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 Table of Contents  
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 38-43

Evolution of restorative dentistry from past to present

1 Department of Conservative Dentistry and Endodontics, Gian Sagar Dental College and Hospital, Patiala, Punjab, India
2 Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Patiala, Punjab, India
3 Department of Conservative Dentistry and Endodontics, Laxmi Bai Dental College, Patiala, Punjab, India

Date of Web Publication6-Mar-2017

Correspondence Address:
Harpreet Singh
Department of Conservative Dentistry and Endodontics, Gian Sagar Dental College and Hospital, Patiala, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-4003.201634

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The history of operative dentistry dates back to the era when Babylonians, Assyrians, and Egyptians (4500–4000 BC) were familiar with gold, and Etruscans and Phoenicians (2700 BC) were practising gold crowns. Since then, there have been numerous advances, developments, and researches which have proceeded continuously. These inventions have transformed the practice of operative dentistry into one which is more efficient and more comfortable for the patients as well as for the operating team. This article highlights the significant advancements in the field of operative dentistry which have occurred over a period of time and have helped us to serve our patients better.

Keywords: Achievements, history, operative dentistry

How to cite this article:
Singh H, Kaur M, Dhillon JS, Mann JS, Kumar A. Evolution of restorative dentistry from past to present. Indian J Dent Sci 2017;9:38-43

How to cite this URL:
Singh H, Kaur M, Dhillon JS, Mann JS, Kumar A. Evolution of restorative dentistry from past to present. Indian J Dent Sci [serial online] 2017 [cited 2023 Sep 29];9:38-43. Available from: http://www.ijds.in/text.asp?2017/9/1/38/201634

  Introduction Top

The field of operative dentistry embraced all of chairside dentistry during the 18th century. It was during this period when maximum progress in the field of dentistry was observed. By the beginning of 19th century, dentistry was no longer in the hands of barbers/artisans but was practised by professionally minded dentists or surgeons. Charles Allen (1678) gave first written material on dentistry “Operator for the Teeth,” and Pierre Fauchard (Father of Dentistry) described the materials and practices of his time in his book “Traite des dents” published in 1728. The textbook “Operative Dentistry” in 1889 included oral surgery and fixed prosthodontics as well as in the area of operative dentistry.[1] It was only later when oral surgery, fixed prosthetics, and other branches broke off on their own, the operative dentistry as we know today came into existence.[2]

With the beginning of the 20th century, there came many refinements and improvements in quality of various materials and processes used in restorative dentistry. Physical and mechanical tests combined with fundamentals of engineering science were applied to structure designs and restorative materials. Shortcomings of materials were recognized and improved by the advent of newer technology. Therefore, intensified efforts were made to invent and improve products with required properties designed for specific purposes.[3],[4],[5] This article presents the key advents in the history of operative dentistry which have happened over a period of time.

  Anesthesia Top

The first ever recorded use of any anesthetic agent dates back to 500 AD, when Peruvians used Coca leaves for psychotropic properties. However, it was not until 1540, when Cordus synthesized Ether, which any synthetic drug was used for anesthesia. Dr. Crawford W. Long in 1842 used Ether as anesthetic, and Dr. William Morton publicized Ether in 1846. Cocaine was isolated, and hypodermic needles were developed in the 1850s. In 1884, Carl Koller discovered the analgesic properties of cocaine,[6] and in the same year, cocaine was used as local anesthesia (inferior alveolar nerve block) in dentistry by Halsted and Hall.[7] Dr. John Snow used chloroform as anesthetic in 1853.

Einhorn and Uhfelder synthesized procaine in 1905 in Germany.[8],[9] Cook marketed cartridge syringe in 1921 bringing a new revolution in the administration of injectable drugs followed by the development of aspirating syringe in 1947. Thiopental was first used in 1934. Procaine (novocaine) was commonly used by physicians and dentists in 1950s. The major breakthrough in the field of dentistry came when Niel Lofgren synthesized lidocaine in 1943[10],[11] and then marketed for mass use in 1948. Lidocaine (Xylocaine ®) was found extreme safe to use and surpassing that of novocaine; it became a widely used anesthetic agent.[12] In today's dentistry, many other local anesthetic agents in use and nitrous oxide is often used for its analgesic effect, but lidocaine is the principle anesthetic in routine use.

