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History Of Orthodontics

- Orthodontics has evolved from early attempts at correcting irregular teeth in ancient civilizations to becoming a recognized dental specialty. - Key figures like Angle established classifications of malocclusion and appliances like the edgewise bracket. - Debate between extraction vs non-extraction methods occurred between Angle and Case. - Modern orthodontics developed analyses using cephalometrics and understanding of growth.

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History of orthodontics -By Dr.Sumayya Shaikh 1st year MDS Department of Orthodontics and Dentofacial Orthopaedics.
WHY STUDY HISTORY?
Introduction to Orthodontics
Evolution of the term ‘ORTHODONTICS’ Prior to 1900s “REGULATION” Up to 1930s “ORTHODONTIA” by Joachim Le Foulon Up to 1970s “ORTHODONTICS” By Sir James Murray Currently “ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS” by BF Dewel ORTHODONTICS
ORTHODONTICS “ORTHOS” Right or Correct “ODONTOS” Tooth
Definition of Orthodontics NOYES – 1911 First definition - “The study of the relation of the teeth to the development of the face, and the correction of arrested and perverted development.”
THE BRITISH SOCIETY FOR THE STUDY OF ORTHODONTICS – 1922 -“Orthodontics includes the study of the growth and development of jaws and face particularly, and the body generally, as influencing the position of the teeth; the study of action and reaction of internal and external influences on the development, and the prevention and correction of arrested and perverted development.”
THE AMERICAN BOARD OF ORTHODONTICS (ABO) AND THE AMERICAN ASSOCIATION OF ORTHODONTISTS(AAO) -“Orthodontics is that specific area of dental practice that has as its responsibility,the study and supervision of growth and development of the dentition and the related anatomical structures from birth to dental maturity,including all preventive and corrective procedures of dental irregularities,requiring the repositioning of teeth by functional or mechanical means to establish normal occlusion and pleasing facial contours.”
Medicine Dentistry Orthodontic s
Ancient Civilization  Specimens dating back to the eight century BC indicate that Etruscans may have been the first people to employ orthodontics to improve tooth alignment.
 Crude appliances to regulate teeth- recovered among the archaelogical remanants in Egypt,Greece and Mexico.  First dental healers were physicians.  Learned by trial,error and observations.
Sacerdotal Medicine
HIPPOCRATES (460-377 BC)  Father of Medicine.  First to separate medicine from fancy.  ‘Corpus Hippocraticum’ – includes descriptions on irregularity and crowding of teeth.
ARISTOTLE (384-322 BC)  Greek philosopher  Compared various dentitions of different species of animals in his work ‘De Partibus Animalia’ or “On the Parts of Animals.”
GALEN  Anatomist  Classified teeth as bones; said they were unlike other bones.  First to recognize nerves (dental pulp) in the teeth.
ANDREAS VESALIUS  Anatomist.  Dared to correct the errors in Galen’s work.  Gave a much more accurate description of the anatomy of teeth.
Aulius Cornelius Celsus (25 BC–50 AD)  Use of finger pressure for the treatment of incorrectly positioned teeth -‘De Re Medicinia.’  “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 and the new one daily pushed towards its place by means of the finger until it arrives at its just proportion.”
Pliny the Elder (23 AD-79 AD)  Advocated the first mechanical treatment of malaligned teeth by filing elongated teeth.
RENAISSANCE PERIOD (14th – 16th Century) Leonardo da Vinci (1452-1519)  First artist to dissect human body for anatomic knowledge.  Drew accurate pictures of these dissections  First to recognize tooth form and relationship of each tooth to another tooth and to the opposing jaw.  Described maxillary and frontal sinuses.
Leonardo Da Vinci's depiction of a skull.
Andreas Vesalius (1514-1564)  Described minute anatomy of teeth, particularly the dental follicle and eruption pattern of teeth in his book ‘De Corpori Humanis Fabrica’
Ambroise Pare (1517-1590)  First to use obturator for treatment of cleft palate.
Gabrile Fallopio(1523-1562)  An Italian anatomist  “Observationes Anatomica”  A detailed description of dental follicle  Wrote the terms hard and soft palate.
Bartholomaeus Eustachio(1520-1574)  An italian anatomist  Libellus de Dentibus(Book on the teeth) in 1563.
