Aims, scope & global history of orthodontics /certified fixed orthodontic courses by Indian dental academy

AIMS, SCOPE & GLOBAL
HISTORY OF
ORTHODONTICS
INDIAN DENTAL ACADEMY
•Leader in continuing dental education
• www.indiadentalacademy.com

www.indiandentalacademy.com

If there is defect in the soul ,
it can’t be corrected on face,
but if there is defect on the face…and one
corrects it,
it can correct a soul.
-Jean Cocteau

What is Orthodontics
All about ??
The word “ ORTHODONTICS “ is
derived from Greek words
Orthos : correct
Odontos : teeth


In 1922, the British Society for Study
of Orthodontics has defined the
specialty as
“Orthodontics ”
includes study of growth and
development of jaws and face
particularly and body generally as
influencing position of teeth;
study of action and reaction of
internal and external influences on
the development ;
prevention and correction of arrested
and perverted development”

According to AAO :
“Area of dentistry concerned with
supervision ,guidance and correction of
growing and mature dentofacial structure
including those conditions that require
movement of teeth or correction of
malrelation and malformation of related
structure, by adjustment of relationship
between and among teeth and facial bone,
by application of force or stimulation and
redirection of functional forces within
craniofacial complex .”

AIMS & OBJECTIVES
CASE(1921): To correct MO to normal function
and esthetic relationship and to beautify facial
form.
ACKERMAN & PROFFIT(1970):
To establish optimal proximal and occlusal contact
of teeth within the framework of acceptable
facial esthetics ,normal function and reasonable
stability.


LINDQUIST(1985): To improve facial
esthetics, to align the teeth evenly ,to create
good occlusal relationship; static and functional;
to obtain psychological benefits; to maintain
healthy supporting structure and
to produce stable dentition.
ROTH : To serve patients need in 5
categories of facial esthetics, dental
esthetics, functional occlusion, pdl health and
stability

According to JACKSON:

1 .Functional efficiency

2. Structural balance
3. Esthetic harmony


Ajo 1958

Structural balance
Orofacial region consists of dentoalveolar
system, skeletal tissue and soft tissue including
musculature.
It depends upon on the correct proportion of
the tooth substance to bone development when
latter has reached its growth limit in order to
permit satisfactory alignment of teeth .

Functional efficiency

It depends
upon correct relationship of teeth to each
other and their orientation to skull as a
whole to permit a satisfactory excursion of
the mandible in function of mastication .


Esthetic harmony:
It is a matter of proportion in shape,
size and orientation of dental organs
as a whole in their
relationship to other facial factors.


This goal is not ‘just cosmetic’….
It reflects the patient’s desire to improve
their social acceptability and eliminate
discrimination based on
appearance, which can affect their
quality of life greatly.


The goal of orthodontic treatment
To improve patient’s life by enhancing dental and
jaw function and dentofacial esthetics.
From this perspective…
Role of orthodontic treatment is analogous to that
of several other medical specialities such as
plastic surgery and orthopedics,in which
patient’s problem often doesn’t result from
disease but distortion of development.

An orthodontist must visualise what he wants
to do

Roger’s idea --- Mechanical advantage
-- “Optimal occlusal relation”


SOCIAL AND PSYCHOLOGICAL ASPECT OF
PHYSICAL ATTRACTVENESS AND ITS
RELEVANCE TO DENTISTRY
IS ORTHODONTICS JUSTIFIED AS A
PROFESSION ???

although we can’t easily justify routine treatment from a physical
dimension ,we can justify from social and psychological dimension.


Spirit

Mind

Body


In late 1970 and early 1980’s
people wearing ortho
appliance were percieved by
their peers and general
public as less socially
desirable than those who
didn’t wear them .
But today, it is somewhat a
status symbol to wear
‘brackets’.
Clear and colored brackets,
even glow in the dark and
colored elastics offer many
choices.

PLUNKETT wrote :
Psychological well being is an intangible benefit to
society as a whole.
Morally ,there must be some provision for orthodontic
treatment for those people , where it is shown that
treatment improves their quality of life.


NEED FOR ORTHODONTIC
TREATMENT
1. Irregular teeth

2. Predisposition to periodontal diseases
Studies in late 90’s on a large no of patients done and no evidence of
beneficial effect of orthodontic treatment on future pdl health was
demostrated as would have been be expected.
An individual willingness and motivation determine oral hygiene plays a
major role than how well the teeth are aligned.


