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History of orthodontics   / fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy

History of orthodontics / fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy




The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call



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    History of orthodontics   / fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy History of orthodontics / fixed orthodontic courses /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • HISTORY OF ORTHODONTICS www.indiandentalacademy.com
    • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • Contents Part I Introduction History of Dentistry Evolution of Orthodontics Historical perspective of biophysical aspects. American Orthodontics – Pre-Angle Era. – Angle Era www.indiandentalacademy.com
    • Introduction “The heritages of the past are the seeds that bring forth the harvest of the future” Awareness of our historical antecedents has acquired more importance today, since changes are occurring so rapidly, that only by keeping our eyes steady on what went before can we progress with intelligence & confidence. www.indiandentalacademy.com
    • “Not to know what has been transacted in former times is to continue always as a child. If no use is made of the labors of the past ages, the world must remain in the infancy of knowledge”. - Cicero, the great Roman orator www.indiandentalacademy.com
    • History of Dentistry  From the earliest times, humans have been plagued by dental problems & have sought a variety of means to alleviate them.  First dental healers were physicians.  Middle ages – Barber-surgeons of Europe.  Learned by trial & error & observation. www.indiandentalacademy.com
    • Pierre Fauchard through his treatise ‘Le Chirurgien dentiste’ established dentistry as a true profession. No longer mired in superstition & ignorance, the field was based at last on sound rational & scientific principles. www.indiandentalacademy.com
    • Baltimore College of Dental Surgery – first dental college in the world – opened its doors to a class of 5 students on Nov 3rd, 1840. www.indiandentalacademy.com
    • Evolution of the first dental specialty – Orthodontics Orthodontics is that branch of dentistry concerned with the study of growth of the craniofacial complex, the development of occlusion & the treatment of dentofacial anomalies. Weinberger points out that there had been an awareness of unsightly appearance of ‘crooked teeth’ www.indiandentalacademy.com
    •  Hippocrates (460-377B.C.) among the first to comment about craniofacial deformity. “Among those individuals with long-shaped heads, some have thick necks, strong parts & bones. Others have strongly arched palates, their teeth are irregularly arrayed, crowding one another & they are bothered by headaches & otorrhea. www.indiandentalacademy.com
    •  Adamandios (5th century A.D.) “Those persons whose lips are pushed out because of cuspid displacement are ill-tempered, abusive shouters & defamers”.  Celsus (25B.C.) advocated that persistent deciduous teeth should be extracted & that permanent teeth which erupt in the wrong direction ought to be corrected by finger pressure. www.indiandentalacademy.com
    •  Celsus’ advise mentioned in ‘Artzney Buchlein’ – the oldest dental text book (1530). “If a second tooth should happen to grow in children before the first has fallen out, that which ought to be shed is to be drawn out & the new one daily pushed towards its place by means of the finger until it arrives at its proper position”. www.indiandentalacademy.com
    • “When in a child a permanent tooth appears before the fall of milk tooth, it is necessary to dissect the gum all around the latter & extract it; the other tooth must then be pushed with the finger, day by day toward the place that was occupied by the one extracted & this is to be continued until it has finally reached its www.indiandentalacademy.com proper position”.
    •  First mechanical treatment for correcting irregularities suggested by Gaius Plinus Secundus (Pliny) (23-79A.D.) – advocated filing of elongated teeth to produce proper alignment. Specimens dating back to VIII century B.C. indicate Etruscans may have been the first people to employ orthodontic bands to improve tooth alignment. www.indiandentalacademy.com
    • Crude appliances designed to regulate teeth have been found as archaeologic artifacts in tombs of ancient Egypt, Greece & the Mayans of Mexico. www.indiandentalacademy.com
    • John Hunter (1728-1793)  Greatest surgeon of 18th century.  Detailed study of mouth & jaws of cadavers.  1771‘The Natural History of the Human Teeth: Explaining their Structure, Use, Formation, Growth & Diseases’. www.indiandentalacademy.com
    •  Exceptionally accurate plates.  Perfect understanding of growth & development of jaws & their relations to the muscles of mastication.  Scientific nomenclature – Incisors, Cuspids & Bicuspids. www.indiandentalacademy.com
    • Disapproved extracting primary teeth to permit permanent teeth to erupt. But advocated first permanent molar is tooth to be sacrificed if insufficient room in the jaw for all teeth. Maintained that teeth do not grow throughout life time, only appear longer because antagonist is missing. www.indiandentalacademy.com
    •  Orthodontics, as we think of it today, has its root in France in 18th century when Pierre Fauchard (1728) – Father of Dentistry – described an orthodontic appliance ‘Bandlette’ later known as expansion arch.  Orthodontia derived from 2 Greek words  ‘Orthos’ – Right/Correct.  ‘Dons’ – Tooth  Term introduced by Frenchman LeFoulon in 1839. www.indiandentalacademy.com
    •  1880 – Norman Kingsley – Father of Orthodontics – published ‘Treatise on Oral Deformities as a Branch of Mechanical Surgery’.  1888 – John N. Farrar – ‘Treatise on the Irregulations of Teeth & their Correction’.  1889 – Superseded by Simeon Guilford’s ‘Orthodontia’ – Standard text in dental colleges. www.indiandentalacademy.com
    •  Emergence of orthodontics as a true specialty was the result of dominant, dynamic & influential leadership of Edward H. Angle (1855-1930) – The Father of Modern Orthodontics.  Angle was embittered with dental schools, dental school politics & domination of the schools by the operative & prosthetic departments. www.indiandentalacademy.com
    • Though he taught prosthetics he found the mechanical procedural aspects stultifying. How could the moulding, guiding biologic science of orthodontia for children be thrown together with artificial replacements for the elderly? 1901 – American Society of Orthodontics was established. www.indiandentalacademy.com
    •  Constitution’s first article – confirmed the name.  Second article – to establish the ‘science of orthodontia’ as a distinct dental specialty.  “Not until orthodontia is studied & practiced as a distinct branch of dentistry will it ever obtain the success it deserves…. There should be a specialist in orthodontia in every city & town of any size; & the general practitioner should send to the specialist freely”. - Angle before Nebraska Dental Society in May 1890. www.indiandentalacademy.com
