HISTORY_OF_ORTHODONTICS-Final by fanzhongqing

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									HISTORY OF ORTHODONTICS
                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 (1722-
  1789)
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 (1829-
 1913)
‘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 (1855-
  1930).
 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 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.
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 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 qualities.
Main disadvantages of pin and tube
  appliance
- Lack of mesiodistal control
- Archwire placement.
     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 to 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       of
 distocclusion for his daughter.
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        factor   for
 development of dentition.
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 cross-
 continental 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 oris action.
Prof. Rudolf Hotz, Zurich –
Vorbissplatte / guide plane plate / forward
  biting plate / removable inclined plane plate.




Refined    propulsor         conceived      by
 Muhlemann.
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       in
 Coolgardie, Western Australia.


1923 – B.D.S. from
 Melbourne University,
 – L.D.S. from Victoria.

1924 – Angle School of
 Orthodontia, Pasadena.
Begg & Fred Ishii – first to treat patients
 with Angle’s ‘new appliance’.
Nov. 1925 - returned to Adelaide.
            - Edgewise mechanism + non-
              extraction.
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 technique-
1. 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.
             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 non-
 extraction & 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   wires     for
  finishing.
 Acrylic-1937.
 Vulcanite, Cellulose, Phenolformaldehyde,
   Vinyl polymers, Styrene, Alkyl resins.
 Plastic brackets – Aromatic polymer /
   polycarbonate,    single-crystal      sapphire,
   polycrystalline alumina / zirconia.
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
E.H. Angle         1887        Angle system
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.   Shift in paradigms.
2.   Technology driven practice.
3.   Evolution of newer materials.
4.   Changes in research.
            Shift in Paradigms

1.   One phase treatment.
2.   Fullness of face.
3.   Smile analysis & function.
4.   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:         Current
     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.
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, AJO-
   BO, 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.

								
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