by Andrew I Spielman

How to cite this paper: Spielman, AI. History of Prosthodontics. In: Illustrated Encyclopedia of the History of Dentistry, 2023. https://historyofdentistryandmedicine.com/

Figure 1. Copy of an Etruscan denture.
Science Museum, London. Creative Commons CC BY 4.0).

What was dentistry 1000 years ago? Mostly toothache and tooth drawing. About 150 years ago, root canal therapy entered our vocabulary, and, for a layperson, it became associated with the worst experiences one could have. But a person may have associated dentistry with false teeth two hundred years ago. In reality, the replacement of teeth has been around for at least 2500-3000 years. Remains of  Etruscan graves from 630 BCE show gold bands to support missing upper incisors. 

These prosthodontic devices were unique to women in Etruscan society and were most likely ceremonial(1). Starting with the 3d century Egypt and later Greece and the Levant, gold-wire supported devices strengthening mobile teeth were unearthed from burial sites. These were not restricted to only females and were dental devices, by all accounts. This type of wiring was also visible 100 years later. In the 10th c., similar to Egyptian or Greek wiring, Albucasis proposed ligation of a block replacing missing teeth with adjacent ones, a technique described word-for-word in the 14th century by Guy de Chauliac (1300-1368) and a century later by Ambroise Paré (1510? -1590). The otherwise detailed work of Pare of 1320 pages has only one paragraph for the section entitled The Way to Accommodate Artificial Teeth. For treating accidental loss of anterior teeth, he offers the very same as Albucasis or Chauliac, a small carved block of teeth made of bone, ivory, or narwhal tusk, tied with a gold or silver wire to adjacent teeth “luy en faut adapter d’autres os ou yvoire, out de dents de Rohart qui sont excellentes pour cet effect faictes…seront liees aux autres dents proches, avec fil commune d’or ou argent…”(2). This type of device was recently unearthed in Tuscany from the grave site of a wealthy  family from the city of Lucca (3) 

Figure 2. Early bridge work, carved from ivory and held on to neighboring teeth with silver wire. (Figure from Pare, A. Oeuvre, 1628).

Peter Lowe, a Scottish physician at the royal court of Phillip II of Spain, in A Discourse of the Whole Art of Chyrurgery, writes, “make artificial teeth of ivory, whales bone or hounds teeth which shall be fastened by a wyre or thread of gold” (4). All attempts to replace missing teeth used a rather “mobile” version of what we consider today “fixed prosthodontics”. They were neither removable nor fixed. They were somewhere in between, wired but not fixed enough, and fixed too much to be easily removed. Nobody had any technical innovation for tooth replacement for at least 700 years.

No significant change occurred until 1746 when Fauchard’s second edition of his Le Chirurgien Dentiste was published. Fauchard suggested connecting an upper and lower removable denture via a back-fastening spring to hold the dentures apart and against the partially or totally edentulous arch. The dentures were carved from a single block of bone, ivory, or similar material without the benefit of an impression. More like a tailor, measurements were taken with a small compass; a craftsman would then do a rough carving of the denture and return to the dentist, who would then adjust the denture. Fitting required the dentist to paint the gums, try the denture, and scrape or drill away from the denture based on the traces of paint left on it, more like adjusting occlusion today with an articulation paper. (5). Teeth were carved to approximate anatomical shape with flat occlusal surfaces or sometimes left as a flat block. (6). Such dentures were meant to replace missing teeth for esthetic and sometimes phonetic reasons. They could not be used for mastication. They were just too unstable and uncomfortable. In fact, during dinner, it was not unusual to simply remove one’s false teeth, eat without them and place the false teeth back for conversation. (7). By the middle of the 18th century, these back-fastened springs were replaced by a lighter, looser coil spring fastened at the side of the denture.

One could argue that the 1746 publication of Claude Mouton was more important in the history of prosthodontics than Fauchard’s seminal book. Claude Mouton’s first text, entitled: Essay d’odontotechnie, ou, Dissertation sur les dents artificielles was the first specialized book on prosthodontics.Mouton (?-1786), the dentist to Louis XV, was the first to create a gold crown (calotte d’or) (8) and is one of the first contributors to the field of cosmetic dentistry.In his 1746 book, Mouton introduced restoring grossly decayed teeth by covering them with a gold-shell crown. For anterior teeth, where the visibility of gold could be objectionable, a layer of enamel was suggested to improve cosmetic appearance.

Why was removable prosthodontics leading the way over fixed prosthodontics? A lack of understanding of the science behind the biology of the teeth and the oral cavity pushed dentistry toward a mechanical solution and a quasi-esthetic reason for tooth replacement rather than for function.

In the 19th century, those without teeth and no opportunity or means to get dentures could use a “masticator”, an instrument that looked like a combination of scissors and a nutcracker (https://phisick.com/item/masticator-in-etui-by-aubry). It helped chew food outside the oral cavity, after which the mashed food was ingested with the need to chew.

