Brief introduction and history of orthodontics. Aims, scope, need, services offer by orthodontics and sequels of malocclusion.

1. Dr. Shweta Kolhe
BDS, MDS(Orthodontist).
Introduction To Orthodontics

2. (Greek word)-
- to correct
- teeth

3. • The term “Orthodontia” – coined by Le Foulon (france) in 1839.
• Sir James Murray 1909 suggested that it should be termed
“Orthodontics”
• The term “Orthopedics” was first used by Bunon in the year 1743
with regards to correction of teeth .
• 196 B. F. Dewel suggested that the term dento-facial orthopedics.
• A.F. Talma used the terms “Orthodontics and Dental
Orthopedics” together.
• 1985- Orthodontics and dentofacial orthopedics.

4. • British Society of Orthodontics (1922)
–“Orthodontics includes the study of growth and
development of the 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.”

5. • American Board of Orthodontics (ABO) :
–“Orthodontics is that specific area of the dental profession
that has its responsibility the study and supervision of the
growth and development of dentition and its related
anatomical structures from birth to dental maturity,
including all preventive and corrective procedures of dental
irregularities requiring the repositioning of teeth by
functional and mechanical means to establish normal
occlusion and pleasing facial contours.”

6. Unfavourable sequel of Malocclusion
• Poor facial appearance
• Risk of caries
• Predisposition to periodontal disease
• Psychological disturbance
• Risk of trauma
• Abnormality of function
• Temporo-mandibular joint problems

7. Poor facial appearance – Dental appearance is one of the most
important characteristic of facial appearance.
Risk of caries – Malalignment Difficult oral hygiene
maintenance interproximal caries loss of arch
length crowding of permanent dentition & alter
molar relation.
Predisposition to periodontal diseases – Poor oral hygiene, TFO.

8. Psychological disturbances – self-conscious, introvert T/t increase confidence.
Risk of trauma –severely proclined teeth (overjet more 3mm twice risk)
Abnormalities of function – Deglutition, Defects in speech, improper
respiration, difficulty in biting and chewing.
TMJ Problem – Occlusal prematurity & deep bite pain & dysfunction.

9. Aims of orthodontics / Jackson’s triad

10. Scopes of Orthodontic Treatment:

11. • Alteration in tooth position-
Teeth can be moved through the bone to the ideal locations
by applying force.
• Alteration in skeletal pattern –
skeletal disharmony in size, position & relationship
between jaws. Orthodontist can bring about change in three
plane i.e. sagittal, transverse & vertical.
• Alteration in soft tissue envelope –
soft tissues, envelop the dentition are greatly influenced by
the placement of the dentition.

12. The Need For Orthodontic Treatment
• To improve dento-facial appearance
• To correct the occlusal relationship and function of the teeth
• To eliminate occlusion that could be potentially damaging to
health of teeth and periodontium.

13. Services offered by orthodontics
• Preventive orthodontics
• Interceptive orthodontics
• Corrective orthodontics
• Surgical orthodontics

14. Preventive orthodontics
• Prevention , is better than cure.
• Preventive orthodontics included procedures undertaken prior
to the onset of a malocclusion in anticipation of a developing
malocclusion.
• Actions taken to preserve the integrity of what appears
normal for that age

15. Interceptive orthodontics
• Interceptive orthodontics incudes procedure that are
undertaken at an early stage of malocclusion to eliminate or
reduce the severity of the same.
• By interceptive procedure , is possible to prevent
establishment of a full-fledged malocclusion that may require
long term orthodontic treatment at later age.

16. Corrective orthodontics
• Corrective orthodontics undertaken to correct a fully
established malocclusion.
Surgical orthodontics
• Surgical procedure, undertaken in conjunction with or as an
adjunct to orthodontic procedure.
• Used to remove etiology, T/t severe dentofacial deformities.

17. Brief History of Orthodontics
• Oldest specialty of dentistry
• Attempt to treat malocclusion done as early as 1000 B.C.
• Crude appliances to regulate teeth – recovered among the
archaeological remnants in Egypt, Greece and Mexico.