 “ARZEI BUCHLEIN”(A Book of the Surgical Art) published in 1530 AD(author unknown).  “When the teeth begin to drop out…push the new one every day toward that place where the first one was until it sits there and fits among the others.”
EIGHTEENTH CENTURY
World Leader in dentistry
Pierre Fauchard (1678-1761) ‘Founder of Modern Dentistry’
 1728- Le Chirurgien Dentiste (The Surgeon Dentist, A Treatise on the Teeth)- First complete scientific description of dentistry.  Pioneer of Dental Prosthesis  Introduced fillings for cavities  BANDEAU- An expansion arch that became the basis for Angle’s E-arch.  Used “pelican” forceps for repositioning of teeth. BANDEAU PELICAN FORCEP
Etienne Bourdet (1722-1789)  Refined Fauchard’s Bandeau  First to recommend serial extraction (1757) and premolars extraction.  First to practise “lingual orthodontics,” expanding the arch lingually.
John Hunter (1728- 1793)  English anatomist and surgeon  First to describe normal occlusion  Established difference between teeth and bone  First to describe the growth of jaws
NINETEENTH CENTURY
Early Nineteenth Century  Joseph Fox (1814) - First English dental textbook- The Natural History and Diseases of the Human Teeth. First to classify malocclusion. First to give directions for correcting irregularities of teeth.  Le Foulon- First to use the term ORTHODONTIA  James Murray- Coined the term ORTHODONTICS  Delabarre (1819)- Introduced the crib. Separated crowded teeth by means of wooden wedges placed between teeth.  J. M. Alexis Schange (1841)- Published the first work confined to orthodontics Coined the term ‘anchorage’  Kneisel (1836)- FIRST to use plaster models to record malocclusion. FIRST to use a removable appliance. FIRST introduced modern impression trays  Joseph Sigmond (1825)- Recognised habit as factor in Malocclusion  William Imrie (1834)- Thumb sucking as cause of dental abnormalities  Rodrigues (1839)- Abnormal muscle pressure causes malocclusion
Year Author Contribution to Orthodontics 1840 JS Gunnell Introduced chin strap. 1841 William Lintott Introduced the use of screws. 1860 Emerson C Angel Introduced arch expansion by opening midpalatal suture “Father of expansion appliances” 1871 William and Magill Developed molar bands. 1888 and 1889 John Nutting Farrar “Father of American Orthodontics” Wrote “irregularities of teeth and their correction” first exclusive textbook devoted to orthodontics. 1829 to 1913 Norman N Kingsley “Treatise on oral deformities” worked on correction of cleft palate Extraoral traction 1893 Henry A Baker Bakers anchorage(intermaxillary elastics)
Orthodontics In United States
Chapin Harris (1806-1860)  Editor- American Journal of Dental Science.  Gave attention to orthodontics.  Founded BALTIMORE COLLEGE OF DENTAL SURGERY in 1840- FIRST dental college.
John Nutting Farrar (1839-1913)  Father of American Orthodontics  Published series of articles in Dental Cosmos between 1881-1887 stating “The principle that in regulating teeth traction must be intermittent and not exceed fixed limits”  1876- He published FIRST paper about movement of teeth in dentistry.  Originator of theory of intermittent force and FIRST to recommend root or bodily movement.
Norman Kingsley (1829-1913)  FATHER OF ORTHODONTICS  Among the first to use extraoral force to correct protruding teeth  Introduced the term ‘Bite Plane.’  Designed fixed and removable inclined planes to correct Class II Malocclusion.  Also, designed first soft-rubber palatal obturators  “A Treatise on Oral Deformities as a Branch of Mechanical Surgery”- First truly comprehensive Textbook about orthodontic problems and treatments.  Wrote over 100 articles on Cleft Lip and Palate Rehabilitation
Henry Baker (1893)  Bakers Anchorage (Intermaxillary elastics with rubber bands)
Eugene Talbot • Stressed that key to treatment was to study and understand causes of malocclusion. • FIRST to recommend surgical exposure of canines. • FIRST to state endocrine glands as agents in development of malocclusion • FIRST to use X-Rays for orthodontic diagnosis.  One of the EARLIEST attempts in analysis of casts for measurement of jaws.
