Page 790 - My FlipBook

788 ORTHODONTIA AS AN OPERATIVE PROCEDURE.

these teeth was jirrcstcd and lliat ol' the iiitcnnaxillai'y bone and ad-
jacent part of the uj)i)('r maxilla retarded as shown. The cast was
made at the age of sixteen, at which time one of the teeth was still so
firm as to permit the insertion of a gold filling, while the other was so
loose from resorption of the root that it was extracted. The socket
was deepened and enlarged and a tooth implanted.
The infincnce of heredity may he prominent in this deformity, several
meml)ers of one family presenting the condition.
AMiile this irregularity is generally of constitutional origin it is not
always dtjveloped till the eruption of the second and tliii-d molars, or, if
slight, while the first molar is the posterior tooth, is increased in de-
gree by the eruption of the second and the third molars, just as a pair
of dividers kept open a certain distance by a prop two inches from the
joint will be opened farther if a prop of the same height be placed
between the first one and the joint.
The writer has been fortunate enough to be able to watch the devel-
opment, in its later stages, of such a case. The occlusion at the first
visit of the patient was entirely with the second molars, and the cut-
ting edges of the upper and lower incisors were a quarter of an inch
apart. As the patient had suffered during childhood from what she
called " bone disease " she was afraid to submit to any treatment for
bringing the anterior portion of the jaws nearer together. Gold crowns
were placed over the lower first molars, to occlude with upper teeth,
and increase the power of mastication. Within two or three years
afterward the third molars erupted and opened the jaws to such an
extent that the gold crowns lacked more than a sixteenth of an inch
of touching the upper teeth. This case was undoubtedly due to the
shortness of the ramus of the lower jaw.
Treatment.—The simplest treatment of such cases is to grind down
the cusps of the occluding teeth. In simple cases this can be done so as
to enable the incisors to bite upon each other. (See Figs. 802 and 80.3.)
The third molars may interfere so much that their extraction will be
indicated. By the use of articulating paper the occluding points whi(;h
need grinding may be easily located.
In some cases there may be a mal-occlusion of the cusps only, so
that grinding them away will be sufficient, while in other cases a con-
siderable portion of the tooth must be ground away. Prof. Guilford
suggests grinding as much as possible without causing too great pain,
and then administering an anesthetic and continuing the grinding.
" The sensitiveness of the exposed dentin may afterward be obtunded
by repeated applications of either zinc chlorid, caustic potash [potas-
sium hydroxid], or silver nitrate. Where neither of these will avail
sufficiently, it may be advisable to devitalize the pulps of two or more