    •  Angle urged one of his young disciples Dr. Charles Tweed to – 1. Dedicate his life to the development of edgewise appliance. 2. To make every effort to establish orthodontics as a specialty within the dental profession. www.indiandentalacademy.com
    •  Dr. Tweed launched a one-man blitz by canvassing & arousing patients, persuading dentists, influencing politicians, speaking at meetings, having petitions signed & taking patients before the legislature.  1929 – Arizona legislature passed the first law limiting the practice of orthodontics to specialists.  Dr. Tweed received Arizona’s Certificate No. 1 & became the first certified specialist in orthodontics in United States. www.indiandentalacademy.com
    • Historical Perspective of the Biophysical Aspects  1863 – Harris – Orthodontic tooth movement is a result of bone resorption on one side & bone deposition on the other side of the root. Supported by Talbot (1888), Guilford (1896). Kingsley (1877) supported by Farrar (1888) claimed that bending of alveolar bone would take place during orthodontic tooth movement. www.indiandentalacademy.com
    • Theories based on clinical observation & macroscopic studies. Sandstedt - First histological study of the problem of tooth movement. Importance of his observations on hyalinization & undermining resorption appreciated only 10 yrs later. www.indiandentalacademy.com
    •  Most important in development of orthodontic thinking- Albin Oppenheim (1911) – disciple of E.H. Angle.  Refuted Walkhoff’s pressure theory – “overcoming the tension of bone by strong pressure for a very short time”.  Oppenheim’s investigations with Angle’s appliances won recognition throughout the world. www.indiandentalacademy.com
    • Orthodontic treatment regarded as tantamount to an artificially effected resorption & deposition of bone. Schwarz recognized the intimate relationship of force magnitude & tissue response. He classified orthodontic forces in 4 degrees of biological efficiency. www.indiandentalacademy.com
    • Immense practical importance of tissue reaction to orthodontic treatment highlighted by Ketcham’s observations on root resorption subsequent to treatment with orthodontic appliances. German-speaking & American orthodontists reacted differently to the findings leading to a parting of ways. www.indiandentalacademy.com
    • In the United States Pathologic effects of orthodontic therapy recognized. Heavy rigid appliances abandoned for resilient & efficient devices. E.H. Angle dominated the orthodontic scene in U.S. more than any one person in Europe. www.indiandentalacademy.com
    • In Europe Early leaders studied more the role of craniofacial skeleton in dentofacial anomalies and malocclusion.  So orthodontics referred in Europe as - Orthopedics - Orthopedie dentofaciale www.indiandentalacademy.com
    • Development of American Orthodontics – The Pre-Angle Era First scientific attempt at tooth movement - by Pierre Fauchard using the ‘Bandlette’  Flat strip of metal formed into an arch. Pierced with holes for tying teeth with threads. www.indiandentalacademy.com
    • Simple anchorage. Tipping movement. Lacked stability. No effective way to firmly fix it in position on the teeth. www.indiandentalacademy.com
    • Etienne Bourdet (17221789)  Fauchard’s follower.  Advocated extraction of first bicuspids to alleviate overcrowding.  Described shifting of misaligned teeth into place by attaching them with threads to a splint of ivory. www.indiandentalacademy.com
    • 1841- Schange a Frenchman invented the adjustable clamp band with introduction of a lingual screw. www.indiandentalacademy.com
    • 1846 – Tucker described the use of rubber elastics though no importance given until Case & Baker used it to provide intermaxillary force & intermaxillary anchorage in 1893. www.indiandentalacademy.com
    • 1861 – Coffin introduced flexible piano wire. 1861 – Kingsley introduced the headgear to apply extraoral force & provide occipital anchorage. www.indiandentalacademy.com
    • Norman Williams Kingsley (18291913)  ‘Orthodontia’s greatest genius’ – E.H. Angle.  Born on 2nd Oct 1829.  Joined Dr. A.W. Kingsley, Pennsylvania.  1852 – first office in Oswego, New York.  1859 – made his first obturator.  Prosthetic restorations for cleft patients - restored normal speech, improved facial appearance. www.indiandentalacademy.com
    •  1865 – founder & first dean of New York University College of Dentistry.  1871 – Honorary degree from Baltimore College of Dental Surgery.  1880 – ‘A Treatise on Oral Deformities as a Branch of Mechanical Surgery.  Cleft palate prostheses.  Artificial replacement of missing parts.  External immobilization. www.indiandentalacademy.com
    •  Over 100 articles on      Cleft palate rehabilitation. Inadequacies of cleft palate surgery. Obturators. Orthodontic diagnosis. Orthodontic appliances.  1880 – described his plate for ‘jumping the bite’ – forerunner of modern functional appliances.  Early awareness of orthodontic potential for adults patients. www.indiandentalacademy.com
    • Practice of orthodontics altered forever with the invention of dental cement by Magill of Erie, Pennsylvania. www.indiandentalacademy.com
    • In this period –  Treatment     modalities formulated without benefit of scientific methodology. Goal of treatment – improved cosmetics. No consideration to occlusal function or biological concepts. Injudicious extractions. Controlling factors in appliance design - Ease of appliance manipulation. - Patient management. www.indiandentalacademy.com
    • The Angle Era  Most dominant, dynamic & influential figure in orthodontics – Edward Hartley Angle (18551930).  Father of Modern Orthodontics.  Born on a farm in Pennsylvania on June 1st, 1855 – fifth of seven children.  Never an outstanding student in “book-learnin”  Marked ability to improve & create mechanical equipment on the farm.  Developed a passion for simplicity in design. www.indiandentalacademy.com
    •  Apprenticed himself to a dentist at his mother’s request.  1878- Graduated from Pennsylvania College of Dentistry.  Being at heart an inventor, the field of general dentistry offered little interest in original mechanical investigation.  Angle became keenly interested in orthodontics. www.indiandentalacademy.com
    • Experienced many technical problems & frustrations in treatment which irritated, motivated & inspired him to develop a standard appliance. www.indiandentalacademy.com
    •  5 properties of an ideal orthodontic appliance1. SIMPLE – Push, Pull & Rotate 2. STABLE – Fixed to teeth. 3. EFFICIENT – Based on Newton’s 3rd law of anchorage. 4. DELICATE – Accepted by tissues. 5. INCONSPICUOUS – Esthetically acceptable. www.indiandentalacademy.com
