Fundamentals of Fixed Prosthodontics by H.T. Shillingburg
Updated: Jul 18, 2020
This book in the BDA library’s “Search for the most influential dental book since 1920” survey has collected more votes than any other book so far and 75% of the prosthetic book votes.
Author of the book, Herbert Tomson Shillingburg, began his academic career in crown and bridge. After attending the University of Southern California School of Dentistry, during which time he met the love of his life, Constance Murphy. They married in the second year of Dental School.
Dr Shillingburg became a faculty member at the new College of Dentistry, Oklahoma. Here, he began creating a series of handouts for dental students that ultimately became the Fundamentals of Fixed Prosthodontics, first published in 1976. The 4th edition was published in 2012.
Dr Shillingburg also wrote ‘Guide to Clinical Waxing’, ‘Restoration of the Endodontically Treated Tooth’ and ‘Fundamentals of Tooth Preparations’ (personally, my favourite!)
As an undergraduate dental student, I am very familiar with this book myself. If you read the Preface, Dr Shillingburg states that “Restorations in the field of dentistry, can be the finest service rendered for dental patients or the finest disservice perpetrated upon them”. This statement is a keystone to the author’s intentions in creating a book of this kind. It was also how my lecturer first introduced the topic to me. I took this as: “Before I give you this weapon on knowledge, prepare to use it skilfully, wisely, safely and ethically”.
I am taught fixed prosthodontics by Professor Richard Ibbetson at the Institute of Dentistry in Aberdeen. So of course, when this book was the first on the list to be illustrated, I went straight to the man that has the same pedantic, self-critical approach to his dentistry as I do to my artwork.
“It is a book for which I have a great deal of affection as I learnt from it and have used it personally, practically, and in teaching for rather a long time” he said. “The best feature of the book has always been in description and illustration of the preparations. They brought a level of detail to preparations for indirect restorations which had not been seen before and trying to achieve what the diagrams showed was both a challenge and a stimulus” .
This is something I can relate to. The book leaves me wanting to attempt the most complex of preparations just to test myself, my accuracy. I’d call Professor over during a clinical skills session and he would always begin with a positive but would equally always find something I could improve on. It would be a tiny, miniscule, frustrating little feature that would leave me with a moment of disheartenment because I was trying so hard! At the same time, it would leave me with more determination than ever to get it right! Yes, I’m as pedantic about tooth preparation as I am about the artwork.
The diagrams within the book are a feature I am also drawn to. Partly because I learn practical dental skills by first studying shape and form. Replicating dexterity and accuracy with a drawing exercise; tracing the path before adding the drill. For me, the theory comes after (but maybe I’m strange that way).
Therefore, the artwork had to incorporate diagrams that could convey specific information and include perspective. “The rationale for the design is explained and referenced well. Many of the references would be considered old but they are not out of date and still apply”. The book was built on early principles established by authors such as Tylman, through the 1950s and 60s. I understand that Dr Shillingburg popularised a very specific occlusal consideration; the ‘functional (supporting) cusp bevel'. Previously described by Gnathologist Charles Stuart as the ‘stamp cusp’. Therefore, this preparation feature had to be included in a diagram.
I had started with an architectural theme and borrowed original dental practice drawings from my boss Andrew Scott. Mainly because I have always seen fixed prosthodontics as engineering rather that an art form. I draw them that way as a learner too; Front, Left and Right Elevation and a Plan Perspective.
You can see here that this had potential (still does) to become a nice piece of artwork. I spent ages deciding how to use the architectural theme and began studying road bridges. Some of the most beautiful pieces of engineering I know are the Forth bridge crossings in Edinburgh. Today, they stand as three industrial timepieces.
Some might think I should have continued with this theme. Yet, as I delved further into the personal side of the book, i.e. the character of the author and the meaning of the book to the profession. I realised that the architectural line drawings were a little too sterile. I needed to soften them, yet kept a few reference lines in the background.
I studied structure and architectural form from other aspects, i.e. marble as opposed to steel and curves as opposed to angles. In doing so, I needed to soften my medium too – from pencil to graphite powder. The sculptures of the ‘Museo Cappella Sansevero’ in Italy are a source I use when I want to add the art to science and human to dentistry. The beauty, exquisite craftmanship, and emotion they bring were qualities that I wanted to lightly transpose across the artwork.
As such the artwork began to breathe a little, seen here on the conventional fixed-fixed bridge preparation on the right.
“The book clearly has a major emphasis on manual dexterity and manual skills which are sometimes viewed as being less important than they were – an error in my view”. I have that same view, because for all the theory in the world, it might as well stay in the textbook if you are not able to apply it with accuracy to the tooth. To symbolise this, I had chosen to add an armamentarium of dental tools to the top of the piece and continue in pencil – a rather rudimentary medium to which all that is left, is a demonstration of an ability in its use.
To make further reference to the author himself, I looked into Dr Shillingburg’s career and considered his Stephen L. Leper Award received in 2000 for teaching excellence from the Omicron Kappa Upsilon Supreme Chapter. It has quite an unusual design, inspired by Greek Mythology and commissioned by GV Black back in 1914.
I removed it, thinking it was a bit busy. In hindsight, I could have added the shape with graphite powder as a background feature. Instead, I chose to include an aspect of the book's front cover. A striking silhouette that distinguishes it from other dental textbooks. The silhouette is in fact Dr Shillingburg making refence to his home country. These are remnants of volcanoes, the natural structural landscape of the Navajo Reservation Arizona where he was born.
The book is written and presented in a “down to earth” way which makes it easier for readers to understand. “Herbert T” as he was known, spoke in the early 1980s and “he lectured in the same way, “down to earth” and straightforward”.
“As a manual for preparations for indirect restorations, it has never had a worthy challenger”. Dr Shillingburg passed away on 12th July 2015 and it is safe to say that his book will continue to be a trusted friend for the dental profession and its developing workforce for many years to come.
Graphite on paper: 47x52 cm (unframed)
So, after 36 hours producing this, I went back to the Professor for his thoughts and as ever he started with a positive “The work is a credit to you”. Yet equally he found a few little things I could improve on and as I always do, I learn and adjust my work. Dr Shillingburg was just as particular about his diagrams too, so I believe.
This current transfer of knowledge and craftsmanship highlights the durability of Shillingburg’s work. Approach fixed prosthodontics with a lax attitude and you will have lost before you have even begun. Dr Shillingburg might have set the standard, but it is up to us now to maintain it.
Throughout this project I am asking a specific question:
"What is the difference between an artist and a dentist?"
Add your answer here
The next textbook to be illustrated is:
Clinical Periodontology by M G Newman, H H Takei and F A Carranza
There is something about the microscopic unity of the periodontium that I find fascinating. If you would like to contribute to the next Blog, share your knowledge of this book and inspire the artwork - answer a few questions here