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Ambler + </title> + <style type="text/css"> +/*<![CDATA[ XML blockout */ +<!-- + p {margin-top: .75em; text-align: justify; margin-bottom: .75em;} + sub {vertical-align: text-bottom; font-size: small;} + h1,h2 {font-weight: normal;} + h1 {line-height: 2.5;} + h2 {margin-bottom: 1.5em;} + hr {width: 65%; margin: 2em auto;} + table {margin: 1em auto; width: 65%;} + td {vertical-align: bottom;} + .td1 {padding: 1.5em 0 .75em;} + .td2 {text-align: justify; padding-left: 2em; text-indent: -2em; padding-right: 4em;} + body {margin-left: 10%; margin-right: 10%;} + .pagenum {position: absolute; right: 1%; font-size: small; font-style: normal; text-align: right; text-indent: 0em;} + .center,.p1,.td1,h1,h2 {text-align: center;} + .smcap {font-variant: small-caps;} + .figc,.figr,.figl {text-align: center; font-variant: small-caps; padding: 0;} + .figc {margin: .5em auto; width: 400px;} + .figl {float: left; clear: left; margin: .5em 1em .5em 0; width: 155px;} + .figl1 {float: left; width: 29px; clear: none; margin: .5em 1em .5em .5em;} + .figr {float: right; clear: right; margin: .5em 0 .5em 1em; width: 151px;} + .poem {margin: .75em auto; text-align: left; width: 19em;} + .poem br {display: none;} + .poem span.i0 {display: block; margin-left: 0em; padding-left: 3em; text-indent: -3em;} + .trn {border: solid 1px; margin: 3em 15%; padding: 1em; text-align: justify;} + img {border: none; margin-top: .5em;} + a:link, a:visited {text-decoration: none;} + .abv, .blw {font-size: 70%;} + .abv {vertical-align: 0.7ex;} + .blw {vertical-align: -0.3ex;} + .fs1 {font-size: medium;} + .bk1 {margin: 3em auto 4em;} + .bk1 h2 {margin-top: .5em; margin-bottom: .5em;} + .bk2 {margin: 1em auto; width: 30em; text-align: justify;} + .p1 {line-height: 1.5;} + .sp1 {padding-left: 25px;} + .rgt {text-align: right;} + .clr,h1,h2,hr {clear: both;} +// --> +/* XML end ]]>*/ + </style> + </head> +<body> + + +<pre> + +The Project Gutenberg EBook of Tin Foil and Its Combinations for Filling +Teeth, by Henry L. Ambler + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Tin Foil and Its Combinations for Filling Teeth + +Author: Henry L. Ambler + +Release Date: October 8, 2008 [EBook #26840] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK TIN FOIL *** + + + + +Produced by Stephen Blundell and the Online Distributed +Proofreading Team at http://www.pgdp.net (This file was +produced from images generously made available by The +Internet Archive/American Libraries.) + + + + + + +</pre> + + +<h1><big>TIN FOIL</big><br /> +<span class="fs1">AND ITS</span><br /> +<span class="smcap">Combinations for Filling Teeth.</span></h1> + +<div class="bk1"><p class="center">BY</p> +<h2>HENRY L. AMBLER, M.S., D.D.S., M.D.,</h2> +<p class="center"><small>Professor of Operative Dentistry and Dental Hygiene, in the Dental Department<br /> +of Western Reserve University.<br /> +Member of the American Dental Association; of the Ohio State Dental<br /> +Society; of the Northern Ohio Dental Association;<br /> +of the Cleveland City Dental Society.</small></p></div> + +<p class="p1">PHILADELPHIA:<br /> +<big>THE S. S. WHITE DENTAL MFG. CO.,</big><br /> +LONDON:<br /> +<big>CLAUDIUS ASH & SONS, Limited.</big><br /> +1897</p> + +<hr /> + +<p class="p1">Copyright, <span class="smcap">Henry L. Ambler</span>, 1896.<br /> +All rights reserved.<br /> +Entered at Stationers Hall, London.</p> + +<hr /><p><span class='pagenum'><a name="Page_iii" id="Page_iii">[iii]</a></span></p> +<h2>PREFACE.</h2> + +<p><span class="smcap">Believing</span> that sufficient and well-deserved prominence +was not being given to the use of tin foil and its combinations, +the author decided to present a brief historical résumé +of the subject, together with such practical information as he +possesses, before the profession in order that it may have the +satisfaction of saving more teeth, since that is the pre-eminent +function of the modern dentist. One object is to meet the +demand for information in regard to the properties and uses +of tin foil; this information has been sought to be given in +the simplest form consistent with scientific accuracy. The +present use of tin is a case of the "survival of the fittest," +because tin was used for filling teeth more than one hundred +years ago. There is not a large amount of literature upon +the subject, and no single text-book has treated the matter +fully enough to answer the needs of both teacher and pupil. +It is difficult for the student to collect and harmonize from +the many different sources just the kind and amount of information +required for his special use. Perhaps this work will +be of assistance to scientific students and practical operators +in the art of using tin foil, including all who wish in compact +form an explanation of the facts and principles upon which +the art is based. A good method to arouse in students an +interest in the use of tin foil is to have them use it in operative +technics, which is becoming an effective adjunct in every +dental college. By this means a great factor will be brought +to bear, and the result will be that hundreds of graduates<span class='pagenum'><a name="Page_iv" id="Page_iv">[iv]</a></span> +every year will begin practice better qualified to save teeth +than if they had not known whatever may be learned about +this material. At the University of Pennsylvania, Department +of Dentistry, session 1896-97, out of the total number +of fillings made in the clinical department (fractions omitted) +55 per cent. were gold, 15 per cent. tin, 10 per cent. amalgam. +This shows that tin has some very strong friends in the persons +of Professors Darby and Kirk.</p> + +<p>The historical sketch of the development of the subject is +arranged in chronological order, and is given partly to show +that some old ideas and methods were good, and some +obviously incorrect when viewed in the light of more recent +developments. Part of the history will be new to the oldest +members of the profession, and the younger ones will certainly +read it with interest. The work has been brought up +to date by considering all the properties and methods available. +More names, good opinions, and dates could have +been given, but the writer believes that what is herein presented +is enough to thoroughly substantiate his own opinions, +experiments, and practical applications. Some of the illustrations +have been made especially for this work; the others +have been obtained through the courtesy of the owners.</p> + +<p>"Let not the foggy doctrine of the superiority of gold in +all cases act on progress as the old medieval superstitions +acted on astronomy, physiology, zoology. Truth sought +after without misgiving, and the humblest as well as the +highest evidence taken in every case, and acted on with skill +and discrimination, will crown all with a high average of +success."</p> + +<p>It is hoped that what has been said in this volume will +enable those who study it to save more teeth, and stimulate +them to make improvements on the material and methods, +doing much better than has been described or suggested.</p> + +<p><span class="smcap">Cleveland, Ohio</span>, June, 1897.</p> + +<hr /><p><span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span></p> + +<div class="poem"> +<span class="i0">"With soft and yielding lamina, and skill,<br /></span> +<span class="i0">The practiced dental surgeon learns to fill<br /></span> +<span class="i0">Each morbid cavity, by caries made,<br /></span> +<span class="i0">With pliant tin; when thus the parts decayed<br /></span> +<span class="i0">Are well supplied, corrosion, forced to yield<br /></span> +<span class="i0">To conquering art the long-contested field,<br /></span> +<span class="i0">Resigns its victim to the smiles of peace,<br /></span> +<span class="i0">And all decay and irritation cease."<br /></span> +<div class="rgt">(<i>Solyman Brown.</i>)</div></div> + +<div class="bk2">The quantity of tin foil used measures the number of teeth +saved with <i>metals</i> in any country during any historical period.</div> + +<hr /><p><span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span></p> +<h2>CONTENTS.</h2> + +<div class='center'> +<table border="0" cellpadding="0" cellspacing="0" summary=""> +<tr><td class="rgt" colspan="2"><small>PAGE</small></td></tr> +<tr><td class="td1" colspan="2">CHAPTER I.</td></tr> +<tr><td class="td2">Antiquity of Tin—Alchemistic Name—Medical Use—Where +Found—Purity Obtained—Physical Characteristics</td><td class="rgt"><a href="#Page_1">1</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER II.</td></tr> +<tr><td class="td2">History of the Use of Tin Foil, 1783-1844</td><td class="rgt"><a href="#Page_7">7</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER III.</td></tr> +<tr><td class="td2">History Continued, 1845-1895</td><td class="rgt"><a href="#Page_15">15</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER IV.</td></tr> +<tr><td class="td2">Columbian Dental Congress—Opinions on Tin Foil—Reasons +for Using—Manufacture in United States—Number +and Weight of Foil—Cohesion—Good +Qualities of Tin Foil—Temporary Teeth—Thermal +Changes—Calcification—Chalky Teeth</td><td class="rgt"><a href="#Page_27">27</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER V.</td></tr> +<tr><td class="td2">Discoloration of Tin—Decomposition of Food—Sulfids—Oxids—Galvanic, +Therapeutic, and Chemical Action</td><td class="rgt"><a href="#Page_40">40</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER VI.</td></tr> +<tr><td class="td2">White Caries—Gold and Tin as Conductors—Wearing +Away of Fillings—Poor Foil—Buccal Cavities—Number +of Years Fillings Last—Strips or Tapes for<span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span> +Filling—Number 10 Foil—Form of Cavities—Shields—Matrices—Condensing—Finishing—Cervical +Margins—Filling +Anterior Teeth—Lining with Gold</td><td class="rgt"><a href="#Page_49">49</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER VII.</td></tr> +<tr><td class="td2">Filling, part Tin, part Gold—Cervical Margin Liable to +Caries—Electrolysis—Hand Pressure—Hand Mallet—Tapes +and Ropes Compared—Manner of Preparing +Foil—Starting the Filling—Cylinders—Mats—Facing +and Repairing—Tin Shavings—Dr. Herbst's Method—Fees</td><td class="rgt"><a href="#Page_56">56</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER VIII.</td></tr> +<tr><td class="td2">Dr. Robinson's Fibrous and Textile Metallic Filling—Tin +and Gold combined (Tg), Methods of Preparing +and Using—Lining Cavities with Tin—Tin and Amalgam—Plastic +Tin—Stannous Gold—Crystal Tin—Filling +Root-Canals—Tin and Watts's Sponge Gold—Capping +Pulps</td><td class="rgt"><a href="#Page_66">66</a></td></tr> + +<tr><td class="td1" colspan="2">CHAPTER IX.</td></tr> +<tr><td class="td2">Temporary Fillings—Sensitive Cavities—Integrity—Tin +with Sponge, Fibrous, and Crystallized Gold—Tin +at Cervical Margin—Filling Completed with Gold—Gutta-Percha +and Tin—Occlusal Cavities with Tin +and Gold—Comparison of Gold with Tin—Wedge-shaped +Instruments—Old Method of Using Rolls, +Ropes, Tapes, or Strips—Later Method—Filling with +Compact and Loose Balls—Cylinder Fillings—Operative +Technics</td><td class="rgt"><a href="#Page_91">91</a></td></tr> +</table></div> + +<hr /><p><span class='pagenum'><a name="Page_1" id="Page_1">[1]</a></span></p> +<h2>CHAPTER I.</h2> + +<p><span class="smcap">Moses</span>, who was born 1600 B.C., mentions tin, +and history records its use 500 B.C., but not for +filling teeth; much later on, the Phœnicians took it +from Cornwall, England, to Tyre and Sidon.</p> + +<p>The alchemistic name for tin is Jove, and in the +alchemistic nomenclature medicinal preparations +made from it are called Jovial preparations.</p> + +<p>Hindoo native doctors give tin salts for urinary +affections. Monroe, Fothergill, and Richter claim +to have expelled worms from the human system, +by administering tin filings.</p> + +<p>Blackie, in "Lays of Highlands and Islands," referring +to tin as money, says,—</p> + +<div class="poem" style="width: 18em;"> +<span class="i0">"And is this all? And have I seen the whole<br /></span> +<span class="i0">Cathedral, chapel, nunnery, and graves?<br /></span> +<span class="i0">'Tis scantly worth the tin, upon my soul."<br /></span> +</div> + +<p>"Tin-penny."—A customary duty formerly paid +to the tithingmen in England for liberty to dig in +the tin-mines.</p> + +<p>In 1846, Tin (Stannum, symbol Sn) was found +in the United States only at Jackson, N. H. Since +then it has been found, to a limited extent, in West +Virginia and adjoining parts of Ohio, North Carolina,<span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span> +Utah, and North Dakota. The richest tin +mines of the world, however, are in Cornwall, +England, which have been worked from the time of +the Phœnician discovery.</p> + +<p>The tin which is found in Malacca and Banca, +India, is of great purity, and is called "Straits Tin" +or "Stream Tin." It occurs in alluvial deposits +in the form of small rounded grains, which are +washed, stamped, mixed with slag and scoriæ, and +smelted with charcoal, then run into basins, where +the upper portion, after being removed, is known +as the best refined tin. Stream tin is not pure +metallic tin, but is the result of the disintegration +of granitic and other rocks which contain veins of +tinstone. Banca tin is 99.961 parts tin, 0.019 iron, +0.014 lead in 100 parts; it is sold in blocks of 40 and +120 pounds, and a bar 0.5 meter long, 0.1 broad, +0.005 deep can be bent seventy-four times without +being broken. Subjected to friction, tin emits a +characteristic odor.</p> + +<p>Tin in solution is largely used in electro-metallurgy +for plating. Pure tin may be obtained by +dissolving commercial tin in hydrochloric acid, by +which it is converted into stannous chlorid; after +filtering, this solution is evaporated to a small +bulk, and treated with nitric acid, which converts it +into stannic oxid, which in turn is thoroughly<span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span> +washed and dried, then heated to redness in a crucible +with charcoal, producing a button of tin which +is found at the bottom of the crucible.</p> + +<p>Pure tin may be precipitated in quadratic crystals +by a slight galvanic current excited by immersing +a plate of tin in a strong solution of stannous +chlorid; water is carefully poured in so as not to +disturb the layer of tin solution; the pure metal will +be deposited on the plate of tin, at the point of +junction of the water and metallic solution.</p> + +<p>In the study of tin as a material for filling teeth, +we have deemed it expedient to consider some of +its physical characteristics, in order that what follows +may be more clearly understood.</p> + +<p>Tin possesses a crystallized structure, and can be +obtained in well-formed crystals of the tetragonal +or quadratic system (form right square prism), and +on account of this crystalline structure, a bar of +tin when bent emits a creaking sound, termed the +"cry of tin;" the purer the tin the more marked the +cry.</p> + +<p>The specific gravity is 7.29; electrical state positive; +fusing point 442° F.; tensile strength per +square inch in tons, 2 to 3. Tensile strength is the +resistance of the fibers or particles of a body to +separation, so that the amount stated is the weight<span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span> +or power required to tear asunder a bar of pure tin +having a cross-section of one square inch.</p> + +<p>Tenacity: Iron is the most tenacious of metals. +To pull asunder an iron wire 0.787 of a line in +diameter requires a weight of 549 lbs. To pull +asunder a gold wire of the same size, 150 lbs.; tin +wire, 34 lbs.; gold being thus shown to be more +than four times as tenacious as tin. (Fractions +omitted.)</p> + +<p>Malleability: Pure tin may be beaten into leaves +one-fortieth of a millimeter thick, thus requiring +1020 to make an inch in thickness. Miller states +that it can be beaten into leaves .008 of a millimeter +thick, thus requiring 3175 to make an inch in +thickness. Richardson says that ordinary tin foil +is about 0.001 of an inch in thickness.</p> + +<p>If the difficulty with which a mass of gold (the +most malleable of metals) can be hammered or +rolled into a thin sheet without being torn, be taken +as one, then it will be four times as difficult to +manipulate tin into thin sheets.</p> + +<p>Ductility: If the difficulty with which gold (the +most ductile of metals) can be drawn be taken as +one, then it will be seven times as difficult to draw +tin into a wire. At a temperature of 212° it has +considerable ductility, and can be drawn into wire.</p> + +<p>Among the metals, silver is the best conductor of<span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span> +heat. If the conductivity of silver be taken as 100, +then the conducting power of gold would be 53.2; +tin, 14.5; gold being thus shown to be nearly four +times as good a conductor of heat as tin. Among +the metals, silver is the best conductor of electricity. +If its electrical conductivity be taken at +100, then the conducting power of gold would be +77.96; tin, 12.36; gold being thus shown to be more +than six times as good a conductor of electricity as +tin.</p> + +<p>Resistance to air: If exposed to dry, pure air, +tin resists any change for a <i>great</i> length of time, but +if exposed to air containing moisture, carbonic acid, +etc., its time resistance is reduced, although even +then it resists corrosion much better than copper +or iron.</p> + +<p>As to linear expansion, when raised from 32° to +212° F., aluminum expands the most of any of the +metals. Taking its expansion as 1, that of tin +would be 3, <i>i.e.</i>, aluminum expands three times as +much as tin. (Dixon, "Vade Mecum.")