3.To close diastema
4. Mouth breathing
5. Correction of speech
defects
6. Risk of trauma: Class
II malocclusion


7. Bruxism
8. Tmj probs: deep bite,
occlusal prematurities.
9. Surgical treatment for congenital
defects : Cleft lip and palate.
10 .Correction of shifted teeth,
prior to construction of bridges
and partial dentures.

Skeletal problems
Skeletal problems result not from
malpositioned teeth or well proportioned jaws
but from disproportion in size or position of
jaws themselves.
Occurs in all three planes


Sagittal


Horizontal


Vertical

Mainly:
1. Esthetics
2. Psychological disturbance
It is found that well aligned teeth and pleasant smile carry positive status
while irregular and protruding teeth carry negative status.


Study was also done to investigate whether young
adults with varying dental esthetics and history
of orthodontic treatment also differ in oral health
attitudes and preventive behaviour
(by Ulrich Klages,Aladar Bruckner
AJO 2005;128:442-9)

Found that previous treatment and
favorable esthetics might be an important
variable in explaining individual difference

RUTZEN :
Studied 250 patients , 5yrs after they
had completed orthodontic treatment .
It is found that those who were treated made
significantly more positive assessment of their
appearance.


SCOPE & SERVICES OFFERED
Orthodontic treatment involves three
main tissue systems concerned in
dentofacial development :
Dentition
Skeletal -Restraining,Promoting,Redirecting
Facial and jaw musculature


SERVICES OFFERED
Preventive
Orthodontics
Interceptive Orthodontics
Corrective Orthodontics
A. Surgical orthodontics:
B. Camouflage
C. Comprehensive
D. Adjunctive Orthodontic treatment

SERVICES OFFERED
Preventive Orthodontics
Prevention is better than cure
Actions taken to preserve the integrity of
what appear normal for that age
 Space maintainence
 Check up for oral habits and habit
breaking appliance if required

Interceptive Orthodontics
Procedure undertaken at early stage of MO to eliminate
or reduce the severity of the same, in order
to prevent establishment of full fledged MO that may
require long term orthodontic treatment at later age.
o Control of abnormal habits

Interception of skeletal malrelation using myofunctional
appliance


Corrective Orthodontics
A. Surgical orthodontics:
Done for patient with no remaining growth
potential and severe malocclusion.

Dentofacial orthognathic surgeries are
the major surgical procedures carried out
along with orthodontic therapy.
Require a team approach with oral surgeon and
orthodontist being imp member of team

Currently a new technique of bone generation in
craniofacial region termed Distraction Osteogenesis
has been introduced.
It is a biologic process of new bone formation
between osteotomised bone segments that are
seperated gradually by incremental traction.
Traction force is applied to bone segments,creating a
tensional stress in repairative callus that joins the
divided bone segments.

 Distraction Histiogenesis-sequence of
adaptive changes.

1. Regeneration following disruptive and
degenerative changes.
2. Neohistogenesis as a result of generalized
cellular proliferation and growth.


DISTRACTION OSTEOGENESIS


B) Camouflage
Bringing the teeth in proper occlusion without correcting
jaw discrepancy.
Underlying skeletal discrepancy be corrected by
orthodontic tooth movement.
Successful for adolescents with moderate problems.

Not useful
1. In transverse or vertical skeleton problems
2. Severe class II and III


C) COMPREHENSIVE
Acc to Proffit,
It implies orthodontic treatment which would
take more than six months duration.
Done with fixed appliances.


Major stages:
1.Alignment and levelling
2.Correction of molar relationship and
space closure
3.Finishing


D) Adjunctive Orthodontic treatment
It facilitates restorative treatment by
repositioning the teeth so that more ideal and
conservative technique can be used.
1.Repositioning teeth that have drifted.
2. Forced eruption of badly broken
Teeth.


