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

HISTORY OF ORTHODONTICS

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INDIAN DENTAL ACADEMY
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Contents
Part I
Introduction
History of Dentistry
Evolution of Orthodontics
Historical perspective of biophysical aspects.
American Orthodontics – Pre-Angle Era.
– Angle Era

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.

“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


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.


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.


Baltimore College of
Dental Surgery – first
dental college in the
world – opened its
doors to a class of 5
students on Nov 3rd,
1840.

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’

 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.

 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.

 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”.

“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
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.

Crude appliances designed to regulate teeth
have been found as archaeologic artifacts in
tombs of ancient Egypt, Greece & the
Mayans of Mexico.


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’.

 Exceptionally accurate
plates.
 Perfect understanding of
growth & development
of jaws & their relations
to the muscles of
mastication.
 Scientific nomenclature
– Incisors, Cuspids &
Bicuspids.

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.

 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.

 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.


 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.


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.

 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.

 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.

 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.

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.

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.

 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.

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.

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.

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.

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

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.

Simple anchorage.
Tipping movement.
Lacked stability.
No effective way to firmly fix it in position
on the teeth.


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.

1841- Schange a Frenchman invented the
adjustable clamp band with introduction
of a lingual screw.


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.


1861 – Coffin introduced flexible piano
wire.
1861 – Kingsley introduced the headgear to
apply extraoral force & provide occipital
anchorage.


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.

 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.

 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.

Practice of orthodontics altered forever with
the invention of dental cement by Magill of
Erie, Pennsylvania.


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.

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.

 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.

Experienced many technical problems &
frustrations in treatment which irritated,
motivated & inspired him to develop a
standard appliance.


 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.

 1880 – “First real appliance” – the jack & traction
screw with pushing action.

 Combination of adjustable clamp band of Schange
& regulating screw of Dwinelle.

1887 – introduced the Angle System.


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.

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.

 “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.


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.

Angle’s classification has 4 classes:


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.

 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.


 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
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.

 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.


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.”

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.

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.

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.

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.’

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.


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”.

 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.

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.

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.


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”.


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.

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.

 ‘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.


 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.

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.

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
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’.

 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.

 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”.

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’.


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”.

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.

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’.


Milo Hellman (1873-1947)
Angle’s student.
1912-Research in Anthropology & its
relation to the growth & development of
human dentofacial complex.


 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”.


 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.


 Spencer Atkinson introduced Universal appliance –
a combination of ribbon arch appliance & edgewise
appliance using a flat wire & round wire in
combination.


 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.

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.


 1938 – Joseph Johnson introduced twin arch
appliance.

 1940 – Oren A. Oliver introduced labiolingual
appliance.


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.

Parallel developments in European
Orthodontics
American Orthodontics – Fixed appliances
European Orthodontics – Removable
appliances


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

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.

1908 – Hawley’s retainer appliance.


1911 – J.H. Badcock - expansion plate
with screw.
Next 3 decades eclipsed by Angle’s fixed
appliances.
Only Hawley retainer stayed.


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.


A.M. Schwarz Biologist,
scientist,
cephalometrician,
clinician & teacher.
1938 – ‘Lehrgang der Gebissregulung’ Orthodontic bible in Europe.


‘Schwarz double plate’ - combination of
activator & active plate for treatment of class
II div 1.


Philip Adams in Belfast Adams crib
Basis for English removable appliances


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.

Development of the ‘Activators’
Simple appliances using muscle forces Group I – forces transmitted directly to teeth.
– Ex: Inclined planes
Oral screens
Lip bumpers


Group II – Activate muscles attached to the
mandible.
Ex: – Andersen – Häupl activator.
– Herbst appliance.
– Bionator.
– Bimler appliance.


Group I Appliances
INCLINED PLANE
 Catalan, more than 200 yrs ago.

 Developed into – Oppenheim splint.
- Hawley type retainer with splint.

VESTIBULAR SCREEN
Newell in 1912
Advocated by Nord, Hotz, Kraus &
Fingeroth.


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.

‘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.


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.

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.

of

1908 - Introduced Activator.


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’.

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.

Most frequently used activator modification
– Bionator by Balters.

Tongue as the essential
development of dentition.

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.


Stockfish Kinetor.


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.


Back in the U.S. – 1940-1950
Charles Tweed (1895-1970)
1941 – introduced edgewise appliance based
on basal bone concept.


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.

Discouraging results in patients during
retention.
Dedicated 3 yrs in study of results.
Upright mandibular incisors on basal bone.
Prepare anchorage + Extract teeth

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.

5. Tweed’s diagnostic facial triangle.

6. Introduced anchorage preparation.
7. Serial extraction of primary & permanent
teeth.
 Tweed philosophy.

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.

1948 – Cephalometric Analysis by William
Downs.

Significance –
1. Objective method of portraying underlying
factors.
2. Causes of malocclusion exclusive of teeth.

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)

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.

Vestibular screen not allowed to touch teeth,
extended to the mucosal transitional folds.

 Precursor of Frankel Philosophy.


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


by

1977 – Pancherz resurrected Herbst
appliance. Add here
Oct. 1979 AJO – stimulation of mandibular
growth by Herbst appliance.
Severe Class II malocclusions.


1977 – Clark’s Twin Block.

Rapid functional correction of malocclusion.

In Europe  Fixed appliances replaced removable
appliances.
Introduction of bonding.
- Raymond Begg of Australia introduced
multiple-loop, light-force wire appliance.

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.

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.

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.

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.

1956 – Differential force concept.
1957 – H.D. Kesling visited Begg.
Return to U.S. – ‘Begg Technique’ practice
with Dr. Robert A. Rocke.


 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.

 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.


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.

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.

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.

Modified edgewise brackets –
1. Perlow 1967.
2. Hocevar ‘Bedditiot’ 1985.
3. Kesling – Tipedge 1988.


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


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.

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.

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.

Joseph R. Jarabak
One of the earliest authors to describe the
mechanics of treatment.
Introduced Jarabak cephalometric analysis.


Jarabak Ratio

First to introduce combination of tip &
torque in edgewise bracket.
Combination of loops in edgewise treatment
– 0.016 Elgiloy round wire.

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.

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.

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.


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.

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.

‘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.

Charles Burstone
Notable authority on Biomechanics.
 Introduced TMA, Chinese NiTi, Fibre
reinforced composite.
Holography & Occlusograms.
Surgical planning analysis – COGS.
Segmented arch technique.

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.

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.

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.

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.

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.

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.

wires

for

 Acrylic-1937.
 Vulcanite, Cellulose, Phenolformaldehyde,
Vinyl polymers, Styrene, Alkyl resins.
 Plastic brackets – Aromatic polymer /
polycarbonate,

single-crystal

polycrystalline alumina / zirconia.


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).


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


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


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


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


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.

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.

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.


Indian Orthodontic Society – Oct. 5th 1965.


 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.

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).

Emerging Trends in Orthodontics
1.
2.
3.
4.

Shift in paradigms.
Technology driven practice.
Evolution of newer materials.
Changes in research.


Shift in Paradigms
1.
2.
3.
4.

One phase treatment.
Fullness of face.
Smile analysis & function.
Non-extraction.


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).

Clinical Practice Scenario
1. Inter-disciplinary approach.
2. Implants reinforcing anchorage.
3. Distraction osteogenesis.


“ The longer you look back, the greater
you can leap ahead .”


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
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.


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.

Thank you
Leader in continuing dental education


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