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Orthodontics in the past millenium

Vijayalakshmi PS* Veereshi AS **
*M.D.S, Reader, **M.D.S, Associate Professor,Department of Periodontics and Implantology,Departmant of
Orthodontics, Rungta College of Dental sciences, Bhilai,India. Email: dr.veereshi@gmail.com
Abstract:
Pearl Buck said if you want understand today,
you have to search yesterday. This article traces the
history of Orthodontics, which evolved as first speciality
of dentistry. It describes the journey in the quest of an
ideal Orthodontic appliance and about various
legendary orthodontists whose contribution in different
areas of orthodontics has led to the development of
orthodontics to the state of art, it is today.

The first mechanical treatment for correcting

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

Keywords:Orthodontics, Evolution, Present

Introduction:
The heritages of the past are the seeds that bring
forth the harvest of the future. Awareness of our historical
antecedents has acquired more importance today, since
changes are occurring so rapidly, that only by keeping our
eyes steady on what went before can we progress with
intelligence and confidence.
History of dentistry:
The first dental healers were physicians, but by
the middle ages the barber-surgeons of Europe had
specialized in the care of teeth. These practitioners not only
learned by trial and error but also by observation.
Baltimore College of Dental Surgery was the
first dental college in the world which opened its doors to a
class of five students on November 3rd, 1840.
Orthodontics- the beginning:
Hippocrates 1 (460-377 B.C.) was among the first
to comment about craniofacial deformity.Aurelius
Cornelius Celsus1 in 25 B.C. advocated that persistent
deciduous teeth should be extracted and that permanent
teeth which erupt in the wrong direction ought to be
corrected by finger pressure.Specimens dating back to VIII
century B.C. indicate Etruscans may have been the first to
employ orthodontic bands to improve tooth alignment.2

Serial Listing: Print-ISSN (2229-4112)

Online-ISSN (2229-4120)
Bibliographic Listing: Index Copernicus.
EBSCO Publishing Database.

The term orthodontia derived from two Greek

words- orthos meaning right or correct and dons
meaning tooth, was first used by the Frenchman LeFoulon
in 1839. 1In 1880 Norman Kingsley (1829-1913) widely
considered as Father of Orthodontics published his bookTreatise on Oral Deformities as a Branch of Mechanical
Surgery, where he offers many practical procedures of his
own like occipital anchorage and attempts for the first time
, the systematization of the treatment of occlusal
abnormalities.1, 2
However the emergence of orthodontics as a
true specialty is largely the result of the dominant, dynamic
and influential leadership of Edward Hartley Angle (18551930),
regarded
as
the
Father
of
Modern
Orthodontics.2Angle felt that orthodontics was as important
as other departments in dentistry and not a part of
prosthetics as it had been traditionally considered. In 1901
Angle and his followers organized the American Society of
Orthodontists (later known as American Association of
Orthodontists)
Development of fixed appliances:
18th Century (1700-1799):The first scientific attempt at
tooth movement was done by Pierre Fauchard through his
appliance known as the Bandlette. It consisted of a flat
strip of metal formed into an arch with suitably placed
holes, through which threads were passed to secure the
teeth, applying force to them.1
19th Century (1800-1899):Schange, a Frenchman invented
the adjustable clamp band with the introduction of a lingual
screw in 1841. The regulating jackscrew which delivered a
pushing force on the teeth was invented by Dwinelle in
New York in 1849.In 1861 Kingsley introduced the
headgear to apply extra-oral force and provide occipital
anchorage.
Norman Williams Kingsley (1829-1913) 2 was
regarded as Orthodontics greatest genius by even the

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eccentric genius E. H. Angle. He made one of his greatest

