Tin foil and its combinations for filling teeth

: IB)

^IP^f^^S<^aW««^^

•?«» ^ PMt"£s** (pM5,t'&&? ^ PK«?

SfC.v?;-^.^

fcc^

yzs:5J?s«?»?! *£X&»n

THE LIBRARY

OF
THE UNIVERSITY

OF CALIFORNIA
LOS ANGELES

V^o^^flP

i9rf^7«,41 ^. /(Oi>K/.^ir\-ri

Mtofrfr&rs&w

^rm^t'-ffisrst

^"a^wf^

W£<?m^mvm^

TIN FOIL

COMBINATIONS FOR FILLING TEETH.

BY
HENRY L. AMBLER, M.S., D.D.S., M.D.,

Professor of Operative Dentistry and Dental Hygiene, in the Dental Depart

ment of Western Reserve University.

Member of the American Dental Association ; of the Ohio State Dental

Society ; of the Northern Ohio Dental Association ;

of the Cleveland City Dental Society.

PHILADELPHIA:
THE S. S. WHITE DENTAL MFG. CO.,

LONDON :
CLAUDIUS AStL&^SQNS, .Limited.

LIBRARY
2O9 :l. 23rd S

N. Y. CITY

% < r Df^>

.*"

Copyright, HENRY L. AMBLER, 1896.

All rights reserved.
Entered at Stationers Hall, London.

f\

PREFACE.

BELIEVING that sufficient and well-deserved prominence
was not being given to the use of tin foil and its combina-
tions, the author decided to present a brief historical resume
of the subject, together with such practical information as he
possesses, before the profession in order that it may have the
satisfaction of saving more teeth, since that is the pre-eminent
function of the modern dentist. One object is to meet the
demand for information in regard to the properties and uses
of tin foil; this information has been sought to be given in
the simplest form consistent with scientific accuracy. The
present use of tin is a case of the "survival of the fittest."
because tin was used for filling teeth more than one hundred
years ago. There is not a large amount of literature upon
the subject, and no single text-book has treated the matter
fully enough to answer the needs of both teacher and pupil.
It is difficult for the student to collect and harmonize from
the many different sources just the kind and amount of infor-
mation required for his special use. Perhaps this work will
be of assistance to scientific students and practical operators
in the art of using tin foil, including all who wish in compact
form an explanation of the facts and principles upon which
the art is based. A good method to arouse in students an
interest in the use of tin foil is to have them use it in opera-
tive technics, which is becoming an effective adjunct in every
dental college. By this means a great factor will be brought
to bear, and the result will be that hundreds of graduates

iv PREFACE.

every year will begin practice better qualified to save teeth
than if they had not known whatever may be learned about
this material. At the University of Pennsylvania, Depart-
ment of Dentistry, session 1896-97, out of the total number
of fillings made in the clinical department (fractions omitted)
55 per cent, were gold, 15 per cent, tin, 10 per cent, amalgam.
This shows that tin has some very strong friends in the per-
sons of Professors Darby and Kirk.

The historical sketch of the development of the subject is
arranged in chronological order, and is given partly to show
that some old ideas and methods were good, and some
obviously incorrect when viewed in the light of more recent
developments. Part of the history will be new to the oldest
members of the profession, and the younger ones will cer-
tainly read it with interest. The work has been brought up
to date by considering all the properties and methods avail-
able. More names, good opinions, and dates could have
been given, but the writer believes that what is herein pre-
sented is enough to thoroughly substantiate his own opinions,
experiments, and practical applications. Some of the illus-
trations have been made especially for this work; the others
have been obtained through the courtesy of the owners.

"Let not the foggy doctrine of the superiority of gold in
all cases act on progress as the old medieval superstitions
acted on astronomy, physiology, zoology. Truth sought
after without misgiving, and the humblest as well as the
highest evidence taken in every case, and acted on with skill
and discrimination, will crown all with a high average of
success."

It is hoped that what has been said in this volume will
enable those who study it to save more teeth, and stimulate
them to make improvements on the material and methods,
doing much better than has been described or suggested.

CLEVELAND, OHIO, June, 1897.

"With soft and yielding lamina, and skill,
The practiced dental surgeon learns to fill
Each morbid cavity, by caries made,
With pliant tin; when thus the parts decayed
Are well supplied, corrosion, forced to yield
To conquering art the long-contested field,
Resigns its victim to the smiles of peace,
And all decay and irritation cease."

(Solyman Brown.)

The quantity of tin foil used measures the number of teeth
saved with metals in any country during any historical period.

CONTENTS.

CHAPTER I.

PAGE

Antiquity of Tin — Alchemistic Name — Medical Use —
Where Found — Purity Obtained — Physical Charac-
teristics i

CHAPTER II.
History of the use of Tin Foil, 1783-1844 7

CHAPTER III.
History Continued, 1845-1895

CHAPTER IV.

Columbian Dental Congress — Opinions on Tin Foil —
Reasons for Using — Manufacture in United States —
Number and Weight of Foil — Cohesion — Good
Qualities of Tin Foil — Temporary Teeth — Thermal
Changes — Calcification — Chalky Teeth 27

CHAPTER V.

Discoloration of Tin — Decomposition of Food — Sulfids —
Oxids — Galvanic, Therapeutic, and Chemical Action. 40

CHAPTER VI.

White Caries — Gold and Tin as Conductors — Wearing
Away of Fillings — Poor Foil — Buccal Cavities —
Number of Years Fillings Last — Strips or Tapes for

Vlll CONTENTS.

Filling — Number 10 Foil — Form of Cavities — Shields
— Matrices — Condensing — Finishing — Cervical Mar-
gins— Filling Anterior Teeth — Lining with Gold.... 49

CHAPTER VII.

Filling, part Tin, part Gold — Cervical Margin Liable to
Caries — Electrolysis — Hand Pressure — Hand Mallet
— Tapes and Ropes Compared — Manner of Preparing
Foil — Starting the Filling — Cylinders — Mats — Facing
and Repairing — Tin Shavings — Dr. Herbst's Method
—Fees 56

CHAPTER VIII.

Dr. Robinson's Fibrous and Textile Metallic Filling —
Tin and Gold combined (Tg), Methods of Preparing
and Using — Lining Cavities with Tin — Tin and Amal-
gam— Plastic Tin — Stannous Gold — Crystal Tin —
Filling Root-Canals — Tin and Watts's Sponge Gold
— Capping Pulps 66

CHAPTER IX.

Temporary Fillings — Sensitive Cavities — Integrity — Tin
with Sponge, Fibrous, and Crystallized Gold — Tin
at Cervical Margin — Filling Completed with Gold —
Gutta-Percha and Tin — Occlusal Cavities with Tin
and Gold — Comparison of Gold with Tin — Wedge-
shaped Instruments — Old Method of Using Rolls,
Ropes, Tapes, or Strips — Later Method — Filling with-
Compact and Loose Balls — Cylinder Fillings — Opera-
tive Technics 91

CHAPTER I.

MOSES, who was born 1600 B.C., mentions tin,
and history records its use 500 B.C., but not for
filling teeth; much later on, the Phoenicians took it
from Cornwall, England, to Tyre and Sidon.

The alchemistic name for tin is Jove, and in the
alchemistic nomenclature medicinal preparations
made from it are called Jovial preparations.

Hindoo native doctors give tin salts for urinary
affections. Monroe, Fothergill, and Richter claim
to have expelled worms from the human system,
by administering tin filings.

Blackie, in "Lays of Highlands and Islands," re-
ferring to tin as money, says, —

"And is this all? And have I seen the whole
Cathedral, chapel, nunnery, and graves?
Tis scantly worth the tin, upon my soul."

"Tin-penny." — A customary duty formerly paid
to the tithingmen in England for liberty to dig in
the tin-mines.

In 1846, Tin (Stannum, symbol Sn) was found
in the United States only at Jackson, N. H. Since
then it has been found, to a limited extent, in West
Virginia and adjoining parts of Ohio, North Car-

2 TIN FOIL AND ITS

olina, Utah, and North Dakota. The richest tin
mines of the world, howeveu, are in Cornwall,
England, which have been worked from the time of
the Phoenician discovery.

The tin which is found in Malacca and Banca,
India, is of great purity, and is called "Straits Tin"
or "Stream Tin." It occurs in alluvial deposits
in the form of small rounded grains, which are
washed, stamped, mixed with slag and scoriae, and
smelted with charcoal, then run into basins, where
the upper portion, after being removed, is known
as the best refined tin. Stream tin is not pure
metallic tin, but is the result of the disintegration
of granitic and other rocks which contain veins of
tinstone. Banca tin is 99.961 parts tin, 0.019 iron,
0.014 lea(i in 100 parts; it is sold in blocks of 40 and
1 20 pounds, and a bar 0.5 meter long, o.i broad,
0.005 deep can be bent seventy-four times without
being broken. Subjected to friction, tin emits a
characteristic odor.

Tin in solution is largely used in electro-metal-
lurgy for plating. Pure tin may be obtained by
dissolving commercial tin in hydrochloric acid, by
which it is converted into stannous chlorid; after
filtering, this solution is evaporated to a small
bulk, and treated with nitric acid, which converts it
into stannic oxid, which in turn is thoroughly

COMBINATIONS FOR FILLING TEETH. 3

washed and dried, then heated to redness in a cruci-
ble with charcoal, producing a button of tin which
is found at the bottom of the crucible.

Pure tin may be precipitated in quadratic crys-
tals by a slight galvanic current excited by immers-
ing a plate of tin in a strong solution of stannous
chlorid; water is carefully poured in so as not to
disturb the layer of tin solution; the pure metal will
be deposited on the plate of tin, at the point of
junction of the water and metallic solution.

In the study of tin as a material for filling teeth,
we have deemed it expedient to consider some of
its physical characteristics, in order that what fol-
lows may be more clearly understood.

Tin possesses a crystallized structure, and can be
obtained in well-formed crystals of the tetragonal
or quadratic system (form right square prism), and
on account of this crystalline structure, a bar of
tin when bent emits a creaking sound, termed the
"cry of tin;" the purer the tin the more marked the
cry.

The specific gravity is 7.29; electrical state posi-
tive; fusing point 442° F. ; tensile strength per
square inch in tons, 2 to 3. Tensile strength is the
resistance of the fibers or particles of a body to
separation, so that the amount stated is the weight

4 TIN FOIL AND ITS

or power required to tear asunder a bar of pure tin
having a cross-section of one square inch.

Tenacity: Iron is the most tenacious of metals.
To pull asunder an iron wire 0.787 of a line in
diameter requires a weight of 549 Ibs. To pull
asunder a gold wire of the same size, 1 50 Ibs. ; tin
wire, 34 Ibs.; gold being thus shown to be more
than four times as tenacious as tin. (Fractions
omitted.)

Malleability: Pure tin may be beaten into leaves
one-fortieth of a millimeter thick, thus requiring
1020 to make an inch in thickness. Miller states
that it can be beaten into leaves .008 of a millimeter
thick, thus requiring 3175 to make an inch in
thickness. Richardson says that ordinary tin foil
is about o.ooi of an inch in thickness.

If the difficulty with which a mass of gold (the
most malleable of metals) can be hammered or
rolled into a thin sheet without being torn, be taken
as one, then it will be four times as difficult to
manipulate tin into thin sheets.

Ductility: If the difficulty with which gold (the
most ductile of metals) can be drawn be taken as
one, then it will be seven times as difficult to draw
tin into a wire. At a temperature of 212° it has
considerable ductility, and can be drawn into wire.

Among the metals, silver is the best conductor of

COMBINATIONS FOR FILLING TEETH. 5

heat. If the conductivity of silver be taken as 100,
then the conducting power of gold would be 53.2;
tin, 14.5; gold being thus shown to be nearly four
times as good a conductor of heat as tin. Among
the metals, silver is the best conductor of elec-
tricity. If its electrical conductivity be taken at
loo, then the conducting power of gold would be
77.96; tin, 12.36; gold being thus shown to be-more
than six times as good a conductor of electricity as
tin.

Resistance to air: If exposed to dry, pure air,
tin resists any change for a great length of time, but
if exposed to air containing moisture, carbonic acid,
etc., its time resistance is reduced, although even
then it resists corrosion much better than copper
or iron.

As to linear expansion, when raised from 32° to
212° F., aluminum expands the most of any of the
metals. Taking its expansion as I, that of tin
would be 3, i.e., aluminum expands three times as
much as tin. (Dixon, "Vade Mecum.")

Solids generally expand equally in all directions,
and on cooling return to their original shape.
Within certain limits, metals expand uniformly in
direct proportion to the increase in temperature,
but the rate of expansion varies with different
metals; thus, under like conditions, tin 'expands

6 TIN FOIL AND ITS

nearly twice (if) as much as gold, but the rate of
expansion for gold is nearly twice (ifjj) that of
tin.

The capacity for absorbing heat varies with each
metal; that of gold is about twice (if) that of tin.

Tin has a scale hardness of about 4, on a scale of
12 where lead is taken as the softest and platinum
the hardest. (Dixon, "Vade Mecum.")

Tin has a scale hardness of about 2. (Dr. Mil-
ler.)

To fuse a tin wire one centimeter in diameter
requires a fusing current of electricity of 405.5
amperes. Up to 225° C, the rise in resistance to
the passage of an electric current is more rapid in
tin than in gold. In some minerals the current
follows the trend of the crystals.

Gold wire coated with tin, and held in the flame
of a Bunsen burner, will melt like a tin wire. At
1600° to 1800° tin boils and may be distilled.

COMBINATIONS FOR FILLING TEETH.

CHAPTER IT.

THE largest and most complete dental library in
the world is owned by Dr. H. J. McKellops, of St.
Louis. Upon his cheerful invitation, the writer
visited that "Mecca," and through his kindness and
assistance a complete search was made, which re-
sulted in obtaining a great portion of the following
historical facts with reference to the use of tin in
dentistry:

"In 1783 I stopped a considerable decay in a
large double under tooth, on the outside of the
crown or near the gums, with fine tin foil, which
lasted for a good number of years." ("A Practical
and Domestic Treatise on Teeth and Gums," by
Mr. Sigmond, Bath, England, 1825.)

"Fine tin foil or gold leaf may be injected into a
cavity successfully, and retained securely for many
years." (Joseph Fox, Dover, England, 1802.)

