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Presented by:
Dr. Jamal Giri
Resident (1st Year)
Introduction and
History of Orthodontics
 Orthodontics (Greek word)-
Orthos - to correct
Odontos - teeth
Dept. of dentistry-PG section, IOM (2011) 2
 The term “Orthodontics” – coined by
Jacques Lefoulon (france) in 1839.
 The term “Orthopedics” was first used by
Bunon ...
 British Society of Orthodontics (1922)
 “Orthodontics includes the study of growth and
development of the jaws and face...
 American Board of Orthodontics (ABO) :
 “Orthodontics is that specific area of the dental
profession that has its respo...
Branches of Orthodontics :
 Preventive Orthodontics
 Interceptive Orthodontics
 Corrective Orthodontics
 Surgical Orth...
(Summarized as Jackson’s Triad)
Functional Structural Esthetic
Efficiency Balance Harmony
Aims of orthodontics
Scopes of Orthodontic Treatment:
 Alteration in tooth position
 Alteration in skeletal pattern
 Alteration in soft tiss...
 Orthodontics is the
oldest speciality of
dentistry.
 Dentistry in turn had
it origins as a part
of medicine.
Medicine
D...
Orthodontic ages
 Ancient civilizations.
 Middle ages (476-1450 AD).
 Renaissance period (14th-16th century).
 Eightee...
Ancient civilizations
 Specimens dating back to VIII century
B.C. indicate Etruscans may have been
the first people to employ orthodontics to
i...
 Crude appliances to regulate teeth –
recovered among the archaeological
remnants in Egypt, Greece and Mexico
(Mayans)
13...
 First dental healers were physicians.
 Learned by trial & error & observation.
14Dept. of dentistry-PG section, IOM (20...
Hippocrates (460BC-377BC)
 The Greek
physician
Hippocrates (460
to 377 BC) is
considered as a
pioneer in medical
science....
 First teeth are formed by the nourishment
of the fetus in the womb.
 The shedding of the first teeth generally
takes pl...
 “Among those individuals with long-
shaped heads, some have thick necks,
strong parts & bones. Others have
strongly arch...
Aristotle (384 to 322 BC)
 First comparative dental
anatomist.
 De Partibus Animalium (On the
Parts of Animals).
 Noted...
 Pitfall
 Males have more teeth than females in the
case of men, sheep, goats, and swine.
 “Aristotle maintained that w...
Aulius Cornelius Celsus(25BC-50AD)
 “If a second tooth
should happen to
grow in children
before the first has
fallen out,...
Claudius Galenus ( 130-200 AD)
 Described dental anatomy
and embryology by
specifically identifying the
origin, growth, a...
Middle ages (476 -1450 AD)
Paulus Aegineta (625-690 AD)
 When supernumerary
teeth cause an
irregularity of dental
arches, they may be
corrected by r...
Barber surgeons (chirurgeons)
 Earliest known organization of barbers
was formed in 1096 AD.
 Began to thrive all over E...
Renaissance period
Leonardo da vinci (1452-1519 AD)
 The first artist to dissect
the human body and draw
accurate pictures of these
dissecti...
 Described the maxillary and frontal
sinuses and established their relationship
to facial height.
 Determined and made d...
Andreas Vesalius (1514-1564 AD)
 Set a precedent in the study
of human anatomy when he
personally performed a
dissection....
Ambrose Paré (1517?-1590 AD)
 A french surgeon
 Paid specific attention to
dentofacial deformities,
especially to the cl...
Gabriele Fallopio (1523 to 1562),
 An Italian anatomist.
 Observationes Anatomica.
 A detailed description of
the denta...
Bartholomaeus Eustachio (1520- 1574)
 Also an Italian anatomist.
 Libellus de Dentibus (Book on
the Teeth).
 Collected ...
 Gave the first accurate account of the
phenomenon of the sequential
development of the first and second
dentitions ( Dis...
Arzei Buchlein
 A book of surgical art published in 1530 AD
(Author unknown).
 “When teeth begin to drop out ... push th...
Eighteenth Century
 France became the leader in dentistry
throughout the world in the eighteenth
century.
 This was primarily attributed to...
Pierre Fauchard (1678-1761 AD)
 Father of modern dentistry.
 The Surgeon Dentist, A
Treatise on the Teeth (1728).
 His ...
 He developed the first
orthodontic appliance:
bandolet, designed for arch
expansion.
 Fauchard described 12 cases
of or...
Etienne Bourdet (1722-1789 AD)
 The dentist to the King of
France.
 Advocated the Fauchard
method but went a step
furthe...
Robert Bunon (1702-1788 AD)
 French dental surgeon.
 Essay on the Teeth.
 “I claim that a good formation of the teeth
c...
John Hunter (1728-1793 AD)
 A great teacher of
anatomy.
 Natural History of the
Human Teeth.
 Demonstrated the growth,
...
 Outlined the internal structure of the
teeth: enamel and dentin and their
separate functions.
 Experimentally establish...
Robert Blake (1772-1822 AD)
 A disciple of Hunter.
 “On the Structure and Formation of the
Teeth in Man and Various Anim...
IN Germany...
 Gottfried Janke
 attributed the shedding of deciduous teeth to
the obliteration of their vessels by the
c...
Orthodontics in United states.
 In Colonial America, primitive conditions
for dental care existed until European-
trained “operators for the teeth” came...
 Benjamin James (1814)
 Noted that he was “often called upon to cure
irregularity, than to prevent it.”
 Levi S. Parmly...
 Robert Augustine (1854)
 The correction of irregularities, however, easy
in theory, will be found most difficult and
de...
 Baltimore College of
Dental Surgery – first
dental college in the
world – opened its
doors to a class of 5
students on N...
 E.G. Tucker (1846) was the first American
to use rubber bands for tooth movement.
 Emerson C. Angell (1860) used a jack...