W.G.A Bonwill  Bonwill Equilateral Triangle  His measurements (2000 cases) showed distance from one condylar process to another is 4 inches and that to the incisors is also 4 inches  Used this in orthodontic treatment
TWENTIETH CENTURY MODERN ORTHODONTICS
EDWARD HARTLEY ANGLE (1855-1930) FATHER OF MODERN ORTHODONTICS  FIRST to limit his practice to orthodontics  Paved way for Orthodontics to be recognised as a specialty.
 1887 - At the Ninth International Medical Congress in Washington, DC, called for the separation of orthodontics from dentistry.  1899 - Angle’s Classification of Malocclusion published in Dental Cosmos.  1900 – Founded the first postgraduate school of orthodontics (Angle School of Orthodontia).  1907 - Founded the first orthodontic journal, The American Orthodontist.
Angles classification of Malocclusion
 E (expansion) Arch Appliance (1907)  Pin & Tube Appliance (1910)
 Ribbon Arch Appliance (1915)  Edgewise Appliance (1925)
Calvin Case (1847-1923)  Did extensive work on Cleft Lip and Palate  Known to have developed Vellum Obturator which allowed wearer to speak clearly  Developed a classification of malocclusion (26) divisions)  Advocated EXTRACTION of teeth  He developed a technique for root movement.  Introduced rubber elastics.  Pioneered the use of retainers and was the FIRST to use thinner, resilient wires for tooth movement.
CASE - ANGLE CONTROVERSY V S
TO EXTRACT OR NOT TO EXTRACT?
EXTRACTION v/s NON-EXTRACTION  In 1911, at the Annual meeting of ADA, the GREAT EXTRACTION DEBATE took place between Angle’s student Dewey and Case. Angle’s proposal and Beliefs-  Ideal facial esthetics would result when the teeth are placed in ideal occlusion.  He believed this can be achieved when the dental arches are expanded so that all the teeth were in ideal occlusion.
Calvin Case  Argued that although the arches could always be expanded so that the teeth could be placed in alignment, neither esthetics nor stability would be satisfactory in the long term for many patients. The Result  Angle followers won- Extraction as treatment modality reduced greatly between World War I & II.
From 1930s to 1970s Charles Tweed  Re-treated the relapse cases with extraction that were previously treated with non- extraction methodology and found occlusion to be more stable. Late 1940s  Extraction reintroduced widely
Dr Martin Dewey (1881-1933)  Champion of Non-Extraction  Founding Editor of International Journal Of Orthodontia  Editor for 17 years  In 1911, established Dewey School of Orthodontics in Kansas City, Missouri  1931- President of ADA
George Ainsworth (1904) – Patented regulating appliance that used vertical tubes and principle of loop wires. Victor Jackson (1850-1929)- Designed JACKSON CRIB,which incorporated finger springs.
Charles Hawley (1861-1929)-  Used celluloid sheet containing a geometric figure that when adapted to a model determined extent of proposed tooth movement  Introduced Hawley’s Retainer.
Benno Lischer (1876-1959)-  Founded International School Of Orthodontics(1907)  Advocated Early Treatment.  Introduced terms ‘neutro-occlusion’, ‘mesio-occlusion, ‘disto-occlusion.’
 Albin Oppenheim(1911)- Serious study of tissue changes during orthodontic treatment  Alfred Rogers(1873-1959)- Introduced concept of myofunctional therapy (1918)  John V. Mershon(1867-1953)- Introduced removable lingual arch  Albert Ketcham(1870-1935)- Founded American Board of Orthodontics President- American Society of Orthodontics(1929).  Milo Hellman(1873-1947)- Introduced classification of dental development and craniofacial measurement Pioneered use of HAND and Wrist X-rays to determine growth age and status for patients Coined the term DIVERGENCE OF FACE
Thomas Graber  20 textbooks  22 chapters in other textbooks  180 publications in journals  930 book and journal abstract reviews 1915- International Journal of Orthodontia and Oral Surgery began publication
1920s  Open tube appliance- James McCoy (1922)  Removable appliance with spring- George Crozat (1928)  Universal appliance- Spencer Atkinson (combination of ribbon arch and edgewise)  Introduction of stainless steel to appliance fabrication- Lucien de Coster
CEPHALOMETRICS  Pacini (1922)- Introduced method for standardised head radiography.  Hofrath (1931)- Introduced standardised cephalometric technique using high-powered X-ray Machine and head holder called CEPHALOSTAT.
