The dental prosthesis from yesterday to today
Louis Pelletier presents an educational article to introduce to the history of dental prostheses and related concepts.
The discovery of the first dental prosthesis dates to the third and fourth century BC; that is at least 6,000 years ago. It is in the tombs of ancient Tanagra, city of ancient Greece (Boeotia) famous for the legend of Oedipus as well as for its terracotta figurines that this discovery took place.
This consisted of perforated teeth connected by gold thread, and subsequently attached to the remaining teeth by gold lamellae. Note that this was not a removable prosthesis.
It was in 2,400 BC that Hippocrates described in writing the technique concerning the art of fixing by means of gold threads, the flickering or missing teeth.
The Phoenicians (Israel, Palestine, Lebanon, Syria) transmitted around 600-700 years before Christ this art to the Etruscans (Etruria or current Tuscany) who refined it by making the device in pure gold. This connected to the remaining teeth, with either gold thread, gold strips or both. These were partially fixed prostheses.
A new era
The religious ideas and customs of the Etruscans did not allow them to use human teeth to replace the missing teeth. They used cattle teeth that they carved.
Among the Romans, during the reign of Domitian (51-96AD), Cascellius was famous for having used gold as a filling material. In Europe, from the 14th century to the 17th century, dental prostheses were mainly used for phonetics and aesthetics due to the pain they caused. They were taken off to eat.
During the Renaissance, around 1560, the first complete dentures were made. The base of which was carved into an ox femur and using teeth taken from soldiers who had died in battle.
In the eighteenth century, the dentist Ladoucette imagined gold springs installed at the joints to maintain full dentures in the mouth. In 1750, the French apothecary Alexis Duchâteau invented the porcelain tooth. He discovered that this material remains white longer than ivory.
Then come the Revolution and the Napoleonic wars. The Battle of Waterloo (1815) offers teeth for the fabrication of prostheses.
More than 10,000 soldiers are falling, including many young men with healthy teeth. These teeth used to make prostheses, increased in great magnitude and were called ‘Waterloo’s teeth’. The Civil War in the United States also created a pool of human teeth (1861-1865).
Use of human teeth
Until 1865, they used human teeth. Gradually porcelain teeth replaced them. The putrid odour of human teeth was not very seductive.
George Washington became the first president of the United States in 1789, at 57 years old. They gave him hippopotamus ivory prosthesis with a combination of human teeth.
In 1789, the French Nicolas Dubois de Chénant presented a patent for porcelain teeth. It was in fact the recovery and improvement of the invention of Alexis Duchâteau.
It was Claudius Ash of London (1792-1854), dental manufacturer descendant of a family of goldsmiths, which made large scale porcelain teeth from 1820. Then, in 1834, LA Billard in Paris shared the same concept. Finally, it was in Philadelphia that Samuel Stockton White developed one of the largest porcelain tooth-making companies.
Around 1839, the house Françoise Coutenau and Godart son of Paris designed a dental prosthesis based on rubber that was maintained in the mouth by suction effect. To improve rubber performance, sulphur was added by vulcanisation, hence the name of the Vulcanite denture.
The first patent was filed in the United States in 1851 by the Charles Goodyear Vulcanite Company. This is the birth of Vulcanite, a rubber-based material (vulcanised rubber) vulcanised under high pressure heat.
Porcelain teeth exported to the US
Around 1840, 500,000 porcelain teeth were exported from Paris to the United States. The profession of dental technician then develops at the same pace as that of a dentist.
In 1940, about 70% of prostheses consist of Vulcanite. Shortly before 1928, in Germany, Great Britain and Spain, polymethyl methacrylate (PMMA) or acrylic was developed. Around 1950, acrylic gradually replaced the rubber.
To compete with the import of European teeth into the United States, Trubyte (now Dentsply) is developing industrially manufactured porcelain teeth.
They are designed by Dr J Leon Williams and Dr Alfred Gysi, professor emeritus of the University of Zurich.
Together, they developed a classification of the shapes of the teeth according to the shapes of the faces. Thus, for the first time, they designed teeth that they could articulate appropriately. Following the parameters of the faces of every individual enabled this.