18. • Specimens dating back to VIII century B.C. indicate Etruscans
may have been the first people to employ orthodontics to
improve tooth alignment

19. Hippocrates (460 BC-377 BC)
• The Greek physician
• A pioneer in medical science.
• A number of references on teeth and
jaws are found in his writing

20. Aristotle (384 to 322 BC)
• Greek philosopher
• First comparative dental anatomist.
• De Partibus Animalium (On the Parts of Animals).
• Noted marked differences between the
dentition among different animals and also
among the species of same animal.

21. Aulius Cornelius Celsus (25BC-50AD)
• Advocated use of finger pressure to
align irregular teeth
• “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”.

22. Claudius Galenus ( 130-200 AD)
• Described dental anatomy and embryology
by specifically identifying the origin,
growth, and development of the teeth and
enumerating the functions of each.
• Pitfall
–He believed the teeth to be true bones.

23. Eighteenth Century

24. • France became the leader in dentistry throughout the world in
the eighteenth century.
• This was primarily attributed to one man, Pierre Fauchard.
• He created order out of chaos, developed a profession out of a
craft.

25. Pierre Fauchard (1678-1761 AD)
• Father of modern dentistry.
• The Surgeon Dentist, A Treatise on the Teeth (1728).
• His book is said to be the first complete scientific
description of dentistry.

26. • He developed the first orthodontic appliance:
bandelette, designed for arch expansion.
• Fauchard described 12 cases of orthodontic
treatment in patients whose ages ranged from
12 to 22 years, with apparently good results.

27. John Hunter (1728-1793 AD)
• A great teacher of anatomy.
• Natural History of the Human Teeth.
• Demonstrated the growth, development, and
articulation of the maxilla and mandible with
the attached musculature.
• Outlined the internal structure of the teeth:
enamel and dentin and their functions.
• Nomenclature of teeth: incisor, bicuspid and
molar.

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

29. • E.G. Tucker (1846) was the first American to use rubber bands
for tooth movement.
• Emerson C. Angell (1860) used a jack screw type of device
between the maxillary premolars in 14 yrs old girl and achieved
and increase in arch width by 1/4th inch in 14 days.
(Father of Rapid Maxillary Expansion.)
• William E. Magill (123-1896) First person to band teeth for
active tooth movement.

30. Chapin. A. Harris (1806-1860 AD)
• Orthodontic tooth movement is a
result of bone resorption on one side
& bone deposition on the other side
of the root.
• Pressure –tension theory
–Schwarz (1932)

31. Norman W. Kingsley (1829-1913 AD)
• “Orthodontia’s greatest genius” –
E.H. Angle.
• Experimented with appliances.
• Fabricated obturator for cleft
patients.
• “Jumping the bite.”
–forerunner of modern functional
appliances.

32. • Introduced the headgear to apply extraoral force & provide
occipital anchorage (1861).
• Emphasized the importance of the relationship between
mechanics and biology as the principle on which orthodontics
should be based.
• Claimed that bending of alveolar bone would take place during
orthodontic tooth movement (1877 AD).
• The first to recommend that etiology, diagnosis, and treatment
planning were the acceptable bases of practice.

33. John Nutting Farrar (1839-1913 AD)
• The Father of American Orthodontics.
• Investigated the physiologic and
pathologic changes occurring in animals
as the result of orthodontically induced
tooth movement.
• The originator of the theory of
intermittent force.
• The first person to recommend root or
bodily movement of the teeth.

34. Edward Hartley Angle (1855-1930)
• Father of Modern Orthodontics.
• Marked ability to improve & create mechanical
equipment on the farm.
• Apprenticed himself to a dentist at his
mother’s request.
• Received his DDS degree from the
Pennsylvania College of Dental Surgery-1878.
• Angle became keenly interested in
orthodontics.

35. • Experienced many technical problems & frustrations in
treatment which irritated, motivated & inspired him to develop
a standard appliance.
• 5 properties of an ideal orthodontic appliance-
1. 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.

36. Angle’s postulates
• Upper first molars are the key to occlusion and the most
stable landmark in craniofacial anatomy.
• Upper & lower molars should be related so that the
mesiobuccal cusp of the upper molar occludes in the buccal
groove of the lower molar.
• The teeth must be in harmony in normal occlusion.

37. The line of occlusion
• The line of occlusion is smooth (catenary)
curve.
• Passing through the central fossa of each
upper molar an across the cingulum of
upper canine and incisor teeth.
• Same line runs along the buccal cusps an
incisal edges of the lower teeth
• Specifies the occlusion as well as inter-
arch relationship.

