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 HX64070573 
 RK52lAn41897 The Angle system ot 
 
 RECAP 
 
 • 
 
 THE ANGLE SYSTEM 
 
 OF 
 
 REGULATION AND RETENTION 
 OF THE TEETH, 
 
 AND 
 
 TREATMENT OF FRACTURES OF THE MAXILLA. 
 
 Fifth Edition Revised. 
 
 With One Hundred and Fifteen Illustrations. 
 
 BY 
 
 EDWARD H. ANGLE, D.D.-S:, 
 
 Member of the American Dental Association, and Honorary Member of the American 
 Dental Society of Europe; Former Professor of Histology, OrtAodontia, and Com- 
 parative Anatomy of the Teeth, in the Dental Department of'the Univkrsity 
 OF Minnksota; Professor of Orthodontia and Lecturer on Fractures of tmk 
 Maxill/E in the Northwestern University Dental School, cSncAGo, III.; 
 Professor of Orthodontia in the Dental Department of the Marion- 
 Sims College of Medicine, St. Louis, Mo.; Surgeon to the Asbury Hos- 
 pital in Minneapolis, Minn., and Surgeon for the Treatment of 
 Fractures of the Maxill/E to the Great Northern Railway. 
 
 PHILADELPHIA : 
 
 THE S. S. WHITE DENTAL MFG. CO. 
 1899. 
 
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THE ANGLE SYSTEM 
 
 OF 
 
 REGULATION AND RETENTION 
 OF THE TEETH, 
 
 AXD 
 
 Treatment of Fractures of the Maxilla. 
 
 Fifth Edition, Revised. 
 
 With One Hundred and Fifteen Illustrations. 
 
 EDWARD H. ANGLE, D.D.S., 
 
 Member of the American Dental Association, and Honorary Member of the American 
 Dental Society of Europe; Former Professor of Histology, Orthodontia, and Com- 
 parative Anatomy of the Teeth, in the Dental Department of the University 
 of Minnesota; Professor of Orthodontia and Lecturer on Fractures of the 
 Maxill/E in the Northwestern University Dental School, Chicago, III. ; 
 Professor of Orthodontia in the Dental Department of the Marion- 
 Si.Ms College of Medicine, St. Louis, Mo.; Surgeon to the Asburv Hos- 
 pital in Minneapolis, Minn., and Surgeo.v for the Treatment of 
 Fractures of the Maxillae to the Great Northern Railway. 
 
 PHILADELPHIA : 
 
 THE .S. S. WHITE DENTAL MFG. CO. 
 1S99. 
 
Copyright 1894, by Edward H. Angle, D.D.S., Minneapolis, Minn. 
 Copyright 1897, by Edward H. Angle. 
 
 
PREFACE TO THE FIFTH EDITION. 
 
 At the earnest solicitation of numerous students and teachers it 
 had been the author's intention in preparing the fifth edition to 
 rewrite and rearrange the subject-matter more in keeping 
 with the exacting requirements of a complete, modern text-book 
 on Orthodontia. But, owing to the fact that the fourth edition 
 has had such a wide circulation, having been published in part in 
 periodicals, compendiums, and text-books both dental and surgi- 
 cal, and complete translations in the French, German, Dutch, 
 Scandinavian, and Spanish languages, it has been thought advis- 
 able, in order to prevent the confusion which would result from 
 the rearranging of pages and numbering of cuts, to incorporate 
 the new subject-matter in the form of a Supplement* into the cor- 
 rected and but slightly modified fifth edition. 
 
 As the fruits of a busy practice, — the author has devoted his 
 time exclusively to the practice and teaching of Orthodontia, — the 
 Supplement will be found to contain numerous additions and mod- 
 ifications of combinations, also new combinations, together with 
 suggestions and comparisons, and a more comprehensive plan of 
 nomenclature and classification of irregularities from the basis of 
 occlusion; all of which the author believes will still further simplify, 
 for both student and teacher, the study and practice of this most 
 useful branch of dental science. 
 
 Edward H. Angle. 
 
 St. Louis, Mo., August, 1897. 
 
 ♦This Supplement is now in course of preparation, but is delayed because 
 
 of the necessity of making a large number of illustrations. When published 
 
 it will be available to those who have the fourth edition, equally with the 
 
 purchasers of this volume. — Publisher. 
 
 iii 
 
TABLE OF CONTENTS. 
 
 PART I. 
 ORTHODONTIA. 
 
 CHAPTER I. p^^^ 
 
 General Consideration of Orthodontia 7 
 
 Set No. 1 Angle's Appliances, Description of 9 
 
 Set No. 2 Angle's Appliances, Description of 10 
 
 Extras, Description of 10 
 
 CHAPTER n. 
 
 Teeth Bands, Adjustment of 13 
 
 Ligatures 17 
 
 CHAPTER HI. 
 Tools Used in Operating Appliances 20 
 
 CHAPTER IV. 
 Soldering 20 
 
 CHAPTER V. 
 Impression and Model Making 23 
 
 CHAPTER VI. 
 Direction of Forces for Tooth-Movement. 
 
 Backward in Line of the Arch 28 
 
 Forward in Line of the Arch 31 
 
 Outward in Line of the Arch 31 
 
 Inward in Line of the Arch 36 
 
 Rotation 37 
 
 Double Rotatioti ■ 40 
 
 Elevation 41 
 
 Expansion 44 
 
 CHAPTER Vn. 
 
 Practical Cases. 
 
 Illustrations and Treatment of Miscellaneous Cases 48 
 
 Jumping the Bite 63 
 
 Excessive Protrusion of the Upper Teeth 67 
 
 Excessive Protrusion of the Lower Teeth 74 
 
 CHAPTER VIII. 
 General Suggestions 80 
 
 5 
 
D TABLE OF CONTENTS. 
 
 PART 11. 
 
 FRACTURES OF THE MAXILLA. 
 
 CHAPTER I. 
 Treatment of Fractures of the Maxillse 
 
 CHAPTER II. 
 Final Suggestions on Fractures 
 
PART I. 
 
 ORTHODONTIA. 
 
 CHAPTER I. 
 
 THE ANGLE SYSTEM OF TEETH-REGULATION AND RETENTION. 
 
 It is often asserted, even by some authoritative writers upon the 
 treatment of dental irregularities (Orthodontia), that no fixed 
 system of appliances should or can be depended upon; that each 
 case so differs from all others as to require some neu^ appliance 
 peculiarly suited to that case, and that only. 
 
 Upon this theory, success would demand not only skill in opera- 
 tion, but the constant exercise of inventive genius. The inventive 
 faculty is rather a natural gift than an acquirement, and can be 
 exercised successfully only by the favored few, while even the 
 greatest inventor must be an experimenter. Hence all treatment 
 upon such theory must be, and in fact has ever been, tedious, 
 costly, and of doubtful result. 
 
 It is probable that, for the foregoing reasons. Orthodontia has 
 never received that attention, even in the schools of dentistry, that 
 its importance demands. 
 
 The author believes, and has proven, that it is not only possible, 
 but practicable, to systematize, classify, and provide ready-made 
 regulating appliances, reducing them to a few simple forms, to 
 meet by their combinations the requirements in all varieties of 
 cases susceptible of treatment. 
 
 The present purpose is to submit such a system, explain the 
 character and use of the appliances, and show by cuts of models of 
 actual cases the methods of treatment. The appliances shown in 
 Sets No. I and No. 2, and the few extra pieces following them, 
 have, in fact, fully and readily met the requirements of every case, 
 while combinations of them, other than those hereinafter shown, 
 have rarely been necessary. 
 
8 THE ANGLE SYSTEM. 
 
 The author will always be glad to afford the profession ample 
 opportunity to inspect his collection of models of actual cases 
 treated, which correctly show each stage of the operation from 
 beginning to completion; and he feels sure that, for variety of 
 difficulties to be overcome, facility and certainty of operation, and 
 success in results, all clearly shown by the models, this collection 
 will compare favorably with any other in the world. 
 
 The claim made by many authors, teachers, and practitioners, 
 that each dentist should from raw materials make his own ap- 
 pliances for use in Orthodontia, is quite as unreasonable and im- 
 practical as to require him to make all his own instruments for 
 use in other branches of dentistry; and the time spent by the 
 student in the dental schools to acquire constructive knowledge 
 and skill for either purpose could and should be more profitably 
 spent in the study of actual cases, and of the application of estab- 
 lished forms of appliances and instruments made by skilled experts, 
 who have become so not only from natural ability, but by intense 
 study and long practice. 
 
 The author claims that his system can be easily taught and 
 learned in the dental schools; that the dentist may quickly acquire 
 a complete knowledge of it; and that the practice of Orthodontia, 
 instead of being regarded, as heretofore, as tedious and unsatisfac- 
 tory, something to be avoided rather than sought for, may be made 
 one of the most useful, satisfactory, and lucrative branches of 
 dentistry. 
 
 Dr. Farrar seems also to have become convinced of the practica- 
 bility of what has been heretofore stated, for he says in vol. xx, 
 page 20, of the Dental Cosmos, — 
 
 "It has for some time been evident to me (though by most peo- 
 ple thought to be impracticable) that the time will come when the 
 regulating process and the necessary apparatus will be so systema- 
 tized and simplified that the latter will actually be kept in stock, in 
 parts and wholes, at dental depots, in readiness for the profession at 
 large, so that it may be ordered by catalogued numbers to suit the 
 needs of any case; so that by a few moments' work at the blow- 
 pipe in the laboratory the dentist may be able, by uniting the parts, 
 to produce any apparatus, of any size desired, at minimum cost of 
 time and money." 
 
 Section I. The limits of this book will not permit of an ex- 
 haustive treatise on the subject of Orthodontia generally, and the 
 author will therefore confine himself to the description and use of 
 the appliances and methods of treatment which he has found so 
 
TEETH-REGULATION AND RETENTION. 9 
 
 satisfactory in an extensive practice, believing that most practi- 
 tioners will succeed best by adopting one complete system and 
 thoroughly familiarizing themselves with the same. 
 
 To those who may desire to study the subject in all its relations, 
 together with the history of methods and appliances in general, 
 he would recommend the excellent treatises of Drs. Guilford and 
 Kingslev. 
 
 Fig. I. 
 
 bl-i No. I. .V.NuLli'b .Vrl'LlANCKS. 
 
 It IS essential to a clear comprehension of the manifold uses of 
 the several appliances to which frequent references will subse- 
 quently be made that their names, shapes, sizes, and indicating 
 numbers or letters should be carefully noted and kept in mind. 
 Every part is important; none can well be omitted. 
 
 For convenience of description and designation, they are divided 
 into Sets No. i and No. 2, together with a few extra parts. Any 
 piece, however, may be ordered separately, as all of a kind are 
 interchangeable, and each accurately fits the part to which it be- 
 longs. 
 
 The Set No. i, Fig. i, consists of the retaining-wire G, and ten 
 sections of retaining and anchor pipes R, R, which will closely 
 slide on wire G. The traction-screw A has its smooth end bent 
 for insertion in the short tube D- When the nut is against the A 
 end of the long tube, and that tube soldered to a tooth-band, turn- 
 ing forward the nut will pull the hook in the tube D when that has 
 been soldered to a tooth-band; if the nut is against the other end 
 
lO THE ANGLE SYSTEM. 
 
 of the long tube, it will pitsh D and its tooth-band. B, C, is a like,. 
 but smaller combination, of the same diametric size as the jack- 
 screw J. When the tube of J is soldered to a tooth-band on one 
 tooth, it will push directly against a notched tooth-band or a tooth. 
 E is a longer piece of the tube than is shown on J, with which a 
 longer jack-screw may be made when required. The thinner, coil 
 of band-material is seen at F, the thicker at H, either of which is 
 sufficient to make about twenty-five tooth-bands. The rotating 
 levers L, three sizes of two each, and wrench W, complete the set, 
 which will suffice for several regulating cases. 
 
 It will thus be seen that the appliances of this set are very simple 
 and few in number, being limited practically to three, — viz, the 
 lever for rotating, the screw for pushing, and the traction-screw 
 for pulling; and the other pieces for the purpose of securing attach- 
 ments. Aside from their advantages of simplicity, efficiency, and 
 cleanliness, their intelligent application will effect a stationary 
 anchorage upon, a positive movement of, and afterward a firm 
 retention of, the teeth. 
 
 Section II. Set No. 2 is designed for the treatment of a special 
 class of irregularities, or that prognathic type known as excessive 
 protrusion of the upper incisors. The plan of this set (No. 2) 
 differs principally from that of Set No. i in that the anchorage is 
 occipital, or by means of a cap covering the back of the head (as 
 seen in Fig. 3), to which heavy elastic bands are attached and 
 received by the hooks upon the ends of traction-bar A. 
 
 The wire arch B encircles the dental arch and bears against the 
 protruding teeth, receiving the necessary pressure from the 
 standard in the center of the traction-bar. D, D represent adjust- 
 able anchor clamp-bands and pipes for securing the ends of the 
 arch B upon the molar teeth, while C, C represent plain bands for 
 holding in position upon the teeth the anterior part of the arch, as 
 shown in Fig. 84. C is a coil of band-material, from which the 
 bands C, C are to be made for each case. This coil is the same as 
 F, Fig. I, Set No. i. 
 
 E, E represent small rubber rings to retain the teeth during in- 
 tervals of rest, when not wearing the head-cap and traction-bar,, 
 also shown in Fig. 84. 
 
 Extra Parts. 
 
 Section III, Fig. 4 shows an extra wire expansion-arch. Its 
 use is directly the opposite of that of wire arch B, in that it is used 
 for expanding the arch, and is to be known as the expansion-arch 
 
teeth-regulation and retention, 
 Fig. 2. 
 
 II 
 
 Set No. 2. Angle's Appliances. 
 
 Fig. 3. 
 
 E. The ends of this arch are threaded and provided with nuts. By- 
 putting the threaded ends into the anchor-tubes upon the clamp- 
 bands D, Set No. 2, secured to anchor-teeth, the arch may be 
 pushed forward by tightening the nuts, thus exerting force against 
 other teeth which may have been secured to the arch by means of 
 ligatures or bands. 
 
 [This arch is not inckided in Set No. 2, but must be ordered 
 separately, as also the extra bands and tubes D, Fig. 2, with which 
 it is always used.) 
 
12 
 
 THE ANGLE SYSTEM. 
 
 In Fig. 5 is shown a metal cap covering the chin, and in connec- 
 tion with the head-gear and heavy elastic bands it is used in the 
 retraction of the inferior maxilla, as shown in the figure. This cap 
 is light, nicely made, highly polished, and will fit all cases, as it is 
 necessary for fit to be only approximately accurate. A layer of 
 
 Fig. 4. 
 
 absorbent cotton should always be placed between the metal and 
 the chin while it is being worn. 
 
 Fig. 6 represents adjustable clamp-bands for encircling the 
 
 Fig. ^. 
 
 molars and bicuspids, to which are attached the various appliances. 
 Nos. 3 and 4 have pins soldered to their sides, to which ligatures 
 may be attached. This style of band is especially designed for the 
 treatment of fractures of the maxillse, and its use, therefore, is fully 
 
TEETH BANDS. I3 
 
 shown in that portion of this work devoted to such treatment, but 
 it is also useful in the regulation of teeth, as described later. 
 
 The head-cap represented as covering the back of the head (Fig. 
 5) is also an extra. It is beautifully made and presents a very neat 
 
 Fig. 6. 
 
 Xo. 2 — Molar. Xo. 3 — Biccspid. Xo. 4 — Molar. 
 
 appearance, is strong, durable, and may be quickly adjusted to fit 
 any size of head. As auxiliaries to the above appliances, ligatures 
 made from waxed floss silk, or wire, are necessary. 
 
 CHAPTER II. 
 
 B.\XDS AND LIGATURES. 
 
 Section I. Teeth Bands. 
 
 In this system two kinds of bands are used for attaching the 
 appliances to the teeth: the plain or soldered band (C, C, Fig. 2), 
 and the clamp or adjustable band (Fig. 6). The plain band is 
 made from the coil of band-material, F and H, Fig. i. F is thinner 
 and narrower than H, and is generally used on the lower incisors 
 or upper laterals, or where a delicate band is desirable. It is ex- 
 tremely thin, being .003 of an inch in thickness, so that it will 
 readily pass between the teeth and occupy but little space; yet the 
 material is so strong that it will resist all necessary strain if not 
 overheated. H is .004 of an inch in thickness, and is used in 
 making the bands for the central incisors or cuspids. Each coil is 
 sufficient for about twenty-five bands. 
 
 I have long discontinued the use of plain bands upon the molars 
 and bicuspids, for it is impracticable to fix and cement them on 
 the.se teeth Cowing to their unfavoral)lc shapes and positions), so 
 that they will not .soon loo.scn under the severe strain to which they 
 are subjected. 
 
 The adjustable clamp-bands, Nos. i and 2, are far more con- 
 venient and desirable, being easily and quickly clamped and bur- 
 
14 THE ANGLE SYSTEM. 
 
 nished to fit the tooth so that they will not loosen, and cement is 
 unnecessary, except in such combinations as shown in Fig. 17, 
 where stationary anchorage is necessary. Another advantage is 
 in their ready removal and replacement, should changes in their 
 attachments be necessary. 
 
 These bands are made in two sizes, which have been determined 
 by the accurate measurement of a large number of bicuspids and 
 molars. They will fit all teeth of normal size, and may be enlarged 
 to accommodate teeth of unusual size by beating the first third or 
 half of the screw flat over the horn of an anvil; to reduce the size 
 for abnormally small teeth it is only necessary to cut the band 
 midway of the flat portion, lap the desired distance, and resolder. 
 
 In adjusting them to the teeth extreme care should be exercised 
 not to crimp, tear, or injure them in any way. If there is not space 
 to admit their passage, it should be provided. The nut should be 
 loosened and the band enlarged to the approximate size, then with 
 a pair of flat-nosed pliers the band should be carefully bent to take 
 the form of the tooth, and, if properly shaped, may be easily 
 worked over the crown to any desired point with the fingers alone, 
 sliding beneath the festoon of the gum and not pressing upon it. 
 The hand should never, under any circumstances, be Med or cut away 
 to avoid contact with the gum. Never be content to stop when the 
 band is only one-half or two-thirds over the crown, as the entire 
 strain is then borne by that partial portion of the band, and break- 
 ing or slipping off is almost certain when the' nut is turned. Care- 
 fully work the band to exactly the position desired, then tighten 
 the nut and burnish, alternately, until the fit is accurate. Burnish- 
 ing is important not only to enhance the fit, but to harden and 
 strengthen the material. 
 
 As the bands are so important in this system, and the making 
 and fitting of the plain bands the most difficult part in the con- 
 struction of any of the combinations, I would recommend that 
 accuracy and care be observed in each step in the operation.. 
 First, in order to insure perfect uniformity in annealing, the coil of 
 band-material should be heated and plunged in dilute sulfuric acid 
 before cutting the wire ligatures encircling it. A loop in the band- 
 strip is then slipped over the tooth to be banded, and worked up or 
 down upon the crown to the exact point it is to occupy when com- 
 pleted. It is held between the thumb and finger, and tightly 
 drawn around the tooth against the opposite side from which the 
 union is to be made. While thus firmly held it is grasped between 
 the flattened beaks of a pair of strong pliers, and pinched or drawn 
 tightly about the tooth, a burnisher being applied at the same time 
 
TEETH BANDS. I5 
 
 to make it conform still more accurately to the shape of the tooth. 
 It is important that the beaks of the pliers should be smooth and 
 fit together accurately. It is then removed and presents the ap- 
 pearance of Fig. 7. A piece of clean silver solder, about one- 
 eighth of an inch square, wet with borax cream, is now placed 
 between the jaws at the junction and held there by being pressed 
 together with the delicate soldering pliers E, Fig. 8 A. It is then 
 held over a fine, sharp soldering flame. When soldered, the inner 
 surface of the band should present one continuous, even surface; 
 any other union is imperfect and should not be used. 
 
