CHARLES STENT: THE 19TH CENTURY DENTIST WHO REVOLUTIONISED THE MOST MODERN SURGICAL BRANCHES WITH DENTAL IMPRESSIONS

Abstract

The term "stent" was slowly absorbed and later monopolized by general medicine during the First World War with the increase of reconstructive interventions and, later on, with its use in urology and plastic surgery. [...]due to its tendency to distort on removal from patients' mouth and to shrink at cold temperatures, the material was not suitable for dental impressions. [...]Stent created a new material, which was later referred to as Stent`s compound, by adding stearic acid for plasticity and stability, and talc as a filler. According to the Oxford Dictionary, it is related to the Anglo-Norman French "extente" - meaning "to stretch", "to expand". The European Gastrointestinal Endoscopy Society recommends the use of stents in bile tract defects and also as a palliative for oncology patients, chronic pancreatitis or when the gallbladder stones cannot be removed [22].

Headnote

Abstract

Today, Stent`s name is no longer mentioned in practice by dentists, any more, however it is rather routinely present in almost all other medical branches. Stenting is a procedure commonly utilised in reconstructive surgery, urology, plastic surgery, cardiology and neurovascular surgery. The term "stent" comes from Charles Thomas Stent (1807-1885), a brilliant English dentist and inventor who created a gutta-percha biomaterial for dental impressions. The term "stent" was slowly absorbed and later monopolized by general medicine during the First World War with the increase of reconstructive interventions and, later on, with its use in urology and plastic surgery. Subsequently, Stent`s name became encountered in obstructive coronary pathology and now in cerebral pathology. For his work, Charles Stent was awarded the membership to the Royal Household in 1885. The Stent logo became renown world-widely through its use by his descendant`s "Claudius Ash and Sons" International Dental Materials Company. Currently, "stent" is recognized as an international brand and is part of the common medical nomenclature. We pay tribute to C.T. Stent and to his invention, which helped unify all medical branches and their international language across all meridians. This year marks 133 years since the death of the doctor who has leftthe name of Stent "inheritance" to the world. The authors present C.T. Stent`s dentistry invention which unexpectedly revolutionised most of the vascular, urological and reconstructive surgical procedures.

Keywords: stent, medical history, dentistry, gutta-percha.

1. CHARLES THOMAS STENT AND THE GUTTA-PERCHA

Charles Tomas Stent (Fig. 1) was a dentist and inventor born on October 17, 1805 in Brighton, England. He was the 6th son of William and Hannah Stent. He was trained in dentistry and practiced it in London in a small clinic near Piccadily Circus. He was described as being "a shrewd little man with an inventive mind" [1,2].

Stent was married to Caroline Osbourn with whom he had two sons, who both became dentists (Charles Robert Osbourn Stent and Arthur Howard Osbourn Stent), and a daughter (Fanny Osbourn Stent) [3].

Gutta-percha was introduced into dentistry in 1847 by Dr. Trueman, who used it as a material for dental base. However, due to its tendency to distort on removal from patients' mouth and to shrink at cold temperatures, the material was not suitable for dental impressions. Thus, Stent created a new material, which was later referred to as Stent`s compound, by adding stearic acid for plasticity and stability, and talc as a filler. He only published one medical article (Fig. 2) in which he described his new material: "I used the improved white plastic compound lately introduced by me to the Profession, which sets in the mouth in a minute or two, so that it can be removed without injury to the impression" [4].

As his activity was appreciated in England, he was rewarded the membership to the Royal Household. The Stent family preserved his legacy: both his sons became dentists and his grandchildren continued working in the dentistry field, creating a dental materials manufacturing company. His descendant, Claudius Ash, created a powerful and renown international company (Claudius Ash and Sons), which used the Stent logo (Fig. 3), thus creating the international Stent "brand" [3].

Today, the use of term "stent" in medical literature is extremely common. Stenting is usually used as an equivalent to both coronary and cerebral endovascular prostheses.

