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Korea Academy of Occlusion, Orthodontics & Osseointegration.

Evolution of dental orthodontics

Categories: 교정, Date: 2014.04.11 15:23:36

Special Articles

A brief history of orthodontics
Milton B. Asbell, DDS, MSc, MA
Cherry Hill, N. J.

AJODO August 1990 ? Volume 98 ? Number 2, p. 176-183
Sections
  •  Ancient civilizations 
  •  Middle ages (476 to 1450) 
  •  Renaissance period (fourteenth to sixteenth century) 
  • Eighteenth century 
  •  Orthodontics in the United States 
  •  American orthodontics, 1800 to 1840 
  •  American orthodontics, 1840 to 1875 
  •  American orthodontics, 1875 to 1900 
  •  References

Man's ancestry may be traced back for more than one hundred millenia. One of the earliest known types of man is Neanderthal Man. The name is erived from a valley in western Germany where the skeletal remains were found in 1856. He was distinguished by a stocky, heavily muscled build, proportionately short forearm and lower leg, and an extremely dolichocephalic skull with projecting occiput, heavy supraorbital tori, receding orehead, and underdeveloped chin.
Another type of man in the early Pleistocene period was Heidelberg Man. His skeletal remains?the famous Heidelberg jaw?consisted of a massive fossilized chinless jaw with distinctly human dentition. The specimen was discovered in 1907 near the town of the same name. Next in the ancestral line of man is pithecanthropus, a primitive man that is known from a skull and other bone fragments found near the village of Trinil, Java, in 1890. The profile is similar to that of the ape, with a very low forehead and an undeveloped chin. The teeth are characteristically like those of human beings. Another link is the sinjanthropus, whose skeletal remains were discovered near Peking, China, in 1929, and is also known as Peking Man. Skulls, many teeth, and other skeletal parts reveal a close anatomic relationship to pithecanthropus. It is considered “close to the main line of descent to modern man.” It was not until the postglacial period, which extended back 30,000 to 40,000 years, that modern man, homo sapiens, appeared. The Cro-Magnon Man is an outstanding representative of the first “true man.” Many of his skeletal remains have been found in various parts of Europe. The name is derived from a cave near Les Eyzies, France. The shape of the skull, face, and brain are characteristic of the modern Caucasian man, except for the difference in size.
During the years from prehistoric time, man has undergone certain evolutionary changes. These changes include the development of an increased cranial capacity; the change in the skull conformation; a heightening of the forehead and a receding of the brow ridges; the reduction of the dental and jaw arches that gave form and prominence to the chin; the progressively humanlike appearance of the teeth; and the increase in stature, with the body becoming more erect.
Contrary to popular belief, early man also suffered from dental and oral diseases. This was probably because of the type of food he ate and altered occlusion due to excessive wear, causing edge-to-edge or a minimal overbite pattern.1,2


Ancient civilizations TOP
The history of orthodontics has been intimately interwoven with the history of dentistry for more than 2000 years. Dentistry, in turn, had its origins as a part of medicine. To properly study our orthodontic origins, we must return to the Greek civilization of the preChristian era. The Greek physician Hippocrates (460 to 377 BC) is revered as a pioneer in medical science, chiefly because of his medical authorship. He was the first to separate medicine from fancy or religion, and with his reports of critical observation and experience, he established a medical tradition based on facts. This collected information was gathered into a text known as the Corpus Hippocraticum, the medical testament of the preChristian era. This treatise does not discuss the dental art independently but contains many references to the teeth and the tissues of the jaws as part of the medical text. An example: ...the 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. Among those individuals whose heads are long-shaped, some have thick necks, strong members and bones; others have strongly arched palates; thus teeth are disposed to irregularity, crowding one on the other and they are molested by headaches and otorrhea. (Epidemics, chapter: de carnibus.)3