"The statement has been made several times that
tin foil was used in the United States for filling
teeth as early as 1800, at which time dentistry be-
gan to be cultivated particularly as a science and
art, and was beginning to be regarded as of more
importance than it formerly had been. The writer
has not found any record of its use in this country

8 TIN FOIL AND ITS

earlier than 1809. Tin may often be employed
with entire confidence. I have seen fillings forty-
one years old (made in 1809) and still perfect.
Several molars had four or five pings in them,
which had been inserted at different periods during
the last half-century. I prefer strips cut from six
sheets laid upon each other. If the foil is well con-
nected, the cut edges will adhere firmly; if they do
not, the foil is not fit for use." (Dr. B. T. Whit-
ney, Dental Register of the West, 1850.) First
reference to the fact that tin is adhesive.

"Tin is desirable in all unexposed cavities. It
has a stronger affinity for acetic, citric, tartaric,
malic, lactic, and nitric acids than the tooth has: a
good material where the secretions are of an acid
character, it is better that the filling should waste
away than the tooth. One cavity in my mouth
was filled with gold, decay occurred, the filling \vas
removed; cavity filled with oxychlorid, which pro-
duced pain; filling removed; cavity filled with
gutta-percha, still experienced pain; filling re-
moved; cavity filled with tin, and pain ceased in an
hour. A tin filling was shown in New York which
was sixty years old; made in 1811." (Dr. E. A.
Bogue, British Journal of Dental Science, 1871.)

"I have lately been removing tin pluggings (the
juices of the mouth having oxidated and dissolved

COMBINATIONS FOR FILLING TEETH. 9

away the metal, so as to expose the teeth to decay)
from teeth which I plugged fifteen years ago (1818)
for the purpose of re-stopping with gold, and have
in almost every instance found the bone of the
tooth at the bottom of the pluggings perfectly
sound and protected from decay." (J. R. Spooner,
Montreal, 1833.)

In 1800 the number of dentists in the United
States was about one hundred, and many of them
were using tin foil for filling teeth.

In 1822 tin was employed by the best dentists,
with hardly an exception; it grew in favor, espe-
cially for large cavities in molars, and for a cheaper
class of operations than gold, but tin was not gen-
erally used until 1830. ("History of Dental and
Oral Science in America.")

"Lead, tin, and silver corrode and become more
injurious than the original disease, and will in every
case ultimately prove the cause of destruction to
the tooth, which might have been preserved by
proper treatment." (Leonard Koecker, 1826, and
''New System of Treating the Human Teeth," by
J. Paterson Clark, London, 1829 and 1830.)

"Tin in situations out of reach of friction in mas-
tication, as between two teeth, is like the tooth
itself apt to be decomposed by acidity unless kept
very clean." ("Practical and Familiar Treatise on

IO TIN FOIL AND ITS

Teeth and Dentism," J. Paterson Clark, London,
1836.) Refer to what the same author said in
1829.

"Tin is used as a plugging material." ("The
Anatomy, Physiology, and Diseases of the Teeth,"
by Thomas Bell, F.R.S., London, 1829.)

"Silver and tin foil, although bright when first
put in a cavity, very soon change to a dark hue.
resembling the decayed parts of the teeth which arc
of a bluish cast; besides this, they are not suffi-
ciently pure to remain in an unchanged state, and
frequently they assist in the destruction of a tooth
instead of retarding it." ("Familiar Treatise on
the Teeth," by Joseph Harris, London, 1830.)

"Tin is objectionable on account of rapid oxida-
tion and being washed by the saliva into the
stomach, as it may materially disorder it; the filling
becomes so reduced that the cavity in which it has
been inserted will no longer retain it, and acid fruits
influence galvanic action." ("Every Man his Own
Dentist," Joseph Scott, London, 1833.)

In 1836 Dr. Diaz, of Jamaica, used tin foil for
filling teeth.

"Gold is now preferred, though tin, from its
toughness when in the leaf, is perhaps the most
suitable. Americans are superior to British in

COMBINATIONS FOR FILLING TEETH.

II

FIG. i. filling." ("Plain Advice on
Care of the Teeth," Dr. A.
Cameron, Glasgow, 1838.)

"Tin foil is used for fill-
ing teeth." (S. Spooner,
New York, 1838, "Guide to
Sound Teeth.")

In 1838 Archibald Mc-
Bride, of Pittsburg, Pa.,
used tin for filling cavities
of decay.

The following facts were
learned from Dr. Corydon
Palmer: E. E. Smith, who
had been a student of John
and William Birkey, in Phil-
adelphia, came to Warren,
Ohio, in 1839, and among
other things made the first
gold plate in that part of the
country. In operating on
the anterior teeth, he first
passed a separating file be-
tween them, excavated the cavity, and
prepared the foil, tin or gold, in tapes
which were cut transversely, every
eighth of an inch, about three-quarters

FIG. 2.

12 TIN FOIL AND ITS

of the way across. Fig. i shows the size of tape
and the manner of cutting. With an instrument
(Fig. 2) he drew the foil in from the labial surface,
using such portion of the tape as desired.

The instrument from which the illustration was
made was furnished by Dr. Palmer, and is shown
full size. Instruments for use on posterior teeth
were short and strong, with as few curves as pos-
sible; no right and left cutters or pluggers were
used, and none of the latter were serrated, but had
straight, tapering round points, flat on the ends,
and of suitable size to fill a good portion of the
cavity. He used what was termed Abbey's chem-
ically pure tin foil, forcing it in hard, layer upon
layer, — as he expressed it, "smacked it up." In
this manner he made tin fillings that lasted more
than thirty years.

In 1839 Dr. Corydon Palmer filled teeth with tin
foil, also lined cavities with gold and filled the re-
mainder with tin. In the same year he filled crown
(occlusal) cavities one-half full with tin and the
other half with gold, allowing both metals to come
to the surface, on the same plan that many proxi-
mal cavities are now filled. (See Fig. 3, showing
about one-half of the cavity nearly completed with
tin cylinders. The same plan was followed when
strips, or ropes, were used.)

COMBINATIONS FOR FILLING TEETH. 13

"I filled cavities about two-thirds full with tin,
and finished with gold." (S. S. Stringfellow,
American Journal of Dental Science, 1839.)

"Tin foil is greatly used by some American den-
tists, but it is not much better than lead leaf."
("Surgical, Operative, and Mechanical Dentistry,"
L. Charles De Londe, London, 1840.)

"In 1841 there were about twelve hundred den-

FIG. 3.

tists in the United States, many of whom were
using tin, and there are circumstances under which
it may be used not only with impunity, but advan-
tage, but it is liable to change." (Harris.)

"I put in tin fillings, and at the end of thirty
years they were badly worn, but there was no
decay around the margins." (Dr. Neall, 1843.)

In 1843 Dr. Amos Westcott, of Syracuse, N. Y.,

14 TIN FOIL AND ITS

filled the base of large cavities with tin, completing
the operation with gold.

"Tin is used in the form of little balls, or tubes,
but folds are better; introduce the metal gradually,
taking care to pack it so that it will bear equally
upon all points; the folds superimpose themselves
one upon the other; thus we obtain a successive
stratification much more exact and dense, and it is
impossible there can be any void." ("Theory and
Practice of Dental Surgery," J. Lefoulon, Paris,
1844.)

COMBINATIONS FOR FILLING TEETH. 15

CHAPTER III.

"BESIDES gold, the only material which can be
used with any hope of permanent success is tin foil.
Some dentists call it silver, and a tooth which can-
not be filled with it cannot be filled with anything
else so as to stop decay and make it last very long.
It can be used only in the back teeth, as its dark
color renders it unsuitable for those in front.
When the general health is good, and the teeth
little predisposed to decay, this metal will preserve
them as effectually perhaps as gold; but where the
fluids of the mouth are much disordered it oxidizes
rapidly, and instead of preserving the teeth rather
increases their tendency to decay." (Dr. Robert
Arthur, Baltimore, 1845, "A Popular Treatise on
the Diseases of the Teeth.")

The false idea that a patient must have good
health, normal oral fluids, and teeth little predis-
posed to decay, or else if filled with tin the decay
would be hastened, originated with a German or
English author, and has been handed down in
works published since early in 1800. It even crept
into American text-books as late as 1860, the
authors of which now disbelieve it.

"Tin undergoes but little change in the mouth,

l6 TIN FOIL AND ITS

and may be used with comparative safety." (''Sur-
gical, Mechanical, and Medical Treatment of the
Teeth," James Robinson, London, 1846.)

"Tin is soft, and can be easily and compactly
introduced, but it is more easily acted on by the
secretions of the mouth than gold and is less dura-
ble, but in the mouth of a healthy person it will last
for years. Still, inasmuch as it cannot be depended
on in all cases, we are of the opinion that it should
never be employed." ("The Human Teeth,"
James Fox, London, 1846.)

The italics are ours. Every metal has a limited
sphere of usefulness, and it should not be expected
that tin will contend single-handed against all the
complicated conditions which caries presents.

"Of all the cheaper materials, I consider tin the
best by far, and regard its use fully justifiable in
deciduous teeth and in large cavities, as it is not
every man who can afford the expense of nine
leaves of gold and four hours of labor by a dentist
on a single tooth." (Dr. Edward Taylor, Dental
Register of the West, 1847.)

"I consider tin good for any cavity in a chalky
tooth: it will save them better than anything else."
(Dr. Holmes, 1848.)

"Tin can be used as a temporary filling, or as a
matter of economy. It may be rendered imper-

COMBINATIONS FOR FILLING TEETH. 17

vious to air and dampness, but it corrodes in most
mouths, unless it comes in contact with food in
chewing, and then it rapidly wears away; it does
not become hard by packing or under pressure, and
that it forms a kind of a union with the tooth is
ridiculous." (Dr. J. D. White, 1849, Dental News
Letter.)

"A tin plug will answer a very good purpose in
medium and large cavities for six years. Much
imposition has been practiced with it, and it is not
made as malleable as it should and can be. An
inferior article is manufactured which possesses
brilliancy and resembles silver. This is often
passed off for silver foil. No harm comes from
this deception except the loss of the amount paid
above the price for tin; but even this inferior tin
foil is better than silver." ("The Practical Family
Dentist," Dewitt C. Warner, New York, 1853.)

"Tin made- into leaves is employed as a stopping
material; with sufficient experience it can be elab-
orated into the finest lines and cracks, and against
almost the weakest walls, and teeth are sometimes
lost with gold that might have been well preserved
with tin. I saw an effective tin stopping in a tooth
of Cramer's, the celebrated musical composer,
which had been placed there thirty-five years ago

3

l8 TIN FOIL AND ITS

by Talma, of Paris." ("The Odontalgist," by J.
Paterson Clark, London, 1854.)

Refer to what the same author said in 1836.

"Tin is the best substitute for gold, and can often
be used in badly shaped cavities where gold can-
not." (Prof. Harris, 1854.)

"Tin is better than any mixture of metals for
filling teeth." (Professor Tomes, London, 1859.)

In 1860 a writer said that "such a change may
take place in the mouth as to destroy tin fillings
which had been useful for years, and that tin was
not entirely reliable in any case; it must not be
used in a tooth where there is another metal, nor be
put in the bottom of a cavity and covered with
gold, for the tin will yield, and when fluids come in
contact with the metals, chemical action is induced,
and the tin is oxidized. Similar fillings in the same
mouth may not save the teeth equally well. Fill-
ing is predicated on the nature of decay, for only
on correct diagnosis can a proper filling-material
be selected."

Reviewing the foregoing statement, we believe
that a change may take place in the mouth which
will destroy gold fillings (or ,the tooth-structure
around them) much oftener than those of tin. It
is now every-day practice to put tin into the same
tooth with another metal; if the bottom of a cavity

COMBINATIONS FOR FILLING TEETH. ig

is filled with tin properly packed, it will not yield
when completed with gold, and if the gold is tight,
the oral fluids cannot come in contact with both
metals and produce chemical action or oxidation;
similar fillings of gold in the same mouth do not
save the teeth equally well. Should we expect
more of tin in this respect, or discard it because it
is not always better than gold?

In Article V of the "New Departure Creed,"
Dr. Flagg says, "Skillful and scrupulous dentists
fill with tin covered with gold, thereby preventing
decay, pulpitis, death of the pulp, and abscess, and*
thus save the teeth."

In 1862 Mr. Hockley, of London, mentions tin
for filling, and the same year Dr. Zeitman, of Ger-
many, recommended it as a substitute for gold, par-
ticularly for poor people.

"Is tin foil poisonous? If not, why are our
brethren so reluctant to use it? Is it nauseous?
If not, why not employ it? Will it not preserve
the teeth when properly used? Then why not
encourage the use of it? Does its name signify
one too common in the eyes of the people, on
account of its daily use in the tin shops, or do pa-
tients murmur when the fee is announced, because
it is nothing but tin? Is it not better than amal-
gam, although the patient may believe it less

2O TIN FOIL AND ITS

costly? Eleven good plugs, twenty-nine years old,
in one mouth demonstrates that tin will last as
long as gold in many cases." (F. A. Brewer,
Dental Cosmos, 1863.)

"So much tin foil is used for personal and do-
mestic purposes that the following is important:
Ordinary tin foil by chemical analysis contained
88.93 per cent, of lead; embossed foil, 76.57 per
cent.; tea foil, 88.66 per cent.; that which was sold
for the pure article, 34.62 per cent. Tin foil of
above kind is made by inclosing an ingot of lead
between two ingots of tin, and rolling them out
into foil, thus having the tin on the outside of the
lead." (Dr. J. H. Baldock, Dental Cosmos, 1867.)

The author used tin foil for filling the teeth of
some of his fellow-students at the Ohio College of
Dental Surgery in 1867.

"Amalgam should never be used in teeth which
can be filled with tin, and most of them can be."
(Dr. H. M. Brooker, Montreal, 1870.)

"I have used tin extensively, and found it more
satisfactory than amalgam. Dentists ignore tin,
because it is easier to use amalgam, less trouble.
This is not right. If your preceptor has told you
that amalgam is as good as tin, and he thinks so,
let him write an article in its defense. Not one
dentist in ten who has come into the profession

COMBINATIONS FOR FILLING TEETH. 21

within the last ten years knows how to make a tin
filling, and only a few of the older ones know how
to make a good one." (Dr. H. S. Chase, Missouri
Dental Journal, 1870.)

"Among the best operators a more general use
of tin would produce advantageous results, while
among those whose operations in gold are not gen-
erally successful an almost exclusive use of tin
would bring about a corresponding quantum of
success to themselves and patients, as against re-
peated failures with gold. The same degree of
endeavor which lacked success with gold, if applied
to tin would produce good results and save teeth.
A golden shower of ducats realized for gold finds
enthusiastic admirers, but a dull gray shower for tin
work is not so admirable, even though many of the
teeth were no better for the gold as gold, nor so
well off in the ultimate as with tin." (Dr. E. W.
Foster, Dental Cosmos, 1873.)