Holly Broadbent (1931)  His article A New X-ray Technique and its Application to Orthodontics was the introduction to the specialty and to dentistry of Cephalometric Roentgenography andCephalometric Tracing; Devised CEPHALOMETER.  William Downs(1899-1966)- Introduced cephalometric analysis  Wendell Wylie – Assessment of anteroposterior dysplasia
 Wilton Krogman(1903-1987)- Applied principles of anthropology to dentofacial complex with Craniometry and Cephalometry.  Allan Brodie- Contributed to study of growth patterns of human head.  Weinmann and Sicher- Sutural theory of growth control.  Joseph Jarabak- Introduced Jarabak Cephalometric Analysis.
Charles Tweed (1895-1970) • Student of Dr. Angle in Pasadena. • Chosen by Dr. Angle in preparing Edgewise bracket for introduction and manufacture • Returned to Phoenix to set up FIRST pure edgewise specialty practice in U.S • Initially treated patients without extraction, but was discouraged by results • In 1940, treated 100 patients without extraction and when treatment failed, he treated them with extraction for no additional fee. • Angle gave orthodontics the edgewise bracket, but Tweed gave orthodontists a way to use it.  Under his leadership, extraction was reintroduced in 1940-50s to enhance facial esthetics and occlusal relationships.
 William Wilding- Patent for use of alginate as impression material.  H.D Kesling- Introduced philosophy of tooth movement by using rubber tooth positioning device in which teeth were moved into ideal cuspid relationship after completion of major occlusion.
ALLOYS IN ORTHODONTICS
 Upto 1940- Wrought gold alloys as arch wires  1903- 1921- Brearly, Beckett, Strauss, Maurer shared honors for development of stainless steel  1940s- Austenitic Stainless Steel- Robert Austen  1950s- Type 300 series of stainless steel alloys most used Martensitic Stainless Steel- Adolf Marten Elgiloy- Elgin Watch Company made an alloy of cobalt, chromium, iron and nickel marketed by Rocky Mountain Orthodontics
Buonocore (1955)- Acid Etch Technique Melvin Moss(1960)- Functional Matrix Theory of Growth
 Newmann (1965)- Introduced Bonding.  Wilson and Kent (1972)- Intoduced Glass Ionomer Cement.  Majjer and Smith (1979)- Introduced crystal growth theory to promote bonding (sulfated polyacrylic acid).
Percival Raymond Begg (1898-1983)  Worked with Dr. Angle in 1924-25 after which he began using edgewise.  In 1940s, along with Arthur Wilcock did extensive research and produced a cold drawn, heat treated wire that combined a balance between hardness and resilience with unique property of zero stress relaxation.  In 1954, he described his multiple loop light force round wire technique in Modified ribbon arch brackets.  In 1956, introduced the concept of DIFFERENTIAL FORCE.
 Lawrence Andrews – Straight Wire Appliance (1972)  William Profitt- Author Contemporary Orthodontics (most widely used) Co-author of 2 books on Surgical Orthodontics 125 scientific papers  Peter Kesling (1980)- Tip Edge Appliance (combination of Begg and straightwire appliance)
History of Archwire  George Andreasen (1970s)- Nitinol  Burstone (1980)- TMA (stabilised beta phase titanium alloy)  Tien Hua Cheng (1985)- Chinese NiTi  Miura F et al (1986)- Japanese NiTi  Rohit Sachdeva – Copper NiTi  A.J Wilcock- alpha phase titanium wire  Rohit Sachdeva- Titanium-Neobium finishing archwire  Deva Devanathan- Timolium  Talass (1992)- Optiflex
Removable Appliances
In The United States-  George Crozat- Crozat appliance In Europe-  Martin Schwarz – Split plate appliances  Philip Adams – Adams Clasp/ Modified arrowhead clasp
Functional Appliances
 Roux (1883)- FIRST articulated the principle of functional appliance  Pierre Robin (1902)- MONOBLOC
 Viggo Andresen (1910)- ACTIVATOR  Balters- BIONATOR  Ian Clark- TWIN BLOCK ACTIVATOR TWIN BLOCK BIONATOR
Emil Herbst (1909)  Introduced first fixed functional appliance.  Also developed Quad Helix which was popularised by Ricketts.
