Henry Lovejoy Ambler

“ 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 completed 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 condenses it continually secures the readaptation at the margin; thus there will be no leakage or caries for years. ”

“ Why, then, in operation on the teeth, should we reverse the plain, simple teaching of nature? 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 ”

“ I am satisfied that I myself until recently 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] 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. ”

“ 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." ”

“ 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 harmony with the living, vital organism with which it comes in contact. ”

“ 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 cohesive 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 accordance with the well-known law that all crystalline [81] bodies, when unobstructed, assume a definite form. ”

“ 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. ”

“ 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 between it and the adjoining tooth being quite inconsiderable, 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 galvanic shock regularly communicated from one tooth to the other when by the movement of jaws or cheeks they were brought near together." ”

“ The only materials we have which meet these conditions are gutta-percha and tin. It is its structureless character that gives to tin its value. Coming 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 lesion 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. ”

“ In proximal cavities attacked by this kind of caries, separate freely on the lingual side, and fill with tin. When such fillings have been removed the dentin has been found somewhat discolored 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. ”

“ 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. ”

“ Some operators have advocated 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. ”

“ An oxid is a combination of oxygen with a metal or base destitute of an acid. In oxidation the oxygen 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. ”

“ 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 adaptation to the retaining points or edges of the cavity. ”

“ 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 cannot 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 ”

“ 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 chemical action which occurs on the surface exposed to moisture. ”

“ Tin is very useful 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 ”

“ 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 surface is obtained in a few moments, and this danger 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. ”

“ Skill is required to make good tin fillings, as well [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 opinion. A roll or rope necessarily contains a large number of spaces, wrinkles, or irregularities, which must be obliterated by using force in order to produce a solid filling; thus more force is employed, and more time occupied in condensing a rope, than a flat tape ”

“ Good tough foil, well condensed by hand or mallet force, stays against the walls of a cavity and makes a tight filling, 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 superior incisors, filled for children from six to eight years of age, are still in good condition after a period of twenty years. ”

“ 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 crystalline 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. ”

“ 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 particles of a body are held together by cohesion, the constituent parts are united by affinity. ”

“ A constant galvanic action is kept up in the mouth when more than one kind of metal is used [45] in filling teeth, and galvanism is often the cause of extensive injury to the teeth. The most remarkable 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. ”

“ 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 present in the mouth. The protosulfuret of tin is black. ”

“ It has been known for years that tin would be tolerated in large cavities very near the pulp without 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. ”

“ 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 generally 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. ”

“ 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 ability to apply that knowledge, will largely depend our success in preserving teeth. ”

“ 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. ”

“ Tin made into leaves is employed as a stopping material; with sufficient experience it can be elaborated 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. ”

“ Where no shield or matrix is used, or where it is used and removed before completing 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. ”

“ 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? ”

“ 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 [80] the physiologist and microscopist; it is in direct opposition to natural law. ”

“ 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 introducing and condensing tin in cavities by means of smooth, highly tempered steel engine or hand burnishers. In the engine set of instruments there is [64] one oval end inverted cone-shaped, one pear-shaped, and one bud-shaped. The revolving burnisher 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. ”

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