Chapin. A. Harris (1806-1860 AD)
 Orthodontic tooth
movement is a result of
bone resorption on one
side & bone deposition...
Norman W. Kingsley (1829-1913 AD)
 “Orthodontia’s greatest
genius” – E.H. Angle.
 Experimented with
appliances.
 Fabric...
 A Treatise on Oral Deformities.
 Over 100 articles on:
 Cleft palate rehabilitation.
 Orthodontic diagnosis.
 Introd...
 Emphasized the importance of the
relationship between mechanics and
biology as the principle on which
orthodontics shoul...
John Nutting Farrar (1839-1913 AD)
 The Father of American
Orthodontics.
 Investigated the
physiologic and pathologic
ch...
 Supported Kingsley’s concept of alveolar
bone bending during orthodontic tooth
movement (1888 AD).
 The originator of t...
Edward Hartley Angle (1855-1930)
 Father of Modern
Orthodontics.
 Never an outstanding student
in “book-learning”
 Mark...
 Received his DDS degree from the
Pennsylvania College of Dental Surgery-
1878.
 Being at heart an inventor, the field o...
 Experienced many technical problems &
frustrations in treatment which irritated,
motivated & inspired him to develop a
s...
 5 properties of an ideal orthodontic
appliance-
1. SIMPLE – Push, Pull & Rotate
2. STABLE – Fixed to teeth.
3. EFFICIENT...
Angle’s postulates
 Upper first molars are the key to occlusion
and the most stable landmark in
craniofacial anatomy.
 U...
 The line of
occlusion is smooth
(caternary) curve.
61Dept. of dentistry-PG section, IOM (2011)
Angle’s classification has 4 classes:
62Dept. of dentistry-PG section, IOM (2011)
Angle’s contribution to orthodontics
 Established orthodontics as a separate
branch of dentistry.
 Classified malocclusi...
 1907 - E -Arch Appliance
 Simple design.
• Heavy interrupted forces.
• Tipping of teeth to new position.
• Not possible...
 1912- Pin and Tube Appliance
Move the teeth bodily.
Capable of great precision in tooth
movement.
• Incredible degree ...
 1915 - Ribbon Arch Appliance
 First bracket.
 Vertically positioned rectangular slot with
ribbon arch of 10 x 20 gold ...
 1928 - Edgewise Appliance
 ‘Latest and the best’.
 Re-orientation of slot from
vertical to horizontal.
 Rectangular w...
Non-extraction paradigm
Rousseau
 Emphasized the
perfectability of man
Wolff
 the internal
architecture of bone
responds...
 Angle consulted the
famous artist of the day
Professor Wuerpel for the
ideal facial form.
 Wuerpel ridiculed that it
is...
 The best balance, the best harmony, the
best proportions of the mouth in its
relation to the other features require that...
Calvin S. Case (1847-1923)
 Graduate of Ohio College of
Dental Surgery.
 First to try bodily tooth
movement.
 Pioneered...
 Initially a genuine admirer of Angle.
 The discord:
 Angle attributed the origin of the use of
intermaxillary elastics...
 The climax of this conflict was a debate in
1911 at the annual meeting of the
National Dental Association (former name
o...
Martin Dewey (1881-1933)
 Known for his
modification of Angle’s
classification of
malocclusion.
 Product of Angle’s
scho...
75
 1914- Book entitled ‘Practical orthodontics.’
 1915- Founded and became editor of the
International Journal of Ortho...
Albert. H. Ketcham (1870-1935 AD)
 1902 - Graduate of
Angle School of
Orthodontics.
 First to introduce
Roentgenogram &
...
Milo Hellman (1873-1947 AD)
• Angle’s student.
• He demonstrated high
percentage of upper 1st
molar rotation and warned
in...
 1929 -The American Board of Orthodontics
(ABO) was founded and is the oldest
specialty board in dentistry.
 1931 – Holl...
Percy Raymond Begg(1898-1983 AD)
 Student of Angle.
 Returned to Australia
in 1925.
 Non-extraction +
Ribbon arch mecha...
 Feb. 1928- started extraction.
 Later started Ribbon arch brackets with
slots facing gingivally.
 Ribbon arch applianc...
 Charactristics of Begg’s appliance
 Replacement of precious metal ribbon arch
with high strength 16mil stainless steel ...
 Begg revolution:
 Begg appliance became widely popular
(1960s).
 Removed the need for headgear.
 Allowed more efficie...
Charles H. Tweed
 Charles H. Tweed applied
to the Angle school in
Pasadena in 1925 but was
refused admittance.
 Angle to...
 Angle and Tweed worked closely together
for the last two years of Angle's life.
 Tweed made progress records of his
pat...
 Angle was so pleased with Tweed's work,
that he was instrumental in making it
possible for Tweed to be invited to give
l...
 Tweed held to Angle's firm conviction that
the practitioner must adhere to the line of
occlusion concept and never extra...
 After 5 years of orthodontic practice,
Tweed became disheartened with his work
for two reasons:
 1) the protrusive face...
 Tweed’s conclusion:
 1) The patients who had pleasing facial
balance and harmony also had mandibular
incisors that were...
 By 1940 he had records of 100 patients,
treated first without extractions and then
retreated with extractions.
 He put ...
 Angle gave orthodontics the edgewise
bracket, but Tweed gave orthodontists a
way to use it.
 He devoted all 42 years of...
Orthodontics in Europe
 Not a single person dominated.
 Development of removable and
myofunctional appliances.
 Angles dogmatic approach to oc...
Development of active plate
 1839 – Charles Goodyear invented
vulcanite. ( late 1930s- vulcanite was
replaced by acrylic)...
 1902- Pierre Robbin devised “Monobloc”
made of single block of vulcanite. It
is used to position the mandible
forward in...
 1908 – Hawley’s
retainer appliance
was developed.
