History of orthodontics post graduate seminar

 Introduction
 Ancient civilizations
 18th & 19th Centuries
 History of orthodontic diagnosis
 History of extraction and expansion in orthodontics
 Development of Myofunctional appliances
 History of removable appliance
 History of fixed orthodontic appliance
 Evolution to latest orthodontic techniques
 History of orthodontics in India
 References
CONTENTS

Orthodontics (Greek word)-
Orthos
Odontos
- to correct
- teeth
INTRODUCTION
“Nobody can know much of a
science unless he
understands its history”
Edward H Angle

 Specimens dating back to VIII
century B.C. indicate
Etruscans may have been the
first people to employ
orthodontics to improve tooth
alignment.
THE ETRUSCANS
• The earliest evidence of appliance
is from around 1000 BC
(Weinberger, 1934).
• Etruscans buried their dead with
appliances that were used to
maintain space and prevent
collapse of the dentition.

• Archaeologists have
discovered Egyptian
mummies with crude
metal bands wrapped
around individual teeth.
• It is speculated that
catgut was also used to
close the gaps.

HIPPOCRATES (460BC-377BC)
• The Greek physician
Hippocrates (460 to
377 BC) is considered
as a pioneer in
medical science.
• Corpus
Hippocraticum

• “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."

ARISTOTLE (384 TO 322 BC)
• First comparative dental
anatomist.
• De Partibus Animalium (On the Parts
of Animals).
• Noted marked differences between
the dentition among different
animals and also among the
species of same animals.

AULIUS CORNELIUS CELSUS
(25BC-50AD)
• “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
pressure until it
arrives at its proper
position”.

PLINY THE ELDER
• Probably the first mechanical
treatment was advocated by
Pliny the Elder (ad 23-79),
who suggested filing
elongated teeth to bring them
into proper alignment at
chapter 49 named Remedies
for Toothache in Naturalis
Historia.
• This method remained in
practice until the 1800s.

BARBER SURGEONS
(CHIRURGEONS)
• Earliest known organization
of barbers began to thrive
all over Europe.
• Up to the year 1416, the barbers
were not interfered with in the
practice of surgery and dentistry.
But it was soon evident that they
were attempting too much.
• They were doing dental practice
by trial and error method.

LEONARDO DA VINCI (1452-1519 AD)
• The first artist to dissect
the human body and
draw accurate pictures
of these dissections.
• The first to
recognize tooth
form.
• The first to perceive
the concept of
articulation.

• He was first to talk about
facial proportions and
aesthetical aspect of human
face.
• He noted that “those teeth
that are the farthest away
from the line of the
temporomandibular
articulation are at a
mechanical disadvantage
as compared with those
that are nearer.”

ANDREAS VESALIUS (1514-1564 AD)
• The Fubric of the Human
Body- De humani corporis
fabrica libri septem
AMBROSE PARÉ (1517-1590 AD)
• A french surgeon.
• Paid specific attention to dentofacial
deformities, especially to the cleft palate.
• He was the first surgeon to devise an
obturator for treatment of cleft.

PIERRE FAUCHARD
(1678-1761 AD)
• 1728, The Surgeon Dentist: A
Treatise on the Teeth.
• Father of modern dentistry.
• He described the use of ligature
wires to straighten teeth.
• He developed the first orthodontic
appliance: bandalette, designed for
arch expansion.

ETIENNE BOURDET
(1722-1789 AD)
• The dentist to the King of
France , Advocated the
Fauchard method but went a
step further by
recommending only gold
strips on the labial surface
for the upper arch and on
the lingual surface for the
lower arch.

JOHN HUNTER
(1728-1793 AD)
• An English anatomist and
surgeon, Hunter took a
particular interest in the
anatomy of the teeth and jaws.
• His text, The Natural History of
the Human Teeth (1771),
presented the first clear
statement of orthopedic
principles.
• He was the first to describe
normal occlusion.

• Nomenclature of teeth:
incisor, bicuspid and
molar.
• Experimentally established the
difference between bone and
teeth for the first time. (But he
concluded tooth to be non
vascular).
• He was the first to describe
the growth of the jaws, not
as a hypothesis, but as a
sound, scientific
investigation.

Joseph , a student of hunter
devoted 4 chapters of his book,
the natural history and diseases
of the human teeth (1814), to that
topic.
He was the first to classify
malocclusion (1803). According
to weinberger, fox “was the first
to give explicit directions for
correcting the irregularities” of
teeth.
JOSEPH FOX

He was particularly
interested in the judicious
removal of deciduous teeth,
treatment timing, and the
use of bite blocks to open the
bite.
His other appliances
included an expansion arch
and a chin cup (about 1802).

