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A Brief History of Prosthetics in Dentistry

From the sterile dental fabrication labs of today, it’s hard to see prosthetics as anything but futuristic. With a 3D printer whirring as an aligner is formed 3 microns at a time, a bleep from the desktop informing the lab of a request for enamel veneers with precise shade and translucency specifications. It seems more like a cybernetics lab from sci-fi, as a dental implant in Brentwood order comes through.

It didn’t start like this though. There’s a very long history of oral prosthetics; it’s less million dollar man and more million-year-old man.

The stone age

What is an ancient man to do? He has a stone axe lashed with sinew and glued with bitumen to a sturdy wooden handle and a very distracting throb in a tooth. Well, if he can form an axe head, a 4mm wide flint scraper should not be too hard, and with a bit of gentle work, clear out the cavity. But how to fill it? A little of that bitumen on a stick softened over the fire might work, if he can quickly get it from the flames pushing it into the hole in the tooth! As the bitumen cooled into a water-proof airtight plug, it was done. The first filling! As far as we can deduce from a skull found in northern Italy, this occurred 13,000 years ago.

All that glitters is not enamel

Bitumen didn’t last, it might be insoluble which is a start, but it is soft and rubbery giving no strength to a crumbling tooth. Pure gold is very soft by metal standards, but it beats tree tar. Malleable and completely unreactive, 2500 years ago, a gold wire was a dental mainstay with Egyptians using it to bind a loose tooth to its neighbour, forming a sort of bridge.

The use of solid gold prosthetic teeth is not unheard of in this time period but is extremely rare.

Pontiff Maximus before the Pontiff

The roman title Pontiff Maximus translates as master bridge builder due to the infrastructure that the empire assembled, but before the rise of Rome, other people lived on the Italian peninsula; the Etruscans. The Etruscan bridge is the first true example of a dental bridge.

These were rows of human-sized teeth, carved from bone or ivory, held together, and attached to the patients remaining teeth with bands of gold and silver. The archaeological evidence suggests these were fitted after deliberate extractions had been performed, in much the same way as a modern clinic would operate.

Teeth and jewellery

The crossover between fine metalwork, like that of a goldsmith or silversmith, seems to be a millennia-long trend. The American revolutionary Paul Revere, who was better known in history for spying on the British empire, was a silversmith by day and often found himself witling down ivory into dentures and individual teeth.

In the post-battle carnage of Bunker hill in 1775, Revere identified the body of his friend and fellow revolutionary general Joseph Warren from a dental bridge that he had carved for him. This is considered the first time a dental record was used to forensically identify someone.