  Infection Control, Asepsis, and Preventive Dentistry Top

Pierre Fauchard was the first who suggested humoral imbalance as the main cause of tooth decay and described its prevention. Before the middle of 19th century, there was no scientific basis for the causation of dental caries and infection control. Antiseptic agents used by surgeons during the American Civil War were known to infection control, but they were misused.[13]

Louis Pasteur in 1865 concluded that microorganism caused putrefaction and could be transferred from one place to other by means of solids, liquids, or airborne particles.[14] During his work, he found that some microorganisms could be destroyed by heat or other methods and also provided the basis for the “germ theory” of infection. Joseph Lister introduced the concept of antisepsis and published papers opposing the established idea of “laudable pus” building on and thus endorsed Pasteur's work.[15] Robert Koch cultured, separated, and classified the microorganism and hence discovered that bacilli caused cholera and tuberculosis.[16]

In 1890, Willoughby D. Miller introduced the chemicobacterial theory of dental caries.[9] In late 19th century, the concepts of microbiology and infection were established in medical and dental fields. The importance and methods of sterilization of dental instruments were promoted by the American Dental Association and recorded saturated steam under pressure, best method for the sterilization of dental instruments.[17]

Black was the first who introduced and published the concept for the development of the scientific cavity preparation.[18],[19],[20],[21],[22] He was a major author for the presentation of the modern system of nomenclature in 1893.[23] His contributions to the operative dentistry are unmatched, cannot be measured or weighed, and is rightly remembered as Father of Operative Dentistry. Wilhelm Conrad Rontgen discovered X-rays in 1895[24] and Dr. C. Edmund Kells implicated this new discovery to dentistry.[25],[26],[27]

In 1960, Dr. Alfred Fones introduced the profession of dental hygienists into dentistry by establishing his own school of dental hygiene.[28],[29],[30],[31],[32] Thus, with the addition of dental hygienist, the dentist was free to perform more operative procedures effectively and provided with valuable aid for the treatment and education of the patients.

Till 1874, fluorine was recognized for the prevention of dental caries until Dr. Frederick McKay discovered the mottling of the enamel in Colorado areas. McKay and Dr. H. Trendley found that fluoride was naturally occurring element in water and by adjusting the level of fluoride in community water supplies to one part per million, mottling could be reduced, and caries rate could be prevented. This research led to the widespread fluoridation of community water supplies throughout the United States and later all over the world.[33]

  Armamentarium Top

Evidence showed that ancient cultures used primitive drills, trephines, files, and other devices to prepare adequate cavities in teeth. In early 17th century, hand-rotated instruments which had clockwise rotating drill were used to make round ornamental cavities in decayed teeth. Hand drills with steel bur heads were used by Twirling in the 19th century. Later, a bur thimble and bendable drills by attaching flexible shank were used. Additional introduction of other mechanical devices was named as Lewis drill, Chevalier's drill stock, and Merry's drill. Dr. James B. Morrison introduced foot treadle dental engine in 1871.[34] This foot engine was the first practical manual (foot) operated engine to be used in dentistry. With the advent of this engine, dental handpieces were constructed to assist the use of hand-made steel drills.

