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Transplantation of Teeth , ^ ^ C^uM^^. 
 
 INTd 
 
 Artificial Sockets 
 
 BY 
 
 \Vm. J. VOUNGEK, XI. \J. 
 
 KX'I'i-nilclcDC or (he C'liMfomla State UuntM AsHoclAtloD. 
 
 Ex-ProsKlent Sail FraiK'laco Dental AsaocUtloii. 
 
 SAN PBANCISCO, CAL. 
 
 REPBlfT FBOM 
 
 "Pacific Medical and SurgicalJournal and Western Lancet" 
 
 JaXUAKY, 1886. 
 
 With Addenda. 
 
Transplantation of Teeth 
 
 INTO 
 
 Artificeil Sockets 
 
 BY 
 
 WM. J. YOUXGER, M. D. 
 
 Ex-Presidint of the California State Dental Association. 
 Ex-President San Francisco Dental Association. 
 
 SAN FRANCISCO, CAL. 
 
 Reprint from 
 
 "^ Pacific Medical and Surgical Journal and IVestern Lancet,' 
 
 January, i886. 
 
 With Addenda. 
 
 SA.V FRANCISCO: 
 
 IV'm. S. Duncombe «&* Co., Publishers, 
 
 211 Post Street. 
 

TRANSPLANTATION OF TEETH 
 
 INTO 
 
 Artificial Sockets. 
 
 Transplantation of teeth from one mouth to another is not, by 
 any means, a new operation, as it was done many years ago for 
 the noble and the ojjulent of the old world. li. is not only 
 mentioned in some of the very old works on surgery, but even 
 by writers of fiction. Not only did the poor mar their mouths 
 to sell their teeth, but even the freshly dead were disfigured for 
 this purpose. Victor Hugo, himself, utilizes a knowledge of 
 this operation in " Les Miserables," and makes one of his her- 
 oines, Fanchon, sell two of her front teeth in order to procure 
 food for her starving child. But so many disastrous conse- 
 quences occurred, so many painful effects followed, and so 
 many failures happened, that the operation fell into disrepute 
 and was abandoned as soon as artificial substitutes were invented 
 that approached, in some measure, a natural appearance and 
 in some degree served the purpose of mastication. 
 
 Not until I was in Paris in 1877, however, did I learn how 
 the operation of transplantation was effected, and in learning 
 that, I acquired an insight into the causes of the many disas- 
 trous, painful and futile results. 
 
I will let Dr. Thomas W. Evans, the famous dentist of the Em- 
 pire, and intimate friend of Napoleon III, explain, in his own 
 language — during a conversation on professional topics — as 
 nearly as I can recollect it, the modas operandi of transplanta- 
 tion, and the reason of his abandonment of it, as it was the 
 narration of this incident in his practice that revealed to me the 
 method pursued in transplanting teeth, and awoke the sugges- 
 tions in my mind, that have made this operation, in my hands, 
 the reverse of what it has been. But I wish it to be distinctly 
 understood, that in whatever strictures I may make on the oper- 
 ation as illustrated in the ease related by Dr. Evans, I do not, 
 in the least, intend to reflect on him, for I have the highest 
 esteem and respect for the professional skill and attainments, 
 erudition and private worth that have gained for this distinguished 
 gentleman, a social position that has contributed immensely in 
 elevating the status of dental professional life abroad. Dr. Evans 
 simply followed the beaten path, and was therefore not respon- 
 sible for it. But to return to the subject. 
 
