Aims, scope & global history of orthodontics /certified fixed orthodontic courses by Indian dental academy


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Aims, scope & global history of orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. AIMS, SCOPE & GLOBAL HISTORY OF ORTHODONTICS INDIAN DENTAL ACADEMY •Leader in continuing dental education •
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  8. 8. If there is defect in the soul , it can’t be corrected on face, but if there is defect on the face…and one corrects it, it can correct a soul. -Jean Cocteau
  9. 9. What is Orthodontics All about ?? The word “ ORTHODONTICS “ is derived from Greek words Orthos : correct Odontos : teeth
  10. 10. In 1922, the British Society for Study of Orthodontics has defined the specialty as “Orthodontics ” includes study of growth and development of jaws and face particularly and body generally as influencing position of teeth; study of action and reaction of internal and external influences on the development ; prevention and correction of arrested and perverted development”
  11. 11. According to AAO : “Area of dentistry concerned with supervision ,guidance and correction of growing and mature dentofacial structure including those conditions that require movement of teeth or correction of malrelation and malformation of related structure, by adjustment of relationship between and among teeth and facial bone, by application of force or stimulation and redirection of functional forces within craniofacial complex .”
  12. 12. AIMS & OBJECTIVES CASE(1921): To correct MO to normal function and esthetic relationship and to beautify facial form. ACKERMAN & PROFFIT(1970): To establish optimal proximal and occlusal contact of teeth within the framework of acceptable facial esthetics ,normal function and reasonable stability.
  13. 13. LINDQUIST(1985): To improve facial esthetics, to align the teeth evenly ,to create good occlusal relationship; static and functional; to obtain psychological benefits; to maintain healthy supporting structure and to produce stable dentition. ROTH : To serve patients need in 5 categories of facial esthetics, dental esthetics, functional occlusion, pdl health and stability
  14. 14. According to JACKSON: 1 .Functional efficiency 2. Structural balance 3. Esthetic harmony Ajo 1958
  15. 15. Structural balance Orofacial region consists of dentoalveolar system, skeletal tissue and soft tissue including musculature. It depends upon on the correct proportion of the tooth substance to bone development when latter has reached its growth limit in order to permit satisfactory alignment of teeth .
  16. 16. Functional efficiency It depends upon correct relationship of teeth to each other and their orientation to skull as a whole to permit a satisfactory excursion of the mandible in function of mastication .
  17. 17. Esthetic harmony: It is a matter of proportion in shape, size and orientation of dental organs as a whole in their relationship to other facial factors.
  18. 18. This goal is not ‘just cosmetic’…. It reflects the patient’s desire to improve their social acceptability and eliminate discrimination based on appearance, which can affect their quality of life greatly.
  19. 19. The goal of orthodontic treatment To improve patient’s life by enhancing dental and jaw function and dentofacial esthetics. From this perspective… Role of orthodontic treatment is analogous to that of several other medical specialities such as plastic surgery and orthopedics,in which patient’s problem often doesn’t result from disease but distortion of development.
  20. 20. An orthodontist must visualise what he wants to do Roger’s idea --- Mechanical advantage -- “Optimal occlusal relation”
  21. 21. SOCIAL AND PSYCHOLOGICAL ASPECT OF PHYSICAL ATTRACTVENESS AND ITS RELEVANCE TO DENTISTRY IS ORTHODONTICS JUSTIFIED AS A PROFESSION ??? although we can’t easily justify routine treatment from a physical dimension ,we can justify from social and psychological dimension.
  22. 22. Spirit Mind Body
  23. 23. In late 1970 and early 1980’s people wearing ortho appliance were percieved by their peers and general public as less socially desirable than those who didn’t wear them . But today, it is somewhat a status symbol to wear ‘brackets’. Clear and colored brackets, even glow in the dark and colored elastics offer many choices.
  24. 24. PLUNKETT wrote : Psychological well being is an intangible benefit to society as a whole. Morally ,there must be some provision for orthodontic treatment for those people , where it is shown that treatment improves their quality of life.
  25. 25. NEED FOR ORTHODONTIC TREATMENT 1. Irregular teeth 2. Predisposition to periodontal diseases Studies in late 90’s on a large no of patients done and no evidence of beneficial effect of orthodontic treatment on future pdl health was demostrated as would have been be expected. An individual willingness and motivation determine oral hygiene plays a major role than how well the teeth are aligned.
  26. 26. 3.To close diastema 4. Mouth breathing 5. Correction of speech defects 6. Risk of trauma: Class II malocclusion
  27. 27. 7. Bruxism 8. Tmj probs: deep bite, occlusal prematurities. 9. Surgical treatment for congenital defects : Cleft lip and palate. 10 .Correction of shifted teeth, prior to construction of bridges and partial dentures.