Dr. Sanford C. Barnum blessed the field of operative dentistry with his discovery of rubber dam in 1864.[35],[36] It was undoubtedly one of the best methods for providing isolation from saliva and soft tissues during the placement of restorations. The first machine made burs known as Revelation Burs were introduced by S.S. White Company in 1891.[37] These machine-made steel burs were later replaced by carbide burs when Acheson discovered a technique for making an industrial abrasive composed of silicon carbide in 1891, and after that, he patented it with name of carborundum in 1893.[38]

Josiah Flagg in 1790 invented first dental chair with adjustable headrest and extended armrest for holding instruments. Morrison introduced his first dental chair in 1867 with a wide range of adjustments.[39] The first pump type hydraulic dental chair called the Wilkinson chair was introduced in 1877.[40] In 1954, Dr. Sanford S. Golden et al. were geared toward sit-down dentistry and developed a reclining chair which would allow dentist to sit while performing various restorative procedures. A major innovation was the DenTalEz chair by John Naughton in 1958 which facilitated sit-down and four-handed dentistry.[41],[42] Since then, there is continuous improvement in the design of dental chair to provide better comforts to the patients and doctor.

With the discovery of electricity, first electric battery-powered drill was introduced in dentistry in 1871. In 1930, modern diamond cutting instruments were first introduced in dentistry.[43] To save the chair side time while doing amalgam restoration, commercially produced amalgamator was marketed in 1937.[34] A series of development led to the use of high-speed handpieces such as ball bearing handpiece, Walsh's air turbine handpiece (1949), Nelson's water turbine handpiece (1952), and Page's belt-driven angle handpiece (1955);[44] Air rotor handpiece with miniature ball bearings and speed of 200,000 rpm was developed by John Borden.[45],[46],[47] Modern diamond bur was purposed by W.H Drendrel in 1932, whereas tungsten carbide dental bur was marketed in 1947.[48] Electric high-speed handpieces have now been developed which have surpassed the merits of air-driven high-speed handpieces.[49] Further advances in the dental equipment such as fiber-optic handpiece, smart prep burs, chemical vapor deposition burs, fissurotomy burs, ultrasonic devices, laser systems, and ozone unit have been added to the literature, and research is still going on.

  Restorative Materials Top

Direct restorative materials

Direct restorative materials are those that can be placed directly in the prepared tooth cavity during a single appointment. During ancient time, the restorative materials were obtained from bone and ivory and later these included waxes, gums, alum, honey, ground mastic, powdered pearl, white Corelle, lead, tin, gold, amalgam, darcet, gutta-percha, silicate cement, resins, glass ionomer cement (GIC), etc.[50] The restorative materials mentioned in Pierre Fauchard book were lead, tin, and gold though his preference was for tin. Gold coins were rolled into noncohesive gold, and gold foil was produced by Marcus Bull through beating method.

August Taveau of Paris combined silver and mercury to form silver paste in 1826 and resulted in beginning of dental amalgam, an outstanding development in the field of operative dentistry.[51] The amalgam was later introduced commercially into the United States in 1833 by Crawcour brothers by cutting silver from coins and adding excess mercury.[51] Unfortunately, the material was used in ruthless way and spoiled its reputation which eventually turned into the “Amalgam war.”[52],[53] Dental profession remained hesitant about the use of Amalgam until Black suggested a balanced amalgam formula (silver 72.5% and tin 27.5%) in 1895.[54] To overcome the drawbacks of low copper amalgam alloy, Dr. William Youdelis developed high copper amalgam in 1963 which enhanced the long-term marginal integrity.

Gold foil was first introduced in America by Robert Woofendale in 1795 and was one of the earliest materials available for restoration of teeth. Arthur discovered cohesive gold foil in 1855.[55] This was the major advance of dentistry. Gutta-percha was discovered in India in 1842. In 1848, Hill advocated the use of gutta-percha along with zinc oxide eugenol as temporary filling material.

Zinc oxychloride cement was purposed in 1860[56] and was used as temporary filling material in spite of its low quality. To overcome this, zinc phosphate was introduced in dentistry in 1879, which exhibited improved properties to be used as a filling material and as cement.[57] Silicate cement was introduced in the United States in the late 19th century and early 20th century. Silicate was the first tooth-colored material used in esthetic dentistry. Along with advantage of high fluoride release, the silicate cement had disadvantages of its solubility, pulp irritation potential, and desiccation. To overcome the problems of silicates, direct-filling methyl methacrylate resins were invented in 1947. Although acrylics provided esthetic restorations but did not last long because of their inherent higher coefficient of thermal expansion and polymerization shrinkage which eventually led to marginal leakage, postoperative sensitivity, secondary caries, and interfacial staining.[58] To improve these drawbacks, filler particles were added, but fillers could not bind with the matrix and remained separated.

