z

CONTENTS
z

 Introduction

 Definitions

 Aims of orthodontic treatment

 Branches of Orthodontics

 Ancient civilization

 16th-17th Century

 18th Century

 19th Century

 20th Century

 History of removable appliances

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 History of Myofunctional appliances

 Orthodontic materials - A timeline

 History of Cephalometrics

 History of Fixed appliances

 History of Extractions

 History of Dentistry in India

 History of Orthodontics in India

 Indian orthodontic Society

 Conclusion

 References
INTRODUCTION
z

Evolution of the term orthodontics -

 “Regulation“ prior to 1900s

 “Orthodontia” up to 1930s (“ia” referred to a medial condition)

 “Orthodontics” up to 1970s

 Currently “Orthodontics and Dentofacial orthopedics”

Orthodontics is derived from a greek word –

 ‘Orthos’ – to correct

 ‘Odontos’ – teeth

The term ‘Orthodontics’ was first coined by Le Felon in 1839

 DEFINITIONS
z
-
 Noyes(1911) gave the first definition of orthodontics as, “The
study of the relation of the teeth to the development of the face
and the correction of arrested and perverted development.”

 The British Society of Orthodontists (1922) proposed that,

“Orthodontics includes the study of growth and development of
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.”
 z

 American Board of Orthodontics (ABO) and the American

Association of Orthodontists (AAO) stated that,
“Orthodontics is that specific area of dental practice that has as
its responsibility, the study and supervision of the growth and
development of the dentition and its related anatomical
structures from birth to dental maturity, including all
preventive and corrective procedures of dental irregularities,
requiring the repositioning of teeth by functional or
mechanical means to establish normal occlusion and pleasing
facial contours.”
AIMS
z OF ORTHODONTIC TREATMENT
 Although orthodontic treatment improves facial appearance
and is occasionally performed for cosmetic reasons, it should
be aimed at restoration of overall dental health.

 Jackson has summarized the aims of orthodontic treatment

that are popularly known as - Jackson’s triad.

Functional
Efficiency

Structural
Balance

Aesthetic
Harmony
 z
 Functional Efficiency - Orthodontic treatment should increase
the efficiency of the significant functions performed such as
mastication and phonation.
 Structural Balance - Orthodontic treatment not only affects
teeth but also the soft tissue envelop and the associated skeletal
structures. The treatment should maintain a balance between
these structures and the correction of one should not affect the
health of the other.
 Esthetic Harmony - Orthodontic treatment should enhance the
overall esthetic appeal of the individual The aim is to get results
which go well with the patient’s personality and make him or
her look more esthetically appealing. It is the far most common
reason for seeking treatment
BRANCHES
z
OF ORTHODONTICS

 The general field of orthodontics can be divided into the

following three categories based on the nature and time of
intervention.

 Preventive orthodontics - Preventive orthodontics is defined

as “Action taken to preserve the integrity of what appears to
be the normal occlusion at a specific time.” It includes actions
undertaken prior to the onset of a malocclusion.
 z

 Interceptive orthodontics - defined by the American

Association of Orthodontists as “That phase of the science
and art of orthodontics employed to recognize and eliminate
potential irregularities and malpositions in the developing
dentofacial complex.”

 Corrective orthodontics - It employs certain technical

procedures to reduce or correct the existing malocclusion and
to eliminate the possible sequelae of malocclusion.
Preventive
z
Interceptive Corrective
orthodontic Orthodontic Orthodontic
s s s
Restoration of
Serial extraction Removable/Fixed
carious lesions
mechanotherapy

Early recognition &

Developing anterior
elimination of oral
crossbite
habits
Functional/Orthopae
dic appliances
Removal of retained
Controlling
deciduous &
abnormal oral habits
supernumerary teeth
Maintainence of Orthognathic/Surgic
Eliminating
space following al approach
bony/tissue barriers
premature loss of
to erupting teeth
deciduous dentition
ANCIENT
z CIVILIZATION

 Specimens dating back to 8th

century B.C shows that Etruscans
may have been first people to
employ orthodontics for
alignment of teeth.
 Archaeologist have discovered
Egyptian mummies with crude
metal bands wrapped around
teeth.
 It is speculated that catgut was
used to close the gap.
 z

HIPPOCRATES (460-377 BC)

 Greek physician considered as a pioneer

in medical sciences.
 1st to separate medicine from Religion.

 His text - “Corpus Hippocraticum” is

medical information based on facts.
 Consisted many references to jaws,
irregularities & crowding of teeth.
 z

ARISTOTLE (384-322 BC)

 1st writer to study teeth in broad

manner.
 His work “De Partibus
Animalium” (parts of animals)
compared various dentitions of
known species of animals.
 AULIUS
z CORNELIUS (25 BC –
50AD)
 Described finger pressure to move
teeth in his work “De Re Medicina”

 “When in a child a permanent tooth

appears before fall of milk tooth, it is
necessary to dissect gum all around
latter and extract it. The other tooth
must be pushed with finger day by
day towards the place that was
occupied by extracted tooth and has
to be continued till it reaches its
proper position”
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16th - 17th CENTURY
LEONARDO DA VINCI (1452– 1519)

 First to recognize tooth form.

 First to realize that each tooth was

related to another tooth and to the
opposing jaw as well, thus perceiving
the articulation of the teeth.
 z

ANDREAS VESALIUS (1514 -1564)

 Belgian physician and anatomist.

 In his classic work- “ On the Fabric of

the Human Body”
 He described the minute anatomy of the
teeth, particularly the dental follicle and
subsequent pattern of tooth eruption.
BARTHOLOMAEUS
z
EUSTACHIO (1520–
1574)

 He wrote “Libellus de Dentibus” (Book

on the Teeth) in 1563, which is the first
important specialized monograph on the
anatomy of the teeth.
 In this book, he collected the writings of
various authors from Hippocrates to
Vesalius, added the results of his own
researches.
 Gave the first accurate account of the
phenomenon of the sequential
development of the first and second
dentitions.
 18zth CENTURY
 18th Century witnessed major events in
the development of dental science and
dentistry.
 France was the leader in dentistry
throughout the world in the 18th century,
mainly due to one person – PIERRE
FAUCHARD (1723) - Founder of
Modern Dentistry.
 He published his two-volume book
entitled “The Surgeon Dentist, A Treatise
on the Teeth” which had an entire chapter
on ways to straighten teeth.
 z

 He developed probably the

first orthodontic appliance
- Bandelette.