</p> + +<p>Solids generally expand equally in all directions, +and on cooling return to their original shape. +Within certain limits, metals expand uniformly in +direct proportion to the increase in temperature, +but the rate of expansion varies with different +metals; thus, under like conditions, tin expands<span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span> +nearly twice (1<span class="abv">3</span>⁄<span class="blw">5</span>) as much as gold, but the <i>rate</i> of +expansion for gold is nearly twice (1<span class="abv">7</span>⁄<span class="blw">10</span>) that of +tin.</p> + +<p>The capacity for absorbing heat varies with each +metal; that of gold is about twice (1<span class="abv">3</span>⁄<span class="blw">4</span>) that of tin.</p> + +<p>Tin has a scale hardness of about 4, on a scale of +12 where lead is taken as the softest and platinum +the hardest. (Dixon, "Vade Mecum.")</p> + +<p>Tin has a scale hardness of about 2. (Dr. Miller.)</p> + +<p>To fuse a tin wire one centimeter in diameter +requires a fusing current of electricity of 405.5 +amperes. Up to 225° C., the rise in resistance to +the passage of an electric current is more rapid in +tin than in gold. In some minerals the current +follows the trend of the crystals.</p> + +<p>Gold wire coated with tin, and held in the flame +of a Bunsen burner, will melt like a tin wire. At +1600° to 1800° tin boils and may be distilled.</p> + +<hr /><p><span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span></p> +<h2>CHAPTER II.</h2> + +<p><span class="smcap">The</span> largest and most complete dental library in +the world is owned by Dr. H. J. McKellops, of St. +Louis. Upon his cheerful invitation, the writer +visited that "Mecca," and through his kindness and +assistance a complete search was made, which resulted +in obtaining a great portion of the following +historical facts with reference to the use of tin in +dentistry:</p> + +<p>"In 1783 I stopped a considerable decay in a +large double under tooth, on the outside of the +crown or near the gums, with fine tin foil, which +lasted for a good number of years." ("A Practical +and Domestic Treatise on Teeth and Gums," by +Mr. Sigmond, Bath, England, 1825.)</p> + +<p>"Fine tin foil or gold leaf may be injected into a +cavity successfully, and retained securely for many +years." (Joseph Fox, Dover, England, 1802.)</p> + +<p>"The statement has been made several times that +tin foil was used in the United States for filling +teeth as early as 1800, at which time dentistry began +to be cultivated particularly as a science and +art, and was beginning to be regarded as of more +importance than it formerly had been. The writer +has not found any record of its use in this country<span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span> +earlier than 1809. Tin may often be employed +with entire confidence. I have seen fillings forty-one +years old (made in 1809) and still perfect. +Several molars had four or five plugs in them, +which had been inserted at different periods during +the last half-century. I prefer strips cut from six +sheets laid upon each other. If the foil is well connected, +the cut edges will adhere firmly; if they do +not, the foil is not fit for use." (Dr. B. T. Whitney, +<i>Dental Register of the West</i>, 1850.) First +reference to the fact that tin is adhesive.</p> + +<p>"Tin is desirable in all unexposed cavities. It +has a stronger affinity for acetic, citric, tartaric, +malic, lactic, and nitric acids than the tooth has: a +good material where the secretions are of an acid +character, it is better that the filling should waste +away than the tooth. One cavity in my mouth +was filled with gold, decay occurred, the filling was +removed; cavity filled with oxychlorid, which produced +pain; filling removed; cavity filled with +gutta-percha, still experienced pain; filling removed; +cavity filled with tin, and pain ceased in an +hour. A tin filling was shown in New York which +was sixty years old; made in 1811." (Dr. E. A. +Bogue, <i>British Journal of Dental Science</i>, 1871.)</p> + +<p>"I have lately been removing tin pluggings (the +juices of the mouth having oxidated and dissolved<span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span> +away the metal, so as to expose the teeth to decay) +from teeth which I plugged fifteen years ago (1818) +for the purpose of re-stopping with gold, and have +in almost every instance found the bone of the +tooth at the bottom of the pluggings perfectly +sound and protected from decay." (J. R. Spooner, +Montreal, 1833.)</p> + +<p>In 1800 the number of dentists in the United +States was about one hundred, and many of them +were using tin foil for filling teeth.</p> + +<p>In 1822 tin was employed by the best dentists, +with hardly an exception; it grew in favor, especially +for large cavities in molars, and for a cheaper +class of operations than gold, but tin was not generally +used until 1830. ("History of Dental and +Oral Science in America.")</p> + +<p>"Lead, tin, and silver corrode and become more +injurious than the original disease, and will in every +case ultimately prove the cause of destruction to +the tooth, which might have been preserved by +proper treatment." (Leonard Koecker, 1826, and +"New System of Treating the Human Teeth," by +J. Paterson Clark, London, 1829 and 1830.)</p> + +<p>"Tin in situations out of reach of friction in mastication, +as between two teeth, is like the tooth +itself apt to be decomposed by acidity unless kept +very clean." ("Practical and Familiar Treatise on<span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span> +Teeth and Dentism," J. Paterson Clark, London, +1836.) Refer to what the same author said in +1829.</p> + +<p>"Tin is used as a plugging material." ("The +Anatomy, Physiology, and Diseases of the Teeth," +by Thomas Bell, F.R.S., London, 1829.)</p> + +<p>"Silver and tin foil, although bright when first +put in a cavity, very soon change to a dark hue, +resembling the decayed parts of the teeth which are +of a bluish cast; besides this, they are not sufficiently +pure to remain in an unchanged state, and +frequently they assist in the destruction of a tooth +instead of retarding it." ("Familiar Treatise on +the Teeth," by Joseph Harris, London, 1830.)</p> + +<p>"Tin is objectionable on account of rapid oxidation +and being washed by the saliva into the +stomach, as it may materially disorder it; the filling +becomes so reduced that the cavity in which it has +been inserted will no longer retain it, and acid fruits +influence galvanic action." ("Every Man his Own +Dentist," Joseph Scott, London, 1833.)</p> + +<p>In 1836 Dr. Diaz, of Jamaica, used tin foil for +filling teeth.</p> + +<p>"Gold is now preferred, though tin, from its +toughness when in the leaf, is perhaps the most +suitable. Americans are superior to British in<span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span> +filling." ("Plain Advice on +Care of the Teeth," Dr. A. +Cameron, Glasgow, 1838.)</p> + +<div class="figl" style="width: 55px;"><a name="Fig_1" id="Fig_1"></a>Fig. 1. +<img src="images/001.png" width="55" height="381" alt="" title="" /> +</div> + +<div class="figr" style="width: 51px;"><a name="Fig_2" id="Fig_2"></a>Fig. 2. +<img src="images/002.png" width="51" height="460" alt="" title="" /> +</div> + +<p>"Tin foil is used for filling +teeth." (S. Spooner, +New York, 1838, "Guide to +Sound Teeth.")</p> + +<p>In 1838 Archibald McBride, +of Pittsburg, Pa., +used tin for filling cavities +of decay.</p> + +<p>The following facts were +learned from Dr. Corydon +Palmer: E. E. Smith, who +had been a student of John +and William Birkey, in Philadelphia, +came to Warren, +Ohio, in 1839, and among +other things made the first +gold plate in that part of the +country. In operating on +the anterior teeth, he first +passed a separating file between +them, excavated the cavity, and +prepared the foil, <i>tin</i> or gold, in tapes +which were cut transversely, every +eighth of an inch, about three-quarters<span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span> +of the way across. <a href="#Fig_1">Fig. 1</a> shows the size of tape +and the manner of cutting. With an instrument +(<a href="#Fig_2">Fig. 2</a>) he drew the foil in from the labial surface, +using such portion of the tape as desired.</p> + +<p>The instrument from which the illustration was +made was furnished by Dr. Palmer, and is shown +full size. Instruments for use on posterior teeth +were short and strong, with as few curves as possible; +no right and left cutters or pluggers were +used, and none of the latter were serrated, but had +straight, tapering round points, flat on the ends, +and of suitable size to fill a good portion of the +cavity. He used what was termed Abbey's chemically +pure tin foil, forcing it in hard, layer upon +layer,—as he expressed it, "smacked it up." In +this manner he made tin fillings that lasted more +than thirty years.</p> + +<p>In 1839 Dr. Corydon Palmer filled teeth with tin +foil, also lined cavities with gold and filled the remainder +with tin. In the same year he filled crown +(occlusal) cavities one-half full with tin and the +other half with gold, allowing both metals to come +to the surface, on the same plan that many proximal +cavities are now filled. (See <a href="#Fig_3">Fig. 3</a>, showing +about one-half of the cavity nearly completed with +tin cylinders. The same plan was followed when +strips, or ropes, were used.)<span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span></p> + +<p>"I filled cavities about two-thirds full with tin, +and finished with gold." (S. S. Stringfellow, +<i>American Journal of Dental Science</i>, 1839.)</p> + +<p>"Tin foil is greatly used by some American dentists, +but it is not much better than lead leaf." +("Surgical, Operative, and Mechanical Dentistry," +L. Charles De Londe, London, 1840.)</p> + +<p>"In 1841 there were about twelve hundred dentists +in the United States, many of whom were +using tin, and there are circumstances under which +it may be used not only with impunity, but advantage, +but it is liable to change." (Harris.)</p> + +<div class="figc" style="width: 195px;"><a name="Fig_3" id="Fig_3"></a>Fig. 3. +<img src="images/003.png" width="195" height="217" alt="" title="" /> +</div> + +<p>"I put in tin fillings, and at the end of thirty +years they were badly worn, but there was no +decay around the margins." (Dr. Neall, 1843.)</p> + +<p>In 1843 Dr. Amos Westcott, of Syracuse, N. Y.,<span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span> +filled the base of large cavities with tin, completing +the operation with gold.</p> + +<p>"Tin is used in the form of little balls, or tubes, +but folds are better; introduce the metal gradually, +taking care to pack it so that it will bear equally +upon all points; the folds superimpose themselves +one upon the other; thus we obtain a successive +stratification much more exact and dense, and it is +impossible there can be any void." ("Theory and +Practice of Dental Surgery," J. Lefoulon, Paris, +1844.)</p> + +<hr /><p><span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span></p> +<h2>CHAPTER III.</h2> + +<p>"<span class="smcap">Besides</span> gold, the only material which can be +used with any hope of permanent success is tin foil. +Some dentists call it <i>silver</i>, and a tooth which cannot +be filled with it cannot be filled with anything +else so as to stop decay and make it last very long. +It can be used only in the back teeth, as its dark +color renders it unsuitable for those in front. +When the general health is good, and the teeth +little predisposed to decay, this metal will preserve +them as effectually perhaps as gold; but where the +fluids of the mouth are much disordered it oxidizes +rapidly, and instead of preserving the teeth rather +increases their tendency to decay." (Dr. Robert +Arthur, Baltimore, 1845, "A Popular Treatise on +the Diseases of the Teeth.")</p> + +<p>The false idea that a patient must have good +health, normal oral fluids, and teeth little predisposed +to decay, or else if filled with tin the decay +would be hastened, originated with a German or +English author, and has been handed down in +works published since early in 1800. It even crept +into American text-books as late as 1860, the +authors of which now disbelieve it.</p> + +<p>"Tin undergoes but little change in the mouth,<span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span> +and may be used with comparative safety." ("Surgical, +Mechanical, and Medical Treatment of the +Teeth," James Robinson, London, 1846.)</p> + +<p>"Tin is soft, and can be easily and compactly +introduced, but it is more easily acted on by the +secretions of the mouth than gold and is less durable, +but in the mouth of a healthy person <i>it will last +for years</i>. Still, inasmuch as it cannot be depended +on in <i>all</i> cases, we are of the opinion that it should +<i>never</i> be employed." ("The Human Teeth," +James Fox, London, 1846.)</p> + +<p>The italics are ours. Every metal has a limited +sphere of usefulness, and it should not be expected +that tin will contend single-handed against all the +complicated conditions which caries presents.</p> + +<p>"Of all the cheaper materials, I consider tin the +best by far, and regard its use fully justifiable in +deciduous teeth and in large cavities, as it is not +every man who can afford the expense of nine +leaves of gold and four hours of labor by a dentist +on a single tooth." (Dr. Edward Taylor, <i>Dental +Register of the West</i>, 1847.)</p> + +<p>"I consider tin good for any cavity in a chalky +tooth: it will save them better than anything else." +(Dr. Holmes, 1848.)</p> + +<p>"Tin can be used as a temporary filling, or as a +matter of economy. It may be rendered impervious<span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span> +to air and dampness, but it corrodes in most +mouths, unless it comes in contact with food in +chewing, and then it rapidly wears away; it does +not become hard by packing or under pressure, and +that it forms a kind of a union with the tooth is +ridiculous." (Dr. J. D. White, 1849, <i>Dental News +Letter</i>.)</p> + +<p>"A tin plug will answer a very good purpose in +medium and large cavities for six years. Much +imposition has been practiced with it, and it is not +made as malleable as it should and can be. An +inferior article is manufactured which possesses +brilliancy and resembles silver. This is often +passed off for silver foil. No harm comes from +this deception except the loss of the amount paid +above the price for tin; but even this inferior tin +foil is better than silver." ("The Practical Family +Dentist," Dewitt C. Warner, New York, 1853.)</p> + +<p>"Tin made into leaves is employed as a stopping +material; with sufficient experience it can be elaborated +into the finest lines and cracks, and against +almost the weakest walls, and teeth are sometimes +lost with gold that might have been well preserved +with tin. I saw an effective tin stopping in a tooth +of Cramer's, the celebrated musical composer, +which had been placed there thirty-five years ago<span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span> +by Talma, of Paris." ("The Odontalgist," by J. +Paterson Clark, London, 1854.)</p> + +<p>Refer to what the same author said in 1836.</p> + +<p>"Tin is the best substitute for gold, and can often +be used in badly shaped cavities where gold cannot." +(Prof. Harris, 1854.)</p> + +<p>"Tin is better than any mixture of metals for +filling teeth." (Professor Tomes, London, 1859.)</p> + +<p>In 1860 a writer said that "such a change may +take place in the mouth as to destroy tin fillings +which had been useful for years, and that tin was +not entirely reliable in any case; it must not be +used in a tooth where there is another metal, nor be +put in the bottom of a cavity and covered with +gold, for the tin will yield, and when fluids come in +contact with the metals, chemical action is induced, +and the tin is oxidized. Similar fillings in the same +mouth may not save the teeth equally well. Filling +is predicated on the nature of decay, for only +on correct diagnosis can a proper filling-material +be selected."</p> + +<p>Reviewing the foregoing statement, we believe +that a change may take place in the mouth which +will destroy gold fillings (or the tooth-structure +around them) much oftener than those of tin. It +is now every-day practice to put tin into the same +tooth with another metal; if the bottom of a cavity<span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span> +is filled with tin properly packed, it will not yield +when completed with gold, and if the gold is tight, +the oral fluids cannot come in contact with both +metals and produce chemical action or oxidation; +similar fillings of gold in the same mouth do not +save the teeth equally well. Should we expect +more of tin in this respect, or discard it because it +is not always better than gold?</p> + +<p>In Article V of the "New Departure Creed," +Dr. Flagg says, "Skillful and scrupulous dentists +fill with tin covered with gold, thereby preventing +decay, pulpitis, death of the pulp, and abscess, and +thus save the teeth."</p> + +<p>In 1862 Mr. Hockley, of London, mentions tin +for filling, and the same year Dr. Zeitman, of Germany, +recommended it as a substitute for gold, particularly +for poor people.</p> + +<p>"Is tin foil poisonous? If not, why are our +brethren so reluctant to use it? Is it nauseous? +If not, why not employ it? Will it not preserve +the teeth when properly used? Then why not +encourage the use of it? Does its name signify +one too common in the eyes of the people, on +account of its daily use in the tin shops, or do patients +murmur when the fee is announced, because +it is nothing but tin? Is it not better than amalgam, +although the patient may believe it less<span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span> +costly? Eleven good plugs, twenty-nine years old, +in one mouth demonstrates that tin will last as +long as gold in many cases." (F. A. Brewer, +<i>Dental Cosmos</i>, 1863.)