 The band is now ready for any attachments which may be made, 
 the untrimmed ends of the band serving the useful purpose of a 
 handle for holding the band in the flame and in contact with the 
 piece to be attached, while soldering, as in G and H, Fig. 21. 
 After the attachment has been made the ends of the bands are 
 trimmed of¥, leaving them long or short as desired. 
 
 Fig. 7. 
 
 If a niche is to be formed as in A, Fig. 21, or C, C, Fig. 2, the 
 ends are left about one-sixteenth of an inch long; but if not to 
 ser\-e as a means of attachment they may be trimmed still shorter, 
 though it is never desirable to trim them even with the surface of 
 the band. These united ends may be further strengthened by an 
 extra piece of the band-material held between the jaws at the junc- 
 tion when soldering. 
 
 It should now be boiled in a few drops of dilute sulfuric acid in 
 a small test-tube or other suitable vessel, after which it is washed 
 and dried. The tooth should now be protected from moisture by 
 a small roll of cotton or bibulous paper, the surface of the tooth 
 cleansed by a pledget of cotton moistened with alcohol or ether, 
 and dried with the chip-blower. A sufficient quantity of oxyphos- 
 phate of zinc to fill the band is now mixed to a creamy consistence, 
 then carried on the end of the finger to the tooth, forcing the 
 cement, as well as band, on to the tooth. By carefully working 
 with the fingers alone, the band is forced nearly to its desired posi- 
 tion, which may be completed by a few gentle taps from the mallet 
 and band-driver TI. and M, Fig. 9> B). The burnisher is now 
 quickly applied and the surplus cement wiped off. Tf the opera- 
 tion has been carefully performed the band will fit with the most 
 
l6 THE ANGLE SYSTEM. 
 
 glove-like accuracy at every point, so that it will occupy the least 
 possible space, which is very desirable in most cases. The attach- 
 ment will be so firm that the annoyance of loosening will be 
 obviated. Only a perfectly-fitting band can be firmly attached. 
 If the band is defective in any particular, as too large, weakened 
 by crimping, or slightly torn when driven in position, it should be 
 immediately condemned, and a more perfect one substituted^ for 
 sooner or later it will surely fail and cause annoyance. 
 
 It is most important that the operation of banding should be 
 thoroughly performed, and at the first operation, or before the 
 tooth has become tender by being moved. 
 
 In making the band, it is desirable that all the attachments 
 which will be needed, both in moving and retaining, shall be added 
 before first setting the band, in order that the subsequent pain and 
 trouble of loosening and resetting may be avoided. 
 
 A little experience (and I would recommend also practice upon 
 teeth out of the mouth) will soon enable the operator to quickly, 
 easily, and perfectly band any tooth. 
 
 In cases where the teeth are crowded firmly together, leave the 
 band in position upon the tooth for a few hours, or over night, 
 before finally cementing. Sufficient space will thus be gained so 
 that the band may be readily cemented without crimping. 
 
 A cuspid is the most difficult of any of the teeth to band, but by 
 forming a seam on the lingual slope and firmly burnishing the 
 outer surface while it is being pinched, an accurate fit can in most 
 instances be made; or, by making the union on the labial surface, 
 and pinching a fold on the lingual slope and again soldering, an 
 accurate fit may be obtained. 
 
 After a band has been set, and the cement thoroughly hardened, 
 the band should be carefully polished and burnished, as it is well 
 known that discoloration is less liable with a smooth, polished 
 surface than a rough one. I have found nothing nearly so efifec- 
 tive for removing the superfluous cement and polishing the sur-. 
 face of the band as little leather poHshing-wheels. 
 
 When desirable to loosen the band, never attempt to do so with 
 forceps, as the shock to the tooth and danger to the enamel are 
 too great to be risked. Cut the band by grinding it with a suit- 
 ably-shaped wheel, carefully supporting the tooth at the same time. 
 
LIGATURES. I7 
 
 Section II. Ligatures. 
 
 Of the various materials employed for ligatures I now use but 
 three. First, the rubber ligature, which is best made by punching 
 with a rubber-dam punch a hole through heavy rubber-dam, or in 
 a thin elastic band, and then trimming the outside down to the 
 desired size; second, waxed floss silk; third, wire. Each possesses 
 advantages in certain cases, but on account of the cleanliness, 
 strength, and ease with which force may be exerted by twisting its 
 ends, the wire ligature is decidedly preferable. The proper sizes 
 of wire are Nos. 26 and 28, and it should be annealed brass. It 
 may be procured of any wholesale hardware dealer, or will be sup- 
 plied if desired. Spring wire will not answer. 
 
 The best way to adjust a wire ligature is to cut a piece from 
 the spool, eight or ten inches long, or sufificient to be grasped 
 firmly with the hands. It is made to encircle the tooth and arch 
 by passing it through the interdental spaces. The ends are 
 grasped firmly, drawn around the tooth and appliance, and twisted, 
 — never more than three-quarters of a circle at first. The surplus 
 wire is then cut ofT with the shears (C, Fig. 8 A), leaving the ends 
 one-eighth of an inch long, then curling them around under the 
 arch, as shown correctly only in Figs. 28, 67, and yT^. It is very 
 important that this point be remembered, for by observing this 
 special way of providing for the sharp ends, a smooth, easy sur- 
 face is presented to the lip. Never attempt to bend the twisted 
 portion of the ligature out of the way, as by so doing the ligature 
 will, in almost every instance, be broken. In tightening the liga- 
 ture, I find a very excellent plan is to gently press the tooth and 
 arch between the roughened beaks of pliers B, Fig. 8 A, while the 
 twist is being made with pliers A, Fig. 8 A. Great force should 
 never be exerted in twisting the wire, or breaking will surely fol- 
 low. It should also be remembered that the spring of the wire 
 arch, when used in connection with the wire ligature, is constantly 
 acting, so that as a rule tightening a ligature should be done only 
 occasionally. 
 
 The different styles of ligatures are well shown in Fig. 28, and 
 should be carefully studied. 
 
THE ANGLE SYSTEM, 
 Fig. 8 A. 
 
LIGATURES. 
 
 19 
 
 Fig. 8 B. 
 
20 THE ANGLE SYSTEM. 
 
 CHAPTER III. 
 
 TOOLS. 
 
 For uniting the different parts of the apphances to form the 
 various combinations, and placing them in position upon the teeth, 
 only a few tools are necessary, but it is important that they should 
 be of the best selection. A pair of shears, C,- Fig. 8 A, for trim- 
 ming soldered bands and cutting wire ligatures, etc. A pair of 
 pliers, E, Fig. 8 A, used in holding bands and some of the small 
 parts while soldering, is the most suitable of any made, on account 
 of their fine, delicate proportions. Coarse pliers should never be 
 used, as they absorb too much heat, and with them fine, delicate 
 soldering cannot be accomplished without danger of overheating. 
 
 A second pair, D, Fig. 8 A, for placing pieces of the solder in 
 position. A pair of wire-cutters; I prefer the style shown in F, 
 Fig. 8 A. 
 
 Two pairs of pliers for forming the plain band, twisting wire 
 ligatures, etc. Those shown at A and B, Fig. 8 A, are most ex- 
 cellently adapted. 
 
 H, Fig. 8 B, shows the author's forceps for stretching wire, 
 which will be found very useful in the regulation of teeth. Its 
 peculiar form renders it easy of application in any part of the 
 mouth. It is adapted to the wire G, Set No. i, and should never 
 be used for stretching hard or large-sized wires. A little experi- 
 ence in its use, and the operator will become skillful, and will prob- 
 ably be surprised to see how much can be accomplished in the 
 regulation of teeth by its use. A little anvil is also quite useful, 
 and the very handy and ingeniously constructed pattern shown at 
 K, Fig. 8 B, will be found the most suitable. 
 
 CHAPTER IV. 
 
 SOLDERING. 
 
 In uniting the parts of the appliances with solder, a fine, sharp 
 flame from a stationary, self-acting blow-pipe is most desirable, as 
 then both hands are free and can be used in holding the pieces. 
 Notwithstanding many ingenious spring-clamps and devices have 
 
SOLDERING. 21 
 
 been invented for holding such small work while soldering, yet I 
 greatly prefer holding them with the fingers, as it is so much 
 easier and simpler, steadying the hands by touching the fingers 
 together, as shown in Figs. 9 and 10. 
 
 The metal of which these appliances are made is most favorable 
 for soldering in this way, it being so extremely poor a conductor 
 of heat that all such attachments as E, F, I, H, and K, Fig. 20, can 
 readily be held with the fingers without hardly noticing a change 
 in the temperature, provided the flame is suitable. I prefer the 
 Herapath blow-pipe, as shown in G, Fig. 8 B, A building where 
 compressed air is furnished and conducted through pipes to all 
 rooms, the same as gas, the pressure being constant, even, and 
 steady, is preferable; yet the ordinary foot-bellows answers very 
 well. ' 
 
 Fig. 9. 
 
 All the small tubes are best held by slipping them on to the end 
 of an excavator shank or, what is just the ideal, one of Gates's 
 nerve-drills after the cutting-point has been broken off. It is so 
 slender that but little of the heat is absorbed. Two of these 
 handles may be employed when a couple of the small tubes are 
 soldered, as R, C, Fig. 44, or the pliers may be used for holding 
 one of them. (See Fig. 10.) 
 
 I should judge it not difficult to learn this method of soldering, 
 as most of my students seem to learn it readily. The only point 
 which at all may perplex the beginner is to hold the pieces im- 
 movable just at the time solder is congealing, but this can be done 
 by touching the fingers of the opposite hand in order to steady and 
 prevent all motion at the point of union, and at the same time 
 holding the pieces gently, not rigidly, just as a good penman holds 
 a pen. After a little practice any of the combinations shown in 
 this !)Ook mav be casilv made in a vcrv few minutes. All of the 
 
22 
 
 THE ANGLE SYSTEM. 
 
 various attachments by solder shown in Figs. 20 and 21 are made 
 in this way. In such attachments as E, F, H, and K, Fig. 20, the 
 pieces of solder may be kept from flying off by gently holding 
 them in position between the pieces to be united. But where the 
 ends of small tubes are to be secured as in C and D, it is best to 
 first use the solder upon the band, and then hold the small tubes 
 by means of the soldering pliers in contact with the solder and 
 again apply heat, otherwise the solder will be drawn into the tube. 
 The solder best adapted in uniting the different parts of these 
 appliances is the ordinary jeweler's silver solder, although any of 
 the gold solders work equally as well. Plenty of borax should 
 
 Fig. 10. 
 
 always be used as a flux. Never use more solder than is necessary, 
 especially in attaching the small tubes; use just sufficient to make 
 the union. 
 
 Always avoid overheating; just enough heat from a small flame 
 to thoroughly fuse the solder is all that should ever be employed. 
 In every instance, avoid heating the screws or nuts. This is to be 
 especially observed with the jack and traction-screws, as great care 
 is observed in their manufacture to produce the greatest stiffness 
 and strength, and this fine temper is ruined by heating. The wire 
 arches B and E are also manufactured in such a way as to give 
 to them the greatest possible spring, second only to steel. They 
 must not be heated, or this delicate temper will be destroyed. 
 
 The three delicate sheaths found on the wire arch B, Set No. 2, 
 are attached by means of soft solder. Should one of them become 
 loosened it may be resoldered, using the soft solder and a drop of 
 muriatic acid, and applying a fine flame, carrying the heat to only 
 just the point sufficient to fuse the solder. 
 
 Where two or more bands are to be united in order to retain the 
 
IMPRESSION AND MODEL MAKING. 23 
 
 teeth, as in Fig. 54, they should be gently held by their untrimmed 
 ends while being soldered, as in Fig. 11, after which they are 
 trimmed with the shears. 
 
 Fig. II. 
 
 %. ^-^ 
 
 CHAPTER V. 
 
 IMPRESSION .AND MODEL MAKING. 
 
 In deciding upon the proper course of treatment in any given 
 case, it is of the first importance to obtain very accurate articulat- 
 ing models of both arches. Such models not only assist in form- 
 ing a basis for correctly establishing the proper line of operation, 
 but are exceedingly valuable as references during the whole course 
 of treatment, for from such models accurate measurements may 
 be taken from time to time, and comparisons be made as the case 
 progresses. In this way one may not only judge of the exact 
 speed of the moving teeth, but any unfavorable movements of the 
 anchor teeth may be detected. 
 
 In order that these models may be of real value, they must not 
 only accurately show both arches and the relative positions of the 
 teeth and cusps, and also the vault of the arch, rugae, and gums, 
 but must correctly show as much of the roots and positions of the 
 same, as indicated by the gums and alveoli, up to the point where 
 the attachments of the muscles render obscure the further shape of 
 the jaw. Such models can only be made from impressions taken 
 in plaster. 
 
 From the large number of imperfect models which I receive 
 each year from dentists, I am of the opinion that the value of cor- 
 rect models is not suflFiciently appreciated. 
 
24 
 
 THE ANGLE SYSTEM. 
 
 If the reader will carefully follow the following simple plan for 
 taking impressions and making models he will find, after a little 
 experience, that the method is both natural and easy, and the most 
 beautiful results certain. He must, however, observe accuracy in 
 each stage of the operation. 
 
 First, the teeth should be thoroughly cleansed from all tartar or 
 soft deposits. For this the little rubber cup disk used with pumice 
 is most excellent. Care should be taken not to wound the gums, 
 as any bleeding prevents accuracy of impression. 
 
 The trays shown at Fig. 12 are essential. They were especially 
 designed for taking impressions of complete or partial arches, and 
 must always be kept thoroughly smooth, bright, and clean. 
 
 Fig. 12. 
 
 Author's Improved Impression-Travs. 
 
 Good impression plaster is mixed in the usual way and care- 
 fully distributed, as shown in Fig. I2,i, the shape and height of the 
 trays making but little impression-material necessary. 
 
 It will be observed that the greater amount is placed in the 
 anterior part of the tray and made to extend over the outer edge 
 of the rim, none being allowed in the vault of the tray. It is now 
 placed in position and allowed to rest evenly in contact with the 
 cutting edges of all the teeth. The lip is then raised and the 
 plaster extending outside the rim is carried high up underneath it 
 zvith the finger; then the tray is forced up evenly until the points of 
 Hie teeth touch, or nearly touch, the bottom of the tray, and 
 
IMPRESSION AND MODEL MAKlNt;. 25 
 
 steadily supported on the end of the index finger only. To expel 
 the air, the lip and cheeks are now gently manipulated, but not 
 drawn down, as to do so would expel a portion of the plaster and 
 prevent one of the important objects, viz, a very high impression. 
 
 Fig. 13. 
 
 As no surplus plaster could have been forced in contact with the 
 soft palate, causing nausea, the patient will not be inconveniencetl, 
 and the impression may, therefore, be allowed to remain until it has 
 
 Fig. 13^2. 
 
 become thoroughly set. '{"he harder the plaster is allowed to set 
 the more perfect will be the impression. (If removed too quickly, 
 portions of the plaster will be found adhering to the surfaces of the 
 teeth.) 
 
26 THE ANGLE SYSTEM. 
 
 The tray must now be loosened and taken away, leaving the 
 impression in the mouth. All superfluous pieces should be re- 
 moved very carefully. Two grooves are then scraped or cut in 
 the hardened plaster on a line parallel with the cuspid teeth, never, 
 however, cutting quite through. Then, with a quick pry with the 
 point of a pen-knife, the anterior plate is wrenched loose and laid, 
 together with all subsequent pieces, on a clean blotting pad. The 
 lateral pieces are then broken off between the thumb and finger, 
 when the large piece covering the roof of the mouth alone will 
 remain. This may be readily worked loose, and, if the operation 
 has been carefully performed, the impression will then consist of 
 four pieces (although a greater number will in no way injure it). 
 Great care should be observed to save all small pieces, removing 
 them as clean as possible. 
 
 Patience and care should be observed in re-uniting the pieces. 
 If skillfully done the line of fracture can hardly be detected. The 
 pieces are best united out of the tray and held with wax made quite 
 hot on the spatula and flow^ed over the outside, the clean, united 
 ends being held so perfectly in contact that little if any will flow 
 into the fracture. When finished it should have the appearance 
 illustrated in Fig. 13. If there be an unusual number of pieces 
 they may be united by replacing them in the tray, but this is never 
 very accurate, as the expansion of the plaster makes a perfect fit 
 with the tray impossible. 
 
 This method of taking impressions preserves the fine points of 
 the interdental spaces. I believe it to be the only practicable way 
 of taking an accurate impression. 
 
 In like manner the impression of the lower arch is secured, 
 being careful to observe the essential points, namely, carrying the 
 impression-material, which has been built up and outside of the 
 anterior part of the rim, well down beneath the lip zvith the Hnger 
 before forcing the tray home, then expelling the air by gradually 
 working the cheeks while the tray is firmly held. Care should be 
 observed in selecting a sufficiently large tray which may, without 
 injury, be bent to conform more perfectly to any peculiar shape of 
 the arch. 
 
 After the impression has been thoroughly dried the inside should 
 be coated with shellac varnish ; at the expiration of half an hour it 
 is again coated with sandarac varnish, and at the end of another 
 half-hour it should be very carefully filled with plaster. 
 
 It is important that both of these varnishes shall be of the proper 
 consistence, which it is difficult to describe. If too thin it will be 
 
IMPRESSION AND MODEL MAKING. 27 
 
 difficult to separate the impression without injury to the model. 
 If too thick all fine tracings of the impression will be obliterated. 
 The proper consistence is best determined by a little experience. 
 The filling of the impression with plaster is best accomplished 
 by applying the soft plaster into the tooth cavities by means of a 
 small camel's-hair brush in order to expel all air-bubbles, then 
 filling the remainder by means of the spatula; then it should be 
 turned upside down on a glass slab. 
 
 After the plaster has thoroughly set, the pieces of the impres- 
 sion may usually be very readily separated in the same order in 
 which they were removed from the mouth, when, should any air- 
 cavities be found in the model, they may be beautifully filled by 
 packing in white oxyphosphate of zinc and pressing it home by 
 replacing the piece of the impression, which should be allowed to 
 remain until the cement is thoroughly hardened, when it will 
 readily separate, leaving a very perfect surface. A cusp or broken 
 tooth may in like manner be repaired. 
 
 The models may now be trimimed, and not only will there be a 
 surface as smooth as polished marble, but each cusp, all the inter- 
 dental spaces, the rugae as well as the inclination of the roots, 
 and even the minute "stipples" of the gum, will all be accurately 
 and beautifully shown. Any coatings of paints or varnishes only 
 detract from the beauty of such models. 
 
 They should now be carefully articulated, after comparison 
 with the natural teeth and the articulation, indicated by two or 
 more pencil markings, so the proper points of contact may be 
 afterward readily found. These serve the purpose quite as well 
 as a metal articulator. The models should also be neatly labeled 
 to serve for study and reference, and, on occasion, be valuable as 
 legal evidence. 
 
 As soon as the teeth have been completely moved, another im- 
 pression should be taken and models made. This is done after 
 all appliances have been removed, the teeth thoroughly cleansed, 
 and immediately previous to adjusting the retaining appliances. 
 These models are valuable for comparison with the natural teeth 
 during the period of retention, as well as for future reference. 
 
 It is also of advantage to have study models occasionally made 
 during treatment and retention, by pressing a piece of softened 
 wax, about three-eighths of an incii deep, onto the cutting edges 
 of the teeth, to accurately show the positions of the teeth only, 
 together with such appliances as may bo upon them. 
 
26 
 
 THE ANGLE SYSTEM. 
 
 CHAPTER VI. 
 
 DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 In the correction of dental irregularities, an appliance must act 
 either by pulling, pushing, or twisting a tooth into proper position ; 
 and the movements of the tooth are limited to seven: backward or 
 forward in the line of the arch, outward or inward in the line of 
 the arch, elongation or depression of the tooth in its socket, and 
 rotation. 
 
 Section I. Backward in the Line of the Arch. 
 
