In introductory remarks at an orthodontic lecture delivered March 1, 1965, in Virginia, Charles H. Tweed ( Fig 1 ) claimed that the most fundamental paragraph ever written in any orthodontic text could be found in the seventh edition of Angle’s Treatment of Malocclusions of the Teeth .
The study of orthodontia is indissolubly connected with that of art as related to the human face. The mouth is a most potent factor in making or marring the beauty and character of the face, and the form and beauty of the mouth largely depend on the occlusal relations of the teeth. Our duties, as orthodontists, force upon us great responsibilities, and there is nothing in which the student of orthodontia should be more keenly interested than in art generally, and especially in its relation to the human face, for each of his efforts, whether he realizes or not, makes for beauty or ugliness, for harmony or disharmony, or for perfection or deformity of the face. Hence, it should be one of his life studies.
Tweed went on to say that for more than 6 years he practiced and advocated that philosophy of orthodontic treatment, which demanded a full complement of teeth. Then, late in 1934, frustrated by his ability to create facial balance in only a few of his patients, he began to analyze his practice results. For the next 4 years, he spent half of his time analyzing the dental casts, photographs, and x-rays of the patients he had treated up to that time. He classified the patient photos into 2 groups: those with balance and harmony of facial proportions, and those that lacked these qualities.
“In virtually every instance,” he said, “those patients possessing balance and harmony of facial proportions had mandibular incisors that were upright over basal bone. The faces that lacked these attributes of facial proportion had teeth that were too prominent and the mandibular incisors were not upright and over basal bone. It must be noted that the lack of harmony in facial contour is in direct proportion to the extent to which the denture has been displaced mesially into protrusion.” He observed that he had successfully obtained all 4 orthodontic objectives in only 20% of his patients and lamented that “These harsh facts all but made me give up the practice of orthodontics.”
Tweed’s contributions to the specialty of orthodontics are legendary. He made a lasting and undeniable impact on the specialty. His letters, lectures, articles, and 2-volume textbook established a foundation in orthodontic thought and treatment that continues to be used today. Essentially, Tweed brought the specialty from the period of simply “straightening” teeth to a concern for the best balance and harmony of facial lines, the stability of the dentition after treatment, a healthy periodontium, and an efficient chewing mechanism. He emphasized these 4 objectives of orthodontic treatment in all that he did. He made the extraction of teeth for correction of a malocclusion acceptable. He started orthodontics on a path of correcting bialveolar protrusions—not creating them. He enhanced the clinical applications of cephalometrics as he developed the diagnostic facial triangle. Tweed’s diagnostic triangle, which defines the anterior limit of the denture, is, in Tweed’s words, “my greatest contribution to orthodontics.” Tweed’s other great contribution was the concept of anchorage preparation. At the end of his years, he developed a sound and consistent preorthodontic guidance program that used serial extractions of deciduous and permanent teeth to achieve the desired end results.
One can ask how did one man do all these things? How did all of it happen? Therein lies an interesting story. Valuable sources of information are Tweed’s many letters that are housed at the Charles Tweed International Foundation in Tucson, Arizona. On the pages that follow, I hope the reader will obtain some insight into Charles Tweed and understand “the rest of his story.”
The edgewise appliance—beginnings
The edgewise appliance was the last in a long line of inventions by Edward H. Angle. Angle decided that since a tooth could only be moved in 3 planes of space, all the necessary forces could be incorporated into the archwire. With that thought in his mind, he designed the edgewise appliance and decided that an article describing the appliance must be published. He chose the journal Dental Cosmos . Because Tweed had just finished the Angle course and because Angle admired and respected Tweed’s abilities, Angle asked Tweed and Glen Terwilliger to help with the article. For 7 weeks, they worked together and, in the process, became close friends. It was during this time that Angle advised Tweed that he (Tweed) could never master the edgewise appliance unless he limited his practice solely to its use. After completing the article for Dental Cosmos , Charles Tweed returned to Arizona and established in Phoenix what might have been the first edgewise specialty practice in the United States.
For the next 2 years, the 2 men worked together closely. Tweed made progress records of his patients every 4 months and took the records by train to Pasadena, California, where Angle studied them and outlined a treatment plan for the next 4 months. Angle was pleased with Tweed’s results, and he was instrumental in getting Tweed invited to lecture at several orthodontic meetings. During these 2 years, in more than 100 letters now housed in the Tweed Memorial Center library, Angle urged his young disciple to carry out 2 vital requests: (1) make every effort to establish orthodontics as a specialty within the dental profession, and (2) dedicate his life to the development of the edgewise appliance.
The Arizona specialty law
Tweed’s work toward the accomplishment of Angle’s first request is outlined in excerpts taken from a letter that he wrote in 1948 to Dr Whitmarsh, in response to Whitmarsh’s request for information about the Arizona specialty law.
In 1929, after surveying the curricula of all the schools of the United States, I was convinced that orthodontia was being held in bondage by dentistry. The reasons for this belief were that the University of California, from which I graduated in 1919, devoted 11 hours to orthodontics, and any clinical experience was optional. I found the same situation prevalent in virtually all the dental colleges in the U.S. The average time devoted to orthodontics, if my memory serves me correctly, varied from no hours to approximately 235 hours. And yet our dental laws allowed us to take a dental examination and with little or no orthodontic training we were allowed to designate ourselves as specialists in orthodontia. This, of course, is most unfair, and I made an endeavor in 1929 to correct this condition in my state.