</p> + +<p>"So much tin foil is used for personal and domestic +purposes that the following is important: +Ordinary tin foil by chemical analysis contained +88.93 per cent. of lead; embossed foil, 76.57 per +cent.; tea foil, 88.66 per cent.; that which was sold +for the pure article, 34.62 per cent. Tin foil of +above kind is made by inclosing an ingot of lead +between two ingots of tin, and rolling them out +into foil, thus having the tin on the outside of the +lead." (Dr. J. H. Baldock, <i>Dental Cosmos</i>, 1867.)</p> + +<p>The author used tin foil for filling the teeth of +some of his fellow-students at the Ohio College of +Dental Surgery in 1867.</p> + +<p>"Amalgam should never be used in teeth which +can be filled with tin, and most of them can be." +(Dr. H. M. Brooker, Montreal, 1870.)</p> + +<p>"I have used tin extensively, and found it more +satisfactory than amalgam. Dentists ignore tin, +because it is easier to use amalgam, less trouble. +This is not right. If your preceptor has told you +that amalgam is as good as tin, and he thinks so, +let him write an article in its defense. Not one +dentist in ten who has come into the profession<span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span> +within the last ten years knows how to make a tin +filling, and only a few of the older ones know how +to make a <i>good</i> one." (Dr. H. S. Chase, <i>Missouri +Dental Journal</i>, 1870.)</p> + +<p>"Among the best operators a more general use +of tin would produce advantageous results, while +among those whose operations in gold are not generally +successful an almost exclusive use of tin +would bring about a corresponding quantum of +success to themselves and patients, as against repeated +failures with gold. The same degree of +endeavor which lacked success with gold, if applied +to tin would produce good results and save teeth. +A golden shower of ducats realized for gold finds +enthusiastic admirers, but a dull gray shower for tin +work is not so admirable, even though many of the +teeth were no better for the gold as gold, nor so +well off in the ultimate as with tin." (Dr. E. W. +Foster, <i>Dental Cosmos</i>, 1873.)</p> + +<p>In 1873 Dr. Royal Varney said, "I am heartily +in favor of tin; it is too much neglected by our first-class +operators."</p> + +<p>"Tin stops the ends of the tubuli and interglobular +spaces which are formed in the teeth of excessive +vascular organization; if more teeth were filled +with tin, and a smaller number with futile attempts<span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span> +with gold, people would be more benefited." (Dr. +Castle, <i>Dental Cosmos</i>, 1873.)</p> + +<p>"If cavities in teeth out of the mouth are well +filled with tin, and put into ink for three days, no +discoloration of the tooth (when split open) can be +seen." (W. E. Driscoll, <i>Dental Cosmos</i>, 1874.)</p> + +<p>"Tin makes an hermetical filling, and resists the +disintegrating action of the fluids of the mouth. +If an operator can preserve teeth for fifteen dollars +with tin, which would cost fifty dollars with gold, +ought he not to do so? Upon examination of the +cavities from which oxidized plugs have been removed, +these oxids will be found to have had a +reflex effect upon the dentin; the walls and floors +will be discolored and thoroughly indurated, and +to a great degree devoid of sensitiveness, although +they were sensitive when filled. Tin is valuable in +case of youth, nervousness, impatience, high vitality +of dentin, low calcification, and low pecuniosity." +(Dr. H. Gerhart, <i>Pennsylvania Journal of +Dental Science</i>, 1875.)</p> + +<p>"Tin Foil for Filling Teeth." Essay by Dr. H. L. +Ambler, read before the Ohio State Dental Society. +(<i>Dental Register of the West</i>, 1875.)</p> + +<p>"Some say that if tin is the material the cavity +must be filled with, that it must be filled entirely<span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span> +with it, but advanced teachings show differently." +(Dr. D. D. Smith, <i>Dental Cosmos</i>, October, 1878.)</p> + +<p>"Frail teeth can be saved better with tin than +with gold. I never saw a devitalized pulp under a +tin filling." (Dr. Dixon, <i>Dental Cosmos</i>, May, +1880.)</p> + +<p>"Tin may be used as a base for proximate fillings +in bicuspids or molars, in third molars, in children's +permanent molars, in the temporary teeth, and in +any cavity where the filling is not conspicuous." +(Dr. A. W. Harlan, <i>Independent Practitioner</i>, 1884.)</p> + +<p>"Tin in blocks, mats, and tapes is used like non-cohesive +gold foil, but absence of cohesion prevents +the pieces from keeping their place as well as the +gold." ("American System of Dentistry," 1887.)</p> + +<p>This is virtually saying that there is cohesion of +non-cohesive gold, and that for this reason it keeps +its place better than tin. It has always been supposed +that there was no cohesion of layers of non-cohesive +gold, and as the tin is used on the non-cohesive +plan, therefore one keeps its place as well +as the other. We claim that generally in starting +a filling, tin will keep its place better than cohesive +or non-cohesive gold, because it combines some of +the cohesiveness of the former with the adaptability +of the latter.</p> + +<p>"Tin will save teeth in many cases as well or<span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span> +better than gold. Put a mat of tin at the cervical +wall of proximate cavities in molars and bicuspids, +and it makes a good filling which has a therapeutic +effect on tooth-structure that prevents the recurrence +of caries, probably because the infiltration of +tin oxid into the tubuli is destructive to animal life. +Where the filling is not exposed to mechanical +force, there is no material under heavens which will +preserve the teeth better." (Dr. Beach, <i>Dental +Cosmos</i>, 1889.)</p> + +<p>"I extracted a tooth in which I found a cavity of +decay which had extended toward a tin filling, but +stopped before reaching it; on examining the +tooth-structure between the new cavity and the tin +filling, it was found to be very hard, indicating +apparently that there had been some action produced +by the presence of the tin." (Dr. G. White, +<i>Dental Cosmos</i>, 1889.)</p> + +<p>"Pure tin in form of foil is used as a filling and +also in connection with non-cohesive gold." +(Mitchell's "Dental Chemistry," 1890.)</p> + +<p>"Tin ranks next to gold as a filling-material." +(Essig's "Dental Metallurgy," 1893.)</p> + +<p>"Tin is good for children's teeth, when gold or +amalgam is not indicated. It can be used in cavities +which are so sensitive to thermal changes as to +render the use of gold or amalgam unwise, but it<span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span> +can only be used in cavities with continuous walls, +and should be introduced in the form of cylinders +or ropes, with wedge-shaped pluggers having sharp +deep serrations, thus depending upon the wedging +or interdigitating process to hold the filling in the +cavity." ("Operative Technics," Prof. T. E. +Weeks, 1895.)</p> + +<p>"Tin for filling teeth has been almost superseded +by amalgam, although among the older practitioners +(those who understand how to manipulate +it) tin is considered one of the best, if not the very +best metal known for preserving the teeth from +caries. In consequence of its lack of the cohesive +property, it is introduced and retained in a cavity +upon the wedging principle, the last piece serving +as a keystone or anchor to the whole filling. Each +piece should fill a portion of the cavity from the +bottom to the top, with sufficient tin protruding +from the cavity to serve for thorough condensation +of the surface, and the last piece inserted should +have a retaining cavity to hold it firmly in place. +The foil is prepared by folding a whole or half-sheet +and twisting it into a rope, which is then cut into +suitable lengths for the cavity to be filled." +(Frank Abbott, "Dental Pathology and Practice," +1896.)</p> + +<p>"Forty-three years ago, for a young lady fourteen<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span> +years of age, I filled with non-cohesive gold +all the teeth worth filling with this metal; the rest I +filled with tin. Three years after that there was +not a perfect gold filling among the whole number, +and yet the tin fillings were just as good as when +made. The explanation as to why the tin fillings +lasted so much longer than the gold ones was, that +there must have been something in the tin that had +an affinity for the teeth and the elements that +formed the dentin, by which some compound was +formed, or else it must have been in the adaptation." +(Dr. H. Gerhart, <i>Dental Cosmos</i>, January, +1897.)</p> + +<hr /><p><span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span></p> +<h2>CHAPTER IV.</h2> + +<p><span class="smcap">At</span> the World's Columbian Dental Congress, +held in Chicago, August, 1893, the author presented +an essay on "Tin Foil for Filling Teeth."</p> + +<p>During the discussion of the subject, the following +opinions were elicited:</p> + +<p>Dr. E. T. Darby: "I have always said that tin +was one of the best filling-materials we have, and +believe more teeth could be saved with it than with +gold. I have restored a whole crown with tin, in +order to show its cohesive properties; the essayist +has paid a very high and worthy tribute to tin."</p> + +<p>Dr. R. R. Freeman: "I have used tin foil for +twenty-five years, and know that it has therapeutic +properties, and is one of the best filling-materials, +not excepting gold."</p> + +<p>Madam Tiburtius-Hirschfield: "I heartily indorse +the use of tin, and have tested its cohesive +properties by building up crowns."</p> + +<p>Dr. A. H. Brockway: "I am a strong believer +in the use of tin, on account of its adaptability, and +the facility with which saving fillings can be made +with it."</p> + +<p>Dr. Gordon White: "After having used tin for<span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span> +nine years, I claim that it is the best filling-material +that has been given to our profession."</p> + +<p>Dr. C. S. Stockton: "Tin is one of the best +materials for saving teeth, and we should use it +more than we do."</p> + +<p>Dr. James Truman: "I use tin strictly upon the +cohesive principle, and would place it in all teeth +except the anterior ones, but would not hesitate to +fill these when of a chalky character."</p> + +<p>Dr. Corydon Palmer: "For fifty-four years I +have been a firm advocate of the use of tin, and I +have a filling in one of my teeth which is forty years +old."</p> + +<p>Dr. William Jarvie: "I rarely fill a cavity with +gold for children under twelve years of age that I +want to keep permanently, but use tin, and in five +or ten years, more or less, it wears out. Still, it +can easily be renewed, or if all the tin is removed +we find the dentin hard and firm. The dentist is +not always doing the best for his patients if he does +not practice in this way."</p> + +<p>Dr. C. E. Francis: "I have proved positively +that tin foil in good condition is cohesive, and my +views have been corroborated by dentists and +chemists."</p> + +<p>Dr. James E. Garretson: "Tin foil is cohesive,<span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span> +and can be used the same as gold foil, and to an +extent answers the same purpose."</p> + +<p>Dr. C. R. Butler: "Tin is cohesive and makes a +first-class saving filling."</p> + +<p>Dr. W. C. Barrett: "Tin is as cohesive as gold, +and if everything was blotted out of existence with +which teeth could be filled, except tin, more teeth +would be saved."</p> + +<p>Dr. L. D. Shepard: "Tin possesses some antiseptic +properties for the preservation of teeth that +gold does not."</p> + +<p>Dr. W. D. Miller: "I use tin foil in cylinders, +strips, and ropes, on the non-cohesive plan, but +admit that it possesses a slight degree of cohesiveness, +and when necessary can be built up like cohesive +gold by using deeply serrated pluggers."</p> + +<p>Dr. Benjamin Lord says, "It is said that we know +the world, or learn the world, by comparison. If +we compare tin foil with gold foil, we find that the +tin, being softer, works more kindly, and can be +more readily and with more certainty adapted to +the walls, the inequalities, and the corners of the +cavities.</p> + +<p>"We find also that tin welds—mechanically, of +course—more surely than soft gold, owing to its +greater softness; the folds can be interlaced or +forced into each other, and united with more certainty,<span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span> +and with so much security that, after the +packing and condensing are finished, the mass may +be cut like molten metal.</p> + +<p>"I contend moreover that for contouring the +filling or restoring the natural shape of the teeth, +where there are three walls remaining to the cavity, +tin is fully equal to gold, and in some respects even +superior; as tin can be secured, where there is very +little to hold or retain the filling, better than gold, +owing to the ease and greater certainty of its adaptation +to the retaining points or edges of the cavity.</p> + +<p>"It will be said, however, that tin fillings will +wear away. The surfaces that are exposed to mastication +undoubtedly will wear in time; but the filling +does not become leaky if it has been properly +packed and condensed, nor will the margins of the +cavity be attacked by further decay on that account.</p> + +<p>"Altogether, I believe that we can make more +perfect fillings with tin than we can with gold, taking +all classes of cavities; but it must not be understood +that it is proposed that tin should ever take +the place of gold where the circumstances and conditions +indicate that the latter should be used. Of +course, the virtue is not in the gold or the tin, but +in the mechanical perfection of the operation, and +tin having more plasticity than gold, that perfection +can be secured with more ease and certainty.<span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span></p> + +<p>"If we compare tin with amalgam, we must certainly +decide in favor of the former and give it preference; +as if it is packed and condensed as perfectly +as may be, we know just what such fillings will do +every time. We know that there will be no +changes or leakage of the fillings at the margins; +whereas, with amalgam, the rule is shrinkage of the +mass, and consequently the admission of moisture +around the filling, the result being further decay. +It is not contended that this is always the result +with amalgam, but it is the general rule; yet we +must use amalgam, as there are not a few cases +where it is the best that we can do; but it is to be +hoped, and I think it may be said, that as manipulative +skill advances, amalgam will be less and less +used. For so-called temporary work, very often I +prefer tin to gutta-percha, as it makes a much more +reliable edge and lasts longer, even when placed +and packed without great care."—<i>N. Y. Odon. Society +Proceedings</i>, page 51, 1894.</p> + +<p>One of the main reasons which induced the +writer to begin the use of tin foil (<i>Stannum Foliatum</i>) +for filling teeth, in 1867, was the fact that +amalgam filling failures were being presented +daily. Believing that tin could do no worse, but +probably would do better, we banished amalgam +from the office for the succeeding seven years,<span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span> +using in the place of it tin, oxychlorid, and gutta-percha. +Since that time we have seen no good +reason for abandoning the use of tin, as time has +proved it worthy of great confidence. There is no +better dental litmus to distinguish the conservative +from the progressive dentist.</p> + +<p>If we take a retrospective view and consider what +tin foil was thirty years ago, we do not wonder that +so many operators failed to make tight, good-wearing +fillings. As it came from the manufacturer +it looked fairly bright, but after being exposed +to the air for a short time it assumed a light +brassy color, and lost what small amount of integrity +it originally possessed. This tin was not +properly refined before beating, or something was +put on the foil while beating, so that it did not have +the clean, bright surface and cohesive quality which +our best foil now has. No. 4 was commonly used, +but it would cut and crumble in the most provoking +manner. Fillings were made by using mats, +cylinders, tapes, and ropes, with hand-pressure, on +the plan for manipulating non-cohesive gold foil, +but it was difficult to insert a respectable approximal +filling.</p> + +<p>From the best information obtainable, the writer +believes that Marcus Bull (the predecessor of +Abbey) was the first to manufacture and sell tin<span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span> +foil in the United States, as he began the manufacture +of gold foil at Hartford in 1812.</p> + +<p>Several years ago a radical change came about in +the preparation of tin foil, for which the manufacturer +should have his share of the credit, even if +the dentist did ask for something better, for the +quality depends largely upon the kind and condition +of the tin used and on the method of manufacture.</p> + +<p>For making tin foil for filling teeth, the purest +Banca tin that can be obtained is used. The tin is +melted in a crucible under a cover of powdered +charcoal. It is then cast into a bar and rolled to +the desired thickness, so that if No. 6 foil is to be +made, a piece one and one-half (1<span class="abv">1</span>⁄<span class="blw">2</span>) inches square +would weigh nine grains. This ribbon is then cut +into lengths of about four feet, and spread on a +smooth board slanted, so that the end rests in a vat +of clean water.</p> + +<p>Then apply to the exposed surface of the ribbon +diluted muriatic acid, and immediately wash with a +strong solution of ammonia. Turn the ribbon and +treat the other side in the same way. It is then +washed and rubbed dry. The object of using the +acid is to remove stains and whiten the tin, and the +ammonia is used to neutralize the effect of the acid.