A great discovery by Dr. Michael Buonocore of phosphoric acid to increase mechanical bonding of resin to enamel in 1955 opened new gates in the world of bonding resins and cosmetic dentistry.[59],[60] The efforts and experiments by R. L. Bowen led to the invention of composites in 1962, which nearly obsolete the use of silicate and acrylic resin from esthetic dentistry.[61] With the introduction of ultraviolet light-curing system, the cosmetic dentistry became more convenient and efficient. Another significant advancement in the development of dentin bonding agent aided retention and stabilization of a tooth-colored restoration without excessive removal of sound tooth structure.[62] Bonding resin is an unfilled or semifilled resin which matches to the resin in the composite but has a lower viscosity to permit easy flow and penetration. Bonding agents are categorized into “generations” according to their evolution. First and second generations bonding agents were developed as a single-step application, whereas the third generation came with three steps included conditioning, priming, and application of bonding agent. Fourth generation came with concept of “hybridization” proposed by Nakabayashi et al., in which diffusion and impregnation of resin into partially decalcified dentin followed by polymerization created a resin-reinforced layer or the “hybrid layer.”[63] Fifth generation dentin bonding agents were based on hybridization and wet bonding technique and advantage of having high bond strength. To improve the bond strength and to make the manipulation easy; sixth and seventh-generation adhesive agents have been tried and still are popular in adhesive restorative dentistry. Composite materials were further improved by modifying the resin matrix and filler, which resulted in the introduction of microfilled, hybrid, microhybrid, flowable, packable, and modified hybrid composites.

GIC was developed in 1968 and first described and named by Wilson and Kent in 1971. The GIC has been evolved from silicate and polycarboxylate cement and thus acts as a potential replacement for the silicate cement. Due to its adhesion to enamel and dentin and fluoride release for anticariogenic effect, it gained popularity widely in dental profession.[64],[65] To improve the abrasive resistance, GIC was modified by addition of silver to develop miracle mix or silver cermet by Simmons in 1983.[66] After that, McLean and Gasser introduced Glass Cermet by sintered glass and metal powders to improve wear resistance and flexural strength in 1985.[67],[68] Resin-modified glass ionomer cement was developed by addition of a hydroxyethyl methacrylate monomer in the polyacrylic acid and their polymerization is initiated along the methacrylate group after exposure of light. More advancements and modifications in the composite and glass ionomer restorative materials aided more benefits in the field of esthetic dentistry.

Indirect restorative materials

Indirect materials are those that can be used to fabricate restorations in the dental laboratory and then are placed in or on the teeth; placement of indirect materials generally requires two or more visits to complete the restoration. In the history of operative dentistry, beeswax was the earliest material used for dental impressions.[69] Some evidence of use of gutta-percha as an impression material were found in literature. Plaster of Paris was started to use in dental profession after it had been discovered from Paris.[70] John Greenwood was the first who used plaster of Paris as an impression material but could not able to produce excellent impression because its inflexibility caused fracture upon removal.[71]

The modeling compound was developed by Charles Stent in 1857 to improve the drawbacks of gutta-percha and provided with plasticity, stability, strengthen, and red coloration.[72],[73],[74],[75] Alphons Poller introduced reversible hydrocolloid in dentistry in 1925 to fabricate plaster reproductions.[76] Sears promoted agar-type reversible hydrocolloids for taking impression in fixed partial denture.[77] Japan was the major source of agar, so during world War II, the irreversible hydrocolloids (alginates) were invented to dental profession.[78] In 1953, polysulfide impression materials were came to the operative and prosthodontic dentistry.[79] Then, the discoveries of polyethers, condensation silicone, and addition silicone offered more stable and less messy materials to dentistry.