A new era in artificial teeth
This was the beginning of a new era in artificial teeth. The global elite prosthesis then began to introduce teeth into the market according to all kinds of theories of articular jaw movements.
To show the teeth, you needed the help of an articulator. William AG Bonwill developed the first high end articulator 1864. Before that date, they used the hinges of modified barn doors. We then begin to speak of ‘bilateral’ and ‘balanced’ montages.
It was in 1920 that Rudolph L Hannau developed an adjustable articulator. Alfred Gysi invented the technique of lingualised editing in 1927 and patented an articulator in 1928.
Albert Gerber patented his in 1948. The latter is considered the most sophisticated articulator. This is because it considered the adjustments of the temporal articulation with the mandible in harmony with the occlusion.
In the 1920s, and because of the large European taxation of imports, Trubyte, then acquired by Dentsply, set up a porcelain tooth factory in Paris. It is Auguste DeTrey, of Swiss origin, who will distribute American products in Europe. DeTrey entered into competition with British manufacturer Ash in London. When the economy slowed down around 1923, the two companies merged to become the Amalgamated Dental Company Ltd.
Dentsply the world’s leading producer
Dentsply was now the world’s leading producer of artificial teeth. Around 1925, Ash and DeTrey, in partnership with Dentsply, acquired a German company in which they set up a research centre led by Dr Konrad Gatzka. The latter developed the best tooth ever sold in Europe, the Biodent.
Dentsply acquired Natudryl manufacturing company of Australia, specialised in the manufacture of plastic teeth. They perfected Neolux and Neolux Pearl teeth in 1962 and 1969 respectively. This was the marketing of the ‘opalescence’ of the tooth. It was also at this time that Dentsply Australia developed the pink acrylic prosthesis base, imitating natural gums.
In the 1920s, the German competitor Vita launched Helios tooth, a system of superimposed layers imitating dentine and enamel. The development of this technique continues until today.
Vita introduced an acrylic teeth technique in 1950. They are entirely hand-made.
Vita developed the first shade guide around 1924. It’s the same universal colour guide we know today, combining shades A1 to D4.
The company has done a lot of research on the natural reproduction of the clarity of the hue and the luminescence of natural teeth. The Vita shade guide divides tones, saturation and degree of clarity into groups.
Manufacturers mainly use this method today. This guide is universally recognised.
In 1982 Vita introduced Vitapan. In 1986, the posterior teeth Physiodens appeared and the previous ones in 1996. Dr Eugen End developed these teeth after a long research. This recommended the physiological side of the tooth, as much concerning the appearance as the technique of assembly. His goal was the reproduction of nature, much like Gaudi and Catalan architecture. Dr End disagreed with balanced and lingual editing techniques. A physician and dentist, he is the author of numerous publications on human anatomy and human physiology. He applied himself to develop a technique of physiological assembly in dental prostheses related to the centric mounting.
The polyacrylic material developed by Vita gives its teeth wear resistance comparable to a natural tooth, unlike many acrylic teeth on the market.
To satisfy all the theories and philosophies of assembly, Vita offers four types of posterior teeth:
- Physiodens: very anatomical, amounts to centric only with a slight elliptical movement up and down like natural chewing (according to Dr End)
- Linguoform: conceived essentially for lingualised assemblies according to the technique of Dr Gysi
- Cuspiform: semi-anatomical tooth designed for balanced mounting (mechanical guidance) recommended by Dr Gerber
- Synoform: 0 degree tooth, used mainly in geriatrics.
For the proper use of these teeth, it is essential to pre-determine what will be the ideal mounting method for each patient. Several companies have put on the market a varied range of teeth more or less equivalent in terms of quality.
Over the last century, research and development has contributed significantly to the development of resins of all kinds, from acrylic to composite. Evolution has placed these materials up to date.