 " The last operation of this kind that I ever attempted," said 
 he, " was that on a certain Marquise, who shall be nameless in 
 consequence of the unfortunate results that followed the oper- 
 ation. She was a young, rich and lovely woman, but whose 
 beauty was marred by the presence of four dead, black, badly 
 decayed front teeth, which were a constant source of mortifica- 
 tion to her. She had such an aversion to wearing false teeth 
 that she would not consent to an artificial substitute; so the op- 
 eration of transplantation was decided on. One of her maids 
 was thereupon commissioned to search among her friends and 
 acquaintances for a woman whose teeth would in size, contour and 
 color suit the requirements of the case. At last one was found 
 whose teeth seemed in every way suitable, and the consideration 
 for them agreed upon. As it was not desirable that the parties 
 
should know or afterwards recognize one another, the utmost 
 secresy had been preserved, and was carried out to the end, in 
 thiswise: Two chairs were placed back to back. The Marquise, 
 heavily veiled, was seated in one, and the woman, also heavily 
 veiled, was then brought in and placed in the other. The lady's 
 teeth were then drawn and laid aside, and then the woman's, 
 which were immediately fitted into the gaping sockets of the 
 Marquise's, and tied in by ligatures to the adjoining teeth. The 
 woman was then led out, paid, and all further interest in her, I 
 supposed, ended. Not so, however, for, as it afterwards trans- 
 pired, this woman had been leading an immoral life, had con- 
 tracted a loathsome disease, which was, unfortunately, commu- 
 nicated to the Marquise, and produced in her great anguish of 
 mind and body, and the subsequent loss of the teeth. I came 
 in for a share in the blame, for not having sufficiently examined 
 the woman as to her health and moral status. I then determined 
 never to perform the operation of transplantation again; it was 
 fraught with too much danger." 
 
 This then was the method practiced in transplantation. The 
 subjects were brought together, the fresh, blood covered teeth 
 of one, with whatever of tartar and filth had accumulated on 
 them, were immediately transfei-red, into the raw, bleeding and 
 clotted sockets of the other; each tooth having in its body a 
 mass of soft tissue, known as the pulp, whose life was ex- 
 tinguished as soon as rupture of its tissues occurred at the apex 
 of the root; and which, being deprived of vitality, was bound to 
 decompose with all the attendant phenomena of putrefaction, 
 to wit : formation of gases, pus, etc. With this style of 
 procedure, the wonder to me is, that the operation was ever 
 successful. 
 
 In the first place, the danger of communicating hereditary or 
 acquired disease, when the blood of one person is placed in con- 
 tact with a raw surface of another must be evident to all. 
 
Secondly. No thought seems to have been given as to how 
 the tooth attached itself. It seems to have been put in in a hap- 
 hazard sort of way, with an indefinite idea that it would grow 
 into the gum. Now, it is due to the pericementum of the 
 tooth, which is the analogue of the periosteum of the bones, 
 that attachment to the walls of the socket is possible. And it is 
 readily seen, that some of the clot into which the tooth is 
 thrust, must remain between the root and the socket, preventing 
 that intimate contact between the pericementum and the alveolar 
 wall so requisite for union, to say nothing of the septic dangers 
 attendant upon a decomposing, confined clot. But, supposing 
 this difficulty and danger to be overcome, and sufficient union 
 effected, we come to 
 
 Thirdly. The pulp or nerve, as it is called by the laity, is the 
 substance, the death of which, jDroduces that frightful torture 
 attendant on the formation of what is known as alveolar abscess. 
 The pulp then in these transplanted teeth, — being devitalized by 
 the solution of continuity effected in extraction, and being un- 
 like the pericementum in its power to retain vitaKty, — dies, and 
 in its death, unless the tooth is secured by ligatures or other- 
 wise, and the gases evolved are not sufficient, consequently, to 
 expel it, all the painful train of phenomena attendant on the 
 formation of alveolar abscess are sure to follow. 
 
 Fourthly. If, in spite of all these deterring causes, the tooth 
 should become fixed in its new habitation, the decomposed pulp 
 is partly absorbed by the tubuli of the dentine and the tooth 
 becomes blackened and unsightly. 
 
 With the operation performed in this manner, we cannot but 
 agree with other writers on the subject, that transplantation 
 of teeth is accompanied with great danger and is bound to be a 
 failure. 
 
 But transplantation can be made a success and void of all danger 
 
and unpleasant consequences, if only common sense, and cleanli- 
 ness, ordinary skill and care are taken. 
 