Aristotle (384 to 322 BC), the Greek philosopher, had equal stature in the fields of
statesmanship, art, and biology. His interest in biology gave to medical science the first system
of comparative anatomy and the studies of zoology and physiology. He was the first writer who
studied the teeth in a broad manner, having examined them in relation to the dentitions of
various types of animals. He may be regarded as the first comparative dental anatomist
because, in his famous work entitled De Partibus Animalium (On the Parts of Animals), he
compared the various dentitions of the known species of animals of that time. He noted that
there were marked differences between human teeth and those of animals and, in fact,
differences between the different species of animals. He described the dental apparatus of the
viviparous animal, distinguishing between teeth, tusks, and horns.
Aulius Cornelius Celsus (25 BC to AD 50), one of the prominent Roman medical authors of the
first century, wrote in De Re Medicina (On Medicine):
When in a child a permanent tooth appears before the fall of the milk tooth, it is necessary to
dissect the gum all around the latter and extract it. The other tooth must then be pushed with
the finger, day by day, toward the place that was occupied by the one extracted; and this is to
be continued until it reaches its proper position.5

The medical art of the Romans reached its zenith under Claudius Galenus, commonly known as
Galen (AD 130 to 200?). For 15 centuries he dominated medical thought, and it was not until
the Renaissance that the infallibility of his medical expertise was questioned. In his medical
writings, he described dental anatomy and embryology by specifically identifying the origin,
growth, and development of the teeth and enumerating the functions of each. He believed the
teeth to be true bones. Because dissection was performed on animals rather than on human
beings, he erroneously applied some of his findings to human beings (e.g., the presence of an
intermaxillary bone and the insensibility of teeth).5

Middle ages (476 to 1450) TOP
There is very little reference to dentition during this period, with one exception. An Arabic
physician, Paulus Aegineta (Paul of Aegina) 625 to 690), wrote:
When supernumerary teeth cause an irregularity of dental arches, they may be corrected by
resection of such teeth or by extraction. In case one projects above the level of others, the part
protruding should be removed by means of a file (epitome).5

He also stated that irregular teeth were “displeasing in women.”6


Renaissance period (fourteenth to sixteenth century) TOP
During the Renaissance, one of the greatest geniuses of history, Leonardo da vinci (1452 to
1519), is remembered because he painted a smile on the lips of Mona Lisa. Her smile remains
most provocative; yet the brush was only one of the many tools he mastered. He was the first
artist to dissect the human body for the acquisition of anatomic knowledge and the first to draw
accurate pictures of these dissections.
Leonardo was the first to recognize tooth form and the first to realize that each tooth was related
to another tooth and to the opposing jaw as well, thus perceiving the articulation of the teeth. He
described the maxillary and frontal sinuses and established their relationship to facial height. He
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.”
Those (teeth) that act most powerfully, the mascellari (molars) have broad flattened crowns
suitable for grinding the food, but not for tearing or cutting it; those that act less powerfully, the
incisors, are suitable for cutting the food but not for grinding it; while the maestre (canines) are
intermediate between these two sets, their function being presumably that of tearing the food.1

Andreas Vesalius (1514 to 1564), a Belgian physician and anatomist, set a precedent in the
study of human anatomy when he personally performed a dissection. It had been the custom for
students to do the dissections while the lecturer described the procedure and specimen. He
proved Galen wrong in many areas of anatomic knowledge. His classic work, On the Fubric of
the Human Body, became the foundation that reconstructed our knowledge of human anatomy
and thereby laid the basis for the practice of medicine and surgery.
In this book, he described the minute anatomy of the teeth, particularly the dental follicle and
subsequent pattern of tooth eruption:
We believe that only the teeth among the bones are given the perceptible faculty of sensation
by certain small soft nerves, propagated by the third pair of cranial nerves and implanted at their
roots ... the Almighty Artificer of things deservedly is to be praised Who, we believe, liberally
bestowed the noteworthy faculty of sensation on the teeth alone among the rest of the bones.
For He knew that they will frequently encounter objects which might cut, break, or scratch them,
unduly heat or chill them, or affect them in some other way... . Consequently, had they no power
of sensation, Man would not be warned by pain and would not protect the tooth by avoiding the
injurious agent before the threatened teeth are damaged. There are usually thirty-two teeth in
all, a single series of sixteen in each jaw, most fittingly placed in the form of a semi-circle. The
first four front teeth, because they cut, are called incisors; next come the canines placed singly
at each side, to have torn apart that not done by the incisors. They receive their name because
of their resemblance to the outthrust of dogs. After them are the maxillares, or molars, five on
each side, rough, broad, hard and large by means of which food cut by the incisors and broken
up by the canines can be ground to perfect smoothness.1