In 1873 Dr. Royal Varney said, "I am heartily
in favor of tin; it is too much neglected by our first-
class operators."

"Tin stops the ends of the tubuli and interglob-
ular spaces which are formed in the teeth of exces-
sive vascular organization; if more teeth were filled
with tin, and a smaller number with futile attempts

22 TIN FOIL AND ITS

with gold, people would be more benefited." (Dr.
Castle, Dental Cosmos, 1873.)

"If cavities in teeth out of the mouth are well
filled with tin, and put into ink for three days, no
discoloration of the tooth (when split open) can be
seen." (W. E. Driscoll, Dental Cosmos, 1874.)

"Tin makes an hermetical filling, and resists the
disintegrating action of the fluids of the mouth.
If an operator can preserve teeth for fifteen dollars
with tin, which would cost fifty dollars with gold,
ought he not to do so? Upon examination of the
cavities from which oxidized plugs have been re-
moved, these oxids will be found to have had a
reflex effect upon the dentin; the walls and floors
will be discolored and thoroughly indurated, and
to a great degree devoid of sensitiveness, although
they were sensitive when filled. Tin is valuable in
case of youth, nervousness, impatience, high vital-
ity of dentin, low calcification, and low pecuni-
osity." (Dr. H. Gerhart, Pennsylvania Journal of
Dental Science, 1875.)

"Tin Foil for Filling Teeth." Essay by Dr. H. L.
Ambler, read before the Ohio State Dental Society.
(Dented Register of the West, 1875.)

"Some say that if tin is the material the cavity
must be filled with, that it must be filled entirely

COMBINATIONS FOR FILLING TEETH. 23

with it, but advanced teachings show differently."
(Dr. D. D. Smith, Dental Cosmos, October, 1878.)

"Frail teeth can be saved better with tin than
with gold. I never saw a devitalized pulp under a
tin filling." (Dr. Dixon, Dental Cosmos, May,
1880.)

"Tin may be used as a base for proximate fillings
in bicuspids or molars, in third molars, in children's
permanent molars, in the temporary teeth, and in
any cavity where the filling is not conspicuous."
(Dr. A. W. Harlan, Independent Practitioner, 1884.)

"Tin in blocks, mats, and tapes is used like non-
cohesive gold foil, but absence of cohesion prevents
the pieces from keeping their place as well as the
gold." ("American System of Dentistry," 1887.)

This is virtually saying that there is cohesion of
non-cohesive gold, and that for this reason it keeps
its place better than tin. It has always been sup-
posed that there was no cohesion of layers of non-
cohesive gold, and as the tin is used on the non-
cohesive plan, therefore one keeps its place as well
as the other. We claim that generally in starting
a filling, tin will keep its place better than cohesive
or non-cohesive gold, because it combines some of
the cohesiveness of the former with the adaptability
of the latter.

"Tin will save teeth in many cases as well or

24 TIN FOIL AND ITS

better than gold. Put a mat of tin at the cervical
wall of proximate cavities in molars and bicuspids,
and it makes a good filling which has a therapeutic
effect on tooth-structure that prevents the recur-
rence of caries, probably because the infiltration of
tin oxid into the tubuli is destructive to animal life.
Where the filling is not exposed to mechanical
force, there is no material under heavens which will
preserve the teeth better." (Dr. Beach, Denial
Cosmos, 1889.)

"I extracted a tooth in which I found a cavity of
decay which had extended toward a tin filling, but
stopped before reaching it; on examining the
tooth-structure between the new cavity and the tin
filling, it was found to be very hard, indicating
apparently that' there had been some action pro-
duced by the presence of the tin." (Dr. G. White,
Dental Cosmos, 1889.)

"Pure tin in form of foil is used as a filling and
also in connection with non-cohesive gold."
(Mitchell's "Dental Chemistry," 1890.)

"Tin ranks next to gold as a filling-material."
(Essig's "Dental Metallurgy," 1893.)

"Tin is good for children's teeth, when gold or
amalgam is not indicated. It can be used in cavi-
ties which are so sensitive to thermal changes as to
render the use of gold or amalgam unwise, but it

COMBINATIONS FOR FILLING TEETH. 25

can -only be used in cavities with continuous walls,
and should be introduced in the form of cylinders
or ropes, with wedge-shaped pluggers having sharp
deep serrations, thus depending upon the wedging
or interdigitating process to hold the filling in the
cavity." ("Operative Technics," Prof. T. E.
Weeks, 1895.)

"Tin for filling teeth has been almost superseded
by amalgam, although among the older practi-
tioners (those who understand how to manipulate
it) tin is considered one of the best, if not the very
best metal known for preserving the teeth from
caries. In consequence of its lack of the cohesive
property, it is introduced and retained in a cavity
upon the wedging principle, the last piece serving
as a keystone or anchor to the whole filling. Each
piece should fill a portion of the cavity from the
bottom to the top, with sufficient tin protruding
from the cavity to serve for thorough condensation
of the surface, and the last piece inserted should
have a retaining cavity to hold it firmly in place.
The foil is prepared by folding a whole or half-sheet
and twisting it into a rope, which is then cut into
suitable lengths for the cavity to be filled."
(Frank Abbott, "Dental Pathology and Practice,"
1896.)

"Forty-three years ago, for a young lady four-

26 TIN FOIL AND ITS

teen years of age, I filled with non-cohesive gold
all the teeth worth filling with this metal; the rest I
filled with tin. Three years after that there was
not a perfect gold filling among the whole number,
and yet the tin fillings were just as good as when
made. The explanation as to why the tin fillings
lasted so much longer that the gold ones was, that
there must have been something in the tin that had
an affinity for the teeth and the elements that
formed the dentin, by which some compound was
formed, or else it must have been in the adapta-
tion." (Dr. H. Gerhart, Dental Cosmos, January,
1897.)

COMBINATIONS FOR FILLING TEETH. 2,"J

CHAPTER IV.

AT the World's Columbian Dental Congress,
held in Chicago, August, 1893, the author pre-
sented an essay on "Tin Foil for Filling Teeth."

During the discussion of the subject, the follow-
ing opinions were elicited:

Dr. E. T. Darby: "I have always said that tin
was one of the best filling-materials- we have, and
believe more teeth could be saved with it than with
gold. I have restored a whole crown with tin, in
order to show its cohesive properties; the essayist
has paid a very high and worthy tribute to tin."

Dr. R. R. Freeman: "I have used tin foil for
twenty-five years, and know that it has therapeutic
properties, and is one of the best filling-materials,
not excepting gold."

Madam Tiburtius-Hirschfield: "I heartily in-
dorse the use of tin, and have tested its cohesive
properties by building up crowns."

Dr. A. H. Brockway: "I am a strong believer
in the use of tin, on account of its adaptability, and
the facility with which saving fillings can be made
with it."

Dr. Gordon White: "After having used tin for

28 TIN FOIL AND ITS

nine years, I claim that it is the best filling-material
that has been given to our profession."

Dr. C. S. Stockton: "Tin is one of the best
materials for saving teeth, and we should use it
more than we do."

Dr. James Truman: "I use tin strictly upon the
cohesive principle, and would place it in all teeth
except the anterior ones, but would not hesitate to
fill these when of a chalky character."

Dr. Corydon Palmer: "For fifty-four years I
have been a firm advocate of the use of tin, and I
have a filling in one of my teeth which is forty years
old."

Dr. William Jarvie: "I rarely fill a cavity with
gold for children under twelve years of age that I
want to keep permanently, but use tin, and in five
or ten years, more or less, it wears out. Still, it
can easily be renewed, or if all the tin is removed
we find the dentin hard and firm. The dentist is
not always doing the best for his patients if he does
not practice in this way."

Dr. C. E. Francis: "I have proved positively
that tin foil in good condition is cohesive, and my
views have been corroborated by dentists and
chemists."

Dr. James E. Garretson: "Tin foil is cohesive,

COMBINATIONS FOR FILLING TEETH. 29

and can be used the same as gold foil, and to an
extent answers the same purpose."

Dr. C. R. Butler: "Tin is cohesive and makes a
first-class saving filling."

Dr. W. C. Barrett : "Tin is as cohesive as gold,
and if everything was blotted out of existence with
which teeth could be filled, except tin, more teeth
would be saved."

Dr. L. D. Shepard: "Tin possesses some anti-
septic properties for the preservation of teeth that
gold does not."

Dr. W. D. Miller: "I use tin foil in cylinders,
strips, and ropes, on the non-cohesive plan, but
admit that it possesses a slight degree of cohesive-
ness, and when necessary can be built up like co-
hesive gold by using deeply serrated pluggers."

Dr. Benjamin Lord says, "It is said that we know
the world, or learn the world, by comparison. If
we compare tin foil with gold foil, we find that the
tin, being softer, works more kindly, and can be
more readily and with more certainty adapted to
the walls, the inequalities, and the corners of the
cavities.

"We find also that tin welds — mechanically, of
course — more surely than soft gold, owing to its
greater softness; the folds can be interlaced or
forced into each other, and united with more cer-

3O TIN FOIL AND ITS

tainty, and with so much security that, after the
packing and condensing are finished, the mass may
be cut like molten metal.

"I contend moreover that for contouring the
filling or restoring the natural shape of the teeth,
where there are three walls remaining to the cavity,
tin is fully equal to gold, and in some respects even
superior; as tin can be secured, where there is very
little to hold or retain the filling, better than gold,
owing to the ease and greater certainty of its adap-
tation to the retaining points or edges of the cavity.

"It will be said, however, that tin fillings will
wear away. The surfaces that are exposed to mas-
tication undoubtedly will wear in time; but the fill-
ing does not become leaky if it has been properly
packed and condensed, nor will the margins of the
cavity be attacked by further decay on that account.

"Altogether, I believe that we can make more
perfect fillings with tin than we can with gold, tak-
ing all classes of cavities; but it must not be under-
stood that it is proposed that tin should ever take
the place of gold where the circumstances and con-
ditions indicate that the latter should be used. Of
course, the virtue is not in the gold or the tin, but
in the mechanical perfection of the operation, and
tin having more plasticity than gold, that perfec-
tion can be secured with more ease and certainty.

COMBINATIONS FOR FILLING TEETH. 3!

"If we compare tin with amalgam, we must cer-
tainly decide in favor of the former and give it pref-
erence; as if it is packed and condensed as perfectly
as may be, we know just what such fillings will do
every time. We know that there will be no
changes or leakage of the fillings at the margins;
whereas, with amalgam, the rule is shrinkage of the
mass, and consequently the admission of moisture
around the filling, the result being further decay.
It is not contended that this is always the result
with amalgam, but it is the general rule; yet we
must use amalgam, as there are not a few cases
where it is the best that we can do; but it is to be
hoped, and I think it may be said, that as manipula-
tive skill advances, amalgam will be less and less
used. For so-called temporary work, very often I
prefer tin to gutta-percha, as it makes a much more
reliable edge and lasts longer, even when placed
and packed without great care." — N. Y. Odon. So-
ciety Proceedings, page 51, 1894.

One of the main reasons which induced the
writer to begin the use of tin foil (Stannum Foli-
atum) 'for filling teeth, in 1867, was the fact that
amalgam filling failures were being presented
daily. Believing that tin could do no worse, but
probably would do better, we banished amalgam
from the office for the succeeding seven years,

32 TIN FOIL AND ITS

using in the place of it tin, oxychlorid, and gutta-
percha. Since that time we have seen no good
reason for abandoning the use of tin, as time has
proved it worthy of great confidence. There is no
better dental litmus to distinguish the conservative
from the progressive dentist.

If we take a retrospective view and consider what
tin foil was thirty years ago, we do not wonder that
so many operators failed to make tight, good-
wearing fillings. As it came from the manufac-
turer it looked fairly bright, but after being ex-
posed to the air for a short time it assumed a light
brassy color, and lost what small amount of in-
tegrity it originally possessed. This tin was not
properly refined before beating, or something was
put on the foil while beating, so that it did not have
the clean, bright surface and cohesive quality which
our best foil now has. No. 4 was commonly used,
but it would cut and crumble in the most provok-
ing manner. Fillings were made by using mats,
cylinders, tapes, and ropes, with hand-pressure, on
the plan for manipulating non-cohesive gold foil,
but it was difficult to insert a respectable approxi-
mal filling.

From the best information obtainable, the writer
believes that Marcus Bull (the predecessor of
Abbey) was the first to manufacture and sell tin

COMBINATIONS FOR FILLING TEETH. 33

foil in the United States, as he began the manu-
facture of gold foil at Hartford in 1812.

Several years ago a radical change came about in
the preparation of tin foil, for which the manu-
facturer should have his share of the credit, even if
the dentist did ask for something better, for the
quality depends largely upon the kind and condi-
tion of the tin used and on the method of manufac-
ture.

For making tin foil for filling teeth, the purest
Banca tin that can be obtained is used. The tin is
melted in a crucible under a cover of powdered
charcoal. It is then cast into a bar and rolled to
the desired thickness, so that if No. 6 foil is to be
made, a piece one and one-half (i|) inches square
would weigh nine grains. This ribbon is then cut
into lengths of about four feet, and spread on a
smooth board slanted, so that the end rests in a vat
of clean water.

Then apply to the exposed surface of the ribbon
diluted muriatic acid, and immediately wash with a
strong solution of ammonia. Turn the ribbon and
treat the other side in the same way. It is then
washed and rubbed dry. The object of using the
acid is to remove stains and whiten the tin, and the
ammonia is used to neutralize the effect of the acid.

The strips are then cut into pieces one and a half

4

34 TIN FOIL AND ITS

inch square, filled into a cutch and beaten to about
three inches square. It is then removed from the
cutch and filled into a mold, and further beaten to
the desired size. When the ragged edges are
trimmed off, the foil is ready for booking.

It takes skill and experience to beat tin foil, for it
is not nearly as malleable as gold; up to No. 20 it
is usually beaten, but higher numbers are prepared
by rolling. In each case the process is similar to
that employed in preparing gold foil. The num-
ber on the book is supposed to indicate the weight
or thickness of the leaf. On the lower numbers
the paper of the book leaves its impression.

