HISTORY OF ORTHODONTICS

Presented to
DRA.ANGELA POLANIA

Presented by
CARLOS MUÑOZ
MATEO BRAVO
JULIANA GOMEZ
MARIA ANGELICA CASTRO

UNIVERSIDAD DEL VALLE

ESCUELA DE ODONTOLOGIA
ESPECIALIZACION EN ORTODONCIA
ASIGNATURA BIOMECÁNICA II
SANTIAGO DE CALI
AÑO 2017
CONTENTS
Orthodontics in Greece and Rome:

The first description of the irregularities of the teeth was given around 400 BC
Hippocrates (460-377 BC). The first treatment of an irregular tooth was recorded by
Celso (25 BC - 50 AD), a Roman writer, who said: "If a second tooth should grow in
children after the first tooth has been dropped, what should be is Extracted and then
pushed into place by the finger until it reaches its right proportion. "The first
mechanical treatment by Pliny the Elder (23-79 AD) was probably defended, who
suggested the classification of elongated teeth to put them in proper alignment . This
method was maintained in practice until the 1800s.

(5th to 15th century) to 18th century:

Progress during the middle ages was completely nil with respect to dentistry. Entered
in a period of marked decadence, like all sciences. After the 16th century, significant
progress was made, although little was written of orthodontics during this period.
In France, dentistry students were admitted to a university as early as 1580. The first
and exclusive mention at the time of speaking of the practice of dentistry was done
by Pierre Dionis (1658-1718).
Purmann Matthaeus Gottfried (1692) was the first to inform the making of
impressions of wax. In 1756, Phillip Pfaff used plaster of Paris for the emptying of
impressions.

Malocclusions were called tooth irregularities, and their respective correction was
called dental regulation.
From the 18th century, the leading country in the field of dentistry was France. This
was due, to a great extent, to the efforts of one man: Pierre Fauchard (1678-1761)
has been called the father of orthodontics. He was the first to eliminate dentistry as
something empirical and laid a scientific foundation. In 1728, he published the first
general work of dentistry, titled The Dentist Surgeon: Treatise on Teeth. Fauchard
describes, but probably was not the first person to use, what he called the Bandeau:
an expansion arc consisting of a horseshoe-shaped strip of precious metals to which
he linked his teeth. Here was the basis for the Angle E, also the "reattachment" of
teeth with a forceps, called "pelican" because of its resemblance to the beak of that
bird, and the tooth was ligated to its neighbors until the In that time, little attention
was paid to anything other than the alignment of the teeth and then almost
exclusively to the jaw.

The Bandeau de Fauchard was refined by Etienne Bourdet (1722-1789), a dentist

of the King of France and was the first to recommend serial extraction (1757) and
extraction of premolars to correct crowding. He was also the first in Practice "lingual
orthodontics" by extending the arch from the lingual surface. Then followed by a long
list of lingual appliances, including the screw and expansion plate and closer to our
time, the lingual arch.

Although not a dentist, John Hunter (1728-1793) made the greatest advances in
dentistry of his time. An English anatomist and surgeon, Hunter took a particular
interest in the anatomy of the teeth and jaws. Its text, the natural history of human
teeth (1771), presented the first clear statement of the principles of orthopedics. He
was the first to describe normal occlusion to try to classify teeth. He established the
difference between the teeth and the bone and gave to the teeth names like cuspidati
and bicuspidati. He was the first to describe the growth of jaws, not as a hypothesis,
but as a sound, scientific research. Their findings have never been successfully
changed.

European pioneers of the early nineteenth century:

Joseph Fox (1776-1816), a student of Hunter, was another Englishman who made
notable contributions to the budding science of orthodontics. He dedicated 4
chapters of his book: The History and Natural Diseases of Human Teeth (1814), with
that theme. The first to classify malocclusion (1803) was also one of the first to
observe that the mandible grows mainly by distal extension beyond the molars, with
little or no increase in the anterior region. According to Weinberger Fox "was the first
to give explicit instructions for correction of tooth irregularities." He was particularly
interested in the removal of deciduous teeth, time of treatment, and the use of bite
blocks to open the bite. Its other devices include an arch expansion and a chin rest
(around 1802).
Joachim Lefoulon, a Frenchman, is probably best known for having given science a
name: orthodontosie (1841), which roughly translates into orthodontics. He was also
the first to combine a labial arch with a lingual arch. In the area of etiology, it came
to factors of a totally different character from those of most authorities. These are
based on biological phenomena that control the growth, shape and dimension of
organs and tissues.

Christophe- François Delabarre (1787-1862; French) introduced the wedge and the
principle of the lever and the screw (1815). He separated the clustered teeth by
means of wooden wedges placed between them.
J. M. Alexis Schange (1807- French) in 1841 published the first work that is limited
to orthodontics. He introduced a modification of the screw, the fastening band and
in 1842 3 years later the vulcanization process was developed, rubber bands
(actually sections of rubber tube). He also coined the term anchorage.
Friedrich Christoph Kneisel (1797-1847, German), went to the dentist with Prince
Charles of Prussia. He was the first to use plaster models to record malocclusion
(1836). That same year, he presented a prognathous patient using a chin strap, and
became the first to use a removable device. Kneisel wrote the first French and
German treatises devoted exclusively to orthodontics.
He and John Tomes (1812-1895, English) used various removable ones. Tomes
was also the first to demonstrate bone resorption and apposition.
American pioneers of the early nineteenth century:

Before the time of Edward Angle and Calvin Caso, the treatment of malocclusions
was chaotic, with little understanding of normal occlusion and even less
understanding of the development of the dentition. The devices were primitive, not
only in the design but also in the metals and materials used. There was no rational
basis for the diagnosis and analysis of the case. In the United States before the
1830s, there was no dental grade. All works in the mouth made by doctors, barbers,
or charlatans, and there were no terms such as orthodontics and poor occlusion.
There were already valuable contributions to the specialty by American authors
actually orthodontics had little literature until 1880. However, during approximately
the fourth decade of that century, most of these gaps began to be filled, as this
country gained the position Of command in dentistry. In 1834, the first American
Dental Association, the Society of City and State Dentist of New York, were founded.
In later decades, Americans invented vulcanite and other dental materials and were
pioneers in electric milling, and in the discovery of anesthesia.

In Philadelphia, dentist Leonard Koecker (1728-1850) offered to provide ligatures to

the teeth of an irregular situation and was an advocate of early treatment, stating
that if placed under appropriate care at an early age, most of the permanent teeth
may Always be preserved in perfect health and regularity, and that if the first molars
are removed in any period before the age of twelve, all the anterior teeth will grow
more or less backwards and the second and third molars will close the empty space.

In 1839, the first dental journal of the American Association of Dental Science
Journal, was established through the efforts of Brown's Solyman (1790-1876), who
wrote the first educational material to the patient "Importance of Regulation of Teeth
of the kids".

Levi S. Parmly (1790-1859), founder of a dental dynasty; And Chapin A. Harris

(1806-1860), edited the WHO journal in 1839 to 1858. Harris was also instrumental,
along with Horace H. Hayden (1769-1844), in founding the first school of dentistry in
University of Maryland, where the first lectures were given on "Irregularities of
Teeth." In 1840, he published the first modern classic book on dentistry: dental art.

Entering the modern era:

Orthodontic pioneers of the late nineteenth century:

Norman W. Kingsley (1825-1896) was the first of those dental pioneers who did the
last half of the 19th century, a period of breakthrough. A splendid thinker and expert
in the field, he introduced a series of innovations, including occipital traction (1879).
Initially, the teeth are removed and the anterior teeth moved back into the created
space. Later, he gave up on the extraction and added a vulcanite inclined plane to
his "jump-open bite" mechanism. He also experimented with cleft palate treatment,
perfecting a gold shutter and an artificial calf of After 1850, the first texts that
systematically describe orthodontics were Kingsley's book, The Oral Deformities
(1880), the first to recommend that the etiology, the Diagnosis and treatment
planning should be the foundation of practice.He was also first to discuss cleft palate
treatment in terms of orthodontics.But his fame as a dentist was almost
overshadowed by his talent as an artist and as a sculptor.
Despite the contributions of Kingsley and his contemporaries, his emphasis on
orthodontics continued to be the alignment of teeth and the correction of facial
proportions. At that time, several dentists showed an interest in the enlargement of
the upper arch. Almost 150 years later, their methods have not been greatly
improved.
Amos Westcott made the first effort using a telescopic rod in the jaw to correct a
crossbite (1859). In the 1840s, he placed mentonera species on his Class III
patients. Emerson C. Angell was the first to open the middle palatal suture with a
partition plate (1860), and William E. Magill was the first to cement platinum bands
(1871).
That same year, CR Coffin, a student of Kingsley, reported on a new design for an
expansion device, which still bears his name. It is embedded, folded as a "W" on a
vulcanite plate, separated from the plate in the middle, and activating the spring so
that its halves drive the honeycomb process to the outside. After World War II, acrylic
replaces vulcanite.

Research by John Nutting Farrar (1839-1913) began the era of biological dental
movement. In an article 1876, he advocated specific limits for tooth movement and,
in so doing, laid the foundation for scientific orthodontics. He was among the first
(1850) to use the occipital anchor to retract the anterior teeth. He recommended the
bodily movement of the teeth (1888). Based on animal studies, Farrar originated the
theory of intermittent force and developed a screw to deliver this force in increments.
Its Treaty on irregularities of the teeth and its correction (1888) is considered the first
great work dedicated exclusively to orthodontics. For these reasons, it has been
called the "Father of American Orthodontics."
Before the end of this century, other men made important contributions to the new
science. Eugene S. Talbot (1847-1925), a prolific inventor, was one of the first to use
Ray Roentgen in orthodontic diagnosis. He emphasized the study of the causes of
malocclusion, especially constitutional and hereditary factors, as the key to
treatment. He was one of the first to suggest endocrine glands as a possible cause
of deformities and proposed that all patients were in "neurotic, idiot, degenerate, or
lunatic malocclusion." His unwavering search for this theory led to much antagonism.

