DENTAL SCHOOL

Treatment of Dental Caries, complicated with Disorders of the Pulp and Peridental Membrane. By ROBERT Arthur, M. D., D. D. S.

No. VI.

WE come now to the consideration of the last step in the operation which has so long engaged our attention. I have given an account in as full detail as I thought consistent with justice to the subject, without being too diffuse, what I conceived to be the best means of accomplishing the entire removal of the pulp. It now remains to describe that part of the operation deemed essential to its completion, viz. filling the fang or fangs. This is a comparatively simple part of the whole process, but there are points about it to which some attention may be given with advantage to those who have not had experience in the practice of this operation.

The instruments for filling the fangs, though exceedingly simple in form, require to be made with care. Piano wire is more suitable for this purpose than steel of any other kind or in any other form of which I am aware, and steel is decidedly

preferable to any other mea. These instruments do not differ in form from those already described, for the removal of the pulp, except that no barbs are cut upon them, but on the contrary they are made perfectly smooth by burnishing and giving them a spring temper. Except when the canal of the fang, to be filled, is flattened, they should be made round so as to obtain the greatest strength with the least bulk. A number of them should be prepared, and graduated from the smallest diameter of the fang to be filled to the largest size required by the canal at its largest diameter. Tempering such small instruments is, I am aware, a nice operation, but it renders them so much more available for this purpose, that no pains ought to be spared to accomplish the object.

The best material for filling the fangs is, undoubtedly, gold; it is better suited, in every respect, for this purpose than any other material with which I am acquainted. I see, however, no objection to the use of tin foil for this purpose-it cannot be consolidated so perfectly as gold, but it can be made sufficiently compact to answer the purpose. But gold, as I have just said, is preferable to any other material for the purpose; it can be used more conveniently and can be rendered more compact with slighter compression.

The facility with which gold may be employed for filling the fangs depends upon the form and manner in which it is used. No. 30, is undoubtedly best adapted for this purpose. Whatever may be thought of this gold, (which I introduced to the profession, and which I have used for nearly two years, and which I still use, almost exclusively, with increasing satisfaction,) for ordinary operations, for filling the fangs, it will be acknowledged upon trial, I am sure, invaluable. For this purpose, indeed, Dr. Maynard, to whom I have had occasion so often to allude in these papers, has used gold of this kind for a number of years.

By Dr. Maynard it is cut into a narrow strip, one end of which is carried to the extremity of the canal of the fang with a suitable instrument, which is withdrawn, leaving the gold in place; a fold of the gold near the extremity is taken by the in

struments, are carried, up, to the end, and so, fold after fold is condensed against the first until the fang is filled.::

I will describe somewhat-nutely. my own method of procedure, which I find after trial of other suggested methods, enables me more conveniently and perfectly to accomplish the desired object.

I first cut the gold from a narrow strip into small oblong squares, about two lines in length, and one in width, which I lay in a convenient place for use. I then set in order the instruments I intend to use for the purpose, and take care to provide several of the smallest size. I then wash out the pulp cavity and fangs with the sponge, and pass the smaller instruments into the fangs to be filled to be sure that they pass readily to the point to which I wish the gold to be carried. The cavity and canal of the fang are then to be carefully dried, which may be done by twisting a small piece of cotton around one of the barbed instruments used for removing the pulp, and passing it repeatedly into the fang. It will be necessary to change the cotton several times, or have several instruments prepared in the same way, as the small quantity which can be used soon becomes saturated.

There are two methods of placing these small pieces of gold in a position where they can be carried conveniently into the fangs-I hope these minute details will not be considered trifling and unnecessary, to many I am sure they will not be so thought, if I judge from my own experience-one is to take up the gold with a pair of spring forceps and place it in the cavity of decay near the opening of the fang, from which place it is carried into and up the fang with suitable instruments-the other is to place the gold on a piece of wood and take it up by sticking the instrument through it, which after some practice will be found a very convenient way of getting over a vexatious little difficulty.

The canal of every fang is a lengthened cone-in some parts it is a simple tube, but from the opening from the pulp cavity to the foramen at the extremity of the fang it is always more or less conical. In filling the fang it is always advisable, in using

the small pieces of gold witieh I have recommended, to carry them into the canil of the fang with an instrument but slightly smaller than the opening from-the-pulp. bavity: As soon as it has passed the opening of the canal as far as the instruments used for introducing it into the canal will go, a smaller instrument is taken with which the gold is forced up somewhat farther until it is again stopped by the narrowing diameter of the canal, and so on till the instrument which was previously ascertained to be sufficently small to pass to the extreme end of the fang, can be used and the piece of foil carried up to its place. After this piece is as well condensed as it can be, another similar piece is to be taken, introduced in the same manner and gradually carried up to its place. The length of the pieces of gold foil may be increased with every piece used, and when the diameter of the canal is large enough, as it is filled toward the opening to permit the use of strong instruments and considerable force, strips of the same kind of gold may be employed with advantage.

I make use of gold foil in the manner described in the more contracted parts of the fangs, for this reason: the canal is liable to become choked with the gold, if too much is used at once before it reaches the desired point, and when this occurs, it is impossible, with the necessarily delicate instruments employed, to force it further up or to remove it. The advantages of first using stouter instruments than will reach the extreme point of the fang, and as the gold is carried up taking the finer and finest instruments, a little reflection must make obvious. The smaller instrumennts would pass entirely through the piece of gold in every attempt to force it into the fang at the place where it is of much larger diameter than the instruments, but as the canal of the fang contracts, the gold is drawn together so as to present a body offering greater resistance, and the finer instruments will then have the same relation to the diameter of the canal, as the larger one when it was larger.

This is my general plan of procedure. It is apparent, that success in this part of this delicate operation requires time, perseverance and careful, patient manipulation. All this, however, is required, daily, in the ordinary faithful practice of our pro