SECTION I

Introduction
Chapter 1

Introduction to Orthodontics

Orthodontics is the branch of dentistry, which is “Concerned with the facial growth; with the
development of the dentition and occlusion; and with the diagnosis, prevention, interception,
and treatment of occlusal anomalies and other abnormalities of the dentofacial region.”

The term ‘Orthodontia’ was apparently used first by the Frenchman Le Foulon in 1839.

The name of the specialty ‘Orthodontics’ is derived from the Greek words “Ortho” meaning
right or correct or straight, “Odontos” meaning tooth and “ics” meaning science.

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

Dentofacial orthopaedics (Orthodontics now) is formally defined by the American Association

of Orthodontists as “The area of dentistry concerned with the supervision, guidance and
correction of the growing and mature dentofacial structures, including those conditions that
require movement of teeth or correction of malrelationships and malformations of related
structures by the adjustment of relationships between and among teeth and facial bones by the
application of forces and/or the stimulation and redirection of the functional forces within the
craniofacial complex.

UNFAVOURABLE CONSEQUENCES OF MALOCCLUSION

Any deviation from normal occlusion and appearance is called malocclusion. The term
‘Malocclusion’ was first coined by Guilford. Proper dentition and occlusion is an important
factor for esthetics, form and function. Protruding, irregular or maloccluded teeth can cause
three types of problems for the patient:

I. PSYCHOSOCIAL PROBLEMS
Well-aligned teeth and a pleasing profile have a positive effect at all social levels, whereas
irregular or protruding teeth carry negative status.
II. ORAL FUNCTION
Any deviation from normal occlusion will affect the functions carried out by the oral cavity.
Some of the functions affected are:

1. Masticatory Patients with anterior open bites and those with markedly function
increased or reverse overjets often complain of difficulty with
eating, particularly when incising
 food.

2. Speech Different types of malocclusion leads to different types of speech

difficulties. For example, if a
patient cannot attain contact between the incisors anteriorly,
this may contribute to the prod-
uction of a lisp Insert from page No.3 (interdental
stigmatism).

3. Abnormal Insufficient chewing due to mal- deglutition occlusion may produce a

food bolus that is difficult for smooth swallowing. This may
change the swallowing and deglutition pattern.

4. Abnormal Malocclusions like increased over- muscle jet may lead to

compensatory function muscle habits like abnormal
mentalis activity.

5. Temporo- The malocclusion may lead to mandibular

temporomandibular dysfunction joint (TMD), manifested as pain in
dysfunction and around the TM joint. The syndrome pain may result from
pathologic changes within the joint, but more often is caused by
muscle fatigue and spasm.

6. Tooth Tooth may be impacted or impaction unerupted due to

malocclusion.
a) Unerupted impacted teeth, e.g., maxillary canines,
may cause resorption of the roots of adja- cent teeth.
b) Dentigerous cyst formation can occur around
unerupted third molars or canine teeth.
c) Supernumerary teeth may also give rise to
problems, most imp-
ortantly where their presence
prevents normal eruption of an associated permanent
tooth or teeth.

III. INTERFERENCE WITH NORMAL GROWTH PROCESS

Sometimes unilateral crossbite of one or two anterior teeth may lead to asymmetry of basal
bone in a growing child.

IV. RELATIONSHIP TO INJURY AND

DENTAL DISEASE

Caries Malalignment may reduce the potential for natural tooth cleansing.
This leads to plaque accumulation and increases the risk of caries.
Periodontal Certain occlusal anomalies may
disease compromise periodontal support.
a) Crowding may lead to one or more teeth being squeezed
buccally or
lingually out of their investing bone,
resulting in the reduction of perio- dontal support.
b) In class III malocclusion where the lower incisors in
crossbite are
pushed labially, leading to gingival
recession.
c) Traumatic overbites can also lead
to increased loss of periodontal support and therefore
are another
indication for orthodontic interven-
tion. Page-3

Trauma to a) The risk of trauma to the upper

the anterior incisors increases with the amount teeth of the overjet. The
prevalence of
trauma reduces with age, with the peak incidence
occurring around
10 years.
b) Extreme overbite, so that the lower
incisors contact the palate, can cause
significant tissue damage, leading to
loss of the upper incisors. In a few patients, extreme
wear of lower
incisors also occurs with excessive overbite.

