Irregular teeth have been found in the skulls of Neanderthal men who existed about 50,000 BC: ancient Greek and Etruscan artefacts revealed designed devices/appliances to exert pressure on teeth. Archaeologists have discovered Egyptian mummies with crude metal bands wrapped around individual teeth. It is speculated that catgut was used to close the gaps ( Fig. 1.1 B).

The W spring made of piano wire by Walter Harris Coffin (1881).

Source: Wahl N. Orthodontics in 3 millennia. Chapter 2 : entering the modern era. Am J Orthod Dentofacial Orthop. 2005 Apr;127(4):510–5.

Hippocrates era, 400 BC to 16th century. Ancient Greek physicians mentioned dental irregularities as early as 400 BC. Celsus (Rome, 25 BC–AD 50) advised the removal of deciduous teeth once the permanent teeth have erupted, and treatment of crooked or irregular teeth could be attempted by pressure exerted by the finger. He stated, ‘If a second tooth should happen to grow in children before the first has fallen out, that ought to be shed is to be drawn out, and the new one daily pushed toward its place by means of the finger until it arrives at its just proportion’.

Early years of AD. In all probability, Pliny the Elder was the first to use (AD 23–79) mechanical treatment to align irregular teeth by filing the elongated teeth. Galen (AD 129–199) suggested the treatment of irregular teeth by the filing of the teeth to gain space. Fabricius (1619) suggested the extraction of teeth in case of crowding. Following years saw an evolution in the dental profession in France, where dental surgeons could undergo formal training and practice correcting dental irregularities.

Before the 1830s, there was no formal professional education or a dental degree in the United States. The physicians, barbers or charlatans performed the work and procedures in the mouth. The literature had few contributions from American authors related to orthodontics until 1880, and the term ‘Malocclusion’ was not known.

During the mid-19th century, significant developments took place, which evolved the dental profession through formal education and training. In 1839, the American Journal of Dental Science, the world’s first dental journal, began publication. A year later, the world’s first dental school, the Baltimore College of Dental Surgery, was founded. The first formal dental degree, Doctor of Dental Surgery (DDS) degree, was awarded from Baltimore.

It is at Baltimore College of Surgery that the first lectures on ‘irregularities’ of the teeth were given to undergraduates by Chapin Harris. Norman Kingsley, who is considered as ‘Father of Orthodontia in the United States’, lectured students on the causes and correction of malocclusion (1872).

Before 1910, orthodontics was taught as a branch of prosthetics, the techniques for the correction of irregular teeth with little or no emphasis on science.

• Norman William Kingsley (1866). Dr Kingsley suggested prosthetic treatment of cleft lip and palate and introduced an extraoral traction device. His student, Walter Harris Coffin, in 1881 ( Fig. 2.1 ), found an innovative method for regulating irregular teeth using a bent W spring made of piano wire embedded on both sides into the palatal vulcanite, which was later replaced by acrylic. The spring is free to expand in the middle of the palate, thereby causing the maxilla’s expansion by moving the two sides of the maxillary alveolar process. ^,

• John Nutting Farrar (1839 – 1913). Dr Farrar authored a text on orthodontics, ‘Irregularities of the Teeth and Their Treatment’, first in 1888, which went through six editions: and more than 90 articles on gingival pathologies and irregularities of the teeth. Farrar opined that forces for moving the teeth should not be continuous and suggested the theory of intermittent force. He developed a screw to deliver this kind of force in controlled increments by activating the device ‘about 1/240 inch every morning, and the same in the evening’. Around the same years, Dr George B. Crozat (1893–1966) developed a universal wire device, which is more popularly known as Crozat appliance and Crozat retainer ( Fig. 2.2 ; Tables 2.1–2.3 ) .

