orthodontics in the past millenium

J. Adv Dental Research REVIEW ARTICLEAll Right Res

Journal of Advanced Dental Research VolI : Issue I: October, 201011

Orthodontics in the past milleniumVijayalakshmi PS* Veereshi AS **

*M.D.S, Reader, **M.D.S, Associate Professor,Department of Periodontics and Implantology,Departmant of Orthodontics, Rungta College of Dental sciences, Bhilai,India. Email: [email protected]

Abstract:Pearl Buck said “if you want understand today,

you have to search yesterday”. This article traces the history of Orthodontics, which evolved as first speciality of dentistry. It describes the journey in the quest of an ideal Orthodontic appliance and about various legendary orthodontists whose contribution in different areas of orthodontics has led to the development of orthodontics to the state of art, it is today.

Keywords:Orthodontics, Evolution, Present

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 and confidence.

History of dentistry: The first dental healers were physicians, but by the middle ages the barber-surgeons of Europe had specialized in the care of teeth. These practitioners not only learned by trial and error but also by observation. Baltimore College of Dental Surgery was the first dental college in the world which opened its doors to a class of five students on November 3rd, 1840.

Orthodontics- the beginning:Hippocrates 1 (460-377 B.C.) was among the first

to comment about craniofacial deformity.Aurelius Cornelius Celsus1 in 25 B.C. advocated that persistent deciduous teeth should be extracted and that permanent teeth which erupt in the wrong direction ought to be corrected by finger pressure.Specimens dating back to VIII century B.C. indicate Etruscans may have been the first to employ orthodontic bands to improve tooth alignment.2

The first mechanical treatment for correcting irregularities was suggested by Gaius PlinusSecundus (Pliny) (23-79 A.D.). 1 He advocated the filing of elongated teeth to produce proper alignment. However, orthodontics, as we think of it today has its roots in France in 18th century when French physician, Pierre Fauchard (1728) considered as Father of Dentistry, described an orthodontic appliance known as ‘Bandlette’, later known as the expansion arch.1

Evolution of orthodontics as the first dental specialty:

The term orthodontia derived from two Greek words- ‘orthos’ meaning right or correct and ‘dons’ meaning tooth, was first used by the Frenchman LeFoulon in 1839. 1In 1880 Norman Kingsley (1829-1913) widely considered as ‘Father of Orthodontics’ published his book-‘Treatise on Oral Deformities as a Branch of Mechanical Surgery’, where he offers many practical procedures of his own like occipital anchorage and attempts for the first time , the systematization of the treatment of occlusal abnormalities.1, 2

However the emergence of orthodontics as a true specialty is largely the result of the dominant, dynamic and influential leadership of Edward Hartley Angle (1855-1930), regarded as the ‘Father of Modern Orthodontics.2Angle felt that orthodontics was as important as other departments in dentistry and not a part of prosthetics as it had been traditionally considered. In 1901 Angle and his followers organized the American Society of Orthodontists (later known as American Association of Orthodontists)

Development of fixed appliances:

18th Century (1700-1799):The first scientific attempt at tooth movement was done by Pierre Fauchard through his appliance known as the ‘Bandlette’. It consisted of a flat strip of metal formed into an arch with suitably placed holes, through which threads were passed to secure theteeth, applying force to them.1

19th Century (1800-1899):Schange, a Frenchman invented the adjustable clamp band with the introduction of a lingual screw in 1841. The regulating jackscrew which delivered a pushing force on the teeth was invented by Dwinelle in New York in 1849.In 1861 Kingsley introduced the headgear to apply extra-oral force and provide occipital anchorage.

Norman Williams Kingsley (1829-1913) 2 was regarded as “Orthodontic’s greatest genius” by even the

Serial Listing: Print-ISSN (2229-4112) Online-ISSN (2229-4120)

Bibliographic Listing: Index Copernicus. EBSCO Publishing Database.



eccentric genius – E. H. Angle. He made one of his greatest contributions in the field of cleft palate when in 1859 he made his first obturator. Through his great skill, Kingsley was able to restore normal speech and to improve facial appearance with prosthetic restoration for his cleft palate patients. However, the practice of orthodontics altered forever in 1870 with an invention that most orthodontists have not associated seriously with treatment. It was the invention of dental cement by Magill of Erie, Pennsylvania. Without adhesives, orthodontic practice would not be possible as we know it today.3