Gutta-percha, a natural latex produced by a Malayan tree (Palaquium gutta), is a white viscous fluid which, after being allowed to evaporate and coagulate in the sun, becomes biologically inert, resilient, acting as a good electrical insulator. The material can be moulded in hot water, returning to its rigid form at cold temperatures, without becoming brittle - as natural rubber.

The first one to have introduced gutta-percha in practical use in the Western world, after observing the native population using it, was Dr. William Montgomerie, a medical officer stationed in India, who used it for surgical appliances. He was awarded the gold medal by the Royal Society of Arts in 1843. Thanks to him, gutta-percha became the new and exciting material of the 19th century [5].

This material had a myriad of utilizations and purposes, which made it the most largely used material by both domestic and industrial manufacturers, quickly becoming a household name. It was used for both decorative and functional objects, such as: chessmen, jewellery, machinery belts, tubes, walking canes, etc.

A notable achievement for Westerner inventors and engineers was its use as an electrical insulator in the first transatlantic telegraph cable. The first message carried by the cable was "Europe and America are united by telegraphy. Glory to God in the highest; on earth, peace and good will toward men" [6].

2. ORIGIN OF THE WORD "STENT"

It is interesting to note that the word "stent" was present in the English language long before Charles Thomas Stent. According to the Oxford Dictionary, it is related to the Anglo-Norman French "extente" - meaning "to stretch", "to expand".

The Merriam-Webster Third New International Dictionary states that the word "stent" is derived from the Middle English word "stenten", which is a short form of "extenten" - meaning to stretch. The word "extenten" is also derived from the Latin "extentere", with the same meaning [2].

It is thus safe to assume that the word "stent" has its origin in ancient times, so C.T. Stent did not create a new word, he just added a new medical meaning to an already existing notion.

Another theory of the origin of the word "stent" is related to the First World War, when the need for more anatomically correct, functional and easy to acquire prostheses increased dramatically. The first doctor to use the word "stent" in a medical scientific article was J.F. Eser (1877-1946). He was an innovator in the field of plastic surgery who, during the First World War, used new implants and reconstruction techniques. Eser was especially prolific in repairing facial traumas [7].

This Dutch doctor was the Special Surgeon for Plastic Operations at the hospital of Vienna. His two most important and successful activities were of reconstructing orofacial region traumas - as known, a difficult challenge for that time - by utilizing the Stent Mold in his daily practice. His work was an inspiration for the English army surgeon H.D. Gillies, who called the procedure of using Stent`s mold as "stenting". This moment marks the first time Stent`s name drops the capital letter and becomes a verbal form [8-10].

3. STENT AND STENTING IN SURGICAL PROCEDURES

In cardiology, the introduction of stents was slow, but had a major advance, especially at the end of the 20th century. Puel and Sigward10 made the first coronary stent in 1986 to act as a support for the vascular wall [11].

Stent vascular endoprostheses cover all obstructive coronary and vascular pathology. Numerous devices have become increasingly complicated, with applications centred on coronary arteries, arteries and, of course, on the aorta. Today, cardiac and vascular surgery cannot be done without the use of endovascular prostheses (stents). Heart surgeons have at their disposal hundreds of types of stents with sizes and shapes adaptable to each case [11-14].

In neurosurgery, the use of stents was slow at first, due to the remarkable personalities in the field who pushed for open microsurgery as a direct approach in intracranial aneurysms occlusion and also for arterio-venous malformations.

Gradually, the vascular endoprostheses got highly improved, up to reaching a science-fiction level, in some cases, due to the outstanding number of adaptation possibilities and to the complete obstruction of intracranial aneurysms and arterio-venous malformations capabilities.

Recently, the use of Stent-Assisted Coiling, together with the Vascular Flow Diverter, represents an improvement in the treatment of cerebrovascular malformations with great Jack Moret results. Barrel Systems and pCONus represent the most modern methods of treating bifurcated aneurysms of neurosurgical nature [15-16].