(Charles. A. Hawley)
 1911 – J.H. Badcock
- expansion plate
with scre...
 A.M. Schwarz
 1938 – ‘Lehrgang der
Gebissregulung’ -
Orthodontic bible in Europe.
 “Removable Orthodontic
Appliances‟ ...
 Philip Adams (1950s)
 modified arrowhead
clasp made by
Schwarz into the
Adam’s crib.
 Versatile clasp: Basis
for Engli...
Development of functional appliances
 Viggo Andresen in Denmark
(1908)- Activator
 Modified Hawley’s type
retainer.
 Fo...
 Later Andersen teamed up with karl
Haupl- changes in the appliances.
 “Functional jaw orthopedics.”
 “Norwegian applia...
 Most frequently
used activator
modification –
Bionator by Balters.
(early 1950s)
100Dept. of dentistry-PG section, IOM (...
 H.P. Bimler – myodynamic appliance.
 Expanding the maxillary arch by cross
wise transmission of transverse
mandibular m...
 Rolf Frankel of
Germany.
 Function Regulator in
1950s.
 Appliance confined to
oral vestibule –
shields buccal and
labi...
The Merger and then after…
 The 50s and 60s were the decades when
cross-continental barriers began
dissolving.
 Egil Har...
 Dr. H. D. Kesling, an orthodontist, was so
impressed by Dr. Begg’s work that he was
instrumental in bringing Dr. Begg to...
Lawrence F. Andrews
 Father of pre-adjusted
bracket system.
 6 keys of occlusion –
1972.
(Research spanning ten
years le...
106
Edward. H. Angle
Raymond Begg
(Conventional
Begg)
P.C Kesling
(Tip-edge & tip-
edge plus)
Messias Rodrigues
(simplifie...
 Vick Alexander
 1978: Vari-Simplex
Discipline.
 Charles Burstone
 Segmented arch
technique.
 COGS
 Introduced TMA, ...
T.M. Graber
 Wrote 20 textbooks, 22
chapters in other textbooks,
180 publications in journals &
930 book & journal abstra...
 William. J. clark
developed the Twin
Block Technique in
1977.
 The technique is now
the most widely used
functional tec...
 1977 – Pancherz resurrected Herbst
appliance.
 Developed by Emil Herbst in early 1900s.
110Dept. of dentistry-PG sectio...
 J.J.Jasper in 1980-
Jasper jumper.
 A flexible, fixed
tooth borne
functional
appliance
111Dept. of dentistry-PG section...
Robert Ricketts
 Bioprogressive therapy
(1950s).
 Concept of VTO (Visual
treatment objective) and
computerized cephalome...
Visual treatment objective (VTO)
Dept. of dentistry-PG section, IOM (2011) 113
Cone beam computed tomography
(CBCT)
Dept. of dentistry-PG section, IOM (2011) 114
Skeletal anchorage
 Vitalium screws (Gainsforth and Higley,
1945).
 Conventional osseointegrated implants
(Roberts et al...
 Palatal implants
(Wehrbein et al.,
1996)
 Mini-implants
(Kanomi, 1997)
 Miniscrews (Costa et
al., 1998).
Dept. of dent...
Orthodontics in Nepal
 B.P.K.I.H.S is the first government
hospital to provide orthodontic treatment
where as in Kathmand...
 Orthodontics and Dentofacial
Orthopaedics Association of Nepal
(ODOAN) has been established in 2009. It
is the first ass...
 ODOAN :affiliated to Asian Pacific
Orthodontic Society (APOS) in Feb 2010
and World Federation of orthodontics
(WFO) in ...
 “History is reading all that you can as
fast as you can and - remembering as
much as you can.”
Lynn Berleffi Darr
120Dep...
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Introduction and history of orthodontics 2nd oct 2011

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Introduction and history of orthodontics 2nd oct 2011

  1. 1. Presented by: Dr. Jamal Giri Resident (1st Year) Introduction and History of Orthodontics
  2. 2.  Orthodontics (Greek word)- Orthos - to correct Odontos - teeth Dept. of dentistry-PG section, IOM (2011) 2
  3. 3.  The term “Orthodontics” – coined by Jacques Lefoulon (france) in 1839.  The term “Orthopedics” was first used by Bunon in the year 1743 with regards to correction of teeth .  A.F. Talma used the terms “Orthodontics and Dental Orthopedics” together.  1985- Orthodontics and dentofacial orthopedics. 3Dept. of dentistry-PG section, IOM (2011)
  4. 4.  British Society of Orthodontics (1922)  “Orthodontics includes the study of growth and development of the jaws and face particularly and the body generally, as influencing the position of the teeth; the study of action and reaction of internal and external influences on the development, and the prevention and correction of arrested and perverted development.” 4Dept. of dentistry-PG section, IOM (2011)
  5. 5.  American Board of Orthodontics (ABO) :  “Orthodontics is that specific area of the dental profession that has its responsibility the study and supervision of the growth and development of 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 and mechanical means to establish normal occlusion and pleasing facial contours.” 5Dept. of dentistry-PG section, IOM (2011)
  6. 6. Branches of Orthodontics :  Preventive Orthodontics  Interceptive Orthodontics  Corrective Orthodontics  Surgical Orthodontics Dept. of dentistry-PG section, IOM (2011) 6
  7. 7. (Summarized as Jackson’s Triad) Functional Structural Esthetic Efficiency Balance Harmony Aims of orthodontics
  8. 8. Scopes of Orthodontic Treatment:  Alteration in tooth position  Alteration in skeletal pattern  Alteration in soft tissue envelope Dept. of dentistry-PG section, IOM (2011) 8
  9. 9.  Orthodontics is the oldest speciality of dentistry.  Dentistry in turn had it origins as a part of medicine. Medicine Dentistry Orthodontics 9Dept. of dentistry-PG section, IOM (2011)
  10. 10. Orthodontic ages  Ancient civilizations.  Middle ages (476-1450 AD).  Renaissance period (14th-16th century).  Eighteenth century.  Nineteenth century onwards.  Orthodontics in United states.  Orthodontics in Europe.  The merger and then after… 10Dept. of dentistry-PG section, IOM (2011)
  11. 11. Ancient civilizations