Impression materials

The first documented case for an impression comes from the Royal Prussian court dentist to the King of Prussia, Phillip Pfaff (1713-1766), in 1756 (9). Pfaff took impressions with beeswax, one-half arch at a time, and obtained cast models with plaster of Paris.  But wax impressions were easy to deform and needed rigid support. In 1820 Christophe Delabarre (10) invented the tray for impressions. Still, wax impressions could not deal with high-precision areas. In 1844 E.J. Dunning, an American dentist, tried to resolve a difficult edentulous case with flabby mucosa that was particularly ill-suited for wax impression and came up with the plaster of Paris impression (11). It was obvious that a detailed impression needed a better-supporting tray. In 1861 B.W. Franklin decided to split the impression, first taking a preliminary wax impression and then removing 1/8th of an inch evenly, taking a second final plaster impression (12). The functional impression using muscle molding was only three years away in 1864  in the hands of Johann Joseph Schrott (13). The only impression material for the next 50 years was wax, plaster, gutta-percha, and synthetic resin. 

Figure. Timeline of impression materials. (Start on the right side. This is one of 6 images that compile timelines in prosthodontics). (c)Spielman

A breakthrough came in 1925 when a Viennese physician, Alphonse Poller (14), invented reversible hydrocolloid agar-agar impression material. That discovery led William Wilding 10 years later, in 1935, to a better hydrocolloid, sodium alginate (15). When raw material for agar-agar, algae on the beaches of Japan dwindled, in 1955, the British S.L. Pearson from the University of Liverpool came up with the silicone rubber-based impression material. (16). The last 65 years have seen additional impression materials introduced, including several that were polysulfide and polyether-based (1965, 1988) and light cured-elastomers (1988) (17). But the digital impression was the most important development of the last three decades. Originally conceived in the mid-1980 as a scanner, it finally took off in the new millennium’s first decade.

  • 1. Becker p.416
  • 2. Paré p.895
  • 3. Minozzi
  • 4. Lowe p.194
  • 5. Woodforde (b). p.27
  • 6. Fauchard, II. p.252
  • 7. Woodforde (c). p.49
  • 8. Moutonp.137
  • 9. Pfaff
  • 10. Delabarre p.129
  • 11. Wescott 
  • 12. Franklin p.155 
  • 13. Schrott
  • 14. Poller
  • 15. Papadiochos
  • 16 Pearson 
  • 17 Papadiochos

Complete dentures

Anyone looking at the image of the upper and lower carved bone denture understands that this denture was carved out of two blocks of bone that were never meant to be used for mastication or speech. They date from 1500 and were found at a grave near Basel. These are the oldest complete dentures so far recovered (18).

In the absence of any precise fit to the edentulous area, dentures made up to the second half of the 18th century were unstable and needed to be supported by springs attached initially at the rear end of the two dentures and later onto the side but each time the springs pushing against the edentulous area,

Pierre Fauchard’s major contribution comes from his systematic and detailed approach to his techniques. While de Chauliac or Paré, where few details are provided for tooth replacement, Fauchard dedicates five chapters (XVI-XX) to fixed and removable prosthodontics in his first edition of 1728. The second 1846 edition of his book has expanded sections primarily in prosthodontics. Fauchard did not know about atmospheric pressure. Upper dentures were as wide as the upper ridge. Most of the 18th-century removable upper dentures were horseshoe-shaped.  Plates covering the entire palate were introduced around 1830 when vacuum chambers needed placement (19). 

Fauchard’s dentures were made of blocks of ivory with teeth carved out from the same block. It was only for appearance and, speech, pronunciation. If the opposing arch still had teeth, metal bars around the existing teeth connected to a whale-bone spring provided the connection to the upper denture.  

At the end of the 18th century, new denture base materials and the usual ivory or hippopotamus bone were tried. Etienne Bourdet (1722-1789), a contemporary of Fauchard and dentist to Louis XV in 1757, publishes Recherché et observations sur toutes les parties de l’art du dentiste (20), advocating …using an enamel-covered gold plate as a base for a denture. The enamel surrounding individual teeth in the denture was colored red, giving the appearance of a gingiva. 

Enamel, particularly in France, where the rediscovery of porcelain in 1693 by the German Böttger brought renewed interest in the inert nature of the material. This became particularly relevant after animal bone or ivory proved problematic as a denture base material. Ivory and bone are porous materials, and after months or years of wearing such dentures, the foul odor emanating from the bacterial putrefaction proved particularly repulsive. 

Alex Duchateau, a French apothecary, came up with the idea of porcelain dentures. Duchateau’s many trials were a failure, and he abandoned them. An earlier collaborator in these experiments, De Chemant, developed better products (18), a mineral paste for which the soon-to-be-beheaded French king, Louis XVI, granted him a patent. De Chemant left for London, and with an additional patent from England, he collaborated with the Wedgwood porcelain factory. By 1802 there were 12000 dentures in use (19). Eventually, these full porcelain dentures gave way to gold or other materials, and only the teeth were made of porcelain.

John Greenwood, the “favorite” dentist of George Washington in 1795, created a gold plate as a denture base for an upper denture to which individual teeth were attached. Charles Willson Peale, one of Washington’s portrait painters, also made a denture for him with a wax-covered lead base and elk and human teeth, a set that weighed close to 4 ounces and must have been extremely uncomfortable to use when speaking. Perhaps it is one of the reasons Washington was so curt when it came to public speaking and kept his second inaugural speech to 133 words.