Talbot was the first specialist in orthodontics and periodontics. He wrote the bad
positions of the teeth and his Treatment (1888), which was through 6 editions;
Degeneration: its causes, signs (1898); And more than 90 articles on gingival
pathologies and poor position of teeth.
In 1893, Henry A. Baker introduced intermaxillary rubber bands to correct poor
positions.
Wilhelm Conrad Roentgen (1845-1923), a German physicist, discovered the X-rays
(1895), for which he received the first Nobel Prize (1901). Although this discovery
instantly revolutionized medical and dental diagnosis, it would be at least 10 years
before it was found to be used in orthodontics and 35 before orthodontists would be
allowed to visualize changes in the skull (cephalometry).
Simeon H. Guilford (1841-1919), dean of the Philadelphia dental school, was one of
the few authors who comprehensively dealt with orthodontics, achieving
biomechanics, causes and factors related to malocclusion. In 1889 he wrote the first
text on: A topic of extractions in orthodontics, chapter he wrote about his book:
Orthodontics: Malposition of human teeth. It determined the indication or not of
exodoncias in the orthodontic treatment.

Calvin S. Case (1847-1923) wrote a practical treatise on techniques and principles

of dental orthopedics (1908), contributed two chapters on the American text of dental
surgery (1897) and wrote 123 articles. He was the first to wear (circa 1893) along
with Henry Baker, class II elastics and was the first to achieve movement in a tooth
body and was the first to use ligature wire (0.16 and 0.18).
Case took the extraction to correct the facial deformities, he incurred in Angle's
school and in his discipline. In 1910 Casé provoked a great debate regarding the
indication of the extractions, and this was known as the Debate of the Great
Extraction. Unlike Angle, Case used a different type of device for each patient
regarding the esthetics stressed face in contrast to Angle standards regarding
occlusion. He advocated the change of the name of the specialty to Facial
Orthopedics, anticipating our concepts of preservation or restoration of harmony and
proportion in the facial contour. He said: Occlusion or malocclusion of the oral teeth
does not give indication of the actual position of the denture in relation to the facial
lines. Case used the Headgears for fissured patients and others. Some considered
their great contribution to prosthetic correction of the cleft palate.
The most influential, dynamic and dominant figure in orthodontics was Edward Angle
(1855-1930). He is known as the father of modern orthodontics. Angle earned his
degree as a dentist in 1878.

He was always interested in the regulation of teeth. In 1886 he achieved enough

reputation to be chief name of the orthodontics department of the University of
Minnesota (1886-92). At the international medical congress in Washingtong (1887)
caused a reaction that marked the beginning of the separation between dentistry
and orthodontics. Later Angle decided to teach small groups in Saint Louis, directly
in his office. He founded the first orthodontic journal: The American Orthodontist in
1907, but could not prolong its publication until the years 1912. The classification
Angle, published in the Dental Cosmos (1899), remains the widely accepted
classification worldwide for malocclusions based on the relationships between the
mandibular and maxillary first molars.In 1907 Angle published his book Treatment
of Dental Malocclusion Angle retained 37 patents, such as the Arc in E (1900), the
pin and tube apparatus (1910), the ribbon bow (1916) and the straight arc apparatus
(1925). Angle organized the first orthodontic society (1900), the American Society of
Orthodontists (now the American Association of Orthodontists) and the result Or be
the first president. In his death his followers organized the Society of Orthodontics
of Edward Angle, which continues defending its high standards.
1908 Angle married his secretary Anna Hopkins (1872-1957). Who obtained her
degree of odontologist from the University of Iowa and her orthodontic training at
Angle School. It was then created in honor of Dr Angle the Angle Orthodontist.
Angle standardized his apparatus and developed a collection of prefabricated parts
(the Angle system) that can be obtained in various combinations and used in many
conditions and that was how orthodontics arose from an empirical and speculative
state to the position of an exact science.

The professionalization of orthodontics in the early twentieth century:

Mr. James Murray (1909) a Philologist performed and said that the suffix "ia" was
properly referring to the medical condition and suggests the term Orthodontics. But
this was not until 1930 that Orthodontics began to be used by the profession of
Dentofacial Orthopedics, suggesting in 1976 by B. F. Dewel has been added to
describe the whole scope of an orthodontist. Before the first American dental school
opened its doors at the University of Maryland in 1840 (Baltmore College Dental
Surgery), the only way to get to dentistry was to be a practitioner or preceptor with
an established dentist, and so Both it was possible to be a practitioner of teeth
straightening without having the degree. The lectures in the school were only
extended from November to February over a period of two years. More pioneers in
orthodontics at the end of the 19th century obtained their medical degree in addition
to their dentist degree. This practice went out of being Fashión during the first
decade of 1900s. Although Christophe Delabarre (1784-1862) had already defended
in 1819 "a special class of the doctors " .

The first lectures on "irregularities" or teeth alterations were given to undergraduate

students at the University of Baltimore by Chapin Harris. Norman Kingsley lectured
students on the causes and correction of malocclusion (1872), but it was another 17
years before a real orthodontic course was given (Simeon Guilford, Philadelphia
Dental College, 1889). Even so, before 1910, orthodontics was taught as a branch
of the prosthesis, emphasizing the technique in basic sciences.
Angle's attempts at teaching undergraduate dental students at four schools had
been frustrated by his inability to separate orthodontics from the dental curriculum,
although the first orthodontic department was eventually established at a university
(Marion Sims Dental College, Saint Louis , 1897).
After the meeting of the National Dental Association in 1899, several members
persuaded Angle to train them in his office.

This was the first postgraduate course in orthodontics, as well as the first school
dedicated exclusively to the specialty, and was 3 weeks long. In 1908, he resigned
his practice in St. Louis and moved, first in New York, then to New London, and
finally to Pasadena, California (1916). Wherever he went, Angle School went with
him. Its students raised what was to become the first building dedicated exclusively
to the teaching of orthodontics (1922). In 1924, the school was charged as the Angle
College of Orthodontics, and the course was extended to one year; Which was
closed in 1927. However, students did not pay tuition (except materials), and no fees
were charged to their patients. Although Angle accordingly sought out experts in
anatomy, histology, embryology, rhinology (the ancient specialty in the face of
diseases of the nose), photography, art and even help him to grow his school.
In 1907, the School of Angle has competition in Saint Louis. A second International
property school, School of Orthodontics which opened less than 2 miles away. It
must have been irritating to Angle to learn that one of its founders, Benno Lischer
(1876-1959), was rejected from the admission of the Angle school, for not having
signed a non-competition agreement. On the other hand, he was not formally trained.

However, Lischer became a leading figure in the specialty: Professor of Orthodontics

at the University of Washington (Saint Louis) 1902-1924 and Dean of the School of
Dentistry from 1933 to 1945. He wrote Elements of Orthodontics (1909), Principles
and Methods of Orthodontics (1912). He was the first to use the term cephalometry
(1922); And he preferred to use the term mesiocclusion, distocclusion and
neutroclusal rather than classes I of Angle, II, and III.
Only one class was trained at the International School, but was revived 7 years later
in Kansas City, Mo by William Brady and Hugh Tansey. When it closed in 1941, the
course was 12 weeks long.
In 1911, Angle's trained (1902) Martin Dewey (1881-1933) opened another school
of his own,
Also in Kansas City. Like the Angle School: The Dewey School changed places as
its own owner and looked for new opportunities.

Dewey finally settled in New York City (1919); The school continued until about 1960.
One of Angle's star students was Dewey who became an educator, an author, a
polemicist, and an editor. He was the first editor of the American Orthodontist
magazine and then helped found the International Journal of Orthodontics (1914),
which he edited until his death. He wrote texts on anatomy and orthodontics. During
the 1911 extraction debate, he was the main spokesman on the non-extraction side.
As editor of the International Journal of Orthodontics, he published an editorial
against Angle's efforts to establish a board of specialty in the state of Arizona. This,
along with their competition school, was the cause of a permanent distance between
them.
To be fair, however, Dewey School drew some graduates who have contributed
significantly to the orthodontic progress (Crozat, Eby, Joe Johnson, Oliver, Margolis,
and Salzmann, to name a few). One of the functions of the school was the awakening
of the universities to the possibilities of orthodontics.

The professionalization of orthodontics:

In 1933 at a conference of the American Dental Association in Chicago, Weinberger

told the audience that he was concerned about the poor state of his beloved specialty
and that he was willing to take the risk of professional suicide with the following
statements regarding the characteristics that he had An orthodontic treatment at the
time:

• Treatment was rarely initiated prior to the eruption of all permanent teeth.
• The aesthetic of the teeth was the main objective of the treatment, and the study
of the occlusion was given little attention, but the mechanical aspect was given much
more attention.
• Biological problems were of secondary importance.
• Extractions are generally recommended, and prevention to them was largely
ignored.
• Standardized devices were sold in supply houses with inadequate instructions on
how to use them.
• Orthodontics was given a minor place in the curriculum without graduate courses
offered.
The first orthodontic undergraduate program at the College of Physicians and
Surgeons (now University of the Pacific), when it was established in 1915 was
headed by Elizabeth E. Richardson (1863-1938; Dewey School, 1915), Guilhermena
G. Mendell .1946; School of Angle, 1902) was the first woman graduated and first
instructor of the woman in the School of Angle (1902)

She later taught at the Pasadena School and practicing with her husband, Harvey
Stallard (1888-1974), a pioneer in gnathology. Josefina M. Abelson (1901-1987, of
the School of Dewey, 1923) was the first woman director of the clinic of the school
Dewey. She married Sidney E. Riesner (1900-1979), a pioneer in radiography and
the treatment of the temporomandibular joint.
Other early pioneer women of the 20th century included Gertrude Locke (1869),
founding member of the American Society of Orthodontists (ASO) (1901); Jane G.
Bunker (Angle School, 1904), founding member of the European Society of
Orthodontics (1907) and the East Association of Graduates of the Faculty of Angle
of Orthodontics (1909); Genette Harbor (1865-1936; Angle School 1911), first
female orthodontist in Los Angeles (1911) and founding member of the Pacific Coast
Orthodontist Society (1913); Eda and B. Schlencker, the first woman to be certified
by the American Board of Orthodontics (ABO) (1933).

