Introduction To Orthodontics

Brief introduction and history of orthodontics.
Aims, scope, need, services offer by orthodontics and sequels of malocclusion.

1. Dr. Shweta Kolhe BDS, MDS(Orthodontist ) . Introduction To Orthodontics

2. Ortho dontics (Greek word)- Orthos - to correct Odontos - teeth

3. The term “ Orthodontia ” – coined by Le Foulon ( france ) in 1839. Sir James Murray 1909 suggested that it should be termed “ Orthodontics ” The term “ Orthopedics ” was first used by Bunon in the year 1743 with regards to correction of teeth . 196 B. F. Dewel suggested that the term dento -facial orthopedics . A.F. Talma used the terms “ Orthodontics and Dental Orthopedics ” together. 1985- Orthodontics and dentofacial orthopedics .

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.”

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.”

6. Unfavourable sequel of Malocclusion Poor facial appearance Risk of caries Predisposition to periodontal disease Psychological disturbance Risk of trauma Abnormality of function Temporo -mandibular joint problems

7. Poor facial appearance – Dental appearance is one of the most important characteristic of facial appearance. Risk of caries – Malalignment Difficult oral hygiene maintenance interproximal caries loss of arch length crowding of permanent dentition & alter molar relation. Predisposition to periodontal diseases – Poor oral hygiene, TFO.

8. Psychological disturbances – self-conscious, introvert T/t increase confidence. Risk of trauma –severely proclined teeth ( overjet more 3mm twice risk) Abnormalities of function – Deglutition, Defects in speech, improper respiration, difficulty in biting and chewing. TMJ Problem – Occlusal prematurity & deep bite pain & dysfunction.

9. Aims of orthodontics / Jackson’s triad Functional efficiency structural balance Esthetic harmony

10. Scopes of Orthodontic Treatment:

11. Alteration in tooth position- Teeth can be moved through the bone to the ideal locations by applying force. Alteration in skeletal pattern – skeletal disharmony in size, position & relationship between jaws. Orthodontist can bring about change in three plane i.e. sagittal, transverse & vertical. Alteration in soft tissue envelope – soft tissues, envelop the dentition are greatly influenced by the placement of the dentition.

12. The Need For Orthodontic Treatment To improve dento -facial appearance To correct the occlusal relationship and function of the teeth To eliminate occlusion that could be potentially damaging to health of teeth and periodontium .

13. Services offered by orthodontics Preventive orthodontics Interceptive orthodontics Corrective orthodontics Surgical orthodontics

14. Preventive orthodontics Prevention , is better than cure. Preventive orthodontics included procedures undertaken prior to the onset of a malocclusion in anticipation of a developing malocclusion. Actions taken to preserve the integrity of what appears normal for that age

15. Interceptive orthodontics Interceptive orthodontics incudes procedure that are undertaken at an early stage of malocclusion to eliminate or reduce the severity of the same. By interceptive procedure , is possible to prevent establishment of a full-fledged malocclusion that may require long term orthodontic treatment at later age.

16. Corrective orthodontics Corrective orthodontics undertaken to correct a fully established malocclusion. Surgical orthodontics Surgical procedure, undertaken in conjunction with or as an adjunct to orthodontic procedure. Used to remove etiology, T/t severe dentofacial deformities.

17. Brief History of Orthodontics Oldest specialty of dentistry Attempt to treat malocclusion done as early as 1000 B.C. Crude appliances to regulate teeth – recovered among the archaeological remnants in Egypt, Greece and Mexico.

18. Specimens dating back to VIII century B.C. indicate Etruscans may have been the first people to employ orthodontics to improve tooth alignment

19. Hippocrates (460 BC-377 BC) The Greek physician A pioneer in medical science. A number of references on teeth and jaws are found in his writing

20. Aristotle (384 to 322 BC) Greek philosopher 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.

21. Aulius Cornelius Celsus (25BC-50AD) Advocated use of finger pressure to align i rregular teeth “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”.

22. 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.

23. Eighteenth Century

24. 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.

25. 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.

26. He developed the first orthodontic appliance: bandelette , 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.

27. 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 . Outlined the internal structure of the teeth: enamel and dentin and their functions . Nomenclature of teeth: incisor, bicuspid and molar.

28. Baltimore College of Dental Surgery – first dental college in the world – opened its doors to a class of 5 students on Nov 3 rd , 1840.