- A horse shoe shaped strip of

precious metal like silver or
gold designed to expand the
arch, particularly the anterior
teeth and was the forerunner
of the expansion arch of
modern times.
JOHN
z HUNTER (1771)

 An influential English anatomist

and surgeon.
 In his book “The Natural History of
the Human Teeth”
 Demonstrated the growth,
development and articulation of the
maxilla and mandible, and outlined
the internal structure of the teeth and
bone and their separate functions.
 He gave the basic nomenclature of
dentistry incisors, bicuspids and
molars.
 19zth CENTURY
By mid 19th century, basic concepts of
diagnosis and treatment had begun.

CHAPLIN A HARRIS (1806–1860)

 One of the most influential dental surgeons.
 During this period, published the first
modern classic book on dentistry - “The
Dental Art” in 1840.
 His personal technique included the use of
gold caps on molars to open the bite and
knobs soldered to a band for tooth
rotations.
JS GUNELL
z (1840)

 Introduced the chin strap as occipital

anchorage.
 Treatment of mandibular protrusion, the
principle of which is used even today.

JOHN NUTTING FARRAR (1839 - 1913)

“Father of American Orthodontics”

 In his studies, he investigated the
physiologic and pathologic changes
occurring in animals as the result of
orthodontically induced tooth movement.
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Contributions by J.N Farrar -

 He published two volumes entitled “Irregularities of the Teeth

and Their Correction” in 1888 and 1889. This textbook was the
first great work devoted exclusively to orthodontics.
 First to suggest the use of ‘mild force’ at timed intervals to
move teeth- ‘In regulating the teeth, the traction must be
intermittent and must not exceed certain fixed limits.’
 He also was the first to recommend ‘root or bodily movement’
of the teeth.
EMERSON C ANGEL (1823–1903)
z
“Father of rapid maxillary
expansion”
 First to advocate the opening of the
median suture.
 Provide space in the maxillary arch,
since he strongly opposed extraction.
 This began the use of arch expansion
in orthodontics.

WILLIAM & MAGILL (1871)

 Developed molar bands on the teeth
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NORMAN KINGSLEY (1829–1913)
 A prominent dentist, artist, sculptor and
orthodontist.
 He is known for his works on
“Correction of cleft palate” in terms of
orthodontics
 In 1866, he devised a technique called
‘Jumping the bite’ with the use of a bite
plane.
 He used vulcanite in conjunction with
ligatures, elastic bands made of rubber,
jackscrews and the chin cap.
 z
 It was the treatment for protrusion of the maxilla, not
necessarily with extractions, shaping the dental arches to be
in harmony with each other.
 In 1880 he published ‘Treatise on Oral Deformities’ which
remained a textbook for many years.
 He emphasized the importance of the relationship between
mechanics and biology as the principle on which
orthodontics should be based.
 His book was the first to recommend etiology, diagnosis &
treatment planning.
HENRY
z BAKER

 In an article “The Use of Indian Rubber

in Regulating teeth” (1896) according
to him, very light forces generated by
the Indian rubber is sufficient for
regulating the tooth movement .
 He used it to provide intermaxillary
force of anchorage and called it Baker’s
Anchorage.
 YEAR AUTHORS CONTRIBUTIONS TO
z ORTHODONTICS
1840 JS Gunnel Introduced chin strap

1860 Emerson C Angel • First to introduce Arch expansion by

opening mid palatine suture
• Father of Expansion Appliances
1871 William & Magill Developed molar bands

1888 - 1889 John Nutting Farrar • Father of American Orthodontics

• Wrote “Irregularities of Teeth & their
Correction”- First great work devoted
exclusively to orthodontics
• Laid foundation for “Scientific
Orthodontics (intermittent forces, limits
to amount of tooth movement)

1829 - 1913 Norman N Kingsley • Treatise on oral deformities

• Worked on correction of cleft palate
1893 Henry Baker Baker’s Anchorage (Intermaxillary elastics)
 20zth CENTURY

EDWARD HARTLEY ANGLE (1855–1930)

“Father of Modern Orthodontics”
 Edward H Angle is one of the most
dominant, dynamic, and influential
figures in the specialty of orthodontics.
 He separated orthodontics from the other
branches of dentistry.
 He did his DDS degree from
Pennsylvania College of Dental Surgery
in 1878.
 His classification of malocclusion was published in Dental
z
Cosmos in 1887.
 He established the first department of orthodontics at Marion
Sims Dental College, Saint Louis, USA in 1897. This was the
first postgraduate course in orthodontics, as well as the first
school devoted exclusively to the specialty.
 Thus was founded the first postgraduate school of orthodontics
‘Angle School of Orthodontia’ in 1900.
 He also founded the first orthodontic journal ‘The American
Orthodontist’ in 1907.
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Appliances contributed by Angle

E-arch appliance (Edward Angle‘s E-arch) 1900

 It was the first Angle’s Orthodontic appliance developed to

treat malocclusions.
 It consists of bands which are placed on molar teeth on either
side of the arch of a heavy labial arch wire extended around
the arch.
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 The ends of labial extended arch wire threaded to the buccal

aspect of the molar bands allowed the arch wire to be
advanced so that the arch perimeter increased.
 Individual teeth were ligated with the heavy labial extended
arch wire with ligature wire of 0.010“
Pin and tube appliance (1901)
z

 In pin and tube appliance, all teeth are banded.

 Vertical tubes were welded to the bands on the labial surface

in the center of the crown for all teeth in the arch.
 Arch wires were secured with soldered pins that inserted into
the vertical tubes.
 Tooth movement was achieved by altering the placement of
these pins.
Ribbon arch appliance (1910)
z

 Modification of pin and tube appliance.