</p> + +<p>The strips are then cut into pieces one and a half<span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span> +inch square, filled into a cutch and beaten to about +three inches square. It is then removed from the +cutch and filled into a mold, and further beaten to +the desired size. When the ragged edges are +trimmed off, the foil is ready for booking.</p> + +<p>It takes skill and experience to beat tin foil, for it +is not nearly as malleable as gold; up to No. 20 it +is usually beaten, but higher numbers are prepared +by rolling. In each case the process is similar to +that employed in preparing gold foil. The number +on the book is supposed to indicate the weight +or thickness of the leaf. On the lower numbers +the paper of the book leaves its impression.</p> + +<p>On weighing sheets of tin foil from different +manufacturers a remarkable discrepancy was found +between the number on the book and the number +of grains in a sheet, viz: Nos. 3, 4, 5, weighed 7 gr. +each; No. 6, 9 gr.; No. 8, from 9 to 18 gr.; No. 10, +from 14 to 15 gr.; No. 20, 18 gr. In some instances +the sheets in the same book varied three grains. +We submit that it would be largely to the advantage +of both manufacturer and dentist to have the +number and the grains correspond. No dentist +wishes to purchase No. 8 and find that he has No. +18; no one could sell gold foil under like circumstances. +Of the different makes tested, White's +came the nearest to being correct. The extra<span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span> +tough foil which can now be obtained is chemically +pure, and with it we can begin at the base of any +cavity, and with mallet or hand force produce a +filling which will be one compact mass, so that it +can be cut and filed; yet in finishing, it will not bear +so severe treatment as cohesive gold. Always +handle tin foil with clean pliers, never with the +fingers; and prepare only what is needed for each +case, keeping the remainder in the book placed in +the envelope in which it is sold, otherwise extraneous +matter collects upon it, and it will oxidize +<i>slightly</i> when exposed to the air for a <i>great</i> length +of time.</p> + +<p>Before using tin foil, a few prefer to thoroughly +crumple it in the hands or napkin, under the impression +that they thus make it more pliable and +easier to manipulate.</p> + +<p>A piece of blue litmus paper moistened and +moved over a sheet of tin foil will occasionally give +an acid reaction, probably owing to the acid with +which it is cleaned before beating not having been +thoroughly removed. Foil held under the surface +of distilled water and boiled for five minutes, then +left until the water is cold, removed and dried, +shows it has been annealed, which makes it work +easily, but not as hard a filling can be made from it +as before boiling.<span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span></p> + +<p>In selecting and using this material for filling, +we are able fully to protect the cavity; and if we +understand the material, and how to manipulate it, +we will surely succeed. This statement demands +serious attention, and appeals to every one who is +anxious to practice for the best interests of his +patients; then let us make a thorough study of the +merits of the method and material.</p> + +<p>Until recently, the term cohesion had but one +special meaning to dentists, and that as applied to +gold for filling teeth; being understood as the property +by which layers of this metal could be united +without force so as to be inseparable. The writer +claims that good tin foil in proper condition is +cohesive when force is applied, and can be used for +filling teeth in the same manner in which cohesive +gold foil is used. This claim has been confirmed +by several dentists, as noted in another part of this +volume.</p> + +<p>Cohesion is the power to resist separation, and +it acts at insensible distances. The integral particles +of a body are held together by cohesion, the +constituent parts are united by affinity.</p> + +<p>The attraction between atoms of pure tin represents +cohesion. Marble is composed of lime and +carbonic acid, which are united and held together +by affinity.<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span></p> + +<p>The condition which obtains in the tin may be +called cohesion, adhesion, welding, or interdigitation, +but the fact remains that layers of tin foil can +be driven together into a solid mass, making a +tight filling with less malleting than is required for +gold; if it is overmalleted, the receiving surface is +injured.</p> + +<p>On account of its pliability it is easily adapted +to the walls and margins, and a perfect fit is made, +thus preventing capillary action and preventing +further caries. Of all the metals used for filling +it is the best tooth-preserver and the most compatible +with tooth-substance, and the facility with +which a saving filling can be made largely commends +it.</p> + +<p>Tin has great possibilities, and has already +gained a high position as a filling-material. Upon +the knowledge we possess of the possibilities and +limitations of tin as a filling-material, and our ability +to apply that knowledge, will largely depend +our success in preserving teeth.</p> + +<p>It is a good material for filling many cavities in +the temporary teeth, and children will bear having +it used, because it can be placed quickly, and but +little force is required to condense one or two layers +of No. 10 foil. The dentin in young teeth has a +large proportion of organic material, for which<span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span> +reason, if caries takes place, many believe it is +hastened by thermal changes. Gold fillings in +such teeth might prevent complete calcification, on +account of the gold being so good a conductor; but +if tin is used, there is much more probability of calcification +taking place, because of its low conductivity +and its therapeutic influence. It does not +change its shape after being packed into a cavity. +Under tin, teeth are calcified and saved by the +deposit of lime-salts from the contents of the dentinal +tubuli. This is termed progressive calcification.</p> + +<p>Like other organs of the human body, the teeth +are more or less subject to constitutional change. +The condition in which we find tooth-structure +which needs repairing or restoring should be a sure +indicator to us in choosing a filling-material. Up +to the age of fourteen, and sometimes later, we find +many teeth which are quite chalky. In some +mouths also, at this period, the fluids are in such a +condition that oxychlorid and oxyphosphate do not +last long; for some reason amalgam soon fails, +while gutta-percha is quickly worn out on an occlusal +surface. In all such cases we recommend +tin, even in the anterior teeth, for as the patient +advances in years the tooth-structure usually becomes +more dense, so that, if desirable, the fillings<span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span> +can be removed, and good saving operations can be +made with gold. By treating cases in this manner +very little, if any, tooth-structure is lost.</p> + +<p>The teeth of the inhabitants of Mexico and +Guatemala are characteristic of their nervous and +nervo-lymphatic temperaments; children ten years +of age often have twenty-eight permanent teeth, +and they are generally soft or chalky, but our +dentists there report good success in saving them +with tin.</p> + +<p>In filling this class of teeth, we should be very +careful not to use force enough to injure the cavity-margin, +for if this occurs, a leaky filling will probably +be the result. Still, we have seen some cases +where <i>slight</i> imperfections at the margin, which +occurred at the time of the filling or afterward, did +no harm, because the deposit of tin oxid filled up +the ends of the tubuli, thus preventing caries. We +believe that this bar to the progress of caries is set +up more frequently when tin is used than with any +other metal under like conditions.</p> + +<hr /><p><span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span></p> +<h2>CHAPTER V.</h2> + +<p><span class="smcap">In</span> some mouths tin does not discolor, but retains +a clean, unpolished tin color, yet when there is a +sesquioxid of the metal formed, fillings present a +grayish appearance. In the same mouth some +fillings will be discolored, while others are not. As +a general rule, proximal fillings are most liable to +show discoloration. Perhaps one reason is that on +occlusal and buccal surfaces they are subject to +more friction from mastication, movements of the +cheeks, and the use of the brush.</p> + +<p>We have seen a large number of fillings which +were not blackened, yet were saving the teeth perfectly, +thus proving to a certainty that blackening +of tin in the tooth-cavity is not absolutely essential +in order to obtain its salvatory effects as a filling-material.</p> + +<p>Where there is considerable decomposition of +food which produces sulfuretted hydrogen, the +sulfid of tin may be formed on and around the +fillings; it is of a yellowish or brownish color, and +as an antiseptic is in such cases desirable. To offset +the discoloration, we find that the sulfid is insoluble, +and fills the ends of the tubuli, thus lending its +aid in preventing further caries. A sulfid is a combination<span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span> +of sulfur with a metal or other body. A +tin solution acted on by sulfuretted hydrogen +(H<sub>2</sub>S) produces a dark-brown precipitate (SnS), +stannous salt, which is soluble in ammonium sulfid +(NH<sub>4</sub>)<sub>2</sub>S<sub>2</sub>; this being precipitated, gives (SnS<sub>2</sub>) +stannic salt, which is yellow. Brown precipitates +are formed by both hydrogen sulfid and ammonium +sulfid, in stannous solutions. Yellow precipitates +are formed by hydrogen sulfid and ammonium +sulfid in stannic solutions. The yellow shade is +very seldom seen on tin fillings; the dark brown is +more common.</p> + +<p>An oxid is a combination of oxygen with a metal +or base destitute of an acid. In oxidation the oxygen +that enters into combination is not sufficient to +form an acid. The protoxid of tin (SnO) is black, +and can be obtained from chlorid of tin, or by <i>long</i> +exposure of tin to the atmosphere. The oxygen in +the saliva helps to blacken the tin, and the metallic +oxid penetrates the dentin more or less, acting as +a protection, because it is insoluble. Oxygen is +the only element which forms compounds with all +others, and is the type of electro-negative bodies; +it combines with all metals, therefore with tin, and +in many cases only the metal is discolored, and not +the tooth. Steam boilers are made tight by oxidation.<span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span></p> + +<p>Where there is complete oxidation, the tooth is +blackened to but a very slight depth, and the oxid +fills the ends of the tubuli, thus affording an additional +barrier to the entrance of caries. The filling +itself will prevent caries, but oxidation acts as an +assistant.</p> + +<p>"In the mouth, a suboxid is more likely to be +formed than a protoxid, but both are black; sulfur +and oxygen are capable of acting on tin under +favorable circumstances, such as warmth, moisture, +full contact, condensation of elements, and their +nascent conditions; the first three are always present +in the mouth. The protosulfuret of tin is +black." (Dr. George Watt.) Others give the +color as bluish-gray, nearly black.</p> + +<p>Experiments show that slight galvanic currents +exist between fillings of dissimilar metals in the +mouth, and practical experience demonstrates that +these currents occasionally produce serious results.</p> + +<p>Direct galvanic currents do not decompose normal +teeth by true electrolysis, but acids resulting +from decomposition of food and fluids react upon +the lime constituents of the teeth and promote secondary +caries.</p> + +<p>When two metals are so situated in the mouth +that the mucous membrane forms a connecting +conductor and the fluids are capable of acting on<span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span> +one metal, galvanic action is established sufficient +to decompose any of the binary compounds contained +in these fluids; the liberated nitrogen and +hydrogen form ammonia, which being exposed to +the action of oxygen is decomposed and nitric oxid +formed, resulting in nitric acid. We also have in +the mouth air, moisture, and decomposing nitrogenous +food to assist in the production of nitric +acid.</p> + +<p>"Galvanic action is more likely to develop hydrochloric +acid, for the chlorids of sodium and potassium +are present in the normal saliva and mucus, +and when decomposed their chlorin unites with the +hydrogen derived from the water of the saliva." +(Dr. George Watt.)</p> + +<p>The fact should also be noted that both nitric and +hydrochloric acids are administered as medicine, +and often assist in producing decay.</p> + +<p>When there is a battery formed in a mouth containing +tin fillings and gold fillings, and the fluids +of the mouth are the exciting media, tin will be +the positive element and gold the negative element; +thus when they form the voltaic pair, the tin becomes +coated or oxidized and the current practically +ceases.</p> + +<p>There is more or less therapeutical and chemical +action in cavities filled with tin, and its compatibility<span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span> +and prophylactic behavior as a filling-material +depends partly upon the chemical action which +occurs.</p> + +<p>Some dentists fill sensitive cavities with tin, in +order to secure gentle galvanic action, which they +believe to be therapeutic, solidifying the tooth-structure.</p> + +<p>"Tin possesses antiseptic properties which do not +pertain to gold for arresting decay in frail teeth; it +not only arrests caries mechanically, but in chalky +(imperfect) structure acts as an antacid element in +arresting the galvanic current set up between the +tooth-structure and filling-material." (Dr. S. B. +Palmer.) If the metal is acted on, the tooth is +comparatively safe; if the reverse, it is more or less +destroyed. The galvanic taste can be produced by +placing a piece of silver on the tongue and a steel +pen or piece of zinc under it; then bring the edges +of the two pieces together for a short time, rinse +the saliva around in the mouth, and the peculiar +flavor will be detected.</p> + +<p>"In 1820 attention was called to the injurious +effects of the galvanic current on the teeth, and +dentists were advised never to use tin and amalgam +in the same mouth.</p> + +<p>"A constant galvanic action is kept up in the +mouth when more than one kind of metal is used<span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span> +in filling teeth, and galvanism is often the cause of +extensive injury to the teeth. The most remarkable +case I ever saw was that of a lady for whom +I filled several teeth with tin. After a time decay +took place around some of the fillings. I removed +them and began to refill, but there was so much +pain I could not proceed. I found that by holding +a steel plugger an inch from the tooth I could give +her a violent galvanic shock. I observed that the +exhalation of the breath increased the evolution of +galvanism." (Dr. L. Mackall, <i>American Journal +of Dental Science</i>, 1839.)</p> + +<p>"When a faulty tooth in the upper jaw had been +stopped from its side with tin, the interstice between +it and the adjoining tooth being quite inconsiderable, +while the upper surface of a tooth not +immediately beneath it in the lower jaw was +stopped with the same metal, I have known a galvanic +shock regularly communicated from one +tooth to the other when by the movement of jaws +or cheeks they were brought near together." (Dr. +E. Parmly, <i>American Journal of Dental Science</i>, +1839.)</p> + +<p>"An interesting debate here sprung up on the +action where two metals are used in one filling, +such as gold and tin, the saliva acting as a medium, +and where the baser metal is oxidized by exhalents<span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span> +and by imbibition through the bony tooth-structure." +(Pennsylvania Society of Dental Surgeons, +1848.)</p> + +<p>"A patient came to me and complained of pain +in the teeth. Upon examination I found an amalgam +filling next to one of tin. With a file I +made a V-shaped separation, when they experienced +immediate relief from pain." (Dr. Nevill, +<i>American Journal of Dental Science</i>, 1867.)</p> + +<p>In regard to the decay of teeth being dependent +on galvanic action present in the mouth, Dr. Chase, +in 1880, claimed that a tooth filled with gold would +necessarily become carious again at the margin of +the cavity, wherever the acid secretions constantly +bathe the filling and tooth-substance. A tooth +filled with amalgam succumbs to this electro-chemical +process less rapidly, while one filled with tin +still longer escapes destruction. The comparative +rapidity with which teeth filled with gold, amalgam, +or tin, are destroyed is expressed by the numbers +100, 67, 50. He prepared pieces of ivory of equal +shape and size, bored a hole in each, and filled them. +After they had been exposed to the action of an +acid for one week, they had decreased in weight,—viz, +piece filled with gold, 0.06; amalgam, 0.04; +tin, 0.03.</p> + +<p>"With tin and gold, some have the superstition<span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span> +that the electricity attendant upon such a filling will +in some way be injurious to the tooth; it matters +not which is on the outside, when rolled and used as +non-cohesive cylinders each appears. We say that +neither experimentally, theoretically, nor practically +can any good or bad result be expected from +the electrical action of a tin-gold filling on tooth-bone, +and neither will the pulp be disturbed." +(Dr. W. D. Miller, <i>Independent Practitioner</i>, August, +1884.)