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 Implants in the
esthetic zone
A step-by-step treatment
strategy
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QUINTESSENCE PUBLISHING

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A CIP record for this book is available from the British Library.
ISBN: 978-1 ·85097·283 9

®.. QUINTESSENCE PUBLISHING

Quintessence Publishing Co. Ltd,

Grafton Road, New Malden, Surrey KT3 3AB,
United Kingdom
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Quintessen~blishing Co. Ltd

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ced, stored 1n a retrieval system, or transmitted in any form or by any
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or written permission of the publisher.
Translation: Rosana Jelaska
Editing: Quintessence Publishing Co. Ltd, London, UK
Layout and Production: Quintessenz Verlags-GmbH, Berlin, Germany

ISBN: 978-1 85097-283 9

Printed in Germany
 TABLE OF CONTENTS

1 Introduction 1 4.7 Summary 62

1 .1 Why this book? 2 References 62
1.2 Citing of references 3
1.3 Instruments used 4 5 Treatment planning principles 63
1.4 Materials used 5 5.1 General 64
References 6 5.2 Dental history 64
5.3 Clinical examination 65
2 Esthetics 7 5.4 Radiographic examination 65

I 2.1
2.2
2.3
General
Long-term results
Summary
8
12
12
5.5

5.6
Special aspects of clinical and
radiographic evaluation
Summary
68
70

I 3
References

Possible failures
12

15 6
References

Prosthetic planning/
70

3.1 Excessively long clinical crown 16 alternatives to dental implants 71

3.2 Scarring 16 6.1 General 72
3.3 Absence of papillae 18 6.2 Replacing a single missing tooth 73
3.4 Buccal tissue volume deficiency 20 6.3 Replacing two missing teeth 77
3.5 Restorative materials that cause soft 6.4 Restoring a large edentulous space 78
tissue discoloration 20 6.5 Summary 81
3.6 Summary 22 References 81
References 22
7 Prosthetic options to compensate
4 Biological principles 25 for tissue deficits 83
4.1 Introduction 26 7.1 General 84
4.2 Papilla between an implant and 7.2 Compensating for vertical defects 84
a natural tooth 28 7.3 Compensating for lack of papillae 87
4.3 Papilla between two adjacent 7.4 Compensating for horizontal defects 92

,
implants 38 7.5 Compensating for lack of lip support 94
4.4 Buccal area 42 7.6 Summary 96
4.5 Effect of the implant-abutment References lj 97
interface 56
4.6 Limits of planning 61
Table of contents Table of contents

8 Initial analysis 99 10 Implant position 187 13 Two-stage implant procedures 491 17 Temporary restoration 657
8.1 General 100 10.1 General 188 13.1 Ridge augmentation before implant 17.1 Requirements 658
8.2 Lip line 102 10.2 Bucco-oral positioning 189 placement - General 492 17.2 The ideal temporary restoration 660
8.3 Shape of the jaw 106 10.3 Axial inclination 196 13.2 Augmentation with membrane 17.3 Summary 664
8.4 Tooth shape 108 10.4 Mesiodistal positioning 200 and xenograft 492
8.5 Tooth position 111 10.5 Apicocoronal depth 206 13.3 Augmentation with an autogenous 18 Prosthetics 665
8.6 Adjacent teeth 11 5 10.6 Ideal implant positioning 212 bone block 498 18.1 General 666
8.7 Soft tissue 118 10.7 Influence of implant position on 13.4 Augmentation with an autogenous 18.2 Cemented versus screw-retained 668
8.8 Available bone 132 prosthetic options 214 bone block and membrane 500 18.3 Soft tissue management with the
8.9 Width of the edentulous space 146 10.8 Number of implants 217 13.5 Augmentation with autogenous bone implant suprastructure 674
8.10 Function 150 10.9 Application example 223 cone, xenograft, and membrane 502 18.4 Final impression of the two-part
8.11 Occlusion 150 10.10 Consequences of implant 13.6 Summary 525 suprastructure 732
8.12 Treatment planning based on malpositioning 225 References 525 18.5 Two-piece crown 740
the pretreatment evaluation 153 10.11 Surgical template 227 18.6 One-piece crown 769
8.13 Application example 154 10.12 Summary 231 14 Soft tissue grafting 527 18.7 One-piece bridge 772
8.14 Summary 158 References 231 14.1 General 528 18.8 Retainer for natural teeth 776
References 158 14.2 Surgical procedure 542 18.9 Summary 778
11 Immediate implants 233 14.3 Limits of possibility 584 References 778
9 Extraction 159 11 .1 Initial mistakes 234 14.4 Typical errors 588
9.1 General 160 11.2 Learning effects 242 14.5 Inlay graft technique 590 19 Summary:
9.2 Papilla collapse at the adjacent 11.3 Procedures to compensate for 14.6 Summary 592 Six case examples step by step 779
tooth after extraction 163 tissue loss 262 References 592 19.1 Immediate implant placement 780
9.3 Papilla preservation atthe 11.4 Temporization 290 19.2 Single-tooth implant with GBR 790
adjacenttooth 165 11.5 Summary 297 15 Stage-two implant surgery 593 19.3 Two implants with GBR 800
9.4 Buccal soft tissue support 170 References 298 15.1 With papilla-sparing incision 594 19.4 Two-stage implant procedure
9.5 Preservation of papilla between 15.2 With flap reflection 596 for single tooth replacement 808
two teeth to be extracted 170 12 Implant placement with 15.3 With scalloped incision 598 19.5 Two implants, two-stage procedure 816
9.6 Ridge preservation procedures 173 simultaneous guided bone 15.4 Limited punch technique 600 19.6 Complex case 826
9.7 No ridge preservation measures regeneration (GBR) 299 15.5 Summary 616
before implant placement 184 12.1 Biological rationale 300 References 616
9.8 Summary 186 12.2 Esthetic rationale 302
References 186 12.3 Long-term results 311 16 Stage-two surgery with
12.4 Surgical procedure 315 simultaneous soft tissue grafting 617
12.5 Failure 462 16.1 With a horizontal incision 618
12.6 Summary 470 16.2 With flap mobilization 620
References 488 16.3 Roll flap technique 622
16.4 Envelope technique (tunnel technique) 626
16.5 Inlay graft 628
16.6 Summary 656
References 656
1 INTRODUCTION
1 Introduction
--
1.1 WHY THIS BOOK?

While it has long been known that dental implants have offered dentistry wonderful treatment op-
tions, 1 and although both scientific evidence and clinical experience show that very high success rates
can be achieved with dental implants, it is not a simple undertaking to achieve optimal esthetic out-
comes when placing dental implants, even today. If the success or failure of implant therapy is consid-
ered from a purely functional point of view, then success is defined in terms of implant survival. Ac-
cording to this definition, it is relatively irrelevant whether there are one to two millimeters more or
less of bone around the implant; however, if the goal is to achieve optimal esthetics, a one-millimeter
loss of soft tissue may mean an esthetic compromise. Likewise, the local biological conditions may
prove to be a limiting factor that makes it impossible to achieve optimal esthetic results. Therefore,
ensuring good esthetics is still one of the greatest challenges in dental implant therapy.
Teeth have a very specific function in the context of the alveolar ridge and the surrounding soft tis-
sue. At sites where no teeth develop, the alveolar ridge and periodontal soft tissue will not develop to
normal dimensions. The teeth are thus the actual lead structures for hard and soft tissue develop-
ment, and the presence of teeth is a condition necessary for a harmonious appearance and esthetic
result. Loss of teeth results in a loss of the necessary structure to maintain the surrounding bone and
soft tissue, and this inevitably leads to changes in the tissue, with corresponding changes in esthetics.
For this reason, it is necessary to either prevent tissue loss or to perform tissue augmentation proced-
ures to compensate for tissue loss when implants are used to treat tooth loss in the esthetic zone. The
fact that the process of tooth extraction itself leads to tissue loss is aggravated by the reality that tooth
extraction is most commonly performed due to infection, a pathology associated with additional tissue
loss.
Dental implant surgery is a special challenge because both oral surgery and prosthodontic expertise
are needed to achieve the desired goals of treatment. Moreover, each stage of treatment has impacts
upon the subsequent stages. Such a complex, multistage treatment process can only be successful if
possibilities and limitations are identified and incorporated into the treatment plan at each stage of
treatment.
In implant therapy concepts, which were developed with the goal of achieving optimal esthetic re-
sults, undisputed factors that must be considered in every case have been identified over the course
of time. However, there are various treatment approaches that lead to the same goal. The author does
not claim that the approaches described in this book are the only ones possible. However, most of
them have proven to be effective over many years of clinical experience. For each procedure de-
scribed, details to consider when using other treatment modalities are also mentioned. In the following
chapters, the goal is not only to provide general guidelines but also to discuss numerous details. This
step-by-step approach is reflected in the subtitle of the book. In order to achieve truly optimal results
and avoid unpleasant surprises, it is crucial to follow a good general strategy, while taking countless
small details into account.
I hope this book will be a useful resource that helps to avoid failures and achieve successes that de-
light not only the patient but also the dentist.
 1.2 Citing of references