 The backward movement of the teeth in the line of the arch is 
 accomplished in two principal ways. First, by the large traction- 
 screw A and D, Set No. i, shown in Fig. 14, for the retraction of a 
 
 Fig 
 
 Retraction of Cuspid. 
 
 superior cuspid. The first molar is encircled by a No. 2 clamp- 
 band (Fig. 6), to which is soldered the long sheath of the traction- 
 screw A, Fig. I. The cuspid is also encircled by a band, having 
 the short tube D, Set No. i, soldered horizontally to it on its distal 
 surface, with which tube the smooth bent end of the traction-screw 
 engages. The nut, operating against the distal end of the tube, 
 will move the cuspid backward into position. The easiest way to 
 adjust this appliance is to first cement the band upon the cuspid; 
 after the cement has become thoroughly set, the angle of the 
 traction-screw is hooked into the short tube, and the adjustable 
 band latched over the molar. It is very important that the bent 
 end be passed into the tube its full length, otherwise it will be 
 broken when force is exerted. The screw may be employed on the 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 29 
 
 outside of the arch; the short tube, in that event, should be at- 
 tached to the mesio-buccal angle of the band, as shown on the 
 right cuspid of Fig. 15. 
 
 If a movement of rotation as well as retraction is desirable, the 
 angle of the screw should be hooked over a spur, as shown on the 
 
 Ktc 
 
 left cuspid of Fig. 15, thus concentrating all the force upon one 
 side of the moving tooth. Recent experience has shown that a 
 staple made from the wire G, Set No. i, is stronger and better than 
 the spur for making this attachment. Should the cuspid be very 
 prominent, requiring the movement to be inward as well as back- 
 ward, that may be accomplished at the same time by bending the 
 screw, which, as the nut is turned, will be gradually straightened. 
 (See Fig. 16.) 
 
 Fig. 16. 
 
 A method of reinforcing the anchor-tooth is also shown in this 
 engraving, by enlisting the resistance of the lateral incisor. This 
 tooth is banded and provided with one of the pipes R, Set No. i, 
 soldered to its distal angle; one end of a piece of the wire G, Set 
 No. I, is soldered to the sheath of the traction-screw, and made to 
 rest in this pipe. 
 
 In making the attachments for retraction after the manner dc- 
 
30 
 
 THE ANGLE SYSTEM. 
 
 scribed, it is of the utmost importance that the band encircling the 
 molars should be tightly clamped, burnished, and firmly cemented, 
 so that the attachment will be perfectly rigid. In this way the re- 
 sistance of the anchorage will be greatly increased, and tipping of 
 the anchor-teeth will be prevented; while, if moved at all, they 
 must be dragged bodily through the alveolus, because the apices 
 of the roots move equally with the crown, as shown in Fig. 17, 
 
 Fig. 17. 
 
 Stationary Anchorage. 
 
 which represents a side view of the appliance in position, the 
 dotted lines showing the movements which must take place if the 
 attachment is properly made. This is a most perfect form of 
 anchorage, and I am indebted to Dr. W. C. Barrett for first sug- 
 gesting it. 
 
 If the nut is placed upon the screw in front of the sheath and 
 tightened, force with the same resistance of anchorage may be 
 
 Fig. 18. 
 
 
 
 >ir:-- 
 
 'Mf.-:^. iV'^:^?; 
 
 exerted in moving the tooth forward instead of backward. When 
 the jack-screw is employed for pushing, the same firmness of 
 anchorage may be gained by soldering the base of the sheath to 
 the anchor-band, which is to be firmly clamped and cemented in 
 position upon the anchor-tooth, as shown in Fig. 18. 
 
 Another way of moving teeth backward in the line of the arch 
 is by means of Set No. 2, and will be described in the treatment of 
 cases of excessive protrusion of the superior incisors. 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 3I 
 
 Section II. Forward. 
 
 The movement of a tooth forward in the Hne of the arch may 
 be accompHshed by means of the traction-screw, in the same way 
 as already described for retraction, by selecting anchor-teeth on 
 the opposite side to be used in overcoming the resistance of the 
 tooth that is being moved, as shown in Fig. 19, which represents 
 
 Fig. 19. 
 
 a case in practice, and shows the screw employed in pulling both 
 incisors forward in the line of the arch to close the wide space 
 between the centrals; at the same time providing space for the 
 cuspid, which is being moved out of inlock by means of the jack- 
 screw. In this case the traction-screw was beaten flat, polished, 
 and bent to conform to the curve of the arch. 
 
 Section III, Outward. 
 
 The movement of a tooth from within outward into the line of 
 the arch is accomplished in four principal ways: First, by means 
 of the jack-screw E and J, Set No. i, the sheath of which is secured 
 to a suitable anchor-tooth, the point acting upon the moving tooth 
 by turning the nut. The base of the sheath of the jack-screw may 
 be secured in various ways, as shown in Fig. 20. First by a dowel 
 made by soft-soldering a piece of the wire G, Set No. i, into the 
 end of the sheath which rests in a pit in the anchor-tooth, as in A. 
 By a spur made from the same wire soldered to the anchor-band, 
 over which the end of the sheath is slipped, as in B. By a dowel 
 made from the same wire, slipped into one of the pipes R, Set No. 
 I, soldered to the anchor-band, as in C. (In this way the length 
 of the sheath may also be increased.) By pointing the end of the 
 sheath with a file and letting the point rest in the pipe on the 
 anchor-band, as in D, By soldering the sheath directly to the 
 anchor-band, as in E and F, By notching the end of the sheath, 
 
32 
 
 THE ANGLE SYSTEM. 
 
 which shall engage the anchor-wire as in G, Fig. 20, and Fig. 41. 
 By soldering the end of the sheath directly to another sheath, as in 
 H. By means of a spur made from the wire G, Set No. i, soldered 
 to the sheath which shall engage one of the pipes R, Set No. i, 
 soldered to the anchor-band, as in I. By slipping the end of the 
 sheath over the screw upon the clamp-band, as in J. Of these 
 
 Fig. 20. 
 
 various ways I prefer that of attaching the sheath directly to the 
 anchor-band, as in E and F, or by means of the spur, as in B (the 
 spur being quickly and easily made by soldering), by holding a 
 long piece of the wire G, Set No. i, between two of the fingers of 
 one hand, while the end of the screw upon the clamp-band is 
 grasped between the thumb and finger of the other hand, carrying 
 it in contact with the fine point of the flame (as in Figs. 9 and 10), 
 presenting the appearance after soldering shown in K, Fig. 20; 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 33 
 
 after which the wire is cut off, leaving the desired length of the 
 spur. The point of the screw is held firmly in position by six 
 principal ways, as shown in Fig. 21, 
 
 First: By notching the point of the screw with a separating 
 file, which notch will engage a similar notch in the united ends 
 of the band, as in A. By pointing the end of the screw to engage 
 one of the small pipes R, Set No. i, soldered to the band as in B. 
 By a mortise in the band to engage the point of the screw, as in C. 
 By soldering an elliptical ring (formed by bending the wire G, 
 Set No. I, as at G, Fig. 21), in which to rest the point of the screw, 
 as in D. By a staple, made from the same wire, soldered (see H) 
 to the band, as in E, the point of the screw being suitably notched. 
 
 I '^, I 
 
 By pointing the screw to be received in the pit formed in the 
 enamel or filling, as in F. Of these various ways of securing the 
 point of a jack-screw, I prefer the plan shown in D and E, forming 
 the ring and staple upon the ends of long pieces of the wire, which 
 serve as handles while soldering, as in G and H, after which the 
 superfluous portions are clipped ofif. The roughened ends are 
 then rounded and made smooth with a fine file. 
 
 Fig. 22 shows an inlocked cuspid being moved outward, the 
 point of the screw resting in a mortise formed in the band upon 
 the moving tooth, the base of the sheath being notched to engage 
 a piece of the anchor-wire G, Set No. i, passing through a tube 
 soldered to the lingual surface of the left cuspid. The anchor- 
 age is greatly reinforced by means of this wire, which is beaten 
 flat where it passes between the central and lateral, the end being 
 
34 
 
 THE ANGLE SYSTEM. 
 
 bent around the labial surface of the central. Force is obtained 
 by turning- the nut. After a tooth has been moved into the 
 desired position, it is retained by a piece of the wire G, Set No. i, 
 passed through a pipe R, Set No. i, soldered to the band, the wire 
 ends resting upon the labial surfaces of the lateral incisor and 
 
 Fig. 22. 
 
 Fig. 23. 
 
 Fig. 24. 
 
 first bi'^uspid. This wire is held in place by a very delicate pin 
 passing through the pipe and one side of the wire, as in Fig. 23. 
 
 Fig. 24 shows a favorite method of reinforcing the anchorage. 
 In this case the sheath of the jack-screw was placed on a spur 
 soldered to a bicuspid clamp-band, as at B, Fig. 20. The point 
 of the screw was sharpened and rested in a pit formed in the 
 
DIRECTIOX OF FORCES FOR TOOTH-MOVEMENT. 35 
 
 enamel. Reinforcement was gained by hooking a piece of the 
 wire G, Set No. i, into two pipes (R, Set No. i), one soldered to 
 the sheath of the jack-screw near its base, the other soldered to 
 the lingual surface of a lateral incisor band. If the appliance has 
 been carefully adjusted the patient may be provided with a wrench, 
 and instructed in turning the nuts at proper intervals. 
 
 Recent experience has proven that an easier way of attaching 
 the reinforcement wire is to omit the pipe attached to the band 
 on the lateral, soldering the straight end of the wire directly to 
 the band. The other end of the wire should be passed straight 
 through the pipe, on the sheath, and secured by bending the end 
 around the pipe end. 
 
 Fig. 25 shows a left lateral being moved outward, reinforcement 
 having been gained in the manner already described, using two 
 
 Fig. 2;. 
 
 pieces of wire attached to bands on the central and cuspid. Not 
 only was the anchorage reinforced, but the incisor and cuspid were 
 prevented from being pushed out, the moving tooth providing 
 space for itself by forcing the adjoining teeth laterally. By this 
 means the most perfect form of anchorage is secured, employing, 
 preferably, the method of attaching the reinforcement wires de- 
 scribed in the last case. 
 
 The second mode of moving a tooth from within outward is 
 shown in Fig. 25, where a right lateral is being forced outward 
 by means of the stnall traction-screws B and C, Set No. i. A 
 strip of the band-material (F, Set No. i) is looped around the 
 lateral, the ends resting upon the labial surfaces of the adjoining 
 teeth. On one end is soldered a short tube, C (accompanying 
 the screw), attached vertically, while on the other end a similar 
 tube is attached horizontally. Into these tubes the traction-screw 
 E, Set No. I, is placed, being bent to conform to the circle of the 
 arch, and used, in this case, to push instead of pull. This appli- 
 
36 
 
 THE ANGLE SYSTEM. 
 
 ance should be frequently tightened by turning the nut, or it will 
 become loose and cause trouble. The parts of this device are 
 shown separately in Fig. 26. 
 
 Fig. 2y shows the teeth as retained by means of pieces of the 
 anchor-wire (G, Set No. i) passing through pipes attached to the 
 labial surfaces of the bands, as described and shown in Fig. 23. 
 
 Fig. 26. 
 
 Fig. 27. 
 
 The third method of moving a tooth from within outward is 
 by lacing the teeth to the expansion arch, as in Fig. 28, force 
 being derived from the spring of the arch and sustained by 
 occasionally turning the nuts. (See also Fig. 68.) 
 
 The fourth method is by means of the wire ligature encircling 
 the tooth and arch, force being exerted by occasionally twisting 
 the wire, as in A, A, Fig. 28. 
 
 Fig. 28 
 
 Section IV. Inward. 
 
 A tooth may be moved in\yard by the small traction-screw 
 B and C, Set No. i, as shown in Fig. 29, in which a cuspid is 
 being drawn into line, the bent end of the screw being hooked 
 into the small tube C, Set No. i, soldered to the band upon the 
 anchor-tooth. The other end of the screw passes through a 
 similar tube, against the end of which the nut works. To the 
 tube is soldered a piece of the wire G, Set No. i, bent at right 
 angles and hooked into a pipe (R, Set No. i), soldered to the 
 lingual surface of the band on the cuspid. Force is exerted by 
 turning the nut. The anchor-tooth was reinforced by a- piece of 
 the wire G, Set No. i, resting in contact with the buccal surfaces 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 37 
 
 of the adjoining teeth, and held in position by one of the small 
 pipes R, Set No. i. This anchor-wire was kept from turning 
 by a very delicate pin passing through the pipe and one side of 
 the wire, as in Fig. 23. Another way of securing this wire is 
 by soldering it directly to the band. 
 
 Prominent teeth may also be forced into the line of the arch 
 by means of the wire arch B, Set No. 2, or the expansion-arch 
 E, Fig. 4, made to encircle the dental arch and bear against the 
 prominent tooth, and the force may be intensified by an inter- 
 vening wedge of rubber. The adjoining teeth are firmly laced 
 to the arch by means of wire ligatures, as described in the treat- 
 ment of the case shown in Fig. 65. 
 
 Fig. 29. 
 
 Section V. Rotation. 
 
 There are three principal modes of rotation by this system. 
 First: by means of the lever, band, and tube, as shown in Fig. 
 30, which represents a lateral incisor in process of rotation. The 
 incisor was encircled with an accurately-fitting band cemented in 
 position and having soldered to it one of the small pipes R, Set 
 No. I, into which was inserted the end of one of the levers L, 
 Set No. I, the other end being sprung around and secured to a 
 suitable anchor-tooth. This attachment of the end of the lever 
 may be made in various ways, — either by being latched into a 
 notch formed in the united ends of the band as shown in Fig. 30, 
 or by a wire ligature made to encircle the anchor-tooth and lever, 
 or by a wire ligature encircling the button on the clamp-band 
 CNo. 3 or 4, Fig. 6), and attached to the end of the lever bent in 
 the form of an eye; which is now my favorite method. The 
 anchor-tooth may be reinforced by a piece of the wire G, Set No. i, 
 resting in contact with the lingual surface of the adjoining teeth, 
 and held in position by one of the pipes R, Set No. i, soldered to 
 
38 THE ANGLE SYSTEM. 
 
 the anchor-band as shown. It will be seen that thus a constant, 
 powerful, rotative force may be exerted upon the tooth. 
 
 Care should be exercised that the lever be not allowed to pry 
 against the intervening teeth, to force the tooth outward. 
 
 It is often desirable to lace one or more of the intervening 
 teeth to the lever by means of the wire ligature, to prevent over- 
 lapping of the teeth. The leverage may be increased by allowing 
 
 Fig. 30. 
 
 the end to pass through the pipe, and to bear against the labial 
 surface of the adjoining tooth. This may be intensified by an 
 intervening wedge of rubber. 
 
 Fig. 31 shows the rotated incisor retained by a short piece of 
 the wire G, Set No. i, slipped into the pipe from the opposite side 
 and made to bear against the labial surface of the central incisor. 
 There should also be soldered a spur to the disto-lingual angle of 
 the band and made to bear against the cuspid. 
 
 Fig. 31. 
 
 Retainer. 
 
 Fig. 32 shows two cuspids being rotated by this method. It 
 will also be seen that the lever may be employed on the inside of 
 the arch, and in this case there was the advantage of reciprocal 
 anchorage resulting from the ends of the levers acting in opposite 
 directions upon the anchor-tooth. 
 
 In all similar cases where the lever is being employed, on the 
 outside of the arch it should be bent at the point nearest the labial 
 surface of the cuspid, so as to concentrate all the spring in the 
 region of the moving tooth. 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 39 
 
 Second : Rotation may also be performed, as shown in Fig. 33, 
 by means of the jack-screw E and J, Set No. i, secured by staple, 
 clamp-band and spur, and pushing against one side of the tooth 
 to be moved, while the small traction-screw, attached by pipe R, 
 Set No. I, and piece of anchor-wire G, Set No. i, soldered to the 
 
 Fig. 32. 
 
 base of the sheath of the jack-screw, is made to pull upon the other 
 side of the tooth. In this way perfect control of the tooth is 
 gained, not only in rotation, but also in pushing it outward or pull- 
 ing it inward into the line of the arch, according as the nuts are 
 adjusted. This method of rotation is principally limited to the 
 
 Fig. 33. 
 
 superior central incisors or cuspids. It should be said tliat because 
 of the powerful force they exert the nuts should be turned but 
 slightly at each sitting. This is also another instance where use 
 is made of reciprocal anchorage, which is to be taken advantage of 
 whenever possible. 
 
40 THE ANGLE SYSTEM. 
 
 Third: Rotation may be accomplished by exerting force on 
 one side of a tooth by means of a wire Hgature on the expansion- 
 arch E, and a spur soldered to a band encircling the tooth to be 
 moved, as at B, Fig. 28. This force may be intensified by a wedge 
 of rubber stretched between the band and arch and acting upon 
 the opposite side of the tooth, as in Fig. 68. A modification of 
 this plan of rotation is shown at C, Fig. 28, in which the band is 
 dispensed with and the double or loop ligature is continued 
 around the tooth, including the wire arch. This plan is less 
 certain on account of the liability to slip: it is also less powerful, 
 since the wedge of rubber cannot be used. It, however, will be 
 found useful where teeth are to be but slightly rotated. At the 
 same time a number of other teeth should be ligatured to the arch 
 to secure greater firmness. 
 
 Section VI. Double Rotation. 
 
 When two teeth are to be rotated in opposite directions at the 
 same time, as the central incisors shown in Fig. 34, double rota- 
 
 FiG. 34. Fig. 35. 
 
 Double Rotation. 
 
 tion may be accomplished by a single lever. In this instance both 
 the teeth are banded, and a tube soldered to each band. A 
 straight lever is inserted in one tube, springing and sliding it into 
 the other tube in the same manner in which a door-bolt is slid 
 into position, as also shown in Fig. 35. It may be necessary to 
 occasionally remove and straighten the lever a little, in order to 
 maintain the pressure. Should one tooth be rotated sufficiently 
 before the other, further movement may be arrested by removing 
 the band and soldering a lug on the lingual surface to rest against 
 the lateral incisor. And should the teeth in rotation assume too 
 much prominence, by reason of pressure from the adjoining teeth, 
 it may be effectually corrected by requiring the patient to wear, 
 for a few nights, the head-gear, traction-bar, and heavy elastic 
 bands shown in Figs. 2 and 3, filing a deep notch in the end of 
 the standard to engage the rotating lever. 
 
 If the teeth show a tendency to separate as they rotate, they 
 should be drawn tightly together by a ligature, made to encircle 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 4I 
 
 both tubes and held in position by the ends of the lever, slightly 
 protruding through the tubes. 
 
 When the teeth are in position they are retained by .substituting 
 a piece of the non-elastic wire G, Set Xo. i, for the spring wire, 
 or, better still, by uniting the bands with solder and re-cementing 
 them, as first suggested by Professor Guilford, and shown in Figs. 
 1 1 and 89. 
 
 Of the levers shown at L, Set No. i, four different sizes are 
 furnished. The smallest size is quite strong enough, in most in- 
 stances, for double rotation, and is most conmionly used by me, 
 especially on the teeth of children. 
 
 These levers are plated in such a manner as to nearly overcome 
 the annoyance of oxidation and discoloration of the teeth in their 
 use, thus obviating an objection to the employment of steel wire 
 in the construction of regulating appliances. 
 
 The reader should never confuse the wire G, Set No. i, with 
 these levers. Their uses are as different as the material of which 
 they are composed. The levers are used only in rotation (occa- 
 sionally in expansion), and are never united by solder in forming 
 an attachment; while the wire G, Set No. i, is extremely tough 
 and malleable and has a very wide range of application, such as 
 reinforcing anchorage, retention, making spurs, staples, etc. 
 
 Section VH. Elevation. 
 