Universities take place:

Finally in the 1920s, some colleges opened the program even though it was a very
short one, as was the Harvard-Forsyth program which was a short-lived program
(1915-1919). It was the first to offer a year of instruction. In 1922, New York
University and Columbia University both in New York City began to teach at
Columbia Graduate School the orthodontic postgraduate under the direction of M.
Leuman Waugh (1877- 1972), Who was also one of the founders of the dental school
itself. A self-taught Canadian orthodontist, Waugh had an illustrious career in
teaching and dental policy. He led the orthodontic department from 1917 to 1945.
He helped found the International Association of Dental Research (1920), of which
he was later president. As president of ASO (1935), he played a decisive role in
organizing association in constituent societies.
Three more schools opened in 1923. Each was associated with an important person
in the history of orthodontics. A. LeRoy Johnson (1881-1967, School of Angle, 1909)
wrote "Basic Principles of Orthodontics", which was considered one of the best
orthodontic expositions in the biology of his time. Schools were influenced to limit
university education to the fundamentals of occlusion, diagnosis, etiology, and
classification of malocclusions. Many schools closed their orthodontic clinics, also
as a result of this article, Johnson was asked to open one of the first masters degree
programs in orthodontics, from the University of Michigan, where he was appointed
professor of orthodontics. As such, he became the first full-time professor of
orthodontics.

John V. Mershon (1867-1953, Angle School in 1908) was head of orthodontics at

the University of Pennsylvania from 1916 to 1925. When he took charge of the
department, he tried to present orthodontics from a biological standpoint instead of
mechanic. His extensive teaching, including the Dewey School, was made free of
charge. His study led him to his memorable date:
The professionalization of orthodontics:

Organizations abroad:

Near the hand of the ASO Foundation, they were organizations outside the United
States. In Berlin, the European Society of Orthodontics was completed in 1907 with
10 founding members, including newly graduated from Angle School: Jane Bunker.
The society met every year thereafter, except during the war years. His journal, the
European Journal of Orthodontics, is now published in English.
The British Society for Orthodontics was conceived the same year, essentially as an
academic group of practitioners by George Northcroft General (1869-1944) and
Harold Chapman (1881-1965, of the Angle School, 1905). Both were twice
President. Another prominent member was E. Sheldon Friel (1888-1970; School of
Angle, 1909), who was the first in Britain to specialize, the first to use stainless steel
bands. Nowadays, orthodontists are represented by the British Orthodontic Society,
organized in 1991 by the unification of 5 national societies; His voice is the British
Journal of Orthodontics. In 1926, Japanese orthodontists organized with 11
founders. A year later, 8 founding members, including 2 recent graduates of Angle
University (Paul R. Begg and J. Stanley Wilkinson), established the Australian
Society of Orthodontists. The Australian Journal of Orthodontics has been published
since 1967. Like the ASO, the Canadian Association of Orthodontists was born "after
school" at the University of Toronto immediately following a straight-arch course
courses in the year 1947. The group 35-member original has grown, as of 2000, to
588.5 pioneers in the Canadian principles of orthodontics including S. Arthur Roberts
(first Canadian specialist in 1904), George W. Grieve and James AC Hoggan. Of the
School of Angle.
Today, orthodontic societies can be about 90 worldwide.

Literature in Orthodontics:

Books:

The first work dedicated exclusively to orthodontics was a book written by the French
J. M. A. Schange (1841). Great American 19th century orthodontists such as
Kingsley, Farrar, Guilford, and Talbot-all published during the 1880s, but the
Kingsley Treaty on Oral Deformities was the most comprehensive work on
orthodontics up to that time.
During the early 20th century, Case, Lischer, Dewey, McCoy and Strang contributed
to the growing body of orthodontic literature, although each emphasized his own
preferred technique. It was not until 1943 that Salzmann produced the first "neutral"
overview, offering broad coverage of the broad spectrum of issues related to
orthodontics. These include evolution, embryology, somatic and facial growth,
biological age, development of the dentition, and the formation of teeth and
eruption.JA Salzmann (1900-1992Came to the States of Russia in 1906 and trained
under Martin Dewey from 1931 to 1933. During his long and productive career,
Salzmann stood out by founding the clinic cleft palate at Mount Sinai Medical Center
and the first free dental program in the United States (in New York City), working as
an advisor to the US Public Health Service, and helping to develop the Salzmann
index of malocclusion. He edited the New York Journal of Dentistry for 26 years and
was the commentator and editor of the American Journal of Orthodontics for 41
years. One of his 11 books, Practice of Orthodontics (1966), was used in almost all
the orthodontic programs of the different universities in the United States.
In 1913 the physicist, physician and publisher C. V. Mosby, MD, proposed the
International Journal of Orthodontics, a year later that Angle's American Orthodontist
failed. His colleague, Philip Skrainka, MD, and the orthodontists Martin Dewey (also
an MD) and HC Pollock, Sr (1884-1970; Angle School, 1911), were co-founders.
Angle refused his offer to edit the magazine, so Dewey took the reins, cleverly
assisted by Pollock. Initially, insufficient articles were submitted for publication, so
Dewey spent many nights writing his own articles. He asked the dental historian
Bernhard W. Weinberger (1885-1960, of the School of Angle, 1909) to present some
articles on the history of orthodontics. Weinberger wrote 36 articles from 1915 to
1922 under the title "Orthodontics: a historical review of its origin and evolution." The
series was later published in book form.
The seed of this work was the suggestion of Angle to his disciple to look for the origin
of the word ortodoncia. From then on, Weinberger was hooked on history. Between
its production of 250 books, monographs, and articles is the historical bibliography,
Introduction to the History of Dentistry (1948) among others. In 1919, another
specialty was called and the words: oral surgery, were added to the title. Six name
changes were made before the present name that was adopted in 1986.
Three years before Dewey's death, Pollock took a step as editor (1931) and directed
the magazine for 38 years, becoming the oldest publisher.
Other popular Journal have taken root since those early days including The Angle
Orthodontist (official organ of the Angle Society in 1930), the Journal of Clinical
Orthodontics (1967) and the World Journal of Orthodontics (2000).

Devices of Angle:

When the Crozat device was being developed, a typical fixture consisted of bands
in the first molars only, with wire ligatures attached to a labial or lingual arch type E
(expansion). Angle developed four important systems of apparatus.
The arc in E was essentially the first design of Angle (1900) which made a
contribution to all orthodontists based on the most suitable characteristics of the
previous apparatuses. This apparatus consisted of some kind of rigid structure to
which the teeth were bound to expand according to the shape of the apparatus.
Only bands were applied on the molars, and around the dental arch extended a
thick bow of labial wire. The end of the wire consisted of a thread, and a small nut
attached to it allowed to advance the wire arch to increase the perimeter of the
dental arch. Each of the teeth was simply attached to this expansion arch. This
appliance can only supply strong and disrupted forces.
Because the E-arc could only tilt teeth into a new position. It was not able to
accurately reposition a tooth, so Angle began to design the Pin and Tube
apparatus which consisted of placing bands on other teeth and using a vertical
tube (1910) on each tooth in which it inserted a welded pin Of a smaller wire bow.
To move the teeth, the pins were repositioned in each appointment by the
laborious process of resolding them. With this device the teeth could be mobilized
by modifying the position of each pin at each visit of the patient. At the beginning of
treatment, the bow had to be shaped to malocclusion and then "resolved". This
tedious procedure proved too difficult for the clinician, so the tube and pin system,
apparatus never reached widespread use. A considerable dexterity was required to
construct and adjust this pin-and-tube apparatus, and although it theoretically
provided great precision in dental mobilization, its clinical application posed many
problems. It is said that only Angle himself and not his students came to master
this technique. The base bow was relatively thick, which meant that it was not
elastic, further complicating the problem, since it required many adjustments.
The ribbon bow was his next set, Angle modified the tubes placed on each tooth by
adding a vertical rectangular slot behind them. He inserted into the slot an arc of
ribbon, made of 0.010 X 0.020 gold wire, and fixed with pins. The ribbon bow was
immediately successful, mainly because, unlike its predecessors, the wire bow was
small enough to have good elasticity and allowed to align misplaced teeth quite
effectively. Although the ribbon bow could be twisted by inserting it into its groove,
the main weakness of the apparatus was that it allowed for relatively poor control
of the position of the roots. Simply, the resilience of the ribbon bow did not allow
the moments necessary to twist the roots to a new position.
The singing bow apparatus created it to overcome the deficiencies of the ribbon
bow, Angle changed the orientation of the vertical groove, making it horizontal, and
introduced a rectangular wire rotated 90 ° in relation to the orientation it had in the
ribbon bow ( Hence the name arc of song). Changed the dimensions of the slot
0.022 X 0.028. These dimensions, reached after numerous tests, allowed to
perfectly control the position of the crown and the root in the three planes of the
space. After its introduction in 1928, this apparatus became the cornerstone of the
treatment with fixed devices of multiple bands, although the bow of tape was
continued using frequently for another decade.

The 20th century was a great age for medical and dental advances. Many fields of
medicine came out such as immunology, nutrition, endocrinology and antibiotics
were hailed as “miracle drugs”.
In 1913 Alfred C, Fones founded the first school for dental hygienists, once they
realized that auxiliaries could do more than just passing instruments.
An orthodontist graduated from the Angle School, Frederick McKay, found that
fluoride was associated with reduced dental caries in 1925.

The American board of orthodontics and albert h. ketcham

By 1929, the American Society of Othodontists considered that for orthodontics, to
be a true specialty, it should be established a means of certifying the competence
of its members, because of that, Albert Ketcham, who was the president ef the
American Society of Orthodontists, created the first specialty board in dentistry:
The American Board of Orthodontics, and Ketcham was elected the first president
of the organization.
By that time there were only 2 specialty boards in the field of medicine:
ophthalmology and otolaryngology.

