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TW Merits Mid Claims of (jown- 
Mid Bridge-Work- 
/ BY 
$■ h Villkms, D.D.S., 
1306 WALNUT ST., 
Philadelphia, pa. Artificial Teeth 
WITHOUT PLATES. 
THE MERITS AND CLAIMS OF CROWN 
AND BRIDGE-WORK. 
BY 
J. L. WILLIAMS, D.D.S., 
PHILADELPHIA, PA. 
PHILADELPHIA : 
PRESS OP PATTERSON & WHITE, 
1885. ARTIFICIAL TEETH WITHOUT PLATES. THE MERITS AND CLAIMS OF 
CROWN AND BRIDHE-WORK. 
J. L. WILLIAMS, D.D.S., Philadelphia, Pa. 
I assume it to be a self-evident truth, that the true purpose of the 
conscientious dentist should be the exercise of his best efforts for 
the conservation of those conditions in the mouth which are in har- 
mony with the laws which govern the organism as a unity. 
That continued integrity of the body which we designate by the 
term health is primarily dependent upon the digestion and assimila- 
tion of food-material. Perfect digestion must begin in the mouth 
with the proper mastication of food. The preservation of the nat- 
ural teeth, therefore, or the maintenance of the mouth in that con- 
dition which we find when there are healthy, well-preserved teeth, 
is the end toward which our energies as specialists should be 
directed. 
It is my purpose to describe in this paper the principles of a me- 
chanical appliance, or, to speak somewhat more elegantly, a form of 
dental prosthesis which is capable of being made of immeasurably 
greater value to humanity, in the preservation of that condition of 
the mouth of which I have just spoken,% than all other forms com- 
bined. I make this statement upon the experience which I have 
gained by giving this work my almost exclusive attention for the 
past three years, during which time I have tested it under almost 
every conceivable condition. I refer to the so-called “ Crown- and 
Bridge-Work.” While something has been known for many years 
of the principles upon which this work is founded yet, the combi- 
nation of all that is valuable in these principles which have been 
worked out by many inventive minds, into a system and the practical 
and successful application of that system is comparatively new. 
What is now known as Crown- and Bridge-Work may be said to be 
a method for restoring the teeth to a condition, which in every 
practical and artistic sense, closely approaches nature’s own 
work. The teeth are as firm and immovable in mastication as are 
the natural teeth, and when properly and artistically constructed, it 4 
is difficult for even a professional expert to detect their artificial 
character. It is also a process which in many instances is applicable 
when every other resource has failed; when the crowns of the 
natural teeth are completely broken down by decay, so that in the 
common order of things extraction of the roots and the insertion of 
a plate is the only thing to be done, then the teeth may be perfectly 
restored by this beautiful process. 
The system is applicable from a single tooth to a full set. When 
three or four firm roots remain in either jaw in the proper position 
there may be inserted upon them a full set of teeth which will be 
immeasurably superior to anything ever before devised. 
The process is as nearly painless as any operation in dentristry 
could be expected to be. In the most extensive operations the pain 
is far less than is usually experienced in the common operation of 
filling teeth. The great beauty of the work and the unbounded 
satisfaction which it gives to patients when it has been properly 
constructed, has sometimes tempted incompetent persons to under- 
take the work. As might be expected in any operation requiring 
more than ordinary skill and experience for its successful accom- 
plishment, the result has almost always been a failure. 
These operations have sometimes come to the notice of brother 
dentists whose opinions of the work have been founded upon these 
failures and the result has been adverse criticism on the work. I 
therefore deem it necessary for me to say that I have given this 
work my almost exclusive attention for the past three years, 
during which time there has not been, so far as I am aware, a 
single failure in the many operations which I have performed. 
While I cannot but regard this as a record which would be con- 
sidered quite unusual in almost any line of professional work, yet, I 
should not feel justified in calling attention to it in this manner but 
for the fact, as already mentioned, that I sometimes hear of adverse 
criticism being passed upon the work. 
It is to be understood that these crowns and bridges are perma- 
nently cemented to the teeth and roots upon which they are placed 
so that the decayed portion of the tooth or root becomes hermetically 
sealed and no further change can occur in the way of decay. The 
following illustrations will best explain the character of this work. 
The single crown, of which there are two forms, is the basis of all this 
work. The gold crown is most commonly used on the molar or 
back teeth. After the roots have been properly prepared a gold 
band is fitted around them, which is united by soldering. A top or 
cap for this band is made from pure gold by swaging between 
metal dies made from a great variety of patterns corresponding in 
style and shape with the natural teeth. This top or cap is soldered 5 
to the band thus producing a hollow gold crown or shell which fits 
over the decayed tooth or root. Gold screws are sometimes set in 
the roots to give additional strength. When the crown is ready for 
final adjustment it is partly filled with a fine white cement (the 
same as is sometimes used in filling teeth) and while this is soft the 
crown is pressed into its proper position. The cement hardens in a 
few moments and the operation is complete. 