 Rolf Frankel (1969-73)- FUNCTIONAL REGULATOR FR 2
FR 3
HISTORY OF FIXED ORTHODONTIC APPLIANCES
 Angle’s progression to the Edgewise Appliance E- Arch Pin and Tube Ribbon arch Edgewise  Begg Appliance - Raymond Begg  Pre-adjusted Edgewise/ Straight Wire Appliance – Lawrence F. Andrews  Tip- Edge Technique – Peter C. Kesling  Lingual Technique – Craven Kurz
E-Arch Appliance (1900)  First design of Angle  Consisted of bands only on the first molars  Wire ligatures tied to a heavy archwire.  Each end of the wire threaded, and a small nut placed on the threaded portion to advance it, to advance arch perimeter.
Pin and Tube Appliance (1910) • Placed bands on other teeth. • Vertical tube on each tooth into which a pin, soldered to the archwire, was placed. • Repositioned the pins.
Ribbon Arch Appliance (1916)  Modified the bracket • Provided a vertically positioned rectangular slot • 10 X 20 gold wire held firmly with pins • Small enough to have good spring qualities • Poor control of root position
THE EDGEWISE APPLIANCE (1928)  Angle reoriented the slot from vertical to horizontal and inserted a rectangular wire “edgewise”— with its greater dimension perpendicular to the long axis of the teeth.  Archwire was tied in place with steel ligatures. The archwire was of .022 x 028-in gold.  First bracket to move teeth in all 3 planes simultaneously.  It soon became the most popular appliance in the United States.
Begg Appliance  Had been taught the ribbon arch appliance at the Angle School .  1925- Returned to Adelaide Used ribbon arch appliances & non- extraction philosophy- Severe relapses- Dissatisfied with the treatment results  1928- Began extraction  Modified Ribbon arch – - Replaced precious metal ribbon arch with 16mil round SS wire - Slot pointed gingivally - Added auxiliary springs for control of root position
Straight Wire Appliance (1970s)  Lawrence F Andrews – 6 keys of occlusion  Modification of edgewise appliance  Rectangular slots similar to edgewise  Pre-programmed brackets  No need for complex wire bending
The Roth Philosophy  Roth introduced a bracket set up containing modifications of the tip, torque, rotations and in-out movements of the Andrew’s standard set up bracket.  Purpose of the Roth Rx- - To reduce the need for a large inventory of bands and brackets. - Over Correction : Roth propagated a therapy goal in which at the end of treatment all teeth were positioned slightly overcorrected and from which the would most likely settle into a non orthodontic normal position. He developed his prescription through trial and error on treated cases, and the Roth Rx was commercially made available in 1975.
MBT •Mclaughlin, Bennett and Trevisi redesigned the entire standard bracket system to complement their proven treatment philosophy and to overcome the inadequacies of SWA. •They re-examined Andrew’s original findings and took into account additional research input from Japanese sources. •This 3rd generation bracket system is designed for use with light continuous forces, lacebacks,bendbacks and sliding mechanics.
Tip-Edge Technique  Introduced by Dr. Peter Kesling  Combined Begg’s light forces with edgewise’s better finishing.  Initial crown tipping done , which greatly facilitates tooth movement, prior to edgewise finishing– Differential Straight Arch Technique Parkhouse R. Tip Edge Orthodontics and the plus bracket. 2nd ed. Elsevier(2009).
Alexander (1978)  "Vari" - variety of bracket types used.  "Simplex" related to the concept of keeping all aspects of the discipline as simple as possible.  Arch wire fabrication and the incorporation of many aspects of treatment options into the brackets (ie, elastics hooks and rotational wings on the brackets) added up to the "simplex" concept.  Based on edgewise philosophy.
Contribution of Indians
Ravindra Nanda  Prof. and Head, Dept of Orthodontics,  University of Connecticut, Farmington.  INNOVATOR.  AUTHOR.  EDITOR.  LECTURER.  AWARDS RECIPIENT.  LIFE MEMBER of IOS.
Bhavna Shroff  Faculty member, Dept of Orthodontics,University of Maryland, Baltimore (1989- 2002).  Currently, Professor, Virginia Commonwealth University.  Research Interests- FUNDAMENTALS MECHANISMS OF TOOTH ERUPTION