Introduction and history of orthodontics 2nd oct 2011

Presented by:Dr. Jamal GiriResident (1st Year)

Introduction and

History of Orthodontics

Orthodontics (Greek word)-

Orthos - to correct

Odontos - teeth

Dept. of dentistry-PG section, IOM (2011) 2

The term “Orthodontics” – coined by Jacques Lefoulon (france) in 1839.

The term “Orthopedics” was first used by Bunon in the year 1743 with regards to correction of teeth .

A.F. Talma used the terms “Orthodontics and Dental Orthopedics” together.

1985- Orthodontics and dentofacial orthopedics.

3Dept. of dentistry-PG section, IOM (2011)

British Society of Orthodontics (1922)

“Orthodontics includes the study of growth and development of the jaws and face particularly and the body generally, as influencing the position of the teeth; the study of action and reaction of internal and external influences on the development, and the prevention and correction of arrested and perverted development.”


American Board of Orthodontics (ABO) :

“Orthodontics is that specific area of the dental profession that has its responsibility the study and supervision of the growth and development of dentition and its related anatomical structures from birth to dental maturity, including all preventive and corrective procedures of dental irregularities requiring the repositioning of teeth by functional and mechanical means to establish normal occlusion and pleasing facial contours.”


Branches of Orthodontics :

Preventive Orthodontics

Interceptive Orthodontics

Corrective Orthodontics

Surgical Orthodontics


(Summarized as Jackson’s Triad)

Functional Structural Esthetic

Efficiency Balance Harmony

Aims of orthodontics

Scopes of Orthodontic Treatment:

Alteration in tooth position

Alteration in skeletal pattern

Alteration in soft tissue envelope


Orthodontics is the oldest speciality of dentistry.

Dentistry in turn had it origins as a part of medicine.

Medicine

Dentistry

Orthodontics


Orthodontic ages

Ancient civilizations.

Middle ages (476-1450 AD).

Renaissance period (14th-16th century).

Eighteenth century.

Nineteenth century onwards.

Orthodontics in United states.

Orthodontics in Europe.

The merger and then after…


Ancient civilizations

Specimens dating back to VIII century B.C. indicate Etruscans may have been the first people to employ orthodontics to improve tooth alignment


Crude appliances to regulate teeth –recovered among the archaeological remnants in Egypt, Greece and Mexico (Mayans)


First dental healers were physicians.

Learned by trial & error & observation.


Hippocrates (460BC-377BC)

The Greek physician Hippocrates (460 to 377 BC) is considered as a pioneer in medical science.

Corpus Hippocraticum


First teeth are formed by the nourishment of the fetus in the womb.

The shedding of the first teeth generally takes place about seven years of age.

Children who cut their teeth in winter time get over the teeth period best.


“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 animal.


Pitfall

Males have more teeth than females in the case of men, sheep, goats, and swine.

“Aristotle maintained that women have fewer teeth than men; although he was twice married, it never occurred to him to verify this statement by examining his wives' mouths”. – Bertrand Russell


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 until it arrives at its proper position”.


Claudius Galenus ( 130-200 AD)

Described dental anatomy and embryology by specifically identifying the origin, growth, and development of the teeth and enumerating the functions of each.

Pitfall

He believed the teeth to be true bones.


Middle ages (476 -1450 AD)

Paulus Aegineta (625-690 AD)

When supernumerary teeth cause an irregularity of dental arches, they may be corrected by resection of such teeth or by extraction.

Irregular teeth were “displeasing in women.”


Barber surgeons (chirurgeons)

Earliest known organization of barbers was formed in 1096 AD.

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.


Renaissance period

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.


Described the maxillary and frontal sinuses and established their relationship to facial height.

Determined and made drawings of the number of teeth and their root formations.

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)

Set a precedent in the study of human anatomy when he personally performed a dissection.

The Fubric of the Human Body

Described the minute anatomy of the teeth, particularly the dental follicle and subsequent pattern of tooth eruption.

Proved Galen wrong!! 28Dept. of dentistry-PG section, IOM (2011)

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.


Gabriele Fallopio (1523 to 1562),

An Italian anatomist.

Observationes Anatomica.

A detailed description of the dental follicle.

Also gave us the terms hard and soft palate.


Bartholomaeus Eustachio (1520- 1574)

Also an Italian anatomist.

Libellus de Dentibus (Book on the Teeth).

Collected the writings of various authors from Hippocrates to Vesalius,added the results of his own researches.