IDEAL ORTHODONTIC
SERVICE
Pre Appliance
Guidance
Interceptive
20%

Preventive
10%

Partial corrective
Mechanotherapy
25%

45%
Full corrective
Mechanotherapy


WHY HISTORY IS
IMPORTANT ??
If anyone has grasped a principle/method
of approach which is universal in
character, He has in his hand the only weapon
applicable to infinite variation.
Techniques are mere servants to principle
When anyone takes over the techniques
of their predecessor without sharing the vision
which animated it ,he takes over the mental
body but loses its immortal soul

TRANSITION FROM CATGUT TO NASA
TECHNOLOGY
• ORTHODONTICS IN GREECE AND ROME
• MIDDLE AGES (5th -15th centuries) TO
THE 18th CENTURY
• EUROPEAN PIONEERS OF EARLY 19TH
CENTURY
• AMERICAN PIONEERS OF EARLY 19th
CENTURY

ORTHODONTICS IN
GREECE AND ROME
The earliest description of irregularities
of teeth was given about 400 BC (460377 BC) by HIPPOCRATES.


He commented that‘Among those individuals with long shaped head
some have thick necks, strong bones;
others have strongly arched palate, their teeth
are irregularly arranged, crowding one other and
they are bothered by headache and ottorhea’


• AURELIUS
CELSUS (25 BCAD 50 )
• 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”.

GAIUS PLINUS SECUNDUS(23-79AD)
Suggested filing elongated teeth to bring them into
proper alignment


MIDDLE AGES (5th -15th centuries) TO
THE 18th CENTURY

The first mention of practicing dentistry was
exclusively made by Pierre Dionis(1658-1718)
He called dentists ‘Operator for the teeth’
and stated that they could also open or widen
the teeth when they are set too close

Beginning in the 18th
century, leading country
in the field of dentistry was
FRANCE.

Efforts of one man:
PIERRE FAUCHARD
(1678-1761)
‘Father of Modern
Dentistry’


MATTHAEUS PURMANN first to report taking wax
impression.
Malocclusions were called ‘irregularities’ of the
teeth ,and their correction was termed
‘regulating’


In 1728 ,he published the general work on
dentistry, 2 volumes entitled

‘THE SURGEON DENTIST :A TREATISE
ON THE TEETH’
Fauchard described ,but probably was not
the first to use ,the bandeau expansion
arch ,

Consists of horse shoe
shaped strip of
precious metal to which
teeth are ligated.
This became the basis of
Angle’s E arch.
He also repositioned teeth
with a ‘pelican’ forcep and
ligated the tooth to
neighbors until
healing took place.


BOURDET (1722-1789):
First record of recommending serial
extraction
First to practice lingual orthodontics,
expanding arch from the lingual side


JOHN HUNTER (1728-1793)
Not a dentist
An English anatomist and surgeon, took
keen interest in anatomy of teeth and
jaws.


His text -‘THE NATURAL HISTORY OF HUMAN
TEETH’ in 1771 presented the first clear statement
of orthopedic principles.
• First to describe normal occlusion to attempt to
classify the teeth
• Gave teeth names like cuspidati and bicuspidati
• First to describe growth of jaws


Disapproved extracting primary teeth to permit
permanent teeth to erupt.
But advocated first permanent molar is the tooth to
be sacrificed if there is insufficient room in the
jaw for all teeth.
Maintained that teeth do not grow throughout life
time, only appear longer because antagonist is
missing.


EUROPEAN PIONEERS OF EARLY
19TH CENTURY
JOSEPH FOX(1776-1816)
Influential student of Hunter, devoted four
Chapters to the book ,
‘The Natural history and Diseases of
Human Teeth’ to the budding science of
orthodontics.
First to classify malocclusion (1803)

Was interested in the
judicious removal of
deciduous
teeth,treatment
timings,and use of bite
blocks to open bite .
His other appliances
included expansion
arch and chin
cup(1802)


First to observe that mandible grows mainly by
distal extension beyond the molars,
with little or no increase in the anterior region.
Acc to Weinberger, Fox was the first to give
explicit directions for correcting the
irregularities


DELABARRE(1787-1862, FRENCH)
Introduced the crib and principle of lever and
screw(1815)
He separated the crowded teeth by means of
swelling threads or wooden wedges placed
between the teeth


He sharply and justifiably
rejected the premature
extraction of deciduous
teeth.
He gave early description of
kind of band appliances
fixed to tooth turned on its
axis.
Achieved bite block through
wire screen put in area of
molar area.Teeth were
repositioned with silk
threads.

i

JOACHIM LEFOULON
 Gave a name
ORTHODONTOISE(1841)
Which roughly translates into Orthodontia.
 First to combine labial arch to lingual arch.