The evidence for the use of cast restoration was found in Mesopotamia (3000 BC) where copper was used to cast. Then, art of casting was introduced in Egypt (2500 BC) where lost wax molding process was first developed for gold casting. Etruscans (500 BC) produced bridges made of soldered gold bands. Then, Romans adapted and developed technique of dental prosthesis which completely disappeared in Europe until the 18th century. After that, Chinese developed specific bronze alloys and made elaborated use of lost-wax process to produce castings. Oldest castings were gold inlays found in teeth of natives of Eucador and Pre-Columbian Indians.[80],[81],[82] There is evidence that the Maya and Aztecs made gold castings in mold prepared from clay or plaster of Paris. After the introduction of dental cement oxychloride of zinc in 1860, various materials were used for the construction of dental inlay, for example, grounded porcelain and gold foil.[56] Dr. D. Philbrook in 1897 described a method of casting for restoration of posterior teeth. In 1907, William H. Taggart introduced lost wax technique for making gold castings.[83] Van Horn introduced different methods of compensation for alloy shrinkage, whereas Weinstein added boric acid and Moore added chlorides to investment to minimized shrinkage and enhanced thermal expansion, respectively.

Nowadays, CAD/CAM system is being used for making inlays and onlays of high strength and with more accuracy. First, chairside ceramic inlay was made in 1985 using CAD/CAM device which was two-dimensional, but in 2000, Cerec 3 was introduced with three-dimensional graphics.[34]

  Illumination and Magnification Top

In ancient days of dentistry, only natural light was the source of illumination. After that, artificial lights used were from candles and kerosene lamps.[84] First, patient lights were purposed in the early 20th century after the invention of electricity.[85] Intraoral illumination was enhanced in surgeries with the help of miner-type headlamps and later by small headlamps. For retraction and visualization, mouth mirrors were introduced in the 1800s, which was further improved to front surface mirrors.[86]

Dutch businessmen, Hans and Zacharias invented first microscope (simple and compound) and after that Robert Hook and Leeuwenhoek used microscope for their work.[87] In the middle of 19th century, Carl Zeiss, Ernst Abbe, and Otto Schott developed the surgical operating microscope in practice of medicine.[88] In earlier days of dentistry, magnifying lenses were tried to examine teeth intraorally for gold margins, fissures, and cracks.[85] The magnification provided was not sufficient, and then plastic loupes were assembled with eyeglass frames. These loupes became heavier as the magnification increased and to prevent occupational stresses, Dr. Harvey Apotheker and Dr. Jako brought the concept of extreme magnification in the form of a dental operating microscope in dentistry in 1978.[89],[90] The “DentiScope” was manufactured by Chayes-Virginia with a single magnification of ×8 and had dual fiber-optic lights, which was poorly configured and difficult to use ergonomically.[91] In 1999, Dr. Gary Carr purposed the first ergonomically configured operating microscope with Galilean optics for routine dental clinical procedures.[92] Various addition in microscopic accessories have been occurred from 2000 onward such as beam splitter, camera, liquid crystal display screens, video camera, and high definition cameras.[93] Some practitioners use loupes, loupes in conjunction with headlamps, and endoscopes as an alternative to operating microscope according to their ease of handling and visibility of operating field.[94]

  Conclusion Top

During the beginning of dental science, dentistry was merely an art practiced by barber-surgeons or artisans. With time, the knowledge of dentistry had spread mainly to France, Germany, Italy, and England. With the advent in science and technology, dentistry came into hands of professionally minded dentists/surgeons. Slowly and gradually operative dentistry came out as one of the major branches of dentistry and dentists started oriented toward restoring and preserving of teeth. With the innovations and discoveries of new equipment, techniques, materials, and methods, operative dentistry continues to enriched, refined, and grow toward bright future.

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