Orthodontics
Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.
Abnormal alignment of the teeth and jaws is very common. The approximate worldwide prevalence of malocclusion was as high as 56%. However, conclusive scientific evidence for the health benefits of orthodontic treatment is lacking, although patients with completed treatment have reported a higher quality of life than that of untreated patients undergoing orthodontic treatment. The main reason for the prevalence of these malocclusions is diets with less fresh fruit and vegetables and overall softer foods in childhood, causing smaller jaws with less room for the teeth to erupt. Treatment may require several months to a few years and entails using dental braces and other appliances to gradually adjust tooth position and jaw alignment. In cases where the malocclusion is severe, jaw surgery may be incorporated into the treatment plan. Treatment usually begins before a person reaches adulthood, insofar as pre-adult bones may be adjusted more easily before adulthood.
History
Though it was rare until the Industrial Revolution, there is evidence of the issue of overcrowded, irregular, and protruding teeth afflicting individuals. Evidence from Greek and Etruscan materials suggests that attempts to treat this disorder date back to 1000 BC, showcasing primitive yet impressively well-crafted orthodontic appliances. In the 18th and 19th centuries, a range of devices for the "regulation" of teeth were described by various dentistry authors who occasionally put them into practice. As a modern science, orthodontics dates back to the mid-1800s. The field's influential contributors include Norman William Kingsley and Edward Angle. Angle created the first basic system for classifying malocclusions, a system that remains in use today.Beginning in the mid-1800s, Norman Kingsley published Oral Deformities, which is now credited as one of the first works to begin systematically documenting orthodontics. Being a major presence in American dentistry during the latter half of the 19th century, not only was Kingsley one of the early users of extraoral force to correct protruding teeth, but he was also one of the pioneers for treating cleft palates and associated issues.
During the era of orthodontics under Kingsley and his colleagues, the treatment was focused on straightening teeth and creating facial harmony. Ignoring occlusal relationships, it was typical to remove teeth for a variety of dental issues, such as malalignment or overcrowding. The concept of an intact dentition was not widely appreciated in those days, making bite correlations seem irrelevant.
In the late 1800s, the concept of occlusion was essential for creating reliable prosthetic replacement teeth. This idea was further refined and ultimately applied in various ways when dealing with healthy dental structures as well. As these concepts of prosthetic occlusion progressed, it became an invaluable tool for dentistry.
It was in 1890 that the work and impact of Dr. Edwards H. Angle began to be felt, with his contribution to modern orthodontics particularly noteworthy. Initially focused on prosthodontics, he taught in Pennsylvania and Minnesota before directing his attention towards dental occlusion and the treatments needed to maintain it as a normal condition, thus becoming known as the "father of modern orthodontics".
By the beginning of the 20th century, orthodontics had become more than just the straightening of crooked teeth. The concept of ideal occlusion, as postulated by Angle and incorporated into a classification system, enabled a shift towards treating malocclusion, which is any deviation from normal occlusion. Having a full set of teeth on both arches was highly sought after in orthodontic treatment due to the need for exact relationships between them. Extraction as an orthodontic procedure was heavily opposed by Angle and those who followed him. As occlusion became the key priority, facial proportions and aesthetics were neglected. To achieve ideal occlusals without using external forces, Angle postulated that having perfect occlusion was the best way to gain optimum facial aesthetics.
With the passing of time, it became quite evident that even an exceptional occlusion was not suitable when considered from an aesthetic point of view. Not only were there issues related to aesthetics, but it usually proved impossible to keep a precise occlusal relationship achieved by forcing teeth together over extended durations with the use of robust elastics, something Angle and his students had previously suggested. Charles Tweed in America and Raymond Begg in Australia re-introduced dentistry extraction into orthodontics during the 1940s and 1950s so they could improve facial esthetics while also ensuring better stability concerning occlusal relationships.
In the postwar period, cephalometric radiography started to be used by orthodontists for measuring changes in tooth and jaw position caused by growth and treatment. The x-rays showed that many Class II and III malocclusions were due to improper jaw relations as opposed to misaligned teeth. It became evident that orthodontic therapy could adjust mandibular development, leading to the formation of functional jaw orthopedics in Europe and extraoral force measures in the US. These days, both functional appliances and extraoral devices are applied around the globe with the aim of amending growth patterns and forms. Consequently, pursuing true, or at least improved, jaw relationships had become the main objective of treatment by the mid-20th century.
At the beginning of the twentieth century, orthodontics was in need of an upgrade. The American Journal of Orthodontics was created for this purpose in 1915; before it, there were no scientific objectives to follow, nor any precise classification system and brackets that lacked features.
Until the mid-1970s, braces were made by wrapping metal around each tooth. With advancements in adhesives, it became possible to instead bond metal brackets to the teeth.
In 1972, Lawrence F. Andrews gave an insightful definition of the ideal occlusion in permanent teeth. This has had meaningful effects on orthodontic treatments that are administered regularly, and these are: 1. Correct interarchal relationships 2. Correct crown angulation 3. Correct crown inclination 4. No rotations 5. Tight contact points 6. Flat Curve of Spee, and based on these principles, he discovered a treatment system called the straight-wire appliance system, or the pre-adjusted edgewise system. Introduced in 1976, Larry Andrews' pre-adjusted edgewise appliance, more commonly known as the straight wire appliance, has since revolutionized fixed orthodontic treatment. The advantage of the design lies in its bracket and archwire combination, which requires only minimal wire bending from the orthodontist or clinician. It's aptly named after this feature: the angle of the slot and thickness of the bracket base ultimately determine where each tooth is situated with little need for extra manipulation.
Prior to the invention of a straight wire appliance, orthodontists were utilizing a non-programmed standard edgewise fixed appliance system, or Begg's pin and tube system. Both of these systems employed identical brackets for each tooth and necessitated the bending of an archwire in three planes for locating teeth in their desired positions, with these bends dictating ultimate placements.
Evolution of the current orthodontic appliances
When it comes to orthodontic appliances, they are divided into two types: removable and fixed. Removable appliances can be taken on and off by the patient as required. On the other hand, fixed appliances cannot be taken off as they remain bonded to the teeth during treatment.Fixed appliances
Fixed orthodontic appliances are predominantly derived from the edgewise appliance approach, which typically begins with round wires before transitioning to rectangular archwires for improving tooth alignment. These rectangluar wires promote precision in the positioning of teeth following initial treatment. In contrast to the Begg appliance, which was based solely on round wires and auxiliary springs, the Tip-Edge system emerged in the early 21st century. This innovative technology allowed for the utilization of rectangular archwires to precisely control tooth movement during the finishing stages after initial treatment with round wires. Thus, almost all modern fixed appliances can be considered variations on this edgewise appliance system.Early 20th-century orthodontist Edward Angle made a major contribution to the world of dentistry. He created four distinct appliance systems that have been used as the basis for many orthodontic treatments today, barring a few exceptions. They are E-arch, pin and tube, ribbon arch, and edgewise systems.