38. Angle’s classification has 4 classes:

39. Angle’s contribution to orthodontics
• Established orthodontics as a separate branch of dentistry.
• Classified malocclusion-1899
• Established Angle School Of Orthodontics in St. Louis
,Connecticut in 1900 and Pasadena in 1920.
• Founded American Society Of Orthodontics in 1901.
• Developed different orthodontic appliances

40. 1907 - E -Arch Appliance
Simple design.
• Heavy interrupted forces.
• Tipping of teeth to new
position.
• Not possible to precisely
position any individual teeth.

41. 1912- Pin and Tube Appliance
• Move the teeth bodily.
• Capable of great precision in
tooth movement.
• Incredible degree of
craftsmanship.
• Impractical in clinical use.

42. 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.
• Poor control of root position.

43. 1928 - Edgewise Appliance
• ‘Latest and the best’.
• Re-orientation of slot from vertical
to horizontal.
• 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.

44. • 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.

45. Calvin S. Case (1847-1923)
• Graduate of Ohio College of Dental
Surgery.
• First to try bodily tooth movement.
• Pioneered use of retainers.
• Fabrication of obturator for
rehabilitation of cleft lip and palate.
• First to use small gauze, light resilient
wires for tooth alignment.

46. • The climax of this conflict was a debate in 1911 at the annual
meeting of the National Dental Association (former name of
the ADA).
• Dewey(Angle’s Student) Vs. Case:
–one of the most sharpest and most heated controversies.
• Angle & his followers won the day.
• Extraction of teeth for orthodontic purpose essentially
disappeared.

47. Martin Dewey (1881-1933)
• Known for his modification of Angle’s
classification of malocclusion.
• Product of Angle’s school of orthodontics.
• 1911-Dewey school of orthodontia.
• 1914- Book entitled ‘Practical orthodontics.’
• 1915- Founded and became editor of the
International Journal of Orthodontia (now
AJO).
• 1931- president of American dental
association (ADA)

48. Albert. H. Ketcham (1870-1935 AD)
• 1902 - Graduate of Angle School of
Orthodontics.
• First to introduce Roentgenogram
& Photography
• Investigated the problem of root
resorption.
• Founding president of ABO.

49. Milo Hellman (1873-1947 AD)
• Angle’s student.
• demonstrated high percentage of upper 1st
molar rotation and warned in classifying
malocclusion.
• pioneered the use of hand- wrist
radiograph to determine the growth age
and status of the patient.
• 1929 -The American Board of Orthodontics
(ABO) was founded and is the oldest
specialty board in dentistry.

50. Percy Raymond Begg (1898-1983 AD)
• Student of Angle.
• Returned to Australia in 1925.
• Non-extraction + Ribbon arch mechanics
• Poor post treatment profiles and relapses.
• Feb. 1928- started extraction.
• Later started Ribbon arch brackets with slots facing
gingivally.
• Ribbon arch appliance + extraction
Begg technique

51. • Charactristics of Begg’s appliance
– Replacement of precious metal ribbon arch with high strength 16mil
stainless steel wire.
– Retained the original ribbon arch bracket but turned it upside down so
that the bracket slot points gingivally.
– Added auxillary springs to the appliance for control of root position.
• Begg revolution:
– became widely popular (1960s).
– Removed the need for headgear.
– Allowed more efficient tooth movement with less discomfort.
– Used stainless steel wire instead of gold or platinum. (Arthur Wilcock)

52. Charles H. Tweed
• Charles H. Tweed applied to the Angle
school in Pasadena in 1925 but was
refused admittance.
• Angle told him to study and to become
more serious about orthodontics.
• Angle and Tweed worked closely
together for the last two years of
Angle's life.

53. • Tweed made progress records of his patients every 4 months. He
packed the records in a suitcase and took them to Pasadena, where
Angle studied them and outlined a treatment plan for the next 4
months.
• Angle was so pleased with Tweed's work, that he was instrumental in
making it possible for Tweed to be invited to give lectures at several
orthodontic meetings.
• In 1932, Tweed published his first article in The Angle Orthodontics. It
was titled "Reports of Cases Treated with the Edgewise Arch
Mechanism."