Albert ketcham (1870-1935)

Graduated from Angle School in 1902
He was born in Vermont but moved to Colorado hoping that the clear air there
would cure his tuberculosis and it did.
He pioneered dental radiography and was the first American orthodontist to install
an X-ray laboratory. In 1926 he presented the first x-ray data on root resorption.
He became one of “Angle´s enemies” when he modified Angle´s appliances and
questioned some of his arbitrary pronouncements. He worked in a more modest
manner in contrast to Angle.
Ketcham ranks as one of the “big 4” of orthodontics
APPLIANCES
Victor H. Jackson (1850-1929).
Was pioneer in removable appliances which most were made of an alloy of copper,
nickel and zinc.
His technique was known as the “Jackson system” opening the door to the “age of
systems” since 1887. He was also the first to mention fixed retention and
fiberotomy.
The Jackson appliance was taken by William Walker, who used precious metals.
George Crozat never met William Walker, but he was interested in Walker´s
technique. Crozat modified Walker´s device and introduce it in 1919. Originally
called “invisible brace” but later known widely as the Crozat appliance. The “Crozat
technique” was one of the most popular in use.

ANGLE´S APPLIANCES
The first contribution of Angle to orthodontics appliances was the E arch (1900).
Because the E-arch could only tip teeth, Angle began placing bands on other teeth
and used a vertical tube (1910) on each tooth into which a pin soldered to the
archwire (pin and tube). The tedious procedure of removing and resolding pins was
too difficult for the average clinician, so the pin and tube appliance never achieved
a wide use.
In addition, the pin and tube appliance could not control de tooth roots because of
the round archwires, so Angle modified the bracket to receive a rectangular arch.
The Ribbon Arch (1916) of .022 x .036 made of gold, was held with pins. It was
springer but lacked premolar control. Despite this, it was successful and used for
about 10 years.
To overcome the drawbacks of the ribbon arch, in 1925 Angle reoriented the slot
from vertical to horizontal and inserted a rectangular wire: Edgewise appliance.
The lock pins were used no more and the archwire became to be held with steel
ligatures. To correct rotations, some rings were soldered to the bracket… in our
days this is no longer necessary thanks to introduction of straightwire
The archwire of this technique was .022 x 0.28 in gold. Later it was found that a
more ideal archwire more resilient to initiate treatment was a round wire .022. the
Edgewise appliance was the first bracket able to move the teeth in all 3 planes
simultaneously and it became very popular in the USA.
Hawley retainer
The first retainers were made of vulcanite with labial wires by Henry Baker.
The vulcanite was not adapted to teeth, so it had metallic spurs embedded in the
vulcanite to prevent the movement of teeth
In 1919, Charles Hawley found the way to flow the base material so in could adapt
to the teeth and so control the rotation movements. In the late 1930´s vulcanite
was replaced by acrylic.

Mershon lingual arch

Jhon Mershon is remembered for the development of a lingual arch in 1909,
consisted of a heavy lingual arch usually .036 or .040 inserted to a vertical pin
located in first molar bands in order to control the forward growth of jaws.

labiolingual appliance
Developed by Lloyd Lourie, Oren Oliver and Lowrie Porter: labiolingual technique
(1940)
An additional labial arch was added and many attachments were incorporated to
the appliance, such as spurs soldered to the labial arch to exert lingual pressure.
No matter how elaborate the design, the appliance was not capable of more than
tipping movements.

open-tube appliance
In 1922, James McCoy developed a banded appliance that consisted of a .030 or
.036 gold round archwire inserted to a horizontal bracket. The archwire was
snapped into the open bracket. It could allow bodily movements in mesodistal
direction but no torque control.

STAINLESS STEEL
Stainless steel was introduced 1913 to protect English cannon bores. In 1924,
W.H. Hatfield patented “18-8” (18% chromium, 8% nickel) stainless steel.
The non-corrosive and rust resistant properties of this alloy have revolutionized
most modern industries.
Its surface resists oxidation at high temperatures, making the sterilization possible.
The first orthodontist to use stainless steel were from Europe: Lucien de Coster
(Belgium 1927) and Rudolf Schwarz in edgewise appliances. In USA Oren Oliver
started using stainless steel ligatures in 1930.
Rocky Mountain Orthodontics got its start when Brusse and Carman founded a
company to manufacture stainless steel brackets in Denver. They got permission
from American Steel and Wire Company and they presented it with the first spot
welder at the 1933 AAO meeting in Oklahoma City. They only sold 1 welder;
despite the high price of gold, orthodontists were still skeptical of stainless steel.

Raymond Begg
P. Raymond Begg was born in Australia (1.889-1.983). he studied in the Angle
school of orthodontics graduated in 1.925. he had difficulties with the edgewise
system when closing extraction spaces and reducing deep overbites, so he
developed his own bracket in 1.933, which was essentially a ribbon arch bracket
turned upside down. With this system it was the first time to use single,round,
stainless steel wire of .016 diameter or less.
By 1.940´s, Begg developed the “Australian” wire, replacing precious metals. This
wire was introduced to US by 1.956
He also used a multiloop wire – Begg technique (1.965). he used Titanium wire
long before it was used in US. Although still in contemporary, the Begg technique
has declined in popularity

universal appliance
Spencer Atkinson (1886-1970) invented the universal braquet in 1.929 with the
puorpose to incorporate light forces into his techniques, influenced by theories
about the goal of light pressures constantly applied. This universal techniqye
became very popular in southern California during 1.930´s and 40´s; Atkinson
donated all profits from its sale to the California Institute of Technology, so Unitek
Corporation (UNIversal TEChnique) got started.

twin wire
At the same time that Atkinson was developing the universal appliance, the idea of
light forces also was taken by Joseph Johnson, who believed that 2 ligth wires
(.010) would be more physiological than a heavy one. That’s why he developed the
twin wire, it was more comfortable and effective at leveling but not for extraction
cases.

preformed bands
The first orthodontic bands were just strips of metal wrapped around teeth and then
soldered.
By the 1.930´s, Rocky Mountain Orthodontics had developed a line of preformed
anterior and molar bands
The cost of maintaining an inventory of defferent sizes was more than offset by the
savings in chair time

acrylics
Vulcanization is a procedure discovered by Charles Goodyear in 1.839 consistent
on natural rubber with sulfure and heat.
For dentistry pourposes, vulcanite is weak, unesthetic, and corrosive to the metals
Otto Rohm was german chemist that invented the acrylics, it was introduced in
1.936 in US for military uses. By 1.940´s acrylic started to be used in dentistry as
pink plates, polymerized by heat. Later, selfcuring acrylics were made by adding an
accelerator.
headgear
Extraoral force can be applied to the teeth, an intraoral appliance or to the chin.
Initially the headgear has been used for anchor maxillary molars while retracting
anterior teeth in cases of premolar extraction, and to distally molars.
Angle used an occipital full headgear attached to the anterior teeth in 1.889, even
for adults, but he abandoned it because he believed that class II elastics would
cause the mandible grow.
Silas Kloehn in 1.947 reported the use of an occipital headgear attached by hooks
to a maxillary archwire but when he noticed the uncontrolled molar tipping, he
modified the appliance, creating the facebow.
Headgear milestones

● 1802: Joseph Fox uses a chincup attached to a

skullcap.
● 1822: Gunnell writes on the use of headgear for
occipital anchorage.
● 1844: Westcott uses chincups to treat Class III
patients.
● 1850: Kingsley is among the first to use occipital
anchorage to retract anterior teeth.
● 1863: Kneisel reports on occipital anchorage to
correct mandibular protrusion.
● 1892: Kingsley describes the use of headgear to
depress and drive the incisors distally after extracting
the maxillary first premolars.
● early 1900s: Calvin Case uses extraoral anchorage
extensively to treat blocked-out canines.
● 1936: Albin Oppenheim reintroduces extraoral anchorage
after a long period of disuse.
● 1947: Silas Kloehn introduces the facebow with a
cervical strap, removing the stigma of “Victorian”
headcaps.
● 1967: Donald R. Poulton (1932- ) warns against the
facebow’s adverse effects: extrusion and tipping of
the maxillary molars, backward rotation of the mandible,
impaction or buccalization of the maxillary
second molars, and tipping of the palatal plane
downward anteriorly.
● 1974: John H. Hickham (1934-2004) develops a line
of headgears based on the concept of “directional
force” in an effort to avoid these adverse effects.
● 1988: Patrick K. Turley (1949- ) researches correction
of Class III malocclusions using palatal expansion
and protraction headgear.

EXTRACTION CONTROVERSY
Teeth extraction to correct maloclusion is an ancient practice. Some clinicians have
said that extraction of premolars is a bad practice because it is related to the “loss
of important organs” and inhibition of growth.
Between the publication of his 6th and 7th editions, Angle renounced extractions
due to he believed a proper function of the dentition could maintain teeth in their
correct positions.
In the annual meeting of the National Dental Association in 1.911, there was a big
discussion of extractions vs no extractions. Angle and his nonextractionist fallowers
won that day and for the next 30 years, extraction of teeth for orthodontic purposes
essentially disappeared from the American scene.
By the 1.930´s, dentists were beginning to notice relapses.
Charles Tweed, was more concerned with dental protrusions and unsatisfactory
facial esthetics. His dissatisfaction led him to begin extracting 4 premolars in
certain patients.
At the 1.940 annual meeting of the AAO, Tweed displayed 100 cases of patients
initially trated with non extraction and then retreated with extractions.
Tweed´s criterion for facial balance was the position of the mandibular central
incisors, from which developed the Tweed triangle (1.936)
Begg, the other alumnus of Angle, was agree with Tweed and took the philosophy
of extraction to Australia. So Begg and Tweed had the greatest influence on
extraction midcentury.
By the early´s 1.969´s, more than half of American patients undergoing orthodontic
treatment had some teeth removed.
FACIAL ANALYSIS BEFORE THE ADVENT OF CEPHALOMETER
During the renaissance, many artists such as Leonardo Da Vinci, made
references of the face, measurements, and proportions in their works and art. Da
Vinci described anatomic structures by making references to the proportions he
studied, based in his extended knowledge of human anatomy and structures. This
work allowed him to find relationships between proportionality and symmetry, as
most known in the Vitruvian Man. Although Da Vinci showed and described
differences in facial structures, he did so from the artistic and scientific purposes,
distanced from the orthodontic diagnosis purposes. Along with Da Vinci, Leonardo
Fibonacci is another referent to human facial studies, he introduced the Golden
ratio.

In 1603, Albrecht Durer made systems in which he proposed a method of

drawings in order to identify different types of profiles. He described them as
straight, convex and concave.