 The elevation of a tooth in its socket may be accomplished as 
 shown in Fig. 36, wherein a superior cuspid is being drawn out 
 or erupted into line. The clamp-band No. 3, Fig. 6, was fixed 
 
 Fig. 36. 
 
 on the lower second bicuspid. A very small hole was drilled 
 into the cuspid, and a short pin was set with thin cement. A 
 common pin answers the purpose very well, and the hole need 
 not be deeper than the enamel if the pin is accurately fitted to 
 it. A rubber ligature was given the patient with instructions 
 
42 THE ANGLE SYSTEM. 
 
 to slip it over the pins, as shown in the engraving. The anchor- 
 tooth in this case is directly opposed by the superior bicuspid. 
 The anchorage is simple and efficient. The ligature may be 
 worn at night only, so as to interfere as little as possible with 
 speech and mastication, although some patients wear it almost 
 continuously. Too strong a ligature should not be worn, as it 
 might endanger the life of the pulp, but gentle traction should be 
 used, gradually directing the tooth into its proper position. The 
 direction of force to be exerted upon the tooth to be moved will 
 of course indicate which tooth in the inferior arch should be 
 selected for anchorage. Should the anchorage fall upon a tooth 
 with no antagonist there would, of course, be danger of loosen- 
 ing it. 
 
 Fig. 37 shows a case in which the anchorage was modified tO' 
 suit the conditions. A deciduous cuspid had been retained too 
 
 Fig. zt. 
 
 long, causing the permanent cuspid to remain in the alveolar 
 process on the lingual side of the lateral incisor, necessitating a 
 complex movement of the tooth backward, outward, and down- 
 ward, requiring a very firm anchorage and a strong ligature. 
 On the inferior cuspid and second bicuspid were fixed bands,, 
 having pipes R, Set No. i, atached to their labial surfaces. A 
 piece of the wire G of suitable length was bent at right angles 
 and hooked into the pipes, as shown. The wire fits the bore of 
 the pipe so accurately that in cutting off the ends which emerge 
 through them, each end spreads sufficiently to prevent its coming 
 out. A pin was soldered to the wire about midway between the 
 pipes. The ligature was stretched from pin to pin, as seen in the 
 engraving. 
 
 Fig. 38 shows a modification of this method of anchorage. 
 The anchor-wire was made detachable and the pin dispensed with, 
 the patient slipping the wire through the ligature and into the 
 pipes upon retiring, and removing it during the day. A delicate 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 43 
 
 band (made of F, Set Xo. i), to which was soldered the pin, was 
 fixed on the moving tooth. 
 
 Fig. 39 ilkistrates a case in which the appHances used were 
 similar to those before described, but the wire anchorage was 
 attached to teeth in the same arch in which was located the 
 malposed tooth. The first bicuspid was banded and a pipe R, 
 Set No. I, soldered to the labial surface of the band, in which was 
 
 Fig. 38. 
 
 hooked a piece of the wire G, Set No. i, the other end of the 
 wire being bent so as to rest on the cutting-edge of the lateral 
 incisor. A pin was soldered to this wire, as in the case before 
 described, and a rubber ligature stretched from pin to pin. In 
 some cases where more force was necessary, I have used the 
 combined anchorage described. 
 
 Fig. 39. 
 
 ^^Sf*""' "^il 
 
 A tooth may also be elevated in its socket by employing either 
 of the wire arches E or B as an anchorage; attaching the ligature 
 to the tooth to be moved in any of the ways already described. 
 
 Fig. 40 shows the application of a modification of this principle 
 in a case where all of the superior incisors are being elevated by 
 means of the spring of the wire arch. ;( The arch is made to bear 
 against spurs soldered to bands upon the cuspids, which act as a 
 fulcrum, while the central portion of the arch is sprung upward 
 
44 
 
 THE ANGLE SYSTEM. 
 
 and hooked over spurs soldered to bands upon the centrals. The 
 arch should be occasionally removed and modified by bending, in 
 order to maintain the proper amount of spring. Either of the 
 arches (E or B) may be used for this purpose. 
 
 Fig. 40. 
 
 f-MA 
 
 Section VIII. Expansion. 
 
 There are several methods of expanding the arch by this system. 
 First: By banding and tubing the first and last teeth of those to 
 be moved on each side, and connecting them by means of wire 
 (G) passing through the tubes. The jack-screw is then placed 
 in position across the arch, from wire to wire. Collars R, Set 
 No. I, are soft-soldered to the wire at intervals to keep the screw 
 
 Fig. 41. 
 
 in proper position. The jack-screw may be moved forward or 
 backward, according to the varying requirements of the case. 
 Before placing in position, the wires which pass along the sides 
 of the arch should be bent to correspond to the shape of the 
 sides of an ideal arch, or exactly as we wish the teeth to be when 
 finally arranged. The appliances in position are accurately shown 
 in Fig. 41. 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 
 
 45 
 
 Fig. 42 shows a modification of this method of expansion, the 
 force being derived from one of the levers L, Set No. i, bent in 
 the form of the well-known Coffin spring, affording all the advan- 
 tages of the Coffin method of expansion, without the disagreeable 
 features of the vulcanite plate. Its chief advantage over the above 
 method is that it may be also used in expanding the lower arch, 
 without interfering with the movement of the tongue, as would 
 jack-screws. 
 
 The appliance for double rotation shown upon the central 
 incisors has already been described, and is repeated only to illus- 
 trate how it may be used with advantage while the arch is being 
 expanded laterally; the rubber ligature is used at the same time 
 to retract the incisors. 
 
 Fig. 42. 
 
 The extra tubes, soldered at right angles to little collars slipped 
 upon the bars on each side of the arch, are for engaging the 
 expanding spring, should it be found necessary to transfer the 
 pressure to that part of the arch. Should it be found necessary 
 to move a tooth beyond this side bar, stretch a rubber wedge 
 between the tooth and bar, as shown in Fig. 86. This simple 
 method of moving a tooth beyond the limits of the appliance 
 will be found valuable in connection with the other parts of the 
 system. 
 
 Another method of expanding the arch laterally, as well as 
 anteriorly, is by means of the appliances shown in Fig. 43, 
 wherein the notched ends of the jack-screw engage a piece of 
 one of the wire levers L, Set No. i, held in position by notches 
 formed in the united ends of the bands upon the lateral incisors. 
 The sheaths of the screws were held by solder to anchor clamp- 
 bands on the first molars. The incisors were moved forward 
 
46 
 
 THE ANGLE SYSTEM. 
 
 by turning the nuts upon the jack-screws, while the arch was 
 being expanded laterally, by means of one of the spring levers 
 L, Set No. I, the ends of which had been bent sharply at right 
 angles, and made to engage the delicate holes bored into the 
 sides of the sheaths of the jack-screws, all as clearly shown in 
 the engraving. A modification of this plan is to exert pressure 
 
 Fig. 43. 
 
 laterally by means of a third jack-screw instead of the spring, 
 this screw being notched at each end and made to rest in contact 
 with the screws upon the sides of the arch, anterior to their nuts. 
 
 Another excellent method of expanding the arch is by means 
 of lacing the teeth to the expansion-arch E, shown in Figs. 4 and 
 68. The wire ligatures are occasionally tightened by twisting, 
 
 Fig. 44. 
 
 until the teeth have been moved outward and made to conform 
 to the shape of the wire arch. The increasing size of the arch 
 is provided for by adjusting the nuts in front of the tubes upon 
 the anchor-bands. By this method, one or both of the lateral 
 sides of the arch may be expanded, or the anterior part of the 
 arch alone may, be moved forward, in which case the teeth are 
 
DIRECTION OF FORCES FOR TOOTH-MOVEMENT. 47 
 
 laced to the arch and moved forward collectively by turning the 
 nuts. (See Fig. 68.) 
 
 In expanding the lateral halves of the arch by this method, the 
 wire arch should be straightened sufficiently to give all possible 
 spring, which in most instances exerts sufficient force. In cases 
 where the teeth are extremely firm, the expansion-arch may be 
 reinforced by the spring from one of the levers L, Set No. i, 
 bent to conform to the inside of the arch, and made to press upon 
 the anchor-bands D. The ends of the wire are held in position 
 by being bent at right angles, and slipped into pipes R, Set No. i, 
 which have been soldered at right angles to tubes C, slipped over 
 the ends of the screw upon the clamp-bands D, all as shown in 
 Fig. 44. 
 
 Fig. 45- 
 
 If it is desirable to exert pressure only upon the bicuspids, the 
 spring of L alone is sufficient, when held in proper position, by 
 securing the ends in either of the following ways: By resting in 
 one of the pipes R, Set No. i, soldered to the clamp-band (the 
 end of the pipe being closed as shown on the left of Fig. 45), the 
 arch being bent so as to lie in contact with and also exert pressure 
 upon the first bicuspid; or the end may be secured, as on the 
 right of Fig. 45, by being bent to engage one of the pipes R, Set 
 No. I, soldered to the nut upon the clamp-band, the end of the 
 band-screw resting against the first bicuspid. The nut must be 
 removed from the screw while soldering, or pieces of the anchor- 
 wire G, Set No. I, may be soldered to the clamp-bands encircling 
 the second bicuspids, the front ends in contact with the lingual 
 surfaces of the first bicuspids. To these wires are soldered at 
 right angles the pipes R, which engage the ends of the spring, 
 as in Fig. 46. Or the same attachments to the clamp-bands upon 
 the bicuspids may be made as already described and shown in 
 Fig. 44. 
 
 If it is desirable to exert i)ressure upon one tooth only, a pipe 
 should be soldered to the band over the tooth to be moved; in 
 this pipe rests the end of the spring. Bend the spring so that 
 
48 THE ANGLE SYSTEM. 
 
 all the force will be exerted upon the one tooth to be moved, 
 while two or even more teeth as anchorage on the opposite side 
 of the arch antagonize this force. This latter plan will be found 
 
 Fig. 46. 
 
 useful in moving outward or inward a single molar, which is 
 sometimes desirable in order to establish perfect occlusion. 
 
 CHAPTER VII. 
 
 PRACTICAL CASES. 
 
 Section I. Having completed the description of the principal 
 ways of constructing and adjusting the appliances for moving 
 and retaining the teeth, some practical cases are appended to 
 familiarize the reader with this system, and enable him to more 
 easily comprehend its intelligent employment. Such simple cases 
 as are found in early childhood will be first cited. There is prob- 
 ably no limit as to the time at which the treatment of dental 
 irregularities may be commenced. Cases treated so late as at 
 sixty years of age have been reported; but I am more and more 
 impressed with the great advantages of beginning the treatment 
 early, just as soon as the appearance of irregularities is manifest 
 and the teeth have emerged from the gum sufficiently to admit of 
 banding. Then, when nature is putting forth her best effort, 
 when growth and repair are most rapid, and the surrounding tis- 
 sues most yielding, employ simple, delicate appliances to gradually 
 move the teeth into their normal positions. Studiously avoid 
 needless interference in those cases where it is apparent that nature 
 will, unaided, correct the deformity; but take professional pride 
 in encounters with the interlocked, twisted and overlapped, or 
 otherwise malposed teeth, which usually become worse and com- 
 plicate the condition of the teeth yet to be erupted. 
 
 There is an impression among a large number of dentists that 
 
PRACTICAL CASES. 
 
 49 
 
 treatment should be deferred until after the age of fifteen, or 
 thereabouts, or until the teeth have taken their positions in the 
 arch; but this impression is erroneous and fruitful of much harm, 
 for by that time cases become complex and often exceedingly 
 difficult to treat, and conditions are established which it is impos- 
 sible to wholly overcome. 
 
 With proper appliances used at the right time, a few days will 
 often accomplish what might otherwise require many months if 
 left until the whole dental apparatus is in disorder. The dis- 
 comfort and annoyance of a suitable regulating appliance is slight 
 in youth, but liable to increase somewhat wath advancing years; 
 yet at no time of life, if the operation be skillfully performed, need 
 there be more than inconvenience; never real pain. 
 
 Fig. 47. 
 
 Fig. 47 shows an erupting central incisor being moved out of 
 inlock. The tooth was banded and one of the pipes R, Set No. i, 
 soldered to the mesio-lingual angle of the band; one end of a piece 
 of the wire G, of suitable length, was inserted into this pipe, and 
 the other end secured in a pit formed in the enamel of the second 
 deciduous molar. Force was exerted upon the tooth to be moved 
 by occasionally pinching this wire with the regulating pliers H, 
 Fig. 8 B, two or three pinches being enough to lengthen the wire 
 sufficiently to move the tooth as far as it should be at one sitting. 
 The force of the wire being exerted wholly upon the mesio-angle 
 of the tooth, it was rotated as well as moved out of inlock. The 
 occlusion of the lower incisors retained it in its new position. 
 
 Of course, one of the jack-screws, instead of the wire, might 
 have been eniplr>ycd, but the force exerted by stretching the wire 
 is so simple, and the mere wire so compact and powerful, that it 
 
50 
 
 THE ANGLE SYSTEM. 
 
 is now employed, especially in the treatment of children's teeth, 
 whenever possible. 
 
 Fig. 48 illustrates a case which I believe to be so common that 
 it may be regarded as typical, and the method of treatment is one 
 which may be generally employed in this class of cases. Because 
 of lateral pressure the superior central incisors had erupted much 
 anterior to their natural positions, and the laterals were appearing 
 
 Fig. 48. 
 
 posterior to their correct positions (this condition is not clearly 
 shown in the engraving); while the lateral pressure from the 
 inferior deciduous cuspids caused the central incisors to erupt 
 inside, and the laterals outside of the line. The treatment clearly 
 indicated was to exert lateral pressure upon the inferior cuspids, 
 sufQciently to provide space for the erupting incisors. As the 
 lower cuspids were gradually forced farther apart their occlusion 
 
 Fig 
 
 with the superior cuspids caused them also to be forced farther 
 apart, thereby providing space for the erupting superior incisors. 
 No attempt was made to straighten the incoming teeth other than 
 to provide space for their proper eruption. 
 
 The appliance exerting lateral pressure upon the inferior cuspids 
 is shown in Fig. 49. A straight piece of the wire G, Set No. i, 
 was secured by springing the ends into pits formed in the enamel 
 
PRACTICAL CASES. 
 
 51 
 
 on the lingual surfaces. Force was exerted by occasionally 
 pinching with the regulating pliers to lengthen the wire as already 
 described. About once a week was as often as the wire was 
 lengthened. 
 
 Fig. 50 shows another case in which a modification of this plan 
 of treatment was used. Not only was it requisite to exert lateral 
 pressure upon the inferior cuspids in order to provide space for 
 the erupting permanent incisors, but also to apply gentle pressure 
 to the laterals which were erupting far inside of the dental arch. 
 The cuspids were banded and pipes R, Set No. i, attached to 
 their disto-labial surfaces. The distal ends of the pipes were then 
 closed by a soldered piece of band material. Into the other ends 
 of these pipes was slipped a piece of the wire G, bent to conform 
 to the curve of the arch. Force was exerted by pinching the wire 
 with the regulating pliers H, Fig. 8 B, as before described. Gentle 
 
 Fig. 50. 
 
 traction upon the malposed laterals was made by encircling them 
 and the regulating-wire with ligatures, which were occasionally 
 tightened by twisting. The occlusion of the cuspids with the 
 superior cuspids, as in the case last described, caused the expan- 
 sion of the upper arch. I believe the line of treatment here indi- 
 cated, namely: beginning at the proper period, gently expanding 
 the inferior arch and perfectly arranging the four incisors, will 
 solve the problem of treatment in a very large percentage of cases, 
 the upper teeth being forced to develop normally by the occlusion 
 with the moving lower teeth. 
 
 In pursuing this line of treatment, the expansion of the lower 
 arch must be accomplished very gradually, or an inlocking of the 
 upper teeth will be the result. 
 
 Fig. 51 shows the expansion of the anterior part of the inferior 
 arch by the same method, the ends of the wire being soldered 
 directly to the Ungual surfaces of the bands encircling the cuspids. 
 The patient was a young lady, twenty-two years of age, and con- 
 
52 
 
 THE ANGLE SYSTEM. 
 
 siderable force was necessary, but the force exerted by pinching 
 the wire was found sufficient. 
 
 The centrals were drawn into the Hne of arch by means of wire 
 ligatures, occasionally tightened. 
 
 A little experience in stretching the wire with the regulating 
 forceps will enable the operator to manipulate the wire, by bending 
 as well as pinching, so that rotation as well as other movements 
 may be thus accomplished. 
 
 Fig. si. 
 
 Fig. 52 shows how an ordinary stay-plate may by this method 
 be modified to advantage by removing a portion of it and substi- 
 tuting in its place a piece of the wire G, Set No. i, bent and 
 inserted in such a way as to bring pressure upon the teeth to be 
 
 Fig. 52. 
 
 moved; which pressure is occasionally intensified by pinching the 
 wire with the stretcher. 
 
 Fig. 53 represents the result of an unnatural contraction of the 
 lips, thus bringing undue pressure on the anterior part of the arch 
 during the eruptive period, and forcing the teeth inward. They 
 were pushed outward by the jack-screws resting over spurs upon 
 the anchor-bands, the chisel ends of the screw resting in slots 
 
PRACTICAL CASES. 
 
 53 
 
 formed in bands on the moving teeth. (See B, Fig". 20, and C, 
 Fig. 21.) The teeth were also rotated at the same time with the 
 rotating levers previously described, and here well shown. In 
 this instance two levers were used, crossing each other in the 
 center. The lever on the left was anchored by latching it into a 
 hook soldered to the anchor-band on the second bicuspid. The 
 
 Fig. 53. 
 
 other lever was anchored by hooking it into one of the little pipes 
 R, Set Xo. I, soldered at right angles to the tube on the band of 
 the lateral which engages the other lever, A better way would 
 have been to have secured this end of the lever by a ligature 
 around the end of the other lever, but it is here shown to illustrate 
 one of the many optional ways of securing the end of the lever. 
 
 Fig. 54. 
 
 It will be .seen that the central incisors also need rotating. 
 This could have been easily accomplished by the double rotation 
 lever, but the same practical result was attained by lacing them 
 to the levers with wire ligatures. They were retained by bands 
 united with solder. (See Fig, 54,) This is an excellent method 
 of retention, and was first suggested by Dr. Guilford. They 
 
54 
 
 THE ANGLE SYSTEM. 
 
 could have been retained by my own method, namely, by passing 
 a piece of retaining-wire G through the horizontal pipes which 
 had secured the ends of the levers, and lacing the centrals to it; 
 but, although a simple and effective device, it would have been a 
 little less sightly. 
 
 Fig. 55 shows a form of irregularity frequently met with. The 
 arch is narrow, and the lateral incisors are being rapidly forced 
 inward by the erupting cuspids. In a very few months, without 
 treatment, the lateral incisors would be forced far inward, and 
 even the apices of the roots would be malposed; therefore, the 
 earlier regulation is begun the better. 
 
 The proper treatment is the expansion of the arch in the region 
 of the bicuspids, and the moving of the centrals forward and the 
 
 Fig. 55- 
 
 laterals outward. In the case illustrated this was accomplished 
 by the jack-screws engaging at their notched ends a piece of one 
 of the levers L, Set No. i, made to rest in notches formed in the 
 united ends of the bands encircling the lateral incisors. Anchor- 
 age for the jack-screws was gained by soldering the sides of the 
 sheaths to the anchor-clamp for the first molars (as in F, Fig. 20), 
 while the lateral sides of the arch were forced outward by means 
 of a piece of one of the spring levers L, Set No. i, the ends of 
 which were bent sharply at right angles and made to engage 
 small holes drilled through the sheaths of the jack-screws. Wire 
 ligatures were made to encircle the central incisors and the spring 
 lever engaged by the notched points of the jack-screws. All as 
 clearly shown in the engraving. The extra holes represented in 
 the sheaths were for shifting the expansion spring, should it be 
 found necessary. 
 
 After the teeth had been moved into their desired positions, the 
 bicuspids were held outward by a delicate-fitting stay-plate, similar 
 to Fig. 52, while the incisors were retained by means of a piece 
 
PRACTICAL CASES. 
 
 55 
 
 of the wire G, Set No. i, connecting the bands upon the lateral 
 incisors, the ends being soldered to the labial surfaces of the bands 
 and the intervening portion of wire lying in contact with the labial 
 surfaces of the central incisors. These retainers were worn until 
 the cuspids were fully erupted and all the teeth had become firm 
 in their new positions. 
 
 I should add, this patient originally suffered from greatly 
 enlarged tonsils. 
 