The most dominant, dynamic and influential figure in the specialty of orthodontics was Edward Hartley Angle (1855-1930) who is regarded as the ‘Father of Modern Orthodontics’. He believed that an orthodontic appliance must have 5 properties- Simple, Stable, Efficient, Delicate and Inconspicuous. In 1880 he invented his “first real appliance”-the jack and traction screw which marked the beginning of his life work. Angle developed a classification of malocclusion, which was published in the ‘Dental Cosmos’ in 1899. Angle’s postulate was that the upper first molars were the key to occlusion and that the upper and lower molars should be related so that the mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar. Angle defined ‘line of occlusion’ as – the linewith which, in form and position according to the type, the teeth must be in harmony if in normal occlusion. This statement, which 100 years of experience has proved to be correct except when there are aberrations in the size of teeth, brilliantly simplified normal occlusion.2 Angle’sclassification has 4 classes. He organized the first school of Orthodontia – The Angle School of Orthodontia in 1900.In May 1900 ‘The American Society of Orthodontists’ was formed and Angle was elected its president. By 1907, he had discontinued using jack screws and was exclusively using E – arch. Angle’s various inventions before his edgewise appliance are as follows, Basic E arch, Ribbed E Arch - for expansion, E Arch without threaded ends, E Arch with hooks, Pin and tube appliance, 1910. Transformation of pin and tube into ribbon arch appliance by ingenious removal of portions of tube and separation of pin from arch wire in 1916. Creation of "tie bracket" by minor alteration of ribbon arch bracket and rotation of ribbon arch to "edgewise" position, 1925. It was in 1928 that Angle made his greatest contribution of all. He gave the world what he called as the ‘latest and the best’. It was the introduction of the Edgewise appliance in 1928 2.The original Angle bracket was made up of soft gold with 0.022 x 0.028” slot. It was .050” wide and was soldered to gold band material.

Dr. Calvin Case-(1847-1923): 1

Dr.Clavin Case was a contemporary of Angle.Case was a pioneer in orthodontic mechanotherapy. He was one of the first to stress on root movement (1892). Use rubber elastics in treatment (1892) and to use small gauge, light, resilient wires for tooth alignment (1919). He pioneered the use of retainers to stabilize orthodontic results

Martin Dewey (1881-1933): 1

Martin Dewey published his textbook on orthodontic philosophy and mechanical procedures in 1914 - ‘Practical orthodontics’. In 1915 with the help of Dr. C. V. Mosby, Dewey founded and became editor of the International Journal of Orthodontia (now AJO-DO). He was the editor for 17 years and also the President of ADA in 1931.Albert H. Ketcham – (1870-1935) 1

Albert.H.ketcham worked diligently in the American Society of Orthodontics and served as its President in 1929. In recognition of his services to orthodontics and in his honor the ABO established what is now considered as the specialty’s most coveted prize - the Albert H. KetchamMemorial. Other developments taking place around the world that influenced American orthodontic history are recounted in the following pages.1900-1910:3

The first decade of 21st century was an era of manufacture of standardized appliances. Dental supply companies sold appliances made as sets of various kinds mounted on cards. By the use of a few simple soldering techniques, dentists could make a required ‘fitting’ as it was called.

Victor Hugo Jackson (1850-1929)1, 2 was the chief proponent and pioneer of removable appliances in US. He devised a specially designed appliance known as the Jackson's crib.Charles Hawley introduced the Hawley’s retainer in 1908.1911- 1930: Serious study of tissue changes during orthodontic tooth movement was carried out by AlbinOppenheim in 1911. George Crozat2 in 1928 developed the Crozat appliance – a removable appliance fabricated entirely of precious metal with effective clasps for I molars modified from Jackson’s designs from which Class II elastics were employed to treat Class II malocclusions.Spencer Atkinson introduced the Universal appliance which was a combination of ribbon arch appliance & edgewise appliance, using a flat wire & round wire in combination.1931-1940: In 1931, Holly Broadbent4 published in the first issue of Angle Orthodontist – ‘A New X-ray Technique & Its Application to Orthodontia’. It was the introduction of cephalometric roentgenography, cephalometric tracing & evaluation, to the specialty and dentistry. Joseph Johnson 1, 2 introduced the twin arch appliance in 1938 in which the resiliency of the double wires provided the gentle force for tooth movement. In 1940, Oren A. Oliver 1, 2 introduced the labiolingual appliance.1941-1950: In 1941 Charles Tweed introduced an ‘edgewise’ appliance. Tweed’s list of contribution to the field is quite long. Few among them are, He emphasized the 4 objectives of orthodontic treatment with emphasis and concern for facial esthetics, serial extraction, uprighting teeth over basal bone, extractions made more acceptable. He developed the diagnostic facial triangle. In 1948 William