  TABLE 2.1

  Origin and worldwide contributions in orthodontics from 400 BC to 19th century

  Years	Events
  400 BC	Hippocrates era: Dental irregularities mentioned for the first time.
  25 BC–AD 50	Celsus was first to recommend the removal of milk teeth once the permanent teeth have erupted. He suggested finger pressure to be used for straightening of crooked or irregular teeth.
  129–199	Galen suggested treatment of the irregular teeth by the filing of the teeth to gain space.
  1619	Fabricius suggested extraction of teeth in case of crowding.
  1678–1761	Pierre Fauchard was the first to introduce the ‘brace’ or the ‘bandeau’, the forerunner of Angle’s E Arch appliance. A bandeau was used as a firm device around the dental arch to which irregular teeth were tied using waxed linen or silk threads.
  1713–1766	Phillip Pfaff, a surgeon dentist, for the first time described taking the impression with sealing wax.
  1728–1793	John Hunter, a British surgeon and inspector general of hospitals, had keen interest in dental and orthodontic works. In contrast to the prevailing belief, he reported that milk teeth have roots. He was also the first to investigate the growth of mandible in animals.
  1771	Adam Anton Brunner was the first to use an inclined plane in 1771. However, it was L. J. Catalan who propagated an inclined plane around 1808 as his contribution.
  1836	Friedrich Christoph Kneisel, a German dentist, was the first to use plaster models to reproduce dental structures in physical form to record malocclusion. He used chin straps for correction of the prognathic mandible and hence, became the first dentist to have used a removable appliance.
  1841	Joachim Lefoulon, in his book Nouveau traité théorique et practique de l’art du dentiste , used the term ‘orthodontosie’ which translates to ‘orthodontia’. He used elastic properties of the gold wire by placing it on palatal sides in attempt to align crowed teeth.
  	M. Alexis Schangé described an adaptable band clamp fixed to the tooth using a screw. He is also perhaps the first one to realise and suggest that active orthodontic treatment should be followed by a period of retention.
  1842	Georg Carabelli was first to present a novel method of classifying types of occlusion.
  1846	The elastic properties of rubber straps for applications in orthodontic treatment was first explored and demonstrated by Claude Lachaise and Elisha Gustavus Tucker.
  1859	John Tomes was the first to show remodelling processes in the alveolar bone.
  1872	Norman Kingsley is considered the ‘Father of Orthodontia in the United States’. He lectured on the causes and correction of malocclusion (orthodontics) at Baltimore College of Dental Surgery, Maryland, United States.
  1878–1930	Edward H. Angle’s contributions are numerous and listed in Table 2.4 .
  1881	Walter Harris Coffin found an innovative method for the regulation of irregular teeth using a bent W spring made of piano wire embedded on both sides into vulcanite, later replaced by acrylic.
  1888	John Nutting Farrar wrote on irregularities of the teeth and their treatment.
  1890	Intermaxillary elastics were proposed by Dr Case and Dr Baker. However, it became popular as Baker’s anchorage.

‘It is well known that Dr Edward H. Angle is the Nestor of orthodontia. To him, more than to any other individual is this science indebted. His life has been spent nursing and developing it’, said Peck Sheldon, one of his disciples.

Much has been written about him in the book ‘The World of Edward Hartley Angle, MD, DDS: His Letters, Accounts and Patents’ and in a series of special articles in Angle Orthod in 2009.

‘No personality central to the history of orthodontics stimulated as much progress, excitement, and polarity as Edward Hartley Angle, MD, DDS (1855–1930), the acknowledged founder of this clinical speciality. Early in the 20th century, he dominated the emergence of orthodontia as a science and a speciality. This inventive doctor gave malocclusion the primacy and order it needed’.

Edward Hartley Angle spent his boyhood on his parent’s farm in District, ‘Ballibay’, Herrick Township, Bradford County, Pennsylvania. His mother Isabel, in the year 1874, introduced HART (Angle’s nickname) at the age of 18 years to a nearby dentist to learn dentistry as an office apprentice. Later, Angle enrolled at the College of Dental Surgery in Philadelphia for the DDS programme. The DDS programme was then arranged in two 6-month terms spaced over a nominal two years.

In 1878, Edward Angle initiated his profession by setting up a general dentistry practice in the centre of town at Bradford County seat, Towanda. In 1881, his health deteriorated, and he decided to abandon dentistry on his physician’s advice to live in an outdoor environment. Angle moved to live in Minneapolis, Minnesota, where his health improved. While Angle contemplated abandoning dentist ry to avoid the physically demanding dental profession, he set up a lucrative sheep-raising business in Montana with his friends and brother. Unfortunately, a record-breaking deep freeze that year killed off the entire herd, and he lost all his savings.

By mid-1882, he moved back to practise again. His curiosity, attention and indulgence in ‘regulating’ the ‘irregular teeth’ continued to flourish. The breaking point in his career was his announcement that he would practise orthodontia and no other forms of dental treatment or therapy. ‘With this decision, he became the first acknowledged exclusive specialist in orthodontics in the world’.