1.2 CITING OF REFERENCES

A list of references is usually provided at the end of a textbook or scientific article. The literature listed
in the reference section serves to give readers the opportunity to deepen their knowledge of the sub-
ject matter of the article or book by reading the scientific literature. Literature references are also an
important way to give credit to the experts who first described something or made an important scien-
tific contribution. However, literature references are rarely selected in an objective manner. In addition
to citing important research results, the articles cited in the literature list are very often mainly those
that provide scientific evidence in support of the concepts the author is putting forward. As you would
expect, supporting evidence for any concept you can imagine can be found in the literature. This high-
ly subjective method of literature selection may suggest to the reader that the text published by an
author is not the author's own personal opinion but a consensus that has been arrived at with other
authors/colleagues who have drawn similar conclusions. When citing the literature, authors often de-
liberately fail to mention articles with contradictory results or conclusions, even if such articles are of a
high scientific standard or describe valid evidence.
Different types of studies are assigned different levels when it comes to the value of the scientific
evidence presented. A case report, for example, is assigned a much lower level than a randomized
double-blind study. However, those in clinical practice may not quite agree. Case studies, which de-
scribe nothing more than the clinical experience of the author - who is usually a skilled clinician - are
often extremely valuable. 2 Conversely, many articles that are assigned high levels in terms of their evi-
dence are indeed subject to criticism. Double-blind studies, for example, are designed to eliminate
selection bias (case selection), yet double-blinding can be quite problematic once one starts perform-
ing studies in patients. For the experienced clinician, case selection is probably the most important
factor when deciding which method is appropriate or inappropriate for successful treatment. If case
selection is not carried out - in spite of the fact that the experienced clinician usually already knows
that a certain method will most likely yield better results in a specific case, or that a certain method
would be more beneficial in another case - it can only be regarded as ethically questionable when
studies that deliberately eliminate patient selection are still performed. A lack of experience is no ex-
cuse when it comes to the selection of the best method for the individual patient case.
On a deeper reading of the dental literature, it is amazing to discover how many scientific papers that
supposedly have a high level of scientific evidence have been accepted by an ethics committee. Per-
forming such randomized double-blind studies on patients is only justifiable when comparing two
methods or materials in cases where even the experienced clinician must admit that both have the
same odds of success in all patients (independent of patient selection), and that the study is only in-
tended to identify any potential differences between the two.
Literature reviews (systematic reviews) have been published in steadily increasing numbers in recent
years. This is a method offiltering the literature on a particular topic using inclusion and exclusion criteria
so that in the end only a few appropriate articles remain. In theory, it makes sense that only high-quality
scientific work is included in the study. In practice, however, it is possible to greatly influence the outcome
through the use of inclusion and exclusion criteria. The initial mass of available studies is further reduced

3
 -
1 Introduction

based on the contents of the summary (abstract) alone and, in the end, only a few studies remai n in the
final selection of articles that are actually read and discussed in detail. Finally, systematic reviews are of-
ten written by less experienced dentists (for continuing education and training purposes). 3.4
Besides the issues related to the definition of inclusion and exclusion criteria and the resulting influ-
ence on the results, another point of criticism is that a study can rarely be fully appreciated based on
the abstract. As there are hardly any studies that are not funded by the industry, particularly in implan-
tology,5,6 the results often have to be published in ways that reflect the interests of the industry. Con-
sequently, one will often not find any really interesting or relevant results in the abstracts. Instead, they
often contain conclusions that prove to be questionable on closer scrutiny and when one performs an
in-depth analysis of the text, results, and numbers. Anothe r facto r to consider is that associates in clin-
ical practice rarely read systematic reviews in detail. These articles often serve to help find appropriate
secondary literature when writing articles.
Meta-analyses are somewhat more useful. Although the inclusion and exclusion criteria have a deci-
sive potential for bias, meta-analyses attempt to aggregate and scientifically analyze very large volumes
of data from various studies. Unfortunately, meta-analyses on the really interesting research problems
are rarely available because high-quality studies on such topics are lacking.
Due to these very critical but probably rea listic reflections regarding the issues relating to the selec-
tion of references cited in the literature (including lectures, articles, or textbooks), this book wi ll d is-
pense with citing countless literature references. Instead, only a small list of relevant scientific literature
is provided at the end of each chapter. The references are, of cou rse, selected according to the au-
thor's subjective opinion. In many cases, the aim of inclusion was to give credit to authors who first
published very interesting work, or to those who succeeded in publishing very useful summaries for
their colleagues in clinical practice. The author recognizes this selection bias and makes no cla im to
objectivity. The number of authors per article has steadily increased in the dental literature in recent
years.7 Against this rather unscientific trend, in this book, if there are more than five authors of a given
article, only the name of the first author plus "et al" is included in the citation. The rationale behind this
is that, unfortunately, most of the countless additional authors often have nothing to do with the actu-
al research. Many researchers mention colleagues as coauthors in order for those colleagues to obtain
as many published articles on their resumes as possible.

1.3 INSTRUMENTS USED

The author deliberately avoids giving a detailed description of the instruments used in the procedures
described in this book. In the cases presented here, surgery was usually performed using convention-
al instruments. Microsurgical instruments were rarely used because, in the author's opinion, they have
no visible benefits. Although we dentists tend to have preferences for certain instruments and often
talk about them, it makes little sense to give general advice on instrument selection. In clinical practice,
dentists must find out for themselves which scalpel or needle holder works best for them. However,
the goal is always the same: To select an instrument that allows for fast yet very precise work. It is not
necessarily a good idea to use extremely fine instruments that slow down the workflow if one can
 1.4 Materials used

achieve exactly the same precision with conventional instruments. Furthermore, experience has shown
that it is usually not advantageous to perform the surgical procedures described here under a micro-
scope in clinical practice because the field of view of a microscope is too small for these applications.
The use of a loupe (4X to 6X magnification) has proven to be an ideal solution. Due to the fact that the
dentist can observe the patient's movements while wearing the loupe, unnecessary workfiow interrup-
tions that increase the working time are avoided.

1.4 MATERIALS USED

The proprietary names of the materials used are not mentioned throughout the book. Especially in the
case of dental implants, there is a wide range of products that produce optimal results.
In the early years, the choice of implant had historical significance, but nowadays, implant selection
is driven primarily by the available suprastructure options. Therefore, the implant system should be
selected primarily by the prosthodontic dentist and not the surgeon. Today, the biggest differences
between the various implant systems relate to the connection between the implant and the supra-
structure, and to the available materials and parts for the implant-abutment connection. Titanium
implants from the following manufacturers were used in the cases presented in this book: Biomet 3i,
Nobel Biocare, and Thommen Medical.
The non-resorbable membrane most commonly used for ridge augmentation procedures was the
Gore-Tex expanded polytetrafluoroethylene (ePTFE) membrane, which is no longer available on the
market. In more recent cases, Cytoplast (Osteogenics), a dense polytetrafluoroethylene (PTFE) mem-
brane, was used as an alternative, following exactly the same principle as for the ePTFE membrane.
OsseoGuard (Biomet 3i) is the cross-linked collagen membrane used today. Bio-Gide (Geistlich Phar-
ma) was the most commonly used pure collagen membrane. Bio-Oss (Geistlich Pharma) was often
used as the bone filler material for alveolar ridge augmentation; this bovine xenograft material was
generally employed as a ready-to-use mixture in combination with Bio-Oss Collagen (Geistlich Phar-
ma), a porcine collagen product. Various other collagen membranes and bovine xenograft products
were occasionally used.
Regarding suture materials, Gore-Tex 50, 60, and 70 monofilament sutures manufactured from PTFE
were most commonly used. In addition, Seralene 7-0 (American Dental System) monofilament polyvi-
nylidene fluoride sutures were used for the adaptation of wound edges. As regards postoperative
medications, our patients were given mefenamic acid * 1 (Ponstan, Pfizer) for pain, and chlorhexidine
rinse (Plak-Out, KerrHawe) to control postoperative inflammation. All ridge augmentation patients re-
ceived antibiotic prophylaxis with Clamoxyl (GlaxoSmithKline) or, in more recent cases, other amoxicil-
lin products.
Regarding innovations, the same rule applies to materials as to surgical techniques, which is that it
only makes sense to switch to new products (which are constantly being introduced onto the market)

*1 Drug approved in many countries around the world, but not in Germany.

c:;
1 Introduction

if they rea lly make it possible to accomplish something that was not possible with the products used
so far. Bearing this in mind, most new products are of no consequence because they usually only offer
that which is already on the market in another form, and their so-called advant ages over existing prod-
ucts, according to the claims of the manufacturers, do not pan out in cl inical practice.

REFERENCES
1. Branemark Pl, et al. Intra osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.
2. Fitzpatrick B. Evidence-based dentistry - it subdivided: accepted truths, once divided, may lack va lidity. Int J Prosthodont 2008;21:
358 363.
3. Creugers NH, Kreulen CM. Systematic review of 10 years of systematic reviews in prosthodontics. Int J Prosthodont 2003;16:123-127.
4. Lang LA, Teich ST. A critical appraisal of the systematic review process: systematic reviews of zirconia single crowns. J Prosthet Dent
2014;111 :476- 484.
5. Koka S. Conflict of interest: the Achilles heel of evidence-based dentistry. lntJ Prosthodont 2008;21 364 368.
6. Barao VA. et al. Trends in funding, internationalization, and types of study for original articles published 1n five implant-related Journals
between 2005 and 2006. Int J Oral Maxillofac Implants 2012;27:69 76.
7. Yuan JC. Lee DJ, Knoernschild KL, Campbell SD. Sukotjo C. Authorship characteristics in prosthodontic literature: proliferation and inter-
nationalization. A review and analysis following a 10-year observation. J Prosthet Dent 2010;104·158-164.
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 Introduction

if they really make it possible to accomplish something that was not possible with the products used
so far. Bearing this in mind, most new products are of no consequence because they usually only offer
that which is already on the market in another form, and their so-called advantages over existing prod- 2 ESTHETICS
ucts, according to the claims of the manufacturers, do not pan out in clinical practice.

REF ERENCES
1. Branemark Pl, et al. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.
2. Fitzpatrick B. Evidence-based dentistry - it subdivided: accepted truths, once divided, may lack validity. Int J Prosthodont 2008;21:
358-363.
3. Creugers NH, Kreulen CM. Systematic review of 10 years of systematic reviews in prosthodontics. Int J Prosthodont 2003;16:123-127.
4. Lang LA, Teich ST. A critical appraisal of the systematic review process: systematic reviews of zirconia single crowns. J Prosthet Dent
2014;111 :476-484.
S. Koka S. Conflict of interest: the Achilles heel of evidence-based dentistry. Int J Prosthodont 2008;21 :364-368.
6. Sarao VA, et al. Trends in funding, internationalization, and types of study for original articles published in five implant-related journals
between 2005 and 2006. lntJ Oral Maxillofac Implants 2012;27:69-76.
7. Yuan JC, Lee DJ, Knoernschild KL, Campbell SD, Sukotjo C. Authorship characteristics in prosthodontic literature: proliferation and inter-
nationalization. A review and analysis following a 10-year observation. J Prosthet Dent 2010;104:158-164.