  12. 12.  Specimens dating back to VIII century B.C. indicate Etruscans may have been the first people to employ orthodontics to improve tooth alignment 12Dept. of dentistry-PG section, IOM (2011)
  13. 13.  Crude appliances to regulate teeth – recovered among the archaeological remnants in Egypt, Greece and Mexico (Mayans) 13Dept. of dentistry-PG section, IOM (2011)
  14. 14.  First dental healers were physicians.  Learned by trial & error & observation. 14Dept. of dentistry-PG section, IOM (2011)
  15. 15. Hippocrates (460BC-377BC)  The Greek physician Hippocrates (460 to 377 BC) is considered as a pioneer in medical science.  Corpus Hippocraticum 15Dept. of dentistry-PG section, IOM (2011)
  16. 16.  First teeth are formed by the nourishment of the fetus in the womb.  The shedding of the first teeth generally takes place about seven years of age.  Children who cut their teeth in winter time get over the teeth period best. 16Dept. of dentistry-PG section, IOM (2011)
  17. 17.  “Among those individuals with long- shaped heads, some have thick necks, strong parts & bones. Others have strongly arched palates, their teeth are irregularly arrayed, crowding one another & they are bothered by headaches & otorrhea. 17Dept. of dentistry-PG section, IOM (2011)
  18. 18. Aristotle (384 to 322 BC)  First comparative dental anatomist.  De Partibus Animalium (On the Parts of Animals).  Noted marked differences between the dentition among different animals and also among the species of same animal. 18Dept. of dentistry-PG section, IOM (2011)
  19. 19.  Pitfall  Males have more teeth than females in the case of men, sheep, goats, and swine.  “Aristotle maintained that women have fewer teeth than men; although he was twice married, it never occurred to him to verify this statement by examining his wives' mouths”. – Bertrand Russell 19Dept. of dentistry-PG section, IOM (2011)
  20. 20. Aulius Cornelius Celsus(25BC-50AD)  “If a second tooth should happen to grow in children before the first has fallen out, that which ought to be shed is to be drawn out & the new one daily pushed towards its place by means of the finger until it arrives at its proper position”. 20Dept. of dentistry-PG section, IOM (2011)
  21. 21. Claudius Galenus ( 130-200 AD)  Described dental anatomy and embryology by specifically identifying the origin, growth, and development of the teeth and enumerating the functions of each.  Pitfall  He believed the teeth to be true bones. 21Dept. of dentistry-PG section, IOM (2011)
  22. 22. Middle ages (476 -1450 AD)
  23. 23. Paulus Aegineta (625-690 AD)  When supernumerary teeth cause an irregularity of dental arches, they may be corrected by resection of such teeth or by extraction.  Irregular teeth were “displeasing in women.” 23Dept. of dentistry-PG section, IOM (2011)
  24. 24. Barber surgeons (chirurgeons)  Earliest known organization of barbers was formed in 1096 AD.  Began to thrive all over Europe.  Up to the year 1416, the barbers were not interfered with in the practice of surgery and dentistry. But it was soon evident that they were attempting too much. 24Dept. of dentistry-PG section, IOM (2011)
  25. 25. Renaissance period
  26. 26. Leonardo da vinci (1452-1519 AD)  The first artist to dissect the human body and draw accurate pictures of these dissections.  The first to recognize tooth form.  The first to perceive the concept of articulation. 26Dept. of dentistry-PG section, IOM (2011)
  27. 27.  Described the maxillary and frontal sinuses and established their relationship to facial height.  Determined and made drawings of the number of teeth and their root formations.  He noted that “those teeth that are the farthest away from the line of the temporomandibular articulation are at a mechanical disadvantage as compared with those that are nearer.” 27Dept. of dentistry-PG section, IOM (2011)
  28. 28. Andreas Vesalius (1514-1564 AD)  Set a precedent in the study of human anatomy when he personally performed a dissection.  The Fubric of the Human Body  Described the minute anatomy of the teeth, particularly the dental follicle and subsequent pattern of tooth eruption.  Proved Galen wrong!! 28Dept. of dentistry-PG section, IOM (2011)
  29. 29. Ambrose Paré (1517?-1590 AD)  A french surgeon  Paid specific attention to dentofacial deformities, especially to the cleft palate.  He was the first surgeon to devise an obturator for treatment of cleft. 29Dept. of dentistry-PG section, IOM (2011)
  30. 30. Gabriele Fallopio (1523 to 1562),  An Italian anatomist.  Observationes Anatomica.  A detailed description of the dental follicle.  Also gave us the terms hard and soft palate. 30Dept. of dentistry-PG section, IOM (2011)
  31. 31. Bartholomaeus Eustachio (1520- 1574)  Also an Italian anatomist.  Libellus de Dentibus (Book on the Teeth).  Collected the writings of various authors from Hippocrates to Vesalius,added the results of his own researches. 31Dept. of dentistry-PG section, IOM (2011)
  32. 32.  Gave the first accurate account of the phenomenon of the sequential development of the first and second dentitions ( Disagreed with Vesalius).  The first clear description of dental pulp and root canal.  Described the periodontal membrane for the first time and thought of it as a gomphosis type of joint. 32Dept. of dentistry-PG section, IOM (2011)
  33. 33. Arzei Buchlein  A book of surgical art published in 1530 AD (Author unknown).  “When teeth begin to drop out ... push the new one every day toward the place where the first one was until it sits there and fits among the others, for if you neglect to attend to this, the old teeth (deciduous) will remain and the young ones (permanent) will be impeded from growing straight.” 33Dept. of dentistry-PG section, IOM (2011)