  28. 28. Skeletal problems Skeletal problems result not from malpositioned teeth or well proportioned jaws but from disproportion in size or position of jaws themselves. Occurs in all three planes
  29. 29. Sagittal
  30. 30. Horizontal
  31. 31. Vertical
  32. 32. Mainly: 1. Esthetics 2. Psychological disturbance It is found that well aligned teeth and pleasant smile carry positive status while irregular and protruding teeth carry negative status.
  33. 33. Study was also done to investigate whether young adults with varying dental esthetics and history of orthodontic treatment also differ in oral health attitudes and preventive behaviour (by Ulrich Klages,Aladar Bruckner AJO 2005;128:442-9) Found that previous treatment and favorable esthetics might be an important variable in explaining individual difference
  34. 34. RUTZEN : Studied 250 patients , 5yrs after they had completed orthodontic treatment . It is found that those who were treated made significantly more positive assessment of their appearance.
  35. 35. SCOPE & SERVICES OFFERED Orthodontic treatment involves three main tissue systems concerned in dentofacial development : Dentition Skeletal -Restraining,Promoting,Redirecting Facial and jaw musculature
  36. 36. SERVICES OFFERED Preventive Orthodontics Interceptive Orthodontics Corrective Orthodontics A. Surgical orthodontics: B. Camouflage C. Comprehensive D. Adjunctive Orthodontic treatment
  37. 37. SERVICES OFFERED Preventive Orthodontics Prevention is better than cure Actions taken to preserve the integrity of what appear normal for that age  Space maintainence  Check up for oral habits and habit breaking appliance if required
  38. 38. Interceptive Orthodontics Procedure undertaken at early stage of MO to eliminate or reduce the severity of the same, in order to prevent establishment of full fledged MO that may require long term orthodontic treatment at later age. o Control of abnormal habits Interception of skeletal malrelation using myofunctional appliance
  39. 39. Corrective Orthodontics A. Surgical orthodontics: Done for patient with no remaining growth potential and severe malocclusion. Dentofacial orthognathic surgeries are the major surgical procedures carried out along with orthodontic therapy. Require a team approach with oral surgeon and orthodontist being imp member of team
  40. 40. Currently a new technique of bone generation in craniofacial region termed Distraction Osteogenesis has been introduced. It is a biologic process of new bone formation between osteotomised bone segments that are seperated gradually by incremental traction. Traction force is applied to bone segments,creating a tensional stress in repairative callus that joins the divided bone segments.
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  44. 44.  Distraction Histiogenesis-sequence of adaptive changes. 1. Regeneration following disruptive and degenerative changes. 2. Neohistogenesis as a result of generalized cellular proliferation and growth.
  48. 48. B) Camouflage Bringing the teeth in proper occlusion without correcting jaw discrepancy. Underlying skeletal discrepancy be corrected by orthodontic tooth movement. Successful for adolescents with moderate problems. Not useful 1. In transverse or vertical skeleton problems 2. Severe class II and III
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  50. 50. C) COMPREHENSIVE Acc to Proffit, It implies orthodontic treatment which would take more than six months duration. Done with fixed appliances.
  51. 51. Major stages: 1.Alignment and levelling 2.Correction of molar relationship and space closure 3.Finishing
  52. 52. D) Adjunctive Orthodontic treatment It facilitates restorative treatment by repositioning the teeth so that more ideal and conservative technique can be used. 1.Repositioning teeth that have drifted. 2. Forced eruption of badly broken Teeth.
  53. 53. IDEAL ORTHODONTIC SERVICE Pre Appliance Guidance Interceptive 20% Preventive 10% Partial corrective Mechanotherapy 25% 45% Full corrective Mechanotherapy
  54. 54. WHY HISTORY IS IMPORTANT ?? If anyone has grasped a principle/method of approach which is universal in character, He has in his hand the only weapon applicable to infinite variation. Techniques are mere servants to principle When anyone takes over the techniques of their predecessor without sharing the vision which animated it ,he takes over the mental body but loses its immortal soul
  56. 56. ORTHODONTICS IN GREECE AND ROME The earliest description of irregularities of teeth was given about 400 BC (460377 BC) by HIPPOCRATES.
  57. 57. He commented that‘Among those individuals with long shaped head some have thick necks, strong bones; others have strongly arched palate, their teeth are irregularly arranged, crowding one other and they are bothered by headache and ottorhea’
  58. 58. • AURELIUS CELSUS (25 BCAD 50 ) • 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”.