A breakthrough in the development of modern dentures was the accidental discovery of the atmospheric pressure to hold the upper denture in place. In 1800, James Gardette (1756-1831), the first medically trained French dentist settled in America, made a house call to adjust one of his patients’ upper dentures. When, months later, he finally arrived, the patient had her denture firmly in place, held by atmospheric pressure (21). Subsequently, James Gardette introduced the suction chamber to maximize the atmospheric pressure for upper denture retention, a technique also introduced in the UK starting in 1835.  Gardette is also credited for mounting natural teeth on a gold mortise plate with teeth secured with gold pins, invented by Etienne Bourdet in 1757, and removing the inter-denture springs from dentures that were the previous main support system. (21).

Using atmospheric pressure and the patient’s muscles gradually takes off among practitioners. In 1842 Solyman Brown, a New York dentist, published in the American Journal of Dental Science a paper on creating extended complete dentures that use the adhesion of dentures to the edentulous surface and the force of cheek muscles for stability without the need for clasps or springs. He used two types of wax for impressions (22)

The material used as a denture base varied from gold, platinum, silver, or gutta-percha until Charles Goodyear patented hard rubber (vulcanite) in 1844 (23). Vulcanized rubber was hard and molded into a denture base. Along with gold, it became the two most thought materials for denture bases. Thomas Evans was the first American dentist in Paris since 1848 and was one of the first to use it. In 1864 The Goodyear Dental Vulcanite Company bought Charles Goodyear’s patent on Vulcanite and started to collect exorbitant fees from dentists for its use. There were hundreds of court cases for patent violations. As an alternative to vulcanite for denture base, John W. Hyatt, Jr. and Isaiah Smyth Hyatt patented celluloid in 1870. It was obtained by mixing camphor gum and cellulose fiber. It was colorless, an improvement over vulcanite, which was black or red, but it was flammable, and some smokers’ celluloid dentures could and did catch fire. The rules for vulcanite patent violation were finally eased after Josiah Bacon, the chief enforcer of the patent license, was shot dead in San Francisco in 1879 by Samuel Chalfant, an irate dentist (24). The patent expired in 1781.

Figure. Timeline of denture-base materials. (This is one of 6 images that compile timelines in prosthodontics) ©Spielman.

Vulcanite had some disadvantages, including its dark color. There were attempts for alternatives. In 1907, a Belgian-American chemist, Leo Baekeland from Yonkers, came up with bakelite. Patented two years later, it was the first plastic material made from synthetic components. It was a phenol formaldehyde resin malleable upon heating (25). 

The acrylic resin we recognize today as a powder and a liquid was first introduced in 1934.

Figure. Timeline of materials used to produce artificial teeth for dentures. (Start on the right side. This is one of 6 images that compile timelines in prosthodontics) ©Spielman

1930 Walter Bauer, a German chemist at Röhm and Haas Company in Darmstadt, patented methacrylicesters (26) as a new denture base material, and in 1936 the Kulzer company in Frankfurt, Germany, patented Palodon, a dental acrylic that polymerized from the mixing of a powder polymer and a liquid monomer.

It is safe to say that the invention of vulcanite and painless anesthesia in the second half of the 19th century were two of the more consequential discoveries in dentistry. Along with the invention of the dental drill, they brought an increased demand for dentistry.

  • 18. Hoffmann-Axthelm p.205
  • 19. de Chemant Fig 1-10
  • 20. Woodforde p.57
  • 21. Gardette
  • 22. Brown
  • 23. Goodyear
  • 24. Editorial
  • 25. Baekeland
  • 26. Bauer

Artificial teeth

The earliest evidence of denture teeth dates back to 1500 in findings dug up from a grave site near Cologne, Germany. The denture teeth were carved from the same block as the denture base itself. 

Figure. Denture from circa 1500, found at a gravesite in Cologne, Germany. It is a carved bone denture connected with two springs.  

In 1612 Jacques Guillemeau, a French dentist, suggested using a mineral paste for teeth that included mastic and powdered white coral (27). Still, using natural teeth was an easier solution. Initially, teeth were bought from live donors or, when insufficient due to demand, from grave robbers. During wars, they were collected from battlefields. In England, these teeth became known as Waterloo teeth due to the many collected from those fallen in the battle of 1815 against Napoleon. The habit extended well into the Crimean War (1853-56). However, due to their seasonal scarcity, their exposure to caries, and their potential for putrefaction, alternatives were thought.

In 1774  Alexis Duchateau, the French apothecary, invented using mineral paste (porcelain) for artificial teeth-replacing human teeth. His method was a crude approach and, in many ways, impractical, but subsequently improved in 1788 upon collaboration with Dubois de Chemant.  De Chemant (1753-1824) was a Parisian dentist who was about to publish a study on mineral paste, a precursor of modern porcelain, Sur Les Avantages Des Nouvelle Dents Et Rateliers Artificiels, Incorruptibles Et Sans Odeur, 1789 (28). He perfected manufacturing porcelain teeth (mineral paste), invented by Alexis Duchateau. He secured a patent from King Louis XVI for a modified porcelain, a mineral paste, to manufacture a denture base, which caused no odor. He used techniques employed by the Royal Manufacturers of Sevres Porcelain, just outside of Paris. Although Duchateau deserves the credit for the invention, Dubois de Chemant was the one that ensured porcelain for posterity. His technical advances were interrupted by the French Revolution. De Chemant was forced to move to London, where he obtained another patent from King George III and further improved his technique.