    •  1880 – “First real appliance” – the jack & traction screw with pushing action.  Combination of adjustable clamp band of Schange & regulating screw of Dwinelle. www.indiandentalacademy.com
    • 1887 – introduced the Angle System. www.indiandentalacademy.com
    • 1887 – Appointed to chair of orthodontia in dental department of University of Minnesota. Read his paper, ‘Notes on Orthodontia with a New System of Regulation & Retention’ at 9th International Medical Congress. 1887 – Ohio Journal of Dental Science. www.indiandentalacademy.com
    • 1888 – Lecture to Iowa State Dental Society – demonstrated expansion arch & its auxiliaries. 1894 – Professor of Orthodontia at Marian Sims College, receiving MD degree the following year. Concepts of Prosthetic occlusion developed in the late 1800s. www.indiandentalacademy.com
    •  “The best balance, the best harmony, the best proportions of the mouth in its relation to the other features require that there shall be a full complement of teeth & that each tooth shall be made to occupy its normal position - i.e. normal occlusion.  Angle developed classification of malocclusion based on this principle – ‘Dental Cosmos’ in 1899. www.indiandentalacademy.com
    • Angle’s postulates  Upper first molars are the key to occlusion.  Most remarkably stable landmark in craniofacial anatomy – upper first molars.  Upper & lower molars should be related so that the mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar.  Line of occlusion – The line with which, in form & position according to type, the teeth must be in harmony if in normal occlusion. www.indiandentalacademy.com
    • Angle’s classification has 4 classes: www.indiandentalacademy.com
    • On being asked about his ‘discovery’ of the constancy of the upper first molar Angle said – “I though about it & I thought about it & all at once it came to me. Anybody who disagrees with me must be a fool”.  Angle was influenced by Rousseau & the German physiologist Wolff. www.indiandentalacademy.com
    •  Rousseau emphasized the perfectability of man.  This led Angle to believe that every person has the potential for an ideal relationship of all 32 natural teeth. www.indiandentalacademy.com
    •  German physiologist Wolff discovered in early 1900s that the internal architecture of bone responds to stresses placed on that part of the skeleton.  So Angle reasoned that if the teeth were placed in proper occlusion, forces transmitted to the teeth would cause bone to grow around them & stabilize them even if a great deal of arch expansion had www.indiandentalacademy.com occurred.
    • Angle consulted the famous artist of the day Professor Wuerpel for the ideal facial form. Wuerpel ridiculed that it is impossible to specify any one facial form as ideal. Hence Angle concluded that the ideal facial esthetics for a person would result when the teeth were placed in ideal occlusion for that person. www.indiandentalacademy.com
    •  Angle stated “The idea of a postgraduate school was forced upon me because I wished to see those who had a desire to study orthodontia better receive the opportunity to do so”.  Angle had commenced informal instructions in orthodontia in his office in 1900. www.indiandentalacademy.com
    • He placed the following advertisements for the Angle School of Orthodontia – “For the fitting of teachers & specialists in orthodontia. Two short sessions are held each year, beginning Nov 1st & May 1st. Postgraduates in dentistry & only those thoroughly ethical, received. Class limited to 15 members. For information, address Edward H. Angle, MD, DDS, 1107 North Grand Ave., St. Louis, Mo.” www.indiandentalacademy.com
    • Course of instruction included art, rhinology, embryology, histology, comparative anatomy & dental anatomy in addition to Angle’s appliances. Among his early students were Dewey, Pullen, Mershon, McCoy, Oppenheim, Weinberger & Fred Noyes. www.indiandentalacademy.com
    • In May 1900 at a banquet in Dr. Angle’s office, the students & teachers decided that “the time was ripe” for an Orthodontic Society. Thus was born ‘The American Society of Orthodontists’. On June 11, 1901, 10 charter members elected Angle as president. www.indiandentalacademy.com
    • The constitution of the society had these 3 articles – 1st – confirmed the name 2nd – to establish ‘science of orthodontia’ as a distinct dental specialty. 3rd – invited ethical dentists with a special interest in orthodontia to become active members. www.indiandentalacademy.com
    • In his presidential speech, Angle – paid his respects to Norman Kingsley, John Farrar, Simeon Guilford, Calvin Case, Henry Baker, Rodrigues Ottolengui, Victor Hugo Jackson & others, who helped extricate orthodontics from the web of prosthetics. hit at politics in dental organization- ‘bane & cause of dry rot within organizations.’ www.indiandentalacademy.com
    • emphasized that the ultimate development of orthodontia will not come about until the present rotten & disgraceful method of dental education is abolished & supplanted by correct principles which reject the damnable practice of extracting first molars. www.indiandentalacademy.com
    • 1 among the 2 women of the 10 charter members was Anna Hopkins of St. Louis. Later became Anna Hopkins Angle – “Mother Angle”. Cecil Steiner said “She was a suitable counterfoil for Edward H. & also she was the power behind the throne”. www.indiandentalacademy.com
    •  1907 – moved his school to New York.  1908 – moved his school to New London, Conn., 6 week sessions at 200$ till 1911.  Decided to give up practice of orthodontia & devote himself to study, teaching & development of better appliances.  1916 – made Pasadena, California their permanent home to avoid the hardships of Eastern winters. www.indiandentalacademy.com
    • James Angle – first student of Edward H. Angle College of Orthodontia in California. 1922 – Graduates of Pasadena, St. Louis & New London formed the Edward H. Angle Society. No officers, no bylaws, society run by Angle. www.indiandentalacademy.com
    • Angle attended the last society meeting on June 1928 in New London, Conn. The society ceased to exist after his passing away in 1930. Nov 17, 1930 – society reorganized & restarted from former members. www.indiandentalacademy.com
    • At this meeting ‘The Angle Orthodontist’ was born. Mrs. Angle – Editor-in-chief. First official address by Charles Tweed on “The History & Revision of Arizona Law”. www.indiandentalacademy.com
    • 1907-E -Arch Appliance  Simplicity.  Heavy interrupted forces.  Tipping of teeth to new position.  Not possible to precisely position any www.indiandentalacademy.com individual teeth.
    • 1912-Pin and Tube Appliance  Move the teeth bodily.  ‘Bone growing appliance’.  Capable of great precision in tooth movement.  Incredible degree of craftsmanship.  Impractical in clinical use.  Poor spring www.indiandentalacademy.com qualities.
