21 Jan Dental History : Orthodontics
Lining things up for 2000 years
Orthodontics is the dental speciality that deals with the diagnosis, prevention and correction of malpositioned teeth and jaws. It was first recognised by the American Dental Association in the 1950s and has become widely practised internationally since then.
It was established as a speciality towards the end of the 19th century. However, archaeologists have discovered mummified bodies more than 2,000 years old with metal bands wrapped around individual teeth and wires to hold teeth together suggesting some form of orthodontic treatment.
The word “Orthodontics” is derived from the Greek words orthos (meaning correct or straight) and odont (meaning tooth).
Orthodontists attempt to manage and correct tooth alignment and the way upper and lower teeth fit together. About 30% of people have some form of orthodontic problem that would benefit from treatment.
What Edward Angle did
Angle was one of the earliest pioneers of orthodontic treatments. He also offered one of the first training courses in Orthodontics.
His course took 6-weeks for qualified dentists to complete. He started it in his St Louis office before founding the Angle School of Orthodontia in 1900. This helped to formally establish orthodontics.
He coined the term malocclusion to refer to anomalies of tooth position and classified various abnormalities of the teeth and jaws. He also invented several appliances for their treatment (there are 46 patents in his name) and devised surgical techniques and treatments.
Angle wrote a series of books and pamphlets, including Treatment of Malocclusion of the Teeth and Fractures of the Maxillae: Angle’s System. These helped to systemise treatments and how appliances were used.
His classification of malocclusion in the 1890s included the first clear definition of normal occlusion.
Angle was concerned with both the aesthetics and functionality of orthodontics. In 1901, he founded the organisation that became the American Society of Orthodontists.
Inventions and Appliances
Angle was credited with introducing many appliances to the field of Orthodontics, including;
Upper and Lower Jaw Functional Expanders
- E (expansion) Arch Appliance (1907) : Basic & Ribbed.
- Pin & Tube Appliance (1910)
- Ribbon Arch Appliance (1915)
- Edgewise Appliance (1925) – These brackets were initially referred to as “open face” or “tie brackets”. The edgewise bracket has been later modified to Single Width Bracket, Siamese Bracket, Lewis Bracket, Steiner Bracket, Broussard Bracket.
What Norman Kingsley did
Kingsley was a 19th-century dentist and an artist. He was also involved in the early development of orthodontic treatments, and also cleft palate therapy.
Norman Kingsley designed fixed and removable appliances to correct Angle Class II malocclusions. He also designed the first soft-rubber palatal obturators, helping patients with a cleft palate to speak normally.
A skilled sculpture, Kingsley became known for crafting dental prosthesis, winning two gold medals at World’s Fair Competitions.
Kingsley founded the New York College of Dentistry, serving as its first dean from 1865 to 1869.
He was a prolific writer on cleft lip and palate rehabilitation. In 1880, he published A Treatise on Oral Deformities as a Branch of Mechanical Surgery. This was the first truly comprehensive textbook covering orthodontic problems and treatments.
Achievements and Appliances
- In 1858, he published the first paper on modern orthodontics
- In 1859, he perfected a gold obturator.
- During the 1860s, Kingsley introduced the concept of “jumping the bite” with the use of a bite plate.
- In 1879, he introduced occipital traction into the field of orthodontics.
- Kingsley was also known for his work related to the vulcanite palatal plate which consisted of anterior incline which allowed a person to bite forward with their lower jaw. His appliance was later modified by Hotz and it was known as Vorbissplatte.
Other Milestones and Notable Characters
Over the years, it seems as though almost as much effort has been expended on classifying orthodontic malalignment as in treating it. As one might expect, they grow in complexity and sophistication, and sometimes simplicity and ease of use – but rarely in all these ways.
Here are some of the systems created, either for planning treatment, financing treatment, or for public health reporting, plus one or two developments in actual treatment and treatment management.
Massler and Frankel’s index recording the number of displaced/rotated teeth
Massler & Frankel produced a way to record the prevalence of malocclusion. This index uses individual teeth as a unit of occlusion instead of a segment of the arch. Each tooth is examined to determine whether it is in correct occlusion or it is maloccluded. The total number of maloccluded teeth is counted and recorded.
Handicapping Malocclusion Assessment Record (HMAR)
Handicapping malocclusion assessment record (HMAR) was created by JA Salzmann to establish needs for treatment of handicapping malocclusion according to a scoring system used when assessing the malocclusion.
The assessment can be made either directly from the oral cavity or from available casts. This index has been accepted as a standard by the Council or Orthodontic Health Care, and the Board of Directors of the American Association due to its ease of use.
