ENDODONTIC HISTORICAL PERSPECTIVE

This # the fi~st of a three-part series. Part 2 of this Historical Perspective will appear in next month's Journal.

A historic review of endodontics, 1689-1963, part 1

William P. Cruse, DDS, and R. Bellizzi, DDS

This review is not intended to add to icant accomplishments since 1963, way into the tooth structure from our technical repertoire but rather to but we have delegated to others the contaminated food, if, in fact, they aid in our current understanding of assignment of recognizing the con- did exist). endodontics. How can we appraise a temporary leaders in endodontia. In 1700, in a letter to the Royal new development or evaluate vol- Society of London, Anton von Leeu- umes of contemporary literature wenhoek, the "father of modern without placing them in their proper The Empirical era (1687-1805) microscopy," identified what he be- perspective? By reviewing and un- lieved was the source of such contam- derstanding the accomplishments of Charles Allen is credited with writ- ination: worm-infested cheese. 2 His our predecessors, perhaps we can ing the first book in English devoted findings did much to quash the expand our future development. exclusively to . Although "tooth worm" theory. The objective of this paper is to endodontics as we know it tody was In 1728, Pierre Fauchard, the review the written history of develop- not practiced at that time, Allen "founder of modern dentistry," ments in endodontic practice in discussed procedures for transplant- wrote The Surgeon . This book chronological order. We have chosen ing teeth in his third edition, pub- provided accurate descriptions of to begin our review with the year lished in 1687. However, he did not pulp cavities and root canals of Vari- 1687, when Charles Allen described record the pulpal procedure per- ous teeth. In it Fauchard described procedures for transplanting teeth in formed when "taking out the rotten the practice of opening teeth to the first English-language book de- teeth or stumps and putting in their relieve abscesses and to evacuate pus. voted entirely to dentistry. Although places some sound ones drawn imme- After leaving the tooth open for a some authors have cited accomplish- diately out of some poor body's period of two to three months he ments made in endodontics from head. ''1 filled the pulp chamber with ancients times, understanding these The "tooth worm" theory per- foil. Although he did not mention in light of the field of endodontics we sisted through the ages since Baby- root canal therapy, he described a know and practice today is some- lonian times. The tooth worm was pulp extirpation procedure using a times difficult. thought to reside in the hollow por- small pin. Fauchard also described This paper is not intended io tion of a tooth, where it would cause his treatment for deep carious review the recent history of endodon- a toothache by gnawing at the struc- lesions: application of the oil of ties. We have purposely ended the ture of the tooth. Even Pierre Fau- cloves or to the affected chronology with the year in which chard would not publicly deny its area for several weeks. For a persis- endodontics achieved recognition as existence (although he said that the tent toothache, he mixed opium with a special area in dentistry. We do not tooth worms were not spontaneously the oiP (Neaverth, E.J., unpublished imply that there have been no signif- generated and must have found their material).

