Biographical Account of DR - Angel - Ortho / Orthodontic Courses by Indian Dental Academy

Biographical account of
Dr. Angle
his life and contributions
to Orthodontics
www.indiandentalacademy.com
Edward Hartley Angle
(1855 1930)

regarded as the "Father of Modern
Orthodontics.

the most dominant, dynamic, and influential
figure in the specialty of orthodontics.

separated orthodontics from the other branches
of dentistry
Early life
born on June 1, 1855, in Herrick,
Pennsylvania.

He did not like school; nor did he care for
work around the farm.

derived his greatest pleasure from
roaming the hills and woods around his
home
fascinated by the crude machines that
were used in the farming community

showing an early flair for inventiveness, he
designed and built the horse-drawn hay
rake that was used on American farms for
many years afterward.

In Dentistry
to avoid the distasteful work of the farmer; he
apprenticed himself to a dentist.

Pennsylvania College of Dental Surgery (1876) -
DDS degree in 1878.

It was then that he started his first orthodontic
case, on his preceptors son.

1886- joined the faculty of the Dental Department
of the University of Minnesota.

1892 - Resigned from the University of Minnesota
- moved to Chicago - the first professor of
orthodontics at Northwestern University School of
Dentistry


1895 - moved to St. Louis, assuming the
same post first at Marion Sims College of
Medicine and shortly afterwards at
Washington University Dental School

1895 - MD degree from Marion Sims
College
Angles school

experiences in various schools led him to
the conviction that orthodontia could not
be properly taught in a dental college.

1900 - the first school of orthodontia The
Angle School of Orthodontia at St. Louis
The course of instruction

art (taught by artist Edmund Wuerpel),
rhinology,
embryology, histology,
comparative anatomy, dental anatomy,
Angles appliances.

the members organized the first orthodontic
society - "The Society of Orthodontists."

In 1935, the society adopted the name it bears
today: The American Association of
Orthodontists (AAO).

They also established the magazine, a quarterly
titled The American Orthodontist, which we read
today as the American Journal of Orthodontics

1903 - Dr. Anna Hopkins was elected the
Societys first secretary.

She completed one of the early Angle
courses, but was never to practice
orthodontia.

In 1906 she became Mrs. Edward Hartley
Angle.

Angles influence on his students was profound

his teaching methods were most unorthodox

he made men learn through a rigid system of discipline.

This covered every phase of their lives while they
were under him, from the preparation of their
assignments in theoretical subjects and the meticulous
execution of their technical procedures to the menial
housekeeping tasks of dusting and polishing their
working quarters and even to sweeping the floors.

His object was to light the fire of ambition in
order that the student would develop to his
highest potential.

His lectures often lasted 3 or more hours and
were gems that were never to be forgotten.

Philosophy, literature and science- became as
familiar to his students as the study of biology
and force control in orthodontia.

Angle felt that his students must have available the best
sources of information possible.

restricted his own private practice to the treatment of
malocclusion, thus becoming the first dental specialist.

He built up a faculty; among them were Milo Hellman,
Raymond Osborn, Frederick Noyes and Albin
Oppenheim.

From them, they learned of tissue tolerance, the
effect of mechanical forces on bone and tooth structure,
and the physiologic and anatomic development of the
dentofacial complex.

1907 - moved his school to New York City.

1908 - found the school in New London,
Connecticut.

1909 - the graduates of the New York and New
London schools organized the Eastern
Association of Graduates of the Angle School of
Orthodontia

1913 - the students of Angle practicing on the
Pacific coast formed the Pacific Coast Society of
Graduates of the Angle School.
ill health forced Angle to leave the East Coast

1916 - Dr. and Mrs. Angle settled in Pasadena

Angle determined to devote his time to study, invention,
and experimentation and relaxation.

One room in the home was set up as a workshop, and it
was here that Angle was his happiest tinkering,
improving, and creating some of the instruments for
which he held 32 patents.
New school
In 1917, a young dentist James Angle who had
once studied under the master appeared at the
door of the Angle home.

He spread the news of Angles experience, and
soon others applied for training

Thus did the 62-year-old Angle once again, and
for the last time, take up teaching.

No clinical facilities were available, and the
little workshop served as a classroom.

Spencer Atkinson, George Hahn and Cecil
Steiner were students of this school.
School at Pasadena, CF

In June 1922, the members of this school
founded a formal association : The Edward H.
Angle Society of Orthodontia (commonly called
the Angle Society).

The meeting of this society in New London in
1928 was the last meeting that Angle ever
attended.


Prior to admission, student was thoroughly grilled
in the basic sciences, either by Dr. Angle or one
of his staff.

The applicant was expected to know the
anatomy, embryology and histology of the head
and neck (exclusive of the brain), the growth,
development, and functioning of the denture

He also expected the applicant to be reasonably
familiar with history, general science, and
English literature
Filing, soldering, and wire bending had to
be mastered before the student was
permitted to do any appliance
manipulation.

Only after surviving the rigors of discipline,
theory, technique, and case analysis, the
student was allowed admission to the
clinic.

They had no acrylics, no alginates, no light wires,
no model trimmers and no preformed bands.