Gave the first accurate account of the phenomenon of the sequential development of the first and second dentitions ( Disagreed with Vesalius).

The first clear description of dental pulp and root canal.

Described the periodontal membrane for the first time and thought of it as a gomphosis type of joint.


Arzei Buchlein

A book of surgical art published in 1530 AD (Author unknown).

“When teeth begin to drop out ... push the new one every day toward the place where the first one was until it sits there and fits among the others, for if you neglect to attend to this, the old teeth (deciduous) will remain and the young ones (permanent) will be impeded from growing straight.” 33Dept. of dentistry-PG section, IOM (2011)

Eighteenth Century

France became the leader in dentistry throughout the world in the eighteenth century.

This was primarily attributed to one man, Pierre Fauchard.

He created order out of chaos, developed a profession out of a craft.


Pierre Fauchard (1678-1761 AD)

Father of modern dentistry.

The Surgeon Dentist, A Treatise on the Teeth (1728).

His book is said to be the first complete scientific description of dentistry.


He developed the first orthodontic appliance: bandolet, designed for arch expansion.

Fauchard described 12 cases of orthodontic treatment in patients whose ages ranged from 12 to 22 years, with apparently good results.


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.


Robert Bunon (1702-1788 AD)

French dental surgeon.

Essay on the Teeth.

“I claim that a good formation of the teeth can be procured if care is given them from the earliest age. I even go further and I say that the tooth germs and the tooth materials are favorably disposed by the regimen of the prospective mother.”


John Hunter (1728-1793 AD)

A great teacher of anatomy.

Natural History of the Human Teeth.

Demonstrated the growth, development, and articulation of the maxilla and mandible with the attached musculature.


Outlined the internal structure of the teeth: enamel and dentin and their separate functions.

Experimentally established the difference between bone and teeth for the first time. (But he concluded tooth to be non vascular).

Nomenclature of teeth: incisor, bicuspid and molar.


Robert Blake (1772-1822 AD)

A disciple of Hunter.

“On the Structure and Formation of the Teeth in Man and Various Animals.” (thesis presented to the University of Edinburgh).

“I feel myself justified that the alveolar arches continue to increase during the entire progress of the formation of the teeth.”


IN Germany...

Gottfried Janke

attributed the shedding of deciduous teeth to the obliteration of their vessels by the compression of the erupting permanent teeth.

Adam A. Brunner

advised that “milk teeth should never be extracted unless there be manifest signs of the presence of the corresponding permanent teeth, or when it is painful or decayed.”


Orthodontics in United states.

In Colonial America, primitive conditions for dental care existed until European-trained “operators for the teeth” came to this country seeking fresh opportunities.

One of the most important native practitioners was John Greenwood (1760 to 1819).


Benjamin James (1814)

Noted that he was “often called upon to cure irregularity, than to prevent it.”

Levi S. Parmly (1819)

“where irregularities are allowed to proceed and become fixed, it is often a matter of difficulty, and sometimes of impossibility to rectify them.”


Robert Augustine (1854)

The correction of irregularities, however, easy in theory, will be found most difficult and delicate in practice; not only will much skill be found requisite, but, in equal degree, patience.

By the mid-nineteenth century basic concepts of diagnosis and treatment had begun.


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


E.G. Tucker (1846) was the first American to use rubber bands for tooth movement.

Emerson C. Angell (1860) used a jackscrew type of device between themaxillary premolars in 14 yrs old girl andachieved and increase in arch width by1/4th inch in 14 days.

(Father of Rapid Maxillary Expansion.)


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.

Pressure –tension theory

Schwarz (1932)


Norman W. Kingsley (1829-1913 AD)

“Orthodontia’s greatest genius” – E.H. Angle.

Experimented with appliances.

Fabricated obturator for cleft patients.

“Jumping the bite.”

forerunner of modern functional appliances.


A Treatise on Oral Deformities.

Over 100 articles on:

Cleft palate rehabilitation.

Orthodontic diagnosis.

Introduced the headgear to apply extraoral force & provide occipital anchorage (1861).


Emphasized the importance of the relationship between mechanics and biology as the principle on which orthodontics should be based.

Claimed that bending of alveolar bone would take place during orthodontic tooth movement (1877 AD).

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.

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”

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.

Being at heart an inventor, the field of general dentistry offered little interest.

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.


Angle’s postulates

Upper first molars are the key to occlusion and the most stable landmark in craniofacial anatomy.