In summary, there are a number of dental traits which has to be corrected . These include the
following:
1. Increased overjet.
2. Increased traumatic overbites.
3. Anterior crossbites
4. Unerupted impacted teeth (where there is a danger of pathology).
5. Crossbites associated with mandibular displacement.

AIMS OF ORTHODONTIC TREATMENT -- JACKSON’S TRIAD

The treatment provided should not only satisfy the patient’s esthetic desires, but should also
satisfy certain functional demands and structural requirements.
Jackson had summarized the aims and objectives of the orthodontic treatment, known as
“Jackson’s triad” (Fig. 1.2). These three are now famous as:

1. Functional efficiency
2. Structural balance
 3. Esthetic harmony

1. Functional Efficiency: Restore the

functional efficiency that is effected by
malocclusion along with Improvement
of esthetics
2. Structural Balance: The disturbed
structures such as Bone, Teeth and soft
tissues have to be restored to normal
form.

1.

AIMS OF AN ORTHODONTIST
JACKSON’S TRIAD

3. Esthetic Harmony: The orthodontic

treatment should increase the overall
esthetic appearance as well as smile of the
individual.
THE SCOPE OF ORTHODONTIC TREATMENT
Orthodontic treatment can bring about changes in the dentition and the structures around the
dentition such as the basal skeletal bone as well as the enveloping soft tissue components.

1. Orthodontic Change (Alteration in tooth position):

Most malocclusions involve only the dental structures and this can be effectively treated by
moving teeth so as to bring them into ideal positions

2. Orthopaedic Change (Alteration in skeletal pattern): Malocclusion may result from

skeletal disproportion between the basal jaw bones (i.e., maxilla and mandible). The jaws
can be moved into more favourable positions by functional appliances or orthopaedic forces
in growing children. The jaws can be brought into favourable position by Orthognathic
surgery in adult patients where active growth has stopped.

3. Altering the Soft Tissue Envelop: It is possible to bring about favourable changes in the
soft tissue pattern such as muscles by orthodontic treatment.

DIVISION OF ORTHODONTICS
Services offered by the orthodontist can be divided into four categories based on the nature and
time of intervention:
1. Preventive orthodontics
2. Interceptive orthodontics
3. Corrective orthodontics
4. Surgical orthodontics

Timing of Dental status Examples

intervention
Preventive Action taken to It begins with the Prentatal instructions,
Orthodontics preserve of what fetal life and genetic counselling, Oral
appears to be the continues throughout hygiene instructions,
normal occlusion at a the life. periodic observation of
specific time. Dentition

Procedures undertaken Most of the

before the onset of a procedures are carried
malocclusion. It is also out during Primary
called as primary dentition stage
prevention
Interceptive Phase of orthodontics, Most of the Growth modulation with
Orthodontics employed to recognize, procedures are carried functional and orthopaedic
and eliminate or reduce out during active appliances, serial
the potential growth phase which extraction, control of
irregularities and coincides with mixed abnormal habits etc..
developing dentition phase.
malocclusion

This includes
secondary preventive
measures. This stage
differs from the
preventive
orthodontics, in that
malocclusion already
sets in.
Corrective orthodontic procedure This is done during The procedures employed
Orthodontics undertaken to correct a permanent stage in correction are
fully established mechanical
malocclusion. Comprehensive: Full
orthodontic correction Examples are
To reduce or eliminate of malocclusion . Fixed appliances such as
the problem and the This is done in .Begg’s, Edgewise,
attendant sequelae. adolescents Preadjusted Edge
wise(straight wire) ,
Adjunctive: only Lingual Orthodontics,
partial . Used for Invisible Orthodontics or
prosthodontic and Aligners , Implants etc..,
periodontic purpose.
This is done in adults
 Surgical They are surgical Usually undertaken Maxillary procedures like
Orthodontics procedures that are when once the active Anterior Segmental
undertaken to correct growth is completed Osteotomy, Le fort
the skeletal bases and skeletal procedures et..,
conjunction with or as maturation occurs
an adjunct to Mandibular procedures
orthodontic treatment. like set back, set down,
BSSO

† preventive and interceptive orthodontic field may overlap. Usually interceptive orthodontics
correlates with the mixed dentition stage.