Ambrose Pare (1517? to 1590), 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. Crude as these appliances may seem, there was no appreciable advance for more
than 3 centuries.1

Gabriele Fallopio (1523 to 1562), commonly known as Fallopius, an Italian anatomist, wrote in
his Observationes Anatomica (Anatomic Observations) a detailed description of the dental
follicle. He also gave us the terms hard and soft palate.
A membranous follicle is formed inside the bone furnished with two apices, one posterior (that is
to say, deeper down, more distant from the gums), to which is joined a small nerve, a small
artery and a small vein; the other anterior (that is, more superficial) which terminates in a
filament ... inside the follicle is formed a special white and tenacious substance, and from this
the tooth itself, which at first is osseous only in the part nearest the surface, whilst the lower part
is still soft, that is, formed of the above mentioned substance. Each tooth comes out traversing
and widening a narrow aperture ... bare and hard; and in process of time the formation of its
deeper part is completed.1

Bartholomaeus Eustachio (1520 to 1574), commonly known as Eustachius, also an Italian
anatomist, described the minute structure of many organs, especially the tube that connects the
middle ear with the nasopharynx and that bears his name. He wrote Libellus de Dentibus (Book
on the Teeth) in 1563, which is the first important specialized monograph on the anatomy of the
teeth. In this book, he collected the writings of various authors from Hippocrates to Vesalius,
added the results of his own researches, and gave the first accurate account of the
phenomenon of the sequential development of the first and second dentitions. He described the
eruption and the function of the teeth, contending that there was no analogy between the
deciduous and permanent dentitions. Eustachius devoted more attention to the teeth than most
anatomists, giving full descriptions of the different forms, number and varieties. He indicated the
manner of articulation of the teeth and gave a somewhat ambiguous explanation of the nature
of the attachment of the teeth to the socket and the gingival tissues, comparing the latter to the
attachment of the nails to the skin. His explanation of the internal structure of the teeth
differentiated the two layers and compared the enamel with the bark of trees.
Eustachius described the dental follicle and its blood supply. He refuted the doctrine that roots
of the deciduous dentition served to form the permanent teeth. He maintained that the germs of
the permanent teeth are too small to be seen in the fetus. He also mentioned that the teeth are
nourished differently than other bones, as witnessed by their inability to repair when fractured.1

The first book in the German language to have reference to the teeth was entitled Arzei
Buchlein (A Book of the Surgical Art) and was published in 1530 (author unknown). It contains
the following comment:
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.6


Eighteenth century TOP
France became the leader in dentistry throughout the world in the eighteenth century. This was
primarily attributed to one man, Pierre Fauchard. No one person exerted a stronger influence on
the development of the profession than he did. In fact, he is referred to as the “Founder of
Modern Dentistry.” He created order out of chaos, developed a profession out of a craft, and
gave to this new branch of medicine a scientific and sound basis for the future.
The results of his labors are reflected in the publication of his two-volume book entitled Le
Chirurgien Dentiste, ou Traite Des Dents (The Surgeon Dentist, A Treatise on the Teeth)
completed in 1723 and published in 1728. It was the work that heralded the advent of the dental
art based on fundamental knowledge. Three editions appeared in France, but it was not until
1946 that an English-language edition was printed. With reference to orthodontics, as early as 1723, he developed what is probably the first
orthodontic appliance. It was called a bandolet. It was designed to expand the arch, particularly
the anterior teeth and was the forerunner of the expansion arch of modern times. If the teeth are
much out of line and cannot be corrected by means of threads, it is necessary to use a band of
silver or gold. The width of the band should be less than the height of the teeth to which it is
applied. The band must neither be too stiff nor too flexible. Two holes are made at each end, a
thread passing partially through forms a loop in the middle of each thread ... by the pressure
and support given the band the inclined teeth will be made upright for a short time.7

Fauchard described 12 cases of orthodontic treatment in patients whose ages ranged from 12
to 22 years, with apparently good results. Other treatment procedures included the filing of
teeth, especially for crowded anterior teeth, and the use of a special forceps called the pelican,
named for its resemblance to the beak of that bird.
Making use of the file, I began by separating the tooth from the neighboring ones which pressed
upon it, slightly diminishing the space it ought to have occupied. This done, I straightened the
tooth with the pelican, placing it in its natural position ... no sooner had I reduced the tooth to its
normal position I fixed it to those next to it by means of a common thread, which I left there for
eight days.7