  59. 59. GAIUS PLINUS SECUNDUS(23-79AD) Suggested filing elongated teeth to bring them into proper alignment
  60. 60. MIDDLE AGES (5th -15th centuries) TO THE 18th CENTURY The first mention of practicing dentistry was exclusively made by Pierre Dionis(1658-1718) He called dentists ‘Operator for the teeth’ and stated that they could also open or widen the teeth when they are set too close
  61. 61. Beginning in the 18th century, leading country in the field of dentistry was FRANCE. Efforts of one man: PIERRE FAUCHARD (1678-1761) ‘Father of Modern Dentistry’
  62. 62. MATTHAEUS PURMANN first to report taking wax impression. Malocclusions were called ‘irregularities’ of the teeth ,and their correction was termed ‘regulating’
  63. 63. In 1728 ,he published the general work on dentistry, 2 volumes entitled ‘THE SURGEON DENTIST :A TREATISE ON THE TEETH’ Fauchard described ,but probably was not the first to use ,the bandeau expansion arch ,
  64. 64. Consists of horse shoe shaped strip of precious metal to which teeth are ligated. This became the basis of Angle’s E arch. He also repositioned teeth with a ‘pelican’ forcep and ligated the tooth to neighbors until healing took place.
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  66. 66. BOURDET (1722-1789): First record of recommending serial extraction First to practice lingual orthodontics, expanding arch from the lingual side
  67. 67. JOHN HUNTER (1728-1793) Not a dentist An English anatomist and surgeon, took keen interest in anatomy of teeth and jaws.
  68. 68. His text -‘THE NATURAL HISTORY OF HUMAN TEETH’ in 1771 presented the first clear statement of orthopedic principles. • First to describe normal occlusion to attempt to classify the teeth • Gave teeth names like cuspidati and bicuspidati • First to describe growth of jaws
  69. 69. Disapproved extracting primary teeth to permit permanent teeth to erupt. But advocated first permanent molar is the tooth to be sacrificed if there is insufficient room in the jaw for all teeth. Maintained that teeth do not grow throughout life time, only appear longer because antagonist is missing.
  70. 70. EUROPEAN PIONEERS OF EARLY 19TH CENTURY JOSEPH FOX(1776-1816) Influential student of Hunter, devoted four Chapters to the book , ‘The Natural history and Diseases of Human Teeth’ to the budding science of orthodontics. First to classify malocclusion (1803)
  71. 71. Was interested in the judicious removal of deciduous teeth,treatment timings,and use of bite blocks to open bite . His other appliances included expansion arch and chin cup(1802)
  72. 72. First to observe that mandible grows mainly by distal extension beyond the molars, with little or no increase in the anterior region. Acc to Weinberger, Fox was the first to give explicit directions for correcting the irregularities
  73. 73. DELABARRE(1787-1862, FRENCH) Introduced the crib and principle of lever and screw(1815) He separated the crowded teeth by means of swelling threads or wooden wedges placed between the teeth
  74. 74. He sharply and justifiably rejected the premature extraction of deciduous teeth. He gave early description of kind of band appliances fixed to tooth turned on its axis. Achieved bite block through wire screen put in area of molar area.Teeth were repositioned with silk threads.
  75. 75. i JOACHIM LEFOULON  Gave a name ORTHODONTOISE(1841) Which roughly translates into Orthodontia.  First to combine labial arch to lingual arch.
  76. 76. He took first step from orthodontics towards jaw orthopedics. The vault of the palate and the dental arches are not unchangable as was believed for long time. He used spring action gold arch designated as passive spring. Method was neither painful nor annoying.
  77. 77. FRIEDRICH C.KNEISEL(1797-1847,German) First to use removable appliances when he fitted his prognathic patient with a chin cap. He used the gold spring as an inclined plane. This modification of inclined plane marks the limit of his orthodontic therapy.
  78. 78. ROBINSON    Regarded maintenance of deciduous teeth as best preventive measure. Devoted 32 pages of his textbook to the “Irregularity of teeth” For expansion of jaws he fitted plate with a hinge at it centre and two traverse springs pressed the dental arch and alveolar process apart.
  79. 79. TOMES(1859) • Was the first to demonstrate bone resorption and apposition • He and Kneisel worked together and used various removable appliances.
  80. 80. ALEXIS SCHANGE (1807,French) In 1841 published the first work confined to orthodontics He introduced modification of screws and the clamp band
  81. 81. Most imp idea is his demand that pulling arrangement can be anchored principally on several molars which are generally bound together with gold clamp and that mechanical immobilisation of what have been achieved so far be carried out for long time He coined the term Anchorage First use of rubber bands
  82. 82. AMERICAN PIONEERS OF EARLY 19th CENTURY Josiah Flagg(1763-1816) • Advertised that he “regulates teeth from their first teeth,to prevent fever in children ,assist nature in extension of the jaws ,for a beautiful arrangement of second set of teeth”
  83. 83. LEONARD KOECKER (1728-1850) Offered to supply ligatures to ‘teeth of an irregular position’ Was an advocate of early treatment J S. GUNNEL Invented occipital anchorage in 1822 SOLYMAN BROWN Through the efforts of Solyman Brown in 1839, the American Journal of Dental Science was established
  84. 84. • Invention of vulcanite by Charles Goodyear in1839. • E.G tucker : first american to use rubber bands(1846). • Baker used it to provide intermaxillary force.