</p> + +<p>"When the bottom of a cavity is filled with tin +which is tightly (completely) covered with gold, +there is <i>practically</i> no galvanic action and there is +no current generated by contact of tin and gold,—<i>i.e.</i>, +no current leaves the filling to affect the dentin. +That portion of tin which forms the base is more +positive than a full tin filling would be. The effect +is to cause the surface exposed to dentin to oxidize +more than tin would do alone; in that there is a +benefit. In very porous dentin there is enough +moisture to oxidize the tin, by reason of the current +set up by the gold." (Dr. S. B. Palmer.)</p> + +<p>Electricity generated by heat is called thermo-electricity. +If a cavity with continuous walls is +half filled with tin and completed with gold, or half +filled with silver and completed with gold, and the +junctions of the metal are at 20<span class="abv">1</span>⁄<span class="blw">2</span>° C. and 19<span class="abv">1</span>⁄<span class="blw">2</span>° C.,<span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span> +if the electrical action between the tin and gold be +1.1, the action between the silver and gold will be +1.8, thus showing the action in silver and gold to be +nearly two-thirds more than in the tin and gold, a +deduction which favors the tin and gold.</p> + +<p>Rubbing two different substances together is a +common method of producing an electric charge. +Is there not more electricity generated during mastication +on metal fillings than when the jaws are at +rest? Friction brings into close contact numerous +particles of two bodies, and perhaps the electrical +action going on more or less all the time through +gold fillings (especially when other metals are in +the mouth) accounts for a powdered condition of +the dentin which is sometimes found under cohesive +gold fillings, but not under tin.</p> + +<hr /><p><span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span></p> +<h2>CHAPTER VI.</h2> + +<p><span class="smcap">White</span> caries, the most formidable variety +known, may be produced by nitric acid, and in +these cases all the components of the tooth are +acted upon and disintegrated as far as the action +extends. In proximal cavities attacked by this +kind of caries, separate freely on the lingual side, +and fill with tin. When such fillings have been removed +the dentin has been found somewhat discolored +and greatly solidified as compared to its +former condition; this solidification or calcification +is more frequent under tin than gold, which is +partly due to the tin as a poor conductor of heat. +Nature will not restore the lost part, but will do the +next best thing—solidify the dentin. In some +cases, under tin, the pulp gradually recedes, and +the pulp-cavity is obliterated by secondary dentin. +In other cases the pulps had partly calcified under +tin. It has been known for years that tin would be +tolerated in large cavities very near the pulp without +causing any trouble, and one reason for this is +its low conducting power. Attention is called to +the fact that gold is nearly four times as good a +conductor of heat as tin, and more than six times +as good a conductor of electricity. Where tin fillings<span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span> +are subject to a large amount of attrition, they +wear away sooner or later, but this is not such a +great detriment, for they can easily be repaired or +replaced, and owing to the concave form produced +by wear the patient is liable to know when a large +amount has been worn away. That portion against +the wall of the cavity is the last removed by wear, +so that further caries is prevented so long as there +is any reasonable amount of tin left. If at this time +the tooth has become sufficiently solidified, proper +anchorage can be cut in the tin or tooth, one or +both, as judgment dictates, and the filling completed +with gold. A tin filling, confined by four +rather frail walls, may condense upon itself, but it is +so soft and adaptable that the force which condenses +it continually secures the readaptation at +the margin; thus there will be no leakage or caries +for years. Owing to its softness and pliability, it +may be driven into or onto the tubuli to completely +close them from outside moisture, and with a hand +burnisher the tin can be made to take such a hold +on dry, rough tubuli that a cutting instrument is +necessary to remove all traces of it.</p> + +<p>Tin foil has been found in the market that under +a magnifying glass showed innumerable tiny black +specks, which, upon being touched with an instrument, +crumbled away, leaving a hole through the<span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span> +foil. More than likely, some of the failures can be +attributed to the use of such foil. Good tough foil, +well condensed by hand or mallet force, stays +against the walls of a cavity and makes a tight filling, +and ought to be called as near perfect as any +filling, because it preserves the tooth, and gives a +surface which will wear from five to twenty years, +depending upon the size and location of the cavity +and tooth-structure. Buccal cavities in the first +permanent molars, and lingual cavities in the superior +incisors, filled for children from six to eight +years of age, are still in good condition after a +period of twenty years. Perhaps the limit is +reached in the following cases, all in the mouths of +<i>dentists</i>: One filling forty years old; one forty-two; +four on the occlusal surface, fifty; in the latter case +gold had been used in other cavities and had failed +several times. Lingual cavities in molars and +bicuspids can be perfectly preserved with tin. +Tapes of No. 10 foil, from one to three thicknesses, +can be welded together and will cohere as well or +better than semi-cohesive gold foil, and it can be +manipulated more rapidly; therefore, if desirable, +any degree of contour can be produced, but the +contour will not have the hardness or strength of +gold, so in many cases it would not be practicable<span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span> +to make extensive contours with tin, owing to its +physical characteristics.</p> + +<p>No. 10 will answer for all cases, and it is not as +liable to be torn or cut by the plugger as a lower +number, but one need not be restricted to it, as +good fillings can be made with Nos. 4, 6, or 8. +More teeth can be saved with tin than with any +other metal or metals, and the average dentist will +do better with tin than with gold. It is invaluable +when the patient is limited for time or means, and +also for filling the first permanent molars, where we +so often find poor calcification of tooth-structure. +In cases of orthodontia, where caries has attacked +a large number of teeth, it is well to fill with tin, +and await further developments as to irregularity +and caries.</p> + +<p>If cavities are of a good general retaining form, +that will be sufficient to hold the filling in place; +but if not, then cut slight opposing angles, grooves, +or pits. Cavities are generally prepared the same +as for gold, except where there is a great deal of +force brought upon the filling; then the grooves or +pits may be a little larger; still, many cavities can be +well filled with less excavating than required for +gold, and proximal cavities in bicuspids and +molars, where there is sufficient space, can be filled +without removing the occlusal surface, and here<span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span> +especially should the cavities be cut square into the +teeth, so as not to leave a feather edge of tin when +the filling is finished, as that would invite further +caries and prove an obstruction to cleansing the +filling with floss.</p> + +<p>In proximal cavities involving the occlusal surface, +cut the cervical portion down to a strong +square base, with a slight pit, undercut, or angle, at +the buccal and lingual corners; where there is sufficient +material, a slight groove across the base, far +enough from the margin so that it will not be +broken out, can be made in place of the pit, undercut, +or angle; then cut a groove in the buccal and +lingual side (one or both, according to the amount +of material there is to work upon), extending from +the base to the occlusal surface; in most of these +cases the occlusal grooves or pits would have to be +excavated on account of caries; thus there would +be additional opportunity for anchorage. In place +of the grooves the cavity may be of the dovetail +form. In nearly all proximal cavities in bicuspids +and molars, some form of metal shield, or matrix, is +of great advantage, as they prevent the tin from +crushing or sliding out. By driving the tin firmly +against the metal, a well-condensed surface is secured; +and as the metal yields a little, we can with a +bevel or thin plugger force the tin slightly between<span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span> +the metal and the margin of the cavity, thus making +sure of a tight filling, with plenty of material to +finish well. After removing the metal, condense +with thin burnishers and complete the finish the +same as for gold. Where no shield or matrix is +used, or where it is used and removed before completing +the filling, it is often desirable to trim the +cervical border, for in either case there is more +light and room to work when only a portion of the +cavity has been filled. Tin cuts so much easier +than gold, it is more readily trimmed down level +with all cervical margins.</p> + +<p>Be sure that all margins are made perfect as the +work progresses, and if the cavity is deep and a +wide shield shuts out the light, then use a narrow +one, which can be moved toward the occlusal surface +from time to time.</p> + +<p>In filling the anterior teeth when the labial wall +is gone, and the lingual wall intact or nearly so, +use a piece of thin metal three-quarters of an inch +long and wide enough to cover the cavity in the +tooth to be filled, insert it between the teeth, and +bend the lingual end over the cavity; the labial end +is bent out of the way over the labial surface of the +adjoining tooth, as shown in <a href="#Fig_4">Fig. 4</a>. When the +labial wall is intact or nearly so, access to the cavity +should be obtained from the lingual side, and in<span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span> +this case the bending of the shield would be reversed, +as shown in <a href="#Fig_5">Fig. 5</a>. The shield is not absolutely +essential, but it helps support the tin, and +also keeps a separation.</p> + +<div class="figc"><div class="figl"><a name="Fig_4" id="Fig_4"></a>Fig. 4. +<img src="images/004.png" width="155" height="124" alt="" title="" /> +</div> + +<div class="figr"><a name="Fig_5" id="Fig_5"></a>Fig. 5. +<img src="images/005.png" width="151" height="124" alt="" title="" /> +</div></div> + +<p class="clr">It is preferable to save the labial wall and line it +with (say) five layers of No. 4 semi-cohesive gold +folded into a mat and extended to the outer edge +of the cavity; this gives the tooth a lighter shade, +and bicuspids or molars can be filled in the same +manner. Cases are on record where incisors with +translucent labial walls, filled by this method, have +lasted from twenty-three to thirty-seven years.</p> + +<hr /><p><span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span></p> +<h2>CHAPTER VII.</h2> + +<p><span class="smcap">For</span> the last ten years the writer has been using +tin at the cervical margin of proximal cavities in +bicuspids and molars, especially in deep cavities +(now an accepted practice), and he finds that it +prevents further caries oftener than any other metal +or combination of metals he has ever seen used. +In filling such cavities, adjust the rubber, and use +a shield or matrix of such form as to just pass beyond +the cervical margin; this will generally push +the rubber out of the cavity, but if it does not, then +form a wedge of wood and force between the metal +and the adjoining tooth, thus bringing the metal +against the cervical margin, and if a small film of +rubber should still remain in the cavity, it may be +forced out by using any flat burnisher which will +reach it, or it can be dissolved out with a little chloroform. +Fill from one-fourth to one-half of the +cavity with tin, and complete the remainder with +gold when the tooth is of good structure; this gives +all the advantages of gold for an occlusal surface.</p> + +<p>Before beginning with the gold, have the tin +solid and square across the cavity, and the rest of +the cavity a good retaining form, the same as for +gold filling; then begin with a strip of gold slightly<span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span> +annealed and mallet it into the tin, but do not place +too great reliance upon the connection of the +metals to keep the filling in place.</p> + +<p>On the same plan, proximal cavities in the anterior +teeth can be filled, and also buccal cavities in +molars, especially where they extend to the occlusal +surface. The cervical margin should be well covered +with tin thoroughly condensed, thus securing +perfect adaptation, and a solid base for the gold +with which the filling is to be completed. Time +has fully demonstrated that the cervical margin is +most liable to caries, and here the conservative and +preservative qualities of tin make it specially applicable.</p> + +<p>"Electrolysis demonstrates to us that no single +metal can be decomposed, but when gold and tin +are used in the above manner they are united at +the line of contact by electrolysis. The surface of +both metals is exposed to the fluids of the mouth, +and the oxid of tin is deposited on the tin, by reason +of the current set up by the gold; thus some atoms +of tin are dissolved and firmly attached to the gold, +but the tin does not penetrate the gold to any great +extent." (Dr. S. B. Palmer.)</p> + +<p>This connection of the metals assists in holding +the filling in place, but it is more likely to break +apart than if it was all gold. After electrolysis has<span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span> +taken place at the junction, it requires a cutting +instrument to completely separate the tin and gold.</p> + +<p>For filling by hand pressure, use instruments +with square ends and sides, medium serrations, and +of any form or size which will best reach the cavity.</p> + +<p>For filling with the hand mallet, use instruments +with medium serrations, and a steady medium blow +with a four-ounce mallet; in force of blow we are +guided by thickness of tin, size of plugger, and +depth of serrations, strength of cavity-walls and +margins, the same as in using gold. The majority +of medium serrated hand mallet pluggers will work +well on No. 10 tin of one, two, or three thicknesses. +If the tin shows any tendency to slide, use a more +deeply serrated plugger. The electro-magnetic, +and mechanical (engine) mallet do not seem to +work tin as well as the hand mallet or hand force, as +the tendency of such numerous and rapid blows is +to chop up the tin and prevent the making of a solid +mass, and also injure the receiving surface of the +filling. In using any kind of force, <i>always</i> aim to +carry the material to place before delivering the +pressure, or blow.</p> + +<p>In order to obtain the best results, there must be +absolute dryness, and care must be exercised, not +thinking that because it is <i>tin</i> it will be all right. +Skill is required to make good tin fillings, as well<span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span> +as when making good gold fillings. Always use +tapes narrower than the orifice of the cavity; they +are preferable to rolls or ropes. After a few trials it +is thought that every one will have the same opinion. +A roll or rope necessarily contains a large +number of spaces, wrinkles, or irregularities, which +must be obliterated by using force in order to produce +a solid filling; thus more force is employed, +and more time occupied in condensing a rope, than +a flat tape; the individual blow in one case may not +be heavier than in the other, but the rope has to be +struck more blows. The idea that a rope could be +fed into a cavity with a plugger faster and easier +than a tape has long ago been disproved. Many +of the old-fashioned non-cohesive gold foil operators +used flat tapes, as did also Dr. Varney, one +of the kings of modern cohesive gold operators.</p> + +<p>The tape is made by folding any portion of a +sheet of foil upon itself until a certain width and +thickness is obtained. This tape is very desirable +in small or proximal cavities where a roll or rope +would catch on the margin and partially conceal +the view.</p> + +<p>In the form of a tape, perhaps more foil can be +put in a cavity, and there may be more uniform +density than when ropes are used. Tapes can also +be made by folding part of a sheet of foil over a<span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span> +thin, narrow strip of metal. Fold the tin into tapes +of different lengths, widths, and thicknesses, according +to the size of the cavity; then fold the end +of the tape once or twice upon itself, place it at the +base of any proximal cavity, and begin to condense +with a foot plugger of suitable size, and if +there is a pit, groove, or undercut which it does +not reach, then use an additional plugger of some +other form to carry the tin to place; fold the tape +back and forth across the cavity, proceeding as for +cohesive gold. In small proximal cavities a very +narrow tape of No. 10, one thickness, can be used +successfully. For cavities in the occlusal surface, +use a tape as just described, generally beginning at +the bottom or distal side, but the filling can be +started at any convenient place, and with more ease +than when using cohesive gold. In any case if the +tin has a tendency to move when starting a filling, +"Ambler's left-hand assistant" is used, by slipping +the ring over the second finger of the left hand, +letting the point rest on the tin. This instrument +is especially valuable in starting cohesive gold (see +<a href="#Fig_6">Fig. 6</a>). This is the easiest, quickest, and best +manner of making a good filling, relying upon the +welding or cohesive properties of the tin.