He seldom had recourse to extraction and urged attention to the deciduous teeth.
Another important French dental surgeon was Robert Bunon (1702 to 1788), who wrote in his
book entitled 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... . One child, by the state of his teeth,
appears too young at fifteen or sixteen years of age for certain operations, which for him may be
premature, and another child of eleven or twelve years old, may sometimes have waited so long
for a remedy that, in this case, it is already too late.1

In 1757 Etienne Bourdet (1722 to 1789), 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.
He wrote in his Recherches et Observationes sur Toutes les Parties de L'art du Dentiste
(Researches and Observations on Every Branch oftheArt ofthe Dentist):
The strings should be removed and retightened twice a week, until the teeth have resumed their
proper position?that is to say, until the teeth of the upper jaw are drawn forward so that no part
of them is hidden behind those of the lower jaw.1

Bourdet differed with Fauchard in that he recommended the extraction of the first premolars to
preserve symmetry of the jaws. In children who had protruding chins, Bourdet corrected this by
extracting the mandibular first molars shortly after eruption.
In England, John Hunter (1728 to 1793), a great teacher of anatomy, is numbered as one of the
foremost surgeons of his day. Hunter left a valuable array of publications, one of which, The
Natural History of the Human Teeth: Explaining Their Structure, Use, Formation, Growth and
Diseases8
is of particular interest. It was published in 1771 and initiated a new era in dentistry
by placing dentistry on the basis of scientific observation at a time when empiricism was
rampant. Hunter's descriptions of the formation and the growth of the teeth and jaws excelled
anything previously published. He demonstrated the growth, development, and articulation of
the maxilla and mandible with the attached musculature and outlined the internal structure of
the teeth (enamel) and bone (dentin) and their separate functions. His innumerable experiments
and observations of case histories established the difference between bone and teeth for the
first time. Because he improperly prepared the specimens, in that he had failed to inject
disclosing material in teeth during a series of experiments, he erroneously concluded that teeth
were “nonvascular.” For the nomenclature of dentistry, he labeled incisors, bicuspids, and
molars.1,4
Robert Blake, a disciple of Hunter, followed in his footsteps of scientific inquiry, as
demonstrated by his thesis presented to the University of Edinburgh entitled “On the Structure
and Formation of the Teeth in Man and Various Animals.” It was published in 1798. The
following is an excerpt from the text:
I feel myself justified that the alveolar arches continue to increase during the entire progress of
the formation of the teeth. It is, however, sufficiently evident that the greatest increase of the
jaws is backward ... we frequently meet with disproportions between the jaws and teeth, and in
such that the permanent teeth never would become regular without the assistance of the art.4

In Germany during the eighteenth century, little attention was paid to the dental art. However,
we should note that 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 (1737 to 1810) 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.”9