;'
2 Esthetics 2.1 General

2.1 GENERAL ~
2.1
The term "esthetic" is often overused. In dentistry, countless books and numerous guidelines have
been published on this top ic.
In the context of implant therapy, it soon becomes clear that the key to optimal esthetics is a harmo-
nious soft tissue profile (assuming an otherwise healthy clinical situation). Harmony is that which is
..
beautiful and esthetically pleasing to the eye of the beholder. It is not possible to achieve the absolute-
ly essential harmony in tooth shape without a harmonious soft tissue profile. Tissue quality and clinical •
•
crown quality are also critical factors because they are ultimately visible. Therefore, the main focus of 2.1a Irregular glngiva margin before extraction of tooth 21 . 2.1 b Good fi nal result thanks to gingival co rrection.
the dentist's work is to establish soft tissue harmony. If this condition is not met, it will be impossible
for the dental technician to fabricate a crown that fits in harmoniously with the surrounding gums and Fig
teeth. A tissue deficit can be very difficult or impossible to correct after the completion of treatment, 2.2
especially in the case of implant therapy. If certain treatment procedures are not performed in a mean-
ingful sequence, it is difficult to achieve the desired result predictably or with high probability.
As described in the introduction section, the tissue deficits encountered in dental implantology gen-
erally occur as a result of tooth loss. Therefore, the restoration of bone and soft tissue volume is a key
element of dental implant therapy (Fig 2.1).

2.2.1 What does "esthetic" mean? 2.2a Missing teeth in the maxillary right quadrant of a heavy 2.2b Nature-inspired implant-supported bridge.
smoker.
The term "esthetic," as used in dentistry, means nothing more than "inspired by nature," provided that
nature has created something that suits the person in question. Only that which suits the patient and Fig
his or her individual appearance and character is esthetic and harmonious. By this definition, a tooth 2.3
replacement for a patient who smokes 80 cigarettes a day must be designed differently from one for a
patient with beautiful white teeth without any caries. A dental prosthesis that reflects the character and
habits of an older smoker can by all means be viewed as an optimal esthetic result (Fig 2.2).
When inserted, the tooth replacement should fit in harmoniously with the natural teeth of the re-
maining dentition . It is usually harder to achieve this goal when replacing a single tooth than multiple
teeth because of the direct comparison with the immediately adjacent natural teeth (Fig 2.3).
If there is a large edentulous space, a harmonious result can still be achieved, for example, if exten- 2.3a Tooth 21 has to be extracted. 2.3b Implant-supported crown 21 matches natural crown 11.

sive papillae loss is present but is symmetrically distributed on both sides (Fig 2.4).

Fig
2.4

2.4a Large edentulous space after ridge augmentation and place 2.4b Harmonious final result although papillae are hardly present.
ment of two mp/ants.
2 Esthetics 2.1 General

It becomes clear relatively quickly that dental treatments have their limits, especially from the esthet- Fig
ic perspective. Tissue around natural teeth that is lost, for example, due to attachment loss (which of- 2.5
ten occurs as a complication of inflammatory periodontal disease) cannot be regenerated in most
cases. In some cases, this may be accepted as an ind ividual characteristic of the patient. On the other
hand, many patients with long teeth and missing papi llae, which appear as "black triangles," do not find
this attractive. However (as was already mentioned above but is often forgotten in clinical practice), not
all problems can be treated, and not all patient wishes fulfilled or, if they can, then only by means that
might not meet the patient's a priori approval.
Periodontal attachment loss is a classic example, where the loss of attachment results in the appear- 2.Sa and b Status after per odontal therapy.

ance of long clinical crowns and, in some cases, the missing papillae. A removable gingival mask can
satisfy the desire of some patients for optimal esthetics in these cases. However, the patient must be
willing to accept the disadvantage that the restoration will have a removable part (Fig 2.5).
Although the esthetic appearance of a restoration is not judged by objective criteria alone because
patient preferences and perceptions of esthetics vary, there are certain esthetic guidelines that have
to be followed that imitate that which nature produces when it creates a harmonious dental appear-
ance. Scharer et al 1 published anesthetic checklist for fixed prostheses in 1980. Although the origina l
version has frequently been copied and modified since then, it is still valid today (Fig 2.6). These esthet-
ic guidelines for restorative dentistry provide rules for ensuring that the soft tissue and clinical crowns
are in harmony with the restoration. Without going into detail, it is sufficient to say that these criteria 2.Sc Flexible, removable gingival mask.

are well known. Even in patients with unsightly presenting conditions, a very harmonious final result
can be achieved by following these guidelines. With this approach, it quickly becomes evident that cre-
ating a harmonious soft tissue profile ("pink esthetics") is the primary key to success, followed by the
restoration with harmonious tooth shape.

2.Sd and e Good esthetic result with the gingival epithesis in place.

__L_ Midline (axis of symmetry) - Tooth shape Fig

2.6
- Tooth axis - lncisal edge

- Gingival margin - lnterincisal angle

-+- Gingival zenith - Furrows and grooves

- Trigone - Smile line (lrer lip line)

- lnterproximal contact point lnc,sal edges

2.6 Modified esthet1c scheme of Scharer et al.

2 Esthetics References

2.2 LONG-TERM RESULTS Fig

2.7
The true success or failure of a treatment can only be determined after several years. From the pa -
tient's perspective, the long-term results are just as important as the immediate results achieved at the
end of active treatment. An optima l esthetic outcome should remain intact for many years .
In the early years of implant therapy, knowledge about the requirements needed for primary success
was lacking. A lot about the rate of osseointegration of dental implants was already known in the
1980s. Information on long-term survival rates and risk factors for implant failure was available. In con-
trast, no real data on the esthetic aspects of implant dentistry was available until the late 1980s to 2.7a and b Implant-supported restoration of the maxillary central Inc sors completed in 1987.
early 1990s. There was a lot of luck involved in many cases that are classified as a success after more
than 25 years of follow-up (Fig 2.7). Much of the knowledge and experience that we have today was
lacking during the period of active treatment back then.
As always in life, learning from failure is the fastest way to learn, assuming that a critical analysis of
the results takes place. Over time, it became clear that non-gentle tooth extraction could result in soft
tissue loss. Experience showed which types of incisions should not be used, what consequences im-
proper implant placement could have, and which tissue augmentation technique did not produce the
desired results. With time, it also became evident which materials failed to achieve the desired results,
and what could go wrong when designing and manufacturing the suprastructure, in terms of tech-
nique as well as choice of materials. 2.7c and d 10-year result.

It is also important to remember that changes occur in the patient's mouth over the course of time
that are not necessarily pathological in nature. Two examples are the change in tooth color, and the
natural soft tissue recession that occurs even around healthy teeth (Fig 2.8). Nowadays, these predict-
able changes can be taken into account to a certain degree.

2.3 SUMMARY
If the dentist pursues the goal of creating dental restorations inspired by nature, then a pleasing es-
thetic outcome will usually be achieved. Ultimately, the widely published guidelines for optimal dental
esthetics are merely the result of careful smile analysis using images of healthy natural teeth that we 2.7e and f 20-year result.

subjectively like or consider to be attractive. However, conditions vary from one individual to another.
Therefore, these idealized notions must be adapted to the individual situation so as to produce an
image that suits the patient - in other words, an optimal esthetic result.

REFERENCES
1. Scharer P, Rinn LA, Kopp FR. Asthetische Richtlinien fur die rekonstruktive Zahnheilkunde. Berlin: Quintessenz, 1980.

2.7g and h Good long-term result after 25 years.

 2 Esthetics

Fig
2.8
3 POSSIBLE FAILURES

2.8a and b Implant supported restorat on of the maxil ary central incisors completed in 1995.

2.8c and d Tissue loss around the mplants and natural teeth after 5 years.

2.Se and f 10-year result.

2.8g and h 15-year result.

 2 Esthetics

Fig
2.8
3 POSSIBLE FAILURES

2.8a and b Implant-supported restoration of the maxillary central incisors completed in 1995.

2.8c and d Tissue loss around the implants and natural teeth after 5 years.

2.Se and f 10-year result.

3 Possible failures 3.2 Scarring

Fuhrhauser et al 1 were the first to publish a scoring system for "pink esthetics." If the presenting clinic- Fig
al conditions are extremely adverse, failure can be unavoidable in some cases. When replacing teeth 3.1
with implant-supported reconstructions, an important goal is to achieve a harmonious soft tissue pro-
file with beautiful pink esthetics.

3.1 EXCESSIVELY LONG CLINICAL CROWN

The first possible complication that comes to mind is excessive clinical crown length. Crown length is
defined as the distance from the incisal edge (smile line) to the most concave part of the gingival mar- 3.1a and b An irregular gingival margin resulted in excessively long clinical crown length of tooth 21.

gin, which defines the apical end of the clinical crown. If a certain amount of soft tissue deficit is present
in the apicocoronal direction, the clinical crown will appear too long, if the position of the incisal edge Fig
is correct. The fact that this does not necessarily cause excessive disharmony in every case is demon- 3.2
strated by the case of a patient who needed to have a natural tooth crowned (Fig 3.1 ). As can be seen
in the photographs, although the entire maxillary anterior segment was not ideal, the overall appear-
ance of the anterior teeth is not inharmonious.
Excessively long clinical crown length is a common failure of dental implant therapy. In most cases,
the surgical error leading to this compromise can be readily identified: improper implant positioning or
inadequate treatment planning with or without sufficient soft tissue augmentation (Fig 3.2).
3.2a and b Failure occu rred due to a vertical soft tissue deficit around the implant crown.

3.2 SCARRING
Fig
If scarring suddenly appears after treatment in an area where there was no scar tissue before treat- 3.3
ment, then it can be assumed that a surgical error was made. Certain surgical techniques can leave
scars in visible places - not in every case, but often (Fig 3.3). Needless to say, these surgical procedures
must be modified accordingly when used in the esthetic zone. Conversely, visible scars are sometimes
already present before surgery. Appropriate measures to eliminate these scars (if possible) should be
incorporated into the treatment plan for such patients.