  85. 85. ENTERING THE MODERN ERA: EARLY 1900 S . In the early 1900s ,groundbreaking scientists ,built the orthodontic edifice brick by brick. NORMAN W.KINGSLEY(18251896): Edward H. Angle referred to Kingsley ‘’Orthodontia’s greatest genius” • Born on 2nd Oct 1829. • Joined Dr. A.W. Kingsley, Pennsylvania. • 1852 – first office in Oswego,
  86. 86. • 1859 – made his first obturator. • Prosthetic restorations for cleft patients restored normal speech, improved facial appearance 1865 – founder & first dean of New York University College of Dentistry. 1871 – Honorary degree from Baltimore College of Dental Surgery.
  87. 87. After 1850, appeared: the most notable was Kingsley’s book ,A Treatise on “Oral Deformities(1880)” Cleft palate prostheses. Artificial replacement of missing parts. External immobilization. Over 100 articles on Cleft palate rehabilitation. Inadequacies of cleft palate surgery. Obturators. Orthodontic diagnosis. Orthodontic appliances.
  88. 88. Described “Jumping the bite”(1880) Main objective was not to protrude lower teeth, but to change or jump the bite in case of excessively retreating lower jaw
  89. 89. Further , clinical trials by Kingsley and others demo difficulty of holding lower Jaw in forward position Was seldom used except some modifications Vorbissplate (hotz) Hawley biteplate Herbst a.pullen, j.lowe young,oren oliver combined with fixed appliance
  90. 90. • AMOS WESTCOTT : first to use telescopic bar in maxilla to correct crossbite (1859) • He placed chincups in cl III pts • EMERSON C.ANGELL: open mid palatal suture with a split plate(1860)
  91. 91. • WILLIAM E.MAGILL: first to cement (platinum) bands (1871)
  92. 92. 1871 C.R.COFFIN : Kingsley student , reported an expansion appliance which bears his name
  93. 93. He embeded spring action piano wire , bent in shape of ‘w” into vulcanite plate seperated the plate in the middle, and activated the springs so that its halves pressed the alveolar process to the outside.
  94. 94. JOHN NUTTING FARRAR: Begin the era of biologic tooth movements. First to use occipital anchorage to retract anterior teeth (1850)
  95. 95. He recommended bodily movements of teeth (1888) He originated the theory of intermittent forces and developed a screw to deliver this force in a controlled increments
  96. 96. His treatise on “irregularites of teeth and their correction” (1888) is considered a great work devoted exclusively to orthodontics. He has been called “Father of American orthodontics”
  97. 97. • EUGENE S. TALBOT(1847-1925) • First to use roentgen rays in orthodontic diagnosis • He stressed the study of causes of MO especially constitutional and hereditary factors,as key to treatment
  98. 98. • He was the first to suggest possible cause of deformities and proposed that all MO pt are either “neurotics, idiots, degenerates or lunatics” led to much antagonism • was the first dentist to specialise in both orthodontics and periodontics
  99. 99. 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.
  101. 101. CALVIN CASE (1847-1923) • Military service in the civil war. • 1871-Graduated from Ohio college of dental surgery. Wrote a practical treatise on “Technics and principles of Dental Orthopedia” (1897) and wrote 123 articles • First to use along with Henry Baker Class II elastics and was the first to attempt bodily movt .
  102. 102. 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 deformitiesCase type of obturator still in use.
  103. 103. • CONTRARY to Angle ,Case used diff type of appliance for each pt and stressed facial esthetics in contrast to Angle’s reliance on occlusion • He advocated changing the name of speciality to ‘Facial Orthopedia’
  104. 104. Case’s 1911 paper provoked acrimonious debate that came to be known as “Great Extraction v/s non extraction debate”
  105. 105. • First to use light wires (.016-.018) • Advocated extraction to correct facial deformities In doing so ,He incurred the wrath of Angle and his disciple
  106. 106. • Case used headgears for cleft patients and other • His greatest contributions to be prosthetic correction of cleft palate. Considered ‘big fours’ in orthodontics
  107. 107. EDWARD H. ANGLE (18551930)
  108. 108. • Casto stated--Through his influence,orthodontics emerged from a speculative or empirical state to the position of an exacting science”
  109. 109. Born in a farm in Pennsylvania on June 1st, 1855 . Marked ability to improve & create mechanical equipment on the farm. Developed a passion for simplicity in design.