</p> + +<p>Many operators have not tried to unite the tin +and make a solid mass; they seem to think that it<span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span> +cannot be accomplished, but with proper pluggers +and manipulation it can be done successfully.</p> + +<div class="figc" style="width: 555px;"><a name="Fig_6" id="Fig_6"></a>Fig. 6. +<img src="images/006.png" width="555" height="108" alt="" title="" /> +</div> + +<p>For large occlusal or proximal cavities, the +tapes may be folded into mats, or rolled into cylinders, +and used on the plan of wedging or interdigitation, +and good fillings can be produced by this +method, but the advantage of cohesion is not obtained, +and more force is required for condensing. +They are, therefore, not so desirable as tapes, especially +for frail teeth. When using mats or cylinders, +the general form of the cavity must be depended +upon to hold the filling in place. To make +the most pliable cylinders, cut a strip of any desired +width from a sheet of foil and roll it on a triangular +broach, cutting it off at proper times, to make the +cylinders of different sizes.</p> + +<p>A cylinder roller, designed by the author, is +much superior to a broach. (See <a href="#Fig_7">Fig. 7</a>.) When +the cavity is full, go over the tin with a mallet or +hand burnisher, being careful not to injure the cavity-margin.<span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span> +Cut down occlusal fillings with burs or +carborundum wheels, and proximal fillings with +sharp instruments, emery strips or disks. After +partially finishing, give the filling another condensing +with the burnisher, then a final trimming +and moderate burnishing; by this method a hard, +smooth surface is obtained.</p> + +<p>Fillings on occlusal surfaces can be faced with +No. 20 or 30 tin, and burnished or condensed, by +using a burnisher in the engine, but do not rely +upon the burnisher to make a good filling out of a +poor one.</p> + +<div class="figc" style="width: 421px;"><a name="Fig_7" id="Fig_7"></a>Fig. 7. +<img src="images/007.png" width="421" height="54" alt="" title="" /> +</div> + +<p>By trimming fillings before they get wet, any +defects can be remedied by cutting them out; then +with a thin tape (one or two layers of No. 10) and +serrated plugger proceed with hand or mallet force +to repair the same as with cohesive gold.</p> + +<p>Another method of preparing tin for fillings is +to make a flat, round sand mold; then melt chemically +pure tin in a clean ladle and pour it into the +mold; put this form on a lathe, and with a sharp +chisel turn off thick or thin shavings, which will<span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span> +be found very tough and cohesive when freshly cut, +but they do not retain their cohesive properties +for any great length of time,—perhaps ten or +twenty days, if kept in a tightly corked bottle. +After more or less exposure to the air they become +oxidized and do not work well, but when they are +very thin they are soft, pliable, and cohesive as +gold, and any size or form of filling can be made +with them.</p> + +<p>Among the uses of tin in the teeth, the writer +notes the following from Dr. Herbst, of Germany: +"After amputating the coronal portion of the pulp, +burnish a mat of tin foil into the pulp-cavity, thus +creating an absolutely air-tight covering to the +root-canal containing the remainder of the pulp; +this is the best material for the purpose." There +has been a great deal said about this method, pro +and con, notably the latter. The writer has had no +practical experience with it, and it need not be +understood that he indorses it.</p> + +<p>If a pulp ever does die under tin, perhaps it will +not decompose as rapidly as it otherwise would, +owing to its being charged with tin-salts.</p> + +<p>The Herbst method of filling consists in introducing +and condensing tin in cavities by means of +smooth, highly tempered steel engine or hand burnishers. +In the engine set of instruments there is<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span> +one oval end inverted cone-shaped, one pear-shaped, +and one bud-shaped. The revolving burnisher +is held firmly against the tin, a few seconds +in a place, and moved around, especially along the +margins, not running the engine too fast. Complicated +cavities are converted into simple ones by +using a matrix, and proximal cavities in bicuspids +and molars are entered from the occlusal surface. +The tin foil is cut into strips, and then made +into ropes, which are cut into pieces of different +lengths; the first piece must be large enough so +that when it is condensed it will lie firmly in the +cavity without being held; thus a piece at a time +is added until the cavity is full. The hand set of +burnishers has four which are pear-shaped and vary +in size, and one which is rather small and roof-shaped. +In filling and condensing they are rotated +in the hand one-half or three-quarters of a turn.</p> + +<p>Dr. Herbst claims a better adaptation to the +walls of the cavity than by any other method. +Proximal cavities in bicuspids and molars can easily +be filled; the tin can be perfectly adapted against +thin walls of enamel without fracturing them; less +annoyance to the patient and less work for the +dentist; can be done in half the time required for +other methods.</p> + +<p>Fees should be reasonably large, certainly more<span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span> +than for amalgam, for we can save many teeth for +a longer time than they could have been preserved +with cohesive gold. Many are not able to pay for +gold, but they want their teeth filled and <i>saved</i>, and +it is expected that we will do it properly and with +the right kind of material; thus it is our duty in +such cases to use more tin and less amalgam.</p> + +<p>We should always take into consideration the +amount of good accomplished for the patient,—the +salvation of the tooth,—and if we are sure, from experience +and observation, that the tin filling will +last as long as a gold one in the same cavity, or +longer, then the fee should be as much as for gold, +with the cost of the gold deducted. The amount +of the fee ought to be based upon the degree of +intelligence, learning, and skill required; upon the +amount of nervous energy expended; upon the +draft made on the dentist's vitality; upon what +benefit has been given the patient; upon the perfection +of the result; and, everything else being equal, +upon the time occupied; the value of this last factor +being estimated in proportion to the shortness of it.</p> + +<hr /><p><span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span></p> +<h2>CHAPTER VIII.</h2> + +<p><span class="smcap">Dr. Robinson's</span> Fibrous and Textile Metallic +Filling is a shredded metallic alloy, mostly tin, and +has the appearance of woven or felt foil. It is prepared +in a machine invented by the doctor especially +for the purpose, and he gives directions for +using as follows: "Cut the material into strips +running with the selvage, and fill as you would with +soft foil; use it in all surrounding walls, and finish +with a mallet burnisher. Where the surface comes +to hard wear, weld on gold with long, sharp serrated +pluggers, and finish the same as with gold +fillings. The advantage over gold for cervical, +buccal, and lingual walls is the perfect ease with +which it is adapted, and it can be burnished so as +to be absolutely impervious to moisture. Sharp, +coarse-serrated pluggers are particularly desirable +when using hand pressure." It comes in one-half-ounce +boxes, filled with sheets less than two inches +square; the thin ones are used for filling, and the +thick ones make good linings for vulcanite.</p> + +<p>This material is easy to manipulate, but great +care is required in condensing at cavity-margins, +so as to make a tight filling, and also not injure the +margins. It makes as hard a surface as tin foil, and<span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span> +can be cut, polished, and burnished so that it is +smooth and looks well; it can be used in temporary +or chalky teeth, as a small amount of force condenses +it. By using a matrix proximal cavities +can be filled from one-fourth to one-half full, and +the rest filled with gold, relying on the form of the +cavity to hold the gold, regardless of its connection +with the fibrous material. If the surface is not +overmalleted so as to make it brittle or powdery, a +strip of No. 4 cohesive gold, of four or five thicknesses, +may be driven into it with a hand mallet and +plugger of medium serrations; this union is largely +mechanical, but of sufficient tenacity to make +manipulation easy, as the material makes a solid +foundation to build upon. After exposure to the +oral fluids, electrolysis takes place at the junction +of the metals.</p> + +<p>In 1884 Dr. Brophy said, "I have used Robinson's +material for two years, and find it possesses +good qualities, and can be used in deciduous teeth, +first permanent molars, and cervical margins with +better results than can be obtained with any other +material by the majority of operators."</p> + +<p>Malleted with deeply serrated pluggers, it will +make a filling which will not leak. It has saved +many teeth from caries at the cervical margin +where it might have recurred sooner had cohesive<span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span> +gold been used. In the mouth it changes color +about the same as tin foil, and a few fillings did not +maintain their integrity, but became crumbly and +granular.</p> + +<p>For conducting properties it ranks about with +tin, and fillings can be made more rapidly than with +cohesive gold. We have used ounces of it, but +time has proved that everything that can be done +with it in filling teeth can also be accomplished as +well and in some cases better with tin foil.</p> + +<p>In 1878 Dr. N. B. Slayton patented his Felt Foil, +which was said to be tin cut into hair-like fibers by +a machine, then pressed into small sheets and sold +in one-half-ounce books, but it sold only to a very +limited extent. Soon after this Dr. Jere Robinson, +Sr., invented a machine and began the manufacture +of a similar article, but he found he was +infringing on the Slayton patent, so he purchased +the Slayton machine and made satisfactory terms +to continue his own manufacture of fibrous material. +After this little was heard of Slayton's Felt +Foil, but Robinson's was considerably used. The +two materials look and are manipulated almost +exactly alike. Dr. Robinson has both of above-mentioned +machines now in his possession.</p> + +<p>Archibald McBride, of Pittsburg, Pa., in 1838, +made a roll of a portion of a sheet of tin, and then<span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span> +used just enough gold to cover it, aiming to keep +the gold on the surface, so as to have the filling +look like one of all gold, and not with the idea of +deriving any special benefit from the effects of wear +or preservation as obtained by thus combining the +two metals. The fee for a gold filling was one +dollar; tin, fifty cents. Some operators have advocated +using tin and gold (symbol Tg), rolled or +folded together in alternate layers, thus exposing +both metals to the fluids of the mouth; claiming +that fillings can be made quicker, are not so subject +to thermal changes, and can be inserted nearer the +pulp than when gold is used. This may be true +in comparison with gold, but these three claims are +entirely met by using tin alone. Others say that +this union of gold and tin will preserve the teeth as +well as a correct gold filling, making no conditions +or restrictions as to tooth-structure or location of +cavity. They say that it preserves the cervical +margin better than gold; that it expands <i>slightly</i>.</p> + +<p>A description of some different methods of combining +and manipulating tin and gold is subjoined:</p> + +<p>(<i>a</i>) Two sheets of No. 4 cohesive gold and one +of the same number of tin are used; place the tin +between the gold, cut off strips, and use with hand +or mallet force the same as cohesive gold; if non-cohesive +gold is used, the strips can be folded into<span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span> +mats or rolled into cylinders, and are used on the +wedging plan, the same as non-cohesive gold, or +the strips can be folded back and forth in the cavity +until it is full.</p> + +<p>(<i>b</i>) Lay a sheet of non-cohesive gold, No. 3, on +a sheet of tin of the same number, cut off strips, roll +into ropes and use as non-cohesive gold. It is +easily packed and harder than tin, and has a preservative +action on the teeth. Line the cavity with +chloro-balsam as an insulator against possible currents +and moisture; especially should this be done +in large cavities or chalky teeth.</p> + +<p>(<i>c</i>) A sheet of non-cohesive gold, No. 4, is laid +on a sheet of tin of the same number, cut into strips +and rolled into cylinders, or folded into blocks, +always in equal portions; then they will unite to the +extent of two leaves. These fillings sometimes +become a solid mass about the color of amalgam, +and last very well, as the metals have become united +by electrolysis. An excess of tin will be marked by +lines or pits in the filling, showing where the tin +has been disintegrated or dissolved by the chemical +action which occurs on the surface exposed to +moisture.</p> + +<p>No doubt, good fillings have been made by the +above methods, yet some were granular, gritty, and +were easily removed, while others were quite<span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span> +smooth and hard; probably in the first instance the +proportion of tin and gold was not proper,—that is, +not equal; or it was not well condensed. Tin being +the positive element, it is more easily acted on and +disintegrated by electrolysis (chemical action of the +fluids).</p> + +<p>When this combination does become hard, it +wears longer than tin on an occlusal surface, but +we believe that in some cases where it was used the +teeth could have been saved just as well with either +tin or gold, or by filling part of the cavity with tin +and the rest with gold.</p> + +<p>If tin foil is laid on 22-carat gold and vulcanized, +it becomes thoroughly attached and will take a +tin polish; the attraction or interchange of atoms +takes place to this extent.</p> + +<p>This combination of tin and gold can be used at +the cervical margin, or a cavity can be lined with it, +and the remainder filled with cohesive or non-cohesive +gold.</p> + +<p>"Tin and gold (Tg) folded or rolled together in +equal portions possesses a greater number of desirable +properties than any other material, for it is +easily adapted, has antiseptic action and a lower +conductivity than gold. A new filling is harder +than tin, softer than gold, but after a time it becomes +as hard as amalgam. It oxidizes and thus<span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span> +helps make tight margins, and is very useful at cervical +margins; generally discolors, but not always, +and does not discolor the tooth unless a carious +portion has been left, and then only discolors that +portion. In oral fluids it is indestructible if well +condensed, otherwise it is crumbly. There is no +change of form, except a <i>slight</i> expansion, which +does no harm. A weak electric current is set up +between the gold and tin, and tin oxid is formed. +The hardening and discoloration both depend upon +the separation of the tin by the electrical action and +its deposition on the surface of the gold. I generally +prepare cavities the same as for non-cohesive +gold, but a Tg filling may be held in a more shallow +cavity and with less undercuts than for gold. +Hand pressure is adopted, but a mallet may be +used advantageously. Lay a sheet of No. 4 non-cohesive +gold on a sheet of No. 4 tin, then cut into +strips and twist into ropes; keep the tin on the outside, +for it does not tear as easily as gold. Carry +the material against the walls and not against the +base, otherwise the filling will be flat or concave; +but should this occur, then force a wedge-shaped +plugger into the center of the filling, and drive the +material toward the walls, and then fill the hole or +remove all the filling and begin anew.</p> + +<p>"In very deep cavities use a mat of Tg, dampened<span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span> +in carbolic acid and dipped in powdered +thymol, as a base; this has an antiseptic action, and +also prevents pressure on or penetration into the +pulp.</p> + +<p>"Drs. Abbot, Berlin; Jenkins, Dresden; Sachs, +Breslau, have observed tin-gold fillings from fifteen +to twenty-five years, and say that for certain cases +it is better than any other material. I use square-pointed +pluggers (four-cornered), as part of the +packing is done with the side of the plugger. Tg +is useful in partly erupted molars, buccal cavities +under the gums, occlusal cavities in temporary +teeth, cavities where all decay cannot be removed. +Use Tg with a gold capping in small, deep occlusal +cavities, cavities with overhanging walls, occlusal +cavities with numerous fissures, large, deep occlusal +cavities near the pulp, in proximal cavities.</p> + +<p>"Line labial walls of incisors with non-cohesive +gold, and fill the remainder with Tg. For repairing +gold fillings I use Tg." (Dr. Miller, Berlin, +<i>Dental Cosmos</i>, 1890.)</p> + +<p>Dr. Jenkins, of Dresden, says, "I use Tg in soft, +imperfect teeth, of which there are plenty in Germany, +because it has pliability, adaptability, slight +susceptibility to thermal changes, makes a water-tight +joint, very useful at cervical margins, and +can be used with a minimum amount of pressure.