He took first step from orthodontics towards jaw
orthopedics.
The vault of the palate and the dental arches are
not unchangable as was believed for long time.
He used spring action gold arch designated as
passive spring. Method was neither painful nor
annoying.


FRIEDRICH C.KNEISEL(1797-1847,German)
First to use removable
appliances when he
fitted his prognathic
patient with a chin cap.
He used the gold spring
as an inclined plane.
This modification of
inclined plane marks
the limit of his
orthodontic therapy.

ROBINSON






Regarded maintenance of
deciduous teeth as best
preventive measure.
Devoted 32 pages of his
textbook to the “Irregularity
of teeth”
For expansion of jaws he
fitted plate with a hinge at it
centre and two traverse
springs pressed the dental
arch and alveolar process
apart.

TOMES(1859)
• Was the first to demonstrate bone resorption and
apposition
• He and Kneisel worked together and used various
removable appliances.


ALEXIS SCHANGE
(1807,French)
In 1841 published the first
work confined to
orthodontics
He introduced modification
of screws and the clamp
band


Most imp idea is his demand that pulling
arrangement can be anchored principally on
several molars which are generally bound
together with gold clamp and that
mechanical immobilisation of what have been
achieved so far be carried out for long time
He coined the term Anchorage
First use of rubber bands


AMERICAN PIONEERS OF EARLY 19th
CENTURY
Josiah Flagg(1763-1816)
• Advertised that he “regulates teeth from their
first teeth,to prevent fever in children ,assist
nature in extension of the jaws ,for a beautiful
arrangement of second set of teeth”


LEONARD KOECKER (1728-1850)
Offered to supply ligatures to ‘teeth of an irregular
position’
Was an advocate of early treatment
J S. GUNNEL
Invented occipital anchorage in 1822
SOLYMAN BROWN
Through the efforts of Solyman Brown in 1839,
the American Journal of Dental Science was
established

• Invention of vulcanite
by Charles Goodyear
in1839.
• E.G tucker : first
american to use
rubber bands(1846).
• Baker used it to
provide intermaxillary
force.

ENTERING THE MODERN ERA:
EARLY 1900 S
.
In the early 1900s
,groundbreaking
scientists ,built the orthodontic
edifice brick by brick.

NORMAN W.KINGSLEY(18251896):
Edward H. Angle referred to
Kingsley
‘’Orthodontia’s greatest genius”
• Born on 2nd Oct 1829.
• Joined Dr. A.W. Kingsley,
Pennsylvania.
• 1852 – first office in Oswego,

• 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.


After 1850, appeared: the most notable was
Kingsley’s book
,A Treatise on “Oral Deformities(1880)”

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.

Described “Jumping the bite”(1880)
Main objective was not to protrude
lower teeth, but to change or jump the bite
in case of excessively retreating lower jaw


Further ,
clinical trials by Kingsley and others demo
difficulty of holding lower Jaw in
forward position
Was seldom used except some modifications
Vorbissplate (hotz)
Hawley biteplate
Herbst a.pullen, j.lowe young,oren oliver
combined with fixed appliance


• AMOS WESTCOTT : first to use
telescopic bar in maxilla to correct
crossbite (1859)
• He placed chincups in cl III pts
• EMERSON C.ANGELL: open mid
palatal suture with a split
plate(1860)


• WILLIAM E.MAGILL:
first to cement
(platinum) bands
(1871)


1871 C.R.COFFIN :
Kingsley student ,
reported an expansion
appliance which
bears his name


He embeded spring action piano wire ,
bent in shape of ‘w” into vulcanite plate
seperated the plate in the middle, and
activated the springs so that its halves
pressed the alveolar process to the
outside.


JOHN NUTTING
FARRAR:
Begin the era of
biologic tooth
movements.
First to use occipital
anchorage to retract
anterior teeth (1850)


He recommended bodily movements of
teeth (1888)
He originated the theory of intermittent
forces and developed a screw to deliver
this force in a controlled increments

His treatise on “irregularites of teeth and their
correction” (1888) is considered a great
work devoted exclusively to orthodontics.
He has been called “Father of American
orthodontics”


• EUGENE S. TALBOT(1847-1925)
• First to use roentgen rays in orthodontic
diagnosis
• He stressed the study of causes of MO
especially constitutional and hereditary
factors,as key to treatment


• He was the first to suggest possible cause
of deformities and proposed that all MO pt are
either “neurotics, idiots, degenerates or
lunatics” led to much antagonism
• was the first dentist to specialise in both
orthodontics and periodontics


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.