Between the 1700s and 1800s there were several studies of the skull using the
“Dry skull” method. This method refers to the use of craniostats for the study of the
skull in a much more reliable way. Additionally, as a byproduct of such scientists
using such method, the cephalostat was introduced into the practice. Some of the
non-vital studies were not of much interest for the orthodontist, as these
measurements and relationship only became useful to the orthodontist after these
were correlated and applied to living subjects.

Petrus Camper (1722-1789) was an anatomist born in Holland, and is known as

the one who made the first attempt to the craniometry. He started using angles and
lines to measure the human face, and probably was the first to employ this
approach in measuring the human face. Additionally, he described the usefulness
of these angles and measurements for anthropologists. During his studies, he
found that the prognatism and measurements of these had variations in regards to
the race, gender and age. In 1780 he presented the Camper plane, known as the
angle formed by the intersection of the line from the base of the nose and the
external auditory meatus with a line tangent to the facial profile. After his death, his
work was published and he became the first author that realted the face to the
cranium, and settled standard values, for the black people of 70°, for the European
Caucasian 80°, 58° for the orangutan, and the macacus of 42°.
In 1872 Sir.Von Ihering introduced this method. Since the Frankfurt agreement
concluded in Germany in 1884, the FH (Frankfurt Horizontal line) has been
generally recognized since that date as the reference plane for the skull and has
proved to be of great value to orthodontists too. This plane is defined by a line
drawn from the lowest point on the inferior orbital margin (orbitale Or]) to the most
superior point of the outline of the external auditory meatus (porion [Po]), directly
above its center. When the FH is used with Nasion Prosthion, it is named the
modern Angle of Camper whose values are Hyperprognathus more than 93°,
Orthognathus 85°- 93°, Mesognathus 80°- 85°, Prognathous 70°-80°,
Hyperprognathus de 70°.
In this period, scientists were allowed to perform experiments on monkeys and
human subjects, for there weren’t many regulations or problems associated to
them. Due this lack of restrictions, the advances made during this period as
recognized as being enormous and substantial. Between 1879 and 1885, Sir.
Williams Flowers developed various studies that included the relationship
between the size of the molars and its relationship with the size of the cranium
using the following measures: Basion Prosthion (B.P) and Basion Nasion (B.N),
dividing these two measurements and multiplying the result by 100. He classified
profiles as prognathous with more than 103, mesognathus within 98 -103, and
orthognathus up to 98.

The second stage in the evolution of the cephalometric tools started in November
of 1895, when by accident, Wilhhelm Conrad Roentgen (1845-1923) discovered
X-rays in the University of Wurzburg. This discovery was made while he was
working with Hittorf-Crookes and the coil of Ruhmkorff during the studies of
fluorescence that were produce by cathodic rays. He identified a yellowish
radiance left in the screen that was made of platinum-cyanide of barium, that
vanished when the coil was turned off.

During this experiment he proved that the rays produced a radiation that was
invisible and penetrant, and that were transferred to the screens and low density
metals. In 1901 he received the Nobel Price of Physics due to his discovery. His
contribution the development of the X ray is also a contribution to cephalometry as
an instrument for the diagnosis in orthodontics. Because of his invention he
provided the possibility of taking measurements of the cranium of living subjects
for the studies of growth and development. He also made possible the study of
soft and hard tissues of individuals, and enabled the records of this in a way that
had never been seen before. The problem was standardizing and developing a
machine in which the position of the subjects could be replicable and exact.

In the 1920s there were problems in regards to the diagnosis in orthodontics, due
to the fact that the most important and known method was Dr. Angle
Classification that established the relationship of the first molars, but this diagnosis
only included dental results and left aside the skeletal problems. Keith, Campion,
Paul Simon, Wallace, and B.E. Lischer were really the first to propose the
inclusion of hard tissue and skeletal diagnosis in orthodontics, becoming the first
developers of the early cephalogram. This cephalogram used a picture and a
cellulose paper for studying open bites and mesocclusions. They found that the
mandibular angle was really obtuse in patients with neutrocclusions and
distocclusions.

In 1924 he stated that the rapid evolution of xray would contribute to the diagnosis
of patients with malocclusions with precision.

Historically, the Cephalostat invention was attributed to Dr. B. Holly

Broadbent,but the real developer of the device was T.Wingate Tood. anatomy
professor at the Western Reserve University in Cleveland, Ohio. He developed a
device that could stabilize the postion of the head in regards to the x ray cone. He
made a study with more than 800 children, where he examined them since birth
until puberty and recorded measurements and observations. However, his work
never received the importance it deserved.

Dr.Paul Simon in 1922 he employed a three dimensional system using FH,

sagittal plane and orbitary plane which are perpendicular in between, Simon said
that in normal circumstances the orbital plane should pass over the cuspid of the
superior canine independent of the patients age, this analysis where made using
pictures and casts that where oriented in those planes, the device used was the
Photostatic apparatus that arranged the cranium in a reproducible way.

Dreyfus 1922 (Switzerland ) and Spencer Atkinsons make the first registered
cephalometric analysis.
It was only in 1931 when Dr. B. Holly Broadbent, Herbert Hofrath and Paccini
developed a more stable and simple cephalostat in Europe, that this received
attention. Their intention was to use this device to study malocclusions, and
skeletal proportions.

Brodie 1934, based in Broadbent method he calculated the facial growth, he

divided the head in separated components and sections, studying them
individually and made a study with live patiente since month 3 and tried
understand this facial areas: Craneal, nasal, manxillar, mandibular and the
occlusal plane. He found that the growth of each area was correlated and in
equilibrium.

The cephalometer takes its place in the orthodontic armamentarium

Arne Björk (1911-96; Swedish) published The Face in Profile, for the Swedish
Institute of Human Genetics (1947), showing that, jaw growth does not proceed in a
linear, translatory fashion. He contended that the mandible becomes more
prognathic with age, which is associated with a decrease in the angulation of the
lower border as well as a decrease in the angle of convexity. In 1955 he conducted
the first human growth study using implants, discovering greater rotation of the
maxilla and mandible.

Form-function relationship

Robert E. Moyers (1919-96) was the most highly decorated dental officer in the
history of the US Army. During World War II. After the war obtained a PhD from the
University of Iowa in 1949.

He spent a lifetime in clinical research, in the role of the neuromus- culature in normal
facial growth as well as during clinical treatment.

Laminagraphy

Robert M. Ricketts (1920-2003). He opened the TMJ with his pioneering work in
laminagraphy (body section radiography).

His other scientific interests were in the fields of bone growth, morphological
variation of the face and jaws, arthritis of the jaw joint, cleft palate treatment,
cephalometrics, computerization, psychology, rehabilitative mechanics, and
treatment effects.

In the field of craniofacial growth, Ricketts:

● Cephalometric analysis that allowed clinicians to compare their

patients with norms based on age, sex, and race (Ricketts analysis). 


● Cephalometric diagnostic system to project treatment plus growth in

treatment planning the visualized treatment objective (VTO). 


● Computer-generated method for projecting growth to maturity using

the mandibular archial growth (long-range forecasting) method. 


● Computer-driven cephalometric diagnostics (Rocky Mountain Data

Systems). 


● Expound in detail on the divine proportion and the Fibonacci series in the
treatment of dental and skeletal problems.

Individual growth

Coenraad F. A. Moorrees (1916-2003) was an American orthodontics. He became

affiliated with the Forsyth Dental Infirmary in Boston and began a long research
career in child growth and dental anthropology.

His research of the Aleut population under the aegis of anthropologist Earnest A.
Hooton (1887- 1954) led to The Aleut Dentition (1957), a comprehensive study of
tooth morphology, emergence, occlusion, and dental diseases.

His use of natural head position was an innovative approach that has demonstrated
biologic variations in many craniofacial landmarks. His classic volume, The Dentition
of the Growing Child (1959) is the product of a most comprehensive longitudinal
study of the denti- tion of children aged 3 to 18.

CEPHALOMETRICS

Cephalometric radiography, which came into widespread use after the Second World
War, enabled orthodontists to measure the changes in tooth and jaw positions
produced by growth and treatment.

According to Salzmann, roentgenographic cephalometrics can:

● Show dimensional relationship of the craniofacial components. 


● Reveal manifestations of growth and developmental abnormalities.




● Aid in treatment planning. 


● Help analyze changes obtained. 


● Assist in evaluating the effectiveness of different 
orthodontic

treatment procedures. 


● Show dentofacial growth changes after treatment is 
completed.

Goal of cephalometric analysis: estimate the relationship, vertically and horizontally,

of the jaws to the cranial base and to each other, the relationships of the teeth to
their supporting bone, and the effect of the teeth on the profile. Orthodostists further
use this technology to evaluate the structures’ proportions and to identify possible
causes for malocclusions. Analysis of growth and alteration of growth could also be
evaluated by taking serial radiographs and comparing them with each other, that is,
before and after treatment.

Maxillofacial triangle

Herbert I. Margolis (1900-84), a Ukrainian by birth, was the first to relate the
mandibular incisor to the lower border of mandible (1943), leading to the Tweed
Triangle. Margolis developed the facial line (nasion-pogonion) and maxillofacial
triangle, which adheres to the concept of individual variation, and designed the
Margolis cephalostat.

Anteroposterior dysplasia

Wendell L. Wylie (1913-66), developed an analysis based on dividing dimensions

along the Frankfort plane into contributing linear components. “Dysplasia” implies a
random combination of craniofacial parts that might be neither abnormally large nor
small, but, when taken together, produce an undesirable combination of parts.

Downs analysis

William B. Downs (1899-1966) was a member of Brodie’s first class (1930) at Illinois.
With Brodie, Goldstein, and Myer, he coauthored “Cephalometric Appraisal of
Orthodontic Results” (1938). In 1947, he completed a landmark study, “Variations in
Facial Relationships: Their Significance in Treatment and Prognosis,” known as the
Downs analysis. It was the first cephalometric analysis that could be applied
clinically, and it marked the end of the era of “model diagnosis.”

Steiner analysis

Cecil C. Steiner (1896-1989; Angle School, 1921). The Steiner analysis (1953),
offered the use of cephalometric measurements in treatment planning, based on
what compromises in incisor positions would be necessary to achieve normal
occlusion when the ANB angle was not ideal. It also incorporated arch length and
other con- siderations, such as the profile.