Downs4 introduced his cephalometric analysis. It presented an objective method of portraying many factors underlying any malocclusion and that there could be a variety of causes of malocclusion exclusive of the teeth. Other analyses were presented by -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)

Development of removable appliances:

In 1881, Coffin plate was introduced by Coffin with the spring that is still part of present appliances, but was then made of piano wire.2, 5

In 1902 Pierre Robin introduced the ‘Monobloc’ named so since it was made of a single block of vulcanite. Though it repositioned the mandible forward it was originally designed to prevent glossoptosis in micromandible& cleft lip & palate patients (later known as Pierre-Robin Syndrome), and not as a functional appliance to stimulate mandibular growth.5,6, Charles Hawley introduced the Hawley’s retainer appliance in 1908. But in the next 3 decades these plates were eclipsed by Angle’s fixed appliances which dominated the orthodontic world. Only the Hawley retainer came to stay.

Two years later A.M. Schwarz published a textbook entirely devoted to treatment with plates, where designs of different split plates with various screws were shown. It was ‘Lehrgang der Gebissregulung’ which became the Orthodontic bible in Europe. It was translated as the immensely successful ‘Removable Orthodontic Appliances’ by Graber and Neumann in 1966.5,6Schwarz also introduced the ‘Schwarz double plate’5 which attempted to combine the advantages of activator & active plate for treatment of class II div 1.Philip Adams2,5,6in Belfast modified the arrowhead clasp favored by Schwarz into Adams crib, which became the basis for English removable appliances and is still the most effective clasp for orthodontic purposes.Thus there was predominance of simple removable plates in Britain and of functional appliances in Central Europe.3,4

Evolution of functional appliances: Andresen6 developed a mobile, loose-fitting appliance modification that transferred functioning muscle stimuli to the jaws, teeth and supporting tissues. Haupl collaborated with Andresen and together wrote about their appliance & the interpretations of its actions. They named the technique as ‘Functional Jaw Orthopedics’5,6 and Haupl gave the name ‘activator’, to the ‘apparatus’ introduced by Andresen, based on its ability to activate muscle forces. The Bionator developed by Balters is the most frequently used activator modification today.5The development of the unique and complex myodynamic appliance was due to the ingenuity of H.P. Bimler5Stockfish originally a disciple of Bimler modified the appliance and produced the Kinetor 5.The 50s and 60s were the decades when cross-continental barriers began dissolving and the dichotomy between European and American orthodontics started disappearing. In Europe fixed appliances started replacing removable

appliances for comprehensive treatment. This was accelerated by the replacement of orthodontic bands with bonded attachment which made placement of fixed appliances easier for both the dentist and the patient. Rolf Frankel6 believed that active perioral muscles and tissue mass have potential restraining effect on the outward development of dental arches particularly during the transitional period of development. Therefore Frankel conceived his Frankel Function Regulator in 1950s as an ‘ought to be matrix’ that allowed the muscles to exercise and adapt.In 1934 Herbst& Schwarz presented a series of articles on their experiences with the appliance. In 1977 Hans Pancherz6 resurrected the Herbst appliance, introduced by Emil Herbst.In 1977, Clark 5,6developed the twin-block appliance as a two-piece appliance. This appliance achieved rapid functional correction of malocclusion by transmitting favorable occlusal forces to the occlusal inclined planes covering the posterior teeth.