On weighing sheets of tin foil from different
manufacturers a remarkable discrepancy was found
between the number on the book and the number
of grains in a sheet, viz: Nos. 3, 4, 5, weighed 7 gr.
each; No. 6, 9 gr.; No. 8, from 9 to 18 gr. ; No. 10,
from 14 to 15 gr.; No. 20, 18 gr. In some instances
the sheets in the same book varied three grains.
We submit that it would be largely to the advan-
tage of both manufacturer and dentist to have the
number and the grains correspond. No dentist
wishes to purchase No. 8 and find that he has No.
1 8; no one could sell gold foil under like circum-
stances. Of the different makes tested, White's
came the nearest to being correct. The extra

COMBINATIONS FOR FILLING TEETH. 35

tough foil which can now be obtained is chemically
pure, and with it we can begin at the base of any
cavity, and with mallet or hand force produce a
rilling which will be one compact mass, so that it
can be cut and filed; yet in finishing, it will not bear
so severe treatment as cohesive gold. Always
handle tin foil with clean pliers, never with the
fingers; and prepare only what is needed for each
case, keeping the remainder in the book placed in
the envelope in which it is sold, otherwise extra-
neous matter collects upon it, and it will oxidize
slightly when exposed to the air for a great length
of time.

Before using tin foil, a few prefer to thoroughly
crumple it in the hands or napkin, under the im-
pression that they thus make it more pliable and
easier to manipulate.

A piece of blue litmus paper moistened and
moved over a sheet of tin foil will occasionally give
an acid reaction, probably owing to the acid with
which it is cleaned before beating not having been
thoroughly removed. Foil held under the surface
of distilled water and boiled for five minutes, then
left until the water is cold, removed and dried,
shows it has been annealed, which makes it work
easily, but not as hard a filling can be made from it
as before boiling.

36 TIN FOIL AND ITS

In selecting and using this material for filling,
we are able fully to protect the cavity; and if we
understand the material, and how to manipulate it,
we will surely succeed. This statement demands
serious attention, and appeals to every one who is
anxious to practice for the best interests of his
patients; then let us make a thorough study of the
merits of the method and material.

Until recently, the term cohesion had but one
special meaning to dentists, and that as applied to
gold for filling teeth; being understood as the prop-
erty by which layers of this metal could be united
without force so as to be inseparable. The writer
claims that good tin foil in proper condition is
cohesive when force is applied, and can be used for
filling teeth in the same manner in which cohesive
gold foil is used. This claim has been confirmed
by several dentists, as noted in another part of this
volume.

"Cohesion is the power to resist separation, and
it acts at insensible distances. The integral parti-
cles of a body are held together by cohesion, the
constituent parts are united by affinity.

The attraction between atoms of pure tin repre-
sents cohesion. Marble is composed of lime and
carbonic acid, which are united and held together
by affinity.

COMBINATIONS FOR FILLING TEETH. 37

The condition which obtains in the tin may be
called cohesion, adhesion, welding, or interdigita-
tion, but the fact remains that layers of tin foil can
be driven together into a solid mass, making a
tight filling with less malleting than is required for
gold; if it is overmalleted, the receiving surface is
injured.

On account of its pliability it is easily adapted
to the walls and margins, and a perfect fit is made,
thus preventing capillary action and preventing
further caries. Of all the metals used for filling
it is the best tooth-preserver and the most com-
patible with tooth-substance, and the facility with
which a saving filling can be made largely com-
mends it.

Tin has great possibilities, and has already
gained a high position as a filling-material. Upon
the knowledge we possess of the possibilities and
limitations of tin as a filling-material, and our abil-
ity to apply that knowledge, will largely depend
our success in preserving teeth.

It is a good material for filling many cavities in
the temporary teeth, and children will bear having
it used, because it can be placed quickly, and but
little force is required to condense one or two layers
of No. 10 foil. The dentin in young teeth has a
large proportion of organic material, for which

38 TIN FOIL AND ITS

reason, if caries takes place, many believe it is
hastened by thermal changes. Gold fillings in
such teeth might prevent complete calcification, on
account of the gold being so good a conductor; but
if tin is used, there is much more probability of cal-
cification taking place, because of its low conduc-
tivity and its therapeutic influence. It does not
change its shape after being packed into a cavity.
Under tin, teeth are calcified and saved by the
deposit of lime-salts from the contents of the den-
tinal tubuli. This is termed progressive calcifica-
tion.

Like other organs of the human body, the teeth
are more or less subject to constitutional change.
The condition in which we find tooth-structure
which needs repairing or restoring should be a sure
indicator to us in choosing a filling-material. Up
to the age of fourteen, and sometimes later, we find
many teeth which are quite chalky. In some
mouths also, at this period, the fluids are in such a
condition that oxychlorid and oxyphosphate do not
last long; for some reason amalgam soon fails,
while gutta-percha is quickly worn out on an oc-
clusal surface. In all such cases we recommend
tin, even in the anterior teeth, for as the patient
advances in years the tooth-structure usually be-
comes more dense, so that, if desirable, the fillings

COMBINATIONS FOR FILLING TEETH. 39

can be removed, and good saving operations can be
made with gold. By treating cases in this manner
very little, if any, tooth-structure is lost.

The teeth of the inhabitants of Mexico and
Guatemala are characteristic of their nervous and
nervo-lymphatic temperaments; children ten years
of age often have twenty-eight permanent teeth,
and they are generally soft or chalky, but our
dentists there report good success in saving them
with tin.

In filling this class of teeth, we should be very
careful not to use force enough to injure the cavity-
margin, for if this occurs, a leaky filling will proba-
bly be the result. Still, we have seen some cases
where sligJit imperfections at the margin, which
occurred at the time of the filling or afterward, did
no harm, because the deposit of tin oxid filled up
the ends of the tubuli, thus preventing caries. We
believe that this bar to the progress of caries is set
up more frequently when tin is used than with any
other metal under like conditions.

4O TIN FOIL AND ITS

CHAPTER V.

IN some mouths tin does not discolor, but retains
a clean, unpolished tin color, yet when there is a
sesquioxid of the metal formed, fillings present a
grayish appearance. In the same mouth some
fillings will be discolored, while others are not. As
a general rule, proximal fillings are most liable to
show discoloration. Perhaps one reason is that on
occlusal and buccal surfaces they are subject to
more friction from mastication, movements of the
cheeks, and the use of the brush.

We have seen a large number of fillings which
were not blackened, yet were saving the teeth per-
fectly, thus proving to a certainty that blackening
of tin in the tooth-cavity is not absolutely essential
in order to obtain its salvatory effects as a filling-
material.

Where there is considerable decomposition of
food which produces sulfuretted hydrogen, the
sulfid of tin may be focmed on and around the
fillings; it is of a yellowish or brownish color, and
as an antiseptic is in such cases desirable. To offset
the discoloration, we find that the sulfid is insol-
uble, and fills the ends of the tubuli, thus lending its
aid in preventing further caries. A sulfid is a com-

COMBINATIONS FOR FILLING TEETH. 4!

bination of sulfur with a metal or other body. A
tin solution acted on by sulfuretted hydrogen
(H2S) produces a dark-brown precipitate (SnS),
stannous salt, which is soluble in ammonium sulfid
(NH4)2 S2; this being precipitated-, gives (SNS2)
stannic salt, which is yellow. Brown precipitates
are formed by both hydrogen sulfid and ammonium
sulfid, in stannous solutions. Yellow precipitates
are formed by hydrogen sulfid and ammonium
sulfid in stannic solutions. The yellow shade is
very seldom seen on tin fillings; the dark brown is
mo-re common.

An oxid is a combination of oxygen with a metal
or base destitute of an acid. In oxidation the oxy-
gen that enters into combination is not sufficient to
form an acid. The protoxid of tin (SnO) is black,
and can be obtained from chlorid of tin, or by long
exposure of tin to the atmosphere. The oxygen in
the saliva helps to blacken the tin, and the metallic
oxid penetrates the dentin more or less, acting as
a protection, because it is insoluble. Oxygen is
the only element which forms compounds with all
others, and is the type of electro-negative bodies;
it combines with all metals, therefore with tin, and
in many cases only the metal is discolored, and not
the tooth. Steam boilers are made tight by oxi-
dation.

42 TIN FOIL AND ITS

Where there is complete oxidation, the tooth is
blackened to but a very slight depth, and the oxid
fills the ends of the tubuli, thus affording an addi-
tional barrier to the entrance of caries. The filling
itself will prevent caries, but oxidation acts as an
assistant.

"In the mouth, a suboxid is more likely to be
formed than a protoxid, but both are black; sulfur
and oxygen are capable of acting on tin under
favorable circumstances, such as warmth, moisture,
full contact, condensation of elements, and their
nascent conditions; the first three are always pres-
ent in the mouth. The protosulfuret of tin is
black." (Dr. George Watt.) Others give the
color as bluish-gray, nearly black.

Experiments show that slight galvanic currents
exist between fillings of dissimilar metals in the
mouth, and practical experience demonstrates that
these currents occasionally produce serious results.

Direct galvanic currents do not decompose nor-
mal teeth by true electrolysis, but acids resulting
from decomposition of food and fluids react up'on
the lime constituents of the teeth and promote sec-
ondary caries.

When two metals are so situated in the mouth
that the mucous membrane forms a connecting
conductor and the fluids are capable of acting on

COMBINATIONS FOR FILLING TEETH. 43

one metal, galvanic action is established sufficient
to decompose any of the binary compounds con-
tained in these fluids; the liberated nitrogen and
hydrogen form ammonia, which being exposed to
the action of oxygen is decomposed and nitric oxid
formed, resulting in nitric acid. We also have in
the mouth air, moisture, and decomposing nitro-
genous food to assist in the production of nitric
acid.

"Galvanic action is more likely to develop hydro-
chloric acid, for the chlorids of sodium and potas-
sium are present in the normal saliva and mucus,
and when decomposed their chlorin unites with the
hydrogen derived from the water of the saliva."
(Dr. George Watt.)

The fact should also be noted that both nitric and
hydrochloric acids are administered as medicine,
and often assist in producing decay.

When there is a battery formed in a mouth con-
taining tin fillings and gold fillings, and the fluids
of the mouth are the exciting media, tin will be
the positive element and gold the negative element;
thus when they form the voltaic pair, the tin be-
comes coated or oxidized and the current prac-
tically ceases.

There is more or less therapeutical and chemical
action in cavities filled with tin, and its compati-

44 TIN FOIL AND ITS

bility and prophylactic behavior as a filling-material
depends partly upon the chemical action which
occurs.

Some dentists fill sensitive cavities with tin, in
order to secure gentle galvanic action, which they
believe to be therapeutic, solidifying the tooth-
structure.

"Tin possesses antiseptic properties which do not
pertain to gold for arresting decay in frail teeth; it
not only arrests caries mechanically, but in chalky
(imperfect) structure acts as an antacid element in
arresting the galvanic current set up between the
tooth-structure and filling-material." (Dr. S. B.
Palmer.) If the metal is acted on, the tooth is
comparatively safe; if the reverse, it is more or less
destroyed. The galvanic taste can be produced by
placing a piece of silver on the tongue and a steel
pen or piece of zinc under it; then bring the edges
of the two pieces together for a short time, rinse
the saliva around in the mouth, and the peculiar
flavor will be detected.

"In 1820 attention was called to the injurious
effects of the galvanic current on the teeth, and
dentists were advised never to use tin and amalgam
in the same mouth.

"A constant galvanic action is kept up in the
mouth when more than one kind of metal is used

COMBINATIONS FOR FILLING TEETH. 45

in filling teeth, and galvanism is often the cause of
extensive injury to the teeth. The most remark-
able case I ever saw was that of a lady for whom
I filled several teeth with tin. After a time decay
took place around some of the fillings. I removed
them and began to refill, but there was so much
pain I could not proceed. I found that by holding
a steel plugger an inch from the tooth I could give
her a violent galvanic shock. I observed that the
exhalation of the breath increased the evolution of
galvanism." (Dr. L. Mackall, American Journal
of Dental Science, 1839.)

"When a faulty tooth in the upper jaw had been
stopped from its side with tin, the interstice be-
tween it and the adjoining tooth being quite incon-
siderable, while the upper surface of a tooth not
immediately beneath it in the lower jaw was
stopped with the same metal, I have known a gal-
vanic shock regularly communicated from one
tooth to the other, when by the movement of jaws
or cheeks they were brought near together." (Dr.
E. Parmly, American Journal of Dental Science,

'An interesting debate here sprung up on the
action where two metals are used in one filling,
such as gold and tin, the saliva acting as a medium,
and where the baser metal is oxidized by exhalents

46 TIN FOIL AND ITS

and by imbibition through the bony tooth-struc-
ture." (Pennsylvania Society of Dental Surgeons,
1848.)

"A patient came to me and complained of pain
in the teeth. Upon examination I found an amal-
gam filling next to one of tin. With a file I
made a V-shaped separation, when they experi-
enced immediate relief from pain." (Dr. Nevill,
American Journal of Dental Science, 1867.)

In regard to the decay of teeth being dependent
on galvanic action present in the mouth, Dr. Chase,
in 1880, claimed that a tooth filled with gold would
necessarily become carious again at the margin of
the cavity, wherever the acid secretions constantly
bathe the filling and tooth-substance. A tooth
filled with amalgam succumbs to this electro-chemi-
cal process less rapidly, while one filled with tin
still longer escapes destruction. The comparative
rapidity with which teeth filled with gold, amalgam,
or tin, are destroyed is expressed by the numbers
100, 67, 50. He prepared pieces of ivory of equal
shape and size, bored a hole in each, and filled them.
After they had been exposed to the action of a'n
acid for one week, they had decreased in weight, —
viz, piece filled with gold, 0.06; amalgam, 0.04;
tin, 0.03.

"With tin and gold, some have the superstition

COMBINATIONS FOR FILLING TEETH. 47

that the electricity attendant upon such a filling will
in some way be injurious to the tooth; it matters
not which is on the outside, when rolled and used as
non-cohesive cylinders each appears. We say that
neither experimentally, theoretically, nor prac-
tically can any good or bad result be expected from
the electrical action of a tin-gold filling on tooth-
bone, and neither will the pulp be disturbed."
(Dr. W. D. Miller, Independent Practitioner, August,
1884.)

"When the bottom of a cavity is filled with tin
which is tightly (completely) covered with gold,
there is practically no galvanic action and there is
no current generated by contact of tin and gold, —
i.e., no current leaves the filling to affect the dentin.
That portion of tin which forms the base is more
positive than a full tin filling would be. The effect
is to cause the surface exposed to dentin to oxidize
more than tin would do alone; in that there is a
benefit. In very porous dentin there is enough
moisture to oxidize the tin, by reason of the current
set up by the gold." (Dr. S. B. Palmer.)