3.3a The gingival margin was relatively harmonious before the 3.3b Unfavorable incision placement when inserting the implant.
extraction of tooth 11 .
3 Possible failures 3.3 Absence of papillae

3.3 ABSENCE OF PAPILLAE Fig

3.4
The loss of attachment between two natural teeth (which usually occurs due to inflammation) results
in the loss of soft t issue support and of perfect papillae esthetics. As the predictable regeneration of
the papil la between two adjacent teeth is hardly possible by therapeutic means, prosthetic correction
is just about the only option. This is done by reshaping the two adjacent teeth so as to move the con-
tact point between them to a more apical position and thus close the open embrasure or "black trian-
gle." The result, however, is an altered tooth shape that no longer fits in harmoniously with its sur-
roundings. The practice of changing a triangular tooth shape into a square tooth shape to compensate 3.4a Missing papilla between the central and latera l incisor. 3.4b Partial interdental space cl osure achieved at the expense of
ideal crown shape (tooth 12).
for the absence of a papilla is a classic example. The square tooth shape is the trade-off for the de-
creased size of the black triangle (Fig 3.4). Fig
Similar rules apply to implants. In some cases, soft tissue loss in the interproximal region may make 3.5
it impossible to restore the papillae at the implant site. In other cases, interproximal soft tissue is pres-
ent initially but destroyed in the course of surgery, resulting in an iatrogenic compromise (Fig 3.5). The
data is clear regarding the factors that must be considered in dental implant surgery to preserve exist-
ing papillae or restore missing papillae to some degree. A papilla missing from an otherwise harmoni-
ous soft tissue profile in which all other papillae are present can have a very disruptive effect. There-
fore, this is an important factor that must be given due consideration.
Experience has shown that, from a biological perspective, a papilla between an implant and an adja- 3.Sa and b Treatment failure due to soft tissue deficiencies, especially in the papillary region.

cent tooth must be treated differently from a papilla between two adjacent implants. Preservation or
reconstruction of the papilla between two adjacent implants is possible but extremely difficult, and a Fig
poor surgical technique will result in immediate failure (Fig 3.6). 3.6

3.6a Preoperative view of a site with three missing teeth. 3.6b Three implants placed very cl ose together.
3 Possible failures 3.5 Restorative materials that cau se soft t issue discoloration

3.4 BUCCAL TISSUE VOLUME DEFICIENCY Fig

3.7
A tissue vo lume deficiency on the buccal side results in the development of a concavity relative to the
adjacent tissue levels. The presence of such a concavity always means one thing: shadowing! Shadow-
ing results in dark discoloration and, in many cases, esthetic compromise. This is already known from
traditiona l crown and bridge work: If, at the pantie site, there is adequate tissue in the vertical dimen-
sion but not on the buccal side, the deficiency cannot be corrected by prosthetic means, and the dark
discoloration and shadowing described above occur (Fig 3.7).
Obviously, the same phenomenon must be taken into account in implant therapy. Again, the pres- 3.7a and b Shadowing on this bridge restoration in the left maxilla due to a buccal concavity of the alveolar ridge.
ence of adequate tissue in the vertical dimension alone will not suffice to prevent shadowing. Sufficient
tissue must also be present on the buccal side, and the tissue volume must harmonize with that of the Fig
adjacent teeth. Otherwise, the result may look great from the intraoral frontal view, but from the extra- 3.8
oral smile view, a patient with a high smile line exposes the volume deficit and reveals the esthetic
compromise (Fig 3.8). The implications for practice are that measures must be undertaken to prevent
buccal tissue resorption, or an appropriate surgical tissue augmentation procedure must be per-
formed.

3.5 RESTORATIVE MATERIALS THAT CAUSE SOFT TISSUE

3.8a and b Failure due to shadowing resulting from a buccal soft tissue deficit around implant crown 22.
DISCOLORATION

In traditional crown and bridge work, it is a well-known fact that dark tooth roots and metal frameworks Fig
supporting crowns can cause soft tissue discoloration. These mostly dark areas have a very negative 3.9

esthetic effect. In conventional prosthodontics we have learnt that the effects of discolored roots,
which are intensified by the crown, can be significantly reduced simply by replacing the restoration with
a metal-free reconstruction (Fig 3.9).
The same applies in implant therapy. In patients with certa in soft tissue types, the insertion of gray
metallic structures in the submucosa can result in unsightly discoloration (Fig 3.10). Again, there are
ways and means available to replace these metal structures with all-ceramic restorations in order to
minimize the problem. 3.9a The effects of soft tissue discoloration are amplified by the 3.9b The appearance improves after switching to an all -ceramic
meta l parts of the crown. crown.

Fig
3.1
3 Possible failures References

3.6 SUMMARY Fig

3.1
When replacing teeth with implant-supported restorations, it is important to use a surgical procedure
that will not destroy the available soft tissue. Failure analysis of one's own cases is a quick way to learn
which guidel ines must be followed in order to prevent such failures in the future. Many key points that
help to prevent tissue destruction from occurring as a consequence of implant therapy are discussed
in the following chapters. Conversely, the limits of modern dental implantology are also discussed.
It does not necessarily take an accident or pathological event to produce tissue conditions that do
not meet the standards for esthetic success. Sometimes, the available tissue provided by nature simply 3.11 a Preoperative view of site with multiple congenitally missing 3.11 b to d Final result with quantitative and qualitative improve-
teeth, some with bone deficiencies and thin soft tissue. ment of tissue conditions.
does not permit an optimal solution. In these cases, as always, the goal of treatment is to make a pos-
itive change in the tissues affected. Congenitally missing teeth, for example, are often associated with
the presence of bone deficiencies and thin soft tissue. Therefore, sufficient bone and soft tissue vol-
ume have to be created. In other words, we have to change the bone and tissue conditions determined
by nature in order to be able to achieve an optimal result. Furthermore, our therapeutic efforts are
only a success if the optimal esthetics achieved by implant therapy can be maintained over the long
term (Fig 3.11). Studies on the long-term stability of esthetic outcomes are scarce, 2•3 but there is an
abundance of clinical experience, albeit not positive in every case.
The choice of treatment procedures is a decisive factor that determines whether the goal of achiev-
ing a harmonious esthetic outcome can also be maintained over the long term. 3.11c 3.11 d

REFERENCES
1. Furhauser R, et al. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res
2005;16:639- 644.
2. Buser D, et al. Long-term stability of contour augmentation with early implant placement fol lowing single tooth extraction in the esthetic
zone: a prospective, cross -sectional study in 41 patients with a 5- to 9 year fol low up. J Periodontal 2013;84:1517- 1527.
3. Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla a systematic review. Int
J Oral Maxillofac Implants 2014;29:186- 215.

3.11 e and f 10-year result.

S=1ldlJNlc1d lVJl:)07018 17
 1 Biological principles

4.1 INTRODUCTION

4.1.1 General
The dental restorative possibilities and procedures for both natural teeth and dental implants ar-e
largely determined by biological principles. When restoring natural teeth, the main structures o• Tter
est are the teeth themselves, the periodontium between them, the bone, and the soft tissue. r 1rr
plants, only the periodontium is absent, so the structures to consider are the implant, the bone and
the soft tissue.
In final, result-driven dental implant planning, the goal is to establish and maintain an optima sc rt
tissue position over the long term. However, the thickness of this soft tissue cannot be augmer ted
arbitrarily. A substantial increase in soft tissue thickness can be achieved by surgical means, t ut rre
augmented tissue is resorbed relatively quickly and returns to a more or less naturally predeterm ned
level. The amount of available bone is an important indicator of the level at which the soft t '=> :: .JP w I,
become established. This bone level along a natural tooth corresponds to the height of bory cit�cldl
ment (attachment level).

4.1.2 Soft tissue complex around natural teeth

The dentogingival complex of soft tissue surrounding teeth of the natural dentition cons Ist ., cfI 1rIP
gingival sulcus, the junctional epithelium, and the gingival connective tissue. The Junctional epi•rIP I1 ,ITI
forms the epithelial attachment of a tooth via hemidesmosomes. The periodontal fiber apparatLb L Jm
prises an alveolar region as well as a supra-alveolar region in the gingival connective tissue r r" ,E'
periodontal fibers insert into the cementum. The blood supply to the soft tissue surrounding a touth ::i
provided by periodontal, alveolar, and subperiosteal blood vessels. The supra-alveolar soft tIs c ,H Lorn
plex has a relatively constant thickness of about 3 mm in the buccal region, and a th1ckne ,s o• •. rrI rrI
in the interdcntal area.'-2
Especially in the interproximal area, the soft tissue automatically adjusts to the pat1en :.,pee ill 1 1 r
acteristic thickness. If the soft tissue in the interdental area is thinned or removed, 1t Is on y a 1-riJttrr of
time before it returns to the naturally predetermined thickness. A study by Van der Velde1 ( l82) 1

showed that following denudation of the interdental soft tissues (papillae), the typica1 averagE' IJT t ., I -
sue thickness at interproximal sites (4.5 mm) is restored within 3 years (Fig 4.1 ).
As described by Tarn ow et al4 in 1992, the logical implication of this finding is that, when tl'e cl I:;,• l"c,
from the contact point to the interproximal bone height between two neighboring teetr is rJ rr rT >r
less, a papilla is almost always present. If the distance from the contact point to the bone c..i-est 1 - l.'
, -ea
er, the odds of generating enough tissue to fill the approximal space decrease s1gn1f1caritly RoJ ccv
erage surgery can achieve therapeutic improvement of reduced attachment level at buccaI., tm At I

interproximal sites, however, the success of such procedures is still unpredictable. Thus, t e tt c1,
ment level in the interproximal region mainly determines the visible papillae height (F g L 2).

26
 41 lntroduct or

Fig
4.1

4.1 b Radiographic view of intact attachment level

4.1d Intact papillae 3 years after final restoration (new crowns).

Fig
4.2

4.2b Radiograph showing s,gnificant loss of attachment

4.2c Healllly c,nft tis5ue with massive gingival recession after 4.2d Hardly any papillae are present 3 years after final restoration
p J ir G Ir �':y (new crowns and bridges).