In 1808, Giuseppangelo Fonzi (1768-1840), an Italian working in Paris, improved on the porcelain teeth of Dubois de Chemant. In contrast to the latter, Fonzi had created individual semi-transparent porcelain teeth with metal hooks to attach them to a base, not a single block of denture base and teeth all made of porcelain. Fonzi’s improvement gave better esthetic results. By 1817 Antoine A. Plantou, who settled in Philadelphia, brought with him to America the knowledge of porcelain teeth. He started manufacturing them in 1819, and in 1822 he received a certificate of approbation from the Medical Society of Philadelphia. At the same time, in Britain, Claudius Ash, a silversmith, converted his business to carving teeth and riveting them to porcelain bases, a company that still bears his name. Each denture set took Ash six weeks to make (29).

Improving the appearance of the teeth alone was not sufficient. By 1819-1820 Christophe Francois Delabarre (1784-1862) invented the “continuous gum”, a colored enamel surrounding each tooth embedded into the base. This led to the manufacturing of individual teeth made with colored artificial porcelain gum. The process was optimized and mass marketed in the US by S.S. White, a company established in Philadelphia in 1840. Parallel with the US, in England in 1837, Claudius Ash, in collaboration with Dubois de Chemant, produced high-quality “tube teeth” that could be riveted to a metal denture base. The Ash and SS White companies competed with each other across the Atlantic and dominated the artificial teeth market during the second half of the 19th century and the first part of the 20th century. 

Once acrylic became available, like the denture base, artificial teeth were made out of it. Starting with the second half of the 20th century, teeth were made of porcelain fused to metal and, subsequently, of all porcelain, further improving its esthetic appearance. Today, much of the process is automated and computer-directed.

  • 27. Guillemeau p.502-3
  • 28. De Chemant (b)
  • 29. Woodforde p.63

Removable partial denture

The story of partial dentures parallels that of complete dentures and artificial teeth with the addition of the discovery of the metal elements of support. 

The first removable partial denture is seen in Pierre Fauchard’s 1728 publication. His anchoring solution for partial dentures was lingual and buccal bars attached to two carved ivory blocks connected by whalebone springs, similar to complete dentures. 

Replacement of single or multiple missing teeth with gold thread-held ivory-carved blocks. Fauchard, P. Le Chirurgien Dentiste, 1746, Vol II, p. 255, Planche 34.

The first clasp, “dents a coulisse” (30), appeared with Mouton in 1746, replacing gold and silver wires. He is the first to use clasps and bracelets instead of threads or wires to attach partial dentures to neighboring abutments. He uses gold springs to anchor dentures instead of steel to avoid rusting.

Clasps evolved from silver or gold wires at the time of Ambroise Paré and Fauchard to elastic flat gold bands preferred by Claude Mouton and Dubois de Chemant at the end of the 18th c., (31), to Christoph Francois Delabarre who in 1815 identifies clasps as “crochet elastique” or “flexible hooks” and occlusal rests as “spurs” (32) (See image to the right, taken from C.Fr. Delabarre,  1815). 

The connecting bar first appeared in 1880 (33), and in 1899, Bonwill made a detailed design of the occlusal rest on abutment teeth and the circumferential clasps linked to major connectors (34). In 1965 the design included a lower connecting bar, and multiple occlusal rests were included for better distribution of occlusal forces (35).

  • 30. Mouton p.107
  • 31. Gardette
  • 32. Delabarre p.93
  • 33. Balkville p.70
  • 34. Bonwill (a). p.656
  • 35. Becker

Fixed prosthodontics

The earliest artifacts showing an artificial tooth dated to 630 BCE, and it is Etruscans, but it appears they did not fulfill dental needs, nor were they made by physicians or anyone involved in healing. They appear to have been associated exclusively with Etruscan women of higher stature in society. The devices replaced, most likely, voluntarily removed (avulsed) incisors, replaced by either the removed upper incisor itself attached to gold support or carved from ivory, shaped from another tooth or gold, and held in place by a thin gold band attached to adjacent incisors (36). Such devices were not seen in any other neighboring or subsequent civilizations in Europe or the Levant. 

Interestingly, the first gold crown created in 1593 did not fulfill a dental need either. It was to deceive onlookers. Jacob Horst, a German physician, published a book, De Aureo Dente Maxillari Pueri Silesii – on the Silesian Boy with the Golden Tooth, the product of a miracle, he stated, of star alignments during the 6-year-old boy’s birth, that turned the first molar into gold (37). The gullible onlookers had to pay the price to glimpse the “miracle”. When the hoax was uncovered later, the child and the father were sent to jail. However, in describing the miracle, Horst inadvertently documented the first gold (swaged) crown made to deceive a gullible and superstitious audience (38).

One key ingredient in prosthodontics was the introduction of wax in dentistry by Mattheus Gottfried Purmann, a German (Prussian) surgeon, in 1711. He was working on a gunshot wound and suggested that the teeth that needed reconstruction by carving from ivory may be easily modeled first in wax (39).