Orthodontics in the United States TOP
In Colonial America, primitive conditions for dental care existed for almost a century until
European-trained “operators for the teeth” came to this country seeking fresh opportunities. The
art of dentistry in America can be said to have had its origin with the importation of these
practitioners to the colonies.
One of the most important native practitioners was John Greenwood (1760 to 1819). His skills
were first learned from his father, who was an instrument maker. He was apprenticed to Dr.
Gamage, who taught him the rudiments of the dental art. Through experience, he became
proficient in the practice. He was a strong advocate of the care of children's teeth. He published
the following advertisement in 179710:
Parents and Guardians. As the attention that is necessary to be paid to children's teeth at the
time of shedding and after being of so great importance to their regularity, evenness and future
preservation, needs no observations. Mr. Greenwood is induced by the patronage of many
families, to reduce his prices for taking the sole care of children's teeth by the year, to give
everyone an opportunity to be benefitted by him. For four children and upwards, in one, family
per year, one guinea. For one child per year, ten shillings to be paid when the year is out from
the time of entering.
Other practitioners include Josiah Flagg (1763 to 1816) of Boston, who advertised that he
“regulates teeth from their first teeth, to prevent pain and fevers in children, assists nature in the
extension of the jaw, for a beautiful arrangement of a second set of teeth.”11,12 In 1798 C. W.
Whitlock of Philadelphia stated that he “supplies the deficiences of nature ... files, regulates,
extracts ... teeth.” John Le Tellier, also of Philadelphia, “regulates teeth from their first cutting in
children.” (1804). B. Fendall of Baltimore advertised that he “regulates the teeth of children”
(1784).
Leonard Koecker (1728 to 1850), practicing in Philadelphia, advertised that he “supplies
ligatures to teeth of an irregular position.” He stated in his published articles in the medical
press (1826)13:
Irregularities of the teeth is one of the chief predisposing causes of disease, and never fails
even in the most healthy conditions to destroy, sooner or later, the strongest and best set of
teeth unless properly attended to. It is not only a most powerful cause of destruction of the
health and beauty of the teeth but also to the regularity of the features of the face, always
producing, though slowly, some irregularity, but frequently the most surprising and disgusting
appearance. It is, however, a great pleasure to know that dental surgery is abundantly provided
with a remedy, and in most delicate subjects if placed under proper care at an early age, the
greater portion of the teeth of the permanent set may invariably be preserved to perfect health
and regularity. A note about his recommendation for extraction. He advocated the extraction of first molars
"since they are generally predisposed to disease ... and if these teeth be extracted at any period
before the age of twelve years, all the anterior teeth will grow more or less backwards and the
second and third molars so move toward the anterior part of the mouth ... to fill up the vacant
space.

American orthodontics, 1800 to 1840 TOP
Irregularity of the teeth had been recognized by dental surgeons early in the nineteenth century.
Benjamin James (1814) noted that he was “often called upon to cure irregularity, than to prevent
it.”4
Levi S. Parmly (1819) stated that “where irregularities are allowed to proceed and become
fixed, it is often a matter of difficulty, and sometimes of impossibility to rectify them.”14
Samuel S . Fitch, MD, whose book entitled A System of Dental Surgery, published in 1829, is
considered the first definitive work on dentistry in this country, devoted a significant amount of
information to irregularities of the teeth. He was the first to classify malocclusion:
There are four states of this kind of irregularity. The first when one central incisor is turned in,
and the under teeth come before it, whilst the other central incisor keeps its proper place,
standing before the under teeth. The second is, when both the central incisors are turned in,
and go behind the under teeth; but the lateral incisors are placed properly and stand out before
the under teeth. The third variety is when the central incisors are placed properly but the lateral
incisors stand very much in; and when the mouth is shut, the under teeth project before them
and keep them backward. The fourth is, when all incisors of the upper are turned in, and those
of the under jaw shut before them.1,4

His treatment consisted of applying “a force which shall act constantly upon the irregular teeth
and bring them forward; the other force to remove that obstruction which the under teeth by
coming before the upper, always occasion.” This is done by “application of an instrument
adapted to the arch of the mouth ... fastening a ligature on the irregular tooth and ... removing
the resistance of the under teeth by placing some intervening substances between the teeth of
the upper and under jaw, so as to prevent them from completely closing.”
Other practitioners found various forms of treatment, such as the use of gold or silver plates “to
exert a gentle but continued pressure.” Shearjashub Spooner (1809 to 1859) wrote in his Guide
to Sound Teeth (1838):
...we have to consider, first, their general appearance as to regularity to the central circle; and,
second, the state of preservation of each individual tooth ... in cases where there is a
predisposition to a projecting chin... .1

M. Bourand from Paris observed that the parents should be alerted to the shedding of the
deciduous teeth and any possible deformity. He stated:
Defects, sometimes, which are of such magnitude, that I have known, in my long practice in
both hemispheres, some young ladies of respectable families and of elegant features who could
not observe their smiling countenances in a looking glass without blushing at the irregularities of
their teeth; when comparing their mouths with some of their young friends toward whom their
parents had bestowed all the necessary care to regulate their growth from childhood.15