  34. 34. Eighteenth Century
  35. 35.  France became the leader in dentistry throughout the world in the eighteenth century.  This was primarily attributed to one man, Pierre Fauchard.  He created order out of chaos, developed a profession out of a craft. 35Dept. of dentistry-PG section, IOM (2011)
  36. 36. Pierre Fauchard (1678-1761 AD)  Father of modern dentistry.  The Surgeon Dentist, A Treatise on the Teeth (1728).  His book is said to be the first complete scientific description of dentistry. 36Dept. of dentistry-PG section, IOM (2011)
  37. 37.  He developed the first orthodontic appliance: bandolet, designed for arch expansion.  Fauchard described 12 cases of orthodontic treatment in patients whose ages ranged from 12 to 22 years, with apparently good results. 37Dept. of dentistry-PG section, IOM (2011)
  38. 38. Etienne Bourdet (1722-1789 AD)  The dentist to the King of France.  Advocated the Fauchard method but went a step further by recommending only gold strips on the labial surface for the upper arch and on the lingual surface for the lower arch. 38Dept. of dentistry-PG section, IOM (2011)
  39. 39. Robert Bunon (1702-1788 AD)  French dental surgeon.  Essay on the Teeth.  “I claim that a good formation of the teeth can be procured if care is given them from the earliest age. I even go further and I say that the tooth germs and the tooth materials are favorably disposed by the regimen of the prospective mother.” 39Dept. of dentistry-PG section, IOM (2011)
  40. 40. John Hunter (1728-1793 AD)  A great teacher of anatomy.  Natural History of the Human Teeth.  Demonstrated the growth, development, and articulation of the maxilla and mandible with the attached musculature. 40Dept. of dentistry-PG section, IOM (2011)
  41. 41.  Outlined the internal structure of the teeth: enamel and dentin and their separate functions.  Experimentally established the difference between bone and teeth for the first time. (But he concluded tooth to be non vascular).  Nomenclature of teeth: incisor, bicuspid and molar. 41Dept. of dentistry-PG section, IOM (2011)
  42. 42. Robert Blake (1772-1822 AD)  A disciple of Hunter.  “On the Structure and Formation of the Teeth in Man and Various Animals.” (thesis presented to the University of Edinburgh).  “I feel myself justified that the alveolar arches continue to increase during the entire progress of the formation of the teeth.” 42Dept. of dentistry-PG section, IOM (2011)
  43. 43. IN Germany...  Gottfried Janke  attributed the shedding of deciduous teeth to the obliteration of their vessels by the compression of the erupting permanent teeth.  Adam A. Brunner  advised that “milk teeth should never be extracted unless there be manifest signs of the presence of the corresponding permanent teeth, or when it is painful or decayed.” 43Dept. of dentistry-PG section, IOM (2011)
  44. 44. Orthodontics in United states.
  45. 45.  In Colonial America, primitive conditions for dental care existed until European- trained “operators for the teeth” came to this country seeking fresh opportunities.  One of the most important native practitioners was John Greenwood (1760 to 1819). 45Dept. of dentistry-PG section, IOM (2011)
  46. 46.  Benjamin James (1814)  Noted that he was “often called upon to cure irregularity, than to prevent it.”  Levi S. Parmly (1819)  “where irregularities are allowed to proceed and become fixed, it is often a matter of difficulty, and sometimes of impossibility to rectify them.” 46Dept. of dentistry-PG section, IOM (2011)
  47. 47.  Robert Augustine (1854)  The correction of irregularities, however, easy in theory, will be found most difficult and delicate in practice; not only will much skill be found requisite, but, in equal degree, patience.  By the mid-nineteenth century basic concepts of diagnosis and treatment had begun. 47Dept. of dentistry-PG section, IOM (2011)
  48. 48.  Baltimore College of Dental Surgery – first dental college in the world – opened its doors to a class of 5 students on Nov 3rd, 1840. 48Dept. of dentistry-PG section, IOM (2011)
  49. 49.  E.G. Tucker (1846) was the first American to use rubber bands for tooth movement.  Emerson C. Angell (1860) used a jack screw type of device between the maxillary premolars in 14 yrs old girl and achieved and increase in arch width by 1/4th inch in 14 days. (Father of Rapid Maxillary Expansion.) 49Dept. of dentistry-PG section, IOM (2011)
  50. 50. Chapin. A. Harris (1806-1860 AD)  Orthodontic tooth movement is a result of bone resorption on one side & bone deposition on the other side of the root.  Pressure –tension theory  Schwarz (1932) 50Dept. of dentistry-PG section, IOM (2011)
  51. 51. Norman W. Kingsley (1829-1913 AD)  “Orthodontia’s greatest genius” – E.H. Angle.  Experimented with appliances.  Fabricated obturator for cleft patients.  “Jumping the bite.”  forerunner of modern functional appliances. 51Dept. of dentistry-PG section, IOM (2011)
  52. 52.  A Treatise on Oral Deformities.  Over 100 articles on:  Cleft palate rehabilitation.  Orthodontic diagnosis.  Introduced the headgear to apply extraoral force & provide occipital anchorage (1861). 52Dept. of dentistry-PG section, IOM (2011)
  53. 53.  Emphasized the importance of the relationship between mechanics and biology as the principle on which orthodontics should be based.  Claimed that bending of alveolar bone would take place during orthodontic tooth movement (1877 AD).  The first to recommend that etiology, diagnosis, and treatment planning were the acceptable bases of practice. 53Dept. of dentistry-PG section, IOM (2011)