    • 1915-Ribbon Arch Appliance  First bracket.  Vertically positioned rectangular slot with ribbon arch of 10 x 20 gold wire.  Good spring qualities.  Allowed versatile movements.  Unable to achieve mesiodistal tipping movements.  Not possible to provide stabilization or anchorage of posterior teeth.  Did not allow towww.indiandentalacademy.com torque roots to a new position.
    • 1928-Edgewise Appliance  ‘Latest and the best’.  Rectangular wire of 0.022 x 0.028 inch inserted in a horizontal slot.  Excellent control of crown & root position in all three planes of space.  Mastered complex metallurgy & had immense knowledge of noble metals. www.indiandentalacademy.com
    • Angle-The controversial man  Possessed extraordinary technical skills, very inventive mind & an unbending, uncompromising, maverick nature.  His national stature, his close relations with members of the medical profession & his writings served to create jealousies among dental faculties.  ‘incestuous interquote’- a term coined by Doris Graber, political scientist. www.indiandentalacademy.com
    •  ‘New school’ of orthodontics - Angle’s gospel of non-extraction, expansionist, occlusion-oriented orthodontic orthodoxy. Dr. Calvin Case-(1847-1923).  Born on April 24 ,1847 in Michigan.  Military service in the civil war.  1871-Graduated from Ohio college of dental surgery. www.indiandentalacademy.com
    •  1884-University of Michigan Medical School.  1890-General Dentistry in Chicago & Professor of Prosthodontic Dentistry & Orthodontia at the Chicago College of Dental Surgery.  1892-First to stress on root movement & used rubber elastics in treatment.  Rehabilitation of cleft palate deformities-Case type of obturator still in use. www.indiandentalacademy.com
    • Case was a genuine admirer of Angle. 1903-The Discord -Angle attributed the origin of the use of intermaxillary elastics to Baker. The ‘Bombshell’ - Case reintroduced the concept of removal of certain teeth to enable correction of malocclusion and improve general health. www.indiandentalacademy.com
    • The Great Extraction Controversy of 1920s Martin Dewey (1881-1933).  Born in 1881, Kansas.  1902-attended one of the first classes of Angle school of orthodontics.  1914- ‘Practical orthodontics’ - orthodontic philosophy and mechanical procedures.  1911-Dewey school of www.indiandentalacademy.com orthodontia.
    • 1915-with Dr.C.V. Mosby, Dewey founded and became editor of the International Journal of Orthodontia (now AJO). Editor for 17 years. 1931 - President of ADA. Merciless in fighting for truth and against the empiricism of the day. ‘Science Knows No Friends’. www.indiandentalacademy.com
    •  1911-Annual meeting of the National Dental Association now ADA.  Debate between Dewey & Case-one of the most sharpest and most heated controversies.  But Angle & his followers won the day.  Extraction of teeth for orthodontic purpose essentially disappeared from the orthodontic scene in the period between the two world wars. www.indiandentalacademy.com
    •  Angle’s unbending anti-extraction, expansionist, dogmatic philosophy may have hindered as much as helped orthodontic development.  His students blindly & uncompromisingly followed the leader.  Angle died on August 11, 1930 but his influence is still felt very strongly in orthodontics.  “I have finished my work, it is as perfect as I can make it”. www.indiandentalacademy.com
    • 1900-1910  Era of manufacture of standardized appliances.  Dental supply companies sold appliances made as sets, dentists could make required fitting by soldering. Victor Hugo Jackson (1850-1929)  Pioneer of removable appliances in US.  Jackson's crib-Auxiliary spring (finger).  1904 - ‘Orthodontia and Orthopedia of the face’. www.indiandentalacademy.com
    • Benno Lischer (1876-1959)  1912 - ‘Principles & methods of Orthodontia’.  Translated Paul Simons German book ‘Diagnosis of Dental Anomalies’.  Stressed relationship between muscles, malformation & malocclusion.  “It is my firm belief that irreparable damage is done by oft repeated advice to wait until the permanent teeth are all erupted before beginning operations for correction of malocclusion”. www.indiandentalacademy.com
    • 1910-1920 1911 - Albin Oppenheim - Serious study of tissue changes during orthodontic tooth movement. John. V. Mershon (1867-1953) introduced removable lingual arch based on the principle that teeth must be free & unrestricted for adaptation to normal growth. www.indiandentalacademy.com
    • Albert. H. Ketcham - (1870-1935)  Devoted researcher & great pioneer.  1902 - Graduate of Angle School of Orthodontics.  First to introduce Roentgenogram & Photography  An inveterate reader & deep thinker questioned some of Angle’s arbitrary pronouncements.  A great teacher & guide- ‘Ketcham Seminar’. www.indiandentalacademy.com
    • Milo Hellman (1873-1947) Angle’s student. 1912-Research in Anthropology & its relation to the growth & development of human dentofacial complex. www.indiandentalacademy.com
    •  Linked development of human dental occlusion to evolution of dentition as whole.  1935 - Introduced craniometric measurements & classification of dental development.  Believed in biologic concept & scientific method.  “Perfection is the goal, adequacy is the standard”. www.indiandentalacademy.com
    •  1922 - James. D. Mc Coy introduced open tube appliance. 1928- George Crozat developed Crozat appliance precious metal, Class II elastics employed with Crozat appliance to treat Class II malocclusions. www.indiandentalacademy.com
    •  Spencer Atkinson introduced Universal appliance – a combination of ribbon arch appliance & edgewise appliance using a flat wire & round wire in combination. www.indiandentalacademy.com
