one ring to the one on the opposite side, constitutes the band; solder the ends of the band to the rings; opposite the teeth to be moved, on the outside of the band, solder a small shot of gold, or a short platinum pin with a head, for the attachment of rubber bands or ligatures. This completes the apparatus-all that is needed in many cases, and it can be made and adjusted in one hour's time by any one of ordinary ability.

I understand that Dr. Patrick has made arrangements with The S. S. White Dental Manufacturing Co. for putting this apparatus on the market. When this is done we can keep in our operating-cases an appliance which will aid us greatly in these most trying and perplexing cases of irregularity.

Dr. DORRANCE: I doubt not that those present hitherto unfamiliar with this method will attempt its use when opportunity hereafter occurs; therefore I wish to emphasize an important point as yet only hinted at. Those who try the Coffin regulating plate must be cautioned against using too large wire, for they will doubtless be tempted so to do. 30 A very small wire (say, 15 to 3% of an inch, or about number 20 to 21 of Brown & Sharpe's plate-gauge in diameter) will accomplish a great deal, with very satisfactory results and little liability to injury, whereas a heavy wire will act so rapidly that severe pain and serious injury are sure to result. Great care should also be observed in opening the spring to increase the pressure, as the expansion will be rapid though a small wire and an apparently slight pressure is used.

I also wish to emphasize the importance of investing all the teeth back of the cuspids with the plate. With the Coffin method, after the arch is spread, any tooth may be moved in or out, or twisted in its socket by means of a simple spring (of the same small piano-wire) imbedded at one end in the plate, and having a direct pulling or pushing bearing, or being attached by hooking into the loop of a ligature well tied to the swell of the tooth.

As the plate may almost invariably be so adjusted as to be readily removed and replaced by the patient with little danger of its proper action being interfered with, this method of regulation has the advantage over every other method in point of cleanliness.

Dr. KEELY: In my quiet way, I have done considerable in the line of correcting irregularities of the teeth, during the past quarter of a century; but at no time have I ever imagined that because my apparatus accomplished the work nicely, there was no better way. Over twenty years ago a little miss, aged eight years, came to me

with the superior incisors erupted and locked inside the inferior teeth. For the first time I made a vulcanite plate, covering the permanent and temporary molars and taking a bite. When the plate. was finished and adjusted-there was a masticating surface and the teeth raised apart to allow the refractory ones to swing clear in their passage to their normal position-a bar was carried in front of the teeth on which were two little buttons opposite the misplaced teeth; rubber ligatures were placed over the teeth and held by the buttons. This plate was adjusted at 4 o'clock in the evening, and when my little patient called the next morning at 8 o'clock, the teeth were in their normal position. She made no complaint of soreness. The plate was put in again, and the teeth tied to the buttons with No. 40 cotton thread, and the mother shown how to do it. My patient was sent home, and the mother instructed to remove the plate next morning, and put it on every night for a week. It has been said that "teeth once in place, they will remain there." Had I not taken these precautions, as stated, these teeth would have fallen back the first night, for the reason that, as a rule, a child sleeps with the mouth slightly open, and when teeth are moved so rapidly, they must be held in position for a time. In a case like this, I would now make the same kind of a plate, dispensing with the bar in front of the teeth, and making the plate thick on the palatal surface of the misplaced teeth, then cut slots in which I would place sea-tangle tent, which expands gently and will soon force the teeth into place. I would then take No. 40 cotton thread, tie it around the deciduous canine on one side, carry it back of the incisors, and tie to the other canine and leave it there for a week, when the work would be accomplished.

Dr. Morrison condemns the extraction of first molars. I wish to say just here that I do not allow any one to appreciate the value of first molars more than I do. They have a very important part to perform, and do very much in keeping in shape the contour of the face; and under no circumstances would I remove one, unless I felt perfectly satisfied I was doing the best possible thing for my patient. We find many of our little patients, 8 and 9 years of age, with the first molars wholly demoralized, and with our best. efforts we can hope to save them only a short time. If the anterior teeth are crowded, I would rarely hesitate to remove the molars; and it should be done prior to the eruption of the second molars, so that they will come forward and take up part of the space made vacant by the first, and, as a rule, they will come squarely up to the second

bicuspid, and look as well as the first molars, and the crowded anterior teeth will fall into line. I only wish I had two or three diagrams here to illustrate this matter from cases in my own practice. A lady, who is now twenty-five years of age, came to me prior to the age of twelve. I found the first inferior molars had been extracted, and the second pretty well erupted. In the superior arch, the anterior teeth were crowded-piled one upon the other. The first molars were decayed, but could have been saved. I did not hesitate to extract them, for it was clearly indicated in this case. I did not see her again for several years, when she came to have some teeth filled. I have a model of this case, taken when she was twenty-five. The superior misplaced teeth fell back, and the second molars came forward bodily, and are squarely up to the second bicuspids in both arches, looking as perfect as any first molars I ever saw. The third molars having ample room are well developed and stand squarely up to the second.