Tweed triangle

Building on Margolis’s research, Tweed determined that, in normal occlusions, the

mandibular incisors are upright over basal bone, he constructed a triangle (1954)
formed by the lower central incisor (LI), mandibular plane (MP), and Frankfort
horizontal plane (FH). By means of this triangle, one can deduce whether or not the
case calls for extraction of the 4 first premolars.

Archial analysis

The Sassouni analysis (1955) was the first analysis to stress both vertical and
horizontal relationships and the interaction between vertical and horizontal
proportions, focusing on the craniofacial structures and how they relate to each
other. Viken Sassouni (1922-83) recognized that there was an interrelationship
between the horizontal anatomic planes, the mandibular plane, the occlusal plane,
the palatal plane, the Frankfort plane, and the inclination of the anterior cranial base,
indicating a vertical proportionality of the face. In a face that is well proportioned,
these planes converge toward a single point (point O).

Harvold analysis

Egil P. Harvold (1912-1992), a Norwegian, research in the treatment of orofacial

clefts and the genetic factors in cranial and facial development. The Harvold and the
Wits analyses are similar in being oriented to describe the severity or degree of jaw
disharmony, Harvold concentrates on the magnitude of jaw discrepancies.
McNamara analysis

James A. McNamara’s (1943-) measurements to indicate tooth and jaw positions

more specifically, and relates the jaws in an A-P position to the vertical.

Two main advantages are that (1) it relates the jaws through a perpendicular from
nasion, thus projecting the difference in the A-P position of the jaws to an
approximation of true vertical, and (2) the norms are based on the well-defined
Bolton sample. Published in 1983, the McNamara analysis has stood the test of time.

Wits analysis

The Wits analysis (1967) gets its name from the University of Witwatersrand in South
Africa; it was brought Stateside by Alexander Jacobson of the Uni- versity of
Alabama. Rejecting dependence on the ANB angle, Jacobson relates A and B
linearly by verticals from the occlusal plane.

Ricketts analysis

Ricketts analysis (1960) tries to determine the proper spatial relationship of the jaws
for both esthetics and function, the Ricketts analysis.

Mesh diagram

In 1953 Moorrees introduced the mesh-diagram analysis, a graphic means of

illustrating cephalometric deviations from the norm. The diagram is based on a
coordinate system of squares that distort in proportion to the severity of the maloc-
clusion.
Functional appliances to midcentury

For many years, the exclusive province of dentofacial orthopedics was Europe, while
North America was firmly rooted in Angle’s fixed- appliance philosophy, yet it was
Norman W. Kingsley who first (1879) used forward positioning of the man- dible in
orthodontic treatment. Kingsley’s removable plate with molar clasps might be
considered the prototype of functional appliances, having a continuous labial wire
and a bite plane extending posteriorly. Edward H. Angle used a pair of interlocking
rings, soldered to opposing first molar bands, much along the lines of today’s
mandibular anterior repositioning appliance, to force the mandible forward. The
Oliver guide plane was another functional adjunct from this side of the Atlantic
serving that purpose.

The monobloc

Pierre Robin (1902). His appliance influenced muscular activity by changing the
spatial relationship of the jaws. Robin’s monoloc was actually an adaptation of
Ottolengui’s removable plate, which, in turn, had been a modification of Kingsley’s
maxillary plate. It extended all along the lingual surfaces of the mandibular teeth, but
it had sharp lingual imprints of the crown surfaces of both maxillary and mandibular
teeth. It incorporated an expansion screw in the palate to expand the dental arches.

Robin designed his monobloc specifically for chil- dren with the glossoptosis
síndrome. It has since been named the Pierre Robin syndrome.

The activator

In 1909, Viggo Andresen (1870-1950) The original Andresen activator was a tooth-
borne, loosely fitting passive appliance consisting of a block of plastic covering the
palate and the teeth of both arches, designed to advance the mandible several
millimeters for Class II correction and open the bite 3 to 4 mm. The original design
had facets incorporated into the body of the appliance to direct erupting posterior
teeth mesially or distally, so, despite the simple design, dental rela- tionships in all 3

planes of space could be changed.5

At the university, Karl Häupl (1893-1960), an Austrian pathologist and periodontist,

saw the possibilities of the appliance and became an enthusiastic advocate of what
he and Andresen called the “Norwe- gian system.” Häupl’s theories were
inadvertently strengthened by the findings of Oppenheim, who showed the potential
tissue damage caused by the heavy orthodontic forces of fixed appliances.

The advantages of the activator include: (1) treatment in the deciduous and early or
late mixed dentition is possible and successful, (2) appointments can be spread out
to 2 months or more, (3) tissues are not easily injured, (4) the appliance is worn at
night only and is acceptable from an esthetic and hygienic stand- point, and (5) it
helps eliminate pressure habits, mouth breathing, and tongue thrusting. Its
disadvantages in- clude: (1) success depends on patient compliance; (2) activators
are of little value in marked crowding, so that patients must be selected; (3) the
appliance does not obtain as good a response in older patients; and (4) forces on
individual teeth cannot be controlled with the same degree of exactness as in fixed
appliances.

The Herbst appliance

The Herbst was introduced in 1905 by Emil Herbst (1842-1917), but his findings
were not published until 1935. Little more was published on the appliance until the
late 1970s, when Hans Pancherz, recognizing its possibilities for mandibular growth
stimulation, revived interest. The typical Herbst consists of a telescoping mechanism
connected to the maxillary first molars at 1 end and a cantilevered arm attached to
the mandibular fist molars at the other end; it forces the mandible forward.

The Bimler appliance

Was Hans Peter Bimler’s (1916-2003) elastischer Gebissformer (elastic bite former)
a fortuitous development. As a surgeon treating jaw injuries during World War II,
Bimler had devised a maxillary splint for a patient who had lost his left gonial angle.
The splint provided a guide into which the patient could insert the remainder of his
mandible. Bimler also developed, about 1938, the “roentgenphotogramm,” by
superimposing a photograph on a head plate, to show the relationship between the
skull, the teeth, and the soft tissues something done today by computer.

World War II brought European orthodontic progress almost to a standstill.

Nevertheless, functional appliances got a boost because precious metals were no
longer available for fixed appliances. In Germany, dentists were ordered to
specialize in functional jaw orthope- dics. Still, the war brought its own brand of
progress.

The Bimler appliance achieved its final form in 1949. Compared with previous
functional appliances, its reduced size made it possible to wear all day, its elasticity
allowed muscular movements to translate more effectively to the dentition, and,
because the upper and lower parts were connected by a wire, gradual forward
positioning of the mandible became possible.

The double plate

Martin Schwarz (1887-1963). In 1956, Schwarz attempted to combine the

advantages of the activator and the active plate by constructing separate mandibular
and maxillary acrylic plates that were designed to occlude with the mandible in a
protrusive position. The double plate resembled a monobloc or an activator
constructed in 2 pieces.
The function regulator

Rolf Fränkel (1908-2001) Germany, inventor of an appliance that corrects

malocclusions with little or no contact with the dentition.

The appliance was designated as FR-1, FR-2, and FR-3, for treating Class I, Class
II, and Class III malocclusions.

The tooth positioner

In 1944, Harold D. Kesling (1901-79) developed the tooth positioner. The technique
involved taking impressions of a patient nearing completion, denuding the plaster of
appliances, and resetting the teeth into ideal positions (the “diagnostic setup”). From
the new models, a rubber positioner was made that, if worn enough hours, acted as
a finishing appliance. Later versions were made of other materials, including clear
plastic.

The bionator and other functional appliances of the early 1950s

In 1950, Wilhelm Balters (1893-1973), modify Andresen’s activator. He gave it the

name bionator. It is indicated for patients with favorable facial growth patterns and
is designed to produce forward positioning of the mandible. As with the function
regulator, the bionator is available in 3 designs.

In 1952, Hans Mühlemann created the propulsor. It was based on the activator, but
it lacked the metal elements. The propulsor was later perfected by Hotz. About a
year later, Leopold Petrik (1902-65) introduced an activator having greater occlusal
thickness to increase the vertical dimension, and Hugo Stockfisch (1914) came out
with his kinetor. This device consisted of 2 movable plates connected by wire
buccinator loops, which keep muscle pressure away from the cheeks. An unusual
feature of the kinetor was the elastic tubes between the 2 plates that acted not only
as shock absorbers but also as a means of broadening and optimizing orofacial
muscle pressures.

Classification by type

Functional appliances can be fixed or removable. Proffit and Fields suggested a

further classification, based on the appliance’s platform. The largest category,
passive tooth-borne appliances, includes monobloc, activator, bionator, Bimler, and
Twin-block. Active tooth-borne appliances comprise tooth positioners (includes Pre-
Finishers, the Ortho-Tain family, and Mini-Positioners). Tissue-borne appliances are

the oral screen, the Nuk Sauger pacifier, and the FR.5 The oral, or vestibular, screen
is a C-shaped plastic appliance that fits loosely in the anterior vestibule. If worn
conscientiously, it is an excellent deterrent for tongue thrust and finger sucking.

The golden age of orthodontics

End of World War II.

By midcentury, university graduate orthodontic departments had proliferated. There

were approximately 1500 orthodontic specialists in the United States. Delegation
was almost nonexistent, appliances were largely handmade by the clinician, and
diagnosis was based on Angle’s classification. After the dampening effect of the
Great Depression and World War II on the demand for our services, the orthodontic
specialty took off.

Orthodontists found themselves in what is now called the “golden age of

orthodontics.”

welcomed the first practical cephalometric analysis, the reintroduction of the

facebow, the “sutural theory” of bone growth, laminagraphy, the Bimler, the bionator,
and twin brackets. Still, many issues remained unresolved.

Orthodontic education

By the mid 1940s, 18 university dental schools were offering graduate and
postgraduate courses varying in length from 8 to 14 months. The so-called short
courses offered by commercial and proprietary schools forced the Council on Dental
Education of the American Association of Orthodontists (AAO) to reevaluate
orthodontic training, proposing a new plan—a full-time course of instruction that
would be equivalent to 2 years of academic time. This plan was approved by the

education committee of the Ameri- can Dental Association in 1963.2

From about 1950 to 1970, the specialty of orthodontics was bathed in prosperity.
The AAO could not direct universities to develop graduate orthodontic programs, so
it developed its own alternative: preceptor training. The American Dental
Association’s Council on Dental Education had previ- ously rejected preceptor-
based education, but in 1950 the American Board of Orthodontics successfully de-
fended before the council the usefulness and validity of careful, rigorous
preceptorship training as an alterna- tive to university-based education.