 1st appliance to use a true bracket

 The bracket has a vertical slot facing occlusally.

 The brackets were attached to the bands at the center of labial

surface of teeth
Edgewise
z Appliance (1925)

 In order to overcome the deficiencies encountered with his

previous techniques Angle desired a metal bracket that could
give a better control over individual tooth movement.
 The edgewise bracket has a rectangular slot facing labially,
rather than occlusally or gingivally, which receives a
rectangular arch wire.
 This unique feature of rectangular arch wire in a rectangular
slot enabled control of tooth movement in all three planes of
space.
 Furthermore, the bracket has four wings, two occlusal and
two gingival, which increase the surface of arch wire with the
bracket slot and thus give accurate control over tooth
movement.
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Edgewise brackets Edgewise Appliance

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CALVIN CASE (1847 - 1923)

 He pioneered use of retainers.

 First one to stress the importance of

root movement.
 He was one of the first to use
rubber elastics in treatment, small
gauge, and light resilient wires for
tooth alignment.
 He was a strong proponent of
extractions.
CASE
z vs ANGLE CONTROVERSY

 Case argued that stability & esthetics would not be

satisfactory in long run for most patients without extraction
 This conflict became a debate in 1911 at the annual meeting
of the National Dental Association (former name of the ADA).
 Angle’s thesis was that “There shall be a full complement of
teeth, and that each tooth shall be made to occupy its normal
position”.
 Case defended the discreet use of extraction as a practical
procedure, while Angle believed in non extraction.
 Angle and his followers won, and therefore, extraction of
teeth for orthodontic purpose essentially disappeared.
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MARTIN DEWEY (1881–1933)
 He was an ardent champion of non-extraction.

 He is known for his modification of Angle’s

Classification of malocclusion.
 He had started his own graduate school in
orthodontics in 1911 as the Kansas City
School of Orthodontia.
 In 1914, he published his book entitled
‘Practical Orthodontics’.
 He was the founder and editor of the
International Journal of Orthodontia (now
AJO) for 17 years and also the president of the
American Dental Association (ADA) in 1931.
PR BEGG (1898 - 1983)
z
 Begg studied in Angle‘s school of
orthodontics and later began practicing
in Australia.
 The treatment period with Ribbon arch
and Pin and Tube appliance was too
long, oral hygiene was a prime issue
and soft tissue irritation and oral ulcers
due to extensive metallic design were
common.
 He introduced the ‘Begg Appliance’
 He modified the ribbon arch bracket
with a vertical slot facing gingivally.
 Although biocompatible, the gold arch
wire was expensive and forces were
insufficient.
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 In search of an alternative, Begg approached his friend AJ
Willcock, who was a metallurgist.
 Willcock developed Australian austenitic arch wires, which
were biocompatible, flexible, formeable, malleable, resilient
and also inexpensive.
 Begg technique - advocates the use of ‘light wire or
differential force technique’ and tipping of teeth crowns
rather than bodily movement. Roots are torqued at the end
of the treatment.
 Begg appliance/technique uses stainless steel arch wires
along with a number of auxiliaries and springs to achieve
the desired tooth movement.
z

Begg’s bracket Begg’s Technique

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CHARLES TWEED (1895 - 1970)

 He challenged Angle’s non extraction
philosophy.
 He observed relapse after non-extraction
expansion treatment and decided to retreat
with extraction
 Tweed advocated the extraction of premolars
based on his diagnostic triangle
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 Tweed’s Triangle - In the year 1954 based on the

hypothesis that, in the normal occlusion, the mandibular
incisors are upright over the basal bone
 Following are the planes of Tweed’s triangle:-

- Frankfort mandibular plane angle (FMPA)

- Incisor mandibular plane angle (IMPA)
- Frankfort-mandibular incisor plane angle (FMIA)
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Planes used in Tweed’s Triangle Angles and their mean values

Angles Value (Mean +/- SD)

Frankfort mandibular plane angle (FMA) 25 +/- 5.00

Frankfort mandibular incisor angle (FMIA) 65 +/- 5.00

Incisor mandibular plane angle (IMPA) 90 +/- 5.75

 z

LAWRENCE ANDREW (1937 - 2007)

 He was one of the first orthodontist to
emphasize on addressing both facial and
dental harmony from beginning of treatment
to achieve best facial form for each patient.
 He collected study models of 120 non-
treated individuals whose occlusion was
considered to be ideal by him and his peers.
 z

 He picked out the six consistent features related to the clinical

crowns, which were common to all the study models.
 He gave ‘Six keys to normal occlusion’ in 1972.

 The uniqueness of Andrews’ study was that the tooth

positions were referenced from clinically visible teeth crowns
more specifically, the labial and buccal surfaces of clinical
crowns and not from the long axis of the teeth, which can be
judged only from the radiographs.
Andrew
z Straight wire appliance/Pre adjusted edge wise
appliance (1979)
 The conventional edgewise brackets are identical for all the
teeth except some mesio - distal width differences. However,
different teeth have different relative prominences, angulations
and inclinations.
 Andrews rightly observed that the brackets should be designed
and affixed on the teeth such that their planes should reflect
the planes of the teeth crowns.
 He modified edgewise brackets with in-built tip, torque
angulations incorporated in their design. The bases of the
brackets were inclined (the angle of inclination precisely
matching the inclination of the facial plane of the respective
crown at the FA point).
 z

Angle’s Standard Edgewise Brackets Andrew’s Pre adjusted Edgewise

Brackets
Tip edge bracket –
z

 The Tip-Edge bracket was invented by Dr. P.C. Kesling

U.S.A. in 1988.
 He introduced differential tooth movement within a modified
Straight-Wire bracket system.
 The brackets of this appliance are made by removing the
diagonally opposed corners from Edward Angle’s edgewise
slot.
 This allows either mesial or distal tipping of a tooth.