AIMS, SCOPE & GLOBAL HISTORY OF
ORTHODONTICS-Part II

DEVELOPMENT OF FIXED APPLIANCES
from 1900-1960.


CALVIN CASE (1847-1923)
• Military service in the civil war.
• 1871-Graduated from Ohio
college of dental surgery.
Wrote a practical treatise on
“Technics and principles of Dental
Orthopedia” (1897) and
wrote 123 articles
• First to use along with Henry
Baker Class II elastics and was
the first to attempt bodily movt .


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 deformitiesCase type of obturator still in use.

• CONTRARY to Angle ,Case used diff type
of appliance for each pt and stressed
facial esthetics in contrast to Angle’s
reliance on occlusion
• He advocated changing the name of
speciality to ‘Facial Orthopedia’


Case’s 1911 paper provoked acrimonious
debate that came to be known as “Great
Extraction v/s non extraction debate”


• First to use light wires (.016-.018)
• Advocated extraction to correct facial
deformities
In doing so ,He incurred the wrath of
Angle and his disciple


• Case used headgears for cleft patients
and other
• His greatest contributions to be
prosthetic correction of cleft palate.
Considered ‘big fours’ in orthodontics


EDWARD H. ANGLE (18551930)


• Casto stated--Through his
influence,orthodontics emerged from a
speculative or empirical state to the
position of an exacting science”


Born in a farm in Pennsylvania on June 1st, 1855 .
Marked ability to improve & create
mechanical equipment on the
farm.
Developed a passion for simplicity
in design.


1878- Graduated from Pennsylvania College of Dentistry.

Angle experienced many technical problems and
frustrations in treatment which irritated, motivated and
inspired him to develop a standard appliance.


He believed that an orthodontic appliance must have 5
properties• Simple
• Stable
• Efficient
• Delicate
• Inconspicuous


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

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


“Angle system” (1887)
It marked the beginning of a relationship between the
manufacturers, the suppliers and the orthodontists.

•The Angle system
A, B - traction screws; C, D – attachment tubes; E, J – jackscrews;
L – lever wires, F, H – www.indiandentalacademy.com archwire; W - wrench
band material; G –

• 1887 – Appointed to Chair of Orthodontia in dental
department of University of Minnesota.

• Conveyed through 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.


“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.

Maxillary first permanent molar - stable landmark
in craniofacial anatomy.
When asked about the story of his “discovery” of
the constancy of the upper first molar, Angle said

“I thought about it and I thought about it, all at once

it came to me. Anybody who disagrees with me must be
a fool !”

Rousseau – perfectability of man
Angle consulted the famous artist of the day
Professor Wuerpel for the ideal facial form.


APOLLO


German physiologist Wolff


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.

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.
‘The American Society of Orthodontists’.
On June 11, 1901, 10 charter members elected
Angle as president.


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”.

‘Mother Angle’ later
became secretary of
American society of
orthodontics, a founding co
editor of the ‘Angle
orthodontist, and honorary
chair of the Angle society
executive committee


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.
Angle attended the last society meeting on
June 1928 in New London, Connecticut.
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

The heavy archwire was
supplied in 4 designs,
depending on treatment
plan 1. Basic E arch - used in
mandible with Baker
anchorage


2. Ribbed E Arch - for expansion
• Simplicity.
• Heavy interrupted
forces.
• Tipping of teeth to
new position.
• Not possible to
precisely position
any individual
teeth.

3. E Arch without threaded ends – attached
ball in incisor area for high-pull headgear


4. E Arch with hooks – moved maxillary
dentition distally and mandibular dentition
mesially through intermaxillary elastics.


1912 Pin and Tube Appliance

Incredible degree of craftsmanship.
Impractical in clinical use.
Poor spring qualities.

1915-Ribbon Arch Appliance

Vertically positioned rectangular slot with ribbon arch of
10 x 20 gold wire.
Good spring qualities.
Allowed versatile movements.

1928 - Edgewise Appliance
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.


