DECAY OF A REPLANTED TOOTH. 
BY 
W. D. MILLER, M.D., D.D.S., BERLIN. 
(Reprinted from the Dental Cosmos for April, 1891.) 
However solidly a house may be built, an extra nail or two may 
do good service when the winds blow and the rains beat upon it. 
The chemico-parasitical theory of dental caries has every appear- 
ance of being built upon a solid foundation, and the various storms 
thus far encountered have produced not even a vibration in its frame- 
work. Nevertheless, having a nail at hand,, we will drive it home, 
since a structure which must bear the test of ages and upon which the 
whole superstructure of a rational dental practice must be built can- 
not be too well supported. We can never learn too much about the 
chief source of all the many ills it is our province to deal with. 
Decay of living teeth, of pulpless teeth, of dead teeth ; decay of 
dogs’ teeth, horses’ teeth, etc., and artificial decay, have all been the 
subject of various contributions to dental literature ; but the appear- 
ance of decay in a replanted tooth has, as far as I am aware, as yet 
received no attention. 
The tooth in question was extracted by mistake about the first of 
October, 1888. After it had been out of the mouth for a fortnight the 
point of the root was removed, the canal filled with oxychloride, and 
the tooth forced into place. 
When I first observed the tooth, two years later, there was a chronic 
fistula at the point of the root ; but notwithstanding this the tooth was 
quite firm. It had been filled with phosphate cement before replant- 
ing, but at the time of examination no trace of the filling was left. As the 
tooth was filled out of the mouth, this filling furnishes an interesting- 
test of the durability or reliability of phosphate cement under the most advantageous circumstances. We should really have expected the 
filling to last longer. Perhaps the particular preparation used was at 
fault. The cavity was lined with a thick layer of soft dentine, as we 
find it in acute caries, the removal of which reduced the tooth to a 
mere shell, and revealed at the same time the fact that the cavity on 
the distal surface communicated with a smaller one on the mesial. 
Macroscopically and physically examined, the decay presented 
nothing to distinguish it from an ordinary case of acute decay. The 
decayed tissue had a brownish-yellow color, an acid reaction, and 
had lost about thirty-five per cent, of its lime-salts. 
Longitudinal section of decayed dentine from a replanted tooth, showing the distended tubules ; 
also, at a, liquefaction-foci, and at b rents due to the advanced stage of decomposition of the 
tissue. Low power. 
Sections of the decayed dentine made on the freezing microtome 
and stained by the Gram-Giinther method showed that while the 
deeper parts had undergone no structural changes whatever the more 
superficial layers were permeated by enormous masses of bacteria, 
which had distended the tubules to several times their normal diameter, 
and in many places had destroyed the basis-substance, giving rise to 
caverns or liquefaction-foci, and finally to a complete destruction of 
the tissue (Fig. i). 
A higher power of the microscope (350-1200) showed that the 
decay was caused by a so-called mixed infection, not only micrococci, 
as in Fig. 2, but in some places bacilli and even very long, much 
twisted and contorted threads being present (Fig. 3). The con- 
tortion of these threads resulted simply from the contracted space in which their development took place, and not from any natural ten- 
dency of the threads to take this shape. 
The preparations also showed the fragmentation of the tubules or 
breaking up into short pieces, resembling pipe-stems. It is much to 
be hoped that some satisfactory explanation of the origin of this 
appearance will soon be furnished. As much as has been written 
about them, we are still absolutely unable to account for them. We 
have thus far only succeeded in showing that they are not the result of 
any vital action, since they occur in artificial caries also. 
A small portion of the preparation shown in Fig. i highly magnified, showing the distention 
of the tubules by micrococci, noo :i. 
We find, consequently, by the examination of this case of decay of 
a replanted tooth, that the same chemical, physical, and structural 
changes have taken place as in the ordinary cases of decay met with 
every day. 
We also find the same agents, viz, bacteria, at work in bringing 
about these changes. Wherever and under whatever conditions 
decay of dentine has been the object of exact study, the same pheno- mena and the same etiological factors have been found, and the mass 
of evidence already heaped up in favor of the chemico-parasitical 
Fig. 3. 
Showing an invasion of rod- and thread-forms. At awe see the well-known pipe-stem ap- 
pearance. 1100: 1. 
theory of decay leaves very little to be desired in the way of conclusive 
proof of the correctness of the theory.