Upper & lower molars should be related so that the mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar.

The teeth must be in harmony in normal occlusion.


The line of occlusion is smooth (caternary) curve.


Angle’s classification has 4 classes:


Angle’s contribution to orthodontics

Established orthodontics as a separate branch of dentistry.

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


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.


Non-extraction paradigm

Rousseau

Emphasized the perfectability of man

Wolff

the internal architecture of bone responds to stresses placed on that part of the skeleton.


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.


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. 71Dept. of dentistry-PG section, IOM (2011)

Initially a genuine admirer of Angle.

The discord:

Angle attributed the origin of the use of intermaxillary elastics to Baker.(1893)

The bombshell:

Concept of extraction for the treatment of malocclusion.


The climax of this conflict was a debate in 1911 at the annual meeting of the National Dental Association (former name of the ADA).

Dewey(Angle’s Student) Vs. Case:

one of the most sharpest and most heated controversies.

Angle & his followers won the day.

Extraction of teeth for orthodontic purpose essentially disappeared.


Martin Dewey (1881-1933)

Known for his modification of Angle’s classification of malocclusion.

Product of Angle’s school of orthodontics.

1911-Dewey school of orthodontia.


75

1914- Book entitled ‘Practical orthodontics.’

1915- Founded and became editor of the International Journal of Orthodontia (now AJO).

1931- president of American dental association (ADA)

Dept. of dentistry-PG section, IOM (2011)

Albert. H. Ketcham (1870-1935 AD)

1902 - Graduate of Angle School of Orthodontics.

First to introduce Roentgenogram & Photography

Investigated the problem of root resorption.

Founding president of ABO.


Milo Hellman (1873-1947 AD)

• Angle’s student.

• He demonstrated highpercentage of upper 1st

molar rotation and warnedin classifying malocclusion.

• He pioneered the use ofhand- wrist radiograph todetermine the growth ageand status of the patient.


1929 -The American Board of Orthodontics (ABO) was founded and is the oldest specialty board in dentistry.

1931 – Holly Broadbent introduced cephalometric radiography and tracing.


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


Charactristics of Begg’s appliance

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.


Begg revolution:

Begg appliance became widely popular (1960s).

Removed the need for headgear.

Allowed more efficient tooth movement with less discomfort.

Used stainless steel wire instead of gold or platinum. (Arthur Wilcock)


Charles H. Tweed

Charles H. Tweed applied to the Angle school in Pasadena in 1925 but was refused admittance.

Angle told him to study and to become more serious about orthodontics.


Angle and Tweed worked closely together for the last two years of Angle's life.

Tweed made progress records of his patients every 4 months. He packed the records in a suitcase and took them to Pasadena, where Angle studied them and outlined a treatment plan for the next 4 months.


Angle was so pleased with Tweed's work, that he was instrumental in making it possible for Tweed to be invited to give lectures at several orthodontic meetings.

In 1932, Tweed published his first article in The Angle Orthodontics. It was titled "Reports of Cases Treated with the Edgewise Arch Mechanism."


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.


Tweed’s conclusion:

1) The patients who had pleasing facial balance and harmony also had mandibularincisors that were upright over basal bone.

2) The carefully planned extractions allowed to improve appearance as well as stability


By 1940 he had records of 100 patients, treated first without extractions and then retreated with extractions.

He put these patient records on display at an American Association of Orthodontists (AAO) meeting.

“Just put your plaster on the table."


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.


Orthodontics in Europe

Not a single person dominated.

Development of removable and myofunctional appliances.

Angles dogmatic approach to occlusion – less impact in Europe.

Precious metal for fixed appliances less available.

2 types of devices :

Active plates or removable appliances

Activator or functional appliances


Development of active plate

1839 – Charles Goodyear invented vulcanite. ( late 1930s- vulcanite was replaced by acrylic)

1881 – Coffin plate by Coffin.


1902- Pierre Robbin devised “Monobloc” made of single block of vulcanite. It is used to position the mandible forward in patients with glossoptosis and severe mandibular retrognathism.


1908 – Hawley’s retainer appliance was developed.

(Charles. A. Hawley)

1911 – J.H. Badcock- expansion plate with screw.


A.M. Schwarz

1938 – ‘Lehrgang derGebissregulung’ -Orthodontic bible in Europe.

“Removable Orthodontic Appliances‟ (1966)

“Schwarz double plate”

combination of activator & active plate. (class II div I)


Philip Adams (1950s)

modified arrowhead clasp made by Schwarz into the Adam’s crib.