GENIUS ECCENTRIC :
Angle was a maverick and not a “team
man”.
His bluntness and quick temper were hardly
diplomatic assets.
He hated the petty rivalries, jealousies and
personal animosities in dental schools, yet
he engendered them.
His national stature, his close relations with
members of the medical fraternity and his
writings served to create jealousies
among dental faculties

•

Smarting under these personal attacks and
jealousies, he subsequently expressed
gratitude to only some of his predecessors
and contemporaries.

“Incestuous interquote”


• All said and done, Angle possessed extraordinary
technical skills, a very inventive mind and an
unbending, uncompromising nature which truly
makes him a mechanical, technical and clinical
genius, the repercussions of whose inventions and
contributions are strongly felt even today.

Very aptly and deservingly he is called the

“Father of Modern Orthodontics’.

• Albin Oppenheim (18751945,Angle school,1911)
• Serious study of tissue changes during
orthodontic tooth movement.


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”.

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’.


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


• 1935 - Introduced craniometric
measurements & classification of
dental development.
• Believed in biologic concept & scientific method.

• “Perfection is the goal, adequacy is the
standard”


SIMEON H GUILFORD
(1841-1919):
• Gnathostatic impression(1914)


He commented in his book
“Orthodontia : Malposition
of human teeth”,
“
His determination to broaden
the horizons of orthodontic
afford him a distinguish place
in the history


1920 -1930

•1922 - James D McCoy introduced open tube
appliance.
•Permit movt in MD direction but no torque
control.

Albert. H. Ketcham - (18701935)
• 1902 - Graduate of Angle School of
Orthodontics.
• First to introduce Roentgenogram &
Photography.
• 1926 Comprehensive data on root
resorption..
• A great teacher & guide- ‘Ketcham
Seminar’.
1929 : President of American Board of
Orthodontics

Acc to Pollock,
“In early days of orthodontia ,when Angle was leading
orthodontics ,It was HE who offerd a harbour to
which the stormtossed
Orthodontic neophyte could come for encouragement
&calm advice”
1936-memorial award
To date (2004) 87 people have received the award.

• Spencer Atkinson
(1929)
• introduced Universal
appliance – a
combination of ribbon
arch appliance &
edgewise appliance using
a flat wire & round wire in
combination.
• Great Anthropologist
• Gave the term key ridge

The Great Extraction
Controversy
P.FAUCHARD
& CELSUS

:recommended extraction

HUNTER

:opposed it on the ground that it
inhibits growth

DELABARRE : It warned against undesirable
sequelae


After initially extraction of premolars,
KINGSLEY later gave it up.

DAVENPORT lectured in New York (1887)

CALVIN CASE - : Reintroduced it


ANGLE’s reasons for renouncing it :
1. acceptance of wolff’s law.
2. personal reasons.


CASE :
Appeared in Chicago before National Dental Association’s
annual meeting in July (1911) with his paper
“The question of extraction in Orthodontia”
Discussion erupted into full scale debate..
He was supported by impressive argument
Matthew Cryer ,a renowned anatomist.


MARTIN DEWEY :
Took gauntlet for non extraction and challenged Case.
ortho thought,including Early regulation,Heredity, Bone
growing and Evolution.
But Angle’s follower won the day and for next 30 yrs
extraction disappeared


Orthodontist such as John Mershon,Joseph
Johnson,George Crozat ,whose appliances relied on
non-extraction philosophy,helped perpetuate this
philosophy.
But by 1930’s dentist were beginning to notice relapse…


AXEL F. LUNDSTROM(1875-1941)
Of Sweden,
Was the first to analyse relapse.
He redefined limits of orthodontics capabilities in his thesis
(1923)showing that, when apical base is deficient
,crowded teeth by orthodontic means into accepted
normal arrangement will relapse when retainer is
removed.