 It is to prove this and unprejudice the scientific mind, and, 
 through it, the public, and to do away with the abomination of 
 false teeth, that I here present to the profession the results of 
 my experiments and experience in this direction. 
 
 I gained courage to try the operation by reflecting on the ex- 
 periment of John Hunter, who, to test the vitality of the peri- 
 cementum, planted a tooth in a cock's comb. This tooth at- 
 tached itself firmly to the crest, and a few mouths afterwards 
 the cock was killed and a microscopical examination showed that 
 a living union had taken place, the blood vessels of the comb 
 and pericementum having established free communications. 
 
 I also tried the experiment upon a cock's comb, to further and 
 personally assure myself of the truth of this statement, and 
 confirmed, as far as attachment was concerned, the exi^eriment 
 of the great surgeon. But, in my experiment, I took the pre- 
 caution of removing the pulp and filling the pulp chamber and 
 root canal with a preparation of gutta percha, known as "Hill's 
 stopping," much used by dentists for temporary fillings. This 
 was in order to avoid any trouble from a decomposing pulp. 
 The tooth was then well cleansed with warm water and dipped 
 in a disinfecting solution. The success of this experiment sat- 
 isfied me that the pericementum would attach itself to any vas- 
 cular body, and that, if properly planted in a fresh socket, it 
 would attach itself and form a living union with the surround- 
 ing tissues, without the production of afterpains or other evil 
 consequences. 
 
 My first experiment January 24:th, 1881, was on a Mrs. H., a 
 lady of about 36, who had nursed a badly diseased root of a left 
 superior lateral incisor for fifteen years, in order to maintain 
 the contour of the gum, while wearing a plate with an artificial 
 
8 
 
 crown resting on it. Whilst waiting for a lateral, I cured the 
 diseased root, but kept its shattered parts together, in order to 
 presei*ve the socket intact. There had been so much disease in 
 this socket that the gum was covered with cicatrices, the sequel- 
 Ise of different discharges. At last I procured the tooth needed 
 from a lady of about forty, and prepared it in the manner 
 already described for the cock's comb. Before doing so, I 
 extracted the root, in order to allow the patulous vessels to close 
 of their own accord. "When the tooth was ready, I carefully 
 wiped out the clots, rinsed the socket with a disinfecting solu- 
 tion and put in the tooth. Finding the root a little too long, 
 Ij cut off the excessive portion of the apex, cleansed the 
 socket again, pressed the tooth into position and held it in 
 place by delicate silk ligatures. No pain ensued, no swelling, 
 and no unpleasant symptoms, of any kind whatever, developed. 
 Four days after, the ligatures were removed and I was gratified 
 to find the tooth well attached and resisting gentle traction 
 made with the fingers. The ligatures were again replaced, in 
 order to hold the tooth firmly in position until the attachments 
 had acquired sufficient strength. In four weeks they were 
 removed. The tooth has now been in its new home, nearly five 
 years and is as firm in its place, and light in color, as any tooth 
 in the delighted lady's mouth. 
 
 I have now had between thirty and forty cases of transplant- 
 ation into sockets already formed, and have to report but two 
 failures. One due to the patient's own neglect, in leaving for 
 foreign parts too soon after the operation, and not allowing 
 me to place the ligatures necessary to retain the tooth in a fixed 
 position, until sufficiently strong attachments could take place, 
 and the other, to my own inexperience. In the latter case, there 
 was a diseased root of fourteen years standing. The attach- 
 ments all around the root had been destroyed and the tooth 
 
hung but by a pedicle at tlie apex. I bad not bad time to cure 
 the root, and so I. drilled tbrougb tbe crown of the new tooth 
 into the pulp chamber, forming a canal through to the end, for 
 drainage, and to treat the diseased socket. Unfortunately, I 
 did not scrape away sufficiently the healed walls of the socket, 
 and, therefore, attachment did not take place along the sides of 
 the root. The tooth, not tightening, became a nuisance to the 
 lady, who was of a highly nei-vous temperament, and three 
 months after its insertion it was removed. 
 