  54. 54. John Nutting Farrar (1839-1913 AD)  The Father of American Orthodontics.  Investigated the physiologic and pathologic changes occurring in animals as the result of orthodontically induced tooth movement.  Published a series of articles in Dental cosmos. 54Dept. of dentistry-PG section, IOM (2011)
  55. 55.  Supported Kingsley’s concept of alveolar bone bending during orthodontic tooth movement (1888 AD).  The originator of the theory of intermittent force.  The first person to recommend root or bodily movement of the teeth.  Treatise on Irregularities of the Teeth and Their Correction (1888). 55Dept. of dentistry-PG section, IOM (2011)
  56. 56. Edward Hartley Angle (1855-1930)  Father of Modern Orthodontics.  Never an outstanding student in “book-learning”  Marked ability to improve & create mechanical equipment on the farm.  Apprenticed himself to a dentist at his mother’s request. 56Dept. of dentistry-PG section, IOM (2011)
  57. 57.  Received his DDS degree from the Pennsylvania College of Dental Surgery- 1878.  Being at heart an inventor, the field of general dentistry offered little interest.  Angle became keenly interested in orthodontics. 57Dept. of dentistry-PG section, IOM (2011)
  58. 58.  Experienced many technical problems & frustrations in treatment which irritated, motivated & inspired him to develop a standard appliance. 58Dept. of dentistry-PG section, IOM (2011)
  59. 59.  5 properties of an ideal orthodontic appliance- 1. SIMPLE – Push, Pull & Rotate 2. STABLE – Fixed to teeth. 3. EFFICIENT – Based on Newton’s 3rd law of anchorage. 4. DELICATE – Accepted by tissues. 5. INCONSPICUOUS – Esthetically acceptable. 59Dept. of dentistry-PG section, IOM (2011)
  60. 60. Angle’s postulates  Upper first molars are the key to occlusion and the most stable landmark in craniofacial anatomy.  Upper & lower molars should be related so that the mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar.  The teeth must be in harmony in normal occlusion. 60Dept. of dentistry-PG section, IOM (2011)
  61. 61.  The line of occlusion is smooth (caternary) curve. 61Dept. of dentistry-PG section, IOM (2011)
  62. 62. Angle’s classification has 4 classes: 62Dept. of dentistry-PG section, IOM (2011)
  63. 63. Angle’s contribution to orthodontics  Established orthodontics as a separate branch of dentistry.  Classified malocclusion-1899  Established Angle School Of Orthodontics in St. Louis ,Connecticut in 1900 and Pasadena in 1920.  Founded American Society Of Orthodontics in 1901.  Developed different orthodontic appliances 63Dept. of dentistry-PG section, IOM (2011)
  64. 64.  1907 - E -Arch Appliance  Simple design. • Heavy interrupted forces. • Tipping of teeth to new position. • Not possible to precisely position any individual teeth. 64Dept. of dentistry-PG section, IOM (2011)
  65. 65.  1912- Pin and Tube Appliance Move the teeth bodily. Capable of great precision in tooth movement. • Incredible degree of craftsmanship. • Impractical in clinical use. 65Dept. of dentistry-PG section, IOM (2011)
  66. 66.  1915 - Ribbon Arch Appliance  First bracket.  Vertically positioned rectangular slot with ribbon arch of 10 x 20 gold wire.  Good spring qualities.  Allowed versatile movements.  Poor control of root position. 66Dept. of dentistry-PG section, IOM (2011)
  67. 67.  1928 - Edgewise Appliance  ‘Latest and the best’.  Re-orientation of slot from vertical to horizontal.  Rectangular wire of 0.022 x 0.028 inch inserted in a horizontal slot.  Excellent control of crown & root position in all three planes of space. 67Dept. of dentistry-PG section, IOM (2011)
  68. 68. Non-extraction paradigm Rousseau  Emphasized the perfectability of man Wolff  the internal architecture of bone responds to stresses placed on that part of the skeleton. 68Dept. of dentistry-PG section, IOM (2011)
  69. 69.  Angle consulted the famous artist of the day Professor Wuerpel for the ideal facial form.  Wuerpel ridiculed that it is impossible to specify any one facial form as ideal. 69Dept. of dentistry-PG section, IOM (2011)
  70. 70.  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 & that each tooth shall be made to occupy its normal position - i.e. normal occlusion. 70Dept. of dentistry-PG section, IOM (2011)
  71. 71. Calvin S. Case (1847-1923)  Graduate of Ohio College of Dental Surgery.  First to try bodily tooth movement.  Pioneered use of retainers.  Fabrication of obturator for rehabilitation of cleft lip and palate.  First to use small gauze, light resilient wires for tooth alignment. 71Dept. of dentistry-PG section, IOM (2011)
  72. 72.  Initially a genuine admirer of Angle.  The discord:  Angle attributed the origin of the use of intermaxillary elastics to Baker.(1893)  The bombshell:  Concept of extraction for the treatment of malocclusion. 72Dept. of dentistry-PG section, IOM (2011)
  73. 73.  The climax of this conflict was a debate in 1911 at the annual meeting of the National Dental Association (former name of the ADA).  Dewey(Angle’s Student) Vs. Case:  one of the most sharpest and most heated controversies.  Angle & his followers won the day.  Extraction of teeth for orthodontic purpose essentially disappeared. 73Dept. of dentistry-PG section, IOM (2011)
  74. 74. Martin Dewey (1881-1933)  Known for his modification of Angle’s classification of malocclusion.  Product of Angle’s school of orthodontics.  1911-Dewey school of orthodontia. 74Dept. of dentistry-PG section, IOM (2011)
  75. 75. 75  1914- Book entitled ‘Practical orthodontics.’  1915- Founded and became editor of the International Journal of Orthodontia (now AJO).  1931- president of American dental association (ADA) Dept. of dentistry-PG section, IOM (2011)