 The appliance is also sometimes referred to as "Kesling the

slot".
z

Tip edge bracket

HISTORY
z
OF REMOVABLE
ORTHODONTIC APPLIANCES
 Removable orthodontic appliances are so-called because they
are designed to be fitted and removed by the patient

 The use of removable orthodontic appliances was always

more popular in Europe than the United States. There were 3
main reasons for this –

1. Angle’s dogmatic approach to occlusion, with its emphasis on

precise positioning of each tooth, had less impact in Europe
Than in United States
2. Social welfare systems that developed much rapidly in
Europe,
z which meant that emphasis tended to be on
widespread, if limited orthodontic treatment, often delivered
by general practitioners rather than orthodontic specialists

3. Precious metal for fixed appliances was less available in

Europe, both as consequence of social systems and because of
precious metals in dentistry was banned in Nazi Germany,
forcing german orthodontists to emphasise removable
appliances that could be made with available materials.

 Removable appliances, made of metal, ivory and, later,

vulcanite developed as soon as practitioners became capable
of taking reliable impressions, that began in 1840.
 z
 The range of malocclusions that can be treated with
removable appliance alone is limited, therefore, is often used
in conjunction with fixed mechanotherapy.

 The most familiar removable device is the retainer,

specifically the Hawley or Begg device. Its function,
however, is retention—keeping teeth in their place after the
desired tooth-movement has been achieved.
 z
VICTOR HUGO JACKSON

 He was the chief proponent of removable appliances in

USA.
 At that time, neither the modern plastics for base plate
material nor stainless steel wire clasp, springs were available.
 Appliances are fabricated with bases and precious metal or
nickel silver wires. In early 20th centuries.
 Designed Jackson clasp or U clasp.
 z
WALTER COFFIN
 Introduced Coffin spring in 1881.

 He embedded spring action piano wire

bent into shape of ‘W’ into vulcanite plate,
separated in middle, activated spring so
that halves presses alveolar process to
outside.
 This expansion appliance still bears its
name.
 z
GEORGE CROZAT
 In early 1900s, Crozat developed a
removable appliance fabricated
entirely of precious metal that is still
used occasionally.
 Crozat appliance consists of:

- Modified Jackson’s clasp or Crozat

clasp.
- Heavy gold wire framework.
- Lighter gold finger springs to produce
desired tooth movement.
PIERRE ROBIN
z

 In 1902 Pierre Robin introduced the

“Monobloc” named so since it was
made of a single block of vulcanite.
 Though it repositioned the mandible
forward it was originally designed to
prevent glossoptosis in
micromandible & cleft palate
patients (later known as Pierre-
Robin Syndrome), and not as a
functional appliance.
 It also reduced the risk obstruction
of airways
CHARLES
z HAWLEY
 He introduced the Hawley’s retainer
appliance in 1908.
 But in the next 3 decades these plates
were dominated by Angle’s fixed
appliances which dominated the
orthodontic world. Only the Hawley
retainer came to stay.

J.H. BADCOCK
 In 1911 J.H. Badcock introduced
expansion plate with screws.
A.M. zSCHWARZ
 He published a textbook in 1913 entirely devoted to treatment
with plates, where designs of different split plates with various
screws were shown.
 It was the book “Lehrgang der Gebissregulung‟ which became
the Orthodontic bible in Europe.
 He designed Schwarz clasp or Arrowhead clasp, but a special
plier was needed for fabrication
 z

CHARLES PHILLIPS ADAMS

 Designed Adam’s clasp in 1949.

 Adams clasp was seen as a development of

the Schwarz arrowhead clasp and was
introduced as the modified arrowhead
clasp.
 Adams was a lecturer in orthodontics at
Liverpool Dental School so the clasp has
also been referred to as the Liverpool
clasp and the term Universal clasp has
been used too.
 z
 The Adams clasp is predominantly used as a
retentive component in orthodontics but is also used
to retain appliances such as partial dentures,
obturators etc.
HISTORY
z
OF MYOFUNCTIONAL
APPLIANCES

 The term “Functional appliance” means that when the appliance

is fully seated in the mouth, the mandible is forced into an
eccentric/Non-ecentric relation position
 This results in force systems being exerted whenever the
appliance is mounted on the teeth or soft tissues of the mouth
 The scientific data were not available until the late 1960s
 z

 This early data consisted of animal experiments demonstrating

histologic and radiographic evidence of increased growth of the
condylar cartilage when the mandible was held in a forward
position
 Petrovic conducted rat studies that suggested the unique
characteristic of the condylar cartilage, including cell division
of the prechondroblast (as opposed to the chondroblast in
epiphyseal cartilage of its long bones) make this cartilage more
responsive
 z

 Investigators in the 1970s and 1980s conducted retrospective

clinical studies that demonstrated some average modest
increases in mandibular growth (2–4 mm per year) during
treatment with functional appliances.
 Also the variability of growth potential in response to
treatment was much greater for the mandible than for the
maxilla
NORMAN KINGSLEY (1879)
z
 Devised a vulcanite plate with anterior incline that guided
mandible to forward position

HOTZ
 Devised ‘Vorbissplate’ - modified form of kingsley plate

 Used to treat mandibular retrognathism associated with deep

bite
VIGGO
z
ANDRESEN (1908)

 Designed a loose filling appliance which he first used on his

daughter.
 He made a modified Hawley type of retainer on the maxillary
arch.
 On the mandibular teeth, he placed a lingual horseshoe flange
that guided the mandible forward about 3 to 4 mm in
occlusion.
 On his daughter’s return after 3 months, he was surprised to
see that night time wearing of the appliances had eliminated
her Class II malocclusion and it was stable.
 He called it a ‘Biomechanical working retainer.’
Andresen Biomechanical Working Retainer
 The original Andresen activator was a tooth-borne, loosely
z
fitting passive retainer 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.
 He modified his retainer into an orthodontic appliance, using
a wax bite to register the mandible in an advanced position
 Andresen moved to Norway and teamed up with Karl Haupl
and modified it. They called it - ‘Functional Jaw
Orthopaedics’
 As they were in Norway, they called it - ‘Nowegian
appliance’
 They later called it - ‘Activator’ due to its ability to activate
muscle forces
WILHEM
z
BALTER
 Developed Bionator in the early 1950s to increase patient’s
comfort and facilitate daytime wear to increase the functional use
of the appliance.