Dr Rudolph Slavicek’s (world renowned expert in gnathology) innovations, birthed new concepts. This includes the new posterior tooth ‘S’ Enigmalife of Schottlander. The morphology of this tooth, with angles of 35 degrees, allows greater flexibility in the choice of different mounting concepts. The posterior tooth is responsible for the stability of the prostheses and the good positioning of the condyle during masticatory movements. The versatility of this tooth makes it possible to modify the lingualised or physiological balance assembly and even crosswise, depending on the situation.
This tooth is also designed for use with natural antagonists such as partial dentures. The quality of intercuspidation is critical for the physiology of chewing, making it also an ideal tooth in implantology.
The basic concept is that of a pestle in a bowl. Mounting is easy and fast thanks to reference points in centric positioning. According to the parameters of each patient, some adjustments allow, from the base of contact, to complete in lingualised, balanced or crossed. The basic contact point is the mesiolingual cusp of the top six sitting in the pit of the bottom six.
In recent decades, to counter the premature wear of acrylic teeth, manufacturers have developed all kinds of composite material teeth whose hardness slows down the wear process. That said, as a result of numerous tooth breakage and bursting problems containing too high percentages of nanohybrid compounds, Schottlander developed the Enigmalife tooth, a new generation formula that offers a tooth that does not sag.
The Schottlander company has combined the best combinations of acrylics and composites to offer a refined, inexpensive and easy-to-use premium product. The Enigmalife tooth is the result of all of the up to date research so far. A sharing of the experiences of years of research, trial and error through the time.
One only has to examine the previous Enigmalife. They are of an exceptional beauty, as much by their opalescence as by their fluorescence. This is often found in ceramics. The light is better distributed throughout the structure, giving a depth effect, and a natural appearance.
The modern principle is to combine composite and acrylic. Posterior composite teeth resist better to abrasion and masticatory forces. Acrylic multilayer anterior teeth are more resistant to anteroposterior forces and breakage because they are more resilient. Their wear is therefore proportional to that of the posterior teeth.
Thanks to this concept, the adhesion to the acrylic base is improved, without having to grind the part where the tooth comes in contact with the resin. This feature makes Enigmalife an ideal tooth for use in implantology, where more stable prostheses need more resistance to the multidirectional forces of chewing.
From yesterday to today, missing teeth are a concern for human beings. The use of dentures will remain important for many years to come due to self-esteem, confidence, and optimal chewing.
At present, the number of seniors (baby boomers) remains high relative to the world’s population, and life expectancy has also increased.
Experts estimate that by the year 2038, only 6% of the population will be edentulous, while the number of inhabitants on earth will have doubled. Ironically, this means that we will probably face a shortage of denturists.
Keep up to date to ensure the sustainability of our profession. Keep this passion that drives you, because we are the elite of an art that continues to evolve and refine.
Bibliography and references
The Dental Prosthesis in Antiquity (1989) by Dr Deneffe, Antwerp
Woodforde J (1968) The Strange Story of False Teeth. Routledge & Kegan Paul (ed) London
International Directory of Company Histories (1995) Vol 10. St James Press
Bennike P and Fredebo L (1986) Dental Treatment in the Stone Age. Bulletin of the History of Dentistry 34/35: 81-87
Dilwyn Jones (2000) An Index of Ancient Egyptian Titles, Epithets and Phrases of the Old Kingdom 1 (1412): 381
Stephanie Pain (2001) The great tooth robbery. New Scientist 2295, June 16 (ISSN 0262-4079)
Dawson PE (2007) Functional Occlusion: From TMJ to smile design, Mosby (ISBN-13: 978-0-323-03371-8)
End E (2006) Physiological occlusion of human dentition. Verlag Neuer Merkur GmbH, Postfach 60 06 62, D-81206 München
Misch CE (2008) Contempory Implant Dentistry. Mosby (ISBN 978-0323-04373-1)
The Robert Dictionary (1975) 107 av. Parmentier, Paris (Iie), Society of the New Littre
Larousse Dictionary (1993) Paris (ISBN: 2-03-401-631-9)
I thank Angela, Davide, Marina, my teacher Alberto Battistelli, my staff, and above all Nazar Bondarchuk, Antonio Bizzoca and Valentina Colella for supporting us with a continued dedication.
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