29. 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 1/4 th inch in 14 days. ( Father of Rapid Maxillary Expansion.) William E. Magill (123-1896) First person to band teeth for active tooth movement.

30. 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)

31. 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.

32. Introduced the headgear to apply extraoral force & provide occipital anchorage (1861). 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.

33. 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. The originator of the theory of intermittent force. The first person to recommend root or bodily movement of the teeth.

34. Edward Hartley Angle (1855-1930) Father of Modern Orthodontics . Marked ability to improve & create mechanical equipment on the farm. Apprenticed himself to a dentist at his mother’s request. Received his DDS degree from the Pennsylvania College of Dental Surgery-1878. Angle became keenly interested in orthodontics.

35. Experienced many technical problems & frustrations in treatment which irritated, motivated & inspired him to develop a standard appliance. 5 properties of an ideal orthodontic appliance- SIMPLE – Push, Pull & Rotate STABLE – Fixed to teeth. EFFICIENT – Based on Newton’s 3 rd law of anchorage. DELICATE – Accepted by tissues. INCONSPICUOUS – Esthetically acceptable.

36. 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.

37. The line of occlusion The line of occlusion is smooth (catenary) curve. Passing through the central fossa of each upper molar an across the cingulum of upper canine and incisor teeth . Same line runs along the buccal cusps an incisal edges of the lower teeth Specifies the occlusion as well as inter-arch relationship.

38. Angle’s classification has 4 classes:

39. 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

40. 1907 - E -Arch Appliance Simple design. Heavy interrupted forces. Tipping of teeth to new position. Not possible to precisely position any individual teeth.

41. 1912- Pin and Tube Appliance Move the teeth bodily. Capable of great precision in tooth movement. Incredible degree of craftsmanship. Impractical in clinical use.

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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. 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)

48. 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.

49. Milo Hellman (1873-1947 AD) Angle’s student. demonstrated high percentage of upper 1 st molar rotation and warned in classifying malocclusion. pioneered the use of hand- wrist radiograph to determine the growth age and status of the patient . 1929 -The American Board of Orthodontics (ABO) was founded and is the oldest specialty board in dentistry .

50. 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. Feb. 1928- started extraction . Later started Ribbon arch brackets with slots facing gingivally . Ribbon arch appliance + extraction Begg technique

51. 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. Begg revolution: 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 )

52. 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. Angle and Tweed worked closely together for the last two years of Angle's life.

53. 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. 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."

54. Tweed held to Angle's firm conviction that the practitioner must adhere to the line of occlusion concept and never extract teeth. 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.

55. 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

56. 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.“ 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.

57. Orthodontics in Europe

58. 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 .

59. 1908 – Hawley’s retainer appliance was developed. ( Charles. A. Hawley ) 1911 – J.H. Badcock - expansion plate with screw.

60. 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)

61. Philip Adams (1950s) modified arrowhead clasp made by Schwarz into the Adam’s crib. Versatile clasp: Basis for English removable appliances.

62. 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”

63. 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 Most frequently used activator modification – Bionator by Balters . (early 1950s)

64. H.P. Bimler – myodynamic appliance. Expanding the maxillary arch by cross wise transmission of transverse mandibular movements. Stockfish Kinetor .

65. Rolf Frankel of Germany. Function Regulator in 1950s. Appliance confined to oral vestibule – shields buccal and labial musculature away from teeth & investing tissues.

66. 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) 1 st generation Ronald Roth 2 nd generation MBT ( McLaughlin, Bennett, Trevisi ) 3 rd generation Modified Begg ( Begg principle without ribbon arch bracket ) Refined Begg (Dr. Jayade , Sims)

67. 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)

68. Vick Alexander 1978: Vari -Simplex Discipline. Charles Burstone Segmented arch technique. Introduced TMA, chinese NiTi , fibre reinforced composite.

69. 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.

70. William. J. clark William. J. clark developed the Twin Block Technique in 1977. The technique is now the most widely used functional technique throughout the world.

71. Emil Herbst 1977 – Pancherz resurrected Herbst appliance. Developed by Emil Herbst in early 1900s.

72. Robert Ricketts Bioprogressive therapy (1950s). Concept of VTO (Visual treatment objective) and computerized cephalometry (mid-1970s).

73. Visual treatment objective (VTO)

74. Thank you