig. 101. 
 
 Fi<i. 100. 
 
 Torsion of Centrals, with Distal Angles 
 pointing Outvviud. 
 
 Fro. lU-2. 
 
 Angle's Appliance for iJouble 
 notation. 
 
 Ketaining Plate on CorreL'ten La;;e. 
 
 tubes, and rotation is effected by 
 the elasticity of the wire. The 
 device is shown in Fig. 102. 
 
 Once in position, the teeth are 
 retained by inserting in the tubes 
 a suitably shaped piece of non-elas- 
 tic gold wire. 
 
 Dr. King.'^ley * accom- 
 plislies the same result 
 l)y the use of a vulcanite 
 ])late and an elastic rub- 
 1 )er l)and. Into the plate 
 at convenient p o i n t s , 
 are inserted gold hooks 
 and staples, and over 
 these and around llu' 
 teeth the rubber l)aiid 
 is woven in such a way 
 as to ])ress outward the 
 instanding corners of 
 
 Kingsley's Vulcanite Plate and Elastic Band. j^J^^ incisorS. Fig. 103 
 
 well illustrates tlie device. 
 
 * Loc. cit., p. 103. 
 
CONTRACTION OF THE ARCH. 
 
 A coiitracted arch may be due to lack of development, 
 caused by late or ]nal-eru})tion of some of the teeth ; to the 
 loss of certain of tlie })ermanent teeth soon after their erup- 
 tion ; or to mal-position of the teeth in the o})})osite jaw. 
 
 Tlie late eruption of the superior cus})id teetli, where their 
 spaces have been pre-occupied by teeth anterior and j)os- 
 terior to tliem, is })erlia})S tlie most frecpient cause of this 
 deformity. 
 
 In some cases, the contraction is limited to the molar and 
 bicuspid region ; in others, to tlie anterior alone ; while in 
 others still, the entire arch needs expansion. 
 
 The enlargement of the arch, either at certain points or in 
 its entirety, may be accomplished Ijy a variety of methods. 
 
 Where lateral expansi(jn is desired, it may usually be 
 brouglit about in a simple manner by the use of the Coffin 
 split-i)late, the construction and operation of which are 
 described on }). 101. 
 
 Another form of appliance, intended to accomplish the 
 same purpose and constructed of piano wire and vulcanite, 
 has been devised by Dr. Talbot, and is illustrated in Figs. 
 104 and 105. 
 
 In his description. Dr. Talbot says : * "A (vulcanite) plate 
 is made to fit the teeth and alveolar process, and cut away 
 so that the anterior parts extend far enough forward to en- 
 close the teeth to be moved. A piece of (piano) wire is bent 
 into either of the forms shown in Fig. 105, wherein " a " is 
 the coil and fixed point, " b b " movable arms extending 
 from "a," and "cc" movable arms extending from "b b." 
 
 * Tall)ot's Irregularities of the Teeth. P. 129. 
 
 (155) 
 
156 
 
 ORTHODONTIA. 
 
 Grooves are cut into the anterior and posterior parts of 
 the plate, to correspond with and receive the points " b b " and 
 " c c." Holes are drilled at these points, and the wires tied 
 to the rubber plates. In order tliat tlie anterior teeth may 
 Fic. 104. Fig. 105. 
 
 Talbot's Appliance for Lateral Expansion Talbut Springs. 
 
 be moved with the greatest force, the arms are so adjusted 
 that the greatest pressure is exerted on the anterior parts of 
 the plates. This appliance is readily removed for cleansing, 
 and returned to place by the patient.'' 
 
 Where more force is required than can be obtained from 
 either of the appliances just described, it can be had by 
 the more direct power of the jack-screw, operating upon 
 the portions of a rubber plate lying next to the teetli to be 
 moved. 
 
 Dr. Kingsley's neat and effective appliances of this char- 
 acter are shown on p. 143. 
 
 The use of the jack-screw in the lower jaw would appear 
 to be objectionable on account of its being in the way of the 
 tongue ; but experience has proven that this objection is, in 
 fact, a slight one. 
 
 The use of the .screw hastens the operation, and thus les- 
 sens tlie period of inconvenience in any given case. 
 
 When expansion of the anterior portion of tlie arch is 
 
PRACTICAL TREAT^[ENT. 
 
 157 
 
 Goddard's Split Vulcanite Plate. 
 
 desired, it may be accoin}>lislied by means of the appliance 
 
 shown on p. 122, or by a modification of the Coffin split })]ate 
 
 devised by Prof. C. L. (Jod- 
 
 dard. TliV latter is shown in ^'''- ^^^'■ 
 
 Fig. 1()(). 
 
 As will be seen, there are 
 two corrugated piano wires 
 attached to the rul)ber plate, 
 one on each side near the free 
 margins, while the plate is 
 split laterally just back of the 
 incisor teeth. As in other 
 split i)lates for anterior ex- 
 pansion, this plate is made in 
 one piece and the wires ar- 
 ranged so that their anterior 
 ends are imbedded in the portion to be detached, while the 
 posterior ends are fastened to the main body of the plate. 
 After the completion of the plate the front portion is sepa- 
 rated by means of a jeweler's saw, and pressure is produced 
 by stretching the wires from time to time. 
 
 The anterior portion is kept down to its place by being 
 ligated to the central incisors. In using this form of plate 
 the author has found it more convenient to hold the front 
 portion down by imbedding hi the plate a gold spur, to pass 
 between the centrals in the free space near the gum. He 
 also prefers to secure the main portion in position by making 
 the plate to cover and grip the bicuspids and molars, as in the 
 Coffin method, instead of fastening it to the side teeth with 
 ligatures. The aj^pliance is most admirably adapted to the 
 purpose for which it was devised. 
 
 Dr. Bonwill's appliance for producing anterior expansion 
 of the arch possesses certain features not met with in other 
 appliances. Fig. 107 represents the device in position, but 
 not under tension.* " It is made of two flat bars of platinized 
 gold, sliding over each other for at least two inches. A 
 
 * Gorgas' Harris Principles and Practice, p. 467. 
 
158 
 
 ORTHODOXTIA. 
 
 loop is soldered to tlie end of each flat bar as guides, to hold 
 them in position while sliding through. A rubber band is 
 shown attached to tlie end of each bar at A A, which, 
 
 in contracting, en- 
 ^^^''- ^*'''- larges the circle, 
 
 and consec|uently 
 not onh' throws 
 out the incisors,but 
 the bicuspids and 
 cuspids as well. 
 