<span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span> +When packed dry and with the gold next +to the tooth, discoloration occurs only on the surface; +packed wet, the whole discolors. I do not +attribute its success to electrical action. Lay a +sheet of No. 4 tin on a sheet of No. 4 non-cohesive +gold, fold so as to keep the gold on the outside; use +the strip with lateral pressure, doubling it upon +itself."</p> + +<p>Dr. A. H. Thompson: "After several years' +successful use of tin-gold, I commend it for approximal +cavities, cervical margins, and frail walls. The +oxid formed penetrates the enamel and dentin; if a +filling wears down, cover the surface with gold."</p> + +<p>Dr. Pearson: "I do not like tin and gold in +alternate layers. I prefer No. 10 tin foil."</p> + +<p>Dr. James Truman: "I believe that tin-gold has +a positive value as a filling-material."</p> + +<p>"I prepare tin-gold by taking a sheet of No. 4 +non- or semi-cohesive gold, fold them together (or +twist them) so as to have the gold on the outside, +and then fill any cavity with it. Since adopting the +above combination I have almost abandoned amalgam. +This is recommended on account of its +density, ease of insertion, capacity for fine finish, +non-conducting and non-shrinking qualities, and +compatibility with tooth-substance. Those who +have not used it will be surprised at the rapidity<span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span> +with which it can be manipulated. It may be employed +in any cavity not exposed to view, also in +crown, buccal, and approximal fillings which extend +into the occlusal surface, as it offers an astonishing +resistance to wear. It can be used anywhere +that amalgam can, and with more certainty +of non-leakage, and it has the additional advantage +that it can be finished at the same sitting. Care is +necessary in manipulating it, so as to avoid chopping. +I use hand pressure when filling, and the +mallet to condense the surface." (Dr. A. W. Harlan, +<i>Independent Practitioner</i>, 1884.)</p> + +<p>"Pure tin foil is employed in connection with +non-cohesive gold in filling proximal cavities in bicuspids +and molars; a sheet of gold and a sheet of +tin are folded together." (C. J. Essig: "Prosthetic +Dentistry.")</p> + +<p>Dr. Benj. Lord says, "A combination in which I +find great interest is in the use of soft or non-cohesive +gold with tin foil. This is no novelty in practice, +but I think that, for the most part, too great +a proportion of tin has been used, and hence has +arisen the objection that the tin dissolved in some +mouths. I am satisfied that I myself until recently +employed more tin than was well. I now +use from one-tenth to one-twelfth as much tin as +gold, and no disintegration or dissolving away of<span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span> +the tin ever occurs. I fold the two metals together +in the usual way of folding gold to form strips, the +tin being placed inside the gold. The addition of +the tin makes the gold tougher, so that it works +more like tin foil. The packing can be done with +more ease and certainty; the filling, with the same +effort, will be harder, and the edges or margins are +stronger and more perfect.</p> + +<p>"The two metals should be thoroughly incorporated +by manipulation. Then, after a time, there +will be more or less of an amalgamation. By using +about a sixteenth of tin, the color of the gold is so +neutralized that the filling is far less conspicuous +than when it is all gold, and I very often use such a +proportion of tin in cavities on the labial surfaces of +the front teeth.</p> + +<p>"If too much tin is employed in such cases, there +will be some discoloration of the surface of the fillings; +but in the proportion that I have named no +discoloration occurs, and the surface of the filling +will be an improvement on gold in color."</p> + +<p>"Dr. Howe. I would like to ask Dr. Lord +whether, in referring to the proportions of tin and +gold, he means them to be considered by weight?</p> + +<p>"Dr. Lord. No, not by weight, but by the +width of the strip of tin and the width of the strip +of gold. I get the proportions in that way, then<span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span> +lay the tin on the gold and fold the gold over and +over, which keeps the tin inside the gold.</p> + +<p>"Dr. Howe. Will Dr. Lord tell us whether he +refers to the same numbers of gold foil and tin foil; +as, for instance, No. 4 gold and No. 4 tin?</p> + +<p>"Dr. Lord. I use the No. 5 gold, and tin, I +think, of about the same number, but I always use +No. 5 gold, both cohesive and non-cohesive."—<i>New +York Odontological Society Proceedings</i>, 1893, +page 103.</p> + +<p>"Tin and gold, in the proportions generally used, +do not present a pleasing color; when finished, it +looks but little better than tin, and after a short +time it grows dark, and sometimes black. I use +five parts of gold to one of tin, prepared as follows: +Lay down one sheet of Abbey's non-cohesive gold +foil, No. 6; upon this place a sheet of No. 4; upon +this place a sheet of White's globe tin foil, No. 4; +upon this another sheet of Abbey's non-cohesive +gold, No. 4; upon this a sheet of No. 6. Cut into +five strips and crimp; the crimped strips are cut into +pieces a little longer than the depth of the cavity +to be filled; some of the strips are rolled into cylinders, +others are left open, because easier to use in +starting a filling. The color of this combination is +slightly less yellow than pure gold, and hardens just +as rapidly as when the proportions are one to one,<span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span> +but does not become quite as hard. This preparation +is non-cohesive, and should be inserted by +the wedge process. I use it in the grinding surface +of molars and bicuspids, buccal cavities in molars +and bicuspids, cervical fissure pits in superior incisors, +proximal cavities in bicuspids and molars. +If proximal cavities are opened from the occlusal +surface, the last portion of the filling should be of +cohesive gold to withstand mastication. In simple +cavities I place as many pieces as can be easily +introduced, using my pliers as the wedging instrument +to make room for the last pieces, and then +condense the whole. If the cavity is too deep for +this, I use Fletcher's artificial dentin as a base, +because it partly fills the cavity and the ends of the +cylinders stick to it. After an approximal cavity is +prepared, use a matrix held in place by wooden +wedges; the cylinders are about one-eighth of an +inch long, and condensed in two or three layers so +as to secure perfect adaptation; hand pressure is +principally used, but a few firm strokes with a hand +mallet are useful. When ready to add the cohesive +gold for the grinding-surface, a few pieces of +White's crystal mat gold should first be used, because +it adheres beautifully; thus a perfect union is +secured, but I never risk adding the gold without +leaving a little undercut for it in the tooth. By<span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span> +this method we obtain a beautiful contour filling +in a short time. Fillings should be burnished and +then polished with a fine strip, or moistened pumice +on a linen tape. Where cohesive gold is used for +the entire filling, in many cases the enamel-walls, +already thin near the cervical margin, are made +thinner by the unavoidable friction of the polishing +strips, but tin and gold is so soft that a good surface +is obtained in a few moments, and this danger +is reduced to a minimum. The surface is as smooth +as a cohesive gold filling, while such a surface is +impossible with non-cohesive gold. In cavities +which extend so far beyond the margin of the gum +that it is impossible to adjust the rubber-dam, I +prepare the cavity as usual, then adjust a matrix, +disinfect, dry, and fill one-third full with tin and +gold, then remove the matrix, apply the rubber, +place matrix again in position, and complete the +filling by adding a little tin and gold, then pure +gold." (Dr. W. A. Spring, <i>Dental Review</i>, February, +1896.)</p> + +<p>Dr. T. D. Shumway says, "To have a scientific +method of treatment, there certainly must be a +recognition of what is known of the nature of +tooth-structure. The method adopted more than +a quarter of a century ago, and which is at present +employed, does not accord with the teachings of<span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span> +the physiologist and microscopist; it is in direct +opposition to natural law. Each new discovery in +the minute structure of the teeth makes this more +plain; pounding the teeth with a mallet cannot be +defended on scientific grounds. That it has not resulted +more disastrously is due to the wonderful recuperative +energy of nature to repair injury. No +one would think of attempting to arrest and prevent +disintegration in any other vital organ by +abrasion. Why, then, in operation on the teeth, +should we reverse the plain, simple teaching of nature? +Placing cohesive gold against the dentinal +walls by pounding it to heal a lesion is opposed to +natural law. Cohesive gold will not be mastered +by force; if compelled to yield by superior strength, +it seeks a way to release itself; it is easily coaxed, +but not easily driven. Cohesive gold will unite +with tin at an insensible distance just as cohesive +gold unites with itself; this union takes place without +force or pressure. Exactly what takes place +when gold and tin are brought in contact in the +way described we do not know; we can only say +that there appears to be a perfect union. When cohesive +gold was introduced to the profession, while +it was softer than non-cohesive foil, it was found to +resist under manipulation. This resistance is in accordance +with the well-known law that all crystalline<span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span> +bodies, when unobstructed, assume a definite +form. With gold the tendency is to a spherical +form. The process of crystallization is always from +within outward. The mallet was introduced to +overcome the resistance caused by the development +of the cohesive property. Pounding gold with a +mallet only increases its crystallization. A crystalline +body coming in contact with a fibrous one +can neither be antiseptic nor preservative; a filling-material +which possesses these properties must be +one that corresponds or is in harmony with tooth-substance.</p> + +<p>"In the interglobular spaces there is a substance +which is called amorphous or structureless, and a +filling to be in harmony with this substance should +be amorphous or structureless in its composition. +The only materials we have which meet these conditions +are gutta-percha and tin. It is its structureless +character that gives to tin its value. Coming +in contact with the living dentin, it is easily +adapted, and does not excite inflammation; it does +not interfere with the process going on within the +teeth to heal the lesion caused by caries. A wound +from a bullet made of tin, unless it struck a vital +part, nature would heal, even if the cause of the +wound was not removed, by encysting the ball. +This process of nature of repairing injury by encysting<span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span> +the cause is of interest to the dentist in the +study of suitable filling-materials. Tin is very useful +at the cervical margin of cavities; it acts as an +antiseptic or preservative, and reduces the liability +to subsequent decay. It is our endeavor to obtain +a filling that will preserve the teeth and reduce the +liability to, if not wholly prevent, secondary decay. +The law of correspondence is of more consequence +than the mechanical construction of the filling. +Tin can be used without that rigid adherence to +mechanical rule that is necessary to retain a filling +of cohesive gold; thus less of the tooth needs to be +sacrificed.</p> + +<p>"Gold will unite with tin under certain conditions +so as to form apparently a solid mass. By +a combination of these metals, not by interlacing +or incorporating one in the other, but by affinity, +secured by simple contact, we have all the preservative +qualities of tin combined with the indestructible +properties of gold. For the base of the +filling we have a material in harmony with tooth-substance, +introduced in a way that is in accord +with the law that governs all living bodies, and for +the outside a crystalline substance that corresponds +to the covering of the teeth. This covering +of gold is a perfect shield to the base, and the +field for the display of artistic skill in restoring<span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span> +contours is as broad as though gold was used entirely. +Will a filling of this kind withstand mastication? +There is in the economy of nature a provision +made to overcome the resistance of occlusion. +The teeth are cushioned in the jaw and yield +under pressure. The elasticity of the substance +of which the teeth are made is well understood. +Ivory is the most elastic substance known. The +teeth coming together is like the percussion of two +billiard balls. Now a filling to save the teeth +should correspond as nearly as possible with the +tooth-substance; it should not be arbitrary, but +elastic and yielding. Tin is interdigitous; it expands +laterally, and is almost as easily introduced +as amalgam, and when put in place does not have +to be bound to be retained. Tin, with an outside +covering of gold to protect it, makes a filling to +which amalgam bears no comparison. In the +light of scientific investigation there can be but +one method—a method based upon the recognized +principle that the <i>filling-material</i> and the <i>manner</i> +of <i>introducing</i> it shall correspond to and be in harmony +with the living, vital organism with which +it comes in contact.</p> + +<p>"After excavating, the cavity is treated with +absolute alcohol, as cleanliness and thorough dryness +are absolutely essential.<span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span></p> + +<p>"The <i>tin</i> is put in with steel pluggers, after the +method of wedging; it must be thoroughly condensed, +so as to leave a smooth surface, and +enough used to come up to where the enamel and +dentin join.</p> + +<p>"The effect is not produced by incorporating or +interlacing the gold with the tin; we rely upon the +affinity of the two metals to retain the gold; no +undercuts, angles, or pits are made in the tin, +dentin, or enamel. The gold, extra cohesive from +No. 4 to 40, is made to adhere to the tin by simple +contact, without pressure or force; the union is not +mechanical.</p> + +<p>"The instruments used for filling the remainder +of the cavity with gold are Shumway's ivory points, +which adapt the gold nicely to the margin.</p> + +<p>"The set consists of five and were patented in +1881, and have been used by me since that time +for manipulating cohesive gold. One 'point' is +for proximal cavities in the anterior teeth; three +'points' of different sizes are for occlusal cavities; +one 'point' for proximal cavities in bicuspids and +molars and labial and buccal cavities; the sides, +edges, and ends of the 'points' are used, as the +purpose is simply to obtain contact.</p> + +<p>"The 'point' shown full size in <a href="#Fig_8">Fig. 8</a> is of more +general application than any of the others, and is<span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span> +used for proximal cavities in bicuspids, +also labial and buccal cavities. The +handle is made of ebony, and has a silver +ferrule, from which the ivory extends to +the end and completes the instrument.</p> + +<p>"The metal pin in the end of the +handle is for picking up and carrying the +gold."</p> + +<div class="figl" style="width: 30px;"><a name="Fig_8" id="Fig_8"></a><span class="sp1">Fig. 8.</span> +<img src="images/008-1.png" width="30" height="635" alt="" title="" /> +</div> + +<div class="figl1"> +<img src="images/008-2.png" width="29" height="227" alt="" title="" /> +</div> + +<p>Tin has been used successfully for +completely lining cavities, filling the remainder +with gold; it is also useful for repairing +gold fillings.</p> + +<p>Two or three thicknesses of tin foil may be +pressed into a cavity with a rubber point or hard +piece of spunk, allowing it to come well out to the +margin; filling the rest with amalgam.</p> + +<p>"As a lining it presents to dentin an amalgam +of tin and mercury which does not discolor the dentin +like ordinary amalgam, and helps do away with +local currents on the filling, which is one cause of +amalgam shrinkage in the mouth." (Dr. S. B. +Palmer.)</p> + +<p>When caries extends to the bifurcation of roots, +make a mat of two or three layers of tin, place it in +the bifurcation and use it as a base in filling the +rest of the cavity with amalgam.</p> + +<p>Tin is second in importance in alloys for amalgam, +as it increases plasticity, prevents discoloration,<span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span> +reduces conductivity and edge strength, +retards setting, favors spheroiding, therefore +should not be the controlling metal.</p> + +<p>It will be noticed that when cavities are lined +with tin foil, it only constitutes a small part of +the filling, and that it has not been melted with +the other metals in the alloy before being amalgamated.</p> + +<p>A thick mat of tin has been recommended as a +partial non-conductor under amalgam fillings.</p> + +<p>Plastic tin can be made by pouring mercury +into melted tin, or by mixing the fillings with mercury +at ordinary temperatures; it has a whitish +color, and if there is not too much mercury it +occurs in the form of a brittle granular mass of +cubical crystals. Generally amalgams of tin and +mercury do not harden sufficiently, but forty-eight +parts of mercury and one hundred of tin make a +fairly good filling, said to have a therapeutical +value; it should not be washed or squeezed before +using, and "is not a chemical combination."