Dr Angle was lecturing orthodontics in several schools. In 1886, 31-year-old Edward Angle was appointed as professor of histology and lecturer on comparative anatomy and orthodontia at Minnesota Hospital College in Minneapolis.

In 1887, Angle was the youngest of the speakers at the Ninth International Medical Congress in Washington, DC on ‘Dental and Oral Surgery’. His talk titled Notes on Orthodontia with a New System of Regulation and Retention demonstrated his classification of tooth movements and his novel orthodontic devices, such as a piano wire in a soldered ‘pipe’ (tube) and the jackscrew and traction screw. He used ‘lantern slides’ to show his presentation, a new lecturing aid in those days. His presentations led to passionate and heated discussions with eminent dentists accusing Angle of presenting old stuff with his claims.

Transactions of the Ninth International Medical Congress contained his edited paper titled ‘ Notes on Orthodontia ’, commonly referred to as ‘First Edition’ of his classic textbook on treating malocclusion. Edward H. Angle had earlier contributed a 14-page chapter appended to Loomis P Haskell’s new book on dental laboratory procedures published in 1887. Angle considered this chapter of his titled ‘ Orthodontia with a New System of Regulation and Retention ’ as the prelude to his writings and the first edition of his book.

Edward Angle’s inventions and teachings

With his talent for mechanical innovations and his zeal to treat patients and teach, he continuously evolved new methods and appliances. He had 46 patents to his credit, 45 during his lifetime and 46th appeared after his death. Angle continued to edit his book, adding his experience and innovations. The seventh and last edition of the 628-page text was published in 1907 ^, ( Fig. 2.3 ). His contribution and events are summarised in Table 2.2 .

Edward Hartley Angle’s model of ideal occlusion was based on this ancient skull which he called ‘Old Glory’.

Richard Summa, one of Angle’s first students and an amateur archaeologist, presented this skull to Angle.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 12 : Two controversies: early treatment and occlusion. Am J Orthod Dentofacial Orthop. 2006 Dec;130(6):799–804. https://doi.org/10.1016/j.ajodo.2006.08.010