 "The attach- 
 ments are made 
 on either side to a 
 molar or bicuspid, 
 owing to the ease 
 of clasping. Be- 
 fore the api^aratus 
 is placed f)6i'™ia- 
 nently in position, 
 the four incisors 
 are ligated with a loop, using gum sandarac varnish to pre- 
 vent slipping or turning on the tooth. These are now tied 
 to the sliding bars, bringing the latter closely in contact 
 with all the teeth intended to be moved. 
 
 " The ruljber band is next tied between the two points A A, 
 and the application is complete." 
 
 The expansion of the entire arch at one time is seldom 
 called for, but Dr. Kingsley, in his work,* records a case in 
 which he accomplished it by simply inserting rubber wedges 
 between all of the teeth in the arch, replacing them with 
 larger ones as space was gained. See Fig. 108. 
 
 Prof. J. B. Littig has accomplished the same result by the 
 use of wooden wedges instead of rubber. 
 
 A better plan, in tlic ()})iui()n of tlic autlior, where expan- 
 sion of the entire arch is desired, is to accomplish it by 
 separate ojierations. Lateral ex]iansion, for instance, can 
 *Loc. fit., p. 12P. 
 
 Bonwill's Appliance for Anterior Expansion. 
 
PRACTICAL TKEAT.M KXT. 
 
 159 
 
 Fig. 108. 
 
 be aeeoinplished first, and after the l)iciLspids and molars 
 liave been brought into proper position, tliey may be retained 
 by means of a rubber plate covering tlicm. This plate will 
 not only hold them 
 firmly, but serve 
 as an anchorage to 
 which other fix- 
 tures may be at- 
 tached for the ex- 
 pansion of the an- 
 terior portion o f 
 the arch, as in the 
 Goddard plan. 
 
 The details of a 
 case of general ex- 
 pansion of the su- - 
 })erior arch, may 
 be of interest to 
 the student. The 
 
 , • , 1 Expansion of Arch hj' Rubber Wedges (Kingsley). 
 
 patient was a boy 
 
 of about fifteen years of age. The inferior arch was of 
 normal size, with the teeth well arranged. In the superior 
 arch, all of the teeth except the cuspids articulated inside 
 of the lower ones, giving the patient a pinched or contracted 
 appearance in the region of the upper lip. The laterals were 
 almost in contact with the first bicuspids, while the cuspids 
 had fully erupted outside of the arch and were overlying 
 the laterals. 
 
 Extraction was not indicated, for all of the teeth were 
 needed to fill the arch after its expahsion. 
 
 By means of a Coffin split-plate, lateral expansion was 
 accomplished in about a month, so that the bicuspids and 
 first molar on each side, occluded normally with those be- 
 low. Next, with another Coffin solid plate encasing the 
 teeth that had been moved, and with two piano wires 
 attached, the laterals were pressed forward ; after which, new 
 
100 ORTHODONTIA. 
 
 rubber was added to the plate to keej) these teetli in position, 
 and the wires ehanged to press the centrals forward into line 
 with the laterals. After this had been accomplished there 
 was still insufficient space for the accommodation of the cus- 
 pids, and as the incisors were ah^eady so far forward that 
 pressure could not advantageously be brought to bear upon 
 them from the rear, another plan for increasing the cuspid 
 space was decided upon. Magill bands were made to fit the 
 laterals, with a gold spur extending along the palatine sur- 
 faces of the centrals to insure uniform movement of the 
 four incisors. Platinum bands were also attached to the 
 first Ijicuspids. All of these bands we re-enforced with an 
 additional piece of platinum soldered to the portion next to 
 the space. Through these re-enforcements, at about the 
 centre of the tooth, holes were drilled entirely through the 
 bands. Piano wire was next bent into the form of small 
 U-shaped springs with the ends at right angles, similar to 
 Dr. Talbot's plan, but without the coil. Grasping these 
 near the neck with a pair of narrow-beaked right-angle forceps, 
 transversely grooved near the points to seize the wire, the 
 springs were placed in position with their ends resting in 
 the holes of th e bands. As, from time to time, the force of th ese 
 springs became spent, they were removed and their power 
 renewed by enlarging their curves. Sufficient additional 
 space having been gained by their use, the cuspids were 
 forced into position by means of a Coffin plate with wires 
 attached to the buccal surfaces, extending forward and rest- 
 ing uj^on the labial surfaces of the cuspids. 
 
 The appearance of the arch and teeth with the U-springs 
 in position, is shown in Fig. 109. The operations were not 
 hurried, and consumed about one year's time. 
 
 A retaining ])late of vulcanite covering the roof of the 
 mouth, with gold loops attached to overlie and retain the cus- 
 pids, is now l>eing worn. 
 
 Another case, differing somewhat from the one just given, 
 was tliat of a young girl about eleven years of age, whose 
 
PRACTICAL TKEATM KNT. 
 
 IGl 
 
 Fui. 109. 
 
 superior arch did not need lateral expansion, but required 
 anterior enlargement to accommodate the in-coming cuspids. 
 False occlu- 
 sion of the 
 superi(^r in- 
 cisors a Iso 
 needed c o r - 
 rection. Fig. 
 110 r e p r e - 
 sents the case 
 as it presen- 
 ted. The su- 
 perior c e n - 
 trals met the 
 
 loWPT n n P S Increasing Space by Curved Spring and Bands. 
 
 edge to edge, while the superior laterals passed inside of 
 the lower ones. There was very little room between the 
 superior laterals and first 
 bicuspids to accommodate 
 the cuspids, which, slow 
 of eruption, were just be- 
 ginning to make their 
 appearance. 
 
 The treatment required 
 was the moving of the lat- 
 erals and centrals so as to 
 overbite the lower ones, 
 and the moving backward of the bicuspids on each side, to 
 afford space for the cuspids. The laterals were first moved 
 forward in line with the centrals, by means of the jdate 
 shown in Fig. 111. This accomplished, the anterior |)ortion 
 of the arch was expanded by a Goddard split plate. 
 
 A plain rubber plate, covering the arch and touching 
 each tooth was next made, and into it were secured on either 
 side pieces of piano wire bent to a right angle at their free 
 ends, the bent portions being arranged to rest upon and press 
 
 Fig. 110. 
 
 Case Requiring Anterior Expansion. 
 
162 
 
 ORTHODONTIA. 
 