  76. 76. Albert. H. Ketcham (1870-1935 AD)  1902 - Graduate of Angle School of Orthodontics.  First to introduce Roentgenogram & Photography  Investigated the problem of root resorption.  Founding president of ABO. 76Dept. of dentistry-PG section, IOM (2011)
  77. 77. Milo Hellman (1873-1947 AD) • Angle’s student. • He demonstrated high percentage of upper 1st molar rotation and warned in classifying malocclusion. • He pioneered the use of hand- wrist radiograph to determine the growth age and status of the patient. 77Dept. of dentistry-PG section, IOM (2011)
  78. 78.  1929 -The American Board of Orthodontics (ABO) was founded and is the oldest specialty board in dentistry.  1931 – Holly Broadbent introduced cephalometric radiography and tracing. 78Dept. of dentistry-PG section, IOM (2011)
  79. 79. Percy Raymond Begg(1898-1983 AD)  Student of Angle.  Returned to Australia in 1925.  Non-extraction + Ribbon arch mechanics  Poor post treatment profiles and relapses. 79Dept. of dentistry-PG section, IOM (2011)
  80. 80.  Feb. 1928- started extraction.  Later started Ribbon arch brackets with slots facing gingivally.  Ribbon arch appliance + extraction Begg technique 80Dept. of dentistry-PG section, IOM (2011)
  81. 81.  Charactristics of Begg’s appliance  Replacement of precious metal ribbon arch with high strength 16mil stainless steel wire.  Retained the original ribbon arch bracket but turned it upside down so that the bracket slot points gingivally.  Added auxillary springs to the appliance for control of root position. 81Dept. of dentistry-PG section, IOM (2011)
  82. 82.  Begg revolution:  Begg appliance became widely popular (1960s).  Removed the need for headgear.  Allowed more efficient tooth movement with less discomfort.  Used stainless steel wire instead of gold or platinum. (Arthur Wilcock) 82Dept. of dentistry-PG section, IOM (2011)
  83. 83. Charles H. Tweed  Charles H. Tweed applied to the Angle school in Pasadena in 1925 but was refused admittance.  Angle told him to study and to become more serious about orthodontics. 83Dept. of dentistry-PG section, IOM (2011)
  84. 84.  Angle and Tweed worked closely together for the last two years of Angle's life.  Tweed made progress records of his patients every 4 months. He packed the records in a suitcase and took them to Pasadena, where Angle studied them and outlined a treatment plan for the next 4 months. 84Dept. of dentistry-PG section, IOM (2011)
  85. 85.  Angle was so pleased with Tweed's work, that he was instrumental in making it possible for Tweed to be invited to give lectures at several orthodontic meetings.  In 1932, Tweed published his first article in The Angle Orthodontics. It was titled "Reports of Cases Treated with the Edgewise Arch Mechanism." 85Dept. of dentistry-PG section, IOM (2011)
  86. 86.  Tweed held to Angle's firm conviction that the practitioner must adhere to the line of occlusion concept and never extract teeth.  But little did he know... 86Dept. of dentistry-PG section, IOM (2011)
  87. 87.  After 5 years of orthodontic practice, Tweed became disheartened with his work for two reasons:  1) the protrusive faces that he was creating.  2) the unstable dentition.  He resolved to study his many failures and his few successes. 87Dept. of dentistry-PG section, IOM (2011)
  88. 88.  Tweed’s conclusion:  1) The patients who had pleasing facial balance and harmony also had mandibular incisors that were upright over basal bone.  2) The carefully planned extractions allowed to improve appearance as well as stability 88Dept. of dentistry-PG section, IOM (2011)
  89. 89.  By 1940 he had records of 100 patients, treated first without extractions and then retreated with extractions.  He put these patient records on display at an American Association of Orthodontists (AAO) meeting.  “Just put your plaster on the table." 89Dept. of dentistry-PG section, IOM (2011)
  90. 90.  Angle gave orthodontics the edgewise bracket, but Tweed gave orthodontists a way to use it.  He devoted all 42 years of his professional life to the use and refinement of Angle's invention, the edgewise appliance. 90Dept. of dentistry-PG section, IOM (2011)
  91. 91. Orthodontics in Europe
  92. 92.  Not a single person dominated.  Development of removable and myofunctional appliances.  Angles dogmatic approach to occlusion – less impact in Europe.  Precious metal for fixed appliances less available.  2 types of devices :  Active plates or removable appliances  Activator or functional appliances 92Dept. of dentistry-PG section, IOM (2011)
  93. 93. Development of active plate  1839 – Charles Goodyear invented vulcanite. ( late 1930s- vulcanite was replaced by acrylic)  1881 – Coffin plate by Coffin. 93Dept. of dentistry-PG section, IOM (2011)
  94. 94.  1902- Pierre Robbin devised “Monobloc” made of single block of vulcanite. It is used to position the mandible forward in patients with glossoptosis and severe mandibular retrognathism. 94Dept. of dentistry-PG section, IOM (2011)
  95. 95.  1908 – Hawley’s retainer appliance was developed. (Charles. A. Hawley)  1911 – J.H. Badcock - expansion plate with screw. 95Dept. of dentistry-PG section, IOM (2011)
  96. 96.  A.M. Schwarz  1938 – ‘Lehrgang der Gebissregulung’ - Orthodontic bible in Europe.  “Removable Orthodontic Appliances‟ (1966)  “Schwarz double plate”  combination of activator & active plate. (class II div I) 96Dept. of dentistry-PG section, IOM (2011)
  97. 97.  Philip Adams (1950s)  modified arrowhead clasp made by Schwarz into the Adam’s crib.  Versatile clasp: Basis for English removable appliances. 97Dept. of dentistry-PG section, IOM (2011)