495 JOURNAL OF ENDODONTICS VO/6, NO 3, MARCH 19~

In 1756, Phillip Pfaff, the German oil, frequently gives relief, and if innovator for his time as he stressed dentist to Frederick the Great, first repeated for sometime, often destroys the importance of preserving natural mentioned a pulp-capping proce- the nerve." He also used repeated teeth.~l dure. He simply cut out a piece of applications of crude opium and John Callow, London, in his Opin- or lead to approximate the camphor to cauterize the nerve. 7 ions on the Causes and Effects of Diseases opening over the pulp and placed By the end of the 18th century, in the Teeth and Gums, published in this over the exposure so that the Frederick Hirsch, a noted German 1819, credited Charles Bew with de- surface nearest the PUlP was concave. practitioner, wrote of diagnosing scribing the flow of blood into the This prevented the metal from con- occult dental diseases by tapping the pulp through the apical foramen and tacting the exposed nerve. The tech- suspected teeth. He found that the out through the dentinal wall and nique was probably an improvement diseased tooth elicited pain on per- periodontal membrane. This placed over Fauchard's method of filling the cussion. The treatment he recom- Bew along others of his time who cavity directly over the exposure.' mended was perforation of the tooth subscribed to the "vitalistic theory" Bourdet, the dentist to Louis XV at its neck followed by repeated of teeth. ~ Of , in 1757 described a proce- insertion of a red-hot probe. He con- A young German immigrant, born dure for extracting carious teeth, fill- sidered the tooth cured after the in 1785, came to this country and ing the root canals with gold or lead, cavity was filled with lead? failed in his efforts to become a and replanting them. He also salesman. In 1807, with little or no described an "intentional" endodon= The Vitalistic era (1806-1878) formal background in dentistry, he tic treatment in which he dislocated opened a Philadelphia dental office. a symptomatic tooth in order to sever In 1805, J. B. Gariot became one Eleazar Parmly, the founder and co- the nerve, and then immediately of the first to recognize the problem editor of the first dental journal, placed it back in its socket? This of vitality in connection with pulp described the young man's first practice had been described treatment, in Traitk des Maladies de la extraction this way: "He grasped the hundreds of years earlier by the Ara- Bouche, he declared that destruction tooth with an instrument, shut his bian physician Avicenna? of the pulp does not destroy the eyes, and turning his head from the The first recorded description of vitality of the tooth. 8 patient, made a strong effort which an endodontic procedure in this Although Bourdet has been cred- dislodged the tooth." This was an country has been attributed to ited by some as the first to have used inauspicious beginning for Leonard Robert Woofendate, who came to an impervious root canal filling, the Koecker, who became a successful New York from England in 1766. He specimen he used was probably a dentist and wrote Principles of Dental brought with him a method of alle- displaced tooth that he reimplanted Surgery in 1826, an excellent text that viating pain by cauterizing the pulp or transplanted. Therefore, the roots became a standard work for 50 with a hot instrument. He concluded were probably not "in situ" while years.1 the treatment by stuffing cotton in being filled? -~ Koecker believed that, when a the open canals? ~ In 1802, B. T. Longbothom, pulp was destroyed by disease or by (Of course, the Greeks and Ro- Charleston, SC, recommended filling artificial means, the whole dentinal mans had used cautery earlier. In the roots of teeth when it was core of the tooth immediately died. addition to hot instruments, they deemed inadvisable to extract them? The tooth then became a foreign also used boiling oil, herbs, opium, However, Edward Hudson, an Irish- body, which necessitated extraction and arsenic to desiccate the dental man practicing in Philadelphia, is to.prevent inflammation and subse- pulp)? generally given credit for having quent suppuration and death of the In his publication Practical Observa- been the first to place fillings in root vital tissues around it. tions on the Human Teeth, Robert Woo- canals in 1809. He packed the canals In an effort to avoid loss of the fendale described his method for with gold foil, using instruments of tooth, Koecker popularized the pulp treating a nerve exposure. "When his own design? 1~ Hudson was an capping procedure. Athough he is the nerve is exposed, a small bit of exceedingly thorough and successful sometimes given credit for introduc- lint, dipped in the oil of cinnamon, clinician in his use of gold as a ing and even for inventing the cap- cloves, turpentine, or any chemical restorative material. 7 He was an ping operation, it was essentially the