 Fig. 111. 
 
 against the mesial surfaces of the first bicuspids to force them 
 backward. The plate having been trimmed to admit of the 
 backward movement of the bicuspids, full space for the cus- 
 pids was soon gained. 
 
 The slow eruption of the cuspids required a retaining 
 
 l»late to l)e made, armed 
 with gold spurs at suitable 
 points, to keep the regu- 
 lated teeth in their new 
 positions and await the full 
 eruption of the cuspids. 
 Til is is now being worn. 
 
 In the course of six 
 montlis or less the cus- 
 pids will prol)ablv have 
 
 Coffin Plate for pressing Laterals forward. • i i' i • 
 
 assumed, unaided, tlieir 
 proper places in the arch, and by their key-like position 
 will preserve the present arrangement without the further 
 aid of any retentive appliance. 
 
 The case had previously been in the hands of two den- 
 tists, who began operations for correction, and it therefore 
 became necessary for the author to carry it forward to 
 completion. 
 
 Had he been consulted in the beginning, he would have 
 advised non-interference until two years later, when the cus- 
 pids would have been partially erupted, and more nearly 
 ready to assume their places in the arch, as soon as room 
 was provided. 
 
 In this way the wearing of a retaining plate, to await the 
 full eruption of the cuspid.s, would have been avoided and 
 the case simplified. 
 
CHAPTER ^^III. 
 
 PKOTRUSION OF THE UPPER JAW. 
 
 The causes tending to produce this condition, have been 
 briefly considered on p. 22. 
 
 There are two varieties of this deformity : — 
 
 Isf. Where tlie lower teeth are in line forming the normal 
 curve, while the upper ones pass over and beyond them in 
 such a way as not only to interfere with enunciation, but also 
 to render them almost unserviceable in mastication. This 
 form is usually attributable to inheritance ; to the abnormal 
 size of the teeth in the superior arch ; or to the mechanical 
 influence of pressure on the part of the posterior teeth. It is 
 the one most easily corrected, on account of the o})erations 
 being confined to a single arch. 
 
 2nd. Where the lower incisors are flattened in outline or 
 introverted, and the superior ones extend so far forward as 
 to leave a large space between the two when the jaws are 
 closed. In this case, the superior protrusion appears to be 
 greater than it really is, on account of the superior and in- 
 ferior teeth inclining in different directions. Where there 
 is introversion of the inferior incisors we generally find their 
 cutting edges on a higher plane than that of the neighbor- 
 ing teeth. This does not signify that these teeth are elon- 
 gated, but simply that their position causes them to reach a 
 higher level. 
 
 This condition is, in most cases, due to the habit of thumb- 
 sucking, the thumb pressing the lower ones in and the upper 
 ones out at the same time. 
 
 The relative height of the cutting edges of the lower in- 
 cisors causes them, in most cases, either to occlude with the 
 base of the crowns of the superior incisors, or to come in 
 contact with the soft tissues back of them. This condition 
 
 (103) 
 
1G4 
 
 ORTHODONTIA. 
 
 seriously complicates the niatter of correction, for it inter- 
 poses an obstacle to the inward movement of the superior 
 teeth, and the outward movement of the inferior ones. 
 
 Where tlie protrusion is slight and the teeth are in con- 
 tact, space for their inward movement may sometimes be 
 obtained by dressing off any discoloration or superficial de- 
 cay from the approximal surfaces of the six anterior teeth 
 with sand-paper discs or emery-cloth strips, followed by thor- 
 ough polishing. 
 
 By this means the author has, in a few instances, materi- 
 ally improved the i)atient's expression, without loss of teeth 
 or injury to tooth-substance. The space once gained, the 
 teeth can easily be brought inward by the use of a Coffin 
 plate, cut away posteriorly to the incisors, and having gold 
 hooks attached to the anterior portions of the plate on the 
 buccal surface. A rubber band caught over the hook on 
 one side, carried along the labial surfaces of the anterior 
 teeth, and attached to the hook on the opposite side, will 
 generally provide the required tension. Small double hooks, 
 made from half-round gold wire and hung over the cutting- 
 edges of the centrals, will, by their second curves, support 
 the rubl^er band in proper place and keep it from resting 
 upon and irritating the soft tissues. Other simple means 
 for effecting the same result, will readily suggest themselves 
 to the operator. Where the protrusion is of greater extent 
 and the teeth are in contact, it will be necessary in most 
 cases to sacrifice a bicuspid or molar on one or both sides of 
 the mouth to obtain sufficient space to enable the anterior 
 teeth to be moved backward into line. 
 
 After the extraction of the tooth or teeth it is well to draw 
 backward, by easy stages, the teeth on either side anterior to 
 tlie space, to and including the cuspids. The subsequent 
 drawing in of the four incisors will then be a comparatively 
 easy matter. In inany cases, if the posterior teeth were 
 used as anchoi'ages for the inward movement of six or ten 
 anterior teeth, they would be more likely to move forward 
 
I'K ACTIC A L TRK AT>[ KNT. 
 
 165 
 
 Fig. 112. 
 
 than to cause the anterior ones to be forced l)ack\var(l, on 
 account of the disparity of resistance. 
 
 A number of methods for moving- backward the cuspid 
 and bicus})id teeth are described on pp. 136 and 137. A simple 
 plan for draAving 
 in tlie four supe- 
 r i o r incisors, i s 
 shown in Fig. 112. 
 Platinum 1 ) a n d s 
 are fitted to the 
 
 laterals, and to y^^\ ^^(^^^K' ^^ ^^ 
 
 their labial por- llil^^ ) "^^W^^^^^l- ' i;'^ 
 
 tions are soldered 
 extensions of gold, 
 to cover and rest 
 upon the labial 
 
 „ . , Author's Device for Retracting the Superior Incisors. 
 
 suiiaces of the ad- 
 joining centrals. A plain rul )ber plate is also made to cover 
 the palatine arch, with a gold hook inserted in its centre. 
 The bands being cemented in place, rubber rings are slipped 
 under the extensions and carried to a point between the cen- 
 trals and laterals, where they are drawn in and over the 
 gold hook in the plate. By their contraction, all four of 
 the incisors a r e 
 drawn inward while 
 but two of them are 
 banded. 
 