 He drastically reduced acrylic bulk of the appliance.

 Uses of Bionator - Standard bionator for Class I & Class II Div 1

- Class III or Reverse bionator

- Open bite bionator
- Deep Bite cases
Bionator
ROLF
z FRANKEL
 Designed Frankel appliance and was
introduced to orthodontics in 1966.
 This appliance was unique that it was
principally tissue-borne, mostly
supported in the vestibule rather than
supported by teeth.
 It has 2 main treatment effects –

- Serve as a template against which

craniofacial muscles function
- Removes muscle forces in labial &
buccal areas that restricts skeletal
growth
WILLIAM CLARKE (1977)
z

 Functional jaw orthopedic appliance was developed by

William Clarke in Scotland in 1977.
 It constists of maxillary and mandibular retainers that fit
tightly against the teeth, alveolus & adjacent supporting
structures.
 He used 45 degree angulation between upper & lower bite
planes.
 Delta clasps are used bilaterally to anchor the maxillary
appliance to the first permanent molars.
 0.030 inch ball clasps are placed in the interproximal areas
anteriorly.
Twin block appliance
 z
NEWELL
 Introduced Oral screen in (1912).

 It is composed of acrylic base material which fits in the

buccal/labial vestibule of the mouth.
 It can be either used to apply forces of circumoral musculature
to certain teeth or to relieve those forces from teeth thereby
allowing them to move due to forces exerted by tongue.
 Thus, vestibular screen works in principle of both force
application as well as force elimination.
 It can be used for various purposes like – Thumb sucking habit,
mouth breathing habit, lip biting, tongue thrusting etc.;
Oral screen
 ORTHODONTIC
z
MATERIALS – A
TIMELINE
Acrylic Resins
 Nelson Goodyear (1851) - Developed
‘Vulcanite’ - a vulcanized (cross-
linked) natural rubber product.

 Acrylic resins - Developed in the

1930s and by the 1940s, acrylic
materials were being polymerized into
plates. By 1946, 98% of all denture
bases were constructed of this
polymer or its copolymers. Today
acrylic is the most frequently used
material for retainers.
 z
Metallic Bands:

 Angle (1887) – Introduced ‘German silver’ in the United

States. It was actually copper, nickel, and zinc alloys that
contained no silver.
 During this period, gold, platinum, silver, steel, gum rubber,
vulcanite and occasionally, wood, ivory, zinc, and copper
were used as was brass in the form of loops, hooks, spurs,
and ligatures.
 z
 14 - 18 karat gold was routinely used for wires, bands,
clasps, ligatures, and spurs, as were iridium-platinum
bands and archwires and platinized gold for brackets.
 z

 By the early 1930s, stainless steels were generally available.

Yet, it was not until about 1960 that stainless steel was
generally accepted. By the 1960s, gold was universally
abandoned in favor of stainless steel .
 The force per unit activation of stainless steel was greater than
that of gold. By being smaller in size, stainless steel
appliances were regarded as being more esthetic than gold
appliances. Stainless steel also had excellent corrosion
resistance.
 z
END OF BANDING ERA -

 Before treatment, the orthodontist had to create enough space

around each tooth to accommodate the bands, and then those
spaces had to be closed at the end of treatment, when the
bands were removed. This was time-consuming for the and
uncomfortable for the patient. Banded appliances frequently
caused gingival trauma when fitted, and decalcification could
occur under the band.
 Buonocore (1955) - “Father of Adhesive Dentistry”-
Proposed the use of a 30-sec 85% phosphoric acid etch to
enhance bonding of acrylic materials to enamel surfaces.
 Dr George Newman(1960s) - An orthodontist in New Jersey,
pioneered
z the bonding of orthodontic brackets to enamel.

Orthodontic Wires:
 Until 1930’s the only orthodontic wires available were made of
Gold and their alloys primarily because nothing else would
tolerate intraoral environment.
 PR Begg(1940) - He partnered with A.J Wilcock, a metallurgist
to make the ultimate in resilient orthodontic wires - Australian
stainless steels.
 Cobalt–Chromium alloys or ‘Elgiloy’ - These were introduced
z
during the 1950s by the Elgiloy Corporation, USA. They were
originally used for watch springs. It was marketed as
ELGILOY by Rocky Mountain Orthodontics.
 It is manufactured in 4 tempers -
 z
 William R Buehler(1962) - Invented
‘Nitinol’ (Nickel Titanium Naval
Ordnance Laboratory) at Naval
Ordnance Laboratory. They were
introduced in orthodontics by Andersen
in 1970.

 C.J Burstone and Jon Goldberg(1977) -

Introduced Beta titanium. Sold as TMA
wire (Titanium Molybdenum Alloy) -
By Ormco Corporation
 M.FzTalass(1992) - Introduced Optiflex - a new Orthodontic
archwire, which is non metallic and has highly esthetic
appearance. Produced by Ormco Company, made of
transparent optical fiber, that is stain and fade resistant

 Dr. Rohit Sachdeva(1994) - Developed Copper NiTi, a new

quaternary alloy containing Nickel and titanium.
HISTORY
z OF CEPHALOMETRICS
 Cephalometric radiography was
introduced into orthodontics during the
1930s.
 Cephalometry had its beginning in
craniometry.
 Craniometry is defined in the Edinburgh
encyclopedia of 1813 as “the art of
measuring skulls of animals so as to
discover their specific differences”.
 Cephalometry is concerned with
measuring the head inclusive of soft
tissues, be it living or dead.
 z
 With the discovery of X-rays by Sir
Wilhem Roentgen in 1895, radiographic
cephalometry came into being.
 Cephalometry - It was defined as the
measurement of head from bony and soft
tissue landmarks on the radiographic
image (Krogman and Sassouni 1957).
 This approach combines the advantages
of craniometry and anthropometry.
 Disadvantage – It produces two-
dimensional image of a three-
dimensional structure.
 z
Van Loon - probably the first to introduce cephalometry to
orthodontics.
- Applied anthropometric procedures in analyzing facial growth
by making plaster casts of face into which he inserted oriented
casts of the dentition.
 z
AJ Pacini & Carrera - First X-ray picture of skull in the standard
lateral view.
 Pacini introduced a tele-roentgenographic technique for
standardized lateral head radiography.
 His method involved a large fixed distance from the X-ray
source to the cassette. The head of the subject, placed adjacent
to a standard holding the cassette, was immobilized with a
gauze bandage wrapped around both the face and the cassette
after the patient’s midsagittal plane was carefully oriented
parallel to the cassette.
 z

Paul Simon (1922) – First to propose the idea of diagnosing

dental deformities by means of planes and angles in his book -
“Fundamental principles of a systematic diagnosis of dental
anomalies”.