During the first half of the 18th century, Pierre Fauchard used the dowel pin with an attached solid crown (pin a tenon) to anchor a multiunit fixed unit carved out of bone or ivory. Units could be stringed together like beads on a string and fastened with a rigid lingual bar to each other, a technique perhaps borrowed from bookbinding. He ground decayed teeth to the gingiva level, removed the carious material from the stump, filled it with lead, and placed a notched dowel pin and solid crown into the root. Two such dowel crowns could hold a carved bridge in place. Using dowel pins to attach to existing stumps was a clever way to anchor the otherwise mobile prosthodontic devices that Fauchard knew how to make. There was neither concept of the shell crown nor of root canal therapy. The microbiological basis of infection and the invention of the shell crown was another 150 years away.  As the industrial revolution was taking off, important innovations appeared which had an effect on dentistry. In 1821, stainless steel was discovered by the French mineralogist Pierre Berthier. 

Fixed prosthodontics was still rudimentary in the middle of the 19th century and late compared to the advances seen with removable prosthodontics. It was inadequate because anchoring crowns inside a root canal would have been an option but for the frequent flare-ups of the infected and non-treated stumps. That led to the need to enlarge and fill the root canal. The Dowel pin became a good solution. Mouton, like Fauchard, used the dent a tenon (40), or post as it became subsequently known and gained traction among practitioners when cement was introduced to fasten them to enlarged root canals. 

The root canal preparation to accept the dowel pin was more by trial and error. The first improvement came from Callman Jacob Linderer in 1834 with a precisely adapted gold plate covering the root. It was Gustave Blume, a Swiss dentist, that enlarged the root canal, cleaned off all pulp tissue, and placed a notched gold post into the canal. In 1859 Jonathan Taft of Cincinnati suggested that gutta-percha be placed into the canal to hold on to the notched pin of the dowel. There was still a need for good cement for anchoring. That came first in 1840 with Rostaig’s Cäment (41)and, in 1878, the “translucent cement” of Thomas Fletcher (42). 

The gold shell crown was a major improvement over the solid carved block crown attached to a dowel pin. Two competing claims had the first gold crown in America. In 1869, William N Morris published an obscure article that did not sign or patent his invention. Four years later, John B. Beers of San Francisco obtained a patent for the gold shell crown (Patent # 144,182). By all appearances, Morrison has priority (43).

The bridge was invented that same year in 1869 when BJ Bing was working in Paris when he fused multiple crowns with a lingual or palatal bar (44) 

Finally, when the dental lathe to grind porcelain crowns was invented in 1880, suddenly fixed prosthodontics of crowns and bridges took off. In short order, 1884 full porcelain-covered crown was patented in 1884 by Marshall L Logan, a dentist from Tyrone, Pennsylvania. That same year,  Cassius M. Richmond introduced the Dowel crown containing the root stump, a gold post covered with a gold crown, and a porcelain veneer, the “Richmond crown” (45,46). The last major improvement for crowns came from Charles H. Land patents with his all-porcelain jacket crown under the name “artificial tooth crown”. His Patent # 405167 was issued on June 11, 1889.

The dowel crown bridge was further improved in 1885 to hold a bridge with crowns, pontics, and dowel support in place. The design of pontics with self-cleaning surfaces was introduced in 1899 by Charles Wesley Stainton of Buffalo. As metal casting techniques improved at the beginning of the 20c. So did the precision in crown and bridge prosthodontics.

Fixed prosthodontics was now in full swing. Porcelain was starting to attain the desired esthetic effects. Metallurgy required special alloys to support the crown, bridge, and implants. These came in the form of chromium-cobalt-nickel alloy invented in 1911, the corrosion-resistant metal developed by Gustav Tammann at the Krupp Company in Gottingen and improved upon in 1919 by Frederich Hauptmeyer, a German dentist that created the first stainless steel prosthesis at Krupp dental clinic in Essen using V2-A, a nickel-chrome-steel alloy (47).

Figure. Timeline of fixed prosthodontics (crown and bridge). This is one of 6 images that compile timelines in prosthodontics. Image ©Spielman.

  • 36. Backer (a). (b).
  • 37. Horst
  • 38. Spielman
  • 39. Purmann p.219 (first use of wax)
  • 40. Mouton p.85
  • 41. Hoffmann-Axthelm (a). p. 294)
  • 42. Fletcher 1878
  • 43. Morrison p.184
  • 44. Bennett p.509
  • 45. Richmond
  • 46. Talbot
  • 47. Hauptmayer

History of articulators

The earliest articulator, two plaster models keyed together to interdigitate; the slab articulator was developed by Phillip Pfaff, who, in 1756, took the first wax impression and poured plaster models. (48) The hinge-joint articulator introduced 50 years later by the French Jean Baptist Gariot in 1805 was an improvement, even though it had only one-dimensional movement (open-close). (49). In 1840, Daniel Evans improved by adding forward and lateral movements to the articulator, imitating the movements of the jaw. This was further improved in 1864 by William A.G. Bonwill with a balanced three-point contact on occlusion. (50). In 1890, Ferdinand Count of Spee introduced the curve of occlusion that bears his name.