 A plan differing 
 somewhat from the 
 one just described, is 
 that of Dr.Kingsley's, 
 illustrated in Fig. 
 113. The band over- 
 lying the incisors is 
 
 of O-old and has hooks Kingsley's GoIcI Bar and Vulcanite Plate lor Retraction. 
 
 soldered to the upper edge, to pi'event its slipping up to the 
 gum. It is also htted with a thin strip of gold to pass 
 
 Fig. 113. 
 
166 
 
 (JirmODONTIA. 
 
 Fig 114. 
 
 between the centrals, Avhile its free end is connected with 
 the centre of a vulcanite plate by means of a ring cut from 
 rubber tubinu'. This ruljljer ring is made fast to the plate 
 either by means of a ligature or by slii)ping it into a horse- 
 shoe slot cut in the plate for the purpose. 
 
 In many cases the elasticity of rubber is not sufficient 
 to move the four teeth as rapidly as desired. In such an 
 event, the direct and forcible action of the screw may be 
 brought into play by means of the device of Dr. S. G. Perry, 
 
 shown in Figure 
 114. It is a vul- 
 canite plate cover- 
 ing the arch and 
 encasing the mo- 
 lars, to which is 
 attached a half- 
 round gold wire 
 bent to a curve and 
 l^ng enough to ex- 
 tend a 1 o n g the 
 outer surfaces of 
 the teeth from mo- 
 lar to molar. One 
 end of this curved wire is j^ermanently attached to the vul- 
 canite plate, while the other terminates in a threaded wire, 
 which engages with a gold nut playing in a slotted recess 
 of the plate on the opjDosite side. Turning the nut shortens 
 the bar and draws the teeth inward. 
 
 When still greater power is demanded, as in cases where 
 it is desired to draw the six anterior teeth inward by one 
 operation, or where the incisors do not yield readily to any 
 i:>ower that can be applied within the mouth, anchorage for 
 resistance must be obtained outside. Dr. Kingsley, we be- 
 lieve, was the first to suggest and utilize the back of the 
 head as an anchorage for appliances intended to produce 
 movements of the teeth. Illustrations of a fixture of this 
 character will lie found in his work, |)p. 133 and 134. 
 
 Perry's Appliance for Ketractiou. 
 
PRACTICAL TK KATM l<:XT. 
 
 167 
 
 ])r. J^'anar al.-so (U'vised an apparatus for the same pur- 
 pose, but it is somewhat complicated in its construction and 
 manner of adjustment. 
 
 One of tlie sini])lest devices of tliis character, is that of 
 Prof. ( '. L. (iroddard.* In describing the construction and 
 use of his a[)pliance, lie says: "On a cast of tlie su])erior 
 incisoi-s a small sheet of wax was placed, covering the labial 
 surfaces, cutting edges and part of the lingual surfaces. In 
 the anterior surface of this wax })late, a steel wire was im- 
 bedded, curved to conform to the arch, and extending later- 
 ally about one inch and a half on each side. The ends of 
 this wire were bent in the form of hooks. The wax plate 
 and wire were then imbedded in a flask by bending the 
 ends of the wire sufficiently to allow them accommodation 
 inside of the flask. By the methods usually employed in 
 vulcanite work, a plate 
 was thus made of Idack 
 rubber with the Avire 
 attached, as shown in 
 Fig. 115. 
 
 " When placed on the 
 patient's teeth, the ends 
 of the wires projected from the corners of the mouth on each 
 side far enough to permit elastic bands to connect them 
 with a cloth cap on the patient's head without touching the 
 cheeks. 
 
 " The ca}) was so shaped that the elastic could be attached 
 to it in two })laces on each side, one above an(J. one below the 
 ear, by means of dress hooks sewed to the cap at these 
 points. Round silk covered elastic cord was used, and the 
 direction of the force could be varied by using a greater 
 number of stands above or Ixdow the ear, according to the 
 requirements of the case. The amount of force was easil}^ 
 
 Fig. 115. 
 
 Goddard's Steel and Vulcanite Appliance for 
 Retraction. 
 
 * Annual of the Universal Medical Sciences, for 1888, Vol. III., pp. 547- 
 551. F. A. Davis, Philadelphia, publisher. 
 
108 
 
 ORTHODONTIA. 
 
 varied by shortening or lengtliening tliese cords. Fig. 116 
 shows the apphance in position. 
 
 " This appliance was worn at niglit < »nly. and the teeth were 
 soon moved back to the desired position. Tlie inferior 
 incisors striking the bases of the sni^erior ones, as they 
 were moved back, were moved with tlicm. After the teeth 
 were in proper position, the tension of the elastic cord was 
 slightly lessened, and the appliance worn at night for a few 
 months as a retaining appliance until the teeth became firm. 
 
 Fio. 116. 
 
 Goddard Appliance in Position. 
 
 " The greatest usefulness of this ap[>liance is in cases where 
 there are no teeth in the mouth sufficiently firm for the 
 anchorage of an appliance of ordinary form, or where the 
 teeth, if firm enough, are of such shape tliat it is practi- 
 cally impossible to fasten appliances to them." 
 
 The author recently corrected the worst case of superior 
 protrusion he ever met witli. using an apphance differing 
 from Prof Goddard's only in certain njinor particulars. 
 
PRACTICAL TREATMENT. 
 
 109 
 
 Superior Protrusion caused by Thumb-Sucking. 
 
 The patient was a boy, sixteen years of age, whose supe- 
 rior teeth projected beyond the lower ones at least three- 
 quarters of an inch. The inferior incisors were relatively 
 long, and their cutting edges, in occlusion, imbedded them- 
 selves in the soft tissues of the palate quite a distance inside 
 of the superior teeth. Botli arches were wide and well- 
 formed, with the exception of the superior protrusion, and 
 
 all the teeth were 
 
 , , T/- Fig. 117. 
 
 Ill contact, t^ ig. 
 
 117 shows the re- 
 lation between the 
 upper and lower 
 teeth at the time 
 of presentation for 
 treatment. All of 
 the teeth b e i n g 
 equally good, the 
 first bicuspids were 
 removed to create space. An aj»pliance of vulcanite and wire, 
 similar to Prof. Goddard's, was then made ; the wire, after it 
 was properly fashioned, being nickel-plated before vulcani- 
 zation. The scull-cap, instead of cloth, was made in skele- 
 ton form, of inch-wide black silk ribbon, each strip being 
 double and lightly stuffed witii cotton to make it more com- 
 fortable to the patient. The elastics used were the ordinary 
 flat and wide rubber bands, cut and perforated near the 
 ends to engage with the hooks on the cap. The teeth being 
 large, strong and firmly set, especially the cuspids, moved 
 slowly ; but in live months' time, by the use of the above 
 appliance alone, the teeth were moved back into proper posi- 
 tion, the cuspids coming into close contact with the second 
 bicuspids. The cutting edges of the lower incisors were 
 ground off somewhat, to enable the superior ones to be 
 moved inward. 
 