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

• The term
was
coined by
Joachim
Lefoulon, who
used the word
‘orthodontosie’ in
1841 which
roughly translates
into orthodontia.
LEFOULON

CHAPIN. A. HARRIS
(1806-1860 AD)
• Orthodontic tooth movement is
a result of bone resorption on
one side & bone deposition on
the other side of the root.

NORMAN W. KINGSLEY
(1829-1913 AD)
• “Orthodontia’s greatest genius”
– E.H. Angle.
• Norman W. Kingsley was the first
of those dental pioneers who made
the last half of the 19th century a
period of great advancement.
• He experimented with appliances
and introduced many creations to
subject.

• Fabricated obturator for cleft
patients. He was also the first to
discuss cleft palate treatment in
terms of orthodontics.
• “Jumping the bite.”
forerunner of modern
functional appliances.
• Introduced the headgear to
apply extraoral force &
provide occipital anchorage
(1861).

• Relationship between
mechanics and biology as
the principle on which
orthodontics should be
based.
• He Claimed that bending of
alveolar bone would take place
during orthodontic tooth
movement (1877 AD).
• He was the first to
recommend that etiology,
diagnosis, and treatment
planning were the acceptable
bases of practice.

JOHN NUTTING FARRAR
(1839-1913 AD)
• The Father of American
Orthodontics
• Investigated the physiologic
and pathologic changes
occurring in animals as the
result of orthodontically
induced tooth movement.
• Published a series of articles
in Dental cosmos.

• Supported Kingsley’s concept of
alveolar bone bending during
orthodontic tooth movement
(1888 AD).
• The originator of the theory of
intermittent force & developed a
screw to deliver this force in
controlled manner.
• The first person to recommend
root or bodily movement of the
teeth.
• Treatise on Irregularities of the
Teeth and Their Correction (1888).

EDWARD HARTLEY ANGLE
(1855-1930)
Father Of Modern
Orthodontics
• Never an outstanding student
in “book-learning”
• He had Marked ability to
improve & create mechanical
equipment on the farm.
• Apprenticed himself to a
dentist at his mother’s
request.

• Received his DDS degree from
the Pennsylvania College of
Dental Surgery- 1878.
• Angle became keenly interested
in orthodontics.
• He experienced many
technical problems &
frustrations in treatment
which irritated,
motivated & inspired
him to develop a
standard appliance.

ANGLE’S CONTRIBUTION TO
ORTHODONTICS
• Classified malocclusion-1899
• Established Angle School Of
Orthodontics in St. Louis ,
Connecticut in 1900 and
Pasadena in 1920.
• Founded American Society Of
Orthodontics in 1901.
• Developed different
orthodontic appliances.

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.

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

MARTIN DEWEY
(1881-1933)
• Known for his modification of
Angle’s classification of
malocclusion.
• 1911-Dewey school of
orthodontia.
• 1915- Founded & became
editor of International
Journal of Orthodontia(now
AJO).
• 1931- president of American
dental association (ADA)

ALBERT. H. KETCHAM
(1870-1935 AD)
• First to introduce
Roentgenogram &
Photography
• Investigated the
problem of root
resorption.
• Founding president of
ABO which is the oldest
specialty board in
dentistry.

ORTHODONTIC PIONEERS OF
THE LATE 19TH CENTURY

BENNO LISCHER
• He was the first to use the
term cephalometrics (1922).
• He backed the term
orthodontics (James Murray)
in place of orthodontia.
• He coined mesiocclusion,
distocclusion and
neutrocclusion, promoting
their use instead of Angle’s
Classes I, II, and III.

MERSHON
• His study of the relapse
phenomenon led to his
memorable quote, “You
can move teeth to where
you think they belong;
nature will place them
where they will best adapt
themselves to the rest of
the organism.”

SPENCER R. ATKINSON
(1886-1970)
• Atkinson’s interest in the
growth and development of the
head led to a collection of some
1400 skulls that are now
housed at the University of the
Pacific School of Dentistry.
• He originated the term key
ridge.

• Development of removable and
myofunctional appliances.
• Angles dogmatic approach to occlusion – less
impact in Europe.
• Precious metal for fixed appliances was
less readily available.
• 2 types of devices :
• Active plates or removable appliances
• Activator or functional appliances
Orthodontics in Europe

• Dr. H. D. Kesling, an
orthodontist, was so
impressed by Dr. Begg’s work
that he was instrumental in
bringing Dr. Begg to USA.
• Tooth positioner – 1945
• Diagnostic set –up

 Vick Alexander
1978: Vari-Simplex
Discipline.
 Charles Burstone
• Segmented arch
technique.
• COGS
• Introduced TMA, chinese
NiTi, fiber reinforced
composite.