American orthodontics, 1840 to 1875 TOP
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.
(Robert Augustine, 1854) Thus, by the mid-nineteenth century basic concepts of diagnosis and treatment had begun. It
was a time when each practitioner attempted treatment by devising his own method based on
purely mechanical principles. Orthodontics was part of prosthetic dentistry, and the literature on
the subject described orthodontics in the area of partial and total replacement of missing teeth.
Chapin A. Harris (1806 to 1860), one of the most influential dental surgeons during this period,
published the first modern classic book on dentistry, The Dental Art, in 1840. In it he gives much
attention to various orthodontic treatment procedures that were adapted from French and
English practitioners; his personal technique included the use of gold caps on molars to open
the bite and knobs soldered to a band for tooth rotations.1

Materials generally used were cotton or silk ligatures, metallic wedged arches, and wooden
wedges, but the discovery of vulcanite?a material used for artificial dentures?permitted the
construction of bite plates and other forms of removable appliances. In addition, springs that
were to be attached to the metal frames for use in individual tooth movement were introduced.
As early as 1841, William Lintott introduced the use of screws. They were described in On the
Teeth, in the chapter entitled “Irregularities of the Teeth”:
When any one or more teeth project beyond the right line, and it is desired to move them
inwards, a small hole must be drilled through the bar, over against the most prominent point of
each; a screw-thread is then to be cut and a short screw introduced, which working through the
bar, will, by a turn or two each day, keep up such a continued pressure against each tooth as
will quickly force it back as desired.1

He described the premature loss of deciduous teeth as a cause of malocclusion, explained that
crowding was due to faulty growth and development, recommended that treatment begin at the
age of 14 or 15 years and also described a bite-opening appliance, which consisted of a labial
arch of a light bar of gold or silver passed around the front surfaces of the teeth by means of
ligatures (known as Indian twist), and the necks of the irregular teeth with pressure applied for
movement.
In this manner, any required movement of the teeth, inwards or outwards may be affected with
great ease, and in very little time causing no serious annoyance to the patient, the whole
apparatus being removed and cleansed every two or three days.1

A modification of the screw, called the crib, was introduced by the Frenchman J. M. A. strange
in 1841. Strange also introduced the use of the clamp band and for retention advised: “I use a
rubber band attached to some hooks on the appliance surrounding the molars for retention.”1,4

The chin strap as occipital anchorage for the treatment of mandibular protrusion was introduced
by J. S. Gunnell in 1840, and the principle of this may be seen today.16 Occipital anchorage was
obtained by the use of headgear devised by F. Christopher Kneisel.1

In 1852 the American Society of Dental Surgeons, the first national dental association
established in this country (1840), committed to a great interest in this phase of dentistry,
formed a committee on dental irregularities. The first report was given by E. J. Tucker, a
respected dental surgeon of Boston, in 1853.17 He condemned the practice of early extraction of
deciduous teeth and advocated the use of rubber bands, or tubes, for tooth movement. He said,
“The exact position of the teeth, the lines of force to be observed and the tenacity of the power
exerted, are all considerations requiring study and a careful judgment.”18 This same Society
sponsored the publication of the first book on orthodontics, Essay on Regulating the Teeth
(1841). It was written by Solymon Brown (1790 to 1876) of New York and was intended to
inform parents by stressing the importance of preventing irregularities.1

In 1854 Thomas W. Evans (1823 to 1897), an American dentist practicing in Paris, France,
published the requirements for an appliance in the Dental Newsletter19:
1st: a film support which shall not loosen or in any way injure the teeth to which it is attached;
2nd: a steady and sufficient pressure;
3rd: great delicacy of construction that the apparatus may be a light as possible;
4th: as a mechanism as simple as the case will admit. In 1860 Emerson C. Angell (1823 to 1903) was probably the first person to advocate the
opening of the median suture to provide space in the maxillary arch, since he took a strong
stand against extraction.20 James D. White also perfected a removable vulcanite appliance with
a hinge in a split palate (1860).21
O. A. Marvin (1828 to 1907), in 1866, outlined the objectives of orthodontic treatment:
1st: the preservation of correct facial expression;
2nd: the restoration of such expression;
3rd: the proper articulation of the teeth for better mastication;
4th: their orderly arrangement, with a view to preventing decay.1

As early as 1871 William E. Magill (1825 to 1896) had cemented bands on the teeth.22
It may be of interest to know that in 1864 George J. Underwood23 of New York presented his
graduation thesis at the Pennsylvania College of Dental Surgery (Philadelphia)
entitled“Orthodontia.”