 One case, where I had but little hope of success, turned out a 
 decided one. At the time, I was surprised, but since I have 
 discovered the wonderful gi'ip a little pericementum has, I am no 
 longer surprised at anything this remarkable membrane will do. 
 As there was a little sentiment, besides cold science, connected 
 with this case, I take a special pleasure in narrating it. Two 
 young girls of sixteen, merry, laughing, loving little friends, 
 came to me, one had an upper bicuspid that was overcrowding 
 her otherwise lovely mouth; the other a badly formed, worse 
 decayed and painful lower one in hers, and they asked me if I 
 would not please take the one out and insert the other in its 
 place. But as the root of the upper was considerably wider than 
 the lower, and would necessitate, to fit the tooth properly, the re- 
 duction of the diameter of the root, and thereby involve the de- 
 struction of considerable pericementum, I did not consider it 
 practicable. Nevertheless, as they seemed to have set their 
 hearts upon it, evidently believing that this transfer of tooth, 
 would, in some subtle manner, unite them more closely, and the 
 one declaring her. willingness to suffer any pain, even with the 
 slight chance of success promised, to have her wish consummated, 
 I yielded. In this operation I had to grind away the labio-lin- 
 gual aspects of the root, thus denuding the whole of these sur- 
 faces of pericementum, and leaving but two strips of this mem- 
 
10 
 
 brane, one anteriorly, and the other posteriorly, with which to 
 form attachments. Nevertheless, it did so, and it is now one of 
 the best and firmest teeth the young lady has in her head. This 
 operation was ijerformed Feb. 21st, 1881, but a month later than 
 the one previously rei^orted. 
 
 The great and only difficulty I had to contend with, was the 
 procurement of teeth at the time they were needed. At last a 
 way suggested itself. I applied to my dental friends for what- 
 ever good teeth or roots the exigencies of cases required them to 
 extract. The experiment of Hunter and my own experience 
 had taught me that teeth could be kept alive, indefinitely, in 
 cocks' combs. But could they be transferred to the human 
 mouth again and made to grow there ? I concluded they could, 
 and my first experiment verified my conclusion. 
 
 On November 28th, 1882, a bicuspid that had been in a cock's 
 comb for ten days, was transferred to the mouth of a gentleman, 
 where it fastened itself, as if there had been no gallinaceous 
 period in its existence. 
 
 Where I have not been able to procure a suitable tooth, I have 
 taken a root, and mounted an artificial crown on it. Sometimes 
 I use the natural crown of a tooth that has been irretrievably 
 loosened by incrustation of tartar on its root. In this case I 
 simply saw off the bad root and attach a good one to the crown 
 by means of one or more gold screws and cement. In these cases 
 the patient simply changes roots. I have also discovered that 
 the pericementum can be kept alive for, certainly, two days, in 
 warm water, temperature 100^ to 110^ Fahrenheit. I have in two 
 cases transj)lanted teeth successfully that had been so kept for 
 fifty hours. 
 
 My former practice when I found a root was too long or too 
 wide for 9, socket, was to cut off from the apical extremity, or 
 shave off from the surface of the root, the necessary quantity to 
 
11 
 
 insure a fit: but so often the best portion of the pericementum 
 was in that way removed, that I tried deepening or widening 
 the cavity as the case required, often cutting freely into the bone 
 in order to save all possible of this valuable tissue. I found that 
 adhesion took place in this' portion as perfectly as in the un- 
 broached. The consideration of this, led me to the grand con- 
 clusion, that artificial sockets could be drilled into the bone ilaelf 
 and teeth planted therein as successfully as into the natural cavities. 
 My first operation of this nature was reported to the Califor- 
 nia State Dental Association in August last, and its success was 
 witnessed by them seven weeks after its j)erformance. But as 
 the transactions of this society for this year, will not be pub- 
 lished for some time, I will incorporate that report in this article. 
 