CHARLES H.TWEED
(1895-1970, Angle
college ,1928)
Concerned with dental
protrusion and unsatisfied
facial esthetics
1940 :at meeting of AAO
displaced 100 consecutive
cases,


Many others noticed the same
effects like
• Raymond begg
• Strang
• Hays N..Nance (1903) : wrote in
paper “Limitations of Orthodontic
treatment”.
He found that treated dentitions
return to their original intercanine
and intermolar width.
Defined leeway space, led to the
Nance analysis


Present view of the controversy
Supporter of alternatives of extraction claim that only non
extraction treatment will result in “full ,pleasing profiles
and wide smiles without detrimental dark corners”


Current controversial issue is the belief that…
Dished facial profile,narrow smile accompany removal of
premolars

Bishara studied 91 ortho pts:
Study indicates:
Both extraction and non extraction had a favorable impact
on facial appearance (single strategy can’t fit all faces)


Both appropriately applied extraction and non extracton
treatment can produce favorable esthetics results.
Key to appropriate treatment is still “Diagnosis”rather
than reliance on a particular “philosophy”
Katie Harman ,Miss America 2002,stated
“I wouldn’t have been Miss America if I had
not had ortho treatment, especially removal of teeth”


In fact there are number of faces that feature
extraction esthetic such as
•
•
•
•
•

Jennifer Hawkins
Diana Princess of Wales
Kylie Minogue
Renee Zellweger
Catherine Zeta Jones


The take home message is not that extraction treatment is
universally good ...or that non extraction alternative is
bad ….
But rather that both produce results for the right
patients, and that extraction does not necessarily lead
to flattened or long faces, narrow smiles with dark
corners


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.

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.
6. Serial extraction of
primary &
permanent teeth.
(preorthodontic
guidance)
• Tweed philosophy.

• 1945 – H.D. Kesling, used a rubber tooth
– positioning device.
• J.A. Salzmann – classification of
malocclusion for handicapping problems


1948 – Cephalometric Analysis by William B Downs.


1950-1960
Other analysis’ –
1.
2.
3.
4.
5.
6.
7.
8.

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

1960-1970
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.

Advantages of Begg technique1. Light continuous forces.
2. Rapid alignment, leveling & derotation of
anterior teeth.
3. Rapid overbite correction.
4. Simultaneous crown tipping retraction of all
anterior teeth.
5. No extraoral force necessary

• Begg & Fred Ishii – first to treat patients with
Angle’s ‘new appliance’.
• Nov. 1925 - returned to Adelaide.
- Edgewise mechanism + nonextraction.
• Serious relapses & poor post-treatment profiles.
• Feb. 1928 – began extraction.
• Edgewise – no rapid closure of extraction
spaces.

• Combined edgewise bracket & round
archwires – undesired root movements.
• Ribbon arch brackets with slot facing
gingivally.
• Early 1940s – Arthur J. Wilcock,
metallurgist at University of Melbourne.
• Modified ribbon arch brackets, lock pins,
special buccal tubes & Australian
stainless steel. www.indiandentalacademy.com

• 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. www.indiandentalacademy.com

• 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.

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 –
Ackerman et al 1969, 1975.
De Angelis 1976.


Modified edgewise
brackets –
1. Perlow 1967.
2. Hocevar ‘Beddtiot’
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.


• 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.

• Army Medical Regiment in II World
War.
• Orthodontics – Northwestern
University.
• 1950 – First PhD to Dentist by
Northwestern University Medical
School


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


• 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.

Terrell L. Root
• Level Anchorage System – straight wire
appliance with anchorage preparation as
described by Holdaway.
• To reach predetermined goals routinely.
• Step-by-step treatment procedure for 7 nonextraction & extraction choices.
• Timing & self check chart.


‘Vick’ Alexander
• 1964 – University of Texas.
• 1978 – Vari-Simplex Discipline.
• Philosophies –
1.Efforts = Results.
2.‘Altruistic egoism’ – Dr. Hans Selye.

• Advocated the word ‘Retractor’ for
headgear, introduced by Fred Schudy

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


Ronald Roth
• Roth’s interests –
1.Functional dynamics.
2.To prove treatment not harmful for
patients.
3.To disprove premolar extractions not good
for TMJ health.
• Roth prescription – 2nd generation
preadjusted brackets.

Bennett, McLaughlin and
Trevisi
• Re-examined Andrew’s SWA bracket
system.
• MBT brackets-3rd generation
preadjusted brackets.

Others – Moyers, Proffit, Holdaway,
Woodside, McNamara, Williamson, Swain
etc.