 Fig. 56 shows a case such as is frequently encountered in some 
 of its modifications. The inlocked cuspid has forced the lateral 
 outward. It will be seen by studying the appliance that it served 
 the double purpose of pushing outward the cuspid, while pulling 
 inward the lateral; the sheath of the jack-screw being cut short, 
 allowing it to travel downward over the spur as the nut is turned. 
 
 Fig. ;6. 
 
 until its base finally rests against the band, when the lateral will 
 have been drawn into place, and will reinforce the anchor-tooth 
 in resisting the moving cuspid. This is another instance of recip- 
 rocal anchorage, or that of pitting one irregular tooth against 
 another. It is a principle of great value, and should be carefully 
 studied and made use of whenever possible. The extra pipe on 
 the sheath of the jack-screw was for further reinforcing the anchor- 
 age, if necessary, by hooking another piece of the wire G into the 
 pipe, and fixing the other end on a band upon the first bicuspid. 
 Reciprocal anchorage may be gained by substituting for the wire 
 attached to the lateral the small traction-screw C and B, Fig. i. 
 Set No. I. They were retained by uniting their bands with solder 
 and recementing them on the teeth. 
 
 Fig. 57 shows a typical case and the combined appliances 
 actually used. The laterals were inlocked, the left cuspid pushed 
 forward. While the large traction-srrow was rlrawing back the 
 
56 THE ANGLE SYSTEM. 
 
 cuspid, as already described on page 28, it was assisted by the 
 loop and small traction-screw (see Fig. 26), acting at the same 
 time in forcing outward the left lateral; another instance of recip- 
 rocal anchorage. 
 
 The other lateral was, at the same time, forced outward by the 
 
 Fig 
 
 jack-screw, the base of which was slipped over a spur soldered to 
 the sheath of the large traction-screw, again making use of recip- 
 rocal anchorage by assisting the traction-screw in resistance to 
 the cuspid. The anchorage of the jack-screw might be reinforced, 
 as already described in Fig. 24. Other modifications of this 
 combination will readily suggest themselves. 
 
 Fig. 58 represents a common form of irregularity. All of the 
 incisors are pressed inward, not enough to cause inlocking of the 
 same, but sufficient to necessitate the closure of the lower jaw 
 posterior to the normal occlusion, in some instances causing 
 jumping of the bite. As a result, there is not sufficient room for 
 the cuspids, and in the effort to take their natural positions (a 
 
PRACTICAL CASES. 
 
 57 
 
 tendency always strong with them), the laterals are forced still 
 farther inward, as well as partially rotated. The aim will be to 
 force forward all the incisors, making correct occlusion, as well 
 as providing space for the cuspids. The rotating levers are 
 applied to the laterals, and the centrals firmly laced to the same, 
 while all are being forced forward by the jack-screws soldered 
 to the anchor-bands (see F, Fig. 20), the chisel-ends resting in 
 staples (as in E, Fig. 21), soldered to the bands on the laterals 
 to also permit their rotation. The cuspids were brought dow'n- 
 ward by the methods shown in Fig. 36 or Fig. 39. 
 
 Fig. 59 represents the case of a little girl, eight and one-half 
 years of age. The centrals were inlocked, the left one being also 
 greatly twisted. As soon as they had sufficiently emerged from 
 the gums they weie banded. The union of the ends of the bands 
 
 Fig. 59. 
 
 was made at the disto-lingual angle. Small holes were made in 
 these united ends, through which was slipped a piece of one of 
 the small levers L, Set No. i. The notched ends of the jack- 
 screws engaged this wire lever. The base of the sheaths was 
 secured by being slipped over the ends of the clamp-band screws. 
 (See J, Fig. 20.) Rotation of the central was accomplished at the 
 same time the teeth were being moved out, by occasionally 
 tightening a wire ligature surrounding the spring wire and a spur 
 soldered to the labial surface of the band. After the teeth had 
 been moved in the desired position, they were retained by the 
 ai)pliances for a few days, until all tenderness had subsided, when 
 the bands upon the centrals were united by solder, re-cemented, 
 and the rest of the apparatus dispensed with. The occlusion of 
 the lower teeth is usually sufficient to retain such teeth as have 
 been moved out of inlock, after they have been steadied in their 
 new position U>r a few days by an ai)j)liancc. T>ut in this case 
 
58 
 
 THE ANGLE SYSTEM. 
 
 the retaining bands were worn until the lateral incisors had fully 
 erupted, in order to prevent the possibility of their again over- 
 lapping. 
 
 Fig. 60 shows a malposed lateral and central. The base of the 
 jack-screw was soldered to a band on the opposite cuspid, and 
 reinforced by a spur resting against the first bicuspid, as also by 
 the large traction-screw, which is hooked into a tube, D, Set No. i, 
 soldered to the labial surface of the band. The screw passes in 
 front of the incisors through a tube (against which the nut works) 
 soldered to a band on the labial surface of the lateral incisor. In 
 this case the left central and lateral were wedged forward in the 
 
 Fig. 60. 
 
 line of arch, closing the space between the centrals and, at the same 
 time, providing space for the outmoving cuspid. The large screw 
 was beaten flat and polished before insertion. 
 
 I have sometimes closed similar spaces between the incisors 
 by the appliance shown in Fig. 61, which consists of tubes, C, 
 Set No. I, soldered to the ends of a piece of the band material 
 long enough to nearly inclose the four incisors. The small 
 traction-screw B is inserted in the tubes, and the space contracted 
 by turning the nut. 
 
 Fig. 61. 
 
 Figs. 62, 63, and 64 show other simple and convenient ways 
 of moving a tooth into line. In Fig. 62 the anchorage for the 
 ligature is a sheath of the jack-screw J, Fig. 20, slipped over the 
 end of the screw upon the molar clamp-band. Force is exerted 
 by occasionally tightening the wire ligature around the sheath and 
 
PRACTICAL CASES. 
 
 59 
 
 tooth to be moved. In some instances the sheath may be dis- 
 pensed with, as in Fig. 63. Another modification is shown in 
 Fig. 64, which consists of a pipe (R, Set No. i) soldered perpen- 
 dicularly to the side of the clamp-band, into which is hooked a 
 piece of the wire G, Set No. i, which rests against some suitable 
 
 Fig. 62. 
 
 "v K*^ h^^ yU-^ \- 
 
 FlG. 63. 
 
 
 Fig. 64. 
 
 tooth, to assist the anchor-tooth ; the anchor-wire and the tooth 
 to be moved being encircled by a wire or rubber ligature. 
 
 Fig, 65 is a side view of a very marked case of irregularities 
 of the teeth of both arches, the patient being a young lady of 
 sixteen years. The superior arch was much compressed in front, 
 the incisors greatly twisted and overlapping, and the cuspids very 
 
 Fig. 6= 
 
 prominent, as shown in Fig. 66. The first molars and bicuspids 
 were also more or less malposcd, while the inferior arch was much 
 contracted, and all the lecth anterior to the first molars were very 
 irregular. The treatment consisted in establishing correct occlu- 
 sion by forcing the malpr)sed teeth into their correct positions in 
 the arches. This was accomplished in the lower jaw by means of 
 the expansion-arch F, anchor-tube and clamp-band D, wire liga- 
 
6o 
 
 THE ANGLE SYSTEM. 
 
 tures and bands, as shown in Fig. 67; also shown in position in 
 Fig. 68. The bicuspids were moved outward by wire ligatures 
 occasionally tightened by twisting, while at the same time and 
 
 Fig. 66. 
 
 Fig. 67. 
 
 by the same means the incisors were being drawn into proper 
 positions, and made to conform to the shape of the wire arch 
 passing in front of them. They were also moved forward at the 
 same time by the tightening of the nuts in front of the anchor- 
 
PRACTICAL CASES. 
 
 6l 
 
 tubes upon the molars, thus providing more space for the bicuspids 
 as they were forced outward. The cuspid was rotated with a wire 
 Hgature, attached to a spur upon the disto-Hngual angle of the 
 band, while force was being exerted in an opposite direction upon 
 the mesio-labial angle of the tooth, by a rubber wedge stretched 
 between the tooth and the wire arch, all as correctly shown in the 
 engraving. 
 
 Fig. 69 shows the case nearing completion. After the move- 
 
 FiG. 69. 
 
 nient of the teeth had been completed they were retained for about 
 two weeks, until all tenderness had subsided, by the appliance 
 already in position and shown in Fig. 69. The appliance was 
 then removed and the teeth permanently retained as seen in Fig. 
 70. The cuspids were carefully banded, and the ends of a piece 
 of the wire G, Set No. t, were soldered to the lingual surfaces of 
 the bands, the wire resting in contact with the lingual surfaces of 
 the incisors, and preventing their again moving inward, as also 
 resisting lateral pressure from the cuspids. The bicuspids were 
 
62 
 
 THE ANGLE SYSTEM. 
 
 prevented from moving inward by pieces of the wire G, resting on 
 the Ungual surfaces and held in position by their anterior ends 
 inserted into pipes (R) soldered to the disto-lingual surfaces of 
 the bands. The distal ends of the wires were made to rest in small 
 cavities formed in the mesial surfaces of the first molars, one of 
 which had long been covered by a gold crown. 
 
 The teeth in the upper arch were forced into their correct 
 positions by an appliance similar to that shown in the treatment 
 of the lower arch already described. The incisors were moved 
 forward and rotated by means of the ligatures and tightening of 
 the nuts in front of the anchor-tubes, while pressure was exerted 
 upon the prominent cuspids and bicuspids by the spring of the 
 wire arch intensified by intervening wedges of rubber. The first 
 
 Fig. 71. 
 
 molars were rotated at the same time by the tubes upon the 
 anchor-bands being so adjusted that rotating force was exerted 
 by the spring of the wire arch. After the teeth had been moved 
 they were retained in the way described for the retention of the 
 teeth in the lower arch, with the exception that one continuous 
 piece of the wire was used, accurately shown in Fig. 71. 
 
 This method of retention is useful in all cases of this class. 
 Considerable accuracy is necessary in the adjustment of the band, 
 wire, etc.; however, if, after adjustment, it is found shorter than 
 it should be, it is easily lengthened by a few pinches with the wire- 
 stretchers H, Fig. 8 B; if found slightly longer than necessary, it 
 is easily shortened by bending it to conform to the circles of the 
 teeth by means of a burnisher pressed against the wire in the 
 region of the interdental spaces. If, after a time, it is found that 
 one of the intervening teeth shall have moved slightly inward, it 
 
PRACTICAL CASES. 03 
 
 should be again moved outward by a wedge of rubber stretched 
 between retaining-wire and tooth for a few days. The wedge is 
 then removed, and the soft wire burnished or driven outward in 
 contact with the readjusted teeth. The distal ends of the retain- 
 ing-wire should always be set in cement, and the pits should be 
 carefully tilled after the removal of the retainer. The retainers 
 in the case here shown were worn for one year. They were so 
 compact and cleanly that the patient was in nowise incon- 
 venienced, and the improvement in her appearance after the treat- 
 ment can be better imagined than described. 
 
 Section II. Jumping the Bite. 
 
 Fig. 72 truthfully represents the side view of a case of increasing 
 prominence of the anterior upper teeth, the cause of which I believe 
 was clearly traceable to the premature loss of the inferior first 
 molars. The occlusion of the second inferior molars with the 
 
 Fig. 'J2. 
 
 superior first permanent molars is well shown in the cut; and as 
 this occlusion naturally continued with the inevitable tipping 
 forward of the inferior second molar into the space vacated by the 
 first molar, the lower jaw was gradually drawn backward until the 
 jumping of the bite of the developing cuspids and bicuspids had 
 taken place. At the same time the compression of the lateral 
 halves of the superior arch, in order to better conform to the de- 
 (-reasing size (by recession) of the lower arch naturally followed, 
 pioducing, as is here well shown, the condition which is similar to 
 thousands of cases resulting from the extraction of the inferior 
 first molars by ignorant or unscrupulous practitioners. 
 
 The treatment consisted in widening the upper arch suf^cicntly 
 to permit of the lower jaw being moved forward, and there retained 
 until the habit of normal occlusion had been re-established. The 
 arch was expanded by means of the wire arch B (expansion-arch 
 R would have answered), and anchor clamp-bands D, as shown in 
 
64 
 
 THE ANGLE SYSTEM. 
 
 Set No. 2. The centrals and laterals were moved outward, and 
 rotated by occasionally tig-htening wire ligatures encircling the 
 arch and spurs soldered to bands upon the moving teeth. All as 
 clearly shown in Fig. 73. 
 
 Fig". 74 correctly represents the case as seen after the expansion 
 of the arch was completed, the deciduous second molars having in 
 the mean time been lost, but not yet replaced by the bicuspids. 
 
 Fig. 75 shows the lower jaw moved forward to its correct posi- 
 tion, where it was retained by means of a spur imbedded in the 
 inferior permanent molar, thus compelling the normal closure of 
 the jaw. The retention of the upper anterior teeth was accom- 
 
 FiG. 74. 
 
 plished wholly by the proper occlusion with the lower. The spur 
 has now been worn six months, and, I believe, might be discon- 
 tinued without fear of recession of the jaw; but, as it occasions 
 no inconvenience, it will be worn for a few months longer, or until 
 the eruption of the second superior bicuspid shall necessitate its 
 being gradually shortened by grinding. 
 
 It seems to me that jumping the bite is not difficult of accom- 
 
PRACTICAL CASES. 
 
 65 
 
 plishment, and is a most natural and advisable plan of treatment 
 where the age of the patient and other conditions are proper. 
 
 Fig. 76 shows another case of very marked irregularity, where 
 both centrals and laterals and right cuspids were greatly turned; 
 they were also pushed forward, as shown in Fig. jy. 
 
 Fig.' 75- 
 
 Fig. 78 shows the appliances as adjusted at the commencement 
 of the treatment. It will be seen that the cuspids are being moved 
 backward into the spaces from which the first bicuspids have been 
 extracted, by means of the large traction-screws (A and D, Set 
 No. i), adjusted and operated as described on page 28. It will 
 
 also be noticed that the angle of the traction-screw on the right 
 is hooked over a spur, or, bettor, a staple made from wire G, Set 
 No. I, soldered at right angles to the band, thus concentrating all 
 the force on one sifle of the tooth as it moved l^ackward. 
 
 The central incisors are being rotated by means of the lever, 
 as described in Fig. 34. Their i)rominence was also reduced at the 
 same time by means of the occipital bandage and traction-l)ar, as 
 described on page 40. 
 
66 
 
 THE ANGLE SYSTEM. 
 
 Fig. 79 exhibits the case after being acted upon by the appli- 
 ances already described. They were retained by uniting with 
 solder the bands and re-cementing them upon the centrals, while 
 
 Fig. ^^. 
 
 Fig 78 
 
 the traction-screws retained the cuspids. The rotation of the 
 lateral incisors was accomplished with the rotating levers in the 
 usual way, securing the ends of the levers by ligatures attached 
 to the distal ends of the traction-screws. After they were rotated, 
 
PRACTICAL CASES. 
 
 67 
 
 the bands were removed, united with solder to the bands upon 
 the centrals, and all reset on the teeth with cement. The traction- 
 screws and bands upon the cuspids were removed, and the case 
 then presented the appearance shown in Fig. 80. The retaining- 
 bands were worn one year, after which the teeth showed no 
 tendency to return to their former positions. 
 
 Fig. 80. 
 
 Section III. Excessive I'rotrusiqx of the Upper Teeth. 
 
 Fig. 81 represents a typical case of a very marked class of dental 
 irregularities, quite common and always unsightly. The principal 
 characteristic is the excessive prominence of the superior incisors, 
 laterals, and cuspids. The upper lip is always short, probably due 
 to lack of development from being held in an abnormal position, 
 and through inability to close the lips over the prominent teeth. 
 
 Fig. 81. 
 
 The lower jaw is generally short, and the occlusion of the molars 
 and bicuspids is usually g(Kjd, although posterior to the normal. 
 As a result the lateral halves of the superior arch are commonly 
 closer than normal, so as to be better acconmiodated to the 
 smaller circle of the lower arch. The lower incisors are more or 
 less irregular, and tluir cutting-edges always occupy a higher 
 l)lane than normal, doubtless owing to the lack of working occlu- 
 sion. As a result of the fre(|ucnt attem])ts at complete closure of 
 the month, the lower lip is forced between the U[)|)er and lower 
 
68 
 
 THE ANGLE SYSTEM. 
 
 incisors, and exerts pressure outward upon the superior and 
 inward upon the lower incisors, which intensifies the malpositions 
 of both. This form of irregularities is usually associated with 
 conditions of the nasal passage which necessitate mouth-breathing. 
 Fig. 82 represents a side view of a case of a child eight years 
 old, whose nasal passage was obstructed for three or four years, 
 necessitating mouth-breathing. The superior centrals had erupted 
 much anterior to their proper positions, their labial surfaces nearly 
 at right angles, while the laterals had not yet erupted. The 
 deciduous cuspids and molars were in position, as well as the first 
 permanent molars. As the mouth was held open so much of the 
 time, the lower jaw was either gradually forced back from its 
 normal occlusion or prevented from developing, while the upper 
 arch contracted laterally, in order to better accommodate the 
 occlusion to the smaller circle of the retreating lower arch. The 
 
 Fig. 82. 
 
 development of the upper lip seemed to have been arrested, and 
 had but little restraining influence upon the upper incisors, which 
 were being acted upon unfavorably by the forcing of the lower lip 
 between the upper and lower incisors, in the frequent attempts at 
 swallowing. This pressure of the lip had also exerted an influence 
 upon the lower incisors. They were becoming bunched and 
 forced inward, thereby allowing more space for the lip to occupy 
 between the upper and lower incisors. The conditions then were 
 favorable for the development of excessive protrusion of the upper 
 anterior teeth and all the accompanying deformities already de- 
 scribed in the case of the adult. 
 
 The plan of treatment of these cases should vary according to 
 the age of the patient. In the present instance the child was first 
 referred to the rhinologist for treatment of the nasal passages. 
 He having been successful, efforts were then directed to the 
 restoring of the normal occlusion of the teeth. 
 
 The central incisors were rotated after the manner described 
 in double rotation. The lower incisors were made to occupy their 
 
PRACTICAL CASES. 69 
 
 correct positions in the arch, after plan shown in Fig. 51, and were 
 also slightly shortened by grinding. The upper arch was ex- 
 panded laterally to permit the movement of the lower jaw forward 
 so that the teeth might occlude normally, as shown in Fig. 83. 
 Breathing through the nose was encouraged, and the patient 
 directed to keep the lips closed and teeth in proper occlusion as 
 much of the time as possible, and I had the satisfaction of seeing 
 the habit of normal occlusion, as well as normal brealhing, re- 
 established. 
 
 In the treatment of cases fully developed, it would be useless to 
 attempt to restore normal occlusion, as in the case last described 
 — viz, widening the upper arch and moving the lower jaw forward. 
 The general plan of treatment, then, is as follows: First, to com- 
 press the superior incisors in their sockets. Second, to reduce the 
 
 Fig. 83. 
 
 size of the superior arch by extracting one or both of the first 
 bicuspids, and move the incisors and cuspids backward. Third, 
 to correct the malpositions of the inferior incisors and cuspids, 
 and reduce their length by grinding. Fourth, to establish normal 
 breathing and normal closure of the lips. For accomplishing this 
 the Set No. 2 (see Figs. 2 and 3) was especially designed, and 
 comes the nearest to the ideal of all appliances yet devised. 
 
 The anchor-bands and tubes D are made to encircle the first 
 molars. The ends of the wire arch B are slipped through the 
 tubes. The anterior part of the arch is held in position by bands 
 on the central incisors, having notches formed in the united ends 
 upon the mesio-labial surfaces, into which the arch rests, as shown 
 in Fig. 84. 
 