Electricity generated by heat is called thermo-
electricity. If a cavity with continuous walls is
half filled with tin and completed with gold, or half
filled with silver and completed with gold, and the
junctions of the metal are at 2o|° C. and 19!° C.,

48 TIN FOIL AND ITS

if the electrical action between the tin and gold be
i.i, the action between the silver and gold will be
1.8, thus showing the action in silver and gold to be
nearly two-thirds more than in the tin and gold, a
deduction which favors the tin and gold.

Rubbing two different substances together is a
common method of producing an electric charge.
Is there not more electricity generated during mas-
tication on metal fillings than when the jaws are at
rest? Friction brings into close contact numerous
particles of two bodies, and perhaps the electrical
action going on more or less all the time through
gold fillings (especially when other metals are in
the mouth) accounts for a powdered condition of
the dentin which is sometimes found under cohe-
sive gold fillings, but not under tin.

COMBINATIONS FOR FILLING TEETH. 49

CHAPTER VI.

WHITE caries, the most formidable variety
known, may be produced by nitric acid, and in
these cases all the components of the tooth are
acted upon and disintegrated as far as the action
extends. In proximal cavities attacked by this
kind of caries, separate freely on the lingual side,
and fill with tin. When such fillings have been re-
moved the dentin has been found somewhat dis-
colored and greatly solidified as compared to its
former condition; this solidification or calcification
is more frequent under tin than gold, which is
partly due to the tin as a poor conductor of heat.
Nature will not restore the lost part, but will do the
next best thing — solidify the dentin. In some
cases, under tin, the pulp gradually recedes, and
the pulp-cavity is obliterated by secondary dentin.
In other cases the pulps had partly calcified under
tin. It has been known for years that tin would be
tolerated in large cavities very near the pulp with-
out causing any trouble, and one reason for this is
its low conducting power. Attention is called to
the fact that gold is nearly four times as good a
conductor of heat as tin, and more than six times
as good a conductor of electricity. Where tin fill-

5

5<D TIN FOIL AND ITS

ings are subject to a large amount of attrition, they
wear away sooner or later, but this is not such a
great detriment, for they can easily be repaired or
replaced, and owing to the concave form produced
by wear the patient is liable to know when a large
amount has been worn away. That portion against
the wall of the cavity is the last removed by wear,
so that further caries is prevented so long as there
is any reasonable amount of tin left. If at this time
the tooth has become sufficiently solidified, proper
anchorage can be cut in the tin or tooth, one or
both, as judgment dictates, and the filling com-
pleted with gold. A tin filling, confined by four
rather frail walls, may condense upon itself, but it is
so soft and adaptable that the force which con-
denses it continually secures the readaptation at
the margin; thus there will be no leakage or caries
for years. Owing to its softness and pliability, it
may be driven into or onto the tubuli to completely
close them from outside moisture, and with a hand
burnisher the tin can be made to take such a hold
on dry, rough tubuli that a cutting instrument is
necessary to remove all traces of it.

Tin foil has been found in the market that under
a magnifying glass showed innumerable tiny black
specks, which, upon being touched with an instru-
ment, crumbled away, leaving a hole through the

COMBINATIONS FOR FILLING TEETH. £1

foil. More than likely, some of the failures can be
attributed to the use of such foil. Good tough foil,
well condensed by hand or mallet force, stays
against the walls of a cavity and makes a tight fill-
ing, and ought to be called as near perfect as any
filling, because it preserves the tooth, and gives a
surface which will wear from five to twenty years,
depending upon the size and location of the cavity
and tooth-structure. Buccal cavities in the first
permanent molars, and lingual cavities in the supe-
rior incisors, filled for children from six to eight
years of age, are still in good condition after a
period of twenty years. Perhaps the limit is
reached in the following cases, all in the mouths of
dentists: One filling forty years old; one forty-two;
four on the occlusal surface, fifty; in the latter case
gold had been used in other cavities and had failed
several times. Lingual cavities in molars and
bicuspids can be perfectly preserved with tin.
Tapes of No. 10 foil, from one to three thicknesses,
can be welded together and will cohere as well or
better than semi-cohesive gold foil, and it can be
manipulated more rapidly; therefore, if desirable,
any degree of contour can be produced, but the
contour will not have the hardness or strength of
gold, so in many cases it would not be practicable

52 TIN FOIL AND ITS

to make extensive contours with tin, owing to its
physical characteristics.

No. 10 will answer for all cases, and it is not as
liable to be torn or cut by the plugger as a lower
number, but one need not be restricted to it, as
good fillings can be made with Nos. 4, 6, or 8.
More teeth can be saved with tin than with any
other metal or metals, and the average dentist will
do better with tin than with gold. It is invaluable
when the patient is limited for time or means, and
also for filling the first permanent molars, where we
so often find poor calcification of tooth-structure.
In cases of orthodontia, where caries has attacked
a large number of teeth, it is well to fill with tin,
and await further developments as to irregularity
and caries.

If cavities are of a good general retaining form,
that will be sufficient to hold the filling in place;
but if not, then cut slight opposing angles, grooves,
or pits. Cavities are generally prepared the same
as for gold, except where there is a great deal of
force brought upon the filling; then the grooves or
pits may be a little larger; still, many cavities can be
well filled with less excavating than required for
gold, and proximal cavities in bicuspids and
molars, where there is sufficient space, can be filled
without removing the occlusal surface, and here

COMBINATIONS FOR FILLING TEETH. 53

especially should the cavities be cut square into the
teeth, so as not to leave a feather edge of tin when
the filling is finished, as that would invite further
caries and prove an obstruction to cleansing the
rilling with floss.

In proximal cavities involving the occlusal sur-
face, cut the cervical portion down to a strong
square base, with a slight pit, undercut, or angle, at
the buccal and lingual corners; where there is suffi-
cient material, a slight groove across the base, far
enough from the margin so that it will not be
broken out, can be made in place of the pit, under-
cut, or angle; then cut a groove in the buccal and
lingual side (one or both, according to the amount
of material there is to work upon), extending from
the base to the occlusal surface; in most of these
cases the occlusal grooves or pits would have to be
excavated on account of caries; thus there would
be additional opportunity for anchorage. In place
of the grooves the cavity may be of the dovetail
form. In nearly all proximal cavities in bicuspids
and molars, some form of metal shield, or matrix, is
of great advantage, as they prevent the tin from
crushing or sliding out. By driving the tin firmly
against the metal, a well-condensed surface is se-
cured; and as the metal yields a little, we can with a
bevel or thin plugger force the tin slightly between

54 TIN FOIL AND ITS

the metal and the margin of the cavity, thus making-
sure of a tight rilling, with plenty of material to
finish well. After removing the metal, condense
with thin burnishers and complete the finish the
same as for gold. Where no shield or matrix is
used, or where it is used and removed before com-
pleting the filling, it is often desirable to trim the
cervical border, for in either case there is more
light and room to work when only a portion of the
cavity has been filled. Tin cuts so much easier
than gold, it is more readily trimmed down level
with all cervical margins.

Be sure that all margins are made perfect as the
work progresses, and if the cavity is deep and a
wide shield shuts out the light, then use a narrow
one, which can be moved toward the occlusal sur-
face from time to time.

In filling the anterior teeth when the labial wall
is gone, and the lingual wall intact or nearly so,
use a piece of thin metal three-quarters of an inch
long and wide enough to cover the cavity in the
tooth to be filled, insert it between the teeth, and
bend the lingual end over the cavity; the labial end
is bent out of the way over the labial surface of the
adjoining tooth, as shown in Fig. 4. When the
labial wall is intact or nearly so, access to the cavity
should be obtained from the lingual side, and in

COMBINATIONS FOR FILLING TEETH. 55

this case the bending of the shield would be re-
versed, as shown in Fig. 5. The shield is not abso-
lutely essential, but it helps support the tin, and
also keeps a separation.

It is preferable to save the labial wall and line it
with (say) five layers of No. 4 semi-cohesive gold

FIG. 4.

FIG 5.

folded into a mat and extended to the outer edge
of the cavity; this gives the tooth a lighter shade,
and bicuspids or molars can be filled in the same
manner. Cases are on record where incisors with
translucent labial walls, filled by this method, have
lasted from twenty-three to thirty-seven years.

TIN FOIL AND ITS

CHAPTER VII.

FOR the last ten years the writer has been using
tin at the cervical margin of proximal cavities in
bicuspids and molars, especially in deep cavities
(now an accepted practice), and he finds that it
prevents further caries oftener than any other metal
or combination of metals he has ever seen used.
In filling such cavities, adjust the rubber, and use
a shield or matrix of such form as to just pass be-
yond the cervical margin; this will generally push
the rubber out of the cavity, but if it does not, then
form a wedge of wood and force between the metal
and the adjoining tooth, thus bringing the metal
against the cervical margin, and if a small film of
rubber should still remain in the cavity, it may be
forced out by using any flat burnisher which will
reach it, or it can be dissolved out with a little chlo-
roform. Fill from one-fourth to one-half of the
cavity with tin, and complete the remainder with
gold when the tooth is of good structure; this gives
all the advantages of gold for an occlusal surface.

Before beginning with the gold, have the tin
solid and square across the cavity, and the rest of
the cavity a good retaining form, the same as for
gold filling; then begin with a strip of gold slightly

COMBINATIONS FOR FILLING TEETH. 57

annealed and mallet it into the tin, but do not place
too great reliance upon the connection of the
metals to keep the filling in place.

On the same plan, proximal cavities in the an-
terior teeth can be filled, and also buccal cavities in
molars, especially where they extend to the occlusal
surface. The cervical margin should be well cov-
ered with tin thoroughly condensed, thus securing
perfect adaptation, and a solid base for the gold
with which the filling is to be completed. Time
has fully demonstrated that the cervical margin is
most liable to caries, and here the conservative and
preservative qualities of tin make it specially appli-
cable.

"Electrolysis demonstrates to us that no single
metal can be decomposed, but when gold and tin
are used in the above manner they are united at
the line of contact by electrolysis. The surface of
both metals is exposed to the fluids of the mouth,
and the oxid of tin is deposited on the tin, by reason
of the current set up by the gold; thus some atoms
of tin are dissolved and firmly attached to the gold,
but the tin does not penetrate the gold to any great
extent." (Dr. S. B. Palmer.)

This connection of the metals assists in holding
the filling in place, but it is more likely to break
apart than if it was all gold. After electrolysis has

58 TIN FOIL AND ITS

taken place at the junction, it requires a cutting
instrument to completely separate the tin and gold.

For filling by hand pressure, use instruments
with square ends and sides, medium serrations, and
of any form or size which will best reach the cavity.

For filling with the hand mallet, use instruments
with medium serrations, and a steady medium blow
with a four-ounce mallet; in force of blow we are
guided by thickness of tin, size of plugger, and
depth of serrations, strength of cavity-walls and
margins, the same as in using gold. The majority
of medium serrated hand mallet pluggers will work
well on No. 10 tin of one, two, or three thicknesses.
If the tin shows any tendency to slide, use a more
deeply serrated plugger. The electro-magnetic,
and mechanical (engine) mallet do not seem to
work tin as well as the hand mallet or hand force, as
the tendency of such numerous and rapid blows is
to chop up the tin and prevent the making of a solid
mass, and also injure the receiving surface of the
filling. In using any kind of force, always aim to
carry the material to place before delivering the
pressure, or blow.

In order to obtain the best results, there must be
absolute drvness, and care must be exercised, not
thinking that because it is tin it will be all right.
Skill is required to make good tin fillings, as well

COMBINATIONS FOR FILLING TEETH. 59

as when making good gold fillings. Always use
tapes narrower than the orifice of the cavity; they
are preferable to rolls or ropes. After a few trials it
is thought that every one will have the same opin-
ion. A roll or rope necessarily contains a large
number of spaces, wrinkles, or irregularities, which
must be obliterated by using force in order to pro-
duce a solid filling; thus more force is employed,
and more time occupied in condensing a rope, than
a flat tape; the individual blow in one case may not
be heavier than in the other, but the rope has to be
struck more blows. The idea that a rope could be
fed into a cavity with a plugger faster and easier
than a tape has long ago been disproved. Many
of the old-fashioned non-cohesive gold foil op-
erators used flat tapes, as did also Dr. Varney, one
of the kings of modern cohesive gold operators.

The tape is made by folding any portion of a
sheet of foil upon itself until a certain width and
thickness is obtained. This tape is very desirable
in small or" proximal cavities where a roll or rope
would catch on the margin and partially conceal
the view.

In the form of a tape, perhaps more foil can be
put in a cavity, and there may be more uniform
density than when ropes are used. Tapes can also
be made by folding part of a sheet of foil over a

6O TIN FOIL AND ITS

thin, narrow strip of metal. Fold the tin into tapes
of different lengths, widths, and thicknesses, ac-
cording to the size of the cavity; then fold the end
of the tape once or twice upon itself, place it at the
base of any proximal cavity, and begin to con-
dense with a foot plugger of suitable size, and if
there is a pit, groove, or undercut which it does
not reach, then use an additional plugger of some
other form to carry the tin to place; fold the tape
back and forth across the cavity, proceeding as for
cohesive gold. In small proximal cavities a very
narrow tape of No. 10, one thickness, can be used
successfully. For cavities in the occlusal surface,
use a tape as just described, generally beginning at
the bottom or distal side, but the filling can be
started at any convenient place, and with more ease
than when using cohesive gold. In any case if the
tin has a tendency to move when starting a filling,
"Ambler's left-hand assistant" is used, by slipping
the ring over the second finger of the left hand,
letting the point rest on the tin. This instrument
is especially valuable in starting cohesive gold (see
Fig. 6). This is the easiest, quickest, and best
manner of making a good filling, relying upon the
welding or cohesive properties of the tin.

Many operators have not tried to unite the tin
and make a solid mass; they seem to think that it

COMBINATIONS FOR FILLING TEETH. 6l

cannot be accomplished, but with proper pluggers
and manipulation it can be done successfully.

For large occlusal or proximal cavities, the
tapes may be folded into mats, or rolled into cylin-
ders, and used on the plan of wedging or interdigi-
«tation, and good fillings can be produced by this
method, but the advantage of cohesion is not ob-
tained, and more force is required for condensing.
They are, therefore, not so desirable as tapes, espe-
cially for frail teeth. When using mats or cylin-

FIG. 6.

ders, the general form of the cavity must be de-
pended upon to hold the filling in place. To make
the most pliable cylinders, cut a strip of any desired
width from a sheet of foil and roll it on a triangular
broach, cutting it off at proper times, to make the
cylinders of different sizes.