TABLE 2.2

Origin and worldwide contributions in orthodontics, 20th century

Years	Events
1908	Charles A. Hawley published ‘Determination of the Normal Arch and Its Application to Orthodontia’ and introduced the retainer appliance that bears his name: Hawley’s appliance.
1911	Albin Oppenheim, an Austrian-Hungarian-born physician turned orthodontist, was the first to report tissue changes, especially in bone, during orthodontic tooth movement. His first article on this subject was published in American Orthodontist.
1915	Albert H. Ketcham, one of the first to introduce the roentgenogram and photography into orthodontic practice.
	The International Journal of Orthodontia was started in 1915 upto 1919, when it was renamed as International Journal of Orthodontia and Oral Surgery from 1919 to 1922.
1918	John V. Mershon introduced the removable lingual arch. He believed that that teeth must have freedom and unrestricted for adaptation to normal growth.
	The concept of myofunctional therapy in orthodontics was introduced by Alfred Rogers.
1919	George B. Crozat developed a universal wire device, which is more popularly known as Crozat appliance and Crozat retainer.
1921	Dr Calvin Suverill Case worked in the area of malocclusion and also cleft palate. His major works were published with the title, ‘A Practical Treatise on the Technics and Principle of Dental Orthopedia and Prosthetic Correction of Cleft Palate’. He claimed to have first used intermaxillary elastics and had a big debate with Angle (1911) in support of the extraction of teeth in the management of malocclusion.
1924	A concept of the orientation of the face beyond teeth was introduced, Paul Simon’s gnathostatics
1931	‘A New X-ray Technique and Its Application to Orthodontia’ by B. Holy Broadbent reported the technique of recording a cephalogram using a head holder. This pioneering technique lead to a new era of understanding of face, skull and the science of orthodontics.
	Bolton’s point on cephalogram was named in recognition of Mrs Chester C. Bolton and her son Charles B. Bolton, who funded the manufacturing of the first cephalostat head holder and X-ray apparatus, which was installed at the anatomical laboratory of the Western Reserve University.
1933	Dr Andresen revived the Monoblock appliance developed by Pierre Robin in 1902 into a new device called Activator.
1940	Dr Robert E. Moyers and Sam Pruzansky inducted electromyography to study the effect of musculature on occlusion.
1946	Dr H.K. Cooper set up the first dedicated interdisciplinary clinic for patients with cleft lip, palate and craniofacial anomalies, what is now famous as Lancaster Cleft Palate Clinic.
1950–1960	Key contributions of Dr Charles H. Tweed: Induction of cephalometry in clinical practice. Several clinicians devised extended analysis William B. Downs in 1952, followed by C. C. Steiner, 1953; C. H. Tweed, 1953; S. E. Coben, 1955.
1952	‘Textbook of Functional Jaw Orthopaedics’ was released by Karl Häupl.
1955	Arne Bjork published his classical work on facial growth in man, studied with the aid of metallic implants in Acta Odontologica Scandinavica.
1960–1970	Standardisation of edgewise mechanism by Charles H. Tweed in USA, and popularisation of extraction philosophy treatment with light wire appliance by P. R. Begg at Adelaide, Australia. Dr Begg promoted the reduction of tooth substance by extractions and created a modified ribbon arch bracket and multiple-loop light-force wire appliance, known as Begg’s light wire technique. His book was first published in 1965.
1968	Dr George Newman, an orthodontist in Orange, New Jersey, and Professor Fujio Miura, chair of the Department of Orthodontics at Tokyo Medical and Dental University in Japan, pioneered the bonding of orthodontic brackets to enamel.
1970s	Robert Murray Ricketts greatly influenced orthodontic thinking through his critical evaluation of existing cephalometric analyses. He evolved bracket modification towards building prescription in 0.018-inch slots. He invented the first cephalometric diagnostic system to project treatment and growth in treatment planning known as Visual Treatment Objectives (VTOs). He evolved a computer-generated method for projecting facial growth.
	R. M. Ricketts also developed the quad helix, utility arches, sectionalisation and, most significantly, bio-progressive philosophy, a biological approach to diagnosis and treatment. He recognised divine proportions as a guide to facial balance in treating dental and skeletal malocclusions. Lawrence F. Andrews introduced the ‘Straight Wire’ Appliance.
1980s	The concept of 3D printing emerged in Nagoya, Japan by Hideo Kodama, who invented the first fabricating technology and method for rendering plastic into 3D with a polymer that was exposed to ultraviolet rays.
1987	Ceramic brackets were first introduced in the market.
1990	DIGI-CEPH, a computerised cephalometric analysis system, was developed at All India Institute of Medical Sciences in collaboration with the Indian Institute of Technology (IIT) New Delhi. Contributors O P Kharbanda SS Sidhu (AIIMS) and SK Guha and Sneh Ananad (IIT).
1990s	Temporary anchorage devices (TADs) are another game changer in orthodontic armamentarium were inducted with a successful case report by Creekmore and Eklund (1983) and later use of miniscrew by Kanomi (1997).
1990-2000	The duo of clinicians McLaughlin and Bennett invented and made the MB (McLaughlin–Bennett) appliance famous. The MB prescription (1991, 1993) was later further modified by Trevisi (1997) and is now widely known as the MBT prescription.

TABLE 2.3

Orthodontic innovations in the 21st century

Years	Events
2006	Dolphin Imaging company introduced its 3D module, which can import and process 3D datasets from MDCT, CBCT, MRI and high-definition facial camera systems.
	The integration of cone beam computed tomography (CBCT) skull, CBCT models and non-radiation 3D facial scanning put to use for ‘real life’ like planning more so the effects of orthodontic treatment on the facial profile.
2007	‘Universal Connector’ Developed at AIIMS by O. P. Kharbanda for indirect Miniscrew anchorage.
Around 2010	Plaster-free clinics wherein intraoral scanners are in use allow 3D scanning of dental structures; this helps to produce digital models, virtual planning and print plastic models.
	The first commercial venture with a robotic bent wire was supplied in the United States by SureSmile/OraMetrix.
2012	Auto-CEPH, the advanced computerised cephalometric system, was developed as a collaborative work by O. P. Kharbanda and H. S. Sardana, working at All India Institute of Medical Sciences, New Delhi and Central Scientific Instrument Organisation, Chandigarh.
2015	‘CollabDDS’ is a network-enabled digital diagnosis and interactive platform developed by a team of clinicians and scientists from various disciplines. The team included scientists and clinicians at the National Informatics Centre (NIC), Orthodontics and Radiology Departments at the All India Institute of Medical Sciences, New Delhi, and imaging scientists at the Central Scientific Instruments Organisation in Chandigarh and the Indian Institute of Technology in Mumbai.
2017	Metal 3D printing in orthodontic applications were introduced.
2018	The algorithms for automated 3D cephalometric analysis and volumetric analysis through CBCT were developed at Orthodontics at All India Institute of Medical Sciences and imaging scientists at Central Scientific Instruments Organisation Chandigarh.
2019	AutoCEPH cephalometric software and service jointly by O. P. Kharbanda, by H. S. Sardana and Team was introduced as online web service. http://ci.csio.res.in/download.html
2020s	Tele-Consult and remote monitoring applications appeared due to COVID epidemic; however, their applications and usefulness continued to influence clinical orthodontic practice.