Fig. 1 shows these gold- crowns before and after they are placed 
in position. 
Fig. 1. 
The porcelain faced crown for the front teeth is made as follows : 
After the end of the root is made perfectly smooth with corundum 
wheels and properly-shaped scalers, a gold ferrule or band is fitted 
around it. If it is desirable that this band should be entirely con- 
cealed, the labial surface of the root should be beveled a little above 
the margin of the gum, and after the band has been soldered it may 
be placed in position, and the line of contour of the margin of the 
Fig. 2. 
gum marked upon the front of the band. The proper bevel can then 
be cut and the edges squared upon a corundum wheel, leaving the 
lingual portion of the band a little longer than the front. Pure gold, 
rolled to No. 34 of the standard gauge (American), is used for sol- 
dering upon the beveled surfaces, thus making a closed cap for the 
end of the root. A suitable tooth is now selected and backed with 
pure platinum or pure gold. The cervical end of the tooth is then 
ground to the proper position on the front bevel of the cap, all of the 
fitting being done while the cap is in position on the root. 6 
After the fitting is completed the cap is removed and the tooth at- 
tached by strong resin wax and again placed in position while the 
wax is warm. Any slight change in position which is necessary 
can then be easily made. The tooth and cap are now removed to- 
gether, invested, and united at the back by solder. It is well to use 
a solder for the cap with a higher melting-point than that used for 
the backing, as it obviates the danger of unsoldering the band when 
the backing is flowed on. After finishing and polishing the work, 
the end of the root is made perfectly dry, a sufficient quantity of 
oxyphosphate cement, mixed somewhat thinner than for filling 
purposes, is placed in the enlarged pulp-canal and also in the cap. 
The crown is then carried to place with firm, steady pressure, and 
held a few minutes until the cement is sufficiently hard to prevent 
displacement. The surplus cement which has oozed out around the 
band should be carefully removed and the work is then completed. 
The bridge-work is simply an extension of the crowns over spaces 
where the natural teeth have been lost. 
Fig. 3. 
Fig. 3 was drawn from a model of a case in practice. In this 
case the roots of the centrals are shown prepared for the fitting of 
the bands, the laterals having been extracted. Single crowns are 
made for these roots precisely as I have described. They are then 
temporarily placed in position. Laterals are selected, backed, 
ground, and fitted to position. The laterals are then attached by 
means of strong wax to the centrals, carefully adjusted in the posi- 
tion which we wish them to occupy, and the wThole removed in an 
impression of investing-material. An additional quantity of invest- 
ment is mixed and poured over the exposed ends of the caps, and 
the whole allowed to harden, after which the investing material is 7 
cut away from the backs of the teeth and crowns, and they are all 
united by soldering. 
Fig. 4 shows the work completed, and Fig. 5 is from a model of 
the mouth as restored with the crowns. 
Fig. 4. 
Fig. 5. 
In cases where the space is occasioned by the loss of more than 
one tooth a somewhat different method of procedure is necessary. 
Fig. 6 shows a model of a mouth in which the superior laterals 
and centrals had been extracted. The canines were badly decayed, 
Fig. 6. 
with exposure of the pulp. The first step is the removal of the 
pulps from the canine roots as previously described. The crowns 
are then fitted as already described and placed in position. An 
impression is then taken in plaster, the 
crowns remaining imbedded on its remo- 
val. The impression is varnished and 
oiled, and a model of investing-material 
poured. After this has hardened, the im- 
pression is carefully cut away, and we 
have a model of the mouth with the crowns 
in position. A “ bite ” is taken and the articulation secured in the 
Fig. 7. 8 
usual manner. The remaining crowns, having been backed, are 
fitted, and the face of the work imbedded in investing material. 
The whole piece is now united at the back by soldering, and when 
finished presents the appearance shown at Fig. 7. 
Fig. 8. 
Fig. 8 shows a model of the mouth after the bridge has been ce- 
mented in place. 