 The boy being in attendance upon school at the time of 
 the operation, and not wishing to subject himself to the rid- 
 
170 
 
 ORTHODONTIA. 
 
 Fig. 118. 
 
 icule tliat the wearing of such a cons]:»icuous appliance would 
 surely luring u})0)i liim on the part of his schoolmates, an 
 accessory appliance was devised for liim to wear during 
 school hours. It consisted of a tliin silver saddle cover- 
 ing the protruding centrals, to which, on the lahial surface 
 near the terminations, were soldered two platinum headed 
 pins. The first molars were fitted with platinum hands, to 
 which platinum hooks were also attached on the buccal sur- 
 face. The bands were cemented to their respective teeth, 
 
 while the saddle was 
 removable. This ap- 
 pliance, in position, 
 is shown in Fig. 118. 
 In use, the saddle 
 was placed in position 
 and the pins upon it 
 and the molar bands 
 connected by means 
 of thin rings cut 
 from French rubber 
 tubing of small diam- 
 eter. This fixture was 
 simply intended t o 
 retain, during the 
 day, the progress 
 made by the more 
 })Owerful appliance at 
 night. It Avas put on 
 in the morning before 
 starting for school, 
 and after school hours 
 was replaced by the 
 pressure api)liance, 
 which was worn until 
 
 Corrected Case. 
 
 morning. 
 Both a])])liances were removaljle for cleansing, and were 
 readjusted and opci-aicd by the patirnl liimself They gave 
 
 Day Retaining A|)pliance. 
 
 Fig. 119. 
 
PRACTICAL TREATMENT. 171 
 
 liini no pain or inconvenience to speak of, and required very 
 little oversight on the part of the operator. 
 
 The day appliance is now being worn as a retainer. For 
 the first three months, it will l)e worn 1)oth day and niglit, 
 and for the succeeding three months at night only. 
 
 Fig. 119 shows the relation of the teeth after the operation 
 was completed. 
 
CHAPTER IX. 
 
 PROTRUSION OF THE LOWER JAW, OR PROGNATHISM. 
 
 This condition, one of the most unsio-htly of dental deform- 
 ities, giving to the individual a rather inhuman expression 
 and interfering greatly with speech and mastication, is quite 
 frequently met with. The causes probably responsible for 
 its inducement are given on pp. 23 and 24. 
 
 When the deformity is slight it may be corrected, or at 
 least modified, by pressing the lower incisors inward and the 
 upper ones outward ; but where the case is pronounced, there 
 seems to be no remedy for it but the retraction of the entire 
 inferior maxilla. This may be best accomplished by using 
 some form of scull cap, and connecting it with a padded 
 chin piece by means of strong rubber bands. The persist- 
 ent contraction of the rubber will, in a greater or less time, 
 dependent largely upon the extent of the deformity and the 
 age of the patient, bring about the desired change. 
 
 In the accomplishment of this retraction, it was formerly 
 supposed to be brought about by a change effected at the 
 angle of the jaw; but the more plausible hypothesis, is the 
 one fir.st advanced by Dr. Geo. S. Allen, namely : That the 
 jjressure applied to the mental region, causes resorption of 
 the posterior wall of tlie glenoid cavity, thus permitting the 
 condyles to recede and articulate somewhat posteriorly to 
 their former position. This theory as to the physiological 
 change brought about, is supported by the fact that an alter- 
 ation of form in the glenoid cavity is more readily accom- 
 plished by resorption, than a bending of the maxilla at one 
 of its strongest points. 
 
 An interesting case of retraction of the lower jaw, was 
 brought before the Odontological Society of New York, in 
 1878, bv Dr. Allen. I quote important points from his 
 
 (172) 
 
PRACTICAL TREATMENT. 
 
 173 
 
 description : " iVs will be .seen from the photograph (Fig. 
 120), taken at the time she was wearing this apparatus, it 
 consists of two parts. For the lower part, I made a brass 
 l)late to tit tlie chin, having arms with hooked ends reaching 
 to a })oint just below the point of the chin. These arms 
 Avere arranged in such a way, that the distance between them 
 could be altered at will, l)y simply pressing them apart or 
 together. The u})per part consisted of a simple network, 
 
 Fig. 120. . 
 
 I I ower Jaw. 
 
 going over the head and having two hooks on each side, one 
 hook being above and the other below the ear. When this 
 apparatus was completed and in use, there were four liga- 
 tures of ordinary elastic rubber, pulling in such a way as to 
 force the lower jaw almost directly backward. The work 
 proceeded very rapidly, so that at the end of two months, 
 the irregularity was almost entirely cured. I see no reason 
 why, in all such cases, either this or similar methods of pro- 
 
174 
 
 ORTHODONTIA. 
 
 Fig. 121. 
 
 cedure slioiild not be adopted. I should certainly, if any- 
 similar eases presented hereafter, even at twelve or thirteen 
 years of age, before attempting any other procedure, try this 
 first and thoroughly." 
 
 The Drs. Winner, of Wihnington, Del., have furnished 
 
 the writer with models 
 and description of a 
 case somewhat similar 
 to the foregoing (Figs. 
 121 and 122). In their 
 case, the patient was a 
 boy fourteen years of 
 age, tall, slender, pos- 
 sessing good g e n e r a 1 
 health, but only fair 
 i;)hysical strength. The 
 models show that there 
 was a bicuspid lacking 
 on each side above, 
 while below there still 
 remained two tempo- 
 rary molars. He stated 
 that he had never had 
 any teeth extracted by 
 a dentist, so it is probable 
 that the two bicuspids 
 were never erupted. 
 The superior centrals 
 were considerably worn 
 away on their cutting 
 edges and labial sur- 
 faces by attrition with the lower ones. After extracting 
 the deciduous molars below, a plate was made covering the 
 upper posterior teeth, and so arranged that in addition to 
 furnishing a masticating surface while the teeth were apart, 
 it also acted as an inclined plane in helping the lower jaw 
 
 Prognathism. 
 
 Fig. 122. 
 
 C;ise Corrected. 
 
PRACTICAL TREATMENT. 
 