In urology, the use of Stents is renown in the treatment of both genito-urinary malformations and urethral dilations [17-19].

Plastic surgery and ENT commonly uses Skin GraftStent procedures for mandibular and nasal reconstructions [20-21].

The European Gastrointestinal Endoscopy Society recommends the use of stents in bile tract defects and also as a palliative for oncology patients, chronic pancreatitis or when the gallbladder stones cannot be removed [22].

Today, all medical fields use the term "stent" as a reconstructive material or device. This subsequently contributes to the very needed international "medical language".

4. CONCLUSIONS

We pay tribute to Charles Thomas Stent (1807- 1855), an English dentist who unknowingly revolutionised most of the surgical branches by inventing gutta-percha dental impressions. Nowadays, obstructive heart pathology as well as vascular neurosurgery recognize the continuous use and refinement of prosthetic materials that have developed from the Stent material up to incredible science fiction materials and applications.

References

References

1. Ambekar S, Nada A. Charles Stent and the mystery behind the word "stent". J Neurosurg. 2013;119(3):774-7.

2. Hedin M. The origin of the word Stent. Acta Radiol. 1997;38(6):937-9.

3. Roguin A. Stent: the man and word behind the coronary metal prosthesis. Circ Cardiovasc Interv. 2011;4(2):206-9.

4. Stent CT. A new articulating and bite frame. Dent Rev. 1859;1:82-3.

5. The Plastics Historical Society. Montgomerie. [Internet]. London: The Plastics Historical Society [cited 2018 Feb 13]. Available from: http:// plastiquarian.com/?page_id=14213

6. Granick H. Underneath New York. New York:Fordham University Press;1991.

7. Esser JF. Studies in plastic surgery of the face. Ann Surg. 1917;65(3):297-315.

8. Mulliken JB, Goldwyn RM. Impressions of Charles Stent. Plast Reconstr Surg. 1978;62(2):173-6.

9. Gillies HD. Plastic Surgery of the Face. London:Oxford University Press;1920.

10. Remine WH, Grindaly JH. Skinlined omentum and plastic sponge tubes for experimental choledochoduodenostomy. Arch Surg. 1954;69(2):255-62.

11. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: description of a new technique and preliminary report of its application. Circulation. 1964;30:654-70.

12. Moore JR. A modification of stent design for preprosthetic surgery. J Oral Surg. 1970;28(4):263-6.

13. Roubin GS, Robinson KA, King SB, Gianturco C, Black AJ, Brown JE, Siegel RJ, Douglas JS. Early and late results of intracoronary arterial stenting after coronary angioplasty in dogs. Circulation. 1987;76(4):891-7.

14. Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987;316(12):701-6.

15. Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. pCONus device for the endovascular treatment of wide-neck middle cerebral artery aneurysms. AJNR Am J Neuroradiol. 2015;36(9):1735-40.

16. Ding D, Starke RM, McGuinness B, Brew S. Doublebarrel Y-configuration stenting for flow diversion of a giant recurrent basilar apex aneurysm with the pipeline flex embolization device. J Neurosci Rural Pract. 2016;7(Suppl 1):S99-S102.

17. Firlit CF, Brown JL. Ureteral stents: a device for removal. J Urol. 1972;108(6):954.

18. Gibbons RP, Correa RJ Jr, Cummings KB, Mason JT. Experience with indwelling ureteral stent catheters. J Urol. 1976;115(1):22-6.

19. Mason JT. Stents and related terms: a brief history. Urology. 1999;54:767-71.

20. Montgomery WW. Reinforced T-tube tracheal stent. Arch Otolaryngol. 1965;82:320-1.

21. Radewan MG. Modern stent for nose surgery. Laryngoscope. 1968;78:89-94.

22. Dumonceau JM, Tringali A, Blero D, Devière J, Laugiers R, Heresbach D, Costamagna G; European Society of Gastrointestinal Endoscopy. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44(3):277-98.