Angles worms /Angle phobes :
Instead of angle philes as they dared
To deviate from their master
In the fallen Angles group:
William brady
Martin dewey
Frank gray
Albert ketcham


• Benno lischer
• Mershon


REMOVABLE APPLIANCES


3. social welfare system developed much
more rapidly in europe,which meant that
emphasis tended to be on limited ortho
treatment for a large no. of people,often
delivered by gp rather than ortho specialist
4. economic reason:precious metal for fixed is
less available in europe,
5. lack of knowledge of fixed appliance


• IN Europe the “Biological superiority”
of RA reinforced due to pioneering work
of
• Anderson
• schwarz
• Haupl
• Supported by definitive research

• REITAN :
• Ojected the above gradation of forces
• Stated no such gradation observed in
histo section
• Acc to him effect of force is more in
relation to surrounding anatomical,
environment n time factor

• 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.

1900-1910
Victor Hugo Jackson
(1850-1929)
• Pioneer of removable
appliances in US.
• Jackson's crib-Auxiliary
spring (finger).
• 1904 - ‘Orthodontia and
Orthopedia of the face’.


1910 -1920
• John. V. Mershon (18671953) introduced
removable lingual arch
based on the principle
that teeth must be free &
unrestricted (if otherwise
rigidly connected) for
adaptation to normal
growth i.e First invisible
Appliance


•1928- George Crozat Class II malocclusions.
•Originally called “Invisible
brace”, later became crozat
appliance


• 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


• 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 Norwegianwww.indiandentalacademy.com
System’.

• 1909 – Herbst presented ‘Scharnier’ or
joint - fixed bite-jumping device at
International Dental Congress in Berlin.
• 1934 – Herbst & Schwarz - series of
articles.


• Uses –
– For treating Class II malocclusions.
– Facilitate healing after mandibular ramus
fractures.
– 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.


• European criticism of British orthodontics
–
1. Overemphasis of simple treatment.
2. Undergraduate orthodontics.
3. Disunity among British orthodontists


• 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.

• 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.

• First annual conference – 1967 in New
Delhi.
• P.G. convention every year since 1996.
• Journal of Indian Orthodontic Society,
1965.


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.

• Technology Driven Practice
1. Computerization.
2. 3D reconstruction
3. Simulation of treatment results.
4. Computerized bracket position.
5.

Robots to bend wires.

6.
6. Custom made trays for tooth
movement (INVISALIGN).

• 1908 - Introduced Activator


• Clinical Practice Scenario
Inter-disciplinary
approach.
Implants reinforcing
anchorage.
Distraction osteogenesis


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

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.


1. Material Scarcity, Abundance of Ideas (17501930)
• Before Angle’s search;
• Noble metals and their alloys.
- Gold (at least 75%), platinum, iridium and
silver alloys



Good corrosion resistance
Acceptable esthetics

 Lacked flexibility and tensile strength
 Inappropriate for complex machining and
joining.

• Angle listed few materials appropriate for
work:







Strips of wire of precious metals.
Wood
Rubber
Vulcanite
Piano wire
Silk thread

EVOLUTION OF REMOVABLE
APPLIANCE
• FROM VERY BEGINNING ,EMPHASIS in

america ortho had been on fixed appliance which
is unknown in europe
• All treatment in europe with removable appliance
not only for growth guidane but also for tooth
movt of all types.

• Reasons??
•
•
•
•
•

1. angle dogmatic approach ,to
occlusion,with its emphasis on precise
positioning of each tooth has less impact
in europe than US
2.concerned over inc root resorption

• SCHWARZ

• Recognised intimate r/l b/w force magnitude
• n tissue response n classifed ortho forces
into 4 types of biologic efficiency
• 1.below threshold of stimulation
• 2. most favorable(15-20g/cm)
• 3.interupt bld circulation(20-50)
• Conductive to resorption n deposition of
alveolar bone
• 4.highest magnitude(>50)

HAUPL:

BELIEVED IN EUROPEAN “JAW ORTHOPEDIC
THINKING”
His treatment based on Roux theory on bone
formation which gave imp to
Trophic stimuli which wud shake bone substance n
inc cell activity of osteoclast
He claimed that activator provide such stimulus


CHARLES GOODYEAR (1839):
Invented vulcanite
AT TIME OF WW 2,there were 2
distinctly diff devices which were in use:
1. Activ plate:utilise forces within appliance
2.Activator :utilise muscular forces


Thank you
•Leader in continuing dental education
• www.indiadentalacademy.com


Aims, scope & global history of orthodontics /certified fixed orthodontic courses by Indian dental academy

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