 On the 17th of June last, Miss Ward, a young lady of 24, 
 presented herself. She had lost the left superior lateral incisor, 
 root and all, four years previously, and had been wearing, as a 
 substitute, an artificial tooth on a rubber plate. The collapse 
 of the gum, consequent on the absorption of the alveolus, was 
 so great, and the exposure of gum so much, in conversation, 
 and especially in smiling, that the falsity of the denture was im- 
 mediately recognized, and was an object of great distress to her. 
 As it was impossible, for the reasons just given, to produce an 
 artificial substitute that would look natural, I determined ujjon 
 the following operation, — one that I had for a long time contem- 
 plated, and which, though satisfied in my mind, in consequence 
 of certain obseiwations and experiments, would be successful, 
 seemed so opposed to scientific thought and the established rules 
 of surgery, that I had not before screwed up my courage suffi- 
 ciently to attempt it. I took a corresponding lateral from a 
 young man, which, from its awkward position, was disfiguring 
 
12 
 
 his mouth, and prepared it as I do all teeth I use in transplanta- 
 tion, viz. : removed the pulp, filled the pulp chamber and root 
 canal with Hill's stojjping, and finished the apex with gold. 
 The tooth was then placed in water of the temperature 100° to 
 110° Fahrenheit, to cleanse it of all blood and impurities, and 
 allowed to remain for about one hour. It was then placed in a 
 bath of bi-chloride of mercury, 2 parts to 1,000 water, for about 
 fifteen minutes, to disinfect it. The tooth being now ready, I 
 turned my attention to the patient. I cut a hole in the gum a 
 little less than the diameter of the root to be inserted. I then 
 took an ordinary flat, angular-edged drill, and drilled into the 
 bone in the line of direction the tooth was to occupy. When 
 fully deep enough, I widened the cavity and formed the socket 
 with a cone-shaped burr. When I found by trial that the cavity 
 would receive the tooth perfectly, I carefully washed and sponged 
 it out, in order to remove eveiy particle of detached bone, first 
 with warm water, then with cold, and lastly with the bi-chloride 
 solution already referred to, and when the bleeding had ceased, 
 I introduced the tooth, and kept it in position by delicate silk 
 ligatures attached to the central incisor on the right and to the 
 canine on the left. There resulted a little swelling over the root, 
 which remained a few days and then gradually disappeared. 
 
 An accident to the gum occurred during the development of 
 its socket. Just as the drill touched the surface of the bone 
 the young lady jerked her head back, which caused the instru- 
 ment to slip forward and through the gum, making a triangular 
 shajDed gash of fully an eighth of an inch in length. Before 
 the tooth was inserted the edge of this cut was brought care- 
 fully together and retained in contact by delicate silk sutures. 
 On the fourth day the sutures were removed and no mark was 
 apparent to tell of the lesion that had existed. In twelve days 
 I removed the ligatures from the tooth and found it well at- 
 
13 
 
 tached. I then removed the threads to fix the tooth while the 
 callus foiiued I'ound the root. About three weeks afterwards, 
 the gum being free from every sign of irritation and the tooth 
 comparatively firm, and desiring to improve the position of the 
 right superior central and lateral, I had to pass the ligatures around 
 the new tooth. This, unfortunately, set up a slight inflamma- 
 tory action, and an epulis formed a few days after, and a little 
 discharge of matter took place. I thereupon removed the liga- 
 tures and treated with injections of iodine. When last seen 
 the epulis had nearly disappeared, the surrounding gum had 
 resumed its normal look, the tooth become firm in its position 
 and performing its functions in common with its fellow teeth as 
 though it had never been a stranger in the mouth. 
 
 This case was examined by several physicians, and by the 
 members of the California State Dental Association, who, with 
 the exception of two, pronounced the operation a great success. 
 These two gentlemen were not thoroughly satisfied with its 
 stability because, only, of the epulis that had formed. 
 