27
4 Biological principles

4.1.3 Soft tissue complex around implants

The peri-implant soft tissue complex also consists of a sulcus, junctional epithelium, and peri-implant
connective tissue. The junctional epithelium also forms the epithelial attachment of an implant via
hemidesmosomes.
The fiber apparatus of the peri-implant connective tissue is oriented parallel to the implant or abut
ment surface. It contains a larger proportion of collagen fibers but fewer fibroblasts than the period on
tal connective tissue.5 The blood supply to the peri-implant soft tissue is provided by alveolar and
subperiosteal blood vessels, whereas the periodontal vessels are naturally missing.5 Consequently,
peri-implant soft tissue is structurally similar to scar tissue and is supplied by fewer blood vessels than
the soft tissue around the natural teeth, so blood circulation is reduced.
The peri-implant soft tissue complex has a relatively constant thickness of about 3 mm on the buccal
aspect, comparable to that of the natural dentition, and is slightly thicker (3.5 mm) between adJacent
implants.6 The thickness of the peri-implant soft tissue also reestablishes itself at a naturally predeter
mined level. If peri-implant soft tissue is thinned or removed, it is only a matter of time before the
natural level of thickness is restored, though at the expense of some bone loss.7

4.2 PAPILLA BETWEEN AN IMPLANT AND A NATURAL TOOTH

4.2.1 General
When evaluating interproximal sites, it is important to distinguish whether the interproximal site c., r
cated between a tooth and an implant or between two implants.
Between a natural tooth and an implant (as between two adjacent teeth), the attachment level at the
natural tooth is primarily responsible for papilla support.8 The most coronal interproximal point o'"
bone-to-implant contact, on the other hand, does not play a role. The clinical implication 1s that, when
calculating the level of attachment from the natural tooth to the tip of the papilla, about 4.5 mm of soft
tissue thickness can still be expected (Fig 4.3). Positively speaking, this means that even 1f the first bom
to-implant contact is significantly more apical, a satisfactory papilla will be present as long as the .:it
tachment of the natural teeth is preserved (Fig 4.4).
 4.2 Papilla between an implant and a natural toot'l

Fig
4.3

4.3b Optimal bony attachment Pnsur < the presence of 1 parn1 -i

despite circumferential bone , « (, ,atu r5) around the irT � I, r

\
I
I
I

\___
4.3c l[ J ThF- " t t LIE' , .. ' IE'SS between
• u 1 n,nJrd, r c.,th 1:, m iverage Jt 1 , mm from the
0ut' c, the up ·::ii the 1rte 1 Jf rtal papilla.
4.3d The circumferential bone oss around the 1mp1ant that ,
monly occurs has a horrzontal componer t of about 1 .5 mrr
Fig
4.4

4.4a and b If he -m ichr1ent level 1s ideal on the mesral surface and slightly reduced on the distal surface, the papilla height wil kew1:,.
be 1de1I 011 the rne,ral ,urf,iuc and slightly r,•du, ed on the distal one.

4.4c and d 15-year result: The attachment level around the natural teeth did not change, so the papilla height also remains unchanged.

29
 4 B 01ogical principles

4.2.2 Attachment loss around a tooth

Clinical attachment loss around a tooth adjacent to an implant limits the therapeutically achievable
papilla height because predictable regeneration of bone and periodontal tissues is not possible at
such sites. Buccal regeneration of bone in the edentulous area (around the implant) is always possible,
but this is irrelevant to papilla development. Soft tissue graft procedures can achieve significant vol
ume gain in interproximal areas but, as explained before, the soft tissue levels will shrink back to the
naturally predetermined level of an average of 4.5 mm, regardless of how much tissue thickness was
established by surgical means. It is the absence of bone/periodontal tissue around the natural tooth
that is responsible for reduced interdental papilla height (Fig 4.5).

Fig
4.5

4.Sa Reduced papilla height mesial of tooth 22 before treatment. 4.Sb Radiographic view of the bony atta, r rlF r , tr t ,
teeth.

4.Sc Reduced bony attachment of tooth 22. 4.Sd Regenerat1or o• lost attachment , ft ,cth ', 1 r ,

30
 4.2 Papilla between an imp ant and a natural tootr

Fig
4.5

4.Sf Reduced bony attachment on the mes1al of tooth 22 pPr' .n

despite bone augmentation

•,;f • rr pr·,•.;ement of the soft ts<ue conditions 6 weeks postoperatively, even mes1al of tooth 22

4.Sk and I yE dr postoperatively, the papilla height is the same as before treatment.

31
 4 Biological principles

4.2.3 Possible solutions for attachment loss around a tooth

There are basically two options for treating reduced periodontal attachment in the interproximal area
between an implant and an adjacent tooth in patients who find papillae loss unacceptable. The fire,• 1s
to extract the tooth in order to create the conditions needed for bone generation between two m
plants or, if only one implant is used to replace two missing teeth, between the implant and the pom1c.
The second option is to attempt forced eruption (extrusion) of the natural tooth with the aim of mov
ing the tooth coronally together with the periodontium.9 If successful, the soft tissue support is raised
to a more favorable level, and papilla regeneration can occur between the implant and the adJacent
tooth that can be maintained even over the long term, provided that the periodontal attachmer t levE.'
is preserved. Forced eruption can be performed before implant placement or at a later· date. Perform
ing extrusion of the tooth before insertion of the adjacent implant creates better conditions for ridge
augmentation, which is best performed simultaneously with implant placement in some cases: If the
adjacent tooth has a more coronal attachment level, then a guided bone regeneration (GBR) mE rr
brane can be supported rnure coronally, thus allowing for more coronal ridge augmentation
From a purely technical point of view, it is easier to perform extrusion after implantation and buccal
alveolar ridge augmentation, if necessary, and after soft tissue augmentation and provis1onalizat11ir'.
The main advantages are that this approach makes it possible to judge the results of extrusion imme
diately, and that the implant can serve as a stable anchor for orthodontic treatment (Fig 4.6).