    •  1924 - Paul Simons studies of facial bones, introduced orbital-canine rule, Gnathostatics.  1929 - American board of Orthodontics was created, incorporated in the state of Illinois in 1930.  American Board of Orthodontics established specialty's most coveted prize- ‘The Albert. H. Ketcham memorial. www.indiandentalacademy.com
    • 1930-1940  1931 – Holly Broadbent published in the first issue of Angle Orthodontist – ‘A New X-ray Technique & Its Application to Orthodontia’.  Introduced cephalometric roentgenography, cephalometric tracing & evaluation.  ‘Bolton point’ – a new point of reference on skull in honour of his sponsor. www.indiandentalacademy.com
    •  1938 – Joseph Johnson introduced twin arch appliance.  1940 – Oren A. Oliver introduced labiolingual appliance. www.indiandentalacademy.com
    • Part II Contents  Parallel developments in Europe.  Back in U.S. (1940-1950).  The Merger.  Evolution of Biomaterials in Orthodontics.  Summary of Appliances.  History of BOS.  History of EOS.  Indian History.  Emerging trends in Orthodontics. www.indiandentalacademy.com
    • Parallel developments in European Orthodontics American Orthodontics – Fixed appliances European Orthodontics – Removable appliances www.indiandentalacademy.com
    • 3 reasons – 1. Angles dogmatic approach to occlusion – less impact in Europe. 2. Social welfare systems developed rapidly. 3. Precious metal for fixed appliances less available. 2 types of devices – 1. ACTIVE PLATE 2. ACTIVATOR www.indiandentalacademy.com
    • Development of the Active Plate  1839 – Charles Goodyear invented vulcanite.  1881 – Coffin plate by Coffin.  1902 – ‘Monobloc’ by Pierre Robin. – Single block of vulcanite. – To prevent glossoptosis in micromandible & Cleft lip & palate patients. www.indiandentalacademy.com
    • 1908 – Hawley’s retainer appliance. www.indiandentalacademy.com
    • 1911 – J.H. Badcock - expansion plate with screw. Next 3 decades eclipsed by Angle’s fixed appliances. Only Hawley retainer stayed. www.indiandentalacademy.com
    • 1929 – European orthodontic society meeting in Heidelberg – C.F.L. Nord presented simple screw split plates. 1936 – 9th International Dental Congress in Vienna - M.Tischler - sophisticated active plates. www.indiandentalacademy.com
    • A.M. Schwarz Biologist, scientist, cephalometrician, clinician & teacher. 1938 – ‘Lehrgang der Gebissregulung’ Orthodontic bible in Europe. www.indiandentalacademy.com
    • ‘Schwarz double plate’ - combination of activator & active plate for treatment of class II div 1. www.indiandentalacademy.com
    • Philip Adams in Belfast Adams crib Basis for English removable appliances www.indiandentalacademy.com
    • Britain – simple removable plates. Central Europe – functional appliances. European criticism of British orthodontics – 1. Overemphasis of simple treatment. 2. Undergraduate orthodontics. 3. Disunity among British orthodontists. www.indiandentalacademy.com
    • Development of the ‘Activators’ Simple appliances using muscle forces Group I – forces transmitted directly to teeth. – Ex: Inclined planes Oral screens Lip bumpers www.indiandentalacademy.com
    • Group II – Activate muscles attached to the mandible. Ex: – Andersen – Häupl activator. – Herbst appliance. – Bionator. – Bimler appliance. www.indiandentalacademy.com
    • Group I Appliances INCLINED PLANE  Catalan, more than 200 yrs ago.  Developed into – Oppenheim splint. - Hawley type retainer with splint. www.indiandentalacademy.com
    • VESTIBULAR SCREEN Newell in 1912 Advocated by Nord, Hotz, Kraus & Fingeroth. www.indiandentalacademy.com
    • Group II Appliances Norman Kingsley in 1879 – bite plate to ‘jump the bite’. Modified by Ottolengui. Combined with fixed appliances – Herbert A. Pullen, J.Lowe Young & Oren A. Oliver. www.indiandentalacademy.com
    • ‘Plane & Spur’ retention – Angle’s sliding device fitted to upper & lower first molars. ‘Vorbisskronen’ – crowns on upper & lower second deciduous molars by A.M. Schwarz. Pin & tube sliding device of Herbst. www.indiandentalacademy.com
    • 1918 – Alfred P. Rogers - exercises for development of muscles of face to increase functional activity. First to recognize importance of muscles for growth & development. Importance of lip exercises – Hotz, Duyzings & Frankel. www.indiandentalacademy.com
    • The Andresen – Haupl Activator Unaware of Pierre Robin’s Monobloc. Correcting sagittal malrelationships in the growing child by changing the functional pattern of stomatognathic system. Modified retainer after correction distocclusion for his daughter. www.indiandentalacademy.com of
    • 1908 - Introduced Activator. www.indiandentalacademy.com
    • 1925 – director of orthodontic department of Dental School in Oslo. Karl Haupl – pathologist, periodontist, eminent scientist. Andresen & Haupl – wrote about their appliance & interpretations of its actions. ‘Functional Jaw Orthopedics’. ‘Activator’ – ability to activate muscle forces. ‘The Norwegian System’. www.indiandentalacademy.com
    • 1909 – Herbst presented ‘Scharnier’ or joint - fixed bite-jumping device at International Dental Congress in Berlin. 1934 – Herbst & Schwarz - series of articles.  Uses – 1. For treating Class II malocclusions. 2. Facilitate healing after mandibular ramus fractures. 3. T.M.D. – clicking & bruxism.  After 1934 - appliance forgotten. www.indiandentalacademy.com
    • Most frequently used activator modification – Bionator by Balters. Tongue as the essential development of dentition. www.indiandentalacademy.com factor for
    • H.P. Bimler – myodynamic appliance. Expanding the maxillary arch by cross wise transmission of transverse mandibular movements. ‘elastischer Gebissformer’ – ‘Oral adaptor’. Combined active & passive components. www.indiandentalacademy.com
    • Stockfish Kinetor. www.indiandentalacademy.com
    • Early 1950s – Reitan’s research on actual effect of functional appliances. Schwarz’s division of forces too theoretical. Force effect related to anatomical environment & time factor. www.indiandentalacademy.com