 CASE TWO. 
 
 On the 15th of August and the 5th of September, similar 
 operations were performed on Mrs. C. , set. 35. In Mrs. C. 's case, 
 however, the teeth (superior bicuspids) had been absent for 
 twenty years, and during this time she had worn an artificial 
 plate. 
 
 On the first date mentioned, a socket was drilled out immed- 
 iately on the right of the right superior canine, and a bicuspid 
 inserted. It was held in position by a silk thread attached to 
 the canine and lateral in front, and a molar a little distance in 
 the rear, the thread simply passing over the crown between the 
 cusps like a tight-rope. 
 
 On the 5th of September, Mrs. C. , being satisfied of the success 
 
14 
 
 of the operation, bad two bicuspids inserted in the left side in a 
 similar manner. In this case, however, there was no molar to 
 attach a thread to and so a little loose, diseased root of a second 
 molar had to be brought in requisition. Into this root a fine 
 gold wire was inserted to which the distal end of the string was 
 attached, the string brought taut over the crowns and between 
 the cusps and fastened to the canine and lateral in front. After 
 the insertion of these teeth the face swelled slightly, but there 
 was no tendency to expel the teeth, nor was there any pain con- 
 nected with them. The face was washed with the ordinary solu- 
 tion of muriate of ammonia in water and alcohol, and the gum 
 painted with iodine. In four days the swelling subsided. The 
 gums have now been for over two months without the slightest 
 mark of irritation. The teeth have become quite firm, and the 
 lady is now using them in mastication, There are three more 
 teeth yet to be inserted, — one right bicuspid and two left 
 superior molars, — which will be done as soon as the proper teeth 
 are procured. 
 
 Among the many medical and dental gentlemen who have 
 critically examined this case, and expressed themselves fully 
 satisfied with the success and utility of this operation, are: 
 
 Prof. E. Beverly Cole, A. M., M. D., M. E. C. S., Medical 
 
 Department, University of California. 
 Prof. F. H. Terrill, M. D., Medical Department, University of 
 
 California. 
 Wm. S. Whitwell, A.M., M. D., Editor Pacific Medical and 
 
 Surgical Journal. 
 "Wm. T. Grarwood, M. D., former Eesident Physician City and 
 
 County Hospital. 
 A. F. Sawyer, A.M., M. D. 
 C. M. Eichter, M. D., late Chief Surgeon of the G-erman 
 
 Hospital, 
 
15 
 
 J. A. W. Lundborg, President California State Dental Asso- 
 ciation. 
 
 S. E. Knowles, M. D., D. D. S., President San Francisco 
 Dental Association. 
 
 "NVm. A. Knowles, M. D., D. D. S., Vice-President California 
 State Dental Association. 
 
 Alex. "Warner, D. D. S., late President California State Den- 
 tal Association. 
 
 So perfectly natural is the appearance of these teeth in the 
 mouth, so firm and so normal the surrounding gum, that the 
 great majority of these, as well as of other gentlemen who have 
 seen the case, were unable, when put to the test, to distinguish 
 the transplanted teeth from those that were " native and to the 
 manor born." Many mistook some of the old teeth for the new, 
 and the three or four who did point out the right teeth acknowl- 
 edged that they merely guessed them, in consequence of their 
 being handsomer and better than the other teeth. 
 
 Mrs. C. herself says: ''"When I think that for twenty long 
 years I have had to wear a nasty, old i^late, and now I have in- 
 stead natural teeth growing in my mouth, I feel so hapjDy that I 
 cannot express myself." 
 
 Practical experiments have convinced me that the views 
 expressed, of the formation of the socket, and method of attach- 
 ment of the teeth, in the books on this subject, are erroneous, 
 and in a subsequent paper, I hope to discuss the method of 
 attachment of the teeth in artificial, as well as natural sockets, 
 and to prove theoretically, as well as I have practically, that 
 they may be transplanted and made to grow in the former, as 
 well as the latter, and be as perfect in appearance and utility as 
 if they were the development of the very jaw itself, and that this 
 can be a rule and not an exception. 
 
