judgment and bungling manipulation cannot succeed in delicate operations.

The unpleasant effects that malformed, mutilated or malposed teeth have upon observers are far too numerous and various for me to attempt to notice all of them; it will suffice for my purpose to describe a few certain cases in my own practice. I deem it unfortunate for the profession at large that some competent dentist has not written a book on Perspective Dentistry. Operative dentistry presents so vast a field that it is necessary to subdivide, classify and circumscribe portions of it, in order that operations having kindred characteristics may be considered and discussed without confusion.

My subject, "Perspective Dental Operations," has nothing to do with correcting irregularities of the teeth, by moving them into proper position; but teeth that are only slightly out of line; partially turned in socket; leaning apart, or inclining toward each other, and even lapping a little; central incisors too long, laterals too short, or one incisor longer than its mate; canines too prominent, sharp-pointed and long; irregular edges, either congenital or from abrasion; pits and grooves in labial surface, and uneven spaces between the teeth; all these ought to be classed under the head of "Perspective Dentistry," because they have to be treated in such manner as to relieve the effect upon the eye; many operations under this class are simply optical delusions, and are yet the very essence of high art.

A lady of about thirty-five years consulted me about the advisability of attempting to correct the irregular arrangement of her anterior superior six teeth. I advised her against having me undertake it, for good enough reasons as I thought. She was preparing to change her residence to St. Louis, Mo., in a few days, and inasmuch as the disarrangement of the left superior lateral incisor was involved with the left lower canine, I thought I would not have enough time to accomplish the removal necessary in both maxilliaries. I recommended a dentist in St. Louis, but the lady insisted upon having me do what I could, so I resolved upon a bit of perspective dentistry.

In this case the central incisors were advanced, with the left one lapping slightly over the right; the mesial corners of both

were considerably projected beyond the true arch, whilst their distal proximal surfaces were retreated; the arrangement, added to the unusual length, gave to these centrals an aggressive ap

pearance.

The lateral incisors were very short indeed; the right lateral occupying its proper position, the left one also in correct line at cervix, but with the cutting edge thrown considerably to the front; this incisor was pushed backward so that the distal corner of its incisive edge rested against the left canine, and was so turned in its socket that the central proximal surface was nearly as much presented as the labial surface; this everted position brought into view the concavity of the palatal surface, thus,

Fig.1

Causing the unsightly A shaped separation seen in the illustration, between the lateral and central.

The canines were rounded and advanced labially, having a hooked-back appearance that was aggravated by the cusps being exaggerated and pointed.

The edges of the central incisors were quite irregular; the left central having a sort of point about its centre, whilst the

Fig. I

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right dropped its distal corner fully as low as the points of the Fig.

canines, being an eighth of an inch apparently lower than the lateral of the left side.

The aspect of these six feature teeth when presented to me for modification is pretty closely represented in the accompanying illustration.

Fig.IV

The left inferior canine stood somewhat advanced from the arch, and the cusps having been lost from mechanical abrasion, the thick stubbed end was applied to the palatal surface of the left superior lateral incisor in such a manner as to retain it in its malposition. As I before observed the patient's contemplated early removal to St. Louis so circumscribed our time that I could not hope to remove the sup. lateral, back to the arch, and at the same time turn it in socket, to secure correct incisive alignment.

By reference to Fig. IV it may be observed that the central incisors, in addition to edging outward and slightly lapping mesially, and being irregularly pointed on cutting edges, were somewhat bellied on lateral proximal surfaces. With a flat file, No. o, I made a separation between the centrals, placing the file so that cutting straight upward it took about an equal portion off each tooth, so that from a direct front observation I could look through the separation into the mouth. The right central having formerly underlapped, I rounded the edges very slightly where left sharp by the file; the left central incisor having for merly overlapped the right, the anterior edge of its newly established proximal surface was considerably in advance of its fellow of the right side, so that in order to modify the abruptness of its advancement I reduced the prominent mesial edge of the left central to a degree extending from one line of the labial surface centrally and backward, until the bevel reached the labial surface plane of the retired right central.

Fig.V

This reduction of surface was not made flat and at a definite

angle, but gently rounded from labial to mesial extremities thereof; this cutting away left an apparent evenness of labial surfaces, but something remained still to be done.

With an Arkansas stone attached to my dental engine I ground down the cusp or point on the center of cutting edge of the left central incisor, and the ugly prolongation of the lateral cutting corner of the right central, until the incisive edges of both were even, slightly convex, and barely lower than the lateral incisors on either side of them. The bellied lateral proximal surfaces of these centrals next received attention; these I cut away with a thin separating file, until nearly straight surfaces were obtained, rounding the cut corners as before

The symmetry of the four incisors was now complete to ordinary observation, except the left lateral, which as previously described and illustrated, was advanced at point, turned in its socket and leaned against the left canine, so as to present much of its central proximal surface and to form an ▲ like space between itself and the central incisor. The cavernous darkness of the mouth seen through this extensive A separation, presented a marked contrast to the very close proximations of the neighboring teeth, and all violent contrasts in such cases only serve to heighten to the eye the impression of irregularity.

This left lateral incisor had been previously operated upon by another gentleman of this city; the filling was of cohesive gold, and was very creditable; by reference to the diagonal line on this tooth in Fig. IV, an adequate idea may be obtained of the form of this filling. and the extent of it. Having determined to close the space between the left lateral and central incisors by building out the contour of the lateral, I removed the surface of the filling above referred to, and after roughening the new surface with plugger and mallet, added new gold, until the contour was carried to the central, thus closing up the A shaped dark space. The turned or everted position of that surface of this lateral incisor would-if followed-have carried the extended gold contour considerably in advance of the proper circle of incision, but thanks to the cohesive property of the gold employed I experienced no difficulty in so manipulating as to carry the filling backward sufficiently to have the labial surface of the gold lie

even with the same surface of the left central incisor; the filling was smoothed and polished in the usual manner.

The last step was to reduce, with revolving Arkansas stone, the bulged or bellied labial portion of each superior canine, and to shorten the points of them to correspond with the cutting edges of the central incisors. I then made separations with the o flat file, between these canines and lateral incisors, rounding and polishing newly cut edges every where.

After polishing the whole of the anterior superior teeth, I stopped to view my work, and had the satisfaction of noting that in perspective the conservation of the arch was complete. Although there was no real correction of irregularity, as the expression commonly indicates, yet modification in some parts. and extension in others, secured an expression in this case that was acceptable to the eye, and very gratifying to the patient.

The general features of this case were congenital, the lady's father having exactly the same arrangement of his anterior superior teeth. In cutting away the undue prominences, the dentine was no where exposed so far as I know, and the patient felt no pain indicating such exposure. The left lateral incisor, after the addition of gold contour, was, of course, wider than the lat eral of the right side, but the tooth itself, being turned in socket so that the distal proximal surface was thrown backward somewhat, the labial surface proper was but slightly presented, so that, on the whole, the crown-gold and all-was apparently of about the proper width for symmetry, and the gold contour filling looked far better than the oral darkness that was formerly visible through the ungainly A formed separation. The reader who has followed me carefully throughout this paper, understands that the effect of these operations was purely perspective, was in fact an optical delusion.

So it was all the way through the operations upon the malformed and malposed teeth of this case, that by breaking contrasts, and rounding abrupt angles, an approximation to harmony was attained that the casual eye would readily accept for true symmetry.