McCowen (1923) - Reported on profile roentgenograms that he

used for orthodontic purposes to visualize the relationship
between the hard and soft tissues and to note the changes in
profile which occur during treatment.
 B Holly
z Broadbent’s Contribution
 During 1920’s, Broadbent refined the Craniostat into
Craniometer by the addition of metric scales.
 This method eliminated practically all of the technical
difficulties encountered in previous methods of recording
dentofacial changes, and proved to be a convenient as well as
scientific method of measuring orthodontic procedures.
Broadbent’s Cephalometer –
z
 Two ear rods - rest on external
auditory meatus
 Orbital marker - indicates lowest
point on inferior border of left orbit
 Nose clamp - fixed at the root of the
nose to support the upper part of the
face.
 Focus - film distance - 5 feet (152.4
cm)
 Subject - film distance - could be
measured to calculate image
magnification
 z
Two X-ray tubes - right angles to each other in the same
horizontal plane : two images (lateral and postero-anterior) could
be simultaneously produced.
 z
Cephalometric Analysis -

 The major use of radiographic cephalometry is in

characterizing the patient’s dental and skeletal relationships
 This led to the development of a number of cephalometric
analyses to compare a patient to his or her peers, using
population standards.
 z

 William B Downs (1948) - Developed the first

cephalometric analysis.
It presented an objective method of portraying many factors
underlying malocclusion and there could be a variety of causes
of malocclusion other than teeth.
 This was followed by another analyses by Steiner (1953),
CH Tweed (1953), RM Ricketts (1958), V Sassouni (1969),
HD Enlow (1969), JR Jaraback (1970), Alex Jacobson
(1975) etc.
HISTORY OF FIXED APPLIANCES
z

 Edward Angle - E Arch appliance (1900)

- Pin & Tube appliance (1901)

- Ribbon Arch (1910)
- Edgewise System (1925)

 Raymond Begg – Modified Ribbon arch/Begg’s Appliance (1956)

 Lawrence Andrew – Pre adjusted edgewise/Straight wire appliance

(1979)
 Peter Kesling – Tip Edge appliance (1988)
 z
DR. ROBERT MURRAY RICKETTS (1920
– 2003)
 He developed the ‘Bioprogressive
therapy’in 1950s.
 Bioprogressive therapy was so named
because it progressively includes
particular groups of teeth into the
therapy (first the molars and the
incisors, followed by the canines and
the premolars) and treatment by the
application of the Visual Treatment
Objective (VTO) in planning treatment,
evaluating anchorage and monitoring
the results.
 z

 He introduced utility arch, Rickett’s Quad Helix made of 0.40

blue elgiloy wire and the use of preformed bands in
orthodontics.
THOMAS M. GRABER (1917 - 2007)
z
 He is known internationally as an
orthodontist, researcher, and dental
educator.
 He was a pioneer in orthodontics and
craniofacial biology.
 He wrote 28 books on orthodontics and
dental anatomy and contributed
chapters to 20 other books. He wrote
more than 175 scientific articles in
refereed dental and medical journals.
 From 1985 to 2000, he served as editor-
in-chief of the American Journal of
Orthodontics (AJO).
WILLIAM
z R. PROFFIT (1936 - 2018)
 On September 30, 2018, the orthodontic
speciality lost one of its most prolific
and esteemed contributors with sudden
death of Willian R. Proffit at age of 82.
 He began his research, clinical practice
and teaching career in 1960s.
 He was proud to be considered
orthodontics’ explainer in chief.
 He embraced jaw surgery in conjunction
with orthodontics as a way of correcting
those dentofacial deformities that could
not be corrected with orthodontics alone.
 z

 The enhancement of the Angle classification with the

development of the Ackerman-Proffit orthogonal analysis
provided a framework for surgeons to better communicate
with orthodontists in planning surgical treatment.
 Contemporary Orthodontics (W.R.Proffit, DDS,PhD, and
Henry W Fields, Jr, DDS, MS, MSD) has been translated to
12 languages, used in dental schools and orthodontic
departments worldwide and is the most comprehensive text
of current orthodontic knowledge.
 His publications include more than 200 scientific papers and
over 60 book chapters and 100 abstracts.
CHARLES BURSTONE (1928 -
z
2015)
 He is credited with introducing
newer materials in orthodontics like -
TMA, Chinese NiTi and Fibre
reinforced composite and
introducing newer approaches like
Holography & use of Occlusograms.
 Burstone also developed the surgical
planning analysis – COGS ie.
Cephalometrics for Orthognathic
Surgery.
 He also devised the segmented arch
technique .
RONALD ROTH (1976)
z
 In 1976 - Ronald Roth published a report entitled “Five year
clinical evaluation of the Andrews Straight Wire Appliance”.
 To avoid the difficulties of a multiple bracket system, Roth
recommended the 2nd generation of pre-adjusted brackets
(Roth Prescription).
 It consisted of minimum extraction series brackets and could
be used in both non-extraction and extraction cases.
McLAUGHLIN, BENNET & TREVESI (1998)
 They modified Andrews’s straight wire bracket system to
MBT bracket system in 1998. These third generation brackets
retained the best in original design but introduced range of
improvements and specifications to overcome the clinical
shortcomings.
 z
SELF LIGATING BRACKETS