54. • Tweed held to Angle's firm conviction that the practitioner
must adhere to the line of occlusion concept and never extract
teeth.
• After 5 years of orthodontic practice, Tweed became
disheartened with his work for two reasons:
– 1) the protrusive faces that he was creating.
– 2) the unstable dentition.
• He resolved to study his many failures and his few successes.

55. • Tweed’s conclusion:
1) The patients who had pleasing
facial balance and harmony also
had mandibular incisors that were
upright over basal bone.
2) The carefully planned extractions
allowed to improve appearance as
well as stability

56. • By 1940 he had records of 100 patients, treated first without
extractions and then retreated with extractions.
• He put these patient records on display at an American Association of
Orthodontists (AAO) meeting.
• “Just put your plaster on the table.“
• Angle gave orthodontics the edgewise bracket, but Tweed gave
orthodontists a way to use it.
• He devoted all 42 years of his professional life to the use and
refinement of Angle's invention, the edgewise appliance.

57. Orthodontics in Europe

58. • 1902- Pierre Robbin devised “Monobloc” made of single
block of vulcanite. It is used to position the
mandible forward in patients with glossoptosis and severe
mandibular retrognathism.

59. • 1908 – Hawley’s retainer appliance was developed.
(Charles. A. Hawley)
• 1911 – J.H. Badcock - expansion plate with screw.

60. A.M. Schwarz
• 1938 – ‘Lehrgang der Gebissregulung’ -
Orthodontic bible in Europe.
• “Removable Orthodontic Appliances‟
(1966)
• “Schwarz double plate”
–combination of activator & active plate.
(class II div I)

61. Philip Adams (1950s)
• modified arrowhead clasp made
by Schwarz into the Adam’s crib.
• Versatile clasp: Basis for English
removable appliances.

62. Development of functional appliances
• Viggo Andresen in Denmark (1908)-
Activator
• Modified Hawley’s type retainer.
• Forward positioning of mandible-for
saggital correction.
• Used for the first time on his own daughter.
• “Biomechanical working retainer”

63. • Later Andersen teamed up with karl Haupl- changes in the
appliances.
• “Functional jaw orthopedics.”
• “Norwegian appliance.”
• Haupl coined the term Activator
– Ability to activate muscles
• Most frequently used activator modification – Bionator by Balters.
(early 1950s)

64. • H.P. Bimler – myodynamic
appliance.
• Expanding the maxillary arch
by cross wise transmission of
transverse mandibular
movements.
• Stockfish Kinetor.

65. • Rolf Frankel of Germany.
• Function Regulator in 1950s.
• Appliance confined to oral
vestibule – shields buccal and
labial musculature away from
teeth & investing tissues.

66. Edward. H. Angle
Raymond Begg
(Conventional Begg)
P.C Kesling
(Tip-edge & tip-edge
plus)
Messias Rodrigues
(simplified straight wire
tech.)
Charles Tweed
(edge-wise)
Lawrence Andrews
(straight wire) 1st generation
Ronald Roth
2nd generation
MBT
(McLaughlin, Bennett, Trevisi)
3rd generation
Modified Begg
(Begg principle without ribbon arch
bracket)
Refined Begg
(Dr. Jayade, Sims)

67. Lawrence F. Andrews
• Father of pre-adjusted bracket
system.
• 6 keys of occlusion – 1972.
(Research spanning ten years led to
The Six Keys to Optimal Occlusion)

68. • Vick Alexander
–1978: Vari-Simplex
Discipline.
• Charles Burstone
– Segmented arch technique.
– Introduced TMA, chinese NiTi,
fibre reinforced composite.

69. T.M. Graber
• Wrote 20 textbooks, 22 chapters in other
textbooks, 180 publications in journals &
930 book & journal abstract reviews.
• 1950 – First PhD to Dentist by
Northwestern University Medical School.
• Editor-in-chief of AJO for 15yrs.

70. William. J. clark
• William. J. clark developed the Twin
Block Technique in 1977.
• The technique is now the most
widely used functional technique
throughout the world.

71. Emil Herbst
• 1977 – Pancherz resurrected
Herbst appliance.
• Developed by Emil Herbst in
early 1900s.

72. Robert Ricketts
• Bioprogressive therapy (1950s).
• Concept of VTO (Visual treatment
objective) and computerized
cephalometry (mid-1970s).

73. Visual treatment objective (VTO)

74. Thank you