1858 William Gibson A Bonwill (1833-1899), an American dentist from Philadelphia, and architect of balanced occlusion, introduced an improved articulator that favors the more dynamic three-point articulation of teeth instead of simple occlusion.  His study of 4000 mandibles led to the discovery of the equilateral (Bonwill) triangle between condyles and mandibular symphysis. Bonwill never patented his invention; he simply gave it to the profession.

1896 Alfred Gysi (1865-1957), Swiss Dentist and founder of the Dental Institute at the University of Zurich (1895), spent half a century perfecting the articulator. (51) His work was slow to be recognized. It took him almost 30 years to get his work published. Gysi’s articulator imitated the glenoid fossa and the condyle. In 1908 Gysi developed the adaptable articulator with an incisal pin and guide plane (52). It is a culmination of the work started by Bonwill and Walker and subsequently improved by Hall, Monson, and Hanau and relied on half of a century of studies of Francis H. Balkwill, a dentist from Plymouth, England (53). There were several minor improvements in the capabilities of articulators (54), but understanding occlusion got a boost when George H. Wilson described in 1911 the curve bearing his name, the “curve of Wilson”. It describes the inclination of maxillary and mandibular teeth to obtain a balanced occlusion. The next major improvement was made by Rudolph H. Hanau in 1921. A  South African, German-educated, American engineer from Buffalo, Hanau, designed several new models of articulators, with Model C being the most popular. It had an incisal pin, guide table, variable rotation centers, individual condylar guidance adjustments, and, compared to previous articulators, improved simulated condylar, lateral, protrusive, and retrusive movements (54). The Hanau articulators dominated the field for half a century. Nevertheless, in the first half of the 20th century alone, there were 38 articulator models put forward (55). In 1952, Ulf Posselt of Sweden described a special motion of the mandible that, in 3D, looks like an envelope. This was termed “the envelope of motion”. As articulator types proliferated and many of the sophistications built into earlier articulators became deemphasized, the profession was less inclined to use complex articulators and settled for more practical and efficient solutions.  However, as the production of fixed prosthodontics is becoming ever more automated and digitized, the role of traditional articulators is fading.

  • 48. Pfaff
  • 49. Gariot p.306-8
  • 50. Bonwill (b).
  • 51. Gysi (a).
  • 52. Ibid (b).
  • 53. Mitchell (a) (b)
  • 54. Hanau
  • 55. Jain

Figure. Timeline of articulators. This is one of 6 images that compile timelines in prosthodontics. Image ©Spielman.

Evolution of management of tooth loss

Over the centuries, dentistry had several distinct stages of evolution (see figure below). The one where prosthodontics fits best started around 1728 with Pierre Fauchard and is still ongoing. Before 1728 attempts to provide tooth replacement were rare and rudimentary by today’s standards. Over the past 300 years, tooth loss management moved from a temporary solution to a more permanent one. Prosthodontic devices, initially, were neither esthetic nor functional. Today, they are both almost imperceptible to the untrained eye. 

The first attempts to replace tooth loss in the 16 through 18 centuries were poorly fixed carved ivory blocks that were neither fixed nor removable. In the 18th century, starting with Pierre Fauchard, more elaborate removable dentures were created with support from coiled springs that pushed dentures apart. With Claude Mouton, in 1746, the shell crown and fixed prosthodontics started. By the end of the 18th century, managing edentulism involved impression taking, new denture base materials like gold, bras, and porcelain, and improved materials used for artificial teeth, including natural teeth and mineral paste. The appearance of the dowel pin helped anchor fixed dentures. Starting with the early 19th century with the industrial revolution underway, demand for services spurred innovations in materials, drills, and instruments. In the second part of the 19th century, with the advent of anesthesia (1844-46), understanding of the microbial basis of infection (1860-82), and the invention of the foot-operated dental drill (1871), services and the type of treatments patients could receive have dramatically improved. By the end of the 19th century, fixed prosthodontics to manage dental needs became a reality. Combined with the appearance of educational institutions (starting in 1840) and licensing requirements for dentists (starting in 1841), the management of patients improved. During the early 20th century, dental care became more science-based (after 1926) and less mechanical. These trends only increased during the rest of the 20th century. Today, the array of treatment options includes implant-supported complete and partial dentures, computer-designed and 3D printed crowns and bridges, and aesthetically pleasing and imperceptible compared to natural teeth.

In 1918 the National Society of Denture Prosthetics was formed in the US, the first specialty-based society. Today it is called The Academy of Prosthodontics.  In 1947 the Academy established a specialty program, Advanced Education in Prosthodontics Programs (AEPP), that is three years in length today. Graduates of the AEPP become specialized in Prosthodontics and board certified if they pass a special exam. Prosthodontics is a specialty recognized in the US, UK, Ireland, Scotland, Canada, and Australia.

Timeline of Prosthodontics

Figure. Timeline of Prosthodontics. Start on the top left. (©Andrew I Spielman)

Primary references and notes on prosthodontics

Baekeland, Leo H. (1909). Method of Making Insoluble Products of Phenol and Formaldehyde. US Patent Office. Patent # 942699, Dec. 7, 1909

Balkville FH (1880). Partial vulcanite uppers. In: Mechanical Dentistry in Gold and Vulcanite. Chapter V, p.70. (first mention of a connecting bar).

Bauer, Walter (1930). Process of producing acrylic acid esters. US Patent Office, Patent # US1890277A, Dec 6, 1932.