THE GOLDEN AGE OF EXTRACTIONS Upswing

By the 1930s, the relatively common extraction practices of the late 19th century.

According to Lischer, “The extraction of 1 or more permanent teeth to facilitate an

orthodontic treatment dates back at least to Fauchard (1728), and has been resorted
to ever since. . . . The narrow, orthodox view that extraction of a tooth is never
justified is being discarded. . . . The profile of a growing child must never be regarded
as a fixed line, but one in which further changes will continue to take place.” As early
as 1920, George W. Grieve (1870-1950, Angle School, 1907, considered the dean
of Canadian orth- odontists, recommended the removal of permanent teeth.
However, the increase in extractions that took place in the mid 1940s was due, in
large part, to the influence of Charles Tweed, whose teachings had become widely
accepted. Extractions in the permanent dentition rapidly became the most common
treatment strategy for the correction of Class I and II malocclusions.The prevalence
of extractions soared from a modest 30% in 1953 to 76% in 1968.

The temporomandibular joint and orthognathic surgery

The treatment of temporomandibular joint (TMJ) disorders was recorded as early as

3000 BC. However, it was not until the early 1900s that treatment modalities gained
attention in the literature.

In 1920, Monson was one of the first to propose that malocclusion was responsible
for the encroachment of the condyle on the auditory canal and associated nerve
structures. The approved treatment for symptoms that included deafness,
headaches, burning sensations in the mouth, and crepitus in the joint itself was
restoration of the lost vertical dimension.

In the 1930s, Costen reported treating 165 patients by opening the bite in the molar
area to increase the vertical dimension and “bring the condyles down from the
glenoid fossa.” A group of symptoms, which included neuralgia and otic symptoms,
became known as “Costen’s syndrome.”

Neuromuscular theories

In 1940, Dingman (1906-69) was convinced that the single most important factor in
preventing damage to the TMJ was restoration of proper occlusion.

In the 1950s, Cobin advocated the construction of occlusal acrylic splints.

Schwartz proposed intraarticular injection of hydrocortisone.

Myofascial theories

In 1954, Schwartz backed off from his emphasis on the joint to the possibility that
muscle spasms were the etiological factor in limited, painful mandibular movement.

Sicher, wrote that overclosure, premature contacts, and mental tension could lead
to overexcitation of the mandibular muscles with trismus and bruxism.

In the 1960s, emphasis was placed on the treatment of muscle spasms rather than
on the mechanical and structural aspects. For the deeper muscular structures, ultra-
sound diathermy, voluntarily avoiding clenching the teeth, biteplate or occlusal
splints, and phenobarbital or Valium were recommended to relax the skeletal
muscles.

Electromyographic research by Moyers, Perry, and others began a new era in the
study of TMJ and muscle dysfunction. Investigators concluded that emotional stress
indeed played a part in masticatory muscle response.

Psychological theories

Schwartz was the first to incorporate the diagnostic skills of a psychiatrist. With Ruth
Moulton, MD, he concluded: “Predisposition, psychologic as well phys- iologic,
seems to be more important than the particular form of the precipitating factor itself.”

In 1969, Laskin proposed a psychophysiologic theory based on myofascial pain

spasms. His studies supported muscle fatigue as a primary factor in the pain, being
primarily psychologically motivated by continuous tension-relieving oral habits

Recent theories

In the 1980s, new imaging techniques such as computed tomography, arthrography,

and magnetic resonance imaging opened new windows to the intracapsular
elements. Using arthrography, surgical findings, and occlusal splint therapy.

In 1990, sample studies indicated that orthodontic treatment is not responsible for
creating TMDs, regardless of the orthodontic technique, and that orthodontic
treatment is not specific or necessary to cure signs and symptoms of TMD.
Articulators and centric relation

In the early 1970s, Roth admonished orthodontists to mount their cases because he
believed that pretreatment, articulated, centric-relation (CR) mounted models are the
best to identify the socalled “Sunday bite” and any occlusal or condylar
disharmonies. At this time, CR was considered a posterior-superior (retruded)
condyle position.

the Journal of Clinical Orthodontics showed that about 21% of the respondents
routinely mounted models, 44% mounted models occasionally, and 35% never
mounted models.

the positions of the condyles in the glenoid fossa and the CR position were not found
to be diagnostic of TMDs. Other myths included the notions that orthodontic
treatment causes TMD.

Orthognathic surgery to midcentury

Early orthognathic surgery was limited to the mandible because of the difficulty in
maintaining the blood supply. Even so, virtually nothing effectively could be done
before the middle of the 19th century because of the lack of satisfactory anesthesia.

The first operation for the correction of malocclusion was performed in the United
States in 1849 by Simon P. Hullihen, MD, DDS (Hon) (1810-57), in a patient with an
openbite deformity secondary to scar contractures of the neck and chest.

In 1844, Horace Wells, a Connecticut dentist, discovered that nitrous oxide could be
used as an anesthetic and successfully used it to conduct several extractions in his
private practice.

In 1901, René LeFort of the University of Lille in France published the results of
cadaver experiments in which he struck cadaver heads with a piano leg and then
dissected the heads to see the location and extent of the fractures. His work resulted
in the classification of 3 types: LeFort I, LeFort II, and LeFort III.

Back in the United States, mandibular ostectomy was further refined with
preservation of the inferior dental nerve by Reed O. Dingman in 1944, a maxillo-
facial and plastic surgeon at the University of Michigan; he improved techniques,
fixation, and the final occlusion, and reduced the risk of complications.

Surgical adjuncts to orthodontics

the related fields of cleft lip and palate treatment, and distraction osteogenesis.

SURGERY MATURES

In 1954, Caldwell and Letterman developed a vertical ramus osteotomy technique,

which had the advantage of minimizing trauma to the inferior alveolar neurovascular
bundle.

Richard Trauner and Hugo Obwegeser (1957), introduced the intraoral bilateral
sagittal split ramus osteotomy, allowing corrections in all 3 planes of space without
a need for bone grafting.

1960s and 1970s. Derek Henderson also developed appropriate planning

techniques using a combination of photocephalometry and accurate model surgery.

In 1959, Heinz Köle, a student of Obwegeser, introduced subapical dentoalveolar

osteotomies in the anterior mandible.

In 1960, Obwegeser began performing maxillary surgery and, by 1969, had

described many LeFort I osteotomies, marking the beginning of a new era in the
correction of dentofacial deformities

Plating techniques (1983) and screws for the fixation of jaw fragments reduced the
risk of relapse and allowed intermaxillary fixation to be dispensed with in many
patients.

CLEFT LIP AND PALATE TREATMENT

The first report of surgical cleft lip repair appears in Chin Annals, involving repair of
an apparently congenital cleft in 390 BC.

The first exact description in the western world of cleft lip surgery was given by Johan
Yperman, who practiced in the 14th century. He performed a 2-layer operation with
waxed, twisted thread. In 1552, Houlier proposed suturing palatal clefts; 12 years
later, Ambroise Paré illustrated obturators for palatal perforations.

1556, when Pierre Franco, along with Paré, described in detail the principles and
techniques of cleft palate surgery. Franco has been called the “father of cleft palate
surgery.”

The first successful closure of a soft palate defect was reported in 1764 by Le
Monnier, a French dentist, using sutures along with cautery of the edges (the first
palatorrhaphy).

The introduction of general anesthesia in the late 1840s led to great advances in
cleft palate surgery. In the 1840s, Simon P. Hullihen (1810-1857) advocated surgical
repair in infancy before eruption of the dentition and used an adhesive strap from
cheek to the other before surgery.

The first cleft palate clinic in the United States was established in 1939 when Herbert
Cooper opened the Lancaster (Pa) Cleft Palate Clinic.

In 1950, C. Kerr McNeil, often called the founder of modernday, premaxillary

orthopedic treatment, described the use of acrylic appliances to reposition bony cleft
segments, in addition to traction.

In the 1960s, Sheldon W. Rosenstein, working with surgeons, introduced the

technique of placing a plate in the maxilla of a newborn before surgical lip closure to
guide the maxillary segments into proper alignment.

DISTRACTION OSTEOGENESIS

DO now allows us to literally “grow bone” in patients hitherto treatable only by

surgery. DO is especially useful in the treatment of the severe growth deficiencies of
craniofacial syndromes.
Pioneers

Wescott first reported placing mechanical forces on the bones of the maxilla in 1859.
Codivilla, who lengthened a femur to correct limb length deficiencies, first reported
bone lengthening by DO in 1905.

Mandibular procedures

According to Limberg, Brown in 1918 and Bruhn- Linderman in 1921, each

performed a vertical osteotomy of the mandibular body followed by acute
advancement of the anterior segment.

In 1927, Rosenthal performed the first mandibular osteodistraction procedure by

using an intraoral tooth- borne appliance that was gradually activated over a month.

Skeletal fixation

The application of external skeletal fixation for craniofacial fractures was first
reported by Haynes in 1939.

Crawford, in 1948, applied gradual incremental traction to the fracture callus of the
mandible.

Ilizarov’s influence

The first description in English of DO in a human maxillofacial application was

reported in 1992 by McCarthy, in lengthening a congenitally hypoplastic mandible.
In 1998, Razdolsky et al demonstrated an intraoral, tooth- borne distractor for
lengthening the mandible

Skeletal anchorage

The earliest endosseous implant, discovered in Honduras in 1931, was a mandibular

fragment of Mayan origin, dating from about ad 600. It consisted of 3 tooth-shaped
pieces of shell placed in the sockets of 3 missing mandibular incisors.

Orthodontists have long searched for the perfect anchorage to minimize undesired
tooth movements. Headgear, elastics, adjacent teeth, and many appliances have
been suggested as anchorage; however, the main drawback was that most relied on
patient compliance to be successful

Types of implants

the retro molar implants described by Roberts et al and palatal implants introduced
by Wehrbein and Merz. Both are used for indirect anchorage, meaning that they are
connected to teeth that serve as the anchorage units.