American orthodontics, 1875 to 1900 TOP
It was not until the latter part of the nineteenth century when a few dedicated dentists gave
special attention and importance to this phase of dentistry, that our specialty began to emerge.
Known in that time as orthodontia, it required special mechanical skills and knowledge in such
basic sciences as anatomy, physiology, and pathology.
The period of the last three decades of the nineteenth century is studied in the framework of
individual dentists and their contributions. Each practitioner developed his own theory and
practice, some to a greater degree of excellence than others. Those to be discussed briefly
include John H. Farrar (1839 to 1913); Norman W. Kingsley (1829 to 1913); Alton H. Thompson
(1849 to 1914); Issac B. Davenport (1854 to 1922); Henry A. Baker (1848 to 1934); Eugene S.
Talbot (1847 to 1925); simeon H. Guilford (1841 to 1919); and W. G. A. Bonwill (1833 to 1899).
John Farrar could be referred to as the Father of American Orthodontics. It was he who gave
impetus to the scientific investigations that permitted the understanding of the theory and
practice of orthodontics. He began his studies in 1875, during which time he investigated the
physiologic and pathologic changes occurring in animals as the result of orthodontically induced
tooth movement. As a result of his studies, he published a series of articles between 1881 and
1887 in the Dental Cosmos, one of the leading dental journals, enunciating the principle that “in
regulating teeth, the traction must be intermittent and must not exceed certain fixed limits.”4
He
also published Irregularities of the Teeth and Their Correction, Vol. 1 in 1888 and Vol. 2 in 1889,
in which he demonstrated the many uses of the screw as the motivating attachment and the
basis of what he referred to as a system of orthodontia. (Copies of these books are in the
American Association of Orthodontists library in St. Louis, Mo.) (The jackscrew was originally
introduced in 1849 by D. William Dwinelle.24) He stressed the “importance of the observance of
the physiologic law which governs tissues, during movement of the teeth, the subject being to
prevent pain.”1
Farrar was the originator of the theory of intermittent force, and the first person
to recommend root or bodily movement of the teeth.
Norman W. Kingsley was a prominent dentist, artist, and orthodontist. As early as 1866, he
experimented with appliances for the correction of cleft palate and is associated with a
technique known as jumping the bite with the use of a bite plate.25 It was the treatment for
protrusion of the maxilla, not necessarily with extractions, shaping the dental arches to be in
harmony with each other. He used vulcanite in conjunction with ligatures, elastic bands made of
rubber, jackscrews, and the chincap. In 1880 he published A Treatise on Oral Deformities,
which remained a textbook for many years. He, too, emphasized the importance of the
relationship between mechanics and biology as the principle on which orthodontics should be
based. His book was the first to recommend that etiology, diagnosis, and treatment planning were the acceptable bases of practice. “Much success in treating irregularities will depend upon
a correct diagnosis and prognosis.”26,27
Alton H. Thompson was one of those forgotten dentists who made a valuable contribution to the
specialty. He was recongized as an authority on comparative dental anatomy -certainly a basic
consideration for orthodontists. (He was a founder of the American Anthropological Society.) He
devoted himself to research into the dynamics of occlusion. This led him to the following
analysis:
a. the construction of the temporomaxillary articulation allows for lateral anteroposterior,
vertical, and oblique movements;
b. the extent of maxillary development is reflected for the necessary support of the
extensive masticating mechanism;
c. there is a suppression of density and diameter of the maxillary bones;
d. there is a predominance of the rotatory over the elevating muscles of mastication; and
e. the special construction of the masticatory armature?this is the teeth, their vertices,
parallel arrangement of the dental tissues, and the apposition of the crushing teeth.28
Isaac B. Davenport, as early as 1881, had created an interest in the study of occlusion. He
developed a theory that the masticatory apparatus was subject to the laws of nature, that
imperfect occlusion was deleterious to the dentition, that extraction of teeth in treatment could
affect the efficiency of the masticatory apparatus. He lectured before the New York Academy of
Medicine in 1887. His lecture entitled “The Significance of the Natural Form and Arrangement of
the Dental Arches, With a Consideration of the Changes Which Occur as a Result of Their
Artificial Derangement by Filing or by the Extraction of Teeth” was a tremendous influence on
the orthodontists. To provide a normal occlusion the practice of extraction of teeth was almost