  110. 110. 1878- Graduated from Pennsylvania College of Dentistry. Angle experienced many technical problems and frustrations in treatment which irritated, motivated and inspired him to develop a standard appliance.
  111. 111. He believed that an orthodontic appliance must have 5 properties• Simple • Stable • Efficient • Delicate • Inconspicuous
  112. 112. 1880 – “First real appliance” – the jack & traction screw with pushing action. Combination of adjustable clamp band of Schange & regulating screw by Dwinelle.
  113. 113. “Angle system” (1887) It marked the beginning of a relationship between the manufacturers, the suppliers and the orthodontists. •The Angle system A, B - traction screws; C, D – attachment tubes; E, J – jackscrews; L – lever wires, F, H – archwire; W - wrench band material; G –
  114. 114. • 1887 – Appointed to Chair of Orthodontia in dental department of University of Minnesota. • Conveyed through his paper, ‘Notes on Orthodontia with a New System of Regulation & Retention’ at 9th International Medical Congress. • 1887 – Ohio Journal of Dental Science.
  115. 115. 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.
  116. 116. “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.
  117. 117. Maxillary first permanent molar - stable landmark in craniofacial anatomy. When asked about the story of his “discovery” of the constancy of the upper first molar, Angle said “I thought about it and I thought about it, all at once it came to me. Anybody who disagrees with me must be a fool !”
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  119. 119. Rousseau – perfectability of man Angle consulted the famous artist of the day Professor Wuerpel for the ideal facial form.
  120. 120. APOLLO
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  122. 122. German physiologist Wolff
  123. 123. 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.
  124. 124. 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.
  125. 125. In May 1900 at a banquet in Dr. Angle’s office, the students & teachers decided that the time was ripe for an Orthodontic Society. ‘The American Society of Orthodontists’. On June 11, 1901, 10 charter members elected Angle as president.
  126. 126. 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”.
  127. 127. ‘Mother Angle’ later became secretary of American society of orthodontics, a founding co editor of the ‘Angle orthodontist, and honorary chair of the Angle society executive committee
  128. 128. 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.
  129. 129. 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. Angle attended the last society meeting on June 1928 in New London, Connecticut. The society ceased to exist after his passing away in 1930. Nov 17, 1930 – society reorganized & restarted from former members.
  130. 130. 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”.
  131. 131. 1907-E -Arch Appliance The heavy archwire was supplied in 4 designs, depending on treatment plan 1. Basic E arch - used in mandible with Baker anchorage
  132. 132. 2. Ribbed E Arch - for expansion • Simplicity. • Heavy interrupted forces. • Tipping of teeth to new position. • Not possible to precisely position any individual teeth.
  133. 133. 3. E Arch without threaded ends – attached ball in incisor area for high-pull headgear
  134. 134. 4. E Arch with hooks – moved maxillary dentition distally and mandibular dentition mesially through intermaxillary elastics.
  135. 135. 1912 Pin and Tube Appliance Incredible degree of craftsmanship. Impractical in clinical use. Poor spring qualities.
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  137. 137. 1915-Ribbon Arch Appliance Vertically positioned rectangular slot with ribbon arch of 10 x 20 gold wire. Good spring qualities. Allowed versatile movements.
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  139. 139. 1928 - Edgewise Appliance 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.
  140. 140. GENIUS ECCENTRIC : Angle was a maverick and not a “team man”. His bluntness and quick temper were hardly diplomatic assets. He hated the petty rivalries, jealousies and personal animosities in dental schools, yet he engendered them. His national stature, his close relations with members of the medical fraternity and his writings served to create jealousies among dental faculties
  141. 141. • Smarting under these personal attacks and jealousies, he subsequently expressed gratitude to only some of his predecessors and contemporaries. “Incestuous interquote”
  142. 142. • All said and done, Angle possessed extraordinary technical skills, a very inventive mind and an unbending, uncompromising nature which truly makes him a mechanical, technical and clinical genius, the repercussions of whose inventions and contributions are strongly felt even today. Very aptly and deservingly he is called the “Father of Modern Orthodontics’.
  143. 143. • Albin Oppenheim (18751945,Angle school,1911) • Serious study of tissue changes during orthodontic tooth movement.
  144. 144. 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”.
  145. 145. 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 orthodontia.
  146. 146. • 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’.
  147. 147. Milo Hellman (1873-1947) • Angle’s student. • 1912-Research in Anthropology & its relation to the growth & development of human dentofacial complex.
  148. 148. • 1935 - Introduced craniometric measurements & classification of dental development. • Believed in biologic concept & scientific method. • “Perfection is the goal, adequacy is the standard”
  149. 149. SIMEON H GUILFORD (1841-1919): • Gnathostatic impression(1914)
  150. 150. He commented in his book “Orthodontia : Malposition of human teeth”, “ His determination to broaden the horizons of orthodontic afford him a distinguish place in the history
  151. 151. 1920 -1930 •1922 - James D McCoy introduced open tube appliance. •Permit movt in MD direction but no torque control.
