Evolutions of Orthodontics

extracted from A HISTORY OF THE AMERICAN ASSOCIATION OF ORTHODONTISTS

Origins of today's orthodontics extend back to the medical practices of ancient times. Herodotus, the historian of the pre-Christian era makes reference to it and Aurelius Celsus, a writer on medicine in the Roman period also mentions irregularities of the teeth.

However, the specialty attracted no special attention until Lafoulon, a French dentist, began to call his work with crooked teeth "orthodontisie." This was in the 1830's at a time when the infant dental profession began to select certain teeth, the multi-rooted ones, as a base for attaching crude homemade appliances.

About the time of the American Civil War, appliances for tooth movement were becoming somewhat more refined but were worked strictly individually--there was no attempt to treat the arch as a unit. Doctors Mortimer and the better known Thomas Evans (1823-1897), introduced the labial arch principle; a gold plate was fitted to all teeth labially except those to be moved forward and the plate was tied to anchor teeth with ligatures. Evans devised buccal tubes instead of ligatures tied to anchor teeth. The tubes were attached to the clamp band and the labial arch inserted in them. This inspired later refinements such as George Ainsworth's vertical tubes and the "power tubes" of Varney Barnes, a pioneer member of the American Association of Orthodontists.

Orthodontic practice or "regulating teeth" as it was called grew rapidly in the 1880's and the 1890's and this span of time might well be called a golden age for the mechanics of regulating. Emerson Angell (1823-1903) advocated opening the median suture in the maxilla thereby accommodating teeth crowded into the anterior region. Lawrence Baker and Edward A. Bogue, prominent in the early discussion of the American Association of Orthodontists, expanded on this principle.

Norman Kingsley (1829-1913) perfected a "bite plane" especially effective for treating Class II, division 1 cases. This "plane" of vulcanite with a shelf fashioned on it was placed in the mouth bringing the lower jaw forward into an occlusion with the upper, a practice called "jumping the bite." Together with his earlier announced (1861) elements of occipitual anchorage, Kingsley included this principle in a book that served to inspire other workers in the field. These included Calvin Case, Henry A. Baker, Charles Hawley, Rodriguez Ottolengui, and Edward Angle, most all of whom were active workers in the American Association of Orthodontists in its beginning years. Angle so highly regarded Kinglsey both as a theorist and as an artist that he has called him on occasions, "Orthodontic's Greatest Genius."

In the 1880's Doctor J. N. Farrar began to add the rudiments of biologic considerations to the advances in mechanics through a studied observance of the effect of force and pressure on moving teeth. This earned for him the frequently bestowed title of "Father of Scientific Orthodontics." Screw force and intermittent force were the two main elements he employed as written up under the quaint title of "Regulation of the Teeth made Easy by the Positive System" and widely printed in the dental magazines. This was followed by two books, the first time a specialty writer dealt exclusively with the subject of orthodontics (regulating) as a distinct discipline of practice.

Accompanying Farrar's contribution to orthodontics as a discipline was a host of workers to include Simeion Guilford, Henry A. Baker, Victor Hugo Jackson, Calvin Case, William Magill, Miland Knapp, William E. Walker, to name a few.

Meanwhile a new sector in orthodontic thought was introduced--a system of classification and terminology for diagnosing cases in order to treat them properly. Beginnings were made in 1885-1887. Edward Angle introduced such a classification thereby shaping orthodontics to the measures of a true science. His classification was founded on mesiodistal relations of the teeth, dental arches and jaws with the first permanent molar in the upper arch as a basic determining point.

Contributing to this thought was the inspiration of a brilliant and eccentric prosthetic teacher, William G. A. Bonwill, whose influence came through his widely published"Geometrical Articulation of the Human Jaws (etc.)"

Emphasis on normal occlusion was also part of the Angle doctrine and this reflects the impression made upon Angle by the work of Isaac B. Davenport, an American dentist who worked in Paris and had introduced the subject as early as 1887. His "The Significance of the Natural Form and Arrangement of the Dental Arches of Man" suggested to Angle that extraction as a practice in treatment was entirely unnecessary and should be avoided. Dr. Clark Goddard was another contemporary who studied and wrote on classification--however, he named 15 classes compared to Angle's three.

Providing other food for thought were the implications of the archeology and the study of skulls of the Indian Mounds around St. Louis which Angle found so fascinating when he came to that city to teach in 1897. Added support came from the work of Henry A. Baker, originally a pioneer in cleft-palate corrections who developed the idea of "elastic bands" or intermaxillary anchorage originally intended for his own private correction of his son's malocclusion. Rolof Stanley, one of the pioneers of the specialty, declared the use of intermaxillary force was the keynote of the arch of modern orthodontics--without it the whole structure would fall.

Unfortunately, the accomplishments of the pre-specialty years provided opportunity for commercial abuses. Manufacturing entered into the picture and appliance standardization developed--parts could be supplied by dental supply houses and easily applied by those not as well qualified as a trained orthodontist. To counteract this problem and take the emphasis from the mechanics, training and education became most desirable. Thereby another dimension of the specialty was added.

Although mechanical achievements had assumed respectable proportions, the study of orthodontics was not accorded its proper place in a dental college curriculum, dominated by prosthetics, crown and bridge, etc. Edward Angle decided to do something about this condition and formed a school of his own to teach the specialty.

Thus began the tri-dimensional attributes of a true specialty: a school, a society, a journal.

In 1899-1900 Edward Angle began his class of a few young men in St. Louis. More formally organized classes continued to be held there until the school moved to New York City for its 1908 annual session. The following year it moved to New London, CT, where courses continued through 1911. Angle's poor health forced its discontinuance and he soon moved to California. Classes resumed in a small, informal way in 1920 and 1921 although there were no provisions for clinical work. To remedy this lack, a group of Angle's former students supported a move to build the Angle College on a lot adjoining Dr. Angle's home in Pasadena. It opened on January 8, 1923, and was formally chartered by the State of California in 1924. In continued to hold classes through 1927 at which time it was discontinued. By the opportunities for orthodontic training had increased and were largely available at many of the country's leading universities. Such a condition would continue to improve both in number of schools and quality of instruction until the present state of sound specialty training was reached.

As for an orthodontic society, in 1901 the first formal scientific session and organizational meeting of a "Society of Orthodontists" was held in St. Louis, MO. Most of the students at the Angle School constituted the roll of its 10 charger members. Officially designated the American Society of Orthodontists, it continued to meet annually in the larger cities of the country. As sectional groups began to form in rapid succession in the 1920's and as national economic conditions made it necessary, the society was reorganized in 1937-38 under its present name of the American Association of Orthodontists with its headquarters and central offices in St. Louis, MO.

In 1915 the American Journal of Orthodontics became the specialty's designated serial--originally published under a series of titles which the International Journal of Orthodontia and Oral Surgery is the better known. The publication today is called the American Journal of Orthodontics and Dento-facial Orthopedics and is widely respected