 Force is exerted upon this wire arch by heavy elastic bands 
 attached to the head-gear, as in Fig. 85. This force is received 
 and transmitted to the wire arch by means of the traction-bar A, 
 Set No. 2, the standard seen upon the center of the traction-bar 
 engaging the delicate ball upon the center of the wire arch. The 
 hooks upon the ends of the traction-bar receive the ends of the 
 elastics. Any degree of force may be exerted upon tlie prominent 
 
70 
 
 THE AXGLE SYSTEM. 
 
 teeth by increasing or diminishing the tension or size of the 
 elastics. The force received from the head-gear acts on the wire 
 arch through the bah-and-socket joint. The ends of the traction- 
 bar may, therefore, be casuahy moved in any direction. The 
 advantage is that in consequence of the freedom of motion, a jar 
 or shock upon the traction-bar ends will not be transmitted to the 
 tender teeth. As the bandage and bar are to be worn at night, 
 contact with the pillow would be liable to occasion pain were it 
 not for this freedom of movement, an advantage possessed by no 
 other device of its class and appreciable by both patient and 
 operator. The usual method is to rigidly attach the traction-bar, 
 or its equivalent, to a swaged or vulcanite cap covering and firmly 
 resting- aeainst all the teeth to be moved. 
 
 Fig. 84. 
 
 At such times as the head-gear and elastics are not worn, 
 provision is made for holding what has been gained by delicate 
 rubber ligatures E, E, Set No. 2, which are slipped over the distal 
 ends of the tubes on the molars, stretched forward, and tied with 
 silk ligatures in front of the small collars which encircle the wire 
 arch opposite the cuspids, as seen in Fig. 84. 
 
 These collars, being rigid, prevent the ligatures from sliding 
 back, and thus exert a gentle but constant traction on the moving 
 teeth, and prevent them from springing back and interfering with 
 the process of repair. Of course, these ligatures are worn con- 
 stantly. Another advantage of the device is, that not only is the 
 prominence of the teeth reduced, but the malposed teeth are grad- 
 ually forced to take regular positions and conform to the shape 
 of the ideal arch (as it is forced backward through the tubes on 
 
J'KACTICAL CASliS. 
 
 7^ 
 
 the molarsj, an actioti iniixjssiljlc with devices havinj,'- fixed caps 
 of vulcanite or gold. Still another advantage is, that if the arch 
 should need lateral expansion, as is frequently the case, it may 
 be accomplished at the same time the teeth are being moved back- 
 ward, by lacing to the wire arch such teeth as need to be moved 
 outward. But in obstinate cases the jack-screw, notched at each 
 end and resting in contact with pieces of the G wire, may be 
 employed, as clearly shown in Fig. 86, wherein two rubber wedges, 
 shown resting between the bicuspids and wire, were used to move 
 them farther outward than was possible with the straight wire. 
 The head-gear projjcr has l)een greatly inijjroved, as a result of 
 
 Fin. 85. 
 
 much experimenting, and is correctly shown in Fig. 85. It con- 
 sists of a non-collapsible sjjring rim, adjustable as to size by the 
 spring latch on the side. The netting covering the head is ad- 
 justed by tightening or loosening the silk cord connecting the rim 
 with the heavy silk netting, which provides for thorough venti- 
 lation. One great advantage of this head-gear is, that the rim 
 receives the force and distributes it equally over the entire back 
 of the head, so that much greater pressure can be borne without 
 causing headache, a comnif>n result of the old styles, through 
 interference with the circulation by local pressure. The engraving 
 -hows two elastics on each side, one attached to the cap above 
 and one belmv the ear. The points of attachments are, however, 
 to be varied according to the requirements of the case. In nearly 
 'verv instance it will be found that the teeth should not only be 
 
72 THE ANGLE SYSTEM. 
 
 moved backward, but be depressed in their s(5ckets. For, if merely 
 moved backward, the teeth will present such a lengthened appear- 
 ance that the result will be nearly as bad as the original deformity. 
 Therefore, it would be plain to any careful observer of these cases 
 that the plan so often advocated, of exerting force from the molars 
 only, is wrong, for tipping of the anterior teeth is the only result 
 by anchorage from that point; but with the occipital anchorage 
 there is perfect control over the direction of the force, by simply 
 making the attachments to the anterior elastics farther forward or 
 backward. Or if elongation of the teeth be necessary, the lower 
 ligature only is used, dispensing with the upper or using only a 
 very light one. These ligatures may be doubled after the patient 
 
 Fig. 86. 
 
 has become well accustomed to wearing them. The teeth are to 
 be retained by the wire arch. Fig. 84 (the head-gear, traction-bar, 
 and delicate ligatures being of course dispensed with), which is 
 kept in position by passing a delicate drill through the tubes on 
 the anchor-teeth, and inserting neatly-fitting pins into the holes 
 thus made, as in Fig. 23. This method of retaining is very 
 efifectual, and as long as the appliance is so worn the teeth cannot 
 change their proper positions. But as it is somewhat unsightly, 
 and the patient has already worn it for some time, its removal will 
 be requested; and, it being of great importance in these cases that 
 the teeth be firmly retained for a long period (at least one year), 
 a device less objectionable in appearance should be used. After 
 much experimenting, I find that the appliance shown in Fig. 87 
 effectually meets the requirements. It is retention by means of 
 the occipital bandage or head-gear, but should never be made use 
 of immediately after the movement of the teeth has been accom- 
 
PRACTICAL CASES. y^ 
 
 plished, but only after the teeth have been retained by the other 
 apphances for at least two months, or long enough to allow the 
 teeth to have become thoroughly rested in their new positions and 
 somewhat firmly established. The arch, bands, and tubes upon 
 the molars, as well as on the incisors, should then be removed, 
 and the teeth thoroughly cleansed. After which, careful impres- 
 sions are taken of both upper and lower jaws, and accurate models 
 made. Careful comparison of the natural teeth with these models 
 is to be made from time to time, in order to detect any unfavorable 
 changes should they occur. 
 
 The retaining appliance. Fig. 87, is then adjusted, and is to be 
 worn at night-time only, thus allowing the patient entire freedom 
 from all appliances during the day. It consists of a segment of 
 the wire arch (B) long enough to pass in front of the incisors and 
 cuspids, and carefully bent, so that it will rest in contact with them. 
 
 Fig. ^7. 
 
 Two short pieces of the wire G, Set No. i, are soldered at right 
 angles to this wire, opposite the front of the central incisors. 
 They are long enough to admit the ends being bent over the 
 cutting-edges of the incisors, and the hooks so formed will hinder 
 the appliance from sliding upward against the gum. The device 
 is prevented from sliding laterally by a short piece of the G wire 
 soldered at a point between the centrals. This spur should rest 
 in the depression between these teeth; the opposite end forms the 
 delicate ball which engages the socket in the standard of the 
 traction-bar, all accurately shown in Fig. 87. It is adjusted by 
 sliding it into position upon the teeth, and, if it has been carefully 
 made, will not be displaced after the head-gear and traction-bar 
 have been adjusted. This device may also be made of vulcanite, 
 having a spur imbedded at the proper point corresponding with 
 the delicate ball which engages the traction-bar. 
 
 In the adjustment of Set No. 2 it is usually better to place in 
 position only the anchor-bands and tubes (D) at the first sitting, 
 or at most the additional bands upon the incisors. At the second 
 sitting the arch B may be placed in position and worn a few days 
 until the patient becomes accustomed to wearing it, when the 
 
74 THE ANGLE SYSTEM. 
 
 head-gear may be adjusted, with hght tension at first, graduaUy 
 increasing the same, as well as the number of hours worn, which 
 should finally include as much of the time as possible, in order to 
 expedite the completion of the case. 
 
 The wire arch B should be bent occasionally as the case pro- 
 gresses, in order to exert pressure on such laterals or cuspids as 
 need to be restrained while moving back; and, if any of the 
 teeth should show tendency to bunching or overlapping, this 
 should be prevented by lacing them to the arch, after plans of 
 ligatures shown in Fig. 28. If any of the teeth show tendency 
 to lengthening, this should also be prevented by bands and 
 notches which shall engage the arch B. Never use larger liga- 
 tures than those shown at E, E, Fig. 2, as the force necessary 
 in moving the teeth is exerted by the heavy elastics and head-gear; 
 by increasing the size of the small ligatures disturbance of the 
 anchor-teeth, such as tipping, elongating, and the establishment 
 of faulty occlusion zvill foUozv, something especially to be avoided 
 in the treatment of these cases, for it should also be remembered 
 that no moving force upon the teeth should be exerted by these 
 merely retaining ligatures. 
 
 In order to produce room for the protruding teeth, it is some- 
 times necessar)^ to extract one or two of the bicuspids. Where 
 the loss of one is sufficient the moving teeth may be shifted 
 laterally in order to fill this space, by inserting a folded hand- 
 kerchief or a small cushion between the face and heavy elastic 
 bands, thus exerting lateral pressure upon the traction-bar stand- 
 ard and wire arch. 
 
 The wire coder shown at N, Fig. 8 A, is well adapted for 
 curving the retaining-wire G, or for modifying the curves in 
 wire arches B and E. This may thus be done without risk of 
 breaking or roughening the smooth surfaces of the wires, as is 
 hable to occur under the use of ordinary pliers. 
 
 Section IV. Excessive Protrusion of the Lower Teeth. 
 
 Another well-defined type of irregularity is characterized by 
 excessive prominence of the lower jaw, or orthognathism, and 
 which in extreme cases presents the most noticeable deformity we 
 are called upon to correct. Unlike the type last described, the 
 inferior dental arch is generally large, and quite free from irreg- 
 ularity, while the upper arch is usually small and the teeth crowded, 
 so that the inferior incisors close anterior to the superior, pro- 
 ducing the greatest malocclusion of the remaining teeth. The 
 
PRACTJCAL CASES. 
 
 /O 
 
 treatment varies according to the age of the patient. If begun 
 at a proper age, as soon as the deformity is manifest, or even up 
 to the twelfth or fourteenth year, it is not difficult to bring about 
 retraction of the jaw by means of force exerted by the heavy elastic 
 bands and head-cap (already described in connection with Set 
 Xo. 2), attached to a metallic cap covering the chin, all as shown 
 in Fig. 5. 
 
 Fic. 88. 
 
 Fig. 88 represents the side view of a case of a child nine years 
 of age. The permanent incisors of the lower jaw had erupted; 
 the superior centrals had also erupted and were twisted nearly at 
 right angles. The deciduous cuspids were in position, although 
 the inferior were loosened and nearly ready to fall out. The four 
 first permanent molars were present, and the first superior bicus- 
 pids were beginning to emerge from the gum. The jaw had 
 moved forward so that the lower incisors closed anterior to the 
 
 Fic. 89. 
 
 superior, all as c(jrrectl\- represented in ihe engraving. The 
 patient could not retract the jaw sufficiently lo bring the cutting- 
 edges of the incisors in contact at any point. The head-gear and 
 chin-cap were worn almost constantly for six weeks. 
 
 Double rotatif)n oi the superior centrals was accomplished by 
 means of the lever already described in double rotation (Fig. 34). 
 They were retained by uniting the bands with solder and re- 
 cementing them ujjon the teeth, and at the cu(\ of six weeks the 
 jaw had i)een retracted into almost a normal pf)sition. presenting 
 the appearance shown in I-'ig. 89. The chin-cap and head-gear 
 
76 
 
 THE ANGLE SYSTEM. 
 
 were worn at night-time only, and dispensed with after six months, 
 as there was no further need of retractive force. 
 
 The first examination proved the patient to be suffering from 
 
 Fig. 
 
 Fig. 91. 
 
 Fig. 92. 
 
 greatly enlarged tonsils, and she was referred to the rhinologist 
 for treatment. 
 
 Fig. 90 shows a side view of another very marked case belong- 
 
PRACTICAL CASES. 
 
 77 
 
 ing to this class of deformity. Fig. 91 accurately represents the 
 upper arch. The effect of the deformity upon the appearance of 
 the patient is shown in Fig. 92. The treatment consisted in en- 
 larging the upper arch by means of the expansion-arch E, and 
 anchor clamp-bands and tubes D, operated as shown in the case 
 illustrated in Fig. 68. The expansion-arch was also reinforced 
 as described on page 47 and illustrated by Fig. 44. 
 
 \\'hile this was being done, the head-gear and chin-retractor 
 were worn as much of the time as possible. At the end of two 
 months the expansion of the upper arch was discontinued, the 
 teeth retained, and the patient allowed to return to her home in 
 a distant city, for a vacation of three months. This was done in 
 
 Fig. 93. 
 
 order to give the upper jaw an opportunity to develop, but the 
 wearing of the chin-retractor was continued faithfully. At the 
 end of the three months the patient returned, and the expansion 
 of the upper arch was continued, at the same time increasing the 
 tension upon the chin. At the end of two months more the 
 enlargement of the upper arch had been completed, and is truth- 
 fully represented in Fig. 93. 
 
 The lower jaw had been moved backward, and the occluded 
 teeth presented the appearance shown in Fig. 94. 
 
 Exactly what changes had taken place in the angle of the jaw, 
 or temporo-maxillary articulation, it is impossible to say, but I 
 am thoroughly convinced that the body of the jaw had been moved 
 backward greatly. The principal change, however, was the instru- 
 mental enlargement of the upper jaw. The improvement in the 
 appearance of the young lady can be better imagined than de- 
 ^rribcd, and the changes that had been brought about were such 
 
78 
 
 THE ANGLE SYSTEM. 
 
 as to encourage attempts at improvement in all such cases. But 
 in cases of advanced years, my experience is that it is useless to 
 attempt the retraction of the jaw. All that we can then hope to 
 accomplish is the contraction of the inferior dental arch and the 
 enlargement of the superior, as illustrated by the case shown in 
 
 Fig. 94. 
 
 Fig. 95. 
 
 Fig. 96. 
 
 Fig. 95. The upper anterior teeth were moved outward by means 
 of the jack-screws as shown in position upon the teeth in Fig. 96, 
 and described in the treatment of a similar case on page 54. After 
 the first bicuspids had been extracted, contraction of the anterior 
 part of the inferior arch was accomplished by means of the trac- 
 
rRACTlCAL CASES. 
 
 79 
 
 tion-screws hooked into staples upon bands encircling the cuspids. 
 The traction-screws were assisted in moving the cuspids and 
 incisors backward by the head-gear, elastics, and traction-bar, 
 exerting pressure upon a section of the wire arch B, Set No. 2, 
 which rested in contact with the incisors and cuspids held in 
 position by the attachment of the band to the ends with solder, all 
 
 Fig. 97. 
 
 as shown in Fig. 97. The external force served the double pur- 
 pose of assisting the traction-screws in moving the teeth as well 
 as in the retraction of the maxilla. The amount accomplished in 
 the last-mentioned movement was cjuite noticeable, as is well 
 shown in Fig. 98, wliich represents the completed case. 
 
 Fig. 98. 
 
 The new regulating pliers (H, Fig. 8 I>) for elongating the 
 several straight or curved wire appliances will be more and more 
 appreciated as experience shall demonstrate the general utility 
 of the invention. A re-examination of the devices shown in 
 l-igs. 10, 24, 25, 26, 37, 56, 70, and 71 will make obvious the fact 
 that any section of the wire G, if inadvertently cut a little short 
 for its designed position, may be repeatedly pinched with the pliers 
 
8o THE ANGLE SYSTEM. 
 
 until its length shall exactly correspond with its function. If 
 desirable, the wire may be so stretched while in situ, as shown and 
 described on page 51. 
 
 In the precise adjustment of retaining-wires the novel action 
 of the regulating pliers is especially manifest. 
 
 CHAPTER VIII. 
 
 GENERAL SUGGESTIONS. 
 
 I. An essential preliminary to the treatment of a case is a clear 
 conception of what is necessary. This can be gained only by a 
 careful study of both models and natural teeth, occlusion and 
 facial expression, history, etc. 
 
 II. It is best to first attend to the crowding teeth, rather than 
 those most irregular. For example: If the molars and bicuspids 
 are irregular, and expansion indicated, expand first and establish 
 correct occlusion in that region, before correcting malpositions of 
 the incisors and cuspids. 
 
 III. Have regular times for seeing the patient; be punctual, 
 and insist upon punctuality by the patient. Always carefully com- 
 pare the original models at each sitting. 
 
 IV. It is not enough to correct the malpositions of the teeth in 
 one arch, but also to establish the correct occlusion of all the teeth 
 and restore proper facial expression. 
 
 V. Exercise such care and judgment in the adjustment of the 
 appliances that delays from slipping, breaking, or changes will be 
 avoided. 
 
 VI. In moving a tooth, the best result is obtainable only by 
 recognizing the regular and proper amount of force necessary to 
 stimulate absorption. The practice of applying great force at 
 irregular intervals serves only to defeat the desired object, for it 
 retards absorption and restoration, causes unnecessary pain, ex- 
 cites inflammation, and thereby endangers pulp-life. It also 
 strains the appliances, causing much delay and pain to the patient 
 by repairs. 
 
 Whether the pressure be constant or irregular, a safe rule is to 
 see that it in no instance exceeds a snug feehng, which is a true 
 indication of the proper amount of force. 
 
 VII. When the screw is used in moving a tooth, and the 
 
GENERAL SUGGESTIONS. »I 
 
 patient is an intelligent one, he may be provided with a wrench, 
 and instructed to tighten the nut each morning, thus greatly econo- 
 mizing the time of both patient and operator; yet the patient 
 should be seen at intervals; usually twice a week will be sufficient. 
 Ylll. It is important that the patient shall observe care in 
 brushing and cleansing the teeth while wearing the regulating ap- 
 pliances. If the appliances are kept properly cleansed, they will, 
 in most instances, take on a beautiful bronze color, far more pleas- 
 ing in appearance than when made of gold, besides possessing 
 greater strength. 
 
 IX. Each succeeding year strengthens the conviction that ex- 
 traction for space is a rare necessity, and moreover it is difficult to 
 produce the best results without the full complement of teeth. 
 With but few exceptions it will be found that the facial expression 
 is too full when all the teeth are ideally arranged in the arches. 
 The conservative method should be first, extraction last. Many 
 C8se§ are greatly complicated by the careless extraction of one or 
 more teeth, in order to gain sufficient space. The author has never 
 seen a case where the extraction of the first molar, one or more, 
 has not been followed by more or less irregularity, sometimes of a 
 very complicated nature. No one can long practice orthodontia 
 without l)eing impressed with the important relation that each 
 tooth in either arch bears to all the rest, nor fail to note the disas- 
 trous results often following the loss of a single tooth. 
 
 X. Slight irregularities should be corrected, because the turn- 
 ing of a slightly twisted tooth, or the correction of any irregularity 
 of the oral teeth, will not only improve their appearance and occlu- 
 sion, but refine the whole facial expression. 
 
 XI. It is important to remember that the pressure should 
 never be wholly relinquished. The movements of a tooth may be 
 arrested as often as is necessary; but never, by the removal of 
 pressure, allow the tooth to .spring backward, thus interfering with 
 the process of repair. Disregard of this principle (as has usually 
 been necessary in the ordinary regulating appliances, the faulty 
 principles on which their construction has been based necessitat- 
 ing their frequent removal for purposes of modification and cleans- 
 ing) has been the occasion of nearly all the pain and soreness in 
 regulating. If intelligently conducted, the movement of a tooth 
 is painless. 
 
 XII. Another very important fact to be remembered is, that 
 support and perfect rest arc essential, after a tooth has been 
 moved into the desired position. 
 
 XTII. In adopting this system the ojjerator should carefully 
 
 6 
 
82 THE ANGLE SYSTEM. 
 
 Study and thoroughly familiarize himself with the names and uses 
 of all the parts of these appliances, which are supplied in sets or 
 separately. A little experience will enable him to readily apply 
 them to any case, for the system is complete in itself. 
 
 XIV. The plate has no place in this system as any part of a 
 regulating- appliance, and only in rare instances as a retainer after 
 lateral expansion of the arch : it should be a relic of the past. 
 
 XV. The wire arches B and E have all the spring possible. 
 They are, therefore, hard, and may be broken if care is not taken 
 in bending to the desired shape. They are made long enough to 
 include the largest arch, and may be cut to suit the smaller ones. 
 
 XVI. In applying the jack-screw, the sheath should be used 
 as long as possible, turning the nut close up to the chisel end be- 
 fore cutting the sheath to the desired length. 
 
 XVII. In making the attachments of tubes, they should be 
 grooved with a round file at the point of contact to make a strong, 
 compact appliance. 
 