Versatile clasp: Basis for English removable appliances.


Development of functional appliances

Viggo Andresen in Denmark (1908)- Activator

Modified Hawley’s type retainer.

Forward positioning of mandible-for saggitalcorrection.

Used for the first time on his own daughter.

“Biomechanical working retainer”


Later Andersen teamed up with karlHaupl- changes in the appliances.

“Functional jaw orthopedics.”

“Norwegian appliance.”

Haupl coined the term Activator

Ability to activate muscles


Most frequently used activator modification –Bionator by Balters.

(early 1950s)


H.P. Bimler – myodynamic appliance.

Expanding the maxillary arch by cross wise transmission of transverse mandibular movements.

Stockfish Kinetor.


Rolf Frankel of Germany.

Function Regulator in 1950s.

Appliance confined to oral vestibule –shields buccal and labial musculature away from teeth & investing tissues.


The Merger and then after…

The 50s and 60s were the decades when cross-continental barriers began dissolving.

Egil Harvold – faculty at University of Toronto, introduced ‘Norwegian system’ in U.S.

In Europe fixed appliances started replacing removable appliances for comprehensive treatment.


Dr. H. D. Kesling, an orthodontist, was so impressed by Dr. Begg’s work that he was instrumental in bringing Dr. Begg to USA.

April, 1960- Dr. Begg presented his cases treated with Begg Technique at the AAO annual meeting.

This was first introduction to BeggMechanics in USA.


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)


106

Edward. H. Angle

Raymond Begg(Conventional Begg)

P.C Kesling(Tip-edge & tip-edge plus)

Messias Rodrigues(simplified straight wire tech.)

Charles Tweed(edge-wise)

Lawrence Andrews(straight wire)1st generation

Ronald Roth2nd generation

MBT (McLaughlin,

Bennett, Trevisi)

3rd generationDept. of dentistry-PG section, IOM (2011)

Modified Begg(Begg principle without

ribbon arch bracket)

Refined Begg(Dr. Jayade, Sims)

Vick Alexander

1978: Vari-Simplex Discipline.

Charles Burstone

Segmented arch technique.

COGS

Introduced TMA, chineseNiTi, fibre 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.

Editor-in-chief of AJO for 15yrs.


William. J. clarkdeveloped the Twin Block Technique in 1977.

The technique is now the most widely used functional technique throughout the world.


1977 – Pancherz resurrected Herbstappliance.

Developed by Emil Herbst in early 1900s.


J.J.Jasper in 1980-Jasper jumper.

A flexible, fixed tooth borne functional appliance


Robert Ricketts

Bioprogressive therapy (1950s).

Concept of VTO (Visual treatment objective) and computerized cephalometry(mid-1970s).


Visual treatment objective (VTO)


Cone beam computed tomography

(CBCT)


Skeletal anchorage

Vitalium screws (Gainsforth and Higley, 1945).

Conventional osseointegrated implants (Roberts et al., 1989).

Mini-plates (Jenner and Fitzpatrick, 1985)

Onplants (Block and Hoffman, 1995)


Palatal implants (Wehrbein et al., 1996)

Mini-implants (Kanomi, 1997)

Miniscrews (Costa et al., 1998).


Orthodontics in Nepal

B.P.K.I.H.S is the first government hospital to provide orthodontic treatment where as in Kathmandu valley, IOM is the first.

Dr. Sambhu Man Singh(DORCS- England,1974) is the first Orthodontist of Nepal.

Dr. Praveen Mishra is the first orthodontistwith MDS degree(MAHE – 1995).


Orthodontics and DentofacialOrthopaedics Association of Nepal (ODOAN) has been established in 2009. It is the first association among dental postgraduate specialities.

At present there are 14 orthodontists (as registered ODOAN) in Nepal most of them are centred in Kathmandu valley.


ODOAN :affiliated to Asian Pacific Orthodontic Society (APOS) in Feb 2010 and World Federation of orthodontics (WFO) in June 2010 as 108th member.

Post graduation in Orthodontics was started in National Academy of Medical Sciences(NAMS) in 2008 for the first time in Nepal.

2010- IOM and people’s dental college.

2011- Universal college of medical sciences.119Dept. of dentistry-PG section, IOM (2011)

“History is reading all that you can as

fast as you can and - remembering as

much as you can.”

Lynn Berleffi Darr


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Introduction and history of orthodontics 2nd oct 2011

Education