A cylinder roller, designed by the author, is
much superior to a broach. (See Fig. 7.) When
the cavity is full, go over the tin with a mallet or
hand burnisher, being careful not to injure the cav-

62' TIN FOIL AND ITS

ity-margin. Cut down occlusal fillings with burs or
carborundum wheels, and proximal fillings with
sharp instruments, emery strips or disks. After
partially finishing, give the filling another con-
densing with the burnisher, then a final trimming
and moderate burnishing; by this method a hard,
smooth surface is obtained.

Fillings on occlusal surfaces can be faced with
No. 20 or 30 tin, and burnished or condensed, by
using a burnisher in the engine, but do not rely
upon the burnisher to make a good filling out of a
poor one.

FIG. 7.

By trimming fillings before they get wet, any
defects can be remedied by cutting them out; then
with a thin tape (one or two layers of No. 10) and
serrated plugger proceed with hand or mallet force
to repair the same as with cohesive gold.

Another method of preparing tin for fillings is
to make a flat, round sand mold; then melt chem-
ically pure tin in a clean ladle and pour it into the
mold; put this form on a lathe, and with a sharp
chisel turn off thick or thin shavings, which will

COMBINATIONS FOR FILLING TEETH. 63

be found very tough and cohesive when freshly cut,
but they do not retain their cohesive properties
for any great length of time, — perhaps ten or
twenty days, if kept in a tightly corked bottle.
After more or less exposure to the air they become
oxidized and do not work well, but when they are
very thin they are soft, pliable, and cohesive as
gold, and any size or form of filling can be made
with them.

Among the uses of tin in the teeth, the writer
notes the following from Dr. Herbst, of Germany:
"After amputating the coronal portion of the pulp,
burnish a mat of tin foil into the pulp-cavity, thus
creating an absolutely air-tight covering to the
root-canal containing the remainder of the pulp;
this is the best material for the purpose." There
has been a great deal said about this method, pro
and con, notably the latter. The writer has had no
practical experience with it, and it need not be
understood that he indorses it.

If a pulp ever does die under tin, perhaps it will
not decompose as rapidly as it otherwise would,
owing to its being charged with tin-salts.

The Herbst method of filling consists in intro-
ducing and condensing tin in cavities by means of
smooth, highly tempered steel engine or hand bur-
nishers. In the engine set of instruments there is

64 TIN FOIL AND ITS

one oval end inverted cone-shaped, one pear-
shaped, and one bud-shaped. The revolving bur-
nisher is held firmly against the tin, a few seconds
in a place, and moved around, especially along the
margins, not running the engine too fast. Compli-
cated cavities are converted into simple ones by
using a matrix, and proximal cavities in bicus-
pids and molars are entered from the occlusal sur-
face. The tin foil is cut into strips, and then made
into ropes, which are cut into pieces of different
lengths; the first piece must be large enough so
that when it is condensed it will lie firmly in the
cavity without being held; thus a piece at a time
is added until the cavity is full. The hand set of
burnishers has four which are pear-shaped and vary
in size, and one which is rather small and roof-
shaped. In filling and condensing they are rotated
in the hand one-half or three-quarters of a turn.

Dr. Herbst claims a better adaptation to the
walls of the cavity than by any other method.
Proximal cavities in bicuspids and molars can easily
be filled; the tin can be perfectly adapted against
thin walls of enamel without fracturing them; less
annoyance to the patient and less work for the
dentist; can be done in half the time required for
other methods.

Fees should be reasonably large, certainly more

COMBINATIONS FOR FILLING TEETH. 65

than for amalgam, for we can save many teeth for
a longer time than they could have been preserved
with cohesive gold. Many are not able to pay for
gold, but they want their teeth rilled and saved, and
it is expected that we will do it properly and with
the right kind of material; thus it is our duty in
such cases to use more tin and less amalgam.

We should always take into consideration the
amount of good accomplished for the patient, — the
salvation of the tooth, — and if we are sure, from. ex-
perience and observation, that the tin filling will
last as long as a gold one in the same cavity, or
longer, then the fee should be as much as for gold,
with the cost of the gold deducted. The amount
of the fee ought to be based upon the degree of
intelligence, learning, and skill required; upon the
amount of nervous energy expended; upon the
draft made on the dentist's vitality; upon what
benefit has been given the patient; upon the perfec-
tion of the result; and, everything else being equal,
-upon the time occupied; the value of this last factor
being estimated in proportion to the shortness of it.

66 TIN FOIL AND ITS

CHAPTER VIII.

DR. ROBINSON'S Fibrous and Textile Metallic
Filling is a shredded metallic alloy, mostly tin, and
has the appearance of woven or felt foil. It is pre-
pared in a machine invented by the doctor espe-
cially for the purpose, and he gives directions for
using as follows: "Cut the material into strips
running with the selvage, and fill as you would with
soft foil; use it in all surrounding walls, and finish
with a mallet burnisher. Where the surface comes
to hard wear, weld on gold with long, sharp ser-
rated pluggers, and finish the same as with gold
fillings. The advantage over gold for cervical,
buccal, and lingual walls is the perfect ease with
which it is adapted, and it can be burnished so as
to be absolutely impervious to moisture. Sharp,
coarse-serrated pluggers are particularly desirable
when using hand pressure." It conies in one-half-
ounce boxes, filled with sheets less than two inches
square; the thin ones are used for filling, and the
thick ones make good linings for vulcanite.

This material is easy to manipulate, but great
care is required in condensing at cavity-margins,
so as to make a tight filling, and also not injure the
margins. It makes as hard a surface as tin foil, and

COMBINATIONS FOR FILLING TEETH. 67

can be cut, polished, and burnished so that it is
smooth and looks well; it can be used in temporary
or chalky teeth, as a small amount of force con-
denses it. By using a matrix proximal cavities
can be filled from one-fourth to one-half full, and
the rest filled with gold, relying on the form of the
cavity to hold the gold, regardless of its connection
with the fibrous material. If the surface is not
overmalleted so as to make it brittle or powdery, a
strip of No. 4 cohesive gold, of four or five thick-
nesses, may be driven into it with a hand mallet and
plugger of medium serrations; this union is largely
mechanical, but of sufficient tenacity to make
manipulation easy, as the material makes a solid
foundation to build upon. After exposure to the
oral fluids, electrolysis takes place at the junction
of the metals.

In 1884 Dr. Brophy said, "I have used Robin-
son's material for two years, and find it possesses
good qualities, and can be used in deciduous teeth,
first permanent molars, and cervical margins with
better results than can be obtained with any other
material by the majority of operators."

"Malleted with deeply serrated pluggers, it will
make a filling which will not leak. It has saved
many teeth from caries at the cervical margin
where it might have recurred sooner had cohesive

68 TIN FOIL AND ITS

gold been used. In the mouth it changes color
about the same as tin foil, and a few fillings did not
maintain their integrity, but became crumbly and
granular.

For conducting properties it ranks about with
tin, and fillings can be made more rapidly than with
cohesive gold. We have used ounces of it, but
time has proved that everything that can be done
with it in filling teeth can also be accomplished as
well and in some cases better with tin foil.

In 1878 Dr. N. B. Slayton patented his Felt Foil,
which was said to be tin cut into hair-like fibers by
a machine, then pressed into small sheets and sold
in one-half-ounce books, but it sold only to a very
limited extent. Soon after this Dr. Jere Robin-
son, Sr., invented a machine and began the manu-
facture of a similar article, but he found he was
infringing on the Slayton patent, so he purchased
the Slayton machine and made satisfactory terms
to continue his own maunufacture of fibrous mate-
rial. After this little was heard of Slayton's Felt
Foil, but Robinson's was considerably used. The
two materials look and are manipulated almost
exactly alike. Dr. Robinson has both of above-
mentioned machines now in his possession.

Archibald McBride, of Pittsburg, Pa., in 1838,
made a roll of a portion of a sheet of tin, and then

COMBINATIONS FOR FILLING TEETH. 69

used just enough gold to cover it, aiming to keep
the gold on the surface, so as to have the filling
look like one of all gold, and not with the idea of
deriving any special benefit from the effects of wear
or preservation as obtained by thus combining the
two metals. The fee for a gold filling was one
dollar; tin, fifty cents. Some operators have advo-
cated using tin and gold (symbol Tg), rolled or
folded together in alternate layers, thus exposing
both metals to the fluids of the mouth; claiming
that fillings can be made quicker, are not so subject
to thermal changes, and can be inserted nearer the
pulp than when gold is used. This may be true
in comparison with gold, but these three claims are
entirely met by using tin alone. Others say that
this union of gold and tin will preserve the teeth as
well as a correct gold filling, making no conditions
or restrictions as to tooth-structure or location of
cavity. They say that it preserves the cervical
margin better than gold; that it expands slightly.

A description of some different methods of com-
bining and manipulating tin and gold is subjoined:

(a) Two sheets of No. 4 cohesive gold and one
of the same number of tin are used; place the tin
between the gold, cut off strips, and use with hand
or mallet force the same as cohesive gold; if non-
cohesive gold is used, the strips can be folded into

7O TIN FOIL AND ITS

mats or rolled into cylinders, and are used on the
wedging plan, the same as non-cohesive gold, or
the strips can be folded back and forth in the cavity
until it is full.

(b) Lay a sheet of non-cohesive gold, No. 3, on
a sheet of tin of the same number, cut off strips, roll
into ropes and use as non-cohesive gold. It is
easily packed and harder than tin, and has a pre-
servative action on the teeth. Line the cavity with
chloro-balsam as an insulator against possible cur-
rents and moisture; especially should this be done
in large cavities or chalky teeth.

(c) A sheet of non-cohesive gold, No. 4, is laid
on a sheet of tin of the same number, cut into strips
and rolled into cylinders, or folded into blocks,
always in equal portions; then they will unite to the
extent of two leaves. These fillings sometimes
become a solid mass about the color of amalgam,
and last very well, as the metals have become united
by electrolysis. An excess of tin will be marked by
lines or pits in the filling, showing where the tin
has been disintegrated or dissolved by the chem-
ical action which occurs on the surface exposed to
moisture.

No doubt, good fillings have been made by the
above methods, yet some were granular, gritty, and
were easily removed, while others were quite

COMBINATIONS FOR FILLING TEETH. /I

smooth and hard; probably in the first instance the
proportion of tin and gold was not proper, — that is,
not equal; or it was not well condensed. Tin being
the positive element, it is more easily acted on and
disintegrated by electrolysis (chemical action of the
fluids).

When this combination does become hard, it
wears longer than tin on an occlusal surface, but
we believe that in some cases where it was used the
teeth could have been saved just as well with either
tin or gold, or by filling part of the cavity with tin
and the rest with gold.

If tin foil is laid on 22-carat gold and vulcanized,
it becomes thoroughly attached and will take a
tin polish; the attraction or interchange of atoms
takes place to this extent.

This combination of tin and gold can be used at
the cervical margin, or a cavity can be lined with it,
and the remainder filled with cohesive or non-
cohesive gold.

"Tin and gold (Tg) folded or rolled together in
equal portions possesses a greater number of desir-
able properties than any other material, for it is
easily adapted, has antiseptic action and a lower
conductivity than gold. A new filling is harder
than tin, softer than gold, but after a time it be-
comes as hard as amalgam. It oxidizes and thus

72 TIN FOIL AND ITS

helps make tight margins, and is very useful at cer-
vical margins; generally discolors, but not always,
and does not discolor the tooth unless a carious
portion has been left, and then only discolors that
portion. In oral fluids it is indestructible if well
condensed, otherwise it is crumbly. There is no
change of form, except a slight expansion, which
does no harm. A weak electric current is set up
between the gold and tin, and tin oxid is formed.
The hardening and discoloration both depend upon
the separation of the tin by the electrical action and
its deposition on the surface of the gold. I gen-
erally prepare cavities the same as for non-cohesive
gold, but a Tg filling may be held in a more shallow
cavity and with less undercuts than for gold.
Hand pressure is adopted, but a mallet may be
used advantageously. Lay a sheet of No. 4 non-
cohesive gold on a sheet of No. 4 tin, then cut into
strips and twist into ropes; keep the tin on the out-
side, for it does not tear as easily as gold. Carry
the material against the walls and not against the
base, otherwise the filling will be flat or concave;
but should this occur, then- force a wedge-shaped
plugger into the center of the filling, and drive the
material toward the walls, and then fill the hole or
remove all the filling and begin anew.

"In very deep cavities use a mat of Tg, damp-

COMBINATIONS FOR FILLING TEETH. 73

ened in carbolic acid and dipped in powdered
thymol, as a base; this has an antiseptic action, and
also prevents pressure on or penetration into the
pulp.

"Drs. Abbot, Berlin; Jenkins, Dresden; Sachs,
Breslau, have observed tin-gold fillings from fifteen
to twenty-five years, and say that for certain cases
it is better than any other material. I use square-
pointed pluggers (four-cornered), as part of the
packing is done with the side of the plugger. Tg-
is useful in partly erupted molars, buccal cavities
under the gums, occlusal cavities in temporary
teeth, cavities where all decay cannot be removed.
Use Tg with a gold capping in small, deep occlusal
cavities, cavities with overhanging walls, occlusal
cavities with numerous fissures, large, deep occlusal
cavities near the pulp, in proximal cavities.

"Line labial walls of incisors with non-cohesive
gold, and fill the remainder with Tg. For repair-
ing gold fillings I use Tg." (Dr. Miller, Berlin,
Dental Cosmos, 1890.)

Dr. Jenkins, of Dresden, says, "I use Tg in soft,
imperfect teeth, of which there are plenty in Ger-
many, because it has pliability, adaptability, slight
susceptibility to thermal changes, makes a water-
tight joint, very useful at cervical margins, and
can be used with a minimum amount of pres-

74 TIN FOIL AND ITS

sure. When packed dry and with the gold next
to the tooth, discoloration occurs only on the sur-
face; packed wet, the whole discolors. I do not
attribute its success to electrical action. Lay a
sheet of No. 4 tin on a sheet of No. 4 non-cohesive
gold, fold so as to keep the gold on the outside; use
the strip with lateral pressure, doubling it upon
itself.''

Dr. A. H. Thompson: ''After several years'
successful use of tin-gold, I commend it for approx-
imal cavities, cervical margins, and frail walls. The
oxid formed penetrates the enamel and dentin; if a
filling wears down, cover the surface with gold."

Dr. Pearson: "I do not like tin and gold in
alternate layers. I prefer No. 10 tin foil."

Dr. James Truman: "I believe that tin-gold has
a positive value as a filling-material."