16 
 
 ADDENDA. 
 
 On the 3d of December, 1885, a right superior central that 
 had been extracted from a young lady by a professional friend, 
 was inserted into an artificial socket formed in the mouth of Mr. 
 James J. Molony, a gentleman of 34, who had lost a correspond- 
 ing tooth 13 years previously. This tooth had been fifty hours 
 out of its original owner's mouth before transplantation. So 
 perfect is the appearance of this tooth and the surrounding gum, 
 and so firmly has it become fixed, that prominent physicians and 
 dentists, to whom Mr. Molony, in his enthusiasm, showed the 
 tooth, disputed his word, and one of our oldest practitioners, 
 Dr. H. H. Thrall, had to come to me in person, to satisfy himself 
 as to the truth of this gentleman's statement. 
 
 On the 8th of December just past, a right lower wisdom tooth 
 that had been extracted, to relieve an overcrowded maxilla, was 
 planted in the left superior jaw of a Mrs. E., aged 45. This lady 
 had lost all the teeth on one side of that jaw, with the exception 
 of the second bicuspid, through phagedenic pericementitis, and 
 had but one molar left in the lower. This tooth was planted 
 directly over that molar, and its articulation with it is perfect. 
 It was held in position for three weeks, by a silver band attached 
 to a clasp fitted to the bicuspid already mentioned that extend- 
 ed to and nearly surrounded the transplanted molar. The 
 band was removed and the tooth found so well attached, that no 
 farther support was deemed necessary. 
 
 This tooth was inserted, with a good many misgivings as to its 
 success; for, in the first place, the negligence of my assistant al- 
 lowed the temperature of the water, in which the tooth was kept 
 immersed over night, to run up to 150^ F., and it must have suf- 
 fered that heat, for at least ten or fifteen minutes before discov- 
 ery. In the second place, the absorption of alveolus had become 
 
17 
 
 so great, that wlien the tooth was placed in situ, only two-thirds 
 of the roots were imbedded in the gum and bone. Neverthe- 
 less, the tooth is becoming firmer every day, and promises in a 
 month or two, to do as good service as ever its predecessor did. 
 The part into which this tooth was inserted had been edentulous 
 for two years. 
 
 On December 15th, the fourth bicuspid was planted in Mrs. 
 C.'s mouth, which completes all the operations of this, kind re- 
 quired on the right upper jaw. Next month we propose, D. V., 
 to plant a molar on the left side and immediately in the rear of 
 the bicuspids, inserted on the 5th of last September. 
 
 This, it will be remembered, is the fourth tooth thathas been 
 planted in this lady's mouth. The retaining ligature was re- 
 moved on the second of this month (January), and the tooth 
 found unusually firm. It has been, since that time, without any 
 other support than the living one derived from its environment. 
 
 I have now transplanted into artificial sockets, seven teeth; 
 four into one mouth and one each into three others. They have 
 been one central incisor, one lateral incisor, four bicuspids and 
 one molar. Sufficient variety to show, that a whole sett may be 
 thus planted into an edentulous jaw, even after the teeth have 
 been absent for twenty or more years. I have as yet had no 
 failures, and with proper care and under proper conditions, I 
 have no fear of any. 
 
 Science has been startled at the success of this operation, 
 from what I believe to be a misconception of the relation of the 
 tooth, to the alveolar socket, through the pericementum or p6ri- 
 dental membrane. Some believing this membrane to be a sin- 
 gle tissue, having two creative sides, one producing the cementum 
 and the other, the alveolar socket; others, that it is a double or 
 reflex membrane, one being a true periosteum and producing 
 the bony environment surrounding the tooth, and the other, a 
 
18 
 
 modified tissue generating cementum, a substance which being 
 analogous to bone is yet not true bone. 
 