Fig. 9 is an illustration of a piece of this work for which there is 
a very frequent demand. It is for supplying the loss of the first 
Fig. 9. 
molar and bicuspids. If the canine is intact the anterior end of the 
bridge may be attached by a strong band of clasp-metal passing 
around the canine, partly beneath the margin of the gum, so as to 
present the least possible exposure. If, as is frequently the case 9 
there is extensive decay, it will be best to excise the remaining por- 
tion of the tooth and replace an artificial crown as shown in the 
illustration. A gold cap is then made for the second molar. If this 
tooth is decayed it will only be necessary to remove the decay, and 
the cement which is used for setting the bridge will make the 
most perfect filling-material beneath the gold cap. The interve- 
ning molar and bicuspid crowns are made in the following manner: 
Fig. 10. 
the porcelain faces, which are furnished by The S. S. White Dental 
Manufacturing Co., are backed with gold or platinum and the tips 
ground squarely off. Zinc pattern-dies, an assortment of which should 
be made from the grinding surfaces of molars and bicuspids, are used 
for swaging from pure gold a tip or cap for the protection of the 
porcelain face; for without this protection the porcelains would be 
almost certain to be broken. The concave surface of these tips is 
filled by melting coin-gQld into them. This surface is then ground 
Fig. 11. 
smooth and fitted to the squared surface of the porcelain face and 
waxed in position. Triangular pieces of platinum are then cut of 
the proper size to fit the sides of the tooth, waxed in position, and 
the whole invested, leaving the back open, which is filled with coin- 
gold. 
These teeth are then fitted into position in the bridge, as previously 
described. 10 
Fig. 11 shows the completed work in the mouth. 
Where only one molar or bicuspid is lost, sufficient support may 
be gained by the cap, which is made to pass over the adjoining 
molar. If the first molar and second bicuspid are lost, the anterior 
end of the bridge may receive sufficient support from a strong spur, 
which may rest in the groove or sulcus between the cusps of the 
first bicuspids; or this groove may be deepened into a cavity, into 
which the spur projects and around which a filling is placed. 
Fig. 12. 
Fig. 12 shows a piece of work made for a case of quite frequent 
occurrence. It represents the restoration of the inferior bicuspids and 
first molar of the right side. A gold crown is made for the second 
molar, and then the three intervening artificial teeth or “ dummies ” 
are made as described above. For the support of the anterior end of 
the bridge the method hitherto practiced has been to excise the 
crown of the cuspid and fit a porcelain crown with gold backing to 
the root, and to this the anterior end of the bridge is soldered. 
Fig. 13 illustrates a device which obviates the necessity for remov- 
ing the cuspid crown. A gold band is fitted around the cuspid. At 
Fig. 13. 
the front, shown at a, Fig. 2, this band is allowed to pass a little be- 
neath the margin of the gum so as to make the smallest possible 
exhibition of gold. On the lingual aspect of the tooth this band is 
allowed to be nearly the length of the crown. It will be seen that 
when this band is fitted as perfectly as possible there must necessarily 
be quite a vacancy between the upper part of the lingual surface of 
the tooth and the band. It is important that this portion of the band 
fit the tooth perfectly, and an accurate adaptation is obtained as fol- 
lows : A piece of pure gold, rolled to 35 American gauge, is fitted over 
that portion of the lingual surface of the tooth which it is desired to cover, d, in Fig. 13, shows the shape that this little pure gold 
plate usually assumes. It can easily be fitted perfectly by the use 
of a burnisher, and then, with the band in position, a drop of melted 
resin wax is flowed into the space between the pure gold and the band 
It is now removed from the tooth, invested, and, after melting out 
the wax, solder is flowed into the vacancy, filling completely the 
Fig. 14. 
space occupied by the wax. The top of the lingual portion will 
now be thicker than is necessary, but can be easily ground or filed 
down to the proper thickness. We now have a band which fits all 
portions of the tooth perfectly. The anterior end of the bridge is 
soldered to this band, and after the work is properly finished it is 
Fig. 15. 
cemented in place in the usual manner, b and c, Fig. 13, shows side 
and lingual views of this band after the fitting is completed. 
Figs. 14,15, and 16 illustrate a method of inserting extensive pieces 
of bridge-work in cases whore there are no natural teeth or roots for 
supporting one end of the bridge. By this method bridges may be 
inserted in cases where all of the teeth on one side of the mouth 12 
have been lost, or where all of the teeth anterior to the molars on 
both sides are wanting. Crowns are first fitted to the teeth which re- 
main. These crowns being in position, an impression is taken. From 
this a cast is obtained with the crowns in their proper position. A 
second impression is also taken of that portion of the mouth where 
there is no natural support for the bridge. From this impression me- 
Fig. 16. 
tallic dies and counter-dies are obtained, from which is “struck” a 
small gold plate about three-fourths of an inch in length and width, 
the size of the plate varying according to position and other condi- 
tions. After this little plate or “ saddle ” has been perfectly fitted, 
it is waxed in tbe proper position on the model, with the crowns. 