Becker, Curtis M., Kaiser, David A. and Goldfogel, Marvin(1994). Evolution of Removable Partial Denture Design. J Prosthodontics, 1994, 3(3): 158-166.

Becker, Marshall J. (1994) (a). Early dental appliances in the Eastern Mediterranean. Berytus 42:71-102.

Becker, Marshall J. (2002) (b). Etruscan female tooth evulsion: gold dental appliances as ornaments. In: Practices, Practitioners, and Patients: New Approaches to Medical Archeology and Anthropology. Gillian Carr and Patricia Baker Eds. Oxford: Oxbow Books. p.236-257.

Bennett, H.D. (1869).Partial Sets of Teeth Without Plate, Clasp, or Pivot. Dental Cosmos,11(10): 509-510. (First description of a bridge done by B.J. Bing in Paris).

Bonwill  W.G.A. (1899) (a). New methods of‘ clasping artificial dentures to human teeth without injury versus immovable bridges. Dent Items Interest; p.656-670. (new design of clasps with occlusal rest.

Bonwill  W.G.A. (1899)(b). The scientific articulation of human teeth as founded on geometrical, mathematical and mechanical laws. The Anatomical Articulator.  Dental Items of Interest 21: 617-636; 873-880.

Brown, Solyman (1842). Of the insertion of entire sets of artificial teeth, both upper and lower, on plates of gold, without clasps or springs. American Journal of Dental Science, Volume II(4):265-279.

de Chemant, Dubois Nicolas (1797) (a). A dissertation on artificial teeth in general. Figure 1 through 10 (unnumbered pages).

de Chemant, Dubois Nicolas (1798) (b). Sur les avantages des nouvelles dents et rateliers artificiels, incorruptibles et sans odeur: inventés par M. Dubois de Chémant.

Delabarre CF. (1815). Odontologie ou observation sur les dents humaines  (Odontology or observations on the human teeth) (Flexible hooks for partial denture support).

Delabarre CF 1820. Traite de la partie mécanique de l’art du chirurgien-dentiste.  (A treatise on the Mechanical part of the Art of the Dentist). Paris. p.159 (impression trays)

Desirabode, Malagaou (1843). Nouveaux éléments complets de la science et de l’art du dentiste, “Prothèse ou mécanique dentaire” Chapter II, p. 545. (functional impression taking)

Editorial etc. (1880). The Death of Josiah Bacon. Am. J. Dental Science, Vol. 13  p.40-45.

Fauchard, Pierre (1746). Le Chirurgien Dentiste. 2d Ed. Vol II. p.252 – flat block instead of the carved occlusal surface.

Franklin BW. (1861). Plaster impressions and other things. Vulcanite. 1:155. (double impression, preliminary wax and plaster, final)

Gardette, Emile B. (1851). Biographical Notice of the Late Dr. James Gardette, Surgeon Dentist of Philadelphia. Am J Dent Sci. 1(3):375-382. (on the first use of atmospheric pressure for upper denture by James Gardette)

Gariot, Jean Baptiste (1805).Traité des maladies de la bouche (inventor of the hinge articulator). p.306-308.

Goodyear, Charles (1844) Improvements in India-rubber Fabrics. US Patent Office, Patent #3633, June 15, 1844.

Guillemeau, Jacques (1612). Les Oeuvres de chirurgie de Jacques Guillemeau, avec les portraicts de toutes les parties du corps humain et des instruments nécessaires au chirurgien, augmentées et mises en un et enrichies de plusieurs traictez, pris des leçons de Me Germain Courtin. p. 502-503. (First attempt to use artificial teeth and restorations made of “mineral paste”). He states: (Cette paste peut aussi ſeruir à mettre dedans une dent creuse, afin d’empecher qu’il ne tombe et se cache quelque viande en mangeant, qui les pourrist d’avantag, et excite souvent grande douleur.) “That same material (mineral paste) can also be used to put inside a hollow cavity to prevent meat from getting stuck inside…and often excites great pain.)

Gysi, Alfred (1908) (a). Beitrag zum Artikulationsproblem. Beschreibung meines neuen Artikulators. p.26-31. Berlin. (New articulator with the guiding plane).

Gysi, Alfred (1912) (b). Neure Gesichtspunkte im Artikulationsproblem. Schweizerische Vierteljahrsschrift fir Zahnheilkunde, 22:118-151. (Articulator and the work of Francis Hancock Balkwill).

Hanau, Rudolph L. (1921). Dental articulator. US Patent Office. Patent # 1,586739 was issued June 1, 1926 (Applied Feb 3, 1921).

Hardy, Irving R. (1965). History of the specialty of prosthodontics. J. Prosth. Dent. 15(5): 946-948.

Hauptmeyer, Frederich (1920). Uber die Verwendung von nicht rostfreiem Stahl in der Zahnheilkunde. Deutsche Monatsschrift Für Zahnheilkunde. 38:1-7. (1919 invention of corrosive resistant alloys in dentistry).

Hoffman-Axthelm, Walter (1981). Hoffmann-Axthelm, Walter (1981). History of Dentistry (Translated from German H.M. Koehler, Chicago:, Quintessence Publishing Co., Inc., p.265 – first plaster impression by Gilbert and Dwinelle.