  152. 152. Albert. H. Ketcham - (18701935) • 1902 - Graduate of Angle School of Orthodontics. • First to introduce Roentgenogram & Photography. • 1926 Comprehensive data on root resorption.. • A great teacher & guide- ‘Ketcham Seminar’. 1929 : President of American Board of Orthodontics
  153. 153. Acc to Pollock, “In early days of orthodontia ,when Angle was leading orthodontics ,It was HE who offerd a harbour to which the stormtossed Orthodontic neophyte could come for encouragement &calm advice” 1936-memorial award To date (2004) 87 people have received the award.
  154. 154. • Spencer Atkinson (1929) • introduced Universal appliance – a combination of ribbon arch appliance & edgewise appliance using a flat wire & round wire in combination. • Great Anthropologist • Gave the term key ridge
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  156. 156. The Great Extraction Controversy P.FAUCHARD & CELSUS :recommended extraction HUNTER :opposed it on the ground that it inhibits growth DELABARRE : It warned against undesirable sequelae
  157. 157. After initially extraction of premolars, KINGSLEY later gave it up. DAVENPORT lectured in New York (1887) CALVIN CASE - : Reintroduced it
  158. 158. ANGLE’s reasons for renouncing it : 1. acceptance of wolff’s law. 2. personal reasons.
  159. 159. CASE : Appeared in Chicago before National Dental Association’s annual meeting in July (1911) with his paper “The question of extraction in Orthodontia” Discussion erupted into full scale debate.. He was supported by impressive argument Matthew Cryer ,a renowned anatomist.
  160. 160. MARTIN DEWEY : Took gauntlet for non extraction and challenged Case. ortho thought,including Early regulation,Heredity, Bone growing and Evolution. But Angle’s follower won the day and for next 30 yrs extraction disappeared
  161. 161. Orthodontist such as John Mershon,Joseph Johnson,George Crozat ,whose appliances relied on non-extraction philosophy,helped perpetuate this philosophy. But by 1930’s dentist were beginning to notice relapse…
  162. 162. AXEL F. LUNDSTROM(1875-1941) Of Sweden, Was the first to analyse relapse. He redefined limits of orthodontics capabilities in his thesis (1923)showing that, when apical base is deficient ,crowded teeth by orthodontic means into accepted normal arrangement will relapse when retainer is removed.
  163. 163. CHARLES H.TWEED (1895-1970, Angle college ,1928) Concerned with dental protrusion and unsatisfied facial esthetics 1940 :at meeting of AAO displaced 100 consecutive cases,
  164. 164. Many others noticed the same effects like • Raymond begg • Strang • Hays N..Nance (1903) : wrote in paper “Limitations of Orthodontic treatment”. He found that treated dentitions return to their original intercanine and intermolar width. Defined leeway space, led to the Nance analysis
  165. 165. Present view of the controversy Supporter of alternatives of extraction claim that only non extraction treatment will result in “full ,pleasing profiles and wide smiles without detrimental dark corners”
  166. 166. Current controversial issue is the belief that… Dished facial profile,narrow smile accompany removal of premolars Bishara studied 91 ortho pts: Study indicates: Both extraction and non extraction had a favorable impact on facial appearance (single strategy can’t fit all faces)
  167. 167. Both appropriately applied extraction and non extracton treatment can produce favorable esthetics results. Key to appropriate treatment is still “Diagnosis”rather than reliance on a particular “philosophy” Katie Harman ,Miss America 2002,stated “I wouldn’t have been Miss America if I had not had ortho treatment, especially removal of teeth”
  168. 168. In fact there are number of faces that feature extraction esthetic such as • • • • • Jennifer Hawkins Diana Princess of Wales Kylie Minogue Renee Zellweger Catherine Zeta Jones
  169. 169. The take home message is not that extraction treatment is universally good ...or that non extraction alternative is bad …. But rather that both produce results for the right patients, and that extraction does not necessarily lead to flattened or long faces, narrow smiles with dark corners
  170. 170. 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.
  171. 171. • 1938 – Joseph Johnson introduced twin arch appliance.
  172. 172. 1940 – Oren A. Oliver introduced labiolingual appliance.
  173. 173. 1940-1950 Charles Tweed (1895-1970) • 1941 – introduced edgewise appliance based on basal bone concept.
  174. 174. • 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.
  175. 175. • Discouraging results in patients during retention. • Dedicated 3 yrs in study of results. • Upright mandibular incisors on basal bone. Prepare anchorage + Extract teeth
  176. 176. 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
  177. 177. 5. Tweed’s diagnostic facial triangle. 6. Introduced anchorage preparation. 6. Serial extraction of primary & permanent teeth. (preorthodontic guidance) • Tweed philosophy.