abandoned, being replaced by the expansion of the arch and the realignment of the teeth.
While admitting the value of extraction as a means of correction of certain irregularities of the
teeth, I am forced to believe that far more irregularities have been caused by extractions than
could ever have been corrected by extraction.29
Henry A. Baker is remembered because in 1893 he introduced the so-called Baker anchorage,
or the use of intermaxillary elastics with rubber bands. The introduction of intermaxillary elastics
was interpreted by some practitioners to mean the elimination of the need for extraction. Clark
Goddard was an early advocate of the study and research into comparative odontology, the
study of skulls and teeth.30 This led to the acceptance of an expansion screw for the forcible
separation of the maxilla. He also attempted to classify malocclusion, which included 15
separate types of irregularities.
Eugene S. Talbot was equally proficient in periodontics and orthodontics. He stressed the study
of the causes of malocclusion to be the key to treatment. He stated that “without the etiology of
irregularities no one can successfully correct deformities, as is evident in the many failures by
men who profess to make this a specialty.” He added, “Eighteen years of experience in the
correction of irregularities of the teeth and a practical knowledge of the laws of mechanics have
taught me not to rely on any particular appliance. Frequently, though a certain appliance has
worked well in one case it may not have been efficient in another case of similar nature...”1
He
advised close attention to disproportion in the size of the maxilla and mandible, “general contour
and profile of the face,” and “the family history including hereditary factors.” He was one of the
first to recommend the surgical exposure of impacted canines.31
In a paper presented to the Mississippi Valley Association of Dental Surgeons in March, 1891,
entitled “Scientific Investigation of the Cranium and Jaws,” he demonstrated intraoral
measurements on casts with such instruments as the registering calipers and the T-square with
graduated sliding indicator. This was one of the earliest attempts applying specific analysis of
casts that reflected measurements of the jaws.
Simeon H. Guilford, dean of the Philadelphia Dental College, was regarded as one of the finest
practitioners of that period. At the request of the National Association of Dental Faculties, he wrote the first textbook for students, Orthodontia: Malposition of Human Teeth, Its Prevention
and Remedy, published in 1889. In it he attempted to offer a classification of malocclusion (p.
142):
There are two divisions -simple irregularities or the malposition of few teeth with no important
facial disharmony and complex irregularities, that is, malposition of many teeth having
corresponding facial deformity. (These divisions contain eleven classes of malposition.)
He commented on extraction in treatments:
Probably no operation in the practice of orthodontia is more important, or has associated with it
greater possibilities for good or evil to the patient than that of extraction.
W. G. A. Bonwill said, “in vying with nature in matching the teeth, there must be more than mere
mechanics, more than being capable of filling a tooth or treating an abscess?we must be
dental artists.” He developed what is known as the Bonwill equilateral triangle.1
It is based on
the mandibular analysis of a tripod arrangement extending from the center of the condyloid
process to the median line at the point where the mandibular central incisors touch at the cutting
edge. His measurements of more than 2000 cases showed that from the center of one
condyloid process to the center of the other was 4 inches and that from the center to the incisor
was also 4 inches. He used this theory in his orthodontic treatment. He advocated a specialty of
orthodontics many years before Angle:
Really, in every city someone should make of this a special practice, and the profession should
encourage such by sending cases for inspection and consultation. And such a specialist should
do all he can in return to teach by example and demonstrations by clinics, to enlighten those
who are placed so far from large cities that they are compelled to take such cases. When we
can have that understanding between us, then we may feel as banded brothers more fully
equipped for those hitherto difficult and thankless operations.1

The principles of resorption and deposition of alveolar bone during tooth movement were
discussed by L. E. Custer (Ohio) in March, 1888, at a meeting of the Mississippi Valley Dental
Association in a paper entitled “Intermittent Pressure: Its Relation to Orthodontia.”1

In 1899 the Items of Interest was the first dental journal to devote a section of each issue to
orthodontia because of the recommendation of its editor, R. Ottolengui (1861 to 1937).4

This article will be continued in the next issue.

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