 Self ligating brackets were introduced as an alternative to

conventional ligation.
 The first patent for a self-ligating attachment, the Boyd band
bracket, was filed by Charles Boyd in 1933. Production was
banned because it was expensive. This bracket was
reintroduced by his son William Ford in 1951.
 z

 The Edgelok bracket was the first self ligating bracket

designed to enjoy any sort of commercial success in 1971.
Another design was found in 1980’s called Mobil – Lock.
Both were passive brackets that achieved limited
acceptance in orthodontic community because of bulky
design.
 In the mid 1970’s an entirely new generation of self-
ligating appliance began, one that was active not passive,
G.H. Hanson’s - SPEED appliance was a revolutionary
step in orthodontic bracket design.
 z
 In 1986, the obsolete self ligating - Activa bracket designed
by E. Pletcher, also offered an alternative to passive ligation.
 In 1996, the Damon bracket was introduced, named the
Damon SL I. This design was passive and bulky, its
commercial life span was short.
 The Twinlock bracket was A.J. Wildman’s second endeavor,
after Edgelok bracket in 1998.
 In 1999, the Twin lock bracket was modified slightly and
renamed as Damon 2 bracket.
 In 2004 a passive, hybrid composite- metal bracket, the
Damon 3 bracket was found.
Self ligating bracket
LINGUAL ORTHODONTICS - KURZ & FUJITA
z

 Since the earliest fixed lingual orthodontic appliances

appeared in the mid- to late 1970s, in 1979, they were
initially released in the USA.
 The main concern for the introduction of lingual appliance
was esthetics.
 Dr. Craven Kurz who with co-workers developed the early
Kurz/Ormco lingual bracket system and over the same
period, significant development was made by Prof. Kinya
Fujita of Japan.
 z
 Dr Craven kruz’ first appliance consisted of plastic brackets
bonded to the lingual aspect of the anterior teeth and metal
brackets bonded to the lingual aspect of the posterior
dentition
 CERAMIC
z BRACKETS

 Ceramic braces entered orthodontics via an indirect route.

 Translucent polycrystalline alumina (TPA) was developed

by NASA (National Aeronautics and Space
Administration) and Ceradyne , a leader in advanced ceramics
for aerospace and industrial use.
 In 1986, a dental equipment and supply company contacted
Ceradyne for an aesthetic material to be used in orthodontics.
 He recommended TPA. Shortly after, in 1987, ceramic brackets
were introduced. In the same year, production of ceramic
braces reached 300,000 pieces a month.
 z
 Ceramic braces have progressed substantially since their first
introduction over 30 years ago.
 Ceramic braces can be more comfortable than metal because
they don’t irritate the inside of the mouth as much.
 CLEAR
z
ALIGNERS
 Align Technology developed the
Invisalign appliance for orthodontic
tooth movement in the USA in 1998.
 This appliance was the first
orthodontic treatment method to be
based solely on three-dimensional
(3D) digital technology.
 Through the use of computer programs
that can manipulate 3D images of
individual malocclusions, a series of
algorithmic stages is produced which
move the teeth in a series of precise
movements (0.15-0.25mm).
 Stereolithographic models are then constructed for each stage.
z
 Clear overlay appliances of 0.030-inch thickness are each worn
sequentially by the patient for between 1 to approximately 2
weeks. Because this appliance is clear and removable, it
provides an esthetic and hygienic appliance to correct
malocclusion.
TEMPORARY
z ANCHORAGE DEVICES (TADs) OR
MINI IMPLANTS

 Orthodontic TADs have become very popular in the

orthodontic practice for the treatment of complex
malocclusion.
 Creekmore et al. inserted these implants below the nasal
cavity in 1983, but it was not until 1997 that Kanomi
described a mini-implant specifically designed for
orthodontic use.
 z
 TADs can be used in orthodontic for the correction of
transverse, anteroposterior, and vertical discrepancies. TADs
have high success rates for orthodontic purposes.
 z
HISTORY OF EXTRACTIONS

 Extraction of one or more teeth is sometimes necessary to

establish normal functional occlusion, especially when jaws are
not large enough to accommodate all the teeth.
 The space gained by extraction is utilized to relieve crowding
or to retract the proclined anteriors.
 The increase in extractions that took place in the mid-1940s
was due, in large part, to the influence of Charles Tweed.
 Hezadvocated positioning the mandibular incisors upright over
basal bone (approximately 90° to the mandibular plane angle)
and argued that expansion of dental units off this bone led to
instability.
 Although John Hunter recognized the role of extraction as early
as 1771 in his book - ‘Natural history of the teeth’; it was not
until mid 20th century that extraction of teeth in conjunction
with orthodontic therapy became more acceptable.
 By the 1980s again, non-extraction became prevalent as
orthodontists began using new appliances and technologies to
increase arch length and width, making it easier to treat
crowded dentitions without extractions
 z

 Several other factors were responsible for this shift, including

some negative ones-
- Relapses (including the return of rotations and overbite) and
the
reopening of extraction spaces
- Gingival depressions at extraction sites
- The finding that extraction is no guarantee of stability
- Flattened lips gives ”aged” look
 HISTORY
z
OF DENTISTRY IN INDIA

DR. RAFIUDDIN AHMED (1890 - 1965)

 The first Indian dental surgeon was Dr.
Rafiuddin Ahmed also regarded as the
‘Father of Modern Dentistry’ in India.
 He graduated from the University of Iowa
School of Dentistry in the United States in
1915 with a doctorate in dental surgery.
 In 1920,
z Dr Ahmed founded the First Dental College of India as
well as of Asia which is currently known as ‘Dr. R. Ahmed
Dental College & Hospital’ in Calcutta.
 Dr Ahmed established the Bengal Dental Association, which
became the forerunner for the Indian Dental Association
(organized in 1928). He also established the Indian Dental
Journal in 1925 and was its Editor until 1946.
 HISTORY
z
OF ORTHODONTICS IN
INDIA