Impressions were taken in plaster and, because
undercuts prevented removing the stony mass in
one piece, the operator was obliged to score the
material and pry it off, piece by piece.

The poured impression was later trimmed by
hand with a plane, a saw, or a huge file.
Angle tried to introduce licensure bill (license
orthodontists separately from dentists)

but was unsuccessful in getting his licensure bill
to pass the California legislature.

He did, however, live to see a similar bill,
introduced by Charles Tweed, become law in
Arizona. (The law was repealed six years later.)
The mechanical genius
Filed 32 patents

the American Society of Orthodontists,
under the presidency of Rodriguez
Ottolengui, passed a resolution
condemning such patents.

Angle, Anna Hopkins Angle, and a number
of Angle disciples resigned
Angles Patented Orthodontic
Devices
First patent - 1889 - Push type jackscrew
for increasing width
1895 Angle patents
A lingual arch soldered to bands that are
cemented on teeth; forcing teeth outward
and forward
special plier pinched the wire increasing its
length
1899 - the E (expansion) arch
appliance
arch wire with threaded ends, extended in
the tube of an anchor molar band

nut is provided with a threadless extension
that works with a friction sleeve to hold the
adjustment

According to the nuts position, the teeth
could be moved either distally or mesially.

the banded teeth were attached to the
arch with the help of a soft wire that
allowed their tipping or aligning.
1901 patent - ribbed arch to
prevent the sliding of ligatures
A ribbed arch to prevent the sliding of
ligatures which could occur in E-arch
1899 patent, clamp band
with long buccal tube

solved the problem caused by the
bulky adjustable clamp band by
Replacing it with molar band which is
streamlined and formed in such a way that
the band is thick where the tube is
soldered on the buccal, but the band is
thin on the lingual ends
1903 patent
both arches connected by elastic traction
modified Kingsley headgear bow and
extraoral force potential, if needed.
1911 patent
detachable arch bar, with a
vertical 90 bent end inserted in a vertical
tube
1912 - pin and tube appliance
soldered vertical pins on arch wire that insert in
vertical tubes soldered to individual bands

Pins are resoldered each time as needed
as the arch wire is straightened out toward
the ideal arch configuration

In 1912
option to add coil springs, held in place by
pins, similar to those
used later in the ribbon arch (and Begg)
appliances.
1915 patent
ribbon arch bracket with retaining pin.
The band wall approximates the inner
surface of the ribbon arch
advanced version with the arch wire wholly
contained within the ribbon arch bracket;
precursor of the Begg bracket
1926 - edgewise bracket

the rectangular wire was inserted in a
horizontal slot in the edgewise position
and kept there with the help of ligature
wires tied around the tie wings.
allows tooth movement in all 3 planes with
the help of a single wire
Dr. Begg cut the first bracket on lathe.

1926 - streamlined edgewise bracket -
soldered eyelets on mesial and distal to
control rotations, paving the way to the
twin brackets (Siamese brackets) of today
Angles last patent

belatedly filed almost 3 years after his
death by his wife

The highly popular Broussard bracket of
the 60s and 70s was based on this patent.
Other contributions
concern about the biological response to
foreign bodies used in oral environment.

reflected in many of his patents in which
he has constantly tried to cover all
possibilities for adverse use or unfavorable
reaction.


Angle made an inventory of the available
materials - gold, silver, platinum, platinous
silver, iridio-platinum, platinoid, aluminum,
brass, copper, aluminum bronze, steel,
iron and vulcanized rubber.

he found that the material most fitting was
nickel silver, a brass (copper-zinc alloy)
that did not have any silver in it at all!
He was largely self-taught, and yet he mastered
complex metallurgy.

in one of his publications, he explains that
pinching the arch
not only spreads the particles of metal,
so as to increase the length of the rod, but
tempers the part subjected to the pinching
action, thereby largely compensating for the
reduction in the area of the rod section at that
point, and consequently maintaining the strength
and rigidity of the rod under the longitudinal
strain thereon.

His knowledge of noble metals is
witnessed also by his use of gold and of
platinum-iridium arches in orthodontics.

He was the first to use coil springs. But he
connected them only to nobler metal
arches
1887 - introduction in orthodontics of both
soldering and a baser alloy which
contained
60% to 70% copper
10% to 20% zinc
10% to 15% nickel
Publications & Presentations
First scientific paper- "Irregularities of the Teeth" -at the
ninth International Medical Congress.

Considered as the first edition of his textbook which was
to go through seven editions

The seven editions of Angles book were published
under the following titles

Irregularities of the Teeth, 1887
A System of Appliances for Correcting Irregularities of
the Teeth, 1890
The Angle system of Regulating and Retention of the
Teeth, 1892

The Angle system of Regulation and Retention of the
Teeth- With an Addition of Treatment of Fractures of the
Maxillae, 1895

Angle system of Regulation and Retention of the Teeth
and Treatment of Fractures of the Maxillae, 1899

Malocclusion of the Teeth and Fractures of the Maxillae,
1900

Treatment of Malocclusion of the Teeth, 1907

1899 - The Classification of
Malocclusion in the Dental Cosmos

His classification provided an intelligent
and easily understood means of
communication among members of the
dental profession.
Angle believed the maxillary first molars were the
key to occlusion

The anterior-posterior position of the maxillary
permanent first molars is relatively immutable

considered the upper first molar as the most
reliable point of reference from which to compare
other teeth

the eruption pattern of the maxillary permanent
first molars causes them to assume a normal
position.