 175 
 
 Fig. 123. 
 
 to move backward. From first to last he wore an occipito- 
 mental sling, as illustrated in Garretson's Oral Surgery, in- 
 creasing the tension from slight at first to as tight as could 
 be worn without too great discomfort. At the end of nine 
 weeks the articulation was normal, but the sling was worn 
 for several weeks longer, without increased tension, to retain 
 the satisfactory 
 result secured. 
 
 Fig. 123 illus- 
 trates the most 
 pronounced 
 case of this class 
 of deformity 
 the writer has 
 ever met with. 
 The patient was 
 a man of about 
 fortv vears of 
 
 " Excessive Prognathism. 
 
 age, and was 
 
 brought by a neighboring dentist for consultation as to 
 whether anything could be done to remedy the defect. The 
 lower jaw was very large in all its aspects, while the upper 
 was correspondingly small. Although the lower incisors 
 inclined decidedly inward, the distance from the cutting 
 edge of the lower incisors to the cutting edge of the upper 
 in a horizontal line, was a little over half an inch. From 
 the upper jaw there were missing the right lateral, second 
 bicuspid and first molar ; while on the left side, the second 
 bicuspid and tv/o molars were absent. In tlie lower jaw, the 
 patient had lost two molars and a bicuspid on the left side, 
 and the first molar on the right. All the teeth of the upper 
 jaw passed inside the lower, except the first bicuspids, whose 
 external cusps articulated slightly with the anterior lingual 
 cusps of the opposite molars below. 
 
 The advanced age of the patient, conjoined with the con- 
 ditions just described, placed his case beyond surgical 
 
176 OKTIK^DOXTIA. 
 
 remedy and ]\v was so int'ornuMl. A ]»latc' covering and 
 maskingthe natnral tooth al)Ove with artihcial tooth niountod 
 outside to artiouhito with the lower ones was suggested, hut 
 the idea (Ud not please him. and ho concluded to pass the 
 remaining portion of his life as ho did the hrst, so far as his 
 dental apparatus was concerned. 
 
ClLVrTER X. 
 
 MISCELLANEOUS. 
 
 LACK OF ANTERIOR OCCLUSION. 
 
 Fig. 124. 
 
 In certain rare instances, cases are met with in wliich 
 the anterior teeth do not come in contact u])on closure of tlie 
 jaws. The bicuspids and mohirs of liotli jaws may articu- 
 late properly, but in the front part of the moutli upon occlu- 
 sion, there exists a space more or less great between the 
 cutting edges of the incisors. The space is greatest at the 
 median line and gradually diminishes toward the cuspids. 
 The condition not only gives a lisp to the speech of the 
 individual but renders these teeth entirely' useless for pur- 
 poses of mastication. 
 
 At first glance the incisors have the appearance of being 
 too short in their 
 crowns, but an exam- 
 ination will show that 
 they are of normal 
 size and length and 
 that the process and 
 possibly the maxilla 
 itself is responsible 
 for the shortened ap- 
 pearance. 
 
 In most cases it will 
 
 be found that both Lack of Anterior Occlusion. 
 
 arches are normal in form and size, that there is no protru- 
 sion or introversion eithei' al)Ove or l)elow, and that the 
 superior teeth alone are at fault. Fig. r24 represents a 
 
 (177) 
 
178 ORTHODONTIA. 
 
 typical case of this character, tlie model being from the 
 collection of Dr. H. A. Baker. 
 
 Fortunately, the condition is seldom met with, for it is 
 tlie one of all others tliat is least amenable to successful 
 treatment. 
 
 The cause of the deformity has l;)een variously attributed 
 to thumb-sucking, to sleeping with the mouth open and to 
 derangement of the articulation caused by ill-ad vi.sed ex- 
 traction of some of the posterior teeth ; but while all of these 
 are doubtless responsible for the condition in many instances, 
 it is probabty more frequently caused either by the lack of 
 alveolar development in the incisor region, or an unaccount- 
 able variation in the plane of the alveolar border of the 
 maxilla. The autlior has met witli no cases of this condi- 
 tion that bore evidence of hereditary transmission, and 
 therefore believes it to be due to a peculiarity in the devel- 
 opment of the maxilla, originating with and confined to the 
 individual him.self 
 
 In the line of treatment, so far as the author is aware, but 
 two plans have been adopted. One, where the deformity is 
 slight, consists in grinding off the cusps and antagonizing 
 points of some or all of the posterior teeth in order to 
 shorten the bite and bring the anterior ones more nearly 
 together. Mucli of tliis cannot be done without denuding 
 the teeth of their enamel at certain i)oints and exposing the 
 sensitive dentine, but done in moderation it will often aid 
 quite a little in lessening the deformity. 
 
 The other plan, for aggravated cases, is to produce pressure 
 upon the anterior portion of the lower jaw by means of a 
 skeleton cap, cliin-piece and rubber bands, very similar to 
 the appliance used in retraction of the lower jaw, only that 
 in the present case the power should be applied in an almost 
 vertical direction. Witli such an apparatus, worn continu- 
 ously for a few months, the condyles of the lower jaw will 
 l)e tipi»cd somewliat out of their cavities and the latter be 
 ])artially filled up with new ossific material. 
 
^ PRACTICAL TREATMENT. 179 
 
 REDUCTION OF ELONGATION OF THE ANTERIOR TEETH. 
 
 Normally, each tooth will advance in the course of its 
 eruption until the whole of its crown projects heyond the 
 free margin of the gum, and its cutting edge or masticating 
 surface is in proper relation with the same surfaces of the 
 adjoining teeth. Full eruption may be delayed or entirely 
 prevented by accidental circumstances, but extra elongation 
 will not occur of its own accord. Wlien it does occur, it is 
 the result of an abnormal condition of the pericementum, 
 most generally due to irritation in some form, or it is caused 
 by lack of occlusion with teeth in the opposite jaw. In the 
 latter case, it is but the manifestation of nature's attempt to 
 rid the system of a useless organ. 
 
 Elongation of one or more of the superior incisor teeth 
 sometimes occurs in connection with regulating, and is due 
 either to the irritation of the soft tissues surrounding the 
 tooth caused by the impingement of the regulating api)li- 
 ance upon them, or to the unfortunate application of power 
 in such manner as to fovor the lifting of the tooth from its 
 socket. 
 