The other category developed from surgical mini-implants, which have been used by
oral surgeons for decades and are highly predictable. These plates are placed by
screws engaging the cortical bone. The most common areas for placement for
orthodontic use are in the zygomatic strut in the maxilla and the buccal aspect of the
body of the mandible—a particular advantage in treating skeletal open-bite
malocclusions.

Evolution of skeletal anchorage

The first implant success was achieved at Harvard University in 1937, with cobalt-
chromium-molybdenum alloy (vitallium) implants. The concept of using implants to
enhance orthodontic anchorage was first published in 1945 by Gainsforth and
Higley, who used vitallium screws to effect tooth movement in dogs

In the 1960s, P. I. Bråne-mark, a Swedish physician and orthopedic surgeon, found

that bone had a high affinity for titanium and coined the term osseointegration.

In 1969, Linkow described the endosseous blade implant for orthodontic

In 1984, Roberts et al evaluated the effect of orthodontic-level forces on titanium

implants in rabbit femurs. Nineteen of 20 implants remained stable after subjection
to 100 g of force for 4 to 8 weeks.

1997 that Kanomi described a mini-implant specifically designed for orthodontic use.
Costa et al described a 2-mm titanium miniscrew with a special bracket like head
that could be used for either direct or indirect anchorage.

Kanomi, Costa et al, Lee et al, and Park et al showed the use of titanium miniscrews
for immediate loading as an alternative anchorage system and discussed possible
placement sites.
This is a thin titanium alloy disk (2 mm high, 10 mm in diameter), textured and coated
with hydroxyapatite on 1 side and with an internal thread on the other.

● Wehrbein et al described the midsagittal area of the palate as a placement site for
implant anchorage in orthodontic treatment of the maxilla using 3.3-mm diameter
implants.

● Melsen et al introduced zygomatic ligatures as anchorage in partially edentulous

patients for intrusion and retraction of the maxillary incisors. 


● Park described a skeletal cortical anchorage system using titanium microscrew

implants.
● Sugawara and Umemori et al treated open-bite patients with molar intrusion using
a miniplate skeletal anchorage system

● Park et al showed that microscrews only 1.2 mm in diameter could be placed

between the roots of teeth to retract the 6 anterior teeth en masse and intrude
the mandibular molars at the same time. 


● Lee et al showed that microimplants can provide reliable and

absolute anchorage for lingual orthodontic treatment and conventional labial
treatment. 


Using TADs, orthodontists can now (1) retract and realign anterior teeth
without posterior support, (2) close edentulous spaces in first-molar extraction
sites, (3) cor- rect midlines in patients with missing posterior teeth, (4)
reestablish proper transverse anteroposterior positions of isolated molar
abutments, (5) intrude or extrude teeth, (6) protract or retract an arch, (7)
stabilize teeth with reduced bone support, and (8) apply orthopedic traction. 7

Late 20th-century fixed appliances

BRACKETS Rotation control

The narrow width of the original edgewise bracket limited its ability to control rotation.

Swain (1911-1999) attached 2 brackets to a single base and called it the twin, or
“Siamese,” bracket. In Seattle, Paul D.
Lewis (1896-1992) soldered curved rotation arms, or “wings,” to a single bracket that
contact the inside of the archwire. A modification of the Lewis bracket, designed by
Howard M.

Lang (1914-94), uses straight arms with a hole to increase flexibility and for ligature
tying.

The principal advantage of these winged brackets over the twin is that they do not
reduce the interbracket span or impede the activation of closing loops.

Preadusted brackets

Holdaway (1952) suggested that the brackets in the mandibular buccal segments
could be angulated by an amount proportional to the severity of the malocclusion

However, in 1959, Ivan F. Lee (1922-) (personal interview, June 25, 2007) produced
a commercially viable torque bracket for anterior brackets, writing about it in his
thesis for the American Board of Orthodontics. Lee Torque Brackets were marketed
by Unitek (Monrovia, Calif) for about 15 years.

At the 1960 AAO meeting, Jarabak, with James A. Fizzell, demonstrated the first
bracket to combine torque and angulation.
Lawrence F. Andrews(1929-) announced an appliance whose brackets were
designed for each tooth so that, on being aligned on an unadjusted archwire, the
teeth would assume ideal positions. Based on his “six keys to normal occlusion,” he
called his design the Straight- Wire appliance.

Building on the innovations of Lee and Jarabak, An- drews cut the appropriate
amount of torque into each bracket and also angulated the bracket in relation to its
base. It was the first bracket to combine torque, angulation, in and out, and offset
Narrow slots

Although stainless steel had been in use in the early 1930s in band material and
ligatures, it was not until 1953 that Steiner brought out the first .018 􏰂 .022 in bracket
to accommodate a like-dimension, stainless- steel archwire, greatly improving the
elasticity (and comfort) of working wires.

Esthetic brackets

In 1963, Morton Cohen and Elliott Silverman brought out the first commercially
available plastic brackets (IPB, GAC International, Bohemia, NY). The ceramic
bracket was commercially introduced in 1987.

In the 1990s, these deficiencies were overcome with design modifications and the
use of reinforced polycarbonate (for plastic) and polycrystalline alumina (for ceramic)
and the addition of a metallic slot.

Bonded brackets

Direct bonding of orthodontic attachments was probably the most significant

development in clinical orthodontics in the second half of the 20th century.

Buonocore’s work stimulated efforts to experiment with bonding orthodontic

attachments to maxillary anterior teeth

in 1990, when Herbert I. Cueto wrote that his “direct-bonding technique was
developed and used for the first time on several patients” in 1966 in the orthodontic
department of the Eastman Dental Center, using a liquid monomer (methyl- 2-
cyanoacrylate) and a silicate filler.

Adhesives mature
In 1968, Smith introduced a polyacrylate (carboxylate) (Dure- lon, 3M ESPE, St Paul,
Minn). In 1970, Retief described an epoxy resin system designed to withstand
orthodontic forces.

In 1962, bisphenol A glycidyl methacrylate (BIS-GMA) resins were introduced by

Rafael Brown as dental adhesives and later applied in orthodontic practice

glass ionomer cements (GICs) were invented in the late 1960s and developed in the
early 1970s by Wilson and Kent, becoming popular in the late 1980s for cementing
bands.

Siomka and Powers (1985) and Newman et al (1995) found that silanation (by Ortho-
Cycle, Hollywood, Fla) improved the bond strength of new meshed brackets by as
much as 21%. Based on Rafael Bowen’s use of a chelating agent, Sunmedical
(Shiga, Japan) introduced Superbond, reported to prevent the risk of postdebonding
enamel cracks.

The first study on light-curing appeared in 1979, but it was not until 1993 that the first
commercial product came on the market (Transbond XT Light Cure, 3M Unitek).

Unitek introduced adhesive-precoated brackets (APCs) in 1991. In addition to speed

and accuracy, Cooper et al listed the following advantages of APCs over
conventional light-cured systems: (1) consistent quality and quantity of adhesive, (2)
easier cleanup after bonding, (3) improved asepsis, (4) reduced waste during
bonding, and (5) better inventory control.

the lingual bracket and the innovation second only to bonding in its impact on
orthodontic bracketing: the self-ligating bracket.
 5. Biography

1. Wahl N. Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th

century. Am J Orthod Dentofacial Orthop 2005; 127:255-9).

2. Wahl N. Orthodontics in 3 millennia. Chapter 2: Entering the modern era. Am

J Orthod Dentofacial Orthop 2005; 127:510-5).

3. Wahl N. Orthodontics in 3 millennia. Chapter 3: The professionalization of

Orthodontics. Am J Orthod Dentofacial Orthop 2005; 127:749-53).

4. Wahl N. Orthodontics in 3 millennia. Chapter 4: The professionalization of

orthodontics (concluded). Am J Orthod Dentofacial Orthop 2005; 127:255-9).

5. Wahl N. Orthodontics in 3 millennia. Chapter 5: The American Board of

Orthodontics, Albert Ketcham, and early 20th – century appliances. J Orthod
Dentofacial Orthop 2005; 128:535-40).

6. Wahl N. Orthodontics in 3 millennia. Chapter 6: More early 20th – century

appliances and the extraction controversy. Am J Orthod Dentofacial Orthop
2005; 128:795-800).

7. Wahl N. Orthodontics in 3 millennia. Chapter 7: Facial analysis before the

advent of the cephalometer. Am J Orthod Dentofacial Orthop 2006; 129:293-
8).

8. Wahl N. Orthodontics in 3 millennia. Chapter 8: The cephalometer takes its

place in the orthodontic armamentarium. Am J Orthod Dentofacial Orthop
2006; 129:574-80).

9. Wahl N. Orthodontics in 3 millennia. Chapter 9: Functional appliances to

midcentury. Am J Orthod Dentofacial Orthop 2006; 129:829-33).

10. Wahl N. Orthodontics in 3 millennia. Chapter 10: Midcentury retrospect. Am

J Orthod Dentofacial Orthop 2006; 130:253-6).

11. Wahl N. Orthodontics in 3 millennia. Chapter 11: The golden age of

orthodontics. Am J Orthod Dentofacial Orthop 2006; 130:549-53).
12. Wahl N. Orthodontics in 3 millennia. Chapter 12: Two controversies: Early
treatment and occlusion. Am J Orthod Dentofacial Orthop 2006; 130:799-
804).

13. Wahl N. Orthodontics in 3 millennia. Chapter 13: The temporomandibular joint

and orrthognatic surgery. Am J Orthod Dentofacial Orthop 2007; 131:263-7).

14. Wahl N. Orthodontics in 3 millennia. Chapter 14: Surgical adjuncts to

orthodontics. Am J Orthod Dentofacial Orthop 2007; 131:561-5).

15. Wahl N. Orthodontics in 3 millennia. Chapter 15: Skeletal anchorage. Am J

Orthod Dentofacial Orthop 2008; 134:707-10).

16. Wahl N. Orthodontics in 3 millennia. Chapter 16: Late 20th – century fixed
appliances. Am J Orthod Dentofacial Orthop 2008; 134: 827-30).