T.M. GRABER
• Wrote 20 textbooks, 22
chapters in other
textbooks,180
publications in
journals & 930 book &
journal abstract
reviews.
• 1950 – First PhD to
Dentist by Northwestern
University Medical
School.

History of Orthodontic
diagnosis

Milo Hellman
• He pioneered the use of hand- wrist
radiograph to determine the growth
age and status of the patient.
Holly Broadbent and H. Hofrath
• In 1931, Holly Broadbent in USA
and H Hofrath in Germany
simultaneously published (A new
X-ray technique and its
application to orthodontia) and in
Fortschritte der Orthodontie,
respectively-CEPHALOMETRY

History of
Cephalometric analysis
Roentgen’s
X-ray
discovery
1895
Down’s
Analysis
1948
Cecil
Steiner
1953
CH
Tweed
1953
RM
Rickets
1958
V
Sassouni
1958
JR
Jarabeck
1969
Jacobson
1975

History of Model Analysis
CAREY’S
ANALYSIS
PONT’S
INDEX
1909
Korkhaus
’ Analysis
Howe’s
analysis
1954
Bolton’s
ratio
Huckaba’s
analysis
Hixon &
Oldfather’s
analysis
1958
Tanaka-
Johnston
analysis
1974
Nance
analysis
1976
Total
space
analysis
1978
Diagnostic
set-up
DR.Kesling
3D model
analysis
Dr.Mormonn

History of Extraction in
orthodontics

Angle vs Case controversy
• Originally, Calvin Case was a genuine admirer of
Angle. In fact, he gave up the general practice of
dentistry because of Angle’s influence.
• The discord - started over the claim that Angle
attributed the origin of the use of inter-maxillary
elastics to Baker.1903
• Case’s claim was that in 1890 he started this
procedure and reported it at the Chicago Dental
Society and also at the Columbian Dental Congress
in 1893.

• The second point - the question of the
extraction of certain teeth as a means of
treatment.
• Case defended the discreet use of extraction as
a practical procedure, while Angle believed in
non-extraction.
• However, the unexpected result of this
controversy was that it convinced general
practitioners that they should not attempt
orthodontic treatment but should refer patients
to the specialist.

Case VS
Dewey
controversy
1911

• Tweed held to Angle's firm conviction that the
practitioner must adhere to the line of occlusion
concept and never extract teeth.
• But little did he know...
• After 5 years of orthodontic practice, Tweed
became disheartened with his work for two
reasons:
• 1) the protrusive faces that he was creating.
• 2) the unstable dentition.
• He resolved to study his many failures and his
few successes.
• ‘Put your plaster on the table’- AAO 1940

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

In Contemporary view,
use of extraction is
cautious decision to be
made on basis of profile,
facial form , muscle
biology and function.
Not all cases need
extraction ,but for some
cases, it could be a
necessity.
Contemporary Orthodontics ,6Th ed, Proffit

Coffin, Kingsley’s student, reported on a new design
for an expansion appliance, which still bears his
name.1877
• Spring embedded piano wire, bent into the shape of
“W" into a vulcanite plate.
History of Expansion
BANDELETTE by
PIERRE
FAUCHARD
Amy Wescott in 1859
FATHER OF RAPID MAXILLARY
EXPANSION
EMERSON C ANGELL
1960

Palatal expansion
appliances
Derichsweiler
Expansion
screw by Jack
Issacson
Andrew Hass, 1961

DEVELOPMENT OF
MYOFUNCTIONAL APPLIANCES
• Development of myofunctional appliances started
with development of Monobloc by Robin,in 1902.
Viggo Andresen in Denmark
(1908)- Activator.
Modified Hawley’s type
retainer.

• Forward positioning of
mandible-for sagittal
correction.
• Later Andresen teamed up with Karl Haupl-
changes in the appliances.
• “Functional jaw orthopedics.”
• “Norwegian appliance.”
• Haupl coined the term Activator-Ability to
activate muscles.

H.P. Bimler – myodynamic
appliance.
• Expanding the maxillary
arch by cross wise
transmission of transverse
mandibular movements.
Stockfish- Kinetor,elastic
activator.
• Most frequently used
activator modification –
Bionator by Balters.
(early 1950s)

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

• 1977 – Pancherz
resurrected Herbst
appliance ;which was
Developed by Emil
Herbst in early 1900s.
Pancherz
Robert Ricketts
• Bioprogressive therapy
(1950s).
• Concept of VTO (Visual
treatment objective) and
computerized cephalometry
(mid-1970s).