</p> + +<p>"Tin unites with mercury in atomic proportions, +forming a weak crystalline compound." (Dr. E. +C. Kirk.)</p> + +<p>Mercury and tin readily unite as an amalgam +under ordinary circumstances, and form a definite +chemical compound having the formula Sn<sub>2</sub>Hg. +(Hodgen.)<span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span></p> + +<p>Another preparation of tin is known as stannous +gold; it is manufactured in heavy sheets and used +the same as cohesive gold foil, and can be easily +manipulated, for it is rather plastic.</p> + +<p>Crystal tin for taking the place of tin foil:</p> + +<p>"Take chemically pure hydrochloric acid and +dissolve tin foil in it until a saturated solution is +obtained; this may be done speedily by heating +the acid to a boiling point, or the same thing can +be accomplished in a few hours with the acid cold; +it is then chlorid of tin. It is then poured into a +clean vessel and an equal quantity of distilled water +added; then a clean strip of zinc is plunged into the +solution, and tin crystals are deposited on the zinc; +when there is sufficient thickness on the zinc, remove +both, and slip the crystals off from the zinc +into pure water, clean the zinc thoroughly, and reinsert +for another coating. The character of the +crystallization will be modified by the extent of the +dilution of the solution in the first place. Wash +the tin in pure water until all traces of the acid are +removed, or a few drops of ammonia can be added +to neutralize the acid. It was suggested that it +would be desirable to have some acid remain in the +tin for filling teeth in which there is no sensitive +dentin. We have put in a few fillings, and it works +beautifully, and makes firmer fillings than foil. It<span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span> +must be kept in water (probably alcohol is better). +It is pure tin, unites perfectly, and works easier +than foil." (Dr. Taft, <i>Dental Register of the West</i>, +1859.)</p> + +<p>For some years it was considered the best practice +to enlarge all root-canals and fill them with +gold; in many of these cases the crown cavities +were filled with tin.</p> + +<p>Tin has been used for filling root-canals, but +should there happen to be any leakage through +the foramen or tooth-structure, the tin will discolor, +and there may be infiltration into the crown, +thus causing discoloration, which might be objectionable +if the crown was filled with gold. Chloro-percha, +gutta-percha, and oxychlorid of zinc are +much better for this purpose.</p> + +<p>The apical quarter of a canal has been filled with +tin, and the remainder with cement. Tin can be +used for filling root-canals. Roll on a broach +small triangular pieces of the foil into very small +cone-shaped cylinders, carry to place, then withdraw +the broach, and force in the cylinder with the +same or a larger broach; sometimes it is necessary +to use another broach, to push the cylinder off from +the one on which it is rolled. Another method is +to carry and pack into the canal by means of a +broach, very narrow strips of No. 10 or 20 foil; or<span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span> +the apical third of the canal could be filled with +gold and the rest with tin.</p> + +<p>"About four years ago I concluded to try tin +for filling root-canals; then I began to look for +patients whose general health was good, who had +strong, hardy-looking teeth, and kept their +mouths in good condition. I found one who +answered all my requirements, with a molar to be +filled, and they would not have it filled with gold, +or could not, on account of the expense. I filled +the canals with tin and the crown with amalgam. +After filling thirty-eight molars in this way I +stopped for developments. In six or seven weeks +a lady returned with an inferior molar abscessed, +but at the time it was filled the circumstances +were such that it could not be properly treated. +In nine months a gentleman for whom I had filled +four molars returned with an inferior one abscessed. +This is the sum-total of abscessed teeth +where tin was used in the root-canals, at the end of +four years. The others are in good condition, as +I have seen them every six months. The roots +were treated from four to six weeks with carbolic +acid before filling." (Dr. A. W. Harlan, <i>Missouri +Dental Journal</i>, 1872.)</p> + +<p>"Tin foil is just as good as gold for filling root-canals, +as it is entirely innocuous and sufficiently<span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span> +indestructible, while its softness and pliability commend +it. Where gold is to be used for the crown, +it is better to fill the bulbous portion of the pulp-cavity +with gold also, so as to weld these portions +of gold together. The success of Dr. Harlan's +treatment was about equal to what might be expected +from the same number of teeth where the +canals had been filled with gold." (Editor, <i>Missouri +Journal</i>.)</p> + +<p>Shavings turned from a disk of pure tin have +been used in combination with Watts's sponge gold +for filling teeth, either by making a portion of the +filling from each metal or using them indiscriminately.</p> + +<p>A mat of tin foil dipped in chloro-percha can be +used to cap an exposed pulp, or a concave tin +disk can be used for the same purpose. A mat of +tin has been used over a slight exposure of the +pulp, because of its slight conduction of heat and +cold, thus avoiding much thermal irritation and +stimulating recuperation.</p> + +<p>Some use Robinson's fibrous material as a surface +for tin fillings, thinking that it is harder and +will wear longer because of the erroneous notion +that it has platinum in it.</p> + +<hr /><p><span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span></p> +<h2>CHAPTER IX.</h2> + +<p><span class="smcap">Tin</span> has been recommended for temporary fillings +in sensitive cavities, because it is soft and +easily packed in contact with the walls, has therapeutic +value, and after a time, when the temporary +filling is removed, the cavity is not as sensitive as +formerly.</p> + +<p>It has been observed that starting gold in a +sensitive cavity causes pain, but starting tin in the +same place seldom does.</p> + +<p>As long as tin preserves its integrity it preserves +the tooth, therefore tin fillings should not +be repaired with amalgam, as their integrity may +be destroyed. Cavities can be partly filled with +tin and completed with sponge, fibrous, or crystalloid +gold, after the manner described for beginning +with tin and finishing with gold foil.</p> + +<p>"I advocated tin at the cervical wall, cervico-lingual +and cervico-buccal angles to the thickness +of 24 plate. Then complete the filling with gold. +Some of my most successful efforts in saving soft +teeth have been made in this way. This method +has great value over gold for the whole filling, but +there are two objections to it: First, it imparts to +the cervical border the color and appearance of<span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span> +decay, so that in three cases where an instrument +passed readily into the tin I have removed the fillings, +without any necessity for it, not even finding +any softening of the margins. Second, its use requires +the same conditions of dryness, shape of cavity, +delicate manipulation, inconvenience to patient, +and strain upon the operator as when gold is used +alone." (Dr. D. D. Smith, <i>Dental Cosmos</i>, 1883.) +He admits that this method saves <i>soft</i> teeth and +also cervical margins. Do not those two very important +factors more than counterbalance the color, +and oversight of the dentist?</p> + +<p>Dryness is an essential in making the best filling +with any material, and the time and strain consumed +by the majority of operators in filling with +tin is not more than one-half what it is in using +gold.</p> + +<p>"I use tin at the cervical margin of all proximal +cavities in bicuspids and molars. I prepare a +matrix of orange-wood to suit each case, letting +it cover about one-third of the cavity, then fill with +tin condensed by hand force and automatic mallet; +now split the matrix and carefully remove it piece +by piece, so as not to disturb the tin; then trim and +finish this part of the filling. Make another +wooden matrix, which covers the tin and remainder +of the cavity, and fit it snugly to place. Use<span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span> +a coarsely serrated plugger and begin packing +non-cohesive gold into the tin, letting it fill about +one-third more of the cavity; then complete the +last third (surface) with cohesive gold. I have +tested this method for twenty years, and it has +given me splendid results. I always tell patients +that there will appear sooner or later a slight discoloration +near the gum, which must not be mistaken +for caries." (Dr. A. P. Burkhart.)</p> + +<p>Another use for tin in the operating-room is +found in Screven's "Gutta-percha-coated Tin +Foil," a cohesive, antiseptic non-conductor, of +which the inventor says: "Cement fillings that +have been kept dry for ten hours after mixing will +be much harder than those soon exposed to moisture, +and they will retain that hardness though +exposed to moisture afterward. This preparation +will keep a filling perfectly dry in the mouth, and +when removed the filling will be found hard as +stone. There is nothing better for lining cavities, +holding nerve-caps in position, holding a preparation +in place when devitalizing a pulp where the +tooth is so much broken away as to make it difficult +to prevent a filling showing through the enamel, +and for many other purposes."</p> + +<p>High-heat gutta-percha has been used as a base +in deep occlusal, buccal, and approximal cavities,<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span> +completing the fillings with tin. Occlusal cavities +may be filled with tin; then after the filling is condensed +and finished, drill out the center and fill +with cohesive gold, not cutting away the tin so +as to expose the margin; such fillings wear well, +as much of the attritial force comes on the gold +portion of the filling.</p> + +<p>With the exception of the part in brackets, the +following article is from the <i>British Journal</i>, May, +1887:</p> + +<p>"If a person eats an oyster stew at 130° F., a +gold filling would carry the difference between the +temperature of the stew and that of the mouth, +130 - 98 = 32°, almost undiminished to the +bottom of the cavity; allowing 2° of diminution, +then the cavity around the gold filling has assumed +128°; now the person feels warm and drinks +ice-water at 32°. Taking into consideration the +specific heat of the gold filling, it will assume about +40°, which it carries with a diminution of the cold +of about 4°,—that is, as if it was 44°,—into the +interior of the cavity; then the cavity will assume +44°, the difference within one-tenth of a minute +being 128 - 44 = 84°, a change which would produce +a violent inflammation in any organ which +was not accustomed to it. This derangement in<span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span> +the tooth means interruption of circulation, and +young teeth will be most affected.</p> + +<p>"Thermal effect depends on heat-conducting +power [gold is nearly four times as good a conductor +of heat as tin] and also on specific heat, +so the more the latter approaches that of the +tooth the less it is liable to produce sudden +changes [thus favoring tin]. Specific heat manifests +itself by the speed of changes, while the heat-conducting +power influences the intensity [then +the intensity of heat in a gold filling would be three +or four times as much as in a tin filling]. In speed +gold produces this change in one-tenth of a minute" +[tin in one-fifth,—that is, gold absorbs heat +and expands about twice as fast as tin].</p> + +<p>In 1838 Dr. J. D. White introduced sharp-wedge-shaped +instruments for filling teeth, and he +claims to have been the first to use them; they pack +laterally as well as downward, and present as small +a surface to the filling as possible, so that the +greatest effect may be produced upon a given surface +with a given power. Rolls of either tin or +gold are made by cutting any desirable portion +from a sheet of No. 4 foil; cut this portion once +transversely, place on a napkin or piece of chamois, +then with a spatula fold a very narrow portion of +the edge once upon itself; then with the spatula<span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span> +resting on the thickened edge draw the spatula +away from it with gentle pressure, and the foil will +follow in a roll.</p> + +<div class="figc" style="width: 211px;"><a name="Fig_9" id="Fig_9"></a>Fig. 9. +<img src="images/009.png" width="211" height="240" alt="" title="" /> +</div> + +<p>The old method of using rolls, ropes, and tapes +or strips is the same, but we will describe one +method of using tapes. (See <a href="#Fig_9">Fig. 9</a>.) A <i>strip</i> is a +single thickness of foil in ribbon form; a strip +folded lengthwise once, twice, or more forms a <i>tape</i> +of two, four, or more thicknesses of foil. The tin +foil should be cut into strips and folded into tapes +proportioned in width and thickness to the size of +the cavity. One end of the tape is carried to the +bottom of the cavity and then forced against the +side opposite the point where we intend to finish; +now remove the wedge-shaped plugger and catch<span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span> +the tape outside of the cavity, and fold another +portion against that already introduced, letting all +the folds extend from the bottom to a little beyond +the margin. Proceed in this manner, with care +and sufficient force, until the cavity is full, using for +the last folds a small instrument. Condense the +surface with a large plugger, then go over it carefully +with a small instrument, and if any part yields, +force in a wedge-shaped plugger and fill the opening +in above-described manner; condense, burnish, +and trim alternately until the surface is level with +the cavity-margin. By extending the folds from +the orifice to the base of the cavity, the liability of +the tin to crumble or come out is effectually prevented, +and by putting it in with a wedge-shaped +plugger it is pressed out into all depressions of the +walls.</p> + +<p>A later method of filling with tape or rope is to +use wedge-shaped pluggers with sharp serrations, +filling the <i>ends</i> of the cavity, and as the two parts +approach each other that next to the wall should +be in advance of the rest, thus an opening will be +left in the center which can be filled with a smaller +tape or rope.</p> + +<p>Another old method: Take a piece of foil and +roll it into a hard ball; then gradually work it into<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span> +the cavity, being careful to have sufficient around +the margin.</p> + +<p>Still another suggested method: Roll a piece +of foil into a loose ball, place it in the cavity, and +pass a wedge-shaped plugger into its center. This +has the effect of spreading the tin toward the walls +of the cavity, the opening to be filled with folds in +a way already described. The wedge is used as +often as it can be made to enter, filling each opening +with folds; then condense the surface, trim, and +burnish.</p> + +<div class="figc" style="width: 191px;"><a name="Fig_10" id="Fig_10"></a>Fig. 10. +<img src="images/010.png" width="191" height="221" alt="" title="" /> +</div> + +<p>The English give the Americans the credit of +first using cylinders. Anyhow, Dr. Clark, of New +Orleans, in 1855, used them made from non-cohesive +gold, and also from gold and tin in alternate +layers. (See <a href="#Fig_10">Fig. 10</a>.)<span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span></p> + +<p>Cylinders were used which were a little longer +than the depth of the cavity, introduced with +wedge-shaped pluggers around the walls, each one +being closely adapted to the margin; then another +row was added, which was forced firmly against +the preceding, continuing this process until the +cavity was full. The wedge, having a smooth end +and sides, is forced into the center so as to drive +the tin toward the sides of the cavity, being careful +not to split the tooth; the opening is then filled +with a cylinder. Now force a smaller-sized wedge +into the center of the last cylinder, and into the +opening introduce another cylinder, proceeding in +this manner until the filling is solid. Then condense +the ends of the cylinders, trim, and burnish. +For the same operation more recent pluggers are +wedge-shaped, with sharp, deep serrations. In +these cases the filling is retained by the general +form of the cavity and wedging within a certain +limit, and not by cohesion of the different parts. +For a time tin cylinders were prepared and put on +sale at the dental depots.</p> + +<p>As far as we are aware, the first tin foil made use +of in operative technics was by Dr. F. S. Whitslar, +who removed a disk of German silver from an ivory +knife-handle in 1845, then used hand pressure to +fill the cavity with tin. In the college course of<span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span> +operative technics tin foil can be used, almost to +the exclusion of gold foil, to demonstrate the +manipulation of both cohesive and non-cohesive +gold. Shavings scraped from a bar of tin are also +useful in operative technics; they are more cohesive +than foil.</p> + +<div class="trn"><b>Transcriber's Note:</b> +Minor typographical errors have been corrected without note. +Variant and obsolete spellings, particularly chemical terms, have been retained.</div> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Tin Foil and Its Combinations for +Filling Teeth, by Henry L. 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