  98. 98. Development of functional appliances  Viggo Andresen in Denmark (1908)- Activator  Modified Hawley’s type retainer.  Forward positioning of mandible-for saggital correction.  Used for the first time on his own daughter.  “Biomechanical working retainer” 98Dept. of dentistry-PG section, IOM (2011)
  99. 99.  Later Andersen teamed up with karl Haupl- changes in the appliances.  “Functional jaw orthopedics.”  “Norwegian appliance.”  Haupl coined the term Activator  Ability to activate muscles 99Dept. of dentistry-PG section, IOM (2011)
  100. 100.  Most frequently used activator modification – Bionator by Balters. (early 1950s) 100Dept. of dentistry-PG section, IOM (2011)
  101. 101.  H.P. Bimler – myodynamic appliance.  Expanding the maxillary arch by cross wise transmission of transverse mandibular movements.  Stockfish Kinetor. 101Dept. of dentistry-PG section, IOM (2011)
  102. 102.  Rolf Frankel of Germany.  Function Regulator in 1950s.  Appliance confined to oral vestibule – shields buccal and labial musculature away from teeth & investing tissues. 102Dept. of dentistry-PG section, IOM (2011)
  103. 103. The Merger and then after…  The 50s and 60s were the decades when cross-continental barriers began dissolving.  Egil Harvold – faculty at University of Toronto, introduced ‘Norwegian system’ in U.S.  In Europe fixed appliances started replacing removable appliances for comprehensive treatment. 103Dept. of dentistry-PG section, IOM (2011)
  104. 104.  Dr. H. D. Kesling, an orthodontist, was so impressed by Dr. Begg’s work that he was instrumental in bringing Dr. Begg to USA.  April, 1960- Dr. Begg presented his cases treated with Begg Technique at the AAO annual meeting.  This was first introduction to Begg Mechanics in USA. 104Dept. of dentistry-PG section, IOM (2011)
  105. 105. Lawrence F. Andrews  Father of pre-adjusted bracket system.  6 keys of occlusion – 1972. (Research spanning ten years led to The Six Keys to Optimal Occlusion) 105Dept. of dentistry-PG section, IOM (2011)
  106. 106. 106 Edward. H. Angle Raymond Begg (Conventional Begg) P.C Kesling (Tip-edge & tip- edge plus) Messias Rodrigues (simplified straight wire tech.) Charles Tweed (edge-wise) Lawrence Andrews (straight wire) 1st generation Ronald Roth 2nd generation MBT (McLaughlin, Bennett, Trevisi) 3rd generation Dept. of dentistry-PG section, IOM (2011) Modified Begg (Begg principle without ribbon arch bracket) Refined Begg (Dr. Jayade, Sims)
  107. 107.  Vick Alexander  1978: Vari-Simplex Discipline.  Charles Burstone  Segmented arch technique.  COGS  Introduced TMA, chinese NiTi, fibre reinforced composite. 107Dept. of dentistry-PG section, IOM (2011)
  108. 108. T.M. Graber  Wrote 20 textbooks, 22 chapters in other textbooks, 180 publications in journals & 930 book & journal abstract reviews.  1950 – First PhD to Dentist by Northwestern University Medical School.  Editor-in-chief of AJO for 15yrs. 108Dept. of dentistry-PG section, IOM (2011)
  109. 109.  William. J. clark developed the Twin Block Technique in 1977.  The technique is now the most widely used functional technique throughout the world. 109Dept. of dentistry-PG section, IOM (2011)
  110. 110.  1977 – Pancherz resurrected Herbst appliance.  Developed by Emil Herbst in early 1900s. 110Dept. of dentistry-PG section, IOM (2011)
  111. 111.  J.J.Jasper in 1980- Jasper jumper.  A flexible, fixed tooth borne functional appliance 111Dept. of dentistry-PG section, IOM (2011)
  112. 112. Robert Ricketts  Bioprogressive therapy (1950s).  Concept of VTO (Visual treatment objective) and computerized cephalometry (mid-1970s). Dept. of dentistry-PG section, IOM (2011) 112
  113. 113. Visual treatment objective (VTO) Dept. of dentistry-PG section, IOM (2011) 113
  114. 114. Cone beam computed tomography (CBCT) Dept. of dentistry-PG section, IOM (2011) 114
  115. 115. Skeletal anchorage  Vitalium screws (Gainsforth and Higley, 1945).  Conventional osseointegrated implants (Roberts et al., 1989).  Mini-plates (Jenner and Fitzpatrick, 1985)  Onplants (Block and Hoffman, 1995) Dept. of dentistry-PG section, IOM (2011) 115
  116. 116.  Palatal implants (Wehrbein et al., 1996)  Mini-implants (Kanomi, 1997)  Miniscrews (Costa et al., 1998). Dept. of dentistry-PG section, IOM (2011) 116
  117. 117. Orthodontics in Nepal  B.P.K.I.H.S is the first government hospital to provide orthodontic treatment where as in Kathmandu valley, IOM is the first.  Dr. Sambhu Man Singh(DORCS- England, 1974) is the first Orthodontist of Nepal.  Dr. Praveen Mishra is the first orthodontist with MDS degree(MAHE – 1995). 117Dept. of dentistry-PG section, IOM (2011)
  118. 118.  Orthodontics and Dentofacial Orthopaedics Association of Nepal (ODOAN) has been established in 2009. It is the first association among dental postgraduate specialities.  At present there are 14 orthodontists (as registered ODOAN) in Nepal most of them are centred in Kathmandu valley. 118Dept. of dentistry-PG section, IOM (2011)
  119. 119.  ODOAN :affiliated to Asian Pacific Orthodontic Society (APOS) in Feb 2010 and World Federation of orthodontics (WFO) in June 2010 as 108th member.  Post graduation in Orthodontics was started in National Academy of Medical Sciences(NAMS) in 2008 for the first time in Nepal.  2010- IOM and people’s dental college.  2011- Universal college of medical sciences. 119Dept. of dentistry-PG section, IOM (2011)
  120. 120.  “History is reading all that you can as fast as you can and - remembering as much as you can.” Lynn Berleffi Darr 120Dept. of dentistry-PG section, IOM (2011)

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