CASE OF GENERAL DISORDER.

157

the corresponding lower ones had been extracted, and the second or twelfth-year molars had tipped forward into their places. Against the first molar on the right side above was an abscess, and on the same side below was still remaining the temporary canine, while the permanent canine was standing outside.

The treatment consisted in the extraction of the temporary canine and each of the first molars; a plate and jackscrew for the upper jaw to widen the arch, followed by appliances on the general principles so abundantly illustrated in these pages. For the lower jaw a somewhat stiff plate was made of vulcanite for the inside of the arch, and sprung into its place; as the arch widened the plate was warmed and straightened and replaced. As the bicuspids of the side teeth were principally in fault, the lower arch was widened in a few weeks. During this time the irregular front teeth, including the malposed canine, were bound to it by elastics and brought into line. The retaining plates for both jaws were vulcanite, with a gold band in each anchored in the plate behind the bicuspids, and passing entirely around the fronts. The disturbance of the alveolar processes by extraction and by pressure set up an action which brought a correction of the abnormal plane, as shown in the engraving.

In the "Dental Cosmos" for January, 1870, Dr. McQuillen describes a case of irregularity which came under his treatment. The patient was a young lady of sixteen:

"On bringing the upper and lower teeth together, the right superior central incisor closed inside of the inferior central and in front of the inferior lateral, while the superior lateral was back of the inferior canine, and the left superior lateral inside of the inferior one, producing an articulation as shown in the accompanying illustration, Fig. 84. The irregularity in this case was so marked as to attract general attention, and the occlusion of the teeth, had it not been

158

DR. MCQUILLEN'S CASES.

corrected, would have eventuated in a permanent and unsightly prominence of the lower jaw most destructive to the harmony of the features. In the course of two months, with a very simple, easily-constructed appliance, which could be readily adapted by the patient, the defective position of all the teeth was corrected, and a result obtained most gratifying to the patient, completely changing the appearance of the mouth, and greatly improving the expression of the face.

"The fixture employed consisted of a silver bar of the thickness of ordinary lower plate for artificial dentures, two inches in length by a quarter of an inch in width, perforated by four holes, and then, with a thin, flat file, cuts were made from the edge of the bar to these holes, making a fixture similar to the lower figure in the accompanying illustration, Fig. 85. India-rubber rings, cut from French tubing, were

FIG. 85.

readily passed over the bar (which rested on the front surface of the superior incisors) and around the deflected teeth. The constant, gradual contraction of the rubber drew the lateral incisors into their proper places in the arch. A bar of similar construction was also used in the lower jaw. After becoming familiar with the necessary manipulation, the application of the fixture was made entirely by the patient, thus relieving the operator of considerable trouble."

HIS METHOD OF REGULATING.

159

This method of securing the rubber rings to the metallic band was described by Dr. McQuillen in 1859, and is substantially the same as recommended by Mr. Tomes in his "System of Dental Surgery." Both gentlemen seem to have adopted this simple expedient and published their plan the same year.

Figs. 86 and 87 illustrate cases also from Dr. McQuillen's practice. "In Fig. 86 the lateral incisors of the lower jaw stood considerably within the arch. The patient, a little girl aged eight years, had the bar and rings described above applied, and at the expiration of a week or two the teeth were brought into line, and there held by a retaining plate until they became permanently fixed.

"In Fig. 87, it will be observed, the right superior central incisor is considerably outside of the arch. The patient from whom this cast was obtained, a lady aged thirty-five years, came under his care about three years ago. From childhood she had labored under the peculiar deformity called limber-jaw or under-hung, with all the lower front teeth striking outside of the upper, due to a preternatural elongation of the inferior maxilla. A short time before placing herself in his hands, by some means or other the right superior central incisor got outside of the lower teeth, and had gradually been driven farther and farther forward by the occlusion of the lower jaw, until it had become not only very prominent, but quite loose in the socket. As the age of the patient contraindicated any attempt at a radical reform

160 MOVING A CENTRAL AT THIRTY-FIVE YEARS OF AGE.

of the original difficulty (the protrusion of the lower jaw), the only course that appeared to be justified was to get the incisor back to its former position, so that when the jaws were closed it would strike inside the lower teeth. This was accomplished by throwing an India-rubber ring round the incisor, and then stretching it over the crown of the first bicuspid of the same side. The contraction of the rubber in a few days drew it into place. To prevent the front teeth from striking during this period, silver caps were placed on the molars."

This would be a dangerous expedient for just such a case if the lower teeth did not shut outside, and thus lock the canine and lateral incisor, which are being pressed outward by the action of the rubber elastic at the same time that the central incisor and bicuspid are approaching each other. The power of the elastic to throw them out is equal to the power drawing the incisor in.

The following quotations and illustrations describe a practice followed by Professor Flagg, and published in the

FLAGG'S OBJECTION TO INCLINED PLANES.

161

"Transactions of the Odontographic Society of Pennsylvania." Referring to cases where the superior incisors articulate within the inferior, he says:

"For the correction of this form of irregularity, the ordinary practice has long been the adaptation of a plate over the teeth of the lower jaw, upon which inclined planes were so arranged that, by occlusion with the upper teeth, these should be forced outwardly, and at the same time some backward movement of the lower teeth be effected by producing a certain amount of change in the angle of the inferior maxilla. The application of this force is dependent upon one of two causes, viz.: the persistent efforts of the patients themselves in closing the teeth upon the planes, or by means of pressure with elastic bands arranged over the head and under the chin, after the manner of the Fox bandage, for preventing luxation during extraction. By means of these appliances, the corrections of very bad cases of this irregularity are sometimes effected in astonishingly short periods of time; but, on the contrary, it is not unfrequently the case that month after month passes by without any manifestation of progress. . . . Children will so protrude the lower jaw as to bite behind incredibly long planes, and upon the least accession of tenderness they will only eat such soft food as can be manipulated with the tongue, and never touch the planes at all. . . . I think that in the correction of irregularities all apparatus should be self-acting-so constructed as to require no coöperation on the part of patients, and, moreover, so arranged as to prevent the possibility of their interference with its workings.

"In consequence of these views I have for several years abandoned entirely the use of inclined planes, and have substituted for them, in correcting cases of the kind under consideration, a combination of wire, ligatures, and gutta-percha, which arrangement I can much more clearly elucidate by means of models than by description.

"Fig. 88.-Miss A., aged fourteen. Inclined planes had