    • Back in the U.S. – 1940-1950 Charles Tweed (1895-1970) 1941 – introduced edgewise appliance based on basal bone concept. www.indiandentalacademy.com
    • Graduated from improvised Angle course by George Hahn in 1928. Worked with Angle for 7 weeks to write an article in Dental Cosmos. Returned to Arizona – First pure edgewise specialty practice in U.S. + Non-extraction. www.indiandentalacademy.com
    • Discouraging results in patients during retention. Dedicated 3 yrs in study of results. Upright mandibular incisors on basal bone. Prepare anchorage + Extract teeth www.indiandentalacademy.com
    • Tweed’s contributions – 1. 4 objectives of orthodontic treatment with emphasis for facial esthetics. 2. Upright mandibular incisors over basal bone. 3. Acceptance of judicious extraction of teeth. 4. Clinical application of cephalometrics. www.indiandentalacademy.com
    • 5. Tweed’s diagnostic facial triangle. 6. Introduced anchorage preparation. 7. Serial extraction of primary & permanent teeth.  Tweed philosophy. www.indiandentalacademy.com
    • 1945 – H.D. Kesling, used a rubber tooth – positioning device. 1947 – Danish orthodontist, Arne Bjork published ‘The Face in Profile’ – anthropologic & radiographic study of effects of variations in jaw growth using facial diagnosis. J.A. Salzmann – classification of malocclusion for handicapping problems. www.indiandentalacademy.com
    • 1948 – Cephalometric Analysis by William Downs. Significance – 1. Objective method of portraying underlying factors. 2. Causes of malocclusion exclusive of teeth. www.indiandentalacademy.com
    • Other analyses – 1. C.C. Steiner (1953) 2. C.H. Tweed (1953) 3. S.E. Coben (1955) 4. R.M. Ricketts (1966) 5. V.Sassouni (1969) 6. H.D. Enlow (1969) 7. J.R. Jarabak (1970) 8. A. Jacobson (1975) www.indiandentalacademy.com
    • The Merger ‘50s & ‘60s – dissolution of crosscontinental barriers. Egil Harvold – faculty at University of Toronto, introduced ‘Norwegian system’ in U.S. Frantisek Kraus of Prague – introduced ‘Double oral screen’. Combination of oral & vestibular screen. www.indiandentalacademy.com
    • Vestibular screen not allowed to touch teeth, extended to the mucosal transitional folds.  Precursor of Frankel Philosophy. www.indiandentalacademy.com
    • Rolf Frankel – Frankel Function Regulator in 1950s. Appliance confined to oral vestibule – shields buccal and labial musculature away from teeth & investing tissues. Exercise device – eliminates lip trap, hyperactive mentalis, aberrant buccinator & orbicularis oriswww.indiandentalacademy.com action.
    • Prof. Rudolf Hotz, Zurich – Vorbissplatte / guide plane plate / forward biting plate / removable inclined plane plate. Refined propulsor Muhlemann. conceived www.indiandentalacademy.com by
    • 1977 – Pancherz resurrected Herbst appliance. Add here Oct. 1979 AJO – stimulation of mandibular growth by Herbst appliance. Severe Class II malocclusions. www.indiandentalacademy.com
    • 1977 – Clark’s Twin Block. Rapid functional correction of malocclusion. www.indiandentalacademy.com
    • In Europe  Fixed appliances replaced removable appliances. Introduction of bonding. - Raymond Begg of Australia introduced multiple-loop, light-force wire appliance. www.indiandentalacademy.com
    • P.R. Begg Born on October 13th, 1898 Coolgardie, Western Australia.  1923 – B.D.S. from Melbourne University, – L.D.S. from Victoria.  1924 – Angle School of Orthodontia, Pasadena. www.indiandentalacademy.com in
    • Begg & Fred Ishii – first to treat patients with Angle’s ‘new appliance’. Nov. 1925 - returned to Adelaide. - Edgewise mechanism + nonextraction. Serious relapses & poor post-treatment profiles. Feb. 1928 – began extraction. Edgewise – no rapid closure of extraction spaces. www.indiandentalacademy.com
    • Combined edgewise bracket & round archwires – undesired root movements. Ribbon arch brackets with slot facing gingivally. Early 1940s – Arthur J. Wilcock, metallurgist at University of Melbourne. Modified ribbon arch brackets, lock pins, special buccal tubes & Australian stainless steel. www.indiandentalacademy.com
    • Natural wear of teeth in Australian aborigines. 1939 – Doctoral dissertation – ‘The Evolutionary Reduction & Degeneration of Man’s Jaws & Teeth’. 1954 – ‘Stone Age Man’s Dentition’. - Attritional occlusion. - New ‘round wire’ technique – 0.018” round stainless steel archwires in modified ribbon arch brackets. www.indiandentalacademy.com
    • 1956 – Differential force concept. 1957 – H.D. Kesling visited Begg. Return to U.S. – ‘Begg Technique’ practice with Dr. Robert A. Rocke. www.indiandentalacademy.com
    •  Demand for organised training in U.S.  1959- first course in Begg technique at Kesling & Rocke Orthodontic Centre in Westville, Indiana.  Begg Revolution.  1964 – North American Begg Society of Orthodontists. www.indiandentalacademy.com
    •  CONVENTIONAL / TRADITIONAL BEGG – Technique outlined by Begg & Kesling.  MODIFIED BEGG – Begg principle with brackets other than ribbon arch bracket.  REFINED BEGG – Current Begg practice using same Begg brackets – Mollenhauer, Wagers, Sims, Hocevar, Swain, Kameda & Dr. Jayade. www.indiandentalacademy.com
    • Integrated Orthodontics Advantages of Begg technique1. Light continuous forces. 2. Rapid alignment, leveling & rotation of anterior teeth. 3. Rapid overbite correction. 4. Simultaneous crown tipping retraction of all anterior teeth. 5. No extraoral force necessary. www.indiandentalacademy.com
    • Advantages of Straight Wire Appliance – 1. Precise control of premolar & molar torque. 2. Bilateral symmetry. 3. Straight wires. 4. Precise control of finishing in both arches in all 3 planes. 5. Stabilization of teeth during final detailing. www.indiandentalacademy.com