32
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 From this thought I somehow got back to my previous ones, and the
longer I lay wakeful the more pronouncedly stern did they become. I am as
loyal and loving a son of the Fatherland as it will ever in all human
probability beget, but what son after a proper period of probation does not
like the ring on the finger, the finer raiment, the paternal embrace, and the
invitation to dinner? In other words (and quitting parable), what son after
having served his time among such husks as majors does not like promotion
to the fatted calves of colonels? For some time past I have been expecting it
every day, and if it is not soon granted it is possible that my patience may be
so changed to anger that I shall refuse to remain at my post and shall send in
my resignation; though I must say I should like a hit at the English first.
Once embarked on these reflections I could not again close my eyes, and
lay awake for the remaining hours of the night with as great a din going on
as ever I heard in my life. I have described this—the effect of heavy rain
when you are in a caravan—in that portion of the narrative dealing with the
night on Grip’s Common, so need only repeat that it resembles nothing so
much as a sharp pelting with unusually hard stones. Edelgard, if she did
indeed sleep, must be of an almost terrifying toughness, for the roof on
which this pelting was going on was but a few inches from her head.
As the cold dawn crept in between the folds of our window-curtains and
the noise had in no way abated, I began very seriously to wonder how I
could possibly get up and go out and eat breakfast under such conditions.
There was my mackintosh, and I also had galoshes, but I could not appear
before Frau von Eckthum in the sponge bag, and yet that was the only
sensible covering for my head. But what after all could galoshes avail in
such a flood? The stubble field, I felt, could be nothing by then but a lake; no
fire could live in it; no stove but would be swamped. Were it not better, if
such was to be the weather, to return to London, take rooms in some water-
tight boarding-house, and frequent the dryness of museums? Of course it
would be better. Better? Must not anything in the world be better than that
which is the worst?
But, alas, I had been made to pay beforehand for the Elsa, and had taken
the entire responsibility for her and her horse’s safe return and even if I
could bring myself to throw away such a sum as I had disbursed one cannot
leave a caravan lying about as though it were what our neighbours across the
Vosges call a mere bagatelle. It is not a bagatelle. On the contrary, it is a
huge and complicated mechanism that must go with you like the shell on the
poor snail’s back wherever you go. There is no escape from it, once you
have started, day or night. Where was Panthers by now, Panthers with its
kind and helpful little lady? Heaven alone knew, after all our zigzagging.
Find it by myself I certainly could not, for not only had we zigzagged in
obedience to the caprices of Mrs. Menzies-Legh, but I had walked most of
the time as a man in a dream, heeding nothing particularly except my
growing desire to sit down.
I wondered grimly as six o’clock drew near, the hour at which the rest of
the company usually burst into activity, whether there would be many
exclamations of healthy and jolly that day. There is a point, I should say, at
which a thing or a condition becomes so excessively healthy and jolly that it
ceases to be either. I drew the curtain of my bunk together—for a great
upheaval over my head warned me that my wife was going to descend and
dress—and feigned slumber. Sleep seemed to me such a safe thing. You
cannot make a man rise and do what you consider his duty if he will not
wake up. The only free man, I reflected with my eyes tightly shut, is the man
who is asleep. Pushing my reflection a little further I saw with a slight start
that real freedom and independence are only, then, to be found in the
unconscious—a race (or sect; call it what you will) of persons untouched by
and above the law. And one step further and I saw with another slight start
that perfect freedom, perfect liberty, perfect deliverance from trammels, are
only to be found in a person who is not merely unconscious but also dead.
These, of course, as I need not tell my hearers, are metaphysics. I do not
often embark on their upsetting billows for I am, principally, a practical man.
But on this occasion they were not as fruitless as usual, for the thought of a
person dead suggested at once the thought of a person engaged in going
through the sickness preliminary to being dead, and a sick man is also to a
certain extent free—nobody, that is, can make him get up and go out into the
rain and hold his umbrella over Jellaby’s back while he concocts his terrible
porridge. I decided that I would slightly exaggerate the feelings of
discomfort which I undoubtedly felt, and take a day off in the haven of my
bed. Let them see to it that the horse was led; a man in bed cannot lead a
horse. Nor would it even be an exaggeration, for one who has been wakeful
half the night cannot be said to be in normal health. Besides, if you come to
that, who is in normal health? I should say no one. Certainly hardly any one.
And if you appeal to youth as an instance, what could be younger and yet
more convulsed with apparent torment than the newly born infant? Hardly
any one, I maintain, is well without stopping during a single whole day. One
forgets, by means of the anodynes of work or society or other excitement;
but cut off a person’s means of doing anything or seeing any one and he will
soon find out that at least his head is aching.
When, therefore, Edelgard had reached the stage of tidying the caravan,
arranging my clothes, and emptying the water out of the window preparatory
to my dressing, I put the curtains aside and beckoned to her and made her
understand by dint of much shouting (for the rain still pelted on the roof) that
I was feeling very weak and could not get up.
She looked at me anxiously, and pushing up the sponge bag—at which
she stared rather stupidly—laid her hand on my forehead. I thought her hand
seemed hot, and hoped we were not both going to be ill at the same time.
Then she felt my pulse. Then she looked down at me with a worried
expression and said—I could not hear it, but knew the protesting shape her
mouth assumed: “But Otto——”
I just shook my head and closed my eyes. You cannot make a man open
his eyes. Shut them, and you shut out the whole worrying, hurrying world,
and enter into a calm cave of peace from which, so long as you keep them
shut no one can possibly pull you. I felt she stood there awhile longer
looking down at me before putting on her cloak and preparing to face the
elements; then the door was unbolted, a gust of wet air came in, the caravan
gave a lurch, and Edelgard had jumped into the stubble.
Only for a short time was I able to reflect on her growing agility, and how
four days back she could no more jump into stubble or anything else than
can other German ladies of good family, and how the costume she had
bought in Berlin and which had not fitted her not only without a wrinkle but
also with difficulty, seemed gradually to be turning into a misfit, to be
widening, to be loosening, and those parts of it which had before been
smooth were changing every day into a greater bagginess—I was unable, I
say, to think about these things because, worn out, I at last fell asleep.
How long I slept I do not know, but I was very roughly awakened by
violent tossings and heavings, and looking hastily through my curtains saw a
wet hedge moving past the window.
So we were on the march.
I lay back on my pillow and wondered who was leading my horse. They
might at least have brought me some breakfast. Also the motion was
extremely disagreeable, and likely to give me a headache. But presently,
after a dizzy swoop round, a pause and much talking showed me we had
come to a gate, and I understood that we had been getting over the stubble
and were now about to rejoin the road. Once on that the motion was not
unbearable—not nearly so unbearable, I said to myself, as tramping in the
rain; but I could not help thinking it very strange that none of them had
thought to give me breakfast, and in my wife the omission was more than
strange, it was positively illegal. If love did not bring her to my bedside with
hot coffee and perhaps a couple of (lightly boiled) eggs, why did not duty? A
fasting man does not mind which brings her, so long as one of them does.
My impulse was to ring the bell angrily, but it died away on my
recollecting that there was no bell. The rain, I could see, had now lightened
and thinned into a drizzle, and I could hear cheerful talk going on between
some persons evidently walking just outside. One voice seemed to be
Jellaby’s, but how could it be he who was cheerful after the night he must
have had? And the other was a woman’s—no doubt, I thought bitterly,
Edelgard’s, who, warmed herself and invigorated by a proper morning meal,
cared nothing that her husband should be lying there within a stone’s throw
like a cold, neglected tomb.
Presently, instead of the hedge, the walls and gates of gardens passed the
window, and then came houses, singly at first, but soon joining on to each
other in an uninterrupted string, and raising myself on my elbow and putting
two and two together, I decided that this must be Wadhurst.
It was. To my surprise about the middle of the village the caravan
stopped, and raising myself once more on my elbow I was forced
immediately to sink back again, for I encountered a row of eager faces
pressed against the pane with eyes rudely staring at the contents of the
caravan, which, of course, included myself as soon as I came into view from
between the curtains of the berth.
This was very disagreeable. Again I instinctively and frantically sought
the bell that was not there. How long was I to be left thus in the street of a
village with my window-curtains unclosed and the entire population looking
in? I could not get out and close them myself, for I am staunch to the night
attire, abruptly terminating, that is still, thank heaven, characteristic during
the hours of darkness of every honest German gentleman: in other words, I
do not dress myself, as the English do, in a coat and trousers in order to go to
bed. But on this occasion I wished that I did, for then I could have leaped out
of my berth and drawn the curtains in an instant myself, and the German
attire allows no margin for the leaping out of berths. As it was, all I could do
was to lie there holding the berth-curtains carefully together until such time
as it should please my dear wife to honour me with a visit.
This she did after, I should say, at least half an hour had passed, with the
completely composed face of one who has no reproaches to make herself,
and a cup of weak tea in one hand and a small slice of dry toast on a plate in
the other, though she knows I never touch tea and that it is absurd to offer a
large-framed, fine man one piece of toast with no butter on it for his
breakfast.
“What are we stopping for?” I at once asked on her appearing.
“For breakfast,” said she.
“What?”
“We are having it in the inn to-day because of the wet. It is so nice, Otto.
Table-napkins and everything. And flowers in the middle. And nothing to
wash up afterward. What a pity you can’t be there! Are you better?”
“Better?” I repeated, with a note of justified wrath in my voice, for the
thought of the others all enjoying themselves, sitting at a good meal on
proper chairs in a room out of the reach of fresh air, naturally upset me. Why
had they not told me? Why, in the name of all that was dutiful, had she not
told me?
“I thought you were asleep,” said she when I inquired what grounds she
had for the omission.
“So I was, but that——”
“And I know you don’t like being disturbed when you are,” said she,
lamely as I considered, for naturally it depends on what one is disturbed for
—of course I would have got up if I had known.
“I will not drink such stuff,” I said, pushing the cup away. “Why should I
live on tepid water and butterless toast?”
“But—didn’t you say you were ill?” she asked, pretending to be
surprised. “I thought when one is ill——”
“Kindly draw those curtains,” I said, for the crowd was straining every
nerve to see and hear, “and remove this stuff. You had better,” I added, when
the faces had been shut out, “return to your own breakfast. Do not trouble
about me. Leave me here to be ill or not. It does not matter. You are my wife,
and bound by law to love me, but I will make no demands on you. Leave me
here alone, and return to your breakfast.”
“But, Otto, I couldn’t stay in here with you before. The poor horse would
never——”
“I know, I know. Put the horse before your husband. Put anything and
anybody before your husband. Leave him here alone. Do not trouble. Go
back to your own, no doubt, excellent breakfast.”
“But Otto, why are you so cross?”
“Cross? When a man is ill and neglected, if he dare say a word he is
cross. Take this stuff away. Go back to your breakfast. I, at least, am
considerate, and do not desire your omelettes and other luxuries to become
cold.”
“It isn’t omelettes,” said Edelgard. “Why are you so unreasonable? Won’t
you really drink this?” And again she held out the cup of straw-coloured tea.
Then I turned my face to the wall, determined that nothing she could say
or do should make me lose my temper. “Leave me,” was all I said, with a
backward wave of the hand.
She lingered a moment, as she had done in the morning, then went out.
Somebody outside took the cup from her and helped her down the ladder,
and a conviction that it was Jellaby caused such a wave of just anger to pass
over me that, being now invisible to the crowd, I leaped out of my berth and
began quickly and wrathfully to dress. Besides, as she opened the door a
most attractive odour of I do not know what, but undoubtedly something to
do with breakfast in the inn, had penetrated into my sick chamber.
“ ’Ere ’e is,” said one of the many children in the crowd, when I emerged
dressed from the caravan and prepared to descend the steps; “ ’ere’s ’im out
of the bed.”
I frowned.
“Don’t ’e get up late?” said another.
I frowned again.
 “ ’Ere ’e is”

“Don’t ’e look different now?” said a third.

I deepened my frown.
“Takes it easy ’e do, don’t ’e,” said a fourth, “in spite of pretendin’ to be
a poor gipsy.”
I got down the steps and elbowed my way sternly through them to the
door of the inn. There I paused an instant on the threshold and faced them,
frowning at them as individually as I could.
“I have been ill,” I said briefly.
But in England they have neither reverence nor respect for an officer. In
my own country if any one dared to speak to me or of me in that manner in
the street I would immediately draw my sword and punish him, for he would
in my person have insulted the Emperor’s Majesty, whose uniform I wore;
and it would be useless for him to complain, for no magistrate would listen
to him. But in England if anybody wants to make a target of you, a target
you become for so long as his stock of wit (heaven save the mark!) lasts. Of
course the crowd in Wadhurst must have known. However much my
mackintosh disguised me it was evident that I was an officer, for there is no
mistaking the military bearing; but for their own purposes they pretended
they did not, and when therefore turning to them with severe dignity I said:
“I have been ill,” what do you think they said? They said, “Yah.”
For a moment I supposed, with some surprise I confess, that they were
acquainted with the German tongue, but a glance at their faces showed me
that the expression must be English and rude. I turned abruptly and left these
boors: it is not part of my business to teach a foreign nation manners.
My frowns, however, were smoothed when I entered the comfortable
breakfast-room and was greeted with a pleasant chorus of welcome and
inquiries.
Frau von Eckthum made room for me beside her, and herself ministered
to my wants. Mrs. Menzies-Legh laughed and praised me for my
sensibleness in getting up instead of giving way. The breakfast was abundant
and excellent. And I discovered that it was the ever kind and thoughtful Lord
Sigismund who had helped Edelgard out of the caravan, Jellaby being
harmlessly occupied writing picture postcards to (I suppose) his constituents.
 By the time I had had my third cup of coffee—so beneficial is the effect
of that blessed bean—I was able silently to forgive Edelgard and be ready to
overlook all her conduct since the camp by the Medway and start fresh
again; and when toward eleven o’clock we resumed the march, a united and
harmonious band (for the child Jumps was also that day restored to health
and her friends) we found the rain gone and the roads being dried up with all
the efficiency and celerity of an unclouded August sun.
That was a pleasant march. The best we had had. It may have been the
weather, which was also the best we had had, or it may have been the
country, which was undeniably pretty in its homely unassuming way—
nothing, of course, to be compared with what we would have gazed at from
the topmost peak of the Rigi or from a boat on the bosom of an Italian lake,
but very nice in its way—or it may have been because Frau von Eckthum
walked with me, or because Lord Sigismund told me that next day being
Sunday we were going to rest in the camp we got to that night till Monday,
and dine on Sunday at the nearest inn, or, perhaps it was all this mingled
together that made me feel so pleasant.
Take away annoyances and worry, and I am as good-natured a man as you
will find. More, I can enjoy anything, and am ready with a jest about almost
anything. It is the knowledge that I am really so good-humoured that
principally upsets me when Edelgard or other circumstances force me into a
condition of vexation unnatural to me. I do not wish to be vexed. I do not
wish ever to be disagreeable. And it is, I think, down-right wrong of people
to force a human being who does not wish it to be so. That is one of the
reasons why I enjoyed the company of Frau von Eckthum. She brought out
what was best in me, what I may be pardoned for calling the perfume of my
better self, because though it contains the suggestion that my better self is a
flower-like object it also implies that she was the warming and vivifying and
scent-extracting sun.
There is a dew-pond at the top of one of the hills we walked up that day
(at least Mrs. Menzies-Legh said it was a dew-pond, and that the water in it
was not water at all but dew, though naturally I did not believe her—what
sensible man would?) and by its side in the shade of an oak tree Frau von
Eckthum and I sat while the three horses went down to fetch up the third
caravan, nominally taking care of those already up but really resting in that
pretty nook without bothering about them, for of all things in the world a
horseless caravan is surely most likely to keep quiet. So we rested, and I
amused her. I really do not know about what in particular, but I know I
succeeded, for her oh’s became quite animated, and were placed with such
dexterous intelligence that each one contained volumes.
She was interested in everything, but especially so in what I said about
Jellaby and his doctrines, of which I made great fun. She listened with the
most earnest attention to my exposure of the fallacies with which he is
riddled, and became at last so evidently convinced that I almost wished the
young gentleman had been there too to hear me.
Altogether an agreeable, invigorating day; and when, about three o’clock,
we found a good camping ground in a wide field sheltered to the north by a
copse and rising ground, and dropping away in front of us to a most
creditable and extensive view, for the second time since I left Panthers I was
able to suspect that caravaning might not be entirely without its
commendable points.
 CHAPTER XII