Peer Assessment Rating Index (PAR)
This index compares the outcomes of orthodontic treatment. It primarily observes the results of a group of patients against results that they would expect.
Created and implemented by the British Orthodontic Standards Working Party, this index is a fast, simple and robust way of assessing the standard of orthodontic treatment that an individual orthodontist is achieving (or trying to achieve) rather than the degree of malocclusion and/or need for orthodontic treatment.
Index of Orthodontic Treatment Need (IOTN)
This index was developed and tested in 1989 by Brook and Shaw in England following a government initiative.
The aim of the IOTN is to assess the probable impact a malocclusion may have on an individual’s dental health and psychosocial wellbeing and easily identifies the individuals who will benefit most from orthodontic treatment. It creates and assigns a treatment priority. It is used to determine whether a patient under the age of 18 years is eligible for orthodontic treatment on the NHS.
1990 – Memorandum of Orthodontic Screen and Indication for Orthodontic Treatment
This index was implemented in 1990 by Danish national board of health and is based on health risks related to malocclusion. It describes possible damage and problems arising from untreated malocclusion and therefore identifies treatment need.
Need for Orthodontic Treatment Index (NOTI)
This index was first described and implemented in 1992 by L.V.Espeland et al and is also known as the Norwegian Orthodontic Treatment Index. It classifies malocclusions into four categories based on the necessity of the treatment need.
This index is used by the Norwegian health insurance system for the allocation of public subsidies of treatment expenses. The value of the reimbursement is related to the category of treatment need.
1997 – Invisalign aligner
Vacuum-formed aligners such as Invisalign consist of clear, flexible, plastic trays that move teeth incrementally to reduce mild overcrowding and to improve mild irregularities and spacing. They are worn full time by the patient apart from when eating and drinking. Though unsuitable for use in complex orthodontic cases requiring body movement, a benefit of these types of orthodontic appliance is that they suitable for use when the patient has porcelain veneers (metal brackets cannot be bonded to the veneer surface) and have become very popular for aesthetic orthodontic treatments.
Although made by at least 27 different manufacturers, arguably the first was produced by Align Technology of San Jose, California during 1997. The company’s Clear Align system has since been used to treat more than 3 million patients.
2000 – Index of Complexity, Outcome and Need (ICON)
This index was produced in 2000 by Charles Daniels and Stephen Richmond in Cardiff with the intention of replacing the PAR and IOTN scales to determine the need for and outcome of orthodontic treatment.
2018 – Pearl Ortho
Late in 2018, BHA Limited – authors of the Pearl Dental Software practice management system – announced the release of Pearl Ortho. This is a simple-to-install and easy-to-use extension of Pearl Dental Software that is a free upgrade for existing users. Yet it provides all the automated facilities an orthodontist needs to chart, plan and manage treatments of both functional and aesthetic orthodontic patients.
Many countries now have formal training programmes in place for Orthodontists. Here are a few examples for comparison.
Dhaka Dental College in Bangladesh is one of the many schools recognized by the Bangladesh Medical and Dental Council (BM&DC) that offer post-graduation orthodontic courses. Applicants must have completed the Bachelor of Dental Surgery (BDS) examination from any dental college.After application, the applicant must take an admissions test held by the specific college. Successfully selected candidates undergo training for six months.
Currently, there are 10 schools in the country offering the orthodontic speciality. The Canadian Dental Association expects orthodontists to complete at least two years of post-doctoral, speciality training in orthodontics in an accredited program, after graduating from their dental degree.
Dentists must graduate with a Bachelor of Dental Surgery (BDS) or equivalent degree. Pakistan Medical & Dental Council (PMDC) has a recognised program in orthodontics as Master in Dental Surgery (MDS) orthodontics and FCPS orthodontics as 4 years post-graduate degree programs.
There are several Orthodontic Specialty Training Registrar posts available. The program is full-time for three years, and upon completion, trainees graduate with a degree at the Masters or Doctorate level. Training may take place within hospital departments linked to recognised dental schools. Obtaining a Certificate of Completion of Specialty Training (CCST) allows an orthodontic specialist to register with the General Dental Council (GDC).
There are several colleges and universities in the United States that offer orthodontic programs. Applicants are required to have graduated with a DDS or DMD from an accredited dental school. Entrance into an accredited orthodontics program is extremely competitive and begins by passing a national or state licensing exam.
The program generally lasts for two to three years, and by the final year, graduates are to complete the written American Board of Orthodontics (ABO) exam.