contributions in the field of cleft palate when in 1859 he
made his first obturator. Through his great skill, Kingsley
was able to restore normal speech and to improve facial
appearance with prosthetic restoration for his cleft palate
patients. However, the practice of orthodontics altered
forever in 1870 with an invention that most orthodontists
have not associated seriously with treatment. It was the
invention of dental cement by Magill of Erie, Pennsylvania.
Without adhesives, orthodontic practice would not be
possible as we know it today.3
The most dominant, dynamic and influential
figure in the specialty of orthodontics was Edward Hartley
Angle (1855-1930) who is regarded as the Father of
Modern Orthodontics. He believed that an orthodontic
appliance must have 5 propertiesSimple, Stable, Efficient, Delicate and Inconspicuous.
In 1880 he invented his first real appliancethe jack and traction screw which marked the beginning of
his life work. Angle developed a classification of
malocclusion, which was published in the Dental Cosmos
in 1899. Angles postulate was that the upper first molars
were the key to occlusion and that the upper and lower
molars should be related so that the mesiobuccal cusp of
the upper molar occludes in the buccal groove of the lower
molar.
Angle defined line of occlusion as the line
with which, in form and position according to the type, the
teeth must be in harmony if in normal occlusion. This
statement, which 100 years of experience has proved to be
correct except when there are aberrations in the size of
teeth, brilliantly simplified normal occlusion.2 Angles
classification has 4 classes. He organized the first school of
Orthodontia The Angle School of Orthodontia in 1900.In
May 1900 The American Society of Orthodontists was
formed and Angle was elected its president.
By 1907, he had discontinued using jack
screws and was exclusively using E arch.
Angles
various inventions before his edgewise appliance are as
follows, Basic E arch, Ribbed E Arch - for expansion, E
Arch without threaded ends, E Arch with hooks, Pin and
tube appliance, 1910. Transformation of pin and tube into
ribbon arch appliance by ingenious removal of portions of
tube and separation of pin from arch wire in 1916. Creation
of "tie bracket" by minor alteration of ribbon arch bracket
and rotation of ribbon arch to "edgewise" position, 1925. It
was in 1928 that Angle made his greatest contribution of
all. He gave the world what he called as the latest and the
best. It was the introduction of the Edgewise appliance in
1928 2.The original Angle bracket was made up of soft gold
with 0.022 x 0.028 slot. It was .050 wide and was
soldered to gold band material.
Dr. Calvin Case-(1847-1923): 1
Dr.Clavin Case was a contemporary of Angle.Case was a
pioneer in orthodontic mechanotherapy. He was one of the
first to stress on root movement (1892). Use rubber elastics
in treatment (1892) and to use small gauge, light, resilient
wires for tooth alignment (1919). He pioneered the use of
retainers to stabilize orthodontic results

Martin Dewey (1881-1933): 1

Martin Dewey published his textbook on
orthodontic philosophy and mechanical procedures in 1914
- Practical orthodontics. In 1915 with the help of Dr. C.
V. Mosby, Dewey founded and became editor of the
International Journal of Orthodontia (now AJO-DO). He
was the editor for 17 years and also the President of ADA
in 1931.
Albert H. Ketcham (1870-1935) 1
Albert.H.ketcham worked diligently in the
American Society of Orthodontics and served as its
President in 1929. In recognition of his services to
orthodontics and in his honor the ABO established what is
now considered as the specialtys most coveted prize - the
Albert H. KetchamMemorial. Other developments taking
place around the world that influenced American
orthodontic history are recounted in the following pages.
1900-1910:3
The first decade of 21st century was an era of
manufacture of standardized appliances. Dental supply
companies sold appliances made as sets of various kinds
mounted on cards. By the use of a few simple soldering
techniques, dentists could make a required fitting as it
was called.
Victor Hugo Jackson (1850-1929)1, 2 was the chief
proponent and pioneer of removable appliances in US. He
devised a specially designed appliance known as the
Jackson's crib.Charles Hawley introduced the Hawleys
retainer in 1908.
1911- 1930:
Serious study of tissue changes during
orthodontic tooth movement was carried out by
AlbinOppenheim in 1911.
George Crozat2 in 1928 developed the Crozat
appliance a removable appliance fabricated entirely of
precious metal with effective clasps for I molars modified
from Jacksons designs from which Class II elastics were
employed to treat Class II malocclusions.Spencer Atkinson
introduced the Universal appliance which was a
combination of ribbon arch appliance & edgewise
appliance, using a flat wire & round wire in combination.
1931-1940:
In 1931, Holly Broadbent4 published in the first
issue of Angle Orthodontist A New X-ray Technique &
Its Application to Orthodontia. It was the introduction of
cephalometric roentgenography, cephalometric tracing &
evaluation, to the specialty and dentistry.
Joseph Johnson 1, 2 introduced the twin arch
appliance in 1938 in which the resiliency of the double
wires provided the gentle force for tooth movement. In
1940, Oren A. Oliver 1, 2 introduced the labiolingual
appliance.
1941-1950:
In 1941 Charles Tweed introduced an edgewise
appliance. Tweeds list of contribution to the field is quite
long. Few among them are, He emphasized the 4 objectives
of orthodontic treatment with emphasis and concern for
facial esthetics, serial extraction, uprighting teeth over
basal bone, extractions made more acceptable. He
developed the diagnostic facial triangle. In 1948 William