W E supped that night beneath the stars with the field dropping
downward from our feet into the misty purple of the Sussex Weald.
What we had for supper was chicken and rice and onions, and very
excellent it was. The wind had gone, and it was cold. It was like a night in
North Germany, where the wind sighs all day long and at sunset it suddenly
grows coldly and clearly calm.
These are quotations from a conversation I overheard between Frau von
Eckthum (oddly loquacious that night) and Jellaby, who both sat near where
I was eating my supper, supposed to be eating theirs but really letting it spoil
while they looked down at the Sussex Weald (I wish I knew what a Weald is:
Kent had one too) and she described the extremely flat and notoriously dull
country round Storchwerder.
Indeed I would not have recognized it from her description, and yet I
know it every bit as well as she can. Blue air, blue sky, blue water, and the
flash of white wings—that was how she described it, and poor Jellaby was
completely taken in and murmured “Beautiful, beautiful” in his foolish slow
voice, and forgot to eat his chicken and rice while it was hot, and little
guessed that she had laughed at him with me a few hours before.
I listened, amused but tolerant. We must not keep a pretty lady too
exactly to the truth. The first part of this chapter is a quotation from what I
heard her say (excepting one sentence), but my hearers must take my word
for it that it did not sound anything like as silly as one might suppose.
Everything depends on the utterer. Frau von Eckthum’s quasi-poetical way
of describing the conduct of our climate had an odd attractiveness about it
that I did not find, for instance, in my dear wife’s utterances when she too,
which she at this time began to do with increasing frequency, indulged in the
quasi-poetic. Quasi-poetic I and other plain men take to be the violent
tearing of such a word as rolling from its natural place and applying it to the
plains and fields round Storchwerder. A ship rolls, but fields, I am glad to
say, do not. You may also with perfect propriety talk about a rolling-pin in
connection with the kitchen, or of a rolling stone in connection with moss.
Of course I know that we all on suitable occasions make use of exclamations
of an appreciative nature, such as colossal and grossartig, but that is brief
and business-like, it is what is expected of us, and it is a duty quickly
performed and almost perfunctory, with one eye on the waiter and the
restaurant behind; but slow raptures, prolonged ones, raptures beaten out
thin, are not in my way and had not till then been in Edelgard’s way either.
The English are flimsier than we are, thinner blooded, more feminine, more
finnicking. There are no restaurants or Bierhalle wherever there is a good
view to drown their admiration in wholesome floods of beer, and not being
provided with this natural stopper it fizzles on to interminableness. Why,
Jellaby I could see not only let his supper get stone cold but forgot to eat it at
all in his endeavour to outdo Frau von Eckthum’s style in his replies, and
then Edelgard must needs join in too, and say (I heard her) that life in
Storchwerder was a dusty, narrow life, where you could not see the liebe
Gott because of other people’s chimney-pots.
Greatly shocked (for I am a religious man) I saved her from further
excesses by a loud call for more supper, and she got up mechanically to
attend to my wants.
Jellaby, however, whose idea seemed to be that a woman is never to do
anything (I wonder who is to do anything, then?) forestalled her with the
sudden nimbleness he displayed on such occasions, so surprising in
combination with his clothes and general slackness, and procured me a fresh
helping.
I thanked him politely, but could not repress some irony in my bow as I
apologized for disturbing him.
“Shall I hold your plate while you eat?” he said.
“Why, Jellaby?” I asked, mildly astonished.
“Wouldn’t it be even more comfortable if I did?” he asked; and then I
perceived that he was irritated, no doubt because I had got most of the
cushions, and he, Quixotic as he is, had given up his to my wife, on whom it
was entirely thrown away for she has always assured me she actually prefers
hard seats.
Well, of course there were few things in the world quite so unimportant as
Jellaby’s irritation, so I just looked pleasant and at the food he had brought
me; but I did not get another evening with Frau von Eckthum. She sat
immovable on the edge of the slope with my wife and Jellaby, talking in
tones that became more and more subdued as dusk deepened into night and
stars grew hard and shiny.
 They all seemed subdued. They even washed up in whispers. And
afterward the very nondescripts lay stretched out quite quietly by the
glowing embers of Lord Sigismund’s splendid fire listening to Menzies-
Legh’s and Lord Sidge’s talk, in which I did not join for it was on the subject
they were so fond of, the amelioration of the condition of those dull and
undeserving persons, the poor.
I put my plate where somebody would see it and wash it, and retired to
the shelter of a hedge and the comfort of a cigar. The three figures on the
edge of the hill became gradually almost mute. Not a leaf in my hedge
stirred. It was so still that people talking at the distant farm where we had
procured our chickens could almost be understood, and a dog barking
somewhere far away down in the Weald seemed quite threateningly near. It
was really extraordinarily still; and the stillest thing of all was that strange
example of the Englishwoman grafted on what was originally such excellent
German stock, Mrs. Menzies-Legh, sitting a yard or two away from me, her
hands clasped round her knees, her face turned up as though she were
studying astronomy.
I do not suppose she moved for half an hour. Her profile seemed to shine
white in the dusk with lines that reminded me somehow of a cameo there is
in a red velvet case lying on the table in our comfortable drawing-room at
Storchwerder, and the remembrance brought a slight twinge of home-
sickness with it. I shook this off, and fell to watching her, and for the
amusement of an idle hour lazily reconstructed from the remnants before me
what her appearance must have been ten years before in her prime, when
there were at least undulations, at least suggestions that here was a woman
and not a kind of elongated boy.
The line of her face is certainly quite passable; and that night in the half
darkness it was quite as passable as any I have seen on a statue—objects in
which I have never been able to take much interest. It is probable she used to
be beautiful. Used to be beautiful? What is the value of that? Just a snap of
the fingers, and nothing more. If women would but realize that once past
their first youth their only chance of pleasing is to be gentle and rare of
speech, tactful, deft—in one word, apologetic, they would be more likely to
make a good impression on reasonable men such as myself. I did not wish to
quarrel with Mrs. Menzies-Legh and yet her tongue and the way she used it
put my back up (as the British say) to a height it never attains in the placid
pools of feminine intercourse in Storchwerder.
 To see her sit so silent and so motionless was unusual. Was she regretting,
perhaps, her lost youth? Was she feeling bitter at her inability to attract me, a
man within two yards of her, sufficiently for me to take the trouble to engage
her in conversation? No doubt. Well—poor thing! I am sorry for women, but
there is nothing to be done since Nature has decreed they shall grow old.
I got up and shook out the folds of my mackintosh—a most useful
garment in those damp places—and threw away the end of my cigar. “I am
now going to retire for the night,” I explained, as she turned her head at my
rustling, “and if you take my advice you will not sit here till you get
rheumatism.”
She looked at me as though she did not hear. In that light her appearance
was certainly quite passable: quite as passable as that of any of the statues
they make so much fuss about; and then of course with proper eyes instead
of blank spaces, and eyes garnished with that speciality of hers, the
ridiculously long eyelashes. But I knew what she was like in broad day, I
knew how thin she was, and I was not to be imposed upon by tricks of light;
so I said in a matter of fact manner, seizing the opportunity for gentle malice
in order to avenge myself a little for her repeated and unjustified attacks on
me, “You will not be wise to sit there longer. It is damp, and you and I are
hardly as young as we were, you know.”
Any normal woman, gentle as this was, would have shrivelled. Instead
she merely agreed in an absent way that it was dewy, and turned up her face
to the stars again.
“Looking for the Great Bear, eh?” I remarked, following her gaze as I
buttoned my wrap.
She continued to gaze, motionless. “No, but—don’t you see? At Christ
Whose glory fills the skies,” she said—both profanely and senselessly, her
face in that light exactly like the sort of thing one sees in the windows of
churches, and her voice as though she were half asleep.
So I hied me (poetry being the fashion) to my bed, and lay awake in it for
some time being sorry for Menzies-Legh, for really no man can possibly like
having a creepy wife.
But (luckily) autres temps autres mœurs, as our unbalanced but
sometimes felicitous neighbours across the Vosges say, and next morning the
poetry of the party was, thank heaven, clogged by porridge.
 It always was at breakfast. They were strangely hilarious then, but never
poetic. Poetry developed later in the day as the sun and their spirits sank
together, and flourished at its full growth when there were stars or a moon.
That morning, our first Sunday, a fresh breeze blew up from the Weald
below and a cloudless sun dazzled us as it fell on the white cloth of the table
set out in the middle of the field by somebody—I expect it was Mrs.
Menzies-Legh—who wanted to make the most of the sun, and we had to
hold on our hats with one hand and shade our eyes with the other while we
ate.
Uncomfortable? Of course it was uncomfortable. Let no one who loves to
be comfortable ever caravan. Neither let any one who loves order and
decency do so. They may take it from me that there is never any order, and
even less frequently is there any decency. I can give you an example from
that Sunday morning. I was sitting at the table with the ladies, on a seat (as
usual) too low for me, and that (also as usual) slanted on the uneven ground,
with my feet slightly too cold in the damp grass and my head slightly too hot