The intervening teeth are now placed in position, and the work in- 
vested and soldered. 
Fig. 17 illustrates another device for obviating the necessity for 
Fig. 17. 
removing the crowns of natural teeth in preparing the mouth for 
bridge-work. Crowns are fitted in the mouth to the points of 
attachment in the usual manner. An impression is taken, bringing 
the crowns away in their proper positions. From this the cast'or 
model is obtained. Heavy bands of half-round gold or platinum bars 
are now fitted around the necks of the natural teeth on their lingual 
surfaces. These bands being waxed in position serve to connect 13 
the different parts of the bridge, uniting them in one piece without 
the loss of any of the natural crowns. We have found this a highly 
satisfactory method of inserting extensive pieces of the work. Fig. 18 
shows the mouth as presented for which the piece shown in Fig. IT 
was constructed. Fig. 19 shows the piece in position. 
Fig. 18. 
Fig. 20 illustrates a case which is a type of a class of frequent oc- 
currence. Alternate molars and bicuspids in the upper and lower 
jaws are lost until the occlusion is somewhat changed, and the force 
of mastication is gradually brought upon the front teeth. Rapid 
wearing of the teeth results. These cases are among the most 
difficult that the operator is called upon to treat by the ordinary 
Fig. 19. 
methods. In the case herewith illustrated the lower bicuspids with 
a molar on one side were in good condition, but the loss of the 
upper bicuspids and molars made them useless. As usually hap- 
pens, the upper incisors had suffered most. The lower incisors were 
restored by capping them with cohesive foil. The bridge shown at 14 
Fig. 21 was constructed for the right side of the upper jaw, while 
the teeth on the left side were restored by contour work, as shown 
at Fig. 22. 
The superiority of the condition of this patient’s mouth, which 
resulted from this work, over anything which could have been accom- 
plished by plate work is almost inconceivable to one not familiar 
with these methods. 
The most extensive pieces of this work which have been attempt- 
ed are cases of twelve and fourteen teeth upon three and four roots- 
Fig. 20. 
Fig. 21. 
Fig. 22. 
Several of these have been worn for three years or more and none of 
which I have any knowledge show any signs of failure. 
The practice of extracting badly-decayed and broken-down teeth, 
particularly when they became a source of constant annoyance, and 
replacing them with artificial substitutes mounted upon rubber, cellu- 
loid, or metallic plates, has become so firmly established in the public 
and professional mind as the proper and unavoidable thing, that the 
folly of such practice can only be demonstrated by persistent and long- 
continued endeavor. The statement, therefore, that it is no less a 
criminal practice, in principle if not in degree, to extract a tooth be- 15 
cause it is in an ulcerated or broken-down condition, than would be 
that of amputating a finger because of the appearance of a felon, or 
removing an eye to get rid of a cataract, will seem a radical one. 
But if my experience has taught me anything it certainly is no ex- 
aggeration of fact. Diseases of the teeth and the surrounding 
tissues are certainly as amenable to treatment as are ulcers or mor- 
bid growths in other parts of the body. The only conditions neces- 
sary to the successful accomplishment of this are requisite knowledge 
and skill in the operator and a desire on the part of the patient to 
have a healthy mouth. 
A properly-made artificial crown mounted upon a root, the in- 
vesting membrane of which is in a healthy condition, is quite as 
useful and, all points considered, perhaps quite as desirable as a pulp- 
less tooth with its natural crown intact. Such is my confidence in 
the intrinsic merit of bridge-work that I think it requires no very 
great degree of foresight to predict that the day is not far distant 
when a large per cent, of the now prevalent partial plate work will 
be a thing of the past. 
I believe that my experience in inserting a very large number of 
these crowns and bridges, and the satisfaction and delight of patients 
as expressed in many letters in my possession, warrant me in claim- 
ing for the new work the following advantages : It is the most beau- 
tiful imitation of the natural teeth ever invented. It is the most 
comfortable, there being no plate covering the roof of the mouth, so 
that after a few days there is nothing to indicate that the patient 
has not his or her own natural teeth. It is the most cleanly work, 
as every part can be easily reached with a brush, and the highly 
polished surfaces of gold and porcelain are without difficulty kept 
free from deposits. 
It is most serviceable for the purposes of mastication, there being 
absolutely no movement, the work being firmly cemented to the 
roots. y^^gg^gj^g^jggjgjggggAy^Ayiy&ygiygjgg^Ayg^ 
Patterson & White, Prs., Philada.