    • Begg principles applied through – 1. Unmodified edgewise brackets. 2. Modified edgewise brackets. 3. Combination of Begg & Edgewise bracket. 4. Alternative use of Begg & Edgwise bracket. Unmodified edgewise brackets – 1. Ackerman et al 1969, 1975. 2. De Angelis 1976. www.indiandentalacademy.com
    • Modified edgewise brackets – 1. Perlow 1967. 2. Hocevar ‘Bedditiot’ 1985. 3. Kesling – Tipedge 1988. www.indiandentalacademy.com
    • Combination of Begg & Edgewise bracket – 1. Universal brackets 1928. 2. Begg Chun Hoon 1960. 3. Fogel Magill 1963. 4. Thompson Bracket. 5. Jayade – J Bracket www.indiandentalacademy.com
    • Levern Merrifield Tweed course in 1953. 1970 – Course director. Reliable, precise, efficient & practical protocol of diagnosis & treatment. Sequential Directional Force Technology. 7th objective of Tweed-Merrifield philosophy – clinical objectives pursued in ethical, moral & compassionate manner with concern for public’s welfare. www.indiandentalacademy.com
    • T.M. Graber Born in St.Louis on May 17th 1917. Graduation – Washington University, St.Louis. Army Medical Regiment in II World War. Orthodontics – Northwestern University. 1950 – First PhD to Dentist by Northwestern University Medical School. www.indiandentalacademy.com
    • 20 textbooks, 22 chapters in other textbooks, 180 publications in journals & 930 book & journal abstract reviews. 1964 – Kenilworth Dental Research Foundation. Editor-in-chief of AJO for 15 years. Changed to AJO-DO. www.indiandentalacademy.com
    • Joseph R. Jarabak One of the earliest authors to describe the mechanics of treatment. Introduced Jarabak cephalometric analysis. www.indiandentalacademy.com
    • Jarabak Ratio First to introduce combination of tip & torque in edgewise bracket. Combination of loops in edgewise treatment – 0.016 Elgiloy round wire. www.indiandentalacademy.com
    • Jarabak Light-wire Edgewise Technique  ‘Light-wire’ – 1. Small cross-section geometrics – Dewey, Atkinson & Johnson. 2. Light forces. - Vertical loop appliance by Storey & Smith in 1952. - Begg in 1956. Precursor to pre-adjusted edgewise appliance. www.indiandentalacademy.com
    • Lawrence F. Andrews Father of pre-adjusted bracket system. Nature’s best-120 non-orthodontic normal cases. 6 keys of occlusion – 1972. Orthodontia’s best – 1150 treated cases. www.indiandentalacademy.com
    • Mismatch due to – 1. Bracket siting variable. 2. Wire bending inconsistencies. 3. Wire bending side effects.  Answer not in wire but in bracket.  Straight Wire Appliance. www.indiandentalacademy.com
    • Robert Ricketts Developed the bioprogressive therapy from a background of edgewise and Begg technique. Introduced utility arch. Use of preformed bands. Ricketts’ Quad Helix – 0.40 blue elgiloy wire. www.indiandentalacademy.com
    • Cephalometric analysis & cephalometric growth prediction technique. Computerized cephalometrics for VTOs & STOs. E-line. 1982 – American Institute of Bioprogressive Education. www.indiandentalacademy.com
    • Terrel L. Root Level Anchorage System – straight wire appliance with anchorage preparation as described by Holdaway. To reach predetermined goals routinely. Step-by-step treatment procedure for 7 nonextraction & extraction choices. Timing & self check chart. www.indiandentalacademy.com
    • ‘Vick’ Alexander  1964 – University of Texas.  1978 – Vari-Simplex Discipline.  Philosophies – 1. Efforts = Results. 2. ‘Altruistic egoism’ – Dr. Hans Selye.  Advocated the word ‘Retractor’ for headgear, introduced by Fred Schudy. www.indiandentalacademy.com
    • Charles Burstone Notable authority on Biomechanics.  Introduced TMA, Chinese NiTi, Fibre reinforced composite. Holography & Occlusograms. Surgical planning analysis – COGS. Segmented arch technique. www.indiandentalacademy.com
    • Ronald Roth  Roth’s interests – 1. Functional dynamics. 2. To prove treatment not harmful for patients. 3. To disprove premolar extractions not good for TMJ health.  Roth prescription – 2nd generation preadjusted brackets. www.indiandentalacademy.com
    • Bennett, McLaughlin and Trevisi Re-examined Andrew’s SWA bracket system. MBT brackets-3rd generation preadjusted brackets. Others – Moyers, Proffit, Holdaway, Woodside, McNamara, Williamson, Swain www.indiandentalacademy.com etc.
    • Evolution of Biomaterials in Orthodontics Earliest material documented – Gold ligature wire, Roman tomb in Egypt. Fauchard – Silk thread. Delabarre (1819) – Wire crib. Schange – Gold wire crib. Kingsley – Elastic straps, forged Stubb’s steel, swaged silver. www.indiandentalacademy.com
    • Angle era – Gold, platinum, silver, steel, gum rubber; wood, ivory, zinc, copper, brass. Wrought alloys – Springiness, fewer cracks at tension points. ‘Stainless’ quality first reported by Monnartz in Germany, 1900-1910. Dumas, Guillet & Portevin developed stainless steel in France. www.indiandentalacademy.com
    • I World War Germans - Austenitic British - Martensitic Americans - Ferritic 1930s – Gold & Stainless steel conflicts. ‘Edgewater’ tradition – Edgewater Beach Hotel, Chicago. 1940s – Begg & Wilcox – Australian Stainless Steel. 1960s – Gold abandoned, steel adopted. 1960s – Cobalt-chromium. www.indiandentalacademy.com
    • 1962 – Buelher – NITINOL. Nickel-Titanium Naval Ordnance Laboratory. 1977 – Titanium-Molybdnum Alloy (β-III). 1986 – Japanese NiTi-Fujio Miura. Copper NiTi-Rohit Sachdeva. Ni-free, Titanium-Niobium finishing. www.indiandentalacademy.com wires for
    •  Acrylic-1937.  Vulcanite, Cellulose, Phenolformaldehyde, Vinyl polymers, Styrene, Alkyl resins.  Plastic brackets – Aromatic polymer / polycarbonate, single-crystal polycrystalline alumina / zirconia. www.indiandentalacademy.com sapphire,