496 JOURNAL OF ENDODONTICS VOL 6, NO 3, MARCH 1980

~me treatment that Pfaff described ic pulp was cauterized with a hot canals2 .13 However, he became most in 1756- 7~ Koecker believed that liv- instrument, or corrosive acids such as famous for the Maynard Rifle, which hag tissue could not remain healthy sulfuric or nitric were used to destroy he designed and which was used by mad viable beside dead tissue. the pulpal tissue. Then, Shearjashub armies all over the world (Milas, Although not all of his successors Spooner, New York, used a proto- V.B., personal communication, Oct, subscribed to this principle, it domi- plasmic poison (arsenic trioxide) to 1974). nated pulp treatment procedures for devitalize the pulp before removing In 1839, Baker wrote in the Ameri- over 50 years, s it 5 (Neaverth, E.J., unpublished ma- can Journal of Dental Science that his Although the "vitalistic" or "dou- terial). Spooner was not the first to treatment for an exposed nerve was ble membrane" theory dates to the use arsenic, however, as the practice to remove the nerve, clean the canal, beginning of the 19th century, it was dates back to the ancient Chinese and fill the canal with gold foil. He is not until 1829 that S. S. Fitch formu- empires where it was described as a credited with writing the first pub- lated and presented its doctrines in treatment for conditions similar to lished account of pulpal extirpation, his book, System of Dental Surgiry. He alveolar abscesses? canal cleaning, and root canal fill- believed that teeth were like hollow This form of pulp treatment ing.:' bones and had an outer periosteum became an immediate success as it During the same year, S. P. Hul- (periodontal membrane) and an was painless. The practice led to lihen, Wheeling, W Va, classified the inner periosteum or lining mem- imprudent use of arsenic devitaliza- causes for toothaches as: exposure of brane that lay between the pulp and tion of the pulp and for treatment of the nerve; fungus of the nerve; con- dentin. The crown was therefore hypersensitive dentin. In addition, finement of pus inside the tooth; nourished exclusively by the dental leakage of the arsenic through the diseased periosteum covering the pulp or by its membrane, whereas root canal destroyed the adjacent fang; and sympathy (psychosomat- the roots were supplied by the pulp vital supporting tissues of the perio- ic). membrane on the interior and by the dontium. As gutta-percha and other According to his classical descrip- alveolar membrane on the exterior. impervious cements were not used at tion of "fungus of the nerve," he According to this theory, when the the time, the problem of leakage probably was referring to what is pulp was removed, only the crown probably occurred with relative fre- now called a pulp polyp? lost all its vitality, whereas the roots quency '~ (Del Rio, C., unpublished Although "mazer wood" had been continued to be nourished by the material). As recently as the 1920s, brought to England as a curiosity for periodontal membrane. This led to arsenic still was being used by many 200 years, it was not until 1847 that the practice of removing the crown of to destroy the pulp before Edwin Truman introduced gutta- teeth after extirpation of the pulp removing it. 'z percha as a filling and denture base and placing a pivot crown on the In 1837, Jacob Linderer and his material.'"" remaining root(s) r8 (Neaverth, E.J., son Joseph, a dental student, pub- Throughout the 1850s, plugs of unpublished material). lished a manual recommending the wood soaked in creosote were used to The nonvitalists of this period use of an essential or narcotic oil to fill root canals. A solution of Hill's included such eminent scientists as render the pulp insensible before stopping and chloroform or eucalyp- John Hunter, the great British sur- attempting to place a permanent tus oil was used as a liquid cement to "geon and anatomist. Hunter believed filling in a tooth with an exposed seal the wooden plug. This was an that dentin had no circulation, sensi- pulp. 4 early attempt to obturate the canals bility, capability of repair, and did Edwin Maynard, Washington, with a solid root-filling point and not possess any of the properties of a DG, is credited with developing the cementing medium or sealer. 3 living tissue. Other leading propo- first root canal broach in 1838, which Hill's stopping (restoration) was nents of the nonvitalistic theory he fabricated by filing a watch composed of gutta-percha, quick- included Cuvier and Robertson from spring. This enabled dentists to enter lime, powdered glass, feldspar, and England. ~ and to treat teeth with small canals, metal filings. After 1848, it was rou- Until 1836, extirpation of vital such as premolars and molars. In tinely used as a temporary restora- pulp was an extremely painful proce- addition, Maynard developed hoe- tion. '2 dure. Before that time, a symptomat- like instruments that could be used In an article published in the Bos- for enlarging and for shaping root 497 IOURNAL OF ENDODONTICS I VOL 6, NO 3, MARCH 1980