Horstius, Jacob (1595). De aureo dente maxillari pueri Silesii. Lipsiae. (The boy with the golden tooth).

Jain, Ashish R. (2016). Articulators through the Years Revisited: From 1900 to 1950 – Part II. World J. Dent. 7(1):23-31.

Ladha, Komal and Verma, Mahesh (2011). 19th Century Denture Base Materials Revisited. J Hist Dent 59 (1), 1-11 Spring 2011 (denture base materials).

Lowe, Peter (1612). A Discourse of the Whole Art of Chyrurgery. Lib V, Chapter XXX, Of the Corrupt and Hallow Tooth, p.194. (whale bone and ivory for artificial teeth). 

Minozzi, Simona;  Panetta, Daniele; De Sanctis, Massimo Giuffra, Valentina (2017). A Dental Prosthesis from the Early Modern Age in Tuscany (Italy) Clinical Implant Dentistry and Related Research, Volume 19(2) 365-371. (Paré type wire attached bridge).

Mitchell, Donald L, Wilkie, Noel D. (1978) (a). Articulators through the years. Part I. Up to 1940. J. Prosth. Dent. 39(3): 330-338. DOI: https://doi.org/10.1016/S0022-3913(78)80106-1

Mitchell, Donald L, Wilkie, Noel D. (1978)(b). Articulators through the years.  Part II. From 1940. J. Prosth. Dent. 39(4): 451-458.

Morrison, Wm. N. (1869). A New Operation. Missouri Dental Journal, Vol I, May 1869, p. 184-185. (The 1869 publication, Morrison claimed to have done the first gold crown for a patient, Mrs. W. It sparked the field of fixed prosthodontics. It was four years before J.B. Beers got a patent. 1869 article is signed “N”. Morrison came forward in 1881, Dental Cosmos, Vol 23, p. 112, claiming he was the author of that 1869 article. He published a second article in 1884, Metallic Crowns,  in American J. Dent. Sci. Vol 17, p.13-20, his claim in more detail. It appears he has the earlier claim but not that of Mouton.

Mouton, Claude (1746). Essay d’odontotechnie, ou, Dissertation sur les dents artificielles. p.85 – on dowel pin;  p.107 – clasps for partial denture,  p.137  (The first gold crown, coulotte d’or;

Papadiochos, Ioannis, Papadiochu, Sofia, and Emmanouil, Ioannis (2017). The Historical Evolution of Dental Impression Materials. J. Hist Dent. 65(2):79-89. (general reference for impression materials) 

Paré, A. (1628). Les oeuvres d’Ambroise Paré. France: Nicolas Buon. p.895 (Tooth replacement). https://www.google.com/books/edition/_/wr8-AAAAcAAJ?hl=en&gbpv=1

Paré, A. (1652). Les oeuvres d’Ambroise Paré. France: https://www.google.com/books/edition/_/Rpfd0Rzd5zgC?hl=en&gbpv=1

Pearson, S.L. (1955). A new elastic impression material: A preliminary report. Brit. Dent. J. 99, 72-76. (First rubber base impression material).

Pfaff, Phillip (1756). Abhandlung von den Zahnen des menschlichen Körpers und deren Krankheiten. (First impression taking, use of plaster for models and the slab articulator).

Poller, Alfred (1924). Kurze Anleitung zum Abformen am lebenden und toten Menschen, sowie an leblosen Gegenstanden. Apostela, Wien. (Hydrocolloid impression material).

Purmannus, Mattheus Gotthofredus (1722). Grosser und gantz neu-gewundener Lorbeer-Krantz oder Wund-Artzney, Frankfurt und Leipzig, p. 219 (the first use of wax in dentistry)

Richmond, Cassius M (1883). Richmond tooth crown. US Patent Office. Patent # 277941, May 22, 1883. A prior patent was awarded to Richmond on Feb 10, 1880, under the title “Artificial tooth crown. The 1883 was an improvement. His patent was challenged in court.

Robinson, James (1846). The surgical, mechanical, and medical treatment of the teeth. London. (Partial denture clasps and asbestos as a liner).

Schrott, Johann Joseph (1864). System den genauesten Abdruck und die siecherste Artikulazionzu Erhalten. Dtsch. Vjschr. Zahnheilk. 4 (1864) 296-304.  (First functional impression for complete dentures).

Spielman, AI (2009). The Boy with the Golden Tooth: A 1593 Case Report of the First Molded Gold Crown. J. Dent. Res. Volume: 88 (1): 8-11 https://doi.org/10.1177/0022034508328196

Talbot, E.S. (1884). Proceedings of the First District Dental Society, State of New York. Dental Cosmos, Vol 26: 411-413. (Richmond Crown presented)

Wescott A. (1870). Using Plaster of Paris for Taking Impressions of the Mouth – Its History and Importance,  12 (4): 169-181. (Dunning was the first to take a plaster of Paris impression in the winter of 1843-44, p.171 of the article)

Woodforde, John (1968) (a). The Strange Story of False Teeth. p. 27. Universe Books. New York City. (denture fitting with paint)

Woodforde, John (1968) (b). The Strange Story of False Teeth. p. 49. Universe Books. New York City. (Remove dentures for a meal)

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