  178. 178. • 1945 – H.D. Kesling, used a rubber tooth – positioning device. • J.A. Salzmann – classification of malocclusion for handicapping problems
  179. 179. 1948 – Cephalometric Analysis by William B Downs.
  180. 180. 1950-1960 Other analysis’ – 1. 2. 3. 4. 5. 6. 7. 8. C.C. Steiner (1953) C.H. Tweed (1953) S.E. Coben (1955) R.M. Ricketts (1966) V. Sassouni (1969) H.D. Enlow (1969) J.R. Jarabak (1970) A. Jacobson (1975
  181. 181.
  182. 182. 1960-1970 P.R. Begg Born on October 13th, 1898 in Coolgardie, Western Australia. 1923 – B.D.S. from Melbourne University, – L.D.S. from Victoria. 1924 – Angle School of Orthodontia, Pasadena.
  183. 183. Advantages of Begg technique1. Light continuous forces. 2. Rapid alignment, leveling & derotation of anterior teeth. 3. Rapid overbite correction. 4. Simultaneous crown tipping retraction of all anterior teeth. 5. No extraoral force necessary
  184. 184. • 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.
  185. 185. • 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.
  186. 186. • 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.
  187. 187. 1956 – Differential force concept. 1957 – H.D. Kesling visited Begg. Return to U.S. – ‘Begg Technique’ practice with Dr. Robert A. Rocke.
  188. 188. • 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.
  189. 189. • 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.
  190. 190. 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.
  191. 191. 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.
  192. 192. • • • Unmodified edgewise brackets – Ackerman et al 1969, 1975. De Angelis 1976.
  193. 193. Modified edgewise brackets – 1. Perlow 1967. 2. Hocevar ‘Beddtiot’ 1985. 3. Kesling – Tipedge 1988.
  194. 194.
  195. 195.
  196. 196. 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
  197. 197. Levern Merrifield • Tweed course in 1953. • 1970 – Course director. • Reliable, precise, efficient & practical protocol of diagnosis & treatment.
  198. 198. • Sequential Directional Force Technology. • 7th objective of Tweed-Merrifield philosophy – clinical objectives pursued in ethical, moral & compassionate manner with concern for public’s welfare.
  199. 199. T.M. Graber • Born in St.Louis on May 17th 1917. • Graduation – Washington University, St.Louis.
  200. 200. • 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.
  201. 201. • Army Medical Regiment in II World War. • Orthodontics – Northwestern University. • 1950 – First PhD to Dentist by Northwestern University Medical School
  202. 202. Joseph R. Jarabak • One of the earliest authors to describe the mechanics of treatment. • Introduced Jarabak cephalometric analysis.
  203. 203. • First to introduce combination of tip & torque in edgewise bracket. • Combination of loops in edgewise treatment – 0.016 Elgiloy round wire.
  204. 204. 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.
  205. 205. 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.
  206. 206. 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.
  207. 207. 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.
  208. 208. • Cephalometric analysis & cephalometric growth prediction technique. • Computerized cephalometrics for VTOs & STOs. • E-line. • 1982 – American Institute of Bioprogressive Education.
  209. 209. Terrell 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.
  210. 210. ‘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
  211. 211. Charles Burstone • Notable authority on Biomechanics. • Introduced TMA, Chinese NiTi, Fibre reinforced composite. • Holography & Occlusograms. • Surgical planning analysis – COGS. • Segmented arch technique.
  212. 212. 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.
  213. 213. 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 etc.
  214. 214. Angles worms /Angle phobes : Instead of angle philes as they dared To deviate from their master In the fallen Angles group: William brady Martin dewey Frank gray Albert ketcham
  215. 215. • Benno lischer • Mershon
  217. 217. 3. social welfare system developed much more rapidly in europe,which meant that emphasis tended to be on limited ortho treatment for a large no. of people,often delivered by gp rather than ortho specialist 4. economic reason:precious metal for fixed is less available in europe, 5. lack of knowledge of fixed appliance
  218. 218. • IN Europe the “Biological superiority” of RA reinforced due to pioneering work of • Anderson • schwarz • Haupl • Supported by definitive research
  219. 219. • REITAN : • Ojected the above gradation of forces • Stated no such gradation observed in histo section • Acc to him effect of force is more in relation to surrounding anatomical, environment n time factor
  220. 220. • 1881 – Coffin plate by Coffin. • 1902 – ‘Monobloc’ by Pierre Robin. – Single block of vulcanite. – To prevent glossoptosis in micromandible & Cleft lip & palate patients.
  221. 221. • 1908 – Hawley’s retainer appliance
  222. 222. • 1911 – J.H. Badcock - expansion plate with screw. • Next 3 decades eclipsed by Angle’s fixed appliances. • Only Hawley retainer stayed.