DR. HARIKRISHAN MERCHANT (1890

- 1955)
IOS president (1965 - 1967)

 The beginning of orthodontics in India was

made in 1935, as Dr HD Merchant gave
the first series of lectures in Orthodontics
at the Nair Hospital Dental College,
Bombay. He is considered to be the ‘The
Father of Indian Orthodontics’.
 z

 The first Department of Orthodontics was properly

established in 1939 in Nair Hospital Dental College under Dr
HD Merchant. Nair Dental College was the only institute in
India, where Orthodontics was taught as an independent
subject.
 Dr. H.D. Merchant was a founder member of IOS and the fist
President of IOS (1965–1967).
 He was the first Editor of the Journal of IOS in 1968 and
stayed editor for a long time.
 z

 He was not only the Founder Member of Indian Dental

Association but also was appointed as the President for three
tenures
 He was honored by Pierre Fauchard Academy as “Dentist of
the year 1976” for his outstanding contribution to Dental
Education in India, which was awarded for the 1st time in
India.
 His main area of expertise was removable mechanotherapy.
 z
Dr. PREM PRAKASH
IOS President (1967–1969)

 Dr. Prem Prakash graduated with a

BDS from De Montmorency Dental
College at Punjab University in Lahore
in 1947. He attained his MS in
Orthodontics from Tuft’s University,
USA, in 1950.
 He was the first orthodontist to start
exclusive orthodontic practice in India.
 z

 Dr. Prem Prakash attended the first course of Begg Technique

given by Dr Begg in 1953.
 In the 1960s he served as a guide for Begg’s method
throughout India.
 He had switched from edgewise to Begg practice earlier.
 z
DR. ASHOK BALWANT RAI MODI
IOS President (1969 to 1971)

 Dr AB Modi did his BDS in 1955 from

Nair Dental College, Mumbai, and DMD
in Orthodontics in Bonn University,
Germany in 1959.
 He worked alongside Dr. HD Merchant to
create the Nair Dental College and
Hospital's orthodontics department from
1960 to 1988, for 28 years.
 He was considered an authority in functional
z
appliances.
 He was appointed by many dental companies
as their advisor because of his thorough
knowledge about functioning of dental
equipments.

DR HS SHAIKH
IOS President (1971 to 1973)
 Dr Shaikh was trained under Dr Prem Prakash
during his post graduation course in 1961.
 He popularized Begg technique in India.
 z

DR NAISHAD PARIKH
IOS President (1973 to 1975)

 Nair Dental College awarded Dr. Naishad

Parikh BDS in 1955.
 The Indian Dental Association (IDA)
selected him in 1957 to be the first student to
complete an internship at Boston University
in the United States.
 DR. zKEKI MISTRY
IOS president (1975 TO 1978)

 Dr. Mistry is a founder member and first

elected President of the IOS.
 Due to his work with the WHO, Dr. Mistry
obtained his Masters in Public Health from
London University
 Oral Health Day, celebrated by WHO on
April 7 every year, was conceptualized by
him.
 z

DR. MOHANDAS BHAT

 He received his orthodontic training in US

 He was an eminent teacher who

introduced orthodontics in India and was
one of the founding members of IOS.
 INDIAN
z ORTHODONTIC
SOCIETY

 The Indian Orthodontic Society started as a Study Group in

Bombay, now Mumbai, way back in the year 1961.
 There were no office bearers, no fees, no constitution. Dr NH
Parikh called regular scientific meetings and there used to be
lectures.
 The IOS was formally established as the Indian Orthodontic
Society on Friday the 15th October 1965.
 z

 Dr. HD Merchant was the Founder President for 3

years and Dr Naishadh Parik, the Founder Secretary
and Treasurer for 8 years.
 The other Founder Members were Late Dr AB Modi,
Dr Keki Mistry, Dr Mohandas Bhat, Late Dr Prem
Prakash and Late Dr HS Shaikh.
 z
 The Indian Orthodontic Society held its first conference in
the year 1967 at New Delhi with a scientific session. The
Journal of the Indian Orthodontic Society was started by Dr
HD Merchant as the first Editor in 1968.

 IOS office was inaugurated at Vellore on December 4, 1998

by Dr BP Rajan under the presidentship of Dr Asha Verma.

 At its headquarters in Vellore, the IOS established a library

and the ‘First dental museum’ in India in 1998. The library
holds various books and journals donated by our eminent
doctors.
 ThezIndian Board of Orthodontics, first dental specialty to
establish a professional certifying board in India, was formed
and the first speciality board examination was conducted on
29th September 1999 at Bangalore, inaugurated by Dr T
Samraj.

 Objectives of IOS -

- To popularize and promote the study of Orthodontics

- To popularize and spread the practice of Orthodontics
- To educate the public of the importance of Orthodontics
 CONCLUSION-
z

 Orthodontics branch is an ever evolving field and

orthodontists are able to treat patients more efficiently ,
effectively and comfortably than ever before.
 Orthodontics has achieved the status of a recognized specialty
of dentistry because of a long period of craftsmanship and
professional expertise.
 A great deal of development is still going on pertaining to
aesthetics, at the same time maintaining the efficiency and
also shorter duration of treatment time.
 Indeed all of dentistry if it is to survive as a profession must
continually re-examine its history and find relevant and
significant ideals to meet the crisis of today.
REFERENCES
z

 Contemporary Orthodontics, 6e : South Asia Edition by William R.

Proffit, Henry W. Fields Jr. , Brent Larson, David M. Sarver
 History of Orthodontics - 1 January 2013 by Phulari

 Review Artice - 50 years of the Indian Orthodontic Society – Keki

Mistry : Journal of Indian Orthodontic Society | Vol 49 | Special
Issue | December, 2015
 International Journal of Current Advanced Research –
RESEARCH ARTICLE - ORTHODONTIC ARCHWIRES: PAST,
PRESENT AND FUTURE, Volume 09, Issue 05
 Review Article - Evolution of orthodontic appliances - Then and
now. International Journal of Dental and Health Sciences - Volume
05,Issue 02
z

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YOU