Subsequent investigations have shown that the
A-P position of the permanent first molar is not
constant in relation to the base of the skull.

Though Angle postulated tooth movements in
three planes, the main focus of his classification
was in one plane (sagittal)
krogman
Angle - the environmentalist
Individual variation from structurofunctional
harmony was due to faulty environment

A Class II Div. 1 malocclusion can be viewed
as basically due to an underdeveloped mandible
- in turn due to an environmental failure

So treatment must also be environmental,
aiming at restoring normal function, to make up
for an unachieved normal mandibular growth.

Angle was aware of the fact that the
orthodontic tooth movement involved a
feedback situation in which tooth and bone
reacted reciprocally.

Angle influenced by Julius Wolff -
Wolffs law of bone bone trabeculae
arranged in response to stress lines on the
bone.

Angle had an uncompromising position against
extraction.

It was his credo that "the best balance, the best
harmony, the best proportions of the mouth in its
relation to the other features require that there
shall be a full complement of teeth, and that
each tooth shall be made to occupy its normal
position i.e., normal occlusion."
CASE/ANGLE CONTROVERSY
Originally, Case was a genuine admirer of
Angle.

Angle attributed the origin of the use of
intermaxillary elastics to Baker, while Case
thought that he should have received that credit.

This led to charges and countercharges
between them in 1903.

The second point of contentionthe
question of the extraction of certain teeth
as a means of treatment.

Case defended the discreet use of
extraction as a practical procedure, while
Angle believed in nonextraction.

The climax of this conflict was a debate in
1911 at the annual meeting of the National
Dental Association

the problem became a matter of calm and
objective evaluation and respectful
appreciation of various points of view, each
of which has made its contribution to
orthodontics.
On August 11, 1930 Angle died at his summer
home in Santa Monica

On November 17, 1930, 22 members of Angle
Society of Orthodontia met in Chicago, with the
purpose of carrying forward Dr. Angles ideals of
orthodontia.

They decided to reorganize the society, and
decided to begin the publication of the Angle
Orthodontist.
Criticisms by Bernstein

Angle favored / did extraction treatment before
1900.

In Angle's sixth edition textbook, extraction
treatments are shown and discussed

Angle changed his position to non-extraction
due to the controversy with Calvin Case who did
advocate extractions

Theodore Adler

Angle changed to nonextraction after
1900 because of :
- introduction of intermaxillary elastics
- and his invention of e-arch appliance

criticisms

Dr. Angle did great harm to many persons, and to
orthodontics, at the same time he was making his many
contributions.
Bernstein

By all accounts Angle was a difficult man. He is reputed
to have harbored much of the bigotry and some of the
xenophobia of his time.

Theodore Adler

"He did not like the Germans. He was
broadminded but he had prejudices.

"He lost many friends, or at least he alienated
them.

"If people had heard the terms he used in regard
to them he would have had still more enemies."

Wuerpel

Angle "could never take criticism or
argument".

When his ideas were verbally attacked, he
would call his attackers "fools.

Frederick Noyes


"E.H.A. was obviously a disturbed man, and his
image has been built up, far beyond what he
deserved"

"approach became a classic example of cultism
and dogma."

"Case was more successful as a contemporary
leader than Angle. Case was on the inside
leading while Angle was the maverick. He
resented Calvin Case.
Tom Graber


"So I turned to the first special course then being
offered. Unfortunately, being a resident of St.
Louis, where the course was then given, I was
asked to sign a contract to locate elsewhere on
completion of the instruction. Angle added: 'You
know, Lischer, I can pick the flowers in my
garden myself.
Lischer
Angle possessed many of the personality
qualities seen in geniuses. They can be
difficult, demanding, and unforgiving. They
tend to be so devoted to their field that
they fail to develop other aspects of their
lives. Angle seems to fit that category.

Robert Rubin

Angle's dedication to orthodontics

it (orthodontics) was his religion and his
god. He would sacrifice everything for its
sake. He could only see his life and his
work and his devotion in terms of
orthodontia.

Wuerpel

Conclusion

Though Angle died 1930, his influence is
still felt strongly in orthodontics.

Even his enemies recognized the many
contributions made by Edward Hartley
Angle.


His pioneer efforts in orthodontic education, his
contribution to orthodontic literature, and his
developments of innumerable instruments and
appliances are not the accomplishments for
which he will be remembered.

Long after these have faded into history, Angles
name will be associated with the onward march
of biologic science and it will be realized how
perceptive was the mind that could penetrate the
empiricism of his day and proclaim the
significance of normal occlusion.


This established orthodontia as a science
and it will remain Angles greatest
monument.

Characteristic of the man was a remark
made shortly before he died: I have
finished my work. It is as perfect as I can
make it.

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