I visited 95% of all of the dentists in the state of Arizona, traveling 5,000 miles, to interview them personally, with a copy of the bill that was proposed. I acted as a lobbyist; addressed various PTA’s; interviewed the House and Senate of the State Legislature; and finally succeeded in having the first specialty law of its kind passed in these United States for my state of Arizona.
Upon the passage of the law, any man taking the dental examination in Arizona after 1929 would be licensed as a dentist and could not practice orthodontia. Any orthodontist passing the orthodontic examination would be licensed as an orthodontist and could not practice dentistry. Those who wished to practice both dentistry and orthodontia would be required to pass the examinations of both the Dental and Orthodontic Boards.
In a class previous to the last class that Dr. Angle gave was enrolled Dr. Steven (Allen G.) Brodie, now Dean of the University of Illinois Dental School. There was an understanding between the three of us that Dr. Brodie would endeavor to develop a course which would fulfill the legal requirements necessary to comply with our proposed new law here in Arizona; and I was designated to crack the ice and have the first law passed. At a later date the University of California, under Guy S. Milberry, Dean of the Dental School, instituted training in that institution whereby dentists who wished to practice orthodontia would take their minimum requirements in prosthetics and utilize the greatest part of their time in clinical orthodontics. This was an effort on the part of Dr. Milberry to fulfill the requirements made necessary by laws such as were passed by Arizona in 1929.
Oh yes! The aftermath of this legislative attempt in behalf of orthodontia was the cold treatment applied to the ‘energetic crusader’ by the dental profession of Phoenix. So effective was the treatment that yours truly had to leave the community of his birth and open his practice here in Tucson. However, great fun was had by all of us in this “joust.” Having been responsible for the passage of this much needed legislation and observing the great pleasure of my benefactor, Dr. Angle, on its passage, was certainly sufficient reward for the efforts put forth for its enactment. My kindest regards to you.
As a “reward” for Tweed’s efforts to get a specialty law passed in Arizona, Angle gave him a diploma from the Angle School. Tweed had no Angle School diploma because he and his 4 classmates had attended an improvised Angle school course given by George Hahn and other Angle School graduates. Angle had accepted Tweed’s class, but subsequently closed his school and traveled to Hawaii. He returned while the class was in session and gave several lectures. Tweed’s class was the last of the Angle School.
The Arizona specialty law
Tweed’s work toward the accomplishment of Angle’s first request is outlined in excerpts taken from a letter that he wrote in 1948 to Dr Whitmarsh, in response to Whitmarsh’s request for information about the Arizona specialty law.
In 1929, after surveying the curricula of all the schools of the United States, I was convinced that orthodontia was being held in bondage by dentistry. The reasons for this belief were that the University of California, from which I graduated in 1919, devoted 11 hours to orthodontics, and any clinical experience was optional. I found the same situation prevalent in virtually all the dental colleges in the U.S. The average time devoted to orthodontics, if my memory serves me correctly, varied from no hours to approximately 235 hours. And yet our dental laws allowed us to take a dental examination and with little or no orthodontic training we were allowed to designate ourselves as specialists in orthodontia. This, of course, is most unfair, and I made an endeavor in 1929 to correct this condition in my state.
I visited 95% of all of the dentists in the state of Arizona, traveling 5,000 miles, to interview them personally, with a copy of the bill that was proposed. I acted as a lobbyist; addressed various PTA’s; interviewed the House and Senate of the State Legislature; and finally succeeded in having the first specialty law of its kind passed in these United States for my state of Arizona.
Upon the passage of the law, any man taking the dental examination in Arizona after 1929 would be licensed as a dentist and could not practice orthodontia. Any orthodontist passing the orthodontic examination would be licensed as an orthodontist and could not practice dentistry. Those who wished to practice both dentistry and orthodontia would be required to pass the examinations of both the Dental and Orthodontic Boards.
In a class previous to the last class that Dr. Angle gave was enrolled Dr. Steven (Allen G.) Brodie, now Dean of the University of Illinois Dental School. There was an understanding between the three of us that Dr. Brodie would endeavor to develop a course which would fulfill the legal requirements necessary to comply with our proposed new law here in Arizona; and I was designated to crack the ice and have the first law passed. At a later date the University of California, under Guy S. Milberry, Dean of the Dental School, instituted training in that institution whereby dentists who wished to practice orthodontia would take their minimum requirements in prosthetics and utilize the greatest part of their time in clinical orthodontics. This was an effort on the part of Dr. Milberry to fulfill the requirements made necessary by laws such as were passed by Arizona in 1929.
Oh yes! The aftermath of this legislative attempt in behalf of orthodontia was the cold treatment applied to the ‘energetic crusader’ by the dental profession of Phoenix. So effective was the treatment that yours truly had to leave the community of his birth and open his practice here in Tucson. However, great fun was had by all of us in this “joust.” Having been responsible for the passage of this much needed legislation and observing the great pleasure of my benefactor, Dr. Angle, on its passage, was certainly sufficient reward for the efforts put forth for its enactment. My kindest regards to you.
As a “reward” for Tweed’s efforts to get a specialty law passed in Arizona, Angle gave him a diploma from the Angle School. Tweed had no Angle School diploma because he and his 4 classmates had attended an improvised Angle school course given by George Hahn and other Angle School graduates. Angle had accepted Tweed’s class, but subsequently closed his school and traveled to Hawaii. He returned while the class was in session and gave several lectures. Tweed’s class was the last of the Angle School.
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