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

HISTORY OF REMOVABLE
ORTHODONTIC APPLIANCE
• Victor Hugo Jackson was from United States of
America. He was the chief proponent of removable
appliances.
• In early 1900s, Crozat developed a removable
appliance fabricated entirely of precious metal that is
still used occasionally.
• Crozat appliance consisted of: Modified Jackson’s
clasp. Heavy gold wire framework. Lighter gold finger
springs to produce desired tooth movement.

A.M. Schwarz
• 1938 – Orthodontic bible in
Europe.
• “Schwarz double plate”-
combination of activator &
active plate. (class II div I)
Philip Adams (1950)
modified arrowhead clasp made
by Schwarz into the Adam’s clasp.
Versatile clasp: Basis for English
removable appliances.

HISTORY OF FIXED
ORTHODONTIC APPLIANCE

1907 - E -Arch Appliance
• Simple design.
• 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.
• Capable of great precision in tooth
movement.
• Incredible degree of craftsmanship.
• Impractical in clinical use.

1915 - Ribbon Arch Appliance
• First bracket.
• Vertically positioned rectangular slot with ribbon
arch of 10 x 20 gold wire.
• Good spring qualities.
• Allowed versatile movements.
• Poor control of root position.

1928 - Edgewise Appliance
• ‘Latest and the best’.
• Re-orientation of slot from vertical to
horizontal.
• Rectangular wire of 0.022 x 0.028 inch inserted
in a horizontal slot.
• Excellent control of crown & root position in all
three planes of space.

CHARLES H. TWEED
• In 1932, Tweed published his first
article in The Angle Orthodontics. It
was titled "Reports of Cases Treated
with the Edgewise Arch Mechanism.”
• Angle gave orthodontics the edgewise
bracket, but Tweed gave orthodontists
a way to use it.
• He devoted all 42 years of his
professional life to the use and
refinement of Angle's invention, the
edgewise appliance.

PERCY RAYMOND BEGG
(1898-1983 AD)
• Student of Angle.
• Returned to Australia in
1925.
• Non-extraction + Ribbon arch
mechanics
Poor post treatment profiles
and relapses.

• Feb. 1928- started extraction.
• Later started Ribbon arch brackets with
slots facing gingivally.
• Ribbon arch appliance + extraction
Begg technique

Begg’s appliance 1960s-
 Replacement of precious metal ribbon
arch with high strength 16mil
stainless steel wire.
 Retained the original ribbon arch
bracket but turned it upside down so
that the bracket slot points gingivally.
 Added auxillary springs to the
appliance for control of root position.
 Used stainless steel wire instead of
gold or platinum. (Arthur Wilcock)

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

HISTORY OF ANCHORAGE
G.S. Gunell in 1840s- Chin straps
Kingsley- extraoral anchorage
Amy Wescott- telescopic bar
Henry Baker- Baker’s anchorage
Temporary Anchorage Devices/ Micro-
implants-
1952- Branemark- implant
1954- Gainforth & Higley-retraction of mx C in
dogs
1969- Linkow- endosseous blade implant for
orthodontic t/t
1975- Kawahara – bioglass coated micro-implant

EVOLUTION TO LATEST TECHNOLOGIES IN
ORTHODONTICS
• Lingual orthodontics-Lingual braces
were given by Craven Kurz in 1976.
• Self-ligating brackets – These were first
proposed by Alexander Wildman (1972). Self-
ligating systems have risen in popularity with the
introduction of the Damon bracket (Damon,1998).
• Invisalign- Invisalign was the brainchild of Zia
Chishti and Kelsey Wirth, graduate students in
Stanford University’s MBA program. The Invisalign
System was developed in 1998 by Align Technology,
first technique to be based on 3D Digital Technology.

HISTORY OF ORTHODONTICS IN
INDIA
• Oldest orthodontic department- Nair dental college, Mumbai.
• MDS course was started at same institute in year 1959
• Indian orthodontic society was formed on 5th October 1965
• Father of Indian Orthodontics- Dr. H D Merchant
He received his degree in dentistry
(DMD) from Germany. Dr Korkhaus
was his teacher and mentor.
He returned to India and gave the
first series of lectures in Orthodontics
in 1935 at Nair Dental College.

References
• History of Orthodontics- Dr.Basavaraj Phulari , JAYPEE
publications.
• Proffit- contemporary orthodontics-6th edition & 5th edition
• Gurkeerat Singh – Textbook of orthodontics,1st ed
• Website-
https://en.wikipedia.org/wiki/John_Greenwood_(dentist)
• Castro FW. A historical sketch of orthodontia. Dent Cosmos,
1934;66:112.
• GEORGE HAHN-History and philosophy of Edward H. angle’s
society of orthodontics
• Asbell, M. B. (1990). A brief history of orthodontics. American
Journal of Orthodontics and Dentofacial Orthopedics, 98(2),
176-183.

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