    • Recent advances in materials 1. Self – ligating brackets. 2. Composite – ceramic+polymer advantages. 3. Bonding – adhesive pre-coated brackets. 4. Curing – Light emitting diodes, Plasma arc lights (Xenon), Laser lights (Argon laser). www.indiandentalacademy.com
    • Summary Pierre Fauchard 1728 Bandlette Etienne Bourdet 1722-1789 Ivory splint Catalan -- Inclined plane Charles Goodyear 1839 Vulcanite Schange 1841 Adjustable clamp band Tucker 1846 Rubber elastics Dwinelle 1849 Jacks screw Emerson Angell 1860 Expansion of palate Coffin 1860 Flexible piano wire Kingsley 1861 Headgear Magill 1870 Dental cement E.H. Angle 1880 Jack & traction screw 1887 Angle system E.H. Angle www.indiandentalacademy.com
    • E.H. Angle 1889 Classification of malocclusion Pierre Robin 1902 Monobloc E.H. Angle 1907 E-Arch Charles Hawley 1908 Retainer Andresen 1908 Activator Balter -- Bionator H.P. Bimler -- Myodynamic appliance John Mershon -- Removable lingual arch E.H. Angle 1912 Pin & tube appliance Newell 1912 Vestibular screen E.H. Angle 1915 Ribbon arch appliance www.indiandentalacademy.com
    • James McCoy 1922 Open tube appliance Paul Simon 1924 Gnathostatics E.H. Angle 1928 Edgewise appliance Spencer Atkinson -- Universal appliance George Crozat 1928 Crozat appliance Broadbent 1930 Cephalometrics Herbst 1934 Herbst appliance Joseph Johnson 1938 Twin-arch appliance Oren A. Oliver 1940 Labio-lingual appliance Tweed 1941 Edgewise-Tweed philosophy H.D.Kesling 1945 Positioner C.P. Adams 1948 Adam’s crib www.indiandentalacademy.com
    • Martin Schwarz -- Schwarz double plate Hotz -- Guide plane plate William Downs 1948 Down’s analysis Kraus -- Double oral screen Hotz -- Propulsor P.R. Begg 1956 Begg technique Jarabak -- Light-wire technique Rolf Frankel 1967 Frankel appliance Andrews 1972 Straight wire appliance Ricketts -- Bioprogressive therapy T.L. Root -- Level anchorage system Pancherz 1977 Herbst appliance Clark 1977 Twin block Alexander 1978 Vari-Simplex Discipline www.indiandentalacademy.com
    • British Orthodontic Society Disunity among British organizations – 1. British Society for Study of Orthodontics (1907). 2. Consultant Orthodontists Group (1964). 3. British Association of Orthodontists (1965). 4. Community Orthodontists Section (1978)  July 1st 1994 – British Orthodontic Society. www.indiandentalacademy.com
    • European Orthodontic Society Founded on 16th May 1907 by 10 charter members. First meeting – 27th Sept. 1907. President – Dr. W.G. Laws. Dr. E.H. Angle elected honorary member. Meetings discontinued between 1914-1919 & 1939-1946. www.indiandentalacademy.com
    • Indian History Oldest orthodontic department – Nair Dental College, Bombay. M.D.S. – 1959 Nair Dental College & Govt. Dental College, Bombay. Study group in Bombay in 1963. www.indiandentalacademy.com
    • Indian Orthodontic Society – Oct. 5th 1965. www.indiandentalacademy.com
    •  7 visionaries – Dr. Prem Prakash, Dr. H.D. Merchant, Dr. H.S. Sheikh, Dr. A.B. Modi, Dr. K.N. Mistri, Dr. Naishadh Parikh, Dr. Mohandas Bhat. Journal of Indian Orthodontic Society, 1965. First annual conference – 1967 in New Delhi. P.G. convention every year since 1996. www.indiandentalacademy.com
    • Library & first Dental Museum in India, 1998. Free Dental Specialty Centre, Vellore – Aug. 1999. Indian Board of Orthodontists – 1998. Member of World Federation of Orthodontics (San Francisco, U.S.A. 1995). www.indiandentalacademy.com
    • Emerging Trends in Orthodontics 1. 2. 3. 4. Shift in paradigms. Technology driven practice. Evolution of newer materials. Changes in research. www.indiandentalacademy.com
    • Shift in Paradigms 1. 2. 3. 4. One phase treatment. Fullness of face. Smile analysis & function. Non-extraction. www.indiandentalacademy.com
    • Technology Driven Practice 1. Computerization. 2. 3D reconstruction 3. Simulation of treatment results. 4. Computerized bracket position. 5. Robots to bend wires. 6. Custom made trays for tooth movement (INVISALIGN). www.indiandentalacademy.com
    • Clinical Practice Scenario 1. Inter-disciplinary approach. 2. Implants reinforcing anchorage. 3. Distraction osteogenesis. www.indiandentalacademy.com
    • “ The longer you look back, the greater you can leap ahead .” www.indiandentalacademy.com
    • References 1. Proffit – Contemporary Orthodontics, II Ed. 2. Proffit – Contemporary Orthodontics, III Ed. 3. Graber, Vanersdal – Orthodontics: Principles & Techniques, II Ed. 4. Graber, Swain – Orthodontics: Current Principles & Techniques, III Ed. 5. T.M. Graber – Orthodontics: Principles & Practice, III Ed. 6. Strang – Textbook of Orthodontia, I Ed. 7. Graber, Rakosi, Petrovic – Dentofacial Orthopedics & Functional Appliances, I Ed. 8. Graber, Neumann – Removable Orthodontic www.indiandentalacademy.com Appliances, I Ed. Current
    • 9. McLaughlin, Bennet, Trevisi – Systemized Orthodontic Treatment Mechanics. 10. New Vistas in Orthodontics, III Ed. 11. Dr. V.P. Jayade – Refined Begg for Modern Times. 12. Jarabak – Jarabak Lightwire Technique. 13. Alexander – Alexander Discipline. 14. George Hahn: History & Philosophy of Edward H. Angle Society of Orthodontia – 25th Anniversary of the Society, Chicago, Nov. 6th 1955. 15. T.M. Graber: An Orthodontic Perspective After 75 years, AJO, May 1976, Vol. 69, No. 5. www.indiandentalacademy.com
    • 16. T.M. Graber: The Past as a Prelude to the Future – Part IV, Heritage Lecture at AAO. 17. Milton Asbel: A Brief History of Orthodontics, AJOBO, Sept. 1990, Vol. 98, No. 3. 18. Dr. V.P. Jayade: Personal Perception of 3 ‘Ps’ of Indian Orthodontics – 32nd IOS Conference, Bangalore. 19. Claude Matasa: Angle, the Innovator, Mechanical Genius & Clinician, AJO-DO, 2000, Vol. 117, No. 4. 20. Lee Graber: Vignette – T.M. Graber, AJO-DO, May 2000, Vol. 117, No. 5 21. Dr. V.P. Jayade: Integrated Orthodontics. 22. Dr. Chetan Jayade: Emerging Trends in Orthodontics. www.indiandentalacademy.com
    • Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com