 When such elongation is noticed, it becomes necessary to 
 remove the cause and give rest to the affected parts. The 
 elongation being due in the first instance to the temporary 
 thickening of the peridental membrane through irritation, 
 a period of rest will usually result in the subsidence of the 
 trouble and the return of the tooth to its former position. 
 Where the elongation is the result of misdirection of power 
 the operation will have to be suspended for a time, to be 
 followed by the use of more correct appliances. Should the 
 condition, however, be allowed to continue for any length 
 of time, as through non-appearance of the })atient, some 
 pressure may have to be applied to force the tooth back into 
 its socket. This may be accomplished in a very simple 
 manner by adopting the plan suggested by Dr. Wilhelm 
 Herbst for retaining a replanted tooth. 
 
 It consists in cutting a short and narrow strip from a 
 
180 
 
 ()i;tih)ik)xtia. 
 
 Herbst Method of Retention. 
 
 Fig. 1-2(). 
 
 piece of rubber dam and perforatiiiu- it in such manner that 
 when in position, the crowns of two teeth on either side of 
 the one affected will protrude througli the openings, while 
 the elongated tooth will be i>artly covered and pressed upon 
 Fig. 1-25. by tile intervening i)ortion of the 
 
 ^ rubber. Figs. 125 and 126 repre- 
 
 ! -eait the strip of rubber separately 
 
 and in position. Another way of 
 producing tension upon the elon- 
 gated tooth, is by means of a rub- 
 ber plate with a strip of gold so 
 attached as to rest and press upon 
 tlie cutting edge of the tooth. 
 
 Neither of the appliances just 
 mentioned need be worn long, for 
 
 Rubber strip Apilied. .1 ,• -n • i 1 
 
 the continuous pressure Will CjUickiy 
 cause retrogression of tlie tooth. 
 
 ASSISTED ERUPTION OF THE ANTERIOR TEETH. 
 
 Incisor teeth that have not erupted to tlieir full extent 
 and have been prevented from doing so by too close prox- 
 imity of adjoining teeth or other cause, may often be assisted 
 in assuming their proper alignment. Where sjjace exists, 
 teeth will naturally accomplish their full eruption unaided, 
 as previously stated. When they do not, and tliere is no 
 visible cause for their not doing so, we may safely infer 
 that some hindrance exists in the tissues beneath the gum. 
 It may only be an unexplainable suspension of the act 
 of erudition, or it may be, and often is, a curvature or 
 enlargement of the root that prevents the further progress 
 of the tooth. Which of tlie two it is, can usually only be 
 decided after measures of assistance have been tried. 
 
 If the delayed eruption has been due simply to a suspen- 
 sion of the act of eruption, the simplest and most effective 
 remedy will be found in tying a silk ligature around the 
 neck of the tooth and pressing it avcU under the free margin 
 
rKACTICAI, TKKATMKNT. 181 
 
 of the gum, or in placing a ring cut from I'uhlxT tubing in 
 the same iKisition. Either one will cause irritation of the 
 pericementum, which by conse(|uent enlargement will tend 
 to force the tooth out of its socket. To prevent undue elon- 
 gation the case will have to be carefully watched, day by 
 day, and the irritating ligature removed as soon as the tooth 
 has been sufficiently elongated. Should this be neglected, 
 the tooth might be entirely ex})elled and lost. 
 
 Should these simple means fail to move tlie tooth from its 
 abnormal position, osseous abnormality is probably the hin- 
 dering cause, and mechanical appliances of not too great 
 power should be tried. Some of this character have been 
 mentioned in Part III, Cha])ter 2. 
 
 Dr. A. E. ^Nfatteson* has devised an a|)]tliance for produc- 
 ing forced elongation of several of the incisor teeth at the 
 same time. It is comj)osed of a rubl)er jjlate to which a 
 piece of clock spring, properly shaped, is attached. The 
 spring is cut and ground along its outer edge in such nuui- 
 ner as to leave projections to pass between the teeth at their 
 necks and l)ear upon the wider jiarts of the crowns. After 
 being properly shaped and titted, the spring is riveted to 
 the' anterior portion of the plate just back of the teeth to 
 be acted upon. In inserting the appliance, the projections of 
 the spring are passed between the teeth at their necks and 
 the plate pressed into place. The elasticity of the slightly 
 curved s])ring with its projections, will })roduce pressure upon 
 the teeth in the direction of their length and cause their 
 elongation. 
 
 The action of all appliances of this character will have to 
 be closely watched to see that the power produced by them 
 is not too great nor too long continued. 
 ^ Should any or all of the appliances mentioned tail to 
 move the partially erupted tooth, we may safely conclude 
 that its root is exostosed or curved at some point of its 
 length, and further operations had better be suspended. 
 
 * Harris' Principles and Practice, 12 Ed. p. 439. 
 
182 ORTHODONTIA. 
 
 Tlie author, in his early practice, attempted to rotate a 
 superior cuspid tooth, and after failing to produce any effect 
 by the commonly adopted appliances, concluded that the 
 trouble nuist lie in the formation of the root. A digital 
 examination of the tissues overlying the root, revealed the 
 fact that it Avas considerably curved, and further efforts at 
 rotation were immediately abandoned. Had tlie examina- 
 tion been made l)efore beginning operations, as it should 
 have been, instead of at their close, much annoyance and 
 trouble would have been spared both patient and operator. 
 Where full eruption of a tooth has been made imj)0ssible 
 by the impingement of adjoining teeth upon the space in- 
 tended for it, increase of space by lateral pressure upon the 
 interfering teeth should first be gained before any attempt 
 is made at elongation. Indeed, the mere enlargement of 
 the space and its retention for a length of time will usually 
 be followed by the unaided eruption of the tooth. Should 
 this not occur, mechanical assistance may be rendered by 
 some of the methods mentioned. 
 
 Forced eruption of a tooth by means of the extracting 
 forceps is seldom justifiable, for we cannot always know 
 what may have interfered with the eruption. In certain 
 exceptional cases, where a careful examination reveals no 
 sign of malformation of the root, and where it is perfectly 
 evident that slight impingement of adjoining teeth has been 
 the sole hindrance to full eruption, the forceps may prove a 
 valuable means of effecting a raj)id and easy correction of 
 the difficulty. 
 
 Fig. 127. Such an exceptional case 
 
 ^^^ r-.^-.. once occurred in the author's 
 
 ])ractice. The ])atient was a 
 gentlemen of about twenty- 
 eight years of age, whose right 
 Incomplete Eruption. Central iiicisor was about a line 
 
 shorter than its mate. It had been tardy in erupting and 
 in consequence there was a slight lack of space for its ac- 
 commodation, as shown in Fig. 127. 
 
