However, Leek, who later examined the appliance, identified a number of problems with these conclusions. He considered that the considerable tooth wear had produced such a significant change in the morphology of the tooth, that positive identification of the position of the tooth in the dentition or indeed confirmation that the teeth belong to the same individual was not possible. Additionally, as the wear is greater on the third molar compared to the second, then it is unlikely to have come from the same individual as this tooth would have erupted some six years later. He also stated that the 0.35 mm diameter gold tubular wire would unlikely achieve even a short term result due to its insubstantial nature.
Overall the indication would seem to be that the appliance was not present during the lifetime of the individual, and a possible explanation could be that it was inserted into the mummified body in an attempt to make the body whole for the afterlife, a practice common in ancient Egypt. Alternatively, the teeth could have been worn as an amulet, with the owner perhaps hoping that they would afford some form of power or protection.
A second appliance, similarly dated to about 2,500 BC, was excavated at el-Quatta, near Cairo and again was not found in situ, but retrieved from amongst the crushed bones of a skull. It was described as consisting of a maxillary right canine around which a double strand of gold wire had been encircled, finishing in a knot on its distal surface (below). Separate from this were a central and lateral incisor connected to each other with similar gold wire, but at one time thought to have been attached to the right canine by a hook in the wire. The central incisor had a hole drilled in a mesial distal direction as well as a labial groove on the crown in order to accommodate the gold wire passing through and around the clinical crown. The lateral incisor also had gold wire wrapped around it, which rested in a prepared labial groove and the roots of both teeth were scraped and polished producing an artificial morphology. The suggestion was that the canine was the right abutment of a four unit bridge with the central and lateral incisors being the pontics, and a missing left central incisor the left abutment. Because calculus was found on the lateral incisor and canine, it was claimed that the bridge was worn for a relatively long period of time during life.
A problem with this conclusion is that the roots of both the incisor and the lateral although slightly scraped and polished are not sufficiently gum fitted to function as a conventional bridge. As the figure indicates, pontics of this length would probably cause food trapping and mucosal irritation. Also it is questionable whether the gold connecting wire would have been sturdy enough to stabilise the teeth during the normal rigours of mastication. The presence of calculus on the roots of the teeth could indicate periodontal involvement during life with associated pocketing and gingival recession. A possibility here is that the teeth could have been accidently dislodged from their sockets during the mummification process, and then later reattached, or even that they were teeth that had been accidentally lost during life and then were being replaced at this time.
The third and final appliance was excavated from Tura el-Asmant, and was found attached to a skull, the only one from ancient Egypt to be found in situ. It was dated to the Greek (Ptolemaic) period of ancient Egypt (332–330 BC), and was described as a bridge whose single pontic was a right maxillary central incisor. It was fixed into place by a silver wire passing through two holes that had been drilled mesio-distally through the crown of the tooth, whilst the exact means of connection to the adjacent teeth is unknown. Radiographs showed no evidence of a radiolucent area above the pontic as well as a much shorter root, suggesting that the tooth had been prepared outside the body before insertion. The recontouring of the labial alveolar bone also pointed to the tooth being placed in situ after healing. The direction of the drill hole would probably exclude the possibility of this procedure from being carried out in the mouth.16 Blustein et al.4 pointed out that the lower central incisor was positioned more labially than the remaining lower anterior teeth, and this could therefore have resulted in trauma to the upper right central incisor, and thus may have been the reason for its loss.
This then would appear to be a true prosthetic device, and dating to the Ptolemaic period, the earliest one discovered from ancient Egypt. However, the Ptolemaic period was a time of trade and cultural exchange in the Mediterranean and because of the lack of similar finds in Egypt there is also the possibility that either the bridge was found on a foreign traveller or that this particular technique had been imported. Certainly dental work of a similar nature has been discovered in Sidon, Greece and in Etruscan cemeteries.17
It is not clear if extractions were performed in ancient Egypt since although there is considerable evidence of ante-mortem loss of teeth; many of these teeth appear to have been periodontally involved and may therefore have been removed by simple digital pressure or displaced naturally. No ancient Egyptian instrument has ever been discovered that could be utilised for the extraction of teeth, nothing like the examples of Greek and Roman extraction forceps that have been unearthed. However, simple elevation of a tooth by means of a primitive metal lever should perhaps not be excluded from consideration, and such a lever may well have been excavated in the past but not identified as such.
However, examinations of skeletal remains have led some workers to conclude that that there were cases where extractions had been performed.18, 19 This judgement was based on a consideration of the amount of space, the inclination of the adjacent teeth, and the contouring of the intervening alveolar bone in areas where there were missing teeth. Nevertheless, there are many examples of periodontally involved teeth which could easily have been removed by finger manipulation or by means of a simple extraction procedure, but have been left in situ.8 These extractions had they been performed would undoubtedly have resulted in considerable pain relief. Why these simple extractions were not carried out seems rather strange when you consider the sophistication of the ancient Egyptian civilisation and their extensive knowledge of medicine and surgery.
SOURCE: R. J. Forshaw Dr. Roger Forshaw, Bramblewood, Park Gate, Park Road, Guiseley, West Yorks, LS20 8EN