TABLE 2.4

Dr Edward Hartley Angle and his life time contributions (1 June 1855–11 August 1930)

Years	Events
1855	Edward Hartley Angle (HART) was born on 1 June 1855. His boyhood home was at his parent’s farm in District 1, ‘Ballibay’, Herrick Township, Bradford County, Pennsylvania.
	As a child, HART had an innovative mind for mechanical artefacts.
1874–1876	HART, at age 18, had his training in dentistry with a nearby dentist as an office apprentice.
1878	Graduated as a dentist with DDS from Pennsylvania College of Dental Surgery in Philadelphia. The DDS programme was then arranged in two 6-month terms spaced over a nominal two years.
	He began practising dentistry in Towanda, the county seat of Bradford County, Pennsylvania. He was interested in regulating teeth and worked on mechanical devices to that effect.
1886	Edward Angle was appointed a professor of histology and lecturer on comparative anatomy and orthodontia. Dr Angle was later appointed to a rare position of professor of orthodontia at the University of Minnesota, within a few years, a position which he retained till 1892.
1887	Angle’s first contribution to orthodontic literature was ‘Notes on Orthodontia’ published in the International Transactions of the Medical Congress, which has also been called the ‘First Edition’ of his classic textbook on the treatment of malocclusion.
1889	He patented a jackscrew mechanism, the first of his series of 46 patents.
	Edward H. Angle taught his first exclusive course on orthodontia and started ‘Angle School of Orthodontia’ in Saint Louis, Missouri in 1900.
1892	The year 1892 has a special significance in Angle’s professional development and orthodontic profession. Dr Angle decided and announced to limit his practice to orthodontia and would not undertake any other dental and oral therapies. Thus, Dr Angle became the world’s first acknowledged exclusive specialist in orthodontics with this announcement.
	Dr Angle continued to teach at several universities. He was a professor of orthodontia at the American College of Dental Surgery (1892–98) in Chicago.
1886–1899	Dr Angle served as professor of orthodontia in the Dental Department of Marion-Sims College of Medicine, St Louis.
1897–1898	He taught in the Dental Department of Washington University, St Louis.
1899	Angle’s classification of malocclusion, published in Dental Cosmos.
	On 6 June 1899, he patented the E-arch, his expansion archwire mechanism.
1900	Founded the Angle School of Orthodontia in St Louis. The course duration was 5 weeks.
Early 1901	Angle organised the first orthodontic society meeting, the American Society of Orthodontists, which is now the American Association of Orthodontists (AAO).
1906–07	Dr Angle retired from the active practice of orthodontia in St Louis.
1907	Released 628-page text of the seventh edition of ‘Treatment of Malocclusion of the Teeth’.
	Founded the American Orthodontist, the first journal in the world devoted exclusively to orthodontics and the forerunner of the Angle Orthodontist.
1910	Patented ‘pin and tube’ appliance.
1916	Patented ‘ribbon arch’.
1917	In late 1916, Angle moved to southern Pasadena, California. Angle School of Orthodontia at his home in Pasadena was reopened in 1917.
1922	His students contributed to erecting an exclusively devoted building to the education and training of orthodontics.
1924	Dr Angle’s school was chartered as the ‘Angle College of Orthodontia’.
1925	Dr Angle patented ‘edgewise appliance’. The edgewise appliance with modifications is today’s most commonly used technique in orthodontics.
1927	Angle College of Orthodontia closed unofficially.
1930	After his death, his students and followers founded Edward H. Angle Society of Orthodontia (now ‘Orthodontists’).
1930s	Anna Hopkins’ ‘Mother Angle’ became secretary of the American Society of Orthodontists. She was appointed founding co-editor of the Angle Orthodontist and honorary chair of the Angle Society executive committee.
1930	Edward H. Angle Society of Orthodontia founded ‘The Angle Orthodontist’, a scientific journal devoted exclusively to orthodontics, in Dr Angle’s memory.