BRIEF HISTORY OF ORTHODONTICS

Orthodontics is considered as the oldest and first specialty of dentistry.

Aristotle (384–322 BC), who is considered to be the Father of Medical Sciences, compared
human dentition with those of various other species.

The Greek physician Hippocrates (460–377 BC) mentioned in his writings about ‘crooked
teeth.

Celsius (25 BC) was the first to observe that teeth can be moved by pressure or force. He used
finger pressure

Kneisel,( 1836) published the first book (in German) entitled Der Schiefstand der Zahne on
malocclusion of the teeth.

Pierre Fauchard, - A French dentist, is considered the Father of Modern Dentistry.

Fauchard (1728) gave to the orthodontics the “Bandelete” later known as the “expansion arch,”
which is probably the first orthodontic appliance.

Kneisel attempted the first classification of malocclusion and was the first to advocate the use
of removable appliances.

In 1743, Bunon first used the term ‘Orthopaedics’ in connection with the correction of
malocclusion.

Norman William Kingsley (1829–1913) is considered to be the “Father of Orthodontics.” He

is a pioneer of cleft palate rehabilitation. In 1859, he made the first obturator for a cleft palate
patient. He is also considered to be the first person to use orthopaedic force to correct
protruding teeth. (Fig. 1.4). Kingsley’s book A Treatise on Oral Deformities (1880), was the
first to recommend that aetiology, diagnosis and treatment planning should be the foundations
of practice.
Emerson C Angell (1823–1903) was the first to advocate the rapid maxillary expansion, which
results in the opening of the mid-palatal suture and increase in transverse dimension.

William E Magill (1823–896) was the first person to band teeth for active tooth movement.

Henry A Baker in 1893 introduced intermaxillary elastics to treat interarch malocclusions. It is

also known as Baker’s anchorage.

The first outstanding work devoted exclusively to orthodontics was written by John Nutting
Farrar (1839–1913) aptly titled ‘Treatise on Irregularities of the Teeth and their
Correction’ (Fig. 1.5).

Contribution of Edward H Angle

Edward H Angle (1855–1930) (Fig 1.6) is considered the ‘Father of Modern Orthodontics’
for his countless contributions to the specialty of orthodontics.

Angle’s contributions include the following.

1. He is the first person to recognize orthodontics as a separate specialty within the branch of
dentistry.
2. In 1900, Edward H Angle started his first school of orthodontics in St Luise, New London,
Connecticut.
3. Angle organized the first orthodontic society (1900), the American Society of
Orthodontists (now the American Association of Orthodontists), and became its first
president.
4. Angle introduced the permanent upper first molars as “Key of occlusion.’ He also
introduced the concept of maxillary and mandibular occlusal lines.
5. In 1887, EH Angle presented his classification of malocclusion. Angle’s classification,
published in Dental Cosmos (1899), remains the most widely accepted classification of
malocclusions. Even after 100 years, it is the universally accepted classification.
6. He also founded the first orthodontic journal, The American Orthodontist, in 1907.
7. He had 37 patents to his name. He developed different appliances. Some of them are the
“E” arch (1900), the pin and tube appliance (1910), the ribbon arch appliance (1916) and
the edgewise appliance (1925).
8. Angle was a proponent of the non-extraction method of Orthodontic treatment.

Calvin Case (1847–1923) was a contemporary and a bitter critic of Angle (Fig. 1.7). Case also
claims to be the first orthodontist to use intermaxillary elastics. He was the first to use (about
1893), along with Henry Baker, class II elastics and was the first to attempt bodily movement.
He was also the first to use light wires (0. 016 and 0.018 in).