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Downs4 introduced his cephalometric analysis. It presented

an objective method of portraying many factors underlying
any malocclusion and that there could be a variety of
causes of malocclusion exclusive of the teeth. Other
analyses were presented by -C.C. Steiner (1953), C.H.
Tweed (1953), S.E. Coben (1955), R.M. Ricketts
(1966),V.Sassouni (1969), H.D. Enlow (1969), J.R. Jarabak
(1970), A. Jacobson (1975)
Development of removable appliances:
In 1881, Coffin plate was introduced by Coffin
with the spring that is still part of present appliances, but
was then made of piano wire.2, 5
In 1902 Pierre Robin introduced the Monobloc
named so since it was made of a single block of vulcanite.
Though it repositioned the mandible forward it was
originally designed to prevent glossoptosis in
micromandible& cleft lip & palate patients (later known as
Pierre-Robin Syndrome), and not as a functional appliance
to stimulate mandibular growth.5,6, Charles Hawley
introduced the Hawleys retainer appliance in 1908. But in
the next 3 decades these plates were eclipsed by Angles
fixed appliances which dominated the orthodontic world.
Only the Hawley retainer came to stay.
Two years later A.M. Schwarz published a
textbook entirely devoted to treatment with plates, where
designs of different split plates with various screws were
shown. It was Lehrgang der Gebissregulung which
became the Orthodontic bible in Europe. It was translated
as the immensely successful Removable Orthodontic
Appliances by Graber and Neumann in 1966.5,6Schwarz
also introduced the Schwarz double plate5 which
attempted to combine the advantages of activator & active
plate for treatment of class II div 1.Philip Adams2,5,6in
Belfast modified the arrowhead clasp favored by Schwarz
into Adams crib, which became the basis for English
removable appliances and is still the most effective clasp
for orthodontic purposes.Thus there was predominance of
simple removable plates in Britain and of functional
appliances in Central Europe.3,4
Evolution of functional appliances:
Andresen6 developed a mobile, loose-fitting
appliance modification that transferred functioning muscle
stimuli to the jaws, teeth and supporting tissues. Haupl
collaborated with Andresen and together wrote about their
appliance & the interpretations of its actions. They named
the technique as Functional Jaw Orthopedics5,6 and Haupl
gave the name activator, to the apparatus introduced by
Andresen, based on its ability to activate muscle forces.
The Bionator developed by Balters is the most frequently
used activator modification today.5The development of the
unique and complex myodynamic appliance was due to the
ingenuity of H.P. Bimler5Stockfish originally a disciple of
Bimler modified the appliance and produced the Kinetor 5.
The 50s and 60s were the decades when cross-continental
barriers began dissolving and the dichotomy between
European and American orthodontics started disappearing.
In Europe fixed appliances started replacing removable