PRACTICAL TREATMENT. 183 
 
 As the difference in length of the two incisors was too 
 great to be remedied by the simple means of reducing the 
 length of the longer one, it was decided to elongate the 
 shorter one. A careful examination proving favorable, a 
 piece of sand paper was folded so as to cover both labial 
 and palatine surfjices of the tooth to protect it from injury, 
 after which it was gras})ed with the force})S and by a combined 
 rotary and downward motion brought into place. Once in 
 position, it was held there firmly by the pressure of the ad- 
 joining teeth, l)ut as good judgment would not sanction so 
 unreliable a means of retention, an ai)pliance had to be 
 devised that would not only prevent the tooth from slip- 
 ping back into its socket ]:)ut also secure it from ])eing 
 forced forward by pressure upon its sides. The patient also 
 desired the appliance to be as inconspicuous as possible. 
 
 To accomplish all of these ends, a piece of platinized gold 
 wire, a little thicker than a vulcanite tooth-pin, w'as bent 
 into horseshoe form and curved to conform to the palatine 
 surfaces of the assisted tooth and the tw^o adjoining ones. 
 The ends of the wdre were then flattened and bent so that 
 they would hook over and rest upon the cutting edges of 
 the adjoining central and lateral. A silk ligature was passed 
 around the moved tooth and tied in front, after whicli the 
 ends were again passed to the palatine surface and tied 
 just below the cingulum. After the gold wire was placed in 
 position, the ligature was attached to it at the low^est point 
 of its central curve. 
 
 The ligature thus held the appliance in position and it 
 in turn held the tooth from receding. The double arrange- 
 ment of wire and ligature also Fig. 128. 
 guarded the tooth against the pos- 
 sibility of moving forward. The 
 fixture in position is shown in 
 Fig. 128. The only parts of it 
 
 visible were the small rounded Retention after correction. 
 
 gold tips that overlapped the cutting edges of the two adja- 
 cent teeth. 
 
184 ORTHODONTIA. 
 
 ^\'here sufficient space exists for the purpose, the tooth 
 after being drawn into position, may be held there by means 
 of the phitinum band and extension bar, as shown elsewhere 
 for retaining a tootli that has been forced backward into the 
 line of the arch. 
 
 TOOTH-SHAPING. 
 
 During tlie act of regulating or after its accomplishment, 
 one of the most useful accessory operations, when called for, 
 is that of dressing or shai:)ing certain teeth so as to still 
 further improve their appearance. 
 
 This operation will probal»ly not be necessary in the 
 majority of cases we treat, but wlien indicated, it adds 
 immensely to the patient's appearance and the satisfaction 
 of the parents and operator. It may be accomplislied by 
 means of the file, corundum point, sand-paper disk or emery 
 cloth strips, each having its value according to the require- 
 ments of the case. 
 
 It will not often be called for on the approximal surfaces 
 of teeth, but when it is, much of the sub.stance should not 
 be removed, and the surface .should afterward be polished 
 in the mo.st perfect manner. 
 
 The author has had one case, and one only, in which such 
 trimming of approximal surfaces seemed advisable. The 
 patient was a young lady of alxjut twenty-one years of age, 
 whose anterior superior teeth were slightly prominent. The 
 teeth were without interdental spaces and all of the j)osterior 
 ones were so perfect in structure, alignment and occlusion, 
 that the extraction of even one of them would have been 
 regarded as an unwarranted sacrifice. 
 
 All of the six anterior teeth had small cavities upon 
 each of their approximal surfaces, and it was therefore decided 
 that in the filling of these cavities a slight portion of each 
 approximal surface should be dressed off in the hope that 
 the aggregate of such spacing would be sufficient to enable 
 the teeth to occupy a position more in harmony with the 
 normal line of the arch. After the filling and dressing of 
 
PRACTICAL TREATMENT. 185 
 
 tlie surfaces, the teetli were drawn inward and the result 
 
 was all that could have been desired. 
 
 Sometimes teeth that have been fully erupted out of line, 
 when ])rought into proper position extend below the line of 
 the cutting edges of their neighlmrs and the rest of the teeth 
 in the arch. Any attempt to reduce their elongation by 
 forcing them up into the socket would not only be extremely 
 difficult, but in many cases futile. The better plan, if the 
 disparity in length be not great, is to grind off th?ir cut- 
 ting edges somewhat, and thus accomplish the desired end 
 in a very simple manner. 
 
 In other cases, teeth out of line have from lack of attri- 
 tion preserved their normal, rounded form, while their 
 fellows have been more or less worn away on their cutting 
 edges either through abnormal occlusion or excessive use. 
 When the malposed teeth have been brought into position, 
 their rounded and unworn cutting edges are apt to contrast 
 strongly with the abraded edges of their neighbors. By so 
 dressing the incisive edges of the unworn teeth as to resemble 
 those next to them, greater harmony of expression Avill be 
 induced. 
 
 Altering the form of a tooth, however, may often be made 
 to serve even a more useful purpose than that of appear- 
 ance. Cases have occurred where an upper tooth, tardy of 
 eruption, has been unable to come entirely down into line 
 owing to its meeting its antagonist of the opposite jaw edge 
 to edge. In such an event, the retarded tooth might be 
 forced sufficiently outward to enable it to accomplish its 
 full eruption and then be held in such position until over- 
 lapping had taken place, but the operation may be advan- 
 tageously simplified in most cases by slightly beveling the 
 edge or cusp of the lower tooth on its labial, and the upper 
 one on its palatine surftice. The inclined plane thus formed 
 will enable the upper tooth to slide over the lower one into 
 line, which it will be almost certain to do provided there be 
 no contingent obstructions. 
 
1S() ORTHODONTIA. 
 
 A case of this character came under the author's notice 
 
 ^ "recently in which a superior lateral incisor was thus impeded 
 
 in eruption until the individual was forty years of age. A 
 
 simple beveling of the cutting edge of it and its opponent, 
 
 caused it to come into proper line within a year. 
 
 Other conditions than those just mentioned will occur to 
 the practitioner in which the slight alteration of the form 
 of a tooth will materially assist, or be the means of entirely 
 accomplishing some simple act of regulating, and in other 
 cases, greatly add to the effect of some long continued and 
 successful operation in orthodontia. 
 
4?m 
 
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