Five years ago a miss of twelve years came to have her inferior molars extracted; the teeth were very much broken down, the pulp dead in one and badly exposed and inflamed in the other. All the anterior teeth were crowded in both arches, the superior canines twothirds erupted but wholly outside the arch, the laterals and first bicuspids being in contact. Both arches were well developed, and I can only account for this crowded condition from the fact that her deciduous molars were removed before the eruption of the first molars, and when they came, they took up a part or all the space legitimately belonging to the second bicuspids: hence this crowded condition. The superior molars were decayed, but could have been saved. The second molars below were partly erupted and the superior ones just appearing, none of them antagonizing. I made an application to the troublesome inferior molars, and sent the girl home with a note to her mother, telling her what I could do for her daughter if she would put her under my care, and that no fee would be charged. The expressions of appreciation in the mother's answer, and the little miss' saying to a mutual friend that she was preparing herself for a teacher, and that if successful Dr. Keely should be fully remunerated for his services and kindness, paid me better than any other case of regulating I had done. I extracted the first molars at one sitting, and the courage she displayed won my admiration. For a time I waited to see what Dame Nature would do, but I found the second molars were coming forward so rapidly, and taking up the space left by the first, that I wedged the bicuspids back to give

room for the rest of the teeth to fall into line. The teeth are now in good condition, the canines are in place. A vulcanite plate was worn a few weeks to expand the superior bicuspids a very little to improve the contour of a beautiful face. The second molars are very nearly in contact with the second bicuspids and have come forward with no indication of tipping. Had it been possible to save the inferior molars permanently, both arches could have been expanded and the teeth brought into line.

Dr. PEIRCE: Where economy in time and simplicity in appliances are desirable, I have found that where lateral incisors-one or both― were encroaching upon the palatal surface and striking within the inferior teeth, a most admirable and prompt method of correcting them was to drill upon the palatal face, just below the cutting edge of the tooth, a small hole, and also upon the first molar of the opposing side a similar hole, just at the margin of the gums; then procure a strip of heavy platinized gold plate, in width about one-fourth inch, and in length sufficient to bend to the outline of the palatine arch and be out of the way of the tongue, and with the end sharpened to a point, to spring with some force into the holes in the opposing teeth. The elasticity of the plate so bent, will be found to be sufficient to press the lateral forward into position, where room has been previously gained. This appliance has the advantage of pressing only upon the teeth, producing no irritation of the gums, and of being of comparatively little inconvenience to the patient; while the plate can be made and adjusted without taking an impression or making a cast. The work and result are promptly accomplished and the small holes in the teeth are readily filled, so that the teeth suffer no disadvantage from them. The same appliance can be used to press forward the central incisors as well as the laterals, and by a little careful adjustment of the plate, the two laterals or the two centrals at the same time.

Dr. KEELY: I spoke of the benefit I had conferred on my little patient by removing the first molars. I wish to refer to another benefit, conferred every time it is necessary to remove first molars before the eruption of the second. The second molar will come forward and give ample room for the eruption of the third. The life of this latter tooth in a majority of cases is crushed out for want of space, and we are all too prone to consider it of little or no account. Give a third molar ample room to develop, and you will find it as good as the second. This you will find is true, nineteen times out of twenty.

When in Chicago, recently, I saw a case of irregularity, which I hope Dr. Crouse will explain.

Dr. CROUSE: I have had one extreme case, the models of which I am sorry I have not here, as they would illustrate what can be done in the mouth of a young man twenty-one years of age. When he came to me the position of the upper teeth was such that by the force of mastication the under back teeth were driven toward the tongue, constantly narrrowing the circle in the lower teeth so that there was not room below for his tongue, and he could not talk in a voice to be understood, the lower front teeth protruding beyond the upper. He had been tinkered at by some inexperienced parties for five or six years. I had first to move the upper teeth; and I do not think I exaggerate when I say the back teeth were moved apart an inch, which just gave room for the teeth to come into proper line in the arch. The patient was a young man of large physique. The work was accomplished entirely with rubber plates and jack-screws, but I had to apply two jack-screws. He would break the screws every

few days with the force applied. It was a year before I dismissed the case. I first enlarged the upper arch and held it in place, and then proceeded with the lower. Now the teeth are all in position.

The young man continued to follow his employment and was very little inconvenienced. He did the work himself while I did the advising. I do not see how any thing could have worked better in this case than rubber plates with jack-screws vulcanized in them, and the plate cut in two.

Dr. MARCKLEIN: Judging from the appliances exhibited and the remarks made on the subject, it seems to me that they all are very efficient so far as expansion is concerned. I would like to ask Dr. McKellops if they are as applicable for drawing teeth backwards? It has always been with me a very easy matter to throw teeth forward, but it has been very difficult to throw them backwards. I have used all appliances in regulating teeth, and I don't think any one of them will answer all cases. I have one case of a young lady sixteen years old, whose upper teeth project just one-half inch beyond her lower ones, giving her a very unpleasant expression. Her first upper molars are lost and the second are sound and in their place. I would like to know what appliance would be best to draw those ten upper permanent teeth so as to get them in their proper place.

Dr. McKELLOPS: Here is a plate for that very purpose. I do not claim that every thing can be done with one plate. There must be a variety of plates, and the skill of the operator comes in play here