 XVIII. The motionless retention of the teeth is of great im- 
 portance, but it will seldom be attained unless proper occlusion 
 has been first established. A retaining appliance should be so 
 delicate that it may be worn without inconvenience to the patient 
 until perfect firmness has been established, and should rarely be 
 under the control of the patient. 
 
 XIX. It is not necessary to separate the upper from the lower 
 teeth by some contrivance while teeth are being moved out of in- 
 lock, so that the occlusion will not cause interference with the 
 moving, teeth. The author has never yet found it necessary, as 
 the patient will invariably avoid biting upon the tender moving 
 teeth. 
 
 XX. Failures to recognize and appreciate the artistic require- 
 ments in the treatment of dental irregularities are frequent, and 
 as easily recognized as they are lasting. All who hope to attain 
 success in the treatment of dental irregularities should cultivate 
 the habit of observing and carefully studying the normal and ab- 
 normal lines of the human face, together with their relations to, 
 and dependence upon, the teeth. 
 
 An appreciation and intelligent application of the principles of 
 art must ever go hand in hand with the successful treatment of 
 irregularities of the teeth. 
 
 XXI. Irregularities of the teeth being so frequently associated 
 with some pathological obstruction of the nasal passages, or naso- 
 pharynx, this fact should be ever present in the operator's mind 
 and suitable examination be made; and in case (as is often found) 
 
GENERAL SUGGESTIONS. 83 
 
 the oral deformity is complicated by the presence of hypertrophied 
 faucial tonsils, adenoid hypertrophies in the vault of the pharynx, 
 or obstruction of the nasal passages, the orthodontist's work can 
 only be made complete by the assistance of the rhinologist and 
 laryngologist. 
 
 XXII. If, however, a dentist, after sufficient experience, finds 
 himself unsuited for this class of work, it is his duty to refer pa- 
 tients to an expert orthodontist, and thus promote the practice of 
 this specialty in dental surgery. 
 
84 THE ANGLE SYSTEM. 
 
 PART II. 
 
 FRACTURES OF THE MAXILLA. 
 
 CHAPTER I. 
 
 TREATMENT OF FRACTl'RES OF THE MAXILLA. 
 
 The limits of this work will not admit of a general discussion of 
 this subject, nor is it deemed necessary, for almost any of the mod- 
 ern works on surgery contains a treatise covering the general prin- 
 ciples of the treatment of fractures. Especially commendable is 
 Hamilton on Fractures. 
 
 The most important consideration, after securing perfect apposi- 
 tion of the parts, is that they shall have uninterrupted rest, and this 
 
 Fig. 99. 
 
 phase of the subject will be set forth, strictly with reference to 
 certain plans for securing fixation of the fractured maxillae while 
 undergoing the healing process ; plans which are original with the 
 author, and have been successfully employed in an extensive ex- 
 perience in the treatment of these lesions. 
 
 The first plan is that of firmly and immovably holding the in- 
 jured jaw in contact with the firm and uninjured jaw, by means of 
 wire ligatures wrapped in the form of the figure eight, around 
 buttons attached to bands encircling suitable opposite or nearly 
 opposite teeth, as shown in Fig. 99. 
 
 All the teeth are thus kept in perfect occlusion, and, as a result, 
 the fractured ends of the bones must necessarily be in apposition, 
 
TREATMENT OF FRACTURES OF THE MAXILLA. 85 
 
 SO that the conditions are most favorable to the process of repair; 
 for it will be apparent upon reflection, that no matter at what point 
 the fracture has occurred, if the jaw contains sufficient teeth and 
 they are placed in perfect occlusion, not only will the fracture be 
 properly set, but the powerful muscles will be greatly relaxed and 
 tlie parts be consequently freed from that tension and tendency to 
 displacement, so difficult to combat in the treatment of fractures, 
 in the long bones especially, or in the maxillae when the jaws are 
 kept apart, as is necessary when the heavy interdental splints are 
 employed. 
 
 Indeed, we believe this plan to be a most natural and easy one, 
 for the cusps of the teeth lock and interlace so perfectly that dis- 
 placement in any direction is impossible, provided the jaws are kept 
 closed. And in this we are further assisted by the natural contrac- 
 tion of the powerful muscles of mastication, it being necessary in 
 most cases only to antagonize the anterior, feeble depressor mus- 
 cles, by attachments on each side to the cuspids, or other teeth in 
 this region, if more suitable. 
 
 The bands, which we term fracture-bands, Fig. lOO, are made 
 
 Fig. 100. 
 
 very thin and strong, are adjustable, and, by means of the screw 
 and nut, they may be firmly clamped about the teeth. Little 
 buttons, strong and of sufficient size to admit the requisite number 
 of wraps of the ligatures, are firmly soldered to the band. Care 
 should always be exercised to work the band well over the crown 
 of the tooth and down upon the neck, then tighten the nut until 
 the band is firmly clamped, being careful not to weaken the band 
 by crimping or tearing. The fingers alone are usually sufficient, 
 although a dull instrument and mallet (as in M and L, Fig. 8 B) 
 may be used to assist in placing the band. If the teeth are 
 ciowded, a thin spatula pressed between them and allowed to re- 
 main for a few moments will i)rovide ami)le space. For the liga- 
 tures, almost any of the usual materials may be employed, such as 
 waxed floss silk, strong linen thread, or the gut ligature so exten- 
 sively employed in surgery, but fine copper or brass wire thor- 
 oughly annealed (No. 26) is j)rc-fcrable on account of its strength, 
 pliability, and cleanliness. 
 
86 
 
 THE ANGLE SYSTEM. 
 
 That the reader may become more famihar with this method of 
 treatment, as well as with a few of the many modifications of which 
 it is susceptible, reports of a few cases from practice are subjoined, 
 with illustrations from models made accurately in each instance 
 after treatment. 
 
 Case I. — The first is represented by Fig. loi. 
 
 On July 14, 1889, Wm. Fraley, aged forty-five, was admitted to 
 the Minneapolis City Hospital. A blow from a policeman's club 
 had produced one simple and one compound fracture of the inferior 
 maxilla. The first was an oblique fracture on the right side, be- 
 ginning with the socket of the second bicuspid, extending down- 
 ward and backward, and involving the socket of the first molar. 
 The second bicuspid had fallen out, and the first molar was much 
 
 Fig. ioi. 
 
 loosened. The second molar had been lost years before, while the 
 third molar and the remaining teeth were much abraded, and much 
 loosened by salivary calculus. The second fracture was on the op- 
 posite side, high up in the ramus of the jaw. I could not detect the 
 exact course the line of fracture had taken, but the crepitation of 
 the ends of the bones, and the pain occasioned thereby, were un- 
 mistakable evidences of a fracture. The patient, as is usual in such 
 cases, was unable to close his jaws. The fractured parts on the 
 right side were widely separated, and the anterior piece much 
 depressed by reason of the action of the digastric muscle, the pos- 
 terior piece of' bone being drawn firmly up, and the molars occlud- 
 ing by reason of the contraction of the masseter muscle. He was 
 treated as follows : 
 
 Bands were made to encircle all four of the cuspids (they being 
 most firmly attached in their sockets). The fractured ends of the 
 
TREATMENT OF FRACTURES OF THE MAXILL/E. 87 
 
 bones were placed in careful apposition, and the lower jaw closed, 
 the lower teeth being correctly occluded with the upper. 
 
 The points on the bands, where the little tubes (C, Set No. i) 
 shown in the engraving should be attached, were carefully noted 
 and marked. The bands were slipped ofif and the tubes soldered 
 to them, after which the bands were cemented in proper position 
 upon the teeth, and two small traction-screws (B, Fig. i), shown 
 in the engraving, inserted in the tubes. The jaws were closed and 
 the nuts tightened. 
 
 During an attack of coughing the following night, one of the 
 bands was loosened, but it was easily replaced the next day. No 
 further accident or trouble occurred, the patient readily taking 
 nourishment through the spaces between the teeth. Thus the 
 fractured jaw was firmly supported without motion for twenty-two 
 days, when the appliance was removed, showing most excellent 
 results. 
 
 That the patient was a great lover of the clay pipe is shown in 
 the engraving, by the much worn ends of the lateral incisors, which 
 resulted from holding the stem of the pipe. While wearing the 
 appliance he was not debarred from his favorite enjoyment, 
 although compelled to grasp the stem between his lips instead of 
 the teeth. 
 
 Case II. — December 28, 1889, Thomas Bremen was admitted to 
 the Dental Infirmary of the University of Minnesota, suffering 
 from the efifects of a blow received on the left side of the jaw from 
 a cant hook, while working in a lumber camp. The result was 
 two fractures of the jaw. 
 
 The first fracture was on the right side, beginning between the 
 first and second bicuspids, and extending downward and backward 
 so far as to involve the lower part of the anterior root of the first 
 molar. The second was on the left side directly through the angle 
 of the jaw (see Fig. 102). The accident had occurred thirty-two 
 days previous to his admission to the infirmary, during which time 
 nothing had been done to reduce the fracture. He reported that 
 he had called upon a physician, who supposed the trouble was 
 merely an abscessed tooth, and had lanced the gum with a view 
 of reducing the swelling. Later, the patient had called upon a 
 dentist in one of the smaller towns, who also failed to diagnose 
 the fracture, and extracted hnth bicuspids in the hope of giving 
 relief Csee Fig. 99). 
 
 Upon examination, T found considerable swelling in the region 
 of the fracture, with the usual result; the patient being unable to 
 close his mouth, bv reason of the anterior piece of the fractured 
 
88 
 
 THE ANGLE SYSTEM. 
 
 bone being drawn down by the depressor muscles. A false joint 
 had also become established, and could be easily moved without 
 causing pain. At the fracture of the right side there was but little 
 displacement; the swelling also was slight. 
 
 The patient was anesthetized, and, with a view to breaking up 
 the false attachments and stimulating activity in repair, the ends 
 of the bones rubbed forcibly together, placed in perfect apposition 
 and the jaw closed, great care being taken to articulate the teeth 
 correctly with the upper ones. The jaw was now firmly bound in 
 this position in the same manner as described and shown in Fig, 
 99, which is quite as efficient and much easier to adjust. Four 
 bands were used, encircling the four cuspids as shown in Fig. 102, 
 
 Fig. 102. 
 
 The bands shown upon the molars in the engraving were not 
 used, as I found them unnecessary, since the jaws were firmly 
 supported by the four anterior bands alone. 
 
 Case No. 3 is represented by Fig. 103, and is that of a healthy 
 young Swede, twenty-two years of age, who, while washing win- 
 dows, had fallen from the second story to the hard pavement. Be- 
 sides receiving several minor injuries he sustained a double fracture 
 of the lower jaw, one extending from between the central incisors, 
 and one posterior to the second molar, the third molar having 
 been extracted. The right superior lateral and cuspid were 
 knocked out, the first bicuspid broken off near the neck, and the 
 alveolar process badly shattered. The centrals and left lateral were 
 bent inward and forced deeper into their sockets. He had been 
 treated by the attending physician at the City Hospital, the method 
 employed being that of the Barton style of bandaging, with the 
 usual result, when the bandage is employed in such cases, of aggra- 
 
TREATMENT OF FRACTURES OF THE MAXILL/E. 
 
 89 
 
 \'ating the condition b\- forcing the pieces inward and the jaw 
 backward. 
 
 Upon examination three weeks after the accident. I found nuicli 
 displacement. The jaw was drawn backward and the right middle 
 section of the bone tipped inward. No attention had been paid to 
 the bent and broken condition of the superior alveoH. The teeth 
 had become quite firm in their new, but abnormal positions, and 
 I allowed them to remain so. A fibrous attachment had been 
 established in the lower fracture, which admitted of considerable 
 movement, and occasioned but little pain. There was much 
 sw-elling, and pus was discharging into the mouth from the anterior 
 fracture. I found it impossible to restore normal occlusion at that 
 
 Fig. 103. 
 
 time. Bands were made to encircle the four bicuspids, and be- 
 tween the two lower bands, on the inside of the mouth, was placed 
 one of the jack-screws (E and J, Set No. i), held in place by the 
 staple and spur (E, Fig. 21, and B, Fig. 20). The nut was tight- 
 ened until the piece of bone had been tipped outward about one- 
 half the distance to its normal position, but the operation caused 
 so much pain that further movement was flcferred. The jaws 
 were then closed and the buttons connected by ligatures, but occlu- 
 sion was far from being normal. On the next day, by again 
 tightening the nut on the jack-screw and with renewed ligatures 
 bound very tightly, I was enabled to secure nearly the normal 
 occlusion. On the third day following, by the same means, cor- 
 rect occlusion was established. The jack-screw was allowed to 
 remain in position to steady the tipj^ing section. 
 
 The abscess was frequently syringed with fresh peroxid of hydro- 
 gen, A few fragments of bone were washed out. The fractures 
 
90 
 
 THE ANGLE SYSTEM. 
 
 readily united, and on the twenty-seventh day the jaw was released 
 and found to be quite firm. 
 
 Case No. 4 shows another modification, and is represented by 
 Fig. 104. A young machinist received a severe blow from the fist 
 of an antagonist, by which two compound fractures were sustained; 
 one posterior to the first molar, the other in the region of the 
 cuspid, which was involved and greatly loosened. Occlusion was 
 established and maintained in the previously described way. Sup- 
 puration occurred in both fractures on about the tenth day, and 
 received proper treatment. The union of the anterior fragment 
 was slow, as the patient was troubled by a persistent hacking 
 cough, which occasioned a slight movement between the ends of 
 the bone, just sufficient to interfere with the healing process. On 
 
 Fig. 104. 
 
 the twentieth day the ligatures were cut, a jack-screw placed in 
 position between the bands on the inside in the same manner as 
 in Fig. 103, with an additional ligature firmly connecting the two 
 buttons on the lower bands, and resting in contact with the labial 
 surfaces of the intervening teeth. This additional support proved 
 successful; the union proceeded slowly, and was found complete 
 when the bands were removed on the sixty-second day after the 
 accident. 
 
 Another modification is shown in a somewhat peculiar case, 
 represented in Fig. 105. The patient, a man of about forty years 
 of age, had sustained a complete fracture of the left angle of the 
 jaw, as the result of a kick from a horse. The jaw was enormously 
 large and protruding, and the occlusion so unusually faulty that I 
 was at a loss to determine what the patient's normal occlusion was; 
 
TREATMENT OF FRACTURES OF THE MAXILLAE. 
 
 91 
 
 but upon questioning him, he informed me that when a boy of ten 
 years he had been hit with a stone, causing a fracture on the right 
 side of the jaw, which had been allowed to heal without any treat- 
 ment. This statement, with the worn facets upon the cusps of 
 some of the teeth, and the readiness with which they occluded only 
 at these points, showed conclusively the position in which the jaw 
 niust be secured. I at first, of course, supposed that the usual 
 number of four bands and two ligatures would be necessary, but 
 I found the single ligature, as shown, was quite sufficient to firmly 
 retain the jaw in this abnormally normal position. The jaw was 
 set a few hours after the accident. Very little swelling ensued, the 
 fractured parts uniting rapidly. I saw the patient but four times, 
 and removed the bands on the twentieth day, as further support 
 
 Fig. 105. 
 
 seemed unnecessary. 1 admonished him, however, to avoid using 
 his jaw as much as possible for at least ten days thereafter. 
 
 Fig. 106 represents a case where the patient suffered in a railroad 
 wreck two compound fractures of the inferior maxilla, one on each 
 side, posterior to the second molar. The left side was quite badly 
 comminuted. The full complement of teeth was present, with the 
 exception of the third molars. The occlusion of all the teeth was 
 excellent. The incisors, however, were crossed (not well shown 
 in this engraving); that is, the left superior central and lateral 
 closed just inside of the points of the lower incisor and cuspid, 
 while the right central and lateral closed just outside of the points 
 of the opposing lower cuspifl, central, and lateral. 
 
 The teeth being so perfect and the occlusion so accurate, liquid 
 U)f)(h only were pfjssiblc TIk- iDiiditioiis were made mr)r<' un- 
 
92 
 
 THE ANGLE SYSTEM. 
 
 favorable on account of the patient suffering from severe spinal 
 injury received at the time of the accident, but with the exception 
 of considerable suppuration in the left fracture, which yielded 
 readily to treatment, nothing unusual occurred. The ligatures 
 were removed on the fortieth day, and excellent results were ap- 
 parent. 
 
 It might be urged against a method of treatment which involves 
 the closure of the teeth and the binding of the jaws firmly together, 
 that the patient would be unable to take sufficient nourishment. 
 Experience, however, shows that this argument has practically no 
 foundation, for it rarely happens that a patient is found without 
 some missing teeth, thereby providing abundant opportunity for 
 the inception of all ordinary chopped foods, and more especially 
 
 Fig. io6. 
 
 for the large number of foods now available in liquid form. Even 
 when all the teeth are sound and in perfect position, there is plenty 
 of space between the teeth, or behind the molars and between the 
 upper and lower incisors, for taking all the nourishment necessary. 
 Of course, in these rare cases more time would be required for 
 eating. This inconvenience is very slight when we consider the 
 advantages of freedom from an uncleanly, bulky, and inconvenient 
 apparatus within the mouth, often accompanied by the disfigure- 
 ment of bandages and splints without, as well as the great import- 
 ance of the accuracy in results which it assures, so uncertain of 
 attainment in many other methods commonly employed. 
 
 There is also another class of lesions in the treatment of which 
 this plan of fixation may be employed to great advantage. I refer 
 to excision of the lower maxilla, or those cases where a large 
 portion of the jaw has been removed, as in Fig, 107, 
 
TREAT-MEXT OF FRACTURES OF THE MAXILL.E. 
 
 93 
 
 In all these cases there is a strong tendency for the remaining 
 portion of the jaw to be drawn greatly to one side (about three- 
 quarters of an inch, by actual measurement, in the case repre- 
 sented), due to the contraction of the cicatricial tissues following 
 the healing of the wound. The plan I propose will prevent this 
 contraction, by securing the remaining portion of the jaw in proper 
 occlusion, by means of the fracture-bands and ligatures in the 
 manner already described. The jaw thus firmly held will exert 
 sufficient tension upon the healing muscles to prevent their con- 
 traction. I would also suggest the advisability of increasing the 
 tension by the attachment of a plumper, by means of a clamp-band, 
 to one of the molars in the upper jaw on the side from which the 
 section has been removed, allowing the shield or plumper to 
 extend downward and outward, to occupy somewhat the position 
 
 Fig. 107. 
 
 of the missing bone. This shield may also serve a useful purpose 
 in holding in better position the dressing of the wound. 
 
 The next plan may be said to be a modification of, or an im- 
 provement upon, the plan advocated by Hippocrates in the fifth 
 century B.C., and which has been employed from that time to 
 this. It consists in holding the fractured ends of the bone in 
 apposition by wrapping ligatures about the teeth, or, as physi- 
 cians now term it, wiring the teeth. The principal disadvantage 
 has always been the slipping of the ligatures, which produced 
 displacement of the bones, and caused inflammation by the pres- 
 sure of the sliding ligature upon the gums. 
 
 My plan is shown in Fig. 108, and consists in encircling suitable 
 teeth with fracture-bands and attaching ligatures to the buttons 
 upon the bands, so that loosening of tlic !)ones or pressure upon 
 the gums is impossible. 
 
94 
 
 THE ANGLE SYSTEM. 
 
 A modification of the plan is shown in Fig. 109, in which addi- 
 tional support is secured by connecting the labial and lingual wire 
 ligatures by loops of wire passed between the teeth, with their ends 
 united by twisting. 
 
 In favorable cases, as in simple transverse fractures with little 
 or no displacement and where the teeth are very firm, if the 
 apparatus is adjusted with skill, the plan will be found valuable, 
 as it is very neat, clean, and compact, and does not interfere with 
 the freedom of the jaw. 
 
 A few suggestions may assist the inexperienced in the adjust- 
 mient of the apparatus, so that it will surely afford equal pressure 
 and support upon the intervening teeth. The only difBculty is in 
 regard to the proper length of the lingual ligature when completed. 
 
 Fig. 108. 
 