  223. 223. 1900-1910 Victor Hugo Jackson (1850-1929) • Pioneer of removable appliances in US. • Jackson's crib-Auxiliary spring (finger). • 1904 - ‘Orthodontia and Orthopedia of the face’.
  224. 224. 1910 -1920 • John. V. Mershon (18671953) introduced removable lingual arch based on the principle that teeth must be free & unrestricted (if otherwise rigidly connected) for adaptation to normal growth i.e First invisible Appliance
  225. 225. •1928- George Crozat Class II malocclusions. •Originally called “Invisible brace”, later became crozat appliance
  226. 226. • 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.
  227. 227. A.M. Schwarz • Biologist, scientist, cephalometrician, clinician & teacher. • 1938 – ‘Lehrgang der Gebissregulung’ Orthodontic bible in Europe.
  228. 228. • ‘Schwarz double plate’ - combination of activator & active plate for treatment of class II div 1.
  229. 229. Philip Adams in Belfast • Adams crib • Basis for English removable appliances
  230. 230. • 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 System’.
  231. 231. • 1909 – Herbst presented ‘Scharnier’ or joint - fixed bite-jumping device at International Dental Congress in Berlin. • 1934 – Herbst & Schwarz - series of articles.
  232. 232. • Uses – – For treating Class II malocclusions. – Facilitate healing after mandibular ramus fractures. – T.M.D. – clicking & bruxism. • After 1934 - appliance forgotten.
  233. 233. • Most frequently used activator modification – Bionator by Balters. • Tongue as the essential factor for development of dentition.
  234. 234. • 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.
  235. 235. • Stockfish Kinetor
  236. 236. • 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.
  237. 237. • European criticism of British orthodontics – 1. Overemphasis of simple treatment. 2. Undergraduate orthodontics. 3. Disunity among British orthodontists
  238. 238. • 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 of distocclusion for his daughter.
  239. 239. • 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.
  240. 240. • Indian Orthodontic Society – Oct. 5th 1965.
  241. 241. 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.
  242. 242. • First annual conference – 1967 in New Delhi. • P.G. convention every year since 1996. • Journal of Indian Orthodontic Society, 1965.
  243. 243. 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).
  244. 244. • Emerging Trends in Orthodontics 1. Shift in paradigms. 2. Technology driven practice. 3. Evolution of newer materials. 4. Changes in research.
  245. 245. • Technology Driven Practice 1. Computerization. 2. 3D reconstruction 3. Simulation of treatment results. 4. Computerized bracket position. 5. Robots to bend wires. 6. 6. Custom made trays for tooth movement (INVISALIGN).
  246. 246. • 1908 - Introduced Activator
  247. 247. • Clinical Practice Scenario Inter-disciplinary approach. Implants reinforcing anchorage. Distraction osteogenesis
  248. 248. 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
  249. 249. 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.
  250. 250. 1. Material Scarcity, Abundance of Ideas (17501930) • Before Angle’s search; • Noble metals and their alloys. - Gold (at least 75%), platinum, iridium and silver alloys   Good corrosion resistance Acceptable esthetics  Lacked flexibility and tensile strength  Inappropriate for complex machining and joining.
  251. 251. • Angle listed few materials appropriate for work:       Strips of wire of precious metals. Wood Rubber Vulcanite Piano wire Silk thread
  252. 252. EVOLUTION OF REMOVABLE APPLIANCE • FROM VERY BEGINNING ,EMPHASIS in america ortho had been on fixed appliance which is unknown in europe • All treatment in europe with removable appliance not only for growth guidane but also for tooth movt of all types. • Reasons?? • • • • • 1. angle dogmatic approach ,to occlusion,with its emphasis on precise positioning of each tooth has less impact in europe than US 2.concerned over inc root resorption
  253. 253. • SCHWARZ • Recognised intimate r/l b/w force magnitude • n tissue response n classifed ortho forces into 4 types of biologic efficiency • 1.below threshold of stimulation • 2. most favorable(15-20g/cm) • 3.interupt bld circulation(20-50) • Conductive to resorption n deposition of alveolar bone • 4.highest magnitude(>50)
  254. 254. HAUPL: BELIEVED IN EUROPEAN “JAW ORTHOPEDIC THINKING” His treatment based on Roux theory on bone formation which gave imp to Trophic stimuli which wud shake bone substance n inc cell activity of osteoclast He claimed that activator provide such stimulus
  255. 255. CHARLES GOODYEAR (1839): Invented vulcanite AT TIME OF WW 2,there were 2 distinctly diff devices which were in use: 1. Activ plate:utilise forces within appliance 2.Activator :utilise muscular forces
  256. 256. Thank you •Leader in continuing dental education •