ton Medical and Surgical Journal in example of early scientific appraisal. first to have used gutta-percha as the 1850, W. W. Codman claimed that However, Rogers concluded by pre- sole material for filling a root the ultimate design of all pulp cap- scribing three leeches and a laxative canal? '1~ Bowman was also the ping was to obtain the production of if the pulp capping failed. co-inventor of the rubber dam clamp secondary dentin at the point of In 1858, Jonathan Taft, professor forceps in 1873. 5 exposure of the pulp. Although the of operative dentistry at the Ohio In 1867, Joseph Lister first re- pulp capping procedure had been in College of Dental Surgery, intro- corded his experiences using carbolic vogue since Koecker popularized it duced a new approach to the dental acid as an antiseptic during surgical in t821, Codman was the first to pulp. He defended those who consid- procedures. By coincidence, Leber claim the ultimate objective of depo- ered the pulp important, even after and Rottenstein, Berlin, proved the: sition of secondary dentin. 7 development and formation of the existence of a parasite they called In t851, S. P. HuIlihen described tooth were completed. Taft claimed Leptothrix buccalis during the same an operation he claimed to have that viable dentin possessed more year. They found this organism to performed since 1845. Although he resistance to decay than nonvital exist on tooth surfaces, in carious labeled it "risodontryphy," it was dentin. lesions, and in the dentinal tubuli.. known for many years as "Hullihen's In making a determination as to Their findings led to the conclusion operation." The procedure was a whether a pulp capping procedure that could cause gan- venting technique used to treat a was indicated, Taft considered the grene of the pulp. It .seems quite congested pulp. After a flap was condition of the patient, the extent of natural that attempts were made to raised over the root of the symptom- the damage, the length of elapsed transfer Lister's newfound antiseptic atic tooth, a spearlike drill was used time since the damage occurred, and treatment of wounds into pulp treat- to bore through the alveolus and root the capacity of the pulp to produce a ment.' to gain access to the canal and to bony deposit. Also in 1867, Magitot suggested induce hemorrhage of the pulp a~s He recommended that the exposed the use of an electric current for pulp (Neaverth, EJ., unpublished materi- pulp be covered with a few drops of testing. 9 al). collodion or gutta-percha dissolved In an 1870 review of 42 cases of Hunter and Fox also had used this in ether or chloroform. This dressing pulp capping with a 10-year follow- technique of drilling into pulp cavi- was to be applied before a gold up, G. V. Black reported only six ties earlier, but they did so in order to restoration was inserted2 cases in which the pulp survived allow the escape of pus; whereas, In t864, S. C. Barnum, New York, longer than five years. Black advo- Hultihen did so to deplete a con- devised a thin sheet of rubber to cated the use of zinc oxychloride as a gested pulp and to allow its preserva- isolate a tooth during gold foil oper- capping material. This seemed to tion. 7 ations. This became the indispensa- gain wide acceptance as a capping Thomas Rogers reviewed the sub- ble rubber dam we know and use medicament and as a root canal filler ject of pulp capping at a meeting of today. The material was quickly throughout the American dental the OdontologicaI Society of London incorporated into root canal filling profession. It was often referred to as in 1857. He reported on 220 cases of procedures and provided more asep- Ash's cement. ~ pulp capping, of which 202 were tic treatment technique? .~ Most European dentists accepted deemed successful. He provided an By t865, E. L. Clarke, Dubuque, the practice of amputating devital*- outline for the conditions of success Iowa, and others of his time (and ized pulps and mummifying pulp in nerve capping as follows: general probably before) were filling the stumps. Adolph Witzel, Germany, good health of the patient; freedom roots of teeth with a hot mass of base has been credited with advocating from inflammatory tendencies; ab- plate gutta-percha. The technique this procedure and introducing it to sence of previous considerable pain was to heat the material as hot and the dental profession ~z (Neaverth, in the tooth; absence of disease in fluid as possible without burning it EJ., unpublished material). In 1873, other parts of the tooth; no caustics and then to churn it into the canals ~Nitzel empirically adopted the to deaden the pain. with a hot instrument. ~'~ methods of Lister by treating root Had he stopped at that point, his G. A. Bowman, Missouri, has been canals with phenol in an attempt to work might be considered a good given credit by many authors as the sterilize them? 8