"I prepare tin-gold by taking a sheet of No. 4
non- or semi-cohesive gold, fold them together (or
twist them) so as to have the gold on the outside,
and then fill any cavity with it. Since adopting the
above combination I have almost abandoned amal-
gam. This is recommended on account of its
density, ease of insertion, capacity for fine finish,
non-conducting and non-shrinking qualities, and
compatibility with tooth-substance. Those who
have not used it will be surprised at the rapidity

COMBINATIONS FOR FILLING TEETH. 75

with which it can be manipulated. It may be em-
ployed in any cavity not exposed to view, also in
crown, buccal, and approximal fillings which ex-
tend into the occlusal surface, as it offers an aston-
ishing resistance to wear. It can be used any-
where that amalgam can, and with more certainty
of non-leakage, and it has the additional advantage
that it can be finished at the same sitting. Care is
necessary in manipulating it, so as to avoid chop-
ping. I use hand pressure when filling, and the
mallet to condense the surface." (Dr. A. W. Har-
lan, Independent Practitioner, 1884.)

''Pure tin foil is employed in connection with
non-cohesive gold in filling proximal cavities in bi-
cuspids and molars; a sheet of gold and a sheet of
tin are folded together." (C. J. Essig: "Pros-
thetic Dentistry.")

Dr. Benj. Lord says, "A combination in which I
find great interest is in the use of soft or non-cohe-
sive gold with tin foil. This is no novelty in prac-
tice, but I think that, for the most part, too great
a proportion of tin has been used, and hence has
arisen the objection that the tin dissolved in some
mouths. I am satisfied that I myself until re-
cently employed more tin than was well. I now
use from one-tenth to one-twelfth as much tin as
gold, and no disintegration or dissolving away of

76 TIN FOIL AND ITS

the tin ever occurs. I fold the two metals together
in the usual way of folding gold to form strips, the
tin being placed inside the gold. The addition of
the tin makes the gold tougher, so that it works
more like tin foil. The packing can be done with
more ease and certainty; the filling, with the same
effort, will be harder, and the edges or margins are
stronger and more perfect.

"The two metals should be thoroughly incorpor-
ated by manipulation. Then, after a time, there
will be more or less of an amalgamation. By using
about a sixteenth of tin, the color of the gold is so
neutralized that the filling is far less conspicuous
than when it is all gold, and I very often use such a
proportion of tin in cavities on the labial surfaces of
the front teeth.

"If too much tin is employed in such cases, there
will be some discoloration of the surface of the fill-
ings; but in the proportion that I have named no
discoloration occurs, and the surface of the filling
will be an improvement on gold in color."

"Dr. Howe. I would like to ask Dr. Lord
whether, in referring to the proportions of tin and
gold, he means them to be considered by weight?

"Dr. Lord. No, not by weight, but by the
width of the strip of tin and the width of the strip
of gold. I get the proportions in that way, then

COMBINATIONS FOR FILLING TEETH. *]*]

lay the tin on the gold and fold the gold over and
over, which keeps the tin inside the gold.

"Dr. Howe. Will Dr. Lord tell us whether he
refers to the same numbers of gold foil and tin foil;
as, for instance, No. 4 gold and No. 4 tin?

"Dr. Lord. I use the No. 5 gold, and tin, I
think, of about the same number, but I always use
No. 5 gold, both cohesive and non-cohesive. "-
New York Odontological Society Proceedings, 1893,
page 103.

"Tin and gold, in the proportions generally used,
do not present a pleasing color; when finished, it
looks but little better than tin, and after a short
time it grows dark, and sometimes black. I use
five parts of gold to one of tin, prepared as follows:
Lay down one sheet of Abbey's non-cohesive gold
foil, No. 6; upon this place a sheet of No. 4; upon
this place a sheet of White's globe tin foil, No. 4;
upon this another sheet of Abbey's non-cohesive
gold, No. 4; upon this a sheet of No. 6. Cut into
five strips and crimp; the crimped strips are cut into
pieces a little longer than the depth of the cavity
to be filled; some of the strips are rolled into cylin-
ders, others are left open, because easier to use in
starting a filling. The color of this combination is
slightly less yellow than pure gold, and hardens just
as rapidly as when the proportions are one to one,

78 TIN FOIL AND ITS

but does not become quite as hard. This prep-
aration is non-cohesive, and should be inserted by
the wedge process. I use it in the grinding surface
of molars and bicuspids, buccal cavities in molars
and bicuspids, cervical fissure pits in superior in-
cisors, proximal cavities in bicuspids and molars.
If proximal cavities are opened from the occlusal
surface, the last portion of the rilling should be of
cohesive gold to withstand mastication. In simple
cavities I place as many pieces as can be easily
introduced, using my pliers as the wedging instru-
ment to make room for the last pieces, and then
condense the whole. If the cavity is too deep for
this, I use Fletcher's artificial dentin as a base,
because it partly fills the cavity and the ends of the
cylinders stick to it. After an approximal cavity is
prepared, use a matrix held in place by wooden
wedges; the cylinders are about one-eighth of an
inch long, and condensed in two or three layers so
as to secure perfect adaptation; hand pressure is
principally used, but a few firm strokes with a hand
mallet are useful. When ready to add the cohesive
gold for the grinding-surface, a few pieces of
White's crystal mat gold should first be used, be-
cause it adheres beautifully; thus a perfect union is
secured, but I never risk adding the gold without
leaving a little undercut for it in the tooth. By

COMBINATIONS FOR FILLING TEETH. 79

this method we obtain a beautiful contour filling
in a short time. Fillings should be burnished and
then polished with a fine strip, or moistened pumice
on a linen tape. Where cohesive gold is used for
the entire filling, in many cases the enamel-walls,
already thin near the cervical margin, are made
thinner by the unavoidable friction of the polishing
strips, but tin and gold is so soft that a good sur-
face is obtained in a few moments, and this clanger
is reduced to a minimum. The surface is as smooth
as a cohesive gold filling, while such a surface is
impossible with non-cohesive gold. In cavities
which extend so far beyond the margin of the gum
that it is impossible to adjust the rubber-dam, I
prepare the cavity as usual, then adjust a matrix,
disinfect, dry, and fill one-third full with tin and
gold, then remove the matrix, apply the rubber,
place matrix again in position, and complete the
filling by adding a little tin and gold, then pure
gold." (Dr. W. A. Spring, Dental Review, Feb-
ruary, 1896.)

Dr. T. D. Shumway says, "To have a scientific
method of treatment, there certainly must be a
recognition of what is known of the nature of
tooth-structure. The method adopted more than
a quarter of a century ago, and which is at present
employed, does not accord with the teachings of

8O TIN FOIL AND ITS

the physiologist and microscopist; it is in direct
opposition to natural law. Each new discovery in
the minute structure of the teeth makes this more
plain; pounding the teeth with a mallet cannot be
defended on scientific grounds. That it has not re-
sulted more disastrously is due to the wonderful re-
cuperative energy of nature to repair injury. No
one would think of attempting to arrest and pre-
vent disintegration in any other vital organ by
abrasion. Why, then, in operation on the teeth,
should we reverse the plain, simple teaching of na-
ture? Placing cohesive gold against the dentinal
walls by pounding it to heal a lesion is opposed to
natural law. Cohesive gold will not be mastered
by force; if compelled to yield by superior strength,
it seeks a way to release itself; it is easily coaxed,
but not easily driven. Cohesive gold will unite
with tin at an insensible distance just as cohesive
gold unites with itself; this union takes place with-
out force or pressure. Exactly what takes place
when gold and tin are brought in contact in the
way described we do not know; we can only say
that there appears to be a perfect union. When co-
hesive gold was introduced to the profession, while
it was softer than non-cohesive foil, it was found to
resist under manipulation. This resistance is in ac-
cordance with the well-known law that all crystal-

COMBINATIONS FOR FILLING TEETH. 8l

line bodies, when unobstructed, assume a definite
form. With gold the tendency is to a spherical
form. The process of crystallization is always from
within outward. The mallet was introduced to
overcome the resistance caused by the development
of the cohesive property. Pounding gold with a
mallet only increases its crystallization. A crys-
talline body coming in contact with a fibrous one
can neither be antiseptic nor preservative; a filling-
material which possesses these properties must be
one that corresponds or is in harmony with tooth-
substance.

"In the interglobular spaces there is a substance
which is called amorphous or structureless, and a
filling to be in harmony with this substance should
be amorphous or structureless in its composition.
The only materials we have which meet these con-
ditions are gutta-percha and tin. It is its struc-
tureless character that gives to tin its value. Com-
ing in contact with the living dentin, it is easily
adapted, and does not excite inflammation; it does
not interfere with the process going on within the
teeth to heal the leison caused by caries. A wound
from a bullet made of tin, unless it struck a vital
part, nature would heal, even if the cause of the
wound was not removed, by encysting the ball.
This process of nature of repairing injury by en-

7

82 TIN FOIL AND ITS

cysting the cause is of interest to the dentist in the
study of suitable filling-materials. Tin is very use-
ful at the cervical margin of cavities; it acts as an
antiseptic or preservative, and reduces the liability
to subsequent decay. It is our endeavor to obtain
a filling that will preserve the teeth and reduce the
liability to, if not wholly prevent, secondary decay.
The law of correspondence is of more consequence
than the mechanical construction of the filling.
Tin can be used without that rigid adherence to
mechanical rule that is necessary to retain a filling
of cohesive gold; thus less of the tooth needs to be
sacrificed.

"Gold will unite with tin under certain condi-
tions so as to form apparently a solid mass. By
a combination of these metals, not by interlacing
or incorporating one in the other, but by affinity,
secured by simple contact, we have all the pre-
servative qualities of tin combined with the inde-
structible properties of gold. For the base of the
filling we have a material in harmony with tooth-
substance, introduced in a way that is in accord
with the law that governs all living bodies, and for
the outside a crystalline substance that corre-
sponds to the covering of the teeth. This cover-
ing of gold is a perfect shield to the base, and the
field for the display of artistic skill in restoring

COMBINATIONS FOR FILLING TEETH. 83

contours is as broad as though gold was used en^-
tirely. Will a filling of this kind withstand masti-
cation? There is in the economy of nature a pro-
vision made to overcome the resistance of occlu-
sion. The teeth are cushioned in the jaw and yield
under pressure. The elasticity of the substance
of which the teeth are made is well understood.
Ivory is the most elastic substance known. The
teeth coming together is like the percussion of two
billiard balls. Now a filling to save the teeth
should correspond as nearly as possible with the
tooth-substance; it should not be arbitrary, but
elastic and yielding. Tin is interdigitous; it ex-
pands laterally, and is almost as easily introduced
as amalgam, and when put in place does not have
to be bound to be retained. Tin, with an outside
covering of gold to protect it, makes a filling to
which amalgam bears no comparison. In the
light of scientific investigation there can be but
one method — a method based upon the recognized
principle that the filling-material and the manner
of introducing it shall correspond to and be in har-
mony with the living, vital organism with which
it comes in contact.

"After excavating, the cavity is treated with
absolute alcohol, as cleanliness and thorough dry-
ness are absolutely essential.

84 TIN FOIL AND ITS

"The tin is put in with steel pluggers, after the
method of wedging; it must be thoroughly con-
densed, so as to leave a smooth surface, and
enough used to come up to where the enamel and
dentin join.

"The effect is not produced by incorporating or
interlacing the gold with the tin; we rely upon the
affinity of the two metals to retain the gold; no
undercuts, angles, or pits are made in the tin,
dentin, or enamel. The gold, extra cohesive from
No. 4 to 40, is made to adhere to the tin by simple
contact, without pressure or force; the union is not
mechanical.

"The instruments used for filling the remainder
of the cavity with gold are Shumway's ivory points,
which adapt the gold nicely to the margin.

"The set consists of five and were patented in
1881, and have been used by me since that time
for manipulating cohesive gold. One 'point' is
for proximal cavities in the anterior teeth; three
'points' of different sizes are for occlusal cavities;
one 'point' for proximal cavities in bicuspids and
molars and labial and buccal cavities; the sides,
edges, and ends of the 'points' are used, as the
purpose is simply to obtain contact.

"The 'point' shown full size in Fig. 8 is of more
general application than any of the others, and is

FIG. 8.

COMBINATIONS FOR FILLING TEETH. 85

used for proximal cavities in bicuspids,
also labial and buccal cavities. The
handle is made of ebony, and has a silver
ferrule, from which the ivory extends to
the end and completes the instrument.

"The metal pin in the end of the
handle is for picking up and carrying the
gold."

Tin has been used successfully for
completely lining cavities, filling the re-
mainder with gold; it is also useful for repairing
gold fillings.

Two or three thicknesses of tin foil may be
pressed into a cavity with a rubber point or hard
piece of spunk, allowing it to come well out to the
margin; filling the rest with amalgam.

"As a lining it presents to dentin an amalgam
of tin and mercury which does not discolor the den-
tin like ordinary amalgam, and helps do away with
local currents on the filling, which is one cause of
amalgam shrinkage in the mouth." (Dr. S. B.
Palmer.)

When caries extends to the bifurcation of roots,
make a mat of two or three layers of tin, place it in
the bifurcation and use it as a base in filling the
rest of the cavity with amalgam.

Tin is second in importance in alloys, for amal-
gam, as it increases plasticity, prevents discolora-

T

86 TIN FOIL AND ITS

tion, reduces conductivity and edge strength,
retards setting, favors spheroiding, therefore
should not be the controlling metal.

It will be noticed that when cavities are lined
with tin foil, it only constitutes a small part of
the filling, and that it has not been melted with
the other metals in the alloy before being amalga-
mated.

A thick mat of tin has been recommended as a
partial non-conductor under amalgam fillings.

Plastic tin can be made by pouring mercury
into melted tin, or by mixing the fillings with mer-
cury at ordinary temperatures; it has a whitish
color, and if there is not too much mercury it
occurs in the form of a brittle granular mass of
cubical crystals. Generally amalgams of tin and
mercury do not harden sufficiently, but forty-eight
parts of mercury and one hundred of tin make a
fairly good filling, said to have a therapeutical
value; it should not be washed or squeezed before
using, and "is not a chemical combination."

"Tin unites with mercury in atomic proportions,
forming a weak crystalline compound." (Dr. E.
C. Kirk.)

Mercury and tin readily unite as an amalgam
under ordinary circumstances, and form a definite
chemical compound having the formula Sn2Hg.
(Hodgen.)

COMBINATIONS FOR FILLING TEETH. 8/

Another preparation of tin is known as stannous
gold; it is manufactured in heavy sheets and used
the same as cohesive gold foil, and can be easily
manipulated, for it is rather plastic.