Calvin Case opposed Angle’s philosophy of non extraction for all the cases. He advocated that
certain teeth has to be extracted as a part of orthodontic treatment to improve the facial esthetics
as well as the stability of the treated cases. Along with the Angle, Dewey, Ketcham and
Calvin case are considered as “Big Four” in Orthodontics.
Martin Dewey (1881–1933) was the founder and first editor of the famous ‘American Journal
of Orthodontics.’ (Fig. 1.8).

Spencer R Atkinson (1886–1970) was originally a pedodontist. He is also an orthodontist,

teacher, inventor, innovator, anatomist, Anthropologist and skilled photographer. He was a
pioneer in the studies of the growth and development. He originated the term key ridge, which is
related to zygomatic buttress or mesiobuccal root of first permanent maxillary molar (Fig. 1.9).

In 1931, Holly Broadbent of USA and Hofarath of Germany independently and separately
developed cephalostat. It helps in standardizing the position of the head taking cephalogram.
This is considered to be a major advancement in orthodontic diagnosis and treatment planning
(Fig. 1.10).

Buonocore in 1955 introduced the concept of acid etch technique. On the basis of this,
Neumann in 1965 introduced direct bonding of orthodontic attachments to the enamel, which
greatly enhanced esthetics by eliminating the metal bands.

In the 1930s, Pacinell Raymond Begg presented the Begg appliance (light wire differential
force technique). It was a modification of the ribbon arch appliance, but used extremely light
forces for treatment. (Fig. 1.11).

In Europe also there was tremendous increase in the orthodontic field. American orthodontists
were much interested in developing and improving fixed orthodontic appliances, while the
European orthodontics saw much growth in the field of functional appliances.

Pierre Robin in 1902 introduced a Monobloc for improving the position of tongue in patients
with glossoptosis by holding the mandible forward.

The Activator was introduced by Viggo Anderson in 1910. Rolf Frankel during 1969–1973
fabricated the true functional appliance—the Function regulator—to treat a variety of skeletal
mal-occlusions.

Melvin Moss (Fig. 1.12) put forward his famous "Moss hypothesis" for growth of craniofacial
structures. This is the basis of many functional appliances.
Lawrence Andrews introduced the Pre-adjusted Edge-wise (PAE)
Straightwire ApplianceTM in 1976. This was a modification of conventional Edgewise fixed
appliance This minimized the burden on orthodontist by minimizing the complex wire bending.
.
Andrews also contributed the famous “Six Keys of Normal Occlusion” in 1972 (Fig. 1.13).

Peter C Kesling developed Tipedge (combination of Begg and straight wire) or Differential
Straight-Arch Technique.

Kurz developed edgewise lingual appliance technique and "Fujita" of Japan developed light
wire lingual appliance known as Mushroom appliance.
REVIOUS YEARS UNIVERSITY QUESTIONS
Essay Questions
1. Define orthodontics and describe the adverse effects of malocclusion.
2. Describe the scope of orthodontics

Short Answer Questions

1. Definition of orthodontics
2. Ill effects of malocclusion
3. Jackson’s triad
4. Angle’s contribution to orthodontics

ACKNOWLEDGEMENTS
1. Wahl N. Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th Century. Am J
Orthod Dentofac Orthop 2005;127(2):255–259.
2. Wahl N. Orthodontics in 3 millennia. Chapter 3: The professionalization of orthodontics. Am
J Orthod Dentofac Orthop 2005;127(6):749–753.
3. Wahl N. Orthodontics in 3 millennia. Chapter 2: Entering the modern era. Am J Orthod
Dentofacial Orthop 2005;127:510–515.
4. Wahl N. Orthodontics in 3 millennia. Chapter 4: The professionalization of orthodontics
(concluded). American Journal of Orthodontics and Dentofacial Orthop 2005;128(2):252–
257.

REFERENCES
1. Graber TM. Orthodontics: Principles and Practice, 3rd ed. WB Saunders; 1988.
2. Asbell MB. A brief history of orthodontics. Am J Orthod Dentofac Orthop 1990;98(2):176–
183.
3. Newman GV. Epoxy adhesives for orthodontic attachments. American Journal of
Orthodontics 1965;51(12): 901–912.