 This is easily overcome by using two small copper wires, passing 
 respectively above and below the buttons and extending beyond 
 them a half-inch or more at each end. Tension is not exerted 
 on the buttons by uniting the ends by twisting until after the 
 external and transverse ligatures have been completed. The 
 engraving is incorrect in this respect, that only one end of the 
 lingual ligature shows imion of the ends, instead of both. 
 
 Fig. no represents a modification of this plan used for holding 
 in position a large section of the inferior alveolus, including the 
 incisors and left cuspid, which had been broken outward as the 
 result of falling from a sled while the individual was coasting with 
 the knotted end of a rope held in the mouth. The second bicus- 
 pids were banded, and a wire ligature made to encircle the buttons 
 and bear against the loosened teeth. The ligatures showed a 
 slight tendency to slide down and impinge upon the gum, but 
 this was easily remedied by encircling the main ligature and the 
 incisors with two or three fine wire ligatures, thus giving addi- 
 tional support in a downward direction. 
 
TREATMENT OF FR.\CTURES OF THE MAXILL.E. 
 
 95 
 
 Fig. Ill shows another plan for securing fixation which pos- 
 sesses several valuable features. It is a thin metal cap, swaged 
 to fit the crowns accurately and covering a sufficient number of 
 the teeth in the arch to afford the necessar}^ support, the whole 
 being firmly cemented to the teeth with oxyphosphate of zinc. 
 Copper, gold, silver, aluminum, or vulcanite may be used; my 
 
 preference is aluminum. The plan is excellent, in that it allows 
 freedom of the jaw, is very clean and compact, and retains the 
 fractured ends of the bone firmly in apposition. Considering the 
 simplicity of this appliance, and the familiarity of dentists with 
 oxyphosphate of zinc, it is surprising that the value of this idea in 
 
 treating fractures has not been before recognized; but I find no 
 record of its use, although dentists frequently use similar splints 
 in the retention of teeth after they have been regulated, and Hulli- 
 hen employed a similar device in 1848 to hold the section of a jaw 
 after a surgical operation, using ligatures to keep the appliance in 
 place. 
 
 For several vears T supposed T had been the first to employ 
 
9D 
 
 THE ANGLE SYSTEM. 
 
 this method of retaining fractures, but I now believe it was first 
 used by Dr. John H. Martindale, of Minneapolis, who preceded 
 me a year or so, by cementing in position a splint made after 
 Kingsley's pattern, in order to dispense with the submental cap 
 
 Fig. III. 
 
 and bandages, which would interfere with the treatment of serious 
 external wounds on the side of the face. 
 
 My first case treated after this method is shown in Fig. 112. 
 Michael P., a baker by trade, had fallen down-stairs, knocking 
 
 Fig. 112. 
 
 out the superior incisors, cuspids, and one bicuspid, also loosen- 
 ing the lower central incisors and fracturing the jaw at the 
 symphysis. As I remember, he also received a fracture of one 
 of the femurs. He was admitted to the Minneapolis City Hos- 
 
TRE.-\TMENT OF FRACTURES OF THE MAXILLAE. 97 
 
 pital some time in June, 1888. I saw him first some two months 
 after the accident occurred, during which time the attending sur- 
 geon had employed the Barton style of bandaging in treatment. 
 Union of the bone had not taken place; on the contrary, a com- 
 plete fibrous joint had been established, with the ends of the bones 
 more or less absorbed and rounded, admitting of a free hinge 
 movement, with pus discharging, for which a large rubber drain- 
 age-tube had been inserted. The tube was removed, the wound 
 thoroughly washed, and an impression taken without any attempt 
 at changing the collapsed condition of the sides of the arch. A 
 model was made and sawed through at the point of fracture. It 
 was then placed in the articulator and adjusted to restore the origi- 
 nal occlusion as nearly as possible. Over this readjusted model a 
 very thin vulcanite splint was formed, the outlines of which cor- 
 respond to the dotted lines in the engraving. 
 
 Fig. 113. 
 
 The first attempt at cementing it in position upon the teeth was 
 unsuccessful, the cement hardening too rapidly, but the next 
 proved successful. The splint remained in position without any 
 trouble for nearly four months, when it worked loose, and we 
 found, upon examination, that firm union had taken place. 
 
 Of course the range of usefulness of this splint is quite limited, 
 as a sufficient number of firm teeth must be present on each side of 
 the fracture. Its principal value will, I think, be found in treating 
 fractures in the anterior part of the jaw, more especially in that 
 class of cases resulting from gunshot wounds in which large sec- 
 tions of the alveolus have been carried away. 
 
 Another plan which I have made use of in a few favorable cases 
 with much satisfaction is shown in Fig. 113, which represents my 
 first case treated by the method in (juestion. On May 29, 1889, a 
 young man of twenty-one years was admitted to the St. Anthony 
 Hospital of Minncai)olis. During an attack of epilepsy he had 
 fallen from a lumber pile to the groniul, a distance of fifteen or 
 
 7 
 
98 THE ANGLE SYSTEM. 
 
 twenty feet. Besides receiving severe bruises, he sustained a com- 
 pound fracture at the symphysis, terminating in front between the 
 central and lateral, as shown by the line in the engraving. The 
 fractured bone, when first seen, was quite widely separated at the 
 top, and the left central incisor was much loosened. He was 
 treated as follows : The ends of the fractured bones were carefully 
 placed in apposition and temporarily fastened by lacing the teeth 
 together with silk ligatures. The cuspids, being very firm, were 
 carefully fitted with plain bands. Tubes were soldered to these 
 bands horizontally. The large traction-screw shown at A, Fig. i, 
 was now slipped through the tubes, and the bands were firmly 
 cemented in position upon the teeth. The nut was then turned 
 upon the screw until the fractured ends of the bones were drawn 
 snugly together. This appliance was worn without displacement 
 or further trouble for twenty-one days, when it was removed, the 
 bones having become firmly united. 
 
 I may add that during the time the appliance was worn, so firmly 
 was the jaw supported that the patient suffered but little incon- 
 venience, and after the third day, partook regularly of his meals, 
 using his jaws freely, but of course avoiding the very hard foods. 
 
 CHAPTER II. 
 
 FINAL SUGGESTIONS ON FRACTURES. 
 
 In adjusting bands for the treatment of a fracture, carefully con- 
 sider the direction in which to exert the proper pressure for secur- 
 ing the jaw. It usually happens in cases of fracture that the 
 muscles in contracting tend not only to depress the jaw, but to 
 draw it backward, especially if the fracture be in the region of the 
 last molar. Consequently such teeth for anchorage should be 
 selected as shall use pressure not only upward but forward, as in 
 Fig. 105. 
 
 This is only a general rule, however, but I would specially advise 
 that the direction of force necessary in each case should be care- 
 fully considered, and then the bands and buttons be adjusted ac- 
 cordingly. 
 
 Sometimes it is an advantage to band more than one tooth in 
 order to distribute the power exactly in the direction necessary. 
 Should any of the teeth which have been selected for anchorage 
 show a tendency to elongation, the bands should be shifted to 
 
FINAL SUGGESTIONS ON FRACTURES. 99 
 
 Other teeth, or the direction of the force be changed. In but 
 two instances have I noted this comphcation, and I am inchned 
 to beheve that one of the cases was due to the band shpping and 
 impinging upon the gum, and thus probably producing the same 
 result as when a hgature is carelessly left about the tooth. 
 
 Should it be found advisable to employ the plan illustrated by 
 Fig. 112 or Fig. 113 in the treatment of a case, it will sometimes 
 be found an advantage to support the jaw by the first plan (Fig. 
 99), for a few days, or until the wounds are in more favorable con- 
 dition for taking an impression or adjusting the apparatus. 
 
 After the jaw has been properly set, the muscles relax in a few 
 hours so that the strain upon the ligature and anchor-tooth is 
 slight. 
 
 \'ery often patients receive severe bruises and internal injuries 
 at the time the fracture is sustained, and these may occasion vomit- 
 ing, more or less violent. Therefore especial caution should be 
 observed that the securing of the jaw be delayed until all tendency 
 to nausea has subsided. Be in no haste, for I know of no ill ef- 
 fects from a few hours' or even days' delay in setting a fracture. 
 Should it be advisable to immediately set the fracture, it might be 
 well to provide the attendant with a pair of strong scissors to cut 
 the ligatures if symptoms of nausea develop. 
 
 It should require but little argument to mipress the importance 
 of extreme cleanliness about the mouth during the treatment of 
 fractures. Frequent rinsing of the mouth with proper antiseptic 
 solutions should be insisted upon. If the fracture is more or less 
 comminuted, as is frequently the case, suppuration may be ex- 
 pected. The plan, then, which has been most successful with me, 
 is extra cleanliness of the wound by fre(|uent injections of pure, 
 fresh peroxid of hydrogen with a suitable syringe. The patient or 
 the attendant, with a little experience, can accomplish this quite as 
 well as the surgeon. Patience and persistence in this line will 
 soon cause the necrotic fragments to be washed out. Only in one 
 instance, in my experience, has it seemed necessary to interfere 
 with the wound by scraping the bone with instruments. 
 
 While the patient is undergoing treatment, his general health 
 should also not be allowed to become impaired. Plenty of exer- 
 cise in the open air, if other injuries do not prevent, should be 
 insisted upon, as well as a re(|uisitc amount of nourishing food, 
 and the surgeon should occasionally inspect the bands and liga- 
 tures, to sec that they are in order, so that the jaw shall not be 
 allowed to get loose, aflmitting movement between the fractured 
 ends of the hones. Should one of the bf)nes become broken, it 
 
lOO THE ANGLE SYSTEM. 
 
 should be replaced as quickly as possible. No special harm will 
 come from cutting the ligatures and separating the jaws, for the 
 purpose of replacing it. 
 
 In cases where a section of the bone shows a tendency to lean, 
 so that the teeth do not properly occlude, a finger of metal made to 
 bear against a tooth in the leaning section and soldered to a band 
 encircling some favorably located anchor-tooth, will effectually 
 restore the proper occlusion. 
 
 In like manner the range of application of this method of retain- 
 ing fractures may be extended to cases where fractures occur in 
 the body of the bone and the molars are absent. The edentulous 
 portion of the jaw may be securely held in proper position by a 
 prop made to bear against the section of bone, and kept in place by 
 attachment to a band secured about one of the molars or bicuspids 
 in the upper jaw. 
 
 The methods so far offered will, I believe, nearly cover the entire 
 range of cases requiring treatment. There still remains, however, 
 one distinct class for consideration, namely: the edentulous patient. 
 Fortunately, patients of this class requiring treatment are exceed- 
 ingly rare, and probably the best plan is the Gunning splint, or 
 what is the same in principle, attaching together by wire or vulcan- 
 ite the artificial dentures, should the patient possess them. 
 
 The cases of fractures so far described have been confined to 
 the inferior maxilla. The methods, however, of securing fixation 
 are all more or less applicable to the treatment of fractures in the 
 upper jaw as well, though I believe the one first described is most 
 applicable; for the reason that, if one of the superior maxillary 
 bones is fractured, it will be more or less displaced and usually 
 forced downward. After carefully replacing the pieces, the jaws 
 are closed and the teeth articulated, and the pieces thus supported 
 and held upward in position by the lower jaw secured in the usual 
 way by bands, buttons, and ligatures, attached on the uninjured 
 side. 
 
 Finally, as all the apparatus possessing any special merit in 
 the treatment of fractures of the maxillae have been invented by 
 dentists, and their familiarity with the parts, special knowledge of 
 mechanics, and facilities at their command fit them above all other 
 surgeons for tHis work, I would recommend that the different den- 
 tal societies throughout the country shall secure appointments of 
 competent dentists, in all hospitals, for the treatment of these 
 lesions, for to them this special line of surgery justly belongs. 
 
DR. EDWARD H. ANGLE S REGULATING IMPLEMENTS. 
 
 SET No. 1. 
 
 Patented March 5, 1SS9. 
 
 lOI 
 
 PRICES. 
 Set No. I, complete (including 100 page descriptive Book). 
 
 .$500 
 
 PARTS separ.^te: 
 
 Traction Screw "A" and "D" $125 
 
 " "B" and "C" 100 
 
 Jack-Screw "E" and "J" ^-^^ 
 
 Coils of Band Material "F" and "H" each .50 
 
 Retaining Wire "G" 50 
 
 Rotating Levers "L" per J^ doz. .25 
 
 Retaining Pipes "R" set of ten .75 
 
 Wrench each .15 
 
 EXTRA PARTS. 
 
 Adjustable Clamp Bands for Bicuspids and Molars. 
 Fig. I. Fig. 2. Fig. 3. Fig. 4. 
 
 Q. 
 
 Bicuspid. 
 
 Molar. 
 
 Bicuspid. 
 
 Molar. 
 
 PRICES. 
 
 Adjustable Bands Nos. i and 2 each $1.00 
 
 " Fracture Bands Nos. 3 and 4 1 '" 
 
 THE S. S. WHITE DENTAL MFG. 00., Sole Agent. 
 
I02 DR. EDWARD H. ANGLE S REGULATING IMPLEMENTS. 
 
 SET No. 2. 
 
 Patented Nov. 6, 1SS9. 
 
 PRICES. 
 
 Set No. 2, complete (including 100 page descriptive Book) $6.50 
 
 PARTS separ.\te: 
 
 , Traction Bar "A" each $2.00 
 
 ■—Wire Arch "B" " 1.50 
 
 X'Two Anchor Bands and Pipes "D," complete " 1.50 
 
 Coils of Band Material " .50 
 
 •—Heavy Elastic Bands set of six .10 
 
 Wrench each .15 
 
 EXTRA PARTS. 
 
 Head Gear. 
 
 Patented. 
 
 PRICE. 
 
 Head Gear, with Heavy Elastic Bands each $4.00 
 
 The cut shows the Traction Bar "A," not included in price. 
 
 THE S. S. WHITE DENTAL MFG. 00., Sole Agent. 
 
DR. EDWARD H. ANGLE S REGULATING IMPLEMENTS. IO3 
 
 EXTRA PARTS. 
 
 Chin Retractor. 
 
 PRICE. 
 Chin Retractor (without Head Gear).... 
 
 .each $2.50 
 
 EXPANSION ARCH. 
 
 THE 8. S. WHITE DENTAL MFG. 00., Sole Agent. 
 
 ANNEALED WIRE. 
 
 For Ligatures in Regulating. 
 
 Dr. Angle remarks that spring wire will not do. Wc ofTer Annealed 
 Wire, in Copper and Brass, and of the gauges he prescribes (Nos. 26 and 
 28, B. & S.;. 
 
 Put up in fiuarter-lb. Spoob 
 
 I'K I (.:]•;. 
 
 Per Spool $0.20 
 
104 DR. EDWARD H. ANGLE S REGULATING IMPLEMENTS. 
 
 (See Fig. 8 B, and pages 20 and 49.) 
 
 Regulating Pliers. 
 
 Patented March ig, 1895. 
 
 (See Fig. 8 B, and 
 page 15.) 
 
 Band Driver. 
 
 Price, 20 cents. 
 
 (See Fig. 8 A, and 
 page 20.) 
 
 Annealing Pliers. 
 
 No. 12. 
 
 'rice, $1.00 
 
 Price, $3.75. 
 
 THE S. S. WHITE DENTAL MPG. 00. 
 
DR. ED\^"ARD H. AN'GLE S REGULATING IMPLEMENTS, 
 
 10 = 
 
 BAND-FORMING PLIERS. 
 
 Patented September 13, 1898. 
 Designed by Dr. Edward H. Angle. 
 
 The Band-Forming Pliers are made 
 especially for pinching or forming the 
 plain bands about the crowns of teeth in 
 regulating, and about roots in crowning. 
 
 The angle of the beaks and plurality 
 of operating edges make them equally 
 adapted to forming the seam upon the 
 lingual or labial surfaces of the teeth in 
 either jaw without requiring a cramped 
 position of the hand. 
 
 Between the beaks are square and 
 round grooves for holding wire, nuts, etc. 
 Price $2.25 
 
 Band Soldering 
 Pliers. 
 
 Designed by 
 Dr. Edward H. Ancle. 
 
 These Pliers are for holding 
 bands when soldering. 
 
 The pressure is brought to 
 bear evenly and at the exact 
 point required, and away from 
 contact with the solder while 
 in the flame. The angle of the 
 
 beaks permits the least absorption of luat, and wilhout injury 
 or change of form. 
 
 Price $0.70 
 
Io6 THE S. S. WHITE DENTAL MFG. CO. 
 
 (See Fig. 8 A, and page 20.) (See Fig. 8 A, and page 80.) 
 
 Solid Steel Cutting Nippers. Spring Wire Ooiler and Bender. 
 
 Price each $1.75 
 
 (See Fig. 8 B, and page 21.) 
 
 Herapath Blow-Pipe. 
 
 Price, Plain per pair $0.80 
 
 " Nickel-plated " i.oo 
 
 Ph 
 
 (See Fig. 8 B, and page 20.) 
 
 Melotte's Combination Anvil and Bench-Block. 
 
 Patented September 13, 1892. 
 
 Price each $3.00 
 
THE S. S. WHITE DENTAL MFG. CO. 
 
 107 
 
 How's Crown Pliers. 
 
 (See Fig. 8 A, and pages 17 and 20.) 
 
 Laboratory 
 and Office Pliers. 
 
 No. 10. Wo. 11. 
 
 Xos. 10 and 11, straiglit and cnrved 
 Pliers for bending pin.s over posts in 
 Dr. How's process of mounting arti- 
 ficial tooth-crowns. 
 
 PRICES. 
 No. 10, Nickcl-i)Iated, Straight $1.5^' 
 No. II, Nickel-plated, Curved 1.75 
 
 A jjair of neat, well-made 
 long-nose Pliers, which find 
 many uses in office and labora- 
 tory. Steel throughout; nick- 
 eled all over. 
 
 Price per i)air $1.50 
 
io8 
 
 THE S. S. WHITE DENTAL MFG. CO. 
 
 (See Fig. 8 A, and page 17.) 
 
 Plate Shears for Crown- and Bridg-e-Work. 
 
 Lignum Vitse or Iron-Wood 
 Head. 
 
 Rosewood Handle. 
 
 Length, 10J/2 inches. 
 
 Price each $0.30 
 
 Solder 
 Tweezers "A." 
 
 Prices, Straight, .per pair $0.60 
 
 Curved. 
 
 .85 
 
 Price, $0.25 
 
THE S. S. WHITE DENTAL MFG. CO. 
 
 ANGLE'S IMPRESSION TRAYS. 
 
 See page 24 for description. 
 UPPER, Nos. 21, 22, and 23. 
 
 109 
 
 Price each $0.35 
 
no THE S. S. WHITE DENTAL MFG. CO. 
 
 ANGLE'S IMPRESSION TRAYS. 
 
 See page 24 for description. 
 
 Price each $0.35 
 
THE S. S. WHITE DENTAL MFG. CO. 
 
 Ill 
 
 ANGLE'S IMPRESSION TRAYS. 
 
 See page 24 for description. 
 LOWER, Nos. 24, 25, and 26. 
 
 Price t-"ach $0.35 
 
112 THE S. S. WHITE DENTAL MFG. CO. 
 
 ANGLE'S IMPRESSION TRAYS. 
 
 See page 24 for description. 
 
 Price ^ach $0.35 
 
COLUMBIA UNIVERSITY LIBRARY 
 
 This book is due on the date indicated below, or at the 
 expiration of a definite period after the date of borrowing, 
 as provided by the rules of the Library or by special ar- 
 rangement with the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 ^.P'^4 iQ. ta 
 
 
 K 
 
 KK521 
 
 An4 
 1897 
 
 The iingle sjrstein of reii;ulation and 
 retention of the teeth 
 
 V 
 
 -' OL. 
 
 194o 
 
 C 
 
 /2.(^ ON PEIISONAL RESERVE SHELF^2.//t 
 
^^ 
 
 7^(\ 
 
 COLUMBIA UNIVERSITY LIBRARIES (hsi.stx) 
 
 RK 521 An4 1897 C.I 
 
 The Annie '.v.T--' 'H ^ca'ii.itin!! :vv\ reten 
 
 2002369630