in the bright sun, and the general feeling of subtle discomfort and ruffledness
that is one of the principal characteristics of this form of pleasure-taking,
when I saw (and so did the ladies) Jellaby emerge from his tent—in his shirt
sleeves if you please—and fastening up a mirror on the roof of his canvas
lair proceed then and there in the middle of the field to lather his face and
then to shave it.
Edelgard, of course, true to her early training, at once cast down her eyes
and was careful to keep them averted during the remainder of the meal, but
nobody else seemed to mind; indeed, Mrs. Menzies-Legh got out her camera
and focussing him with deliberate care snap-shotted him.
Were these people getting blunted as the days passed to the refinements
and necessary precautions of social intercourse? I had been stirred to much
silent indignation by the habit of the gentlemen of walking in their shirt
sleeves, and had not yet got used to that, but to see Jellaby dressing in an
open field was a little more than I could endure in silence. For if, I asked
myself rapidly, Jellaby dresses (shaving being a part of dressing) out-of-
doors in the morning, what is to prevent his doing the opposite in the
evening? Where is the line? Where is the logical limit? We had now been
three days out, and we had already got to this. Where, I thought, should we
have got to in another six? Where should we be by, say, the following
Sunday?
 I cannot think a promiscuous domesticity desirable, and am one of those
who strongly disapprove of that worst example of it, the mixed bathing or
Familienbad which blots with practically unclothed Jews of either sex our
otherwise decent coasts. Never have I allowed Edelgard to indulge in it, nor
have I done so myself. It is a deplorable spectacle. We used to sit and watch
it for hours, in a condition of ever-increasing horror and disgust—it was
quite difficult to find seats sometimes, so many of our friends were there
being disgusted too.
But these denizens of the deep at the points where the deep was a
Familienbad were, as I have said, chiefly Jews and their Jewesses, and what
can you expect? Jellaby, however, in spite of his other infirmities, was not
yet a Jew; he was everything else I think, but that crowning infamy had up to
then been denied him.
But not to be one and yet to behave with the laxness of one within view
of the rest of the party was very inexcusable. “Are there no hedges to this
field?” I cried in indignant sarcasm, looking pointedly at each of its four
hedges in turn and raising my voice so that he could hear.
“Oh, Baron dear, it’s Sunday,” said Mrs. Menzies-Legh, no longer a
rather nice-looking if irreverent cameo in a velvet case, but full of morning
militancy. “Don’t be cross till to-morrow. Save it up, or what will you do on
Monday?”
“Be, I trust, just as capable of distinguishing between the permitted and
the non-permitted as I am to-day,” was my ready retort.
“Oh, oh,” said Mrs. Menzies-Legh, shaking her head and smiling as
though she were talking to a child or a feeble-minded; and turning her
camera on to me she took my photograph.
“Pray why,” I inquired with justifiable heat, “should I be photographed
without my consent?”
“Because,” she said, “you look so deliciously cross. I want to have you in
my scrap-book like that. You looked then exactly like a baby I know.”
“Which baby?” I asked, frowning and at a loss how to meet this kind of
thing conversationally. And there was Edelgard, all ears; and if a wife sees
her husband being treated disrespectfully by other women is it not very
likely that she soon will begin to treat him so herself? “Which baby?” I
asked; but knew myself inadequate.
 “Oh, a perfectly respectable baby,” said Mrs. Menzies-Legh carelessly,
putting her camera down and going on with her breakfast, “but irritable and
exacting about things like bottles.”
“But I do not see what I have to do with bottles,” I said nettled.
“Oh, no—you haven’t. Only it looks at its nurse just like you did then if
they’re late, or not full enough.”
“But I did not look at its nurse,” I said angrily, becoming still more so as
they all (including my wife) laughed.
I rose abruptly. “I will go and smoke,” I said.
Of course I saw what she meant about the nurse the moment I had
spoken, but it is inexcusable to laugh at a man because he does not
immediately follow the sense (or rather the senselessness) of a childishly
skipping conversation. I am as ready as any one to laugh at really amusing
phrases or incidents, but being neither a phrase nor an incident myself I do
not see why I should be laughed at. Surely it is unworthy of grown men and
women to laugh at each other in the way silly children do? It is ruin to the
graces of social intercourse, to the courtliness that should uninterruptedly
distinguish the well-born. But there was a childish spirit pervading the whole
party (with the exception of myself) that seemed to increase as the days went
by, a spirit of unreasoning glee and mischievousness which I believe is
characteristic of very young and very healthy children. Even Edelgard was
daily becoming more calf-like, as we say, daily descending nearer to the
level occupied at first only by the two nondescripts, that level at which you
begin to play idiotic and heating games like the one the English call Blind
Man’s Buff (an obviously foolish name, for what is buff?) and which we so
much more sensibly call Blind Cow. Therefore I, having no intention at my
age and in my position of joining in puerilities or even of seeming to
countenance them by my presence, said abruptly, “I will smoke”—and
strode away to do it.
One of the ladies called after me to inquire if I were not going to church
with them, but I pretended not to hear and strode on toward the shelter of the
hedge, giving Jellaby as I passed him such a look as would have caused any
one not overgrown with the leather substitute for skin peculiar to persons
who set order, morals, and religion at defiance, to creep confounded into his
tent and stay there till his face was ready and his collar on. He, however,
called out with the geniality born of brazenness, that it was a jolly morning;
of which, of course, I took no notice.
In the dry ditch beneath the hedge on the east side of the field sat Lord
Sigismund beside his batterie de cuisine, watching over, with unaccountable
and certainly misplaced kindness, the porridge and the coffee that were
presently to be Jellaby’s. While he watched he smoked his pipe, stroked his
dog, and hummed snatches of what I supposed were psalms with the
pleasant humming of the good, the happy, and the well-born.
Near him lay Menzies-Legh, his dark and sinister face bent over a book.
He nodded briefly in response to my lifted hat and morning salutation, while
Lord Sigismund, full as ever of the graciousness of noble birth, asked me if I
had had a good night.
“A good night, and an excellent breakfast, thanks to you, Lord Sidge,” I
replied; the touch of playfulness contained in the shortened name lightening
the courteous correctness of my bow as I arranged myself next to him in the
ditch.
Menzies-Legh got up and went away. It was characteristic of him that he
seemed always to be doing that. I hardly ever joined him but he was
reminded by my approach of something he ought to be doing and went away
to do it. I mentioned this to Edelgard during the calm that divided one
difference of opinion from another, and she said he never did that when she
joined him.
“Dear wife,” I explained, “you have less power to remind him of
unperformed duties than I possess.”
“I suppose I have,” said Edelgard.
“And it is very natural that it should be so. Power, of whatever sort it may
be, is a masculine attribute. I do not wish to see my little wife with any.”
“Neither do I,” said she.
“Ah—there speaks my own good little wife.”
“I mean, not if it is that sort.”
“What sort, dear wife?”
“The sort that reminds people whenever I come that it is time they went.”
She looked at me with the odd look that I observed for the first time
during our English holiday. Often have I seen it since, but I cannot recollect
having seen it before. I, noticing that somehow we did not understand each
other, patted her kindly on the shoulder, for, of course, she cannot always
quite follow me, though I must say she manages very creditably as a rule.
“Well, well,” I said, patting her, “we will not quibble. It is a good little
wife, is it not?” And I raised her chin by means of my forefinger, and kissed
her.
This, however, is a digression. I suppose it is because I am unfolding my
literary wings for the first time that I digress so frequently. At least I am
aware of it, which is in itself, I should say, a sign of literary instinct. My
Muse has been, so to speak, kept in bed without stopping till middle age, and
is now suddenly called upon to get up and go for a walk. Such a muse must
inevitably stagger a little at first. I will, however, endeavour to curb these
staggerings, for I perceive that I have already written more than can be
conveniently read aloud in one evening, and though I am willing the same
friends should come on two, I do not know that I care to see them on as
many as three. Besides, think of all the sandwiches.
(This last portion of the narrative, from “one evening” to “sandwiches”
will, of course, be omitted in public.)
I will, therefore, not describe my conversation with Lord Sigismund in
the ditch beyond saying that it was extremely interesting, and conducted on
his side (and I hope on mine) with the social skill of a perfect gentleman.
It was brought to an end by the arrival of Jellaby and his dog, which was
immediately pounced on by Lord Sigismund’s dog, who very properly
resented his uninvited approach, and they remained inextricably mixed
together for what seemed an eternity of yells, the yells rending the Sabbath
calm and mingling with the distant church bells, and all proceeding from
Jellaby’s dog, while Lord Sigismund’s, a true copy of his master, did that
which he had to do with the silent self-possession of, if I may so express it, a
dog of the world.
The entire company of caravaners, including old James, ran up with cries
and whistling to try to separate them, and at last Jellaby, urged on I suppose
to deeds of valour by knowing the eyes of the ladies upon him, made a
mighty effort and tore them asunder, himself getting torn along his hand as
the result.
Menzies-Legh helped Lord Sigismund to drag away the naturally
infuriated bull-terrier, and Jellaby, looking round, asked me to hold his dog
while he went and washed his hand. I thought this a fair instance of the