Crystal tin for taking the place of tin foil:
"Take chemically pure hydrochloric acid and
dissolve tin foil in it until a saturated solution is
obtained; this may be done speedily by heating
the acid to a boiling point, or the same thing can
be accomplished in a few hours with the acid cold;
it is then chlorid of tin. It is then poured into a
clean vessel and an equal quantity of distilled water
added; then a clean strip of zinc is plunged into the
solution, and tin crystals are deposited on the zinc;
when there is sufficient thickness on the zinc, re-
move both, and slip the crystals off from the zinc
into pure water, clean the zinc thoroughly, and re-
insert for another coating. The character of the
crystallization will be modified by the extent of the
dilution of the solution in the first place. Wash
the tin in pure water until all traces of the acid are
removed, or a few drops of ammonia can be added
to neutralize the acid. It was suggested that it
would be desirable to have some acid remain in the
tin for filling teeth in which there is no sensitive
dentin. We have put in a few fillings, and it works
beautifully, and makes firmer fillings than foil. It

88 TIN FOIL AND ITS

must be kept in water (probably alcohol is better).
It is pure tin, unites perfectly, and works easier
than foil." (Dr. Taft, Dental Register of the West.

1859.)

For some years it was considered the best prac-
tice to enlarge all root-canals and fill them with
gold; in many of these cases the crown cavities
were filled with tin.

Tin has been used for filling root-canals, but
should there happen to be any leakage through
the foramen or tooth-structure, the tin will dis-
color, and there may be infiltration into the crown,
thus causing discoloration, which might be objec-
tionable if the crown was filled with gold. Chloro-
percha, gutta-percha, and oxychlorid of zinc are
much better for this purpose.

The apical quarter of a canal has been filled with
tin, and the remainder with cement. Tin can be
used for filling root-canals. Roll on a broach
small triangular pieces of the foil into very small
cone-shaped cylinders, carry to place, then with-
draw the broach, and force in the cylinder with the
same or a larger broach; sometimes it is necessary
to use another broach, to push the cylinder off from
the one on which it is rolled. Another method is
to carry and pack into the canal by means of a
broach, very narrow strips of No. 10 or 20 foil; or

COMBINATIONS FOR FILLING TEETH. 89

the apical third of the canal could be filled with
gold and the rest with tin.

"About four years ago I concluded to try tin
for filling root-canals; then I began to look for
patients whose general health was good, who had
strong, hardy-looking teeth, and kept their
mouths in good condition. I found one who
answered all my requirements, with a molar to be
filled, and they would not have it filled with gold,
or could not, on account of the expense. I filled
the canals with tin and the crown with amalgam.
After filling thirty-eight molars in this way I
stopped for developments. In six or seven weeks
a lady returned with an inferior molar abscessed,
but at the time it was filled the circumstances
were such that it could not be properly treated.
In nine months a gentleman for whom I had filled
four molars returned with an inferior one ab-
scessed. This is the sum-total of abscessed teeth
where tin was used in the root-canals, at the end of
four years. The others are in good condition, as
I have seen them every six months. The roots
were treated from four to six weeks with carbolic
acid before filling." (Dr. A. W. Harlan, Missouri
Dental Journal, 1872.)

"Tin foil is just as good as gold for filling root-
canals, as it is entirely innocuous and sufficiently

9O TIN FOIL AND ITS

indestructible, while its softness and pliability com-
mend it. Where gold is to be used for the crown,
it is better to fill the bulbous portion of the pulp-
cavity with gold also, so as to weld these portions
of gold together. The success of Dr. Harlan's
treatment was about equal to what might be ex-
pected from the same number of teeth where the
canals had been filled with gold." (Editor Mis-
souri Journal.)

Shavings turned from a disk of pure tin have
been used in combination with Watt's sponge gold
for filling teeth, either by making a portion of the
filling from each metal or using them indiscrim-
inately.

A mat of tin foil dipped in chloro-perdia can be
used to cap an exposed pulp, or a concave tin
disk can be used for the same purpose. A mat of
tin has been used over a slight exposure of the
pulp, because of its slight conduction of heat and
cold, thus avoiding much thermal irritation and
stimulating recuperation.

Some use Robinson's fibrous material as a sur-
face for tin fillings, thinking that it is harder and
will wear longer because of the erroneous notion
that it has platinum in it.

COMBINATIONS FOR FILLING TEETH.

CHAPTER IX.

TIN has been recommended for temporary fill-
ings in sensitive cavities, because it is soft and
easily packed in contact with the walls, has thera-
peutic value, and after a time, when the temporary
filling is removed, the cavity is not as sensitive as
formerly.

It has been observed that starting gold in a
sensitive cavity causes pain, but starting tin in the
same place seldom does.

As long as tin preserves its integrity it pre-
serves the tooth, therefore tin fillings should not
be repaired with amalgam, as their integrity may
be destroyed. Cavities can be partly filled with
tin and completed with sponge, fibrous, or crystal-
loid gold, after the manner described for begin-
ning with tin and finishing with gold foil.

"I advocated tin at the cervical wall, cervico-
lingual and cervico-buccal angles to the thickness
of 24 plate. Then complete the filling with gold.
Some of my most successful efforts in saving soft
teeth have been made in this way. This method
has great value over gold for the whole filling, but
there are two objections to it: First, it imparts to
the cervical border the color and appearance of

92 TIN FOIL AND ITS

decay, so that in three cases where an instrument
passed readily into the tin I have removed the fill-
ings, without any necessity for it, not even finding
any softening of the margins. Second, its use re-
quires the same conditions of dryness, shape of cav-
ity, delicate manipulation, inconvenience to patient,
and strain upon the operator as when gold is used
alone." (Dr. D. D. Smith, Dental Cosmos, 1883.)
He admits that this method saves soft teeth and
also cervical margins. Do not those two very im-
portant factors more than counterbalance the color,
and oversight of the dentist?

Dryness is an essential in making the best filling
with any material, and the time and strain con-
sumed by the majority of operators in filling with
tin is not more than one-half what it is in using
gold.

"I use tin at the cervical margin of all proximal
cavities in bicuspids and molars. I prepare a
matrix of orange-wood to suit each case, letting
it cover about one-third of the cavity, then fill with
tin condensed by hand force and automatic mallet;
now split the matrix and carefully remove it piece
by piece, so as not to disturb the tin; then trim and
finish this part of the filling. Make another
wooden matrix, which covers the tin and remain-
der of the cavity, and fit it snugly to place. Use

COMBINATIONS FOR FILLING TEETH. 93

a coarsely serrated plugger and begin packing
non-cohesive gold into the tin, letting it fill about
one-third more of the cavity; then complete the
last third (surface) with cohesive gold. I have
tested this method for twenty years, and it has
given me splendid results. I always tell patients
that there will appear sooner or later a slight dis-
coloration near the gum, which must not be mis-
taken for caries." (Dr. A. P. Burkhart.)

Another use for tin in the operating-room is
found in Screven's "Gutta-percha-coated Tin
Foil," a cohesive, antiseptic non-conductor, of
which the inventor says: "Cement fillings that
have been kept dry for ten hours after mixing will
be much harder than those soon exposed to moist-
ure, and they will retain' that hardness though
exposed to moisture afterward. This preparation
will keep a filling perfectly dry in the mouth, and
when removed the filling will be found hard as
stone. There is nothing better for lining cavities,
holding nerve-caps in position, holding a prepara-
tion in place when devitalizing a pulp where the
tooth is so much broken away as to make it difficult
to prevent a filling showing through the enamel,
and for many other purposes."

High-heat gutta-percha has been used as a base
in deep occlusal, buccal, and approximal cavities,

94 TIN FOIL AND ITS

completing the fillings with tin. Occlusal cavities
may be filled with tin; then after the filling is con-
densed and finished, drill out the center and fill
with cohesive gold, not cutting away the tin so
as to expose the margin; such fillings wear well,
as much of the attritial force comes on the gold
portion of the filling.

With the exception of the part in brackets, the
following article is from the British Journal, May,
1887:

"If a person eats an oyster stew at 130° F., a
gold filling would carry the difference between the
temperature of the stew and that of the mouth,
130 - - 98 = 32°, almost undiminished to the
bottom of the cavity; allowing 2° of diminution,
then the cavity around the gold filling has as-
sumed 128°; now the person feels warm and drinks
ice-water at 32°. Taking into consideration the
specific heat of the gold filling, it will assume about
40°, which it carries with a diminution of the cold
of about 4°, — that is, as if it was 44°, — into the
interior of the cavity; then the cavity will assume
44°, the difference within one-tenth of a minute
being 128 — 44 = 84°, a change which would pro-
duce a violent inflammation in any organ which
was not accustomed to it. This derangement in

COMBINATIONS FOR FILLING TEETH. 95

the tooth means interruption of circulation, and
young teeth will be most affected.

"Thermal effect depends on heat-conducting
power [gold is nearly four times as good a con-
ductor of heat as tin] and also on specific heat,
so the more the latter approaches that of the
tooth the less it is liable to produce sudden
changes [thus favoring tin]. Specific heat mani-
fests itself by the speed of changes, while the heat-
conducting power influences the intensity [then
the intensity of heat in a gold filling would be three
or four times as much as in a tin filling] . In speed
gold produces this change in one-tenth of a min-
ute" [tin in one-fifth, — that is, gold absorbs heat
and expands about twice as fast as tin] .

In 1838 Dr. J. D. White introduced sharp-
wedge-shaped instruments for filling teeth, and he
claims to have been the first to use them; they pack
laterally as well as downward, and present as small
a surface to the filling as possible, so that the
greatest effect may be produced upon a given sur-
face with a given power. Rolls of either tin or
gold are made by cutting any desirable portion
from a sheet of No. 4 foil; cut this portion once
transversely, place on a napkin or piece of chamois,
then with a spatula fold a very narrow portion of
the edge once upon itself; then with the spatula

96

TIN FOIL AND ITS

resting on the thickened edge draw the spatula
away from it with gentle pressure, and the foil will
follow in a roll.

The old method of using rolls, ropes, and tapes
or strips is the same, but we will describe one
method of using tapes. (See Fig. 9.) A strip is a
single thickness of foil in ribbon form; a strip

FIG. 9

folded lengthwise once, twice, or more forms a tape
of two, four, or more thicknesses of foil. The .tin
foil should be cut into strips and folded into tapes
proportioned in width and thickness to the size of
the cavity. One end of the tape is carried to the
bottom of the cavity and then forced against the
side opposite the point where we intend to finish;
now remove the wedge-shaped plugger and catch

COMBINATIONS FOR FILLING TEETH. 97

the tape outside of the cavity, and fold another
portion against that already introduced, letting- all
the folds extend from the bottom t~> a little beyond
the margin. Proceed in this manner, with care
and sufficient force, until the cavity is full, using for
the last folds a small instrument. Condense the
surface with a large plugger, then go over it care-
fully with a small instrument, and if any part yields,
force in a wedge-shaped plugger and fill the open-
ing in above-described manner; condense, burnish,
and trim alternately until the surface is level with
the cavity-margin. By extending the folds from
the orifice to the base of the cavity, the liability of
the tin to crumble or come out is effectually pre-
vented, and by putting it in with a wedge-shaped
plugger it is pressed out into all depressions of the
walls.

A later method of filling with tape or rope is to
use wedge-shaped pluggers with sharp serrations,
filling the ends of the cavity, and as the two parts
approach each other that next to the wall should
be in advance of the rest, thus an opening will be
left in the center which can be filled with a smaller
tape or rope.

Another old method: Take a piece of foil and
roll it into a hard ball; then gradually work it into

98 TIN FOIL AND ITS

the cavity, being careful to have sufficient around
the margin.

Still another suggested method: Roll a piece
of foil into a loose ball, place it in the cavity, and
pass a wedge-shaped plugger into its center. This
has the effect of spreading the tin toward the walls
of the cavity, the opening to be filled with folds in
a way already described. The wedge is used as

FIG. 10.

often as it can be made to enter, filling each open-
ing with folds; then condense the surface, trim, and
burnish.

The English give the Americans the credit of
first using cylinders. Anyhow, Dr. Clark, of New
Orleans, in 1855, used them made from non-
cohesive gold, and also from gold and tin in alter-
nate layers. (See Fig. 10.)

COMBINATIONS FOR FILLING TEETH. 99

Cylinders were used which were a little longer
than the depth of the cavity, introduced with
wedge-shaped pluggers around the walls, each one
being closely adapted to the margin; then another
row was added, which was forced firmly against
the preceding, continuing this process until the
cavity was full. The wedge, having a smooth end
and sides, is forced into the center so as to drive
the tin toward the sides of the cavity, being careful
not to split the tooth; the opening is then filled
with a cylinder. Now force a smaller-sized wedge
into the center of the last cylinder, and into the
opening introduce another cylinder, proceeding in
this manner until the filling is solid. Then con-
dense the ends of the* cylinders, trim, and burnish.
For the same operation more recent pluggers are
wedge-shaped, with sharp, deep serrations. In
these cases the filling is retained by the general
form of the cavity and wedging within a certain
limit, and not by cohesion of the different parts.
For a time tin cylinders were prepared and put on
sale at the dental depots.

As far as we are aware, the first tin foil made use
of in operative technics was by Dr. F. S. \Yhitslar,
who removed a disk of German silver from an ivory
knife-handle in 1845, tnen usec^ lianct pressure to
fill the cavity with tin. In the college course of

IOO

TIN FOIL FOR FILLING TEETH.

operative technics tin foil can be used, almost to
the exclusion of gold foil, to demonstrate the
manipulation of both cohesive and non-cohesive
gold. Shavings scraped from a bar of tin are also
useful in operative technics; they are more co-
hesive than foil.

LIBRA**
2O9 £. 23rd S

N. Y. CITY

UNIVERSITY OF CALIFORNIA LIBRARY

Los Angeles
This book is DUE on the last date stamped below.

Form L9-116m-8,'62(D1237s8)444

>-y<i. nx>^' ,^c\ '<sn-~ •tM&y \rty-i— ' s*~<.\* w-"j

fo'flp ^^iJ^J?^ J^-tZLf*^

w

*y & (yyBvS&ic^

I h

Kv v-' ^tt^fe® R. - ^^

^^ ''T^fo/^^'y w* ^^t^c ^S^7^°<9fe?C'"^:: ^'<$^^9?:^^ ^Cfj

5* sswfessfee.^^sb^s* 4^, .kl J^*s

m

(5 vxv> \ & ^ V,,L ; ^ k" ; -.

-^8 •