 I am convinced that the alveolar socket has no periosteum, 
 and that only one side of this single or double membi'ane, has a 
 callus generative energy, and that is, its dental aspect ; the 
 other, has simply the power of forming attachment. 
 
 True periosteum will revive its function of producilig bone, 
 after its first osseous creation has been removed, and if the outer 
 layer or side of the peridental membrane was such, it would 
 also produce callus, upon the loss of its osseous structure. But 
 in treating irregularities of the teeth, where a malposed tooth 
 has to be moved, sometimes a quarter of an inch, we find the 
 deposition taking place, from the alveolar surface only and con- 
 tinuing from there, until the tooth is reached. Also in the 
 experiment on the cock's comb, it simply forms attachments with 
 the surrounding vascular substance, without producing the pe- 
 trous crust, which it would do, had it the function of periosteum. 
 Besides, if the development of a tooth is followed, it will be 
 seen, that no periosteum is employed, in the formation of the 
 socket. It is the pressure of the crown, due to the force of 
 growth in the developing tooth, that produces the absorption of 
 bone, necessary for its eruption. While the crown is in the 
 alveolar process, there is no attachment to it, and there 
 is certainly, no periosteum lining the alveolar wall. "When 
 the crown has passed through into the mouth and the root 
 or roots of the tooth have taken its place, in the space formed 
 in the alveolus, its wall is still as minus a periosteum, as when 
 the unsympathetic crown, forced its way through. Now, the 
 crown of the tooth, is considerably larger than the body and 
 roots, and makes a larger space in its progress, than is required 
 by its continuation. Therefore, when the crown has escaped 
 from its osseous imprisonment, there is a space left between the 
 
11) 
 
 tooth and the alveolar wall. This enables the tooth, to assume its 
 recjuired elevation in the mouth, before the deposition of bone, 
 fills up the space and firm attachments take place. 
 
 I think I have shown, that the investing membrane of the tooth 
 produces callus only on its dental aspect; that the socket, being 
 formed by the crown, no periosteum is present or engaged 
 in its formation ; therefore, this filling up of the space with 
 osseous matter, and attachment to the pericementum must come, 
 and is only possible, from the eadosleam. This delicate mem- 
 brane, lining the cells and interstices of the bony structure, is 
 but a continuation of the periosteum, surrounding the maxillary 
 bone and alveolar process, and has, as is well known, all the 
 powers of its mother tissue. In moving a tooth from a wrong 
 position into a right one, the space left, is filled up and attach- 
 ment renewed by this endosteum. When a tooth is e.Ktracted, 
 it is due to the endosteum that the space is filled. When a lesion 
 occurs in the jaw or other bones, at points remote from peri- 
 osteum, it is to this very membrane that reparation is due. 
 Therefore, when a socket is artificially formed, and a tooth is 
 planted therein, it must be evident, that it is the endosteum of 
 the osseous surrounding, that performs the task of union, and 
 that it will do so, as naturally with a strange tooth, as with the 
 organ developed in its own structure; for, to the endosteum, it 
 makes no difference, if the lesion in its structure is caused by a 
 developing tooth or by an instrument. It is, in either case, 
 a lesion, and only the variation in a subjective, from an object- 
 ive cause. 
 
 I am about to commence a series of operations on rabbits and 
 other animals, to test the assertions I have made, regarding the 
 reparation of bone and attachment of a tooth thereto, b}' drilling 
 into some portion of their osseous structure, and planting roots 
 into the cavities thus formed. At different times, the animals 
 
20 
 
 will be killed and microscopical examinations made. In this 
 way, I hope to place beyond doubt, the method of attachment 
 of a tooth to a bony surface. I shall publish the result of these 
 experiments, trusting^ that it will lead the professional mind, 
 everj'where, to a kind consideration and endorsement of this 
 operation, and thus assist, in doing away with the necessity for 
 false teeth, and so, add immeasurably, to the comfort, beauty and 
 health, of the human mouth. 
 
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 Transplantation of teeth into 
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