appliances for comprehensive treatment. This was

accelerated by the replacement of orthodontic bands with
bonded attachment which made placement of fixed
appliances easier for both the dentist and the patient.
Rolf Frankel6 believed that active perioral
muscles and tissue mass have potential restraining effect on
the outward development of dental arches particularly
during the transitional period of development. Therefore
Frankel conceived his Frankel Function Regulator in 1950s
as an ought to be matrix that allowed the muscles to
exercise and adapt.In 1934 Herbst& Schwarz presented a
series of articles on their experiences with the appliance. In
1977 Hans Pancherz6 resurrected the Herbst appliance,
introduced by Emil Herbst.In 1977, Clark 5,6 developed the
twin-block appliance as a two-piece appliance. This
appliance achieved rapid functional correction of
malocclusion by transmitting favorable occlusal forces to
the occlusal inclined planes covering the posterior teeth.
Fixed appliances: At this point in time the world received
another landmark contribution in the field of fixed
appliance. It was the introduction of multiple-loop, lightforce wire appliance by P. R. Begg of Australia. In 1956
Begg introduced the concept of Differential force.1,2,5As of
now, the Begg technique has undergone many
modifications from the way it was practiced by Begg
originally. It is known and practiced in its various forms as
conventional / traditional begg, modified begg, refined
begg.9Peter Kesling modified the edgewise bracket to
create Tip-Edge bracket in 1988.7
T.M. Graber : (1917-2007)
Dr. Thomas Graber was born in St. Louis on May
17th 1917. He graduated from the Washington University
in St. Louis. His ability to express complex concepts in an
easy-to-read style has resulted in over 20 textbooks, 22
chapters in other textbooks, 180 publications in journals &
930 book & journal abstract reviews. 10 Graber founded the
Kenilworth Dental Research Foundation in 1964.. He was
the Editor-in-chief of AJO for 15 years and was responsible
for changing its name to AJO-DO in 1985. He started the
World Federation of Orthodontics in May 15, 1995 and the
World Journal of Orthodontics in 2000.
Lawrence F. Andrews :1, 6
In 1972, Dr. Lawrence F. Andrews ushered in the
preadjusted era with the introduction of the Straight Wire
Appliance (SWA) which was hailed as a revolutionary
development with the dual advantage of less wire bending
and improved quality of finished cases.Another landmark
contribution of Andrews is the 6 keys of occlusion which
he gave in 1972.
Robert M. Ricketts 11:
Dr. Robert Murray Ricketts developed the
bioprogressive therapy. He introduced utility arch,
Ricketts Quad Helix made of 0.40 blue elgiloywire and the
use of preformed bands in orthodontics. Ricketts developed
his cephalometric analysis & cephalometric growth
prediction technique in 1960s. He popularized
computerized cephalometrics for VTOs & STOs. He rightly

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stressed the importance of soft-tissues while treating a

patient and introduced his E-line for evaluating the position
of lips in relation to the profile.

11. T.M. Graber: An Orthodontic Perspective after 75

years, AJO, May 1976, Vol. 69, No.5

Vick Alexander :
In 1978 Alexander introduced his Vari-Simplex
Discipline to get high quality results in a large practice
using a relatively simple appliance technique. 11
Charles Burstone :
Charles Burstone is credited with introducing
newer materials in orthodontics like - TMA, Chinese NiTi
and Fibre reinforced composite and introducing newer
approaches like Holography & use of Occlusograms.
Burstone also developed the surgical planning analysis
COGS i. e. Cephalometrics for Orthognathic Surgery. He
also devised the segmented arch technique 11,
Ronald H. Roth :(1933-2004)
In 1976 Ronald Roth published a report entitled
Five year clinical evaluation of the Andrews Straight Wire
Appliance. To avoid the difficulties of a multiple bracket
system, Roth recommended the 2nd generation of
preadjusted brackets (roth prescription) which consisted of
minimum extraction series brackets and could be used in
both non-extraction and extraction cases. He came out with
innovation self-ligating brackets. 11
Bennett, McLaughlin and Trevisi
They have modified Andrewss standard SWA
bracket system to MBT bracket system. These third
generation brackets retained the best in original design but
introduced range of improvements and specifications to
overcome the clinical shortcomings.
References:
1. T.M. Graber. Orthodontics: Principles & Practice,
2nd edition, Philadelphia, W.B. Saunders Company,
1966.
2. William R Proffit, Henry W Fields. Contemporary
Orthodontics, 3rd Edition. Mosby,1999.
3. Milton Asbel: A Brief History of Orthodontics,
AJO-DO, Sept. 1990, Vol. 98, No.3,176-83
4. Orthodontics in 3 millennia. Chapter 3: The
professionalization of orthodontics AJO-DO, Sept.
2005, Vol. 127 No. 6,749-53.
5. Graber,
Neumann.
Removable
Orthodontic
Appliances, 2nd Edition. Philadelphia, Saunders
1977.
6. Graber, Swain. Orthodontics: Current Principles &
Techniques, III Ed. Philadelphia, Saunders 1975.
7. Graber, Vanarsdall. Orthodontics: Current Principles
& Techniques, 4th Edition, Mosby, 2005.
8. Graber, Rakosi, Petrovic. Dentofacial Orthopedics &
Functional Appliances, 2nd edition Mosby, 2007
9. Dr. V.P. Jayade: Refined Begg for Modern Times.
1st edition, Published by A.V.Jayade, Hubli
10. Lee Graber: Vignette T.M. Graber, AJO-DO, May
2000, Vol. 117, No. 5, 516-524.

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