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About the same time, J. W. Keyes as a pulp capping material, most 7. Koch, C.R. History of dentat surgery, vol described the use of iodoform as a American authors credit N. C. Keep, I. Chicago, National Arts Publishing Co., t909, pp 208-219. pulp and periapical dressing. Iodo- Boston, with introducing this prepa- 8. Denton, G.B., and othet~. The history of form had been discovered more than ration in 1876. The use of this mate- vitalism in pulp treatment. Dent Cosmos 50 years before by Serullas. rial gained wide acceptance and was 73:267-273, 1931. Most historians credit Witzel for used for many years. 5'7,1~ (Part 2 of 9. Tagger, M. Endodontics: a review of the providing the first description of a this article will appear in next month's past and its present status. Alpha Omegan 107-118, 1967. vital pulpotomy in 1847, although Journal.) 10. Lightfoot, V.C.,Jr. Brief history of root Chase was performing this procedure canal therapy. Dent Students J 33(9):11-17, as early as 1866. Witzel's technique Drs. Cruse and Bellizzi are lieutenant colo- 42, 1955. was to apply arsenous acid to the nels, US Army Dental Corps~ Requests for 11. Monica, W.S. Outline of dental history'. reprints should be directed to Dr. Be|lizzi, inflamed pulp for 24 hours so as to Hackensack, NJ, Fairteigh Dickinson Univer- director, Endodontic Residency Training Pro- sity Dental School, t972. devitalize only the coronal portion, gram, PO Box 59, Madigan Army Medical 12. Grossman, LI. Endodontics: a peep At the next appointment, he ampu- Center, Tacoma, Wash 98431. into the past and the future. Oral Surg 37:599- tated that portion of the pulp and 608, 1974. treated the root stumps as healthy, 13. Ostrander, F.D. The practice of endo- References freshly exposed pulps? z donties: past, present and future. J Dent Educ 1. Costich, E.R., and others. Plantation of 31(3):386-388, 1967. Necessity was the mother of inven- teeth: a review of the literature. NY State 14. Goodman, A.; Schilder, H.; and tion in this instance, as pulp amputa- Dent J 29:3-13, 1963. Aldrich, W. The thermomechanical properties tion was advocated in order to avoid 2. Ring, M~E~ Anton yon Leeuwenhoek of gutta-percha. Oral Surg 37:954-961, 1974. the need for instrumentation and and the tooth-worm. JADA 83:999-I001, 15. Noyes, E. Fifty years of root-canal fill- filling of the root canals. Few endo- 1971. ings. JADA 9:784-794, 1922. 3. Curson, I. History and endodontics. 16. Ingle, J. Endodontics. Philadelphia, dontic instruments were commercial- Dent Pratt 15(12):435-439, 1965. Lea & Febiger, 1965. ly available at the time, and, conse- 4. Francke, O.C. Capping of the living 17. Coolidge, E.D. Past and present con- quently, the success or failure of root pulp: from Philip Pfaff to John Wessler. Bull eepts in endodonfics. JADA 61:676-688, canal therapy depended largely Hist Dent 19(2):17-23, 1971. 1960. upon the ingenuity" and manual dex- 5. Anthony, L,P., and Grossman, L.T. A 18. Prlnz, H. Electro-sterlization of root brief history of root canal therapy in the canals. Dent Comos 59(4):373-388, I917. terity of the operator. United States. JADA 32:43-50, 1945. Although in 1870 G. V. Black 6. Farley,J.R. Brief history of endodonties. suggested the use of zinc oxychloride Tex Dent J 92(2):9, 1974.

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