Fixed appliances: At this point in time the world received another landmark contribution in the field of fixed appliance. It was the introduction of multiple-loop, light-force wire appliance by P. R. Begg of Australia. In 1956 Begg introduced the concept of Differential force.1,2,5As of now, the Begg technique has undergone many modifications from the way it was practiced by Begg originally. It is known and practiced in its various forms as conventional / traditional begg, modified begg, refined begg.9Peter Kesling modified the edgewise bracket to create Tip-Edge bracket in 1988.7

T.M. Graber : (1917-2007) Dr. Thomas Graber was born in St. Louis on May

17th 1917. He graduated from the Washington University in St. Louis. His ability to express complex concepts in an easy-to-read style has resulted in over 20 textbooks, 22 chapters in other textbooks, 180 publications in journals & 930 book & journal abstract reviews. 10 Graber founded the Kenilworth Dental Research Foundation in 1964.. He was the Editor-in-chief of AJO for 15 years and was responsible for changing its name to AJO-DO in 1985. He started the World Federation of Orthodontics in May 15, 1995 and the World Journal of Orthodontics in 2000.Lawrence F. Andrews :1, 6

In 1972, Dr. Lawrence F. Andrews ushered in the preadjusted era with the introduction of the Straight Wire Appliance (SWA) which was hailed as a revolutionary development with the dual advantage of less wire bending and improved quality of finished cases.Another landmark contribution of Andrew’s is the 6 keys of occlusion which he gave in 1972.

Robert M. Ricketts 11: Dr. Robert Murray Ricketts developed the bioprogressive therapy. He introduced utility arch, Rickett’s Quad Helix made of 0.40 blue elgiloywire and the use of preformed bands in orthodontics. Ricketts developed his cephalometric analysis & cephalometric growth prediction technique in 1960s. He popularized computerized cephalometrics for VTOs & STOs. He rightly



stressed the importance of soft-tissues while treating a patient and introduced his E-line for evaluating the position of lips in relation to the profile.

‘Vick’ Alexander :In 1978 Alexander introduced his Vari-Simplex

Discipline to get high quality results in a large practice using a relatively simple appliance technique. 11

Charles Burstone :Charles Burstone is credited with introducing

newer materials in orthodontics like - TMA, Chinese NiTi and Fibre reinforced composite and introducing newer approaches like Holography & use of Occlusograms. Burstone also developed the surgical planning analysis –COGS i. e. Cephalometrics for Orthognathic Surgery. He also devised the segmented arch technique 11,

Ronald H. Roth :(1933-2004) In 1976 –Ronald Roth published a report entitled “Five year clinical evaluation of the Andrews Straight Wire Appliance. To avoid the difficulties of a multiple bracket system, Roth recommended the 2nd generation of preadjusted brackets (roth prescription) which consisted of minimum extraction series brackets and could be used in both non-extraction and extraction cases. He came out with innovation self-ligating brackets. 11

Bennett, McLaughlin and Trevisi They have modified Andrews’s standard SWA bracket system to MBT bracket system. These third generation brackets retained the best in original design but introduced range of improvements and specifications to overcome the clinical shortcomings.

References:1. T.M. Graber. Orthodontics: Principles & Practice,

2nd edition, Philadelphia, W.B. Saunders Company, 1966.

2. William R Proffit, Henry W Fields. Contemporary Orthodontics, 3rd Edition. Mosby,1999.

3. Milton Asbel: A Brief History of Orthodontics, AJO-DO, Sept. 1990, Vol. 98, No.3,176-83

4. Orthodontics in 3 millennia. Chapter 3: The professionalization of orthodontics AJO-DO, Sept. 2005, Vol. 127 No. 6,749-53.

5. Graber, Neumann. Removable Orthodontic Appliances, 2nd Edition. Philadelphia, Saunders 1977.

6. Graber, Swain. Orthodontics: Current Principles & Techniques, III Ed. Philadelphia, Saunders 1975.

7. Graber, Vanarsdall. Orthodontics: Current Principles & Techniques, 4th Edition, Mosby, 2005.

8. Graber, Rakosi, Petrovic. Dentofacial Orthopedics & Functional Appliances, 2nd edition Mosby, 2007

9. Dr. V.P. Jayade: Refined Begg for Modern Times. 1st edition, Published by A.V.Jayade, Hubli

10. Lee Graber: Vignette – T.M. Graber, AJO-DO, May 2000, Vol. 117, No. 5, 516-524.

11. T.M. Graber: An Orthodontic Perspective after 75 years, AJO, May 1976, Vol. 69, No.5

orthodontics in the past millenium

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