He initiated the first formal exclusive school in orthodontia ( Fig. 2.4 ), ‘The Angle School of Orthodontia’, at 1023 N. Grand Avenue, Saint Louis, MO, United States, in 1903. Angle organised the first orthodontic society meeting in 1900 of the American Society of Orthodontists, now known as the American Association of Orthodontists (AAO). He developed several appliances ( Figs 2.5 and 2.6 ) like pin and tube ( Fig. 2.7 ), ribbon arch ( Fig. 2.8 ) and finally, the best gift to orthodontic professionals, the Edgewise appliance ( Fig. 2.9 ). The edgewise appliance with its modifications is still in use as the mainstay fixed appliance around the world.

The newspaper advertisement of Angle School of Orthodontia.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 2 : entering the modern era. Am J Orthod Dentofacial Orthop. 2005 Apr; 127(4):510–5. https://doi.org/10.1016/j.ajodo.2005.01.002

Angle’s non-compliance functional class II corrector.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 9 : functional appliances to mid-century. Am J Orthod Dentofacial Orthop. 2006 Jun; 129(6):829–33.

E arch appliance by Edward Hartley Angle was introduced in 1887.

The adjustable clamp bands closely adapted to the teeth. The E arch appliance was used to expand the arches.

Source: Angle EH. Orthodontia- New Combinations of Well-Known Forms of Appliances. Dental Cosmos. 1899;41(9):836-41.

Pin and tube appliance was developed in 1910.

The apparatus is expected to control the movement of the tooth root. The base wire has multiple pins soldered, one for each tooth to be moved. The base wire was inserted from the occlusal direction, with pins inserted into tubes.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 5 : the American Board of Orthodontics, Albert Ketcham, and early 20th-century appliances. Am J Orthod Dentofacial Orthop. 2005 Oct;128(4):535–40.

Ribbon arch appliance in 1915 replaced cumbersome pin and tube appliance, where soldering was replaced with brass pins in a slot cut in the tube contemporary to edgewise bracket.

The rectangular wire was held in place in a ribbon mode with pins.

Source: Based on the concept of Angle EH. Some New Forms of Orthodontic Mechanism, and the Reasons for Their Introduction. Dental Cosmos. 1916; 58(9):969–994.

(A–J) First edgewise appliance by Edward H. Angle was developed in 1928. The edgewise appliance of the 0.022 in. x 0.028 in. slot was introduced by Angle. It was described in a series of articles in Dental Cosmos, 1928 and 1929.

Source: Based on the concept of Angle EH. The Latest and Best in Orthodontic Mechanism. Dental Cosmos. 1928;70(12):1143–1158.

Angle ( Figs 2.10 and 2.11 ) taught orthodontics to 198 disciples, including Charles H. Tweed. Most of them (185) completed formal training with him and received certificates of course completion, and 13 had some training. Dr Angle was very choosy to accept a dentist for training in orthodontia; only some people who applied were lucky enough to work under him. His disciples included 6 Canadians and 27 from 15 countries outside North America and were leaders in promoting the science of orthodontics in their country ( Table 2.2 ).

Edward Hartley Angle.

Source: Peck S. A biographical portrait of Edward Hartley Angle, the first specialist in orthodontics, Part 1. Angle Orthodont. 2009;79:1021–27. https://doi.org/10.2319/021009-93.1

Anna Hopkins and Edward H. Angle.

(Source: Reproduced with permission from Wahl N. Orthodontics in 3 millennia. Chapter 2 : entering the modern era. Am J Orthod Dentofacial Orthop. 2005 Apr;127(4):510–5.)

The first decade of the 20th century was marked by the ‘Great Extraction Debate’ by Angle–Case on extraction versus the non-extraction treatment. The dental manufacturers sold standardised orthodontic appliances that the dentists could modify by simple soldering and adapting to fit different teeth.

Dr Calvin Suverill Case (1847–1923) ( Fig. 2.12 ) was a graduate of Ohio and professor of prosthetic dentistry and orthodontia at the Chicago College of Dental Surgery. In 1890, he devised original appliances and suggested using intermaxillary elastics. Both Dr Case and Baker were to claim originality on intermaxillary elastics. Dr Case strongly advocated the relationship between occlusion and facial aesthetics. He advocated the ‘Face First’ approach, whereby expected facial improvement guided the nature and type of orthodontic treatment.

Dr Calvin Suverill Case (24 April 1847–16 April 1923) is known for the reintroduction of the concept that the removal of certain teeth will enable the correction of malocclusion.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 2 : entering the modern era. Am J Orthod Dentofacial Orthop. 2005 Apr;127(4):510–5.

He is known for reintroducing the concept that removing certain teeth will enable the correction of malocclusion. His suggestions met massive and challenging opposition from many practitioners, particularly those who followed Angle’s philosophy. Angle and his disciples followed a non-extraction approach to orthodontic treatment and philosophy, stating, ‘there shall be a full complement of teeth, and each tooth shall be made to occupy its normal position’. The climax of this conflict was a debate in 1911 at the annual meeting of the American Dental Association, which was then called the National Dental Association. The debate led to unpleasantness, bitterness and animosity among those supporting and not supporting the concept. However, the positive outcome of the debate was the initiation of thought processes towards rationalisation and objective evaluation of the extraction procedure.

Dr Charles A. Hawley introduced the retainer appliance in 1908. Charles Hawley’s (1861–1929) contributions are his published work on Determination of Normal Arch, and Its Application to Orthodontia and the concretising retainer appliance, which bears his name.

The next decade of the 20th century (1911–20) was marked by a critical review and analysis of the cases and thought process on individual case planning from non-extraction to extraction in exceptional cases. Formal orthodontic education from men-centred private orthodontic training schools to institutionalised education was also initiated during this decade.

Milo Hellman made two notable and classical contributions. Dr Hellman, a Professor of Dentistry at Columbia University and a Research Associate, also worked as a Research Associate at the Physical Anthropology American Museum of Natural History in New York.

Milo Hellman focused his research on integrating physical anthropology and craniometric measurements to evaluate the growth and development of the human face and dentofacial complex. His works saw with great inquisitiveness so as to how human dental development and occlusion have evolved through the process of evolution. He was the first to emphasise the use of craniometric measurements and introduced classical stages of the classification of dental development. Dr Hellman, through his classical works on a sample, through observation over two to seven years, showed that the human face grows by an increase in size in three planes, that is, vertical, transverse and anteroposterior. The increase in facial dimensions is greatest in width, less in height and least in depth. Interestingly, the greatest dimension increases the least and the smallest the most, leading to a change in facial proportions. There are sexual variations in facial growth between males and females. He also gave a sequence of growth stages of the face based on the sequence of eruption and shedding of deciduous teeth and the eruption of permanent teeth. ^,

John V. Mershon, in 1918, introduced the removable lingual arch based on the principle that teeth must have freedom and be unrestricted for adaptation to normal growth. He, in detail, explained the technique and steps of wire bending, adaptation, activation soldering of the attachments and uses in attaining tooth movement.

Albin Oppenheim ( Fig. 2.13 ), an Austrian-Hungary-born physician turned orthodontist, was the first to report detailed tissue changes in histology, more so in bone during orthodontic tooth movement through animal experiments on baboon owing to the similarity in bone behaviour close to that of humans. He experimented with one of the firm deciduous teeth on one-half of the jaw while mandating the other half as a control for the comparison. He described histological changes after the application of force for labial, lingual, depression, elongation and rotation movements. The histological changes were reported in the bony tissue, periodontal (sic) membrane in the tooth itself and the reaction of the tissues during retention. His first article on this subject was published in American Orthodontist (1911).

• •

  The International Journal of Orthodontia was started in 1915.

• •

  Alfred Rogers introduced the concept of myofunctional therapy in 1918.

Albin Oppenheim (8 January 1875–20 November 1945), an Austrian-Hungary-born physician turned orthodontist, was the first to report tissue changes, more so in bone during orthodontic tooth movement.

Source: Wahl N. Orthodontics in 3 millennia. Chapter 4 : the professionalisation of orthodontics (concluded). Am J Orthod Dentofacial Orthop. 2005 Aug;128(2):252–7.

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