Evolution of orthodontic appliances /certified fixed orthodontic courses by Indian dental academy

EVOLUTION OFOF ORTHODONTICORTHODONTIC
APPLIANCESAPPLIANCES
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing dental educationLeader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
 The word orthodontics is derivedThe word orthodontics is derived
from two greek words , ORTHOSfrom two greek words , ORTHOS
meaning RIGHT OR CORRECT;meaning RIGHT OR CORRECT;
and ODONTOS meaning TOOTH.and ODONTOS meaning TOOTH.
AND the term “ DENTOFACIALAND the term “ DENTOFACIAL
ORTHOPAEDICS “ was suggestedORTHOPAEDICS “ was suggested
…….. By NORMAN BENNET.…….. By NORMAN BENNET.
ORTHODONTICS may beORTHODONTICS may be
described as the study of growth anddescribed as the study of growth and
development of the masticatorydevelopment of the masticatory
apparatus and the prevention andapparatus and the prevention and
treatment of abnormalaties of thistreatment of abnormalaties of this

Orthodontics has made tremendousOrthodontics has made tremendous
strides as a specialised branch ofstrides as a specialised branch of
Dentistry. In fact, it was the FIRSTDentistry. In fact, it was the FIRST
Bonafide dental speciality with theBonafide dental speciality with the
SECOND oldest qualifying BoardSECOND oldest qualifying Board
in ALL of DENTISTRY and MEDICINE.in ALL of DENTISTRY and MEDICINE.
ORTHODONTICS was thenORTHODONTICS was then
considerded a part of the regularconsiderded a part of the regular
prosthetic course, and accordedprosthetic course, and accorded
SECONDARY CONSIDERATION.SECONDARY CONSIDERATION.
This academic affliation still exists,This academic affliation still exists,
in some areas of the world, andin some areas of the world, and
indicates a primarily mechanicalindicates a primarily mechanicalwww.indiandentalacademy.comwww.indiandentalacademy.com

orientation of orthodontic philosphyorientation of orthodontic philosphy
and treatment procedures.and treatment procedures.
Fortunately, the developmentFortunately, the development
of orthodontics as a speciality hasof orthodontics as a speciality has
been more successful. Orthodonticbeen more successful. Orthodontic
therapy depends upon the reactiontherapy depends upon the reaction
of the teeth, and more generally theof the teeth, and more generally the
facial structures to a gentle butfacial structures to a gentle but
persistent force. Orthodontic treatmentpersistent force. Orthodontic treatment
is based on the principle that ifis based on the principle that if
prolonged pressure is applied to aprolonged pressure is applied to a
tooth, tooth movement will occur andtooth, tooth movement will occur and
the bone around the tooth remodels.the bone around the tooth remodels.www.indiandentalacademy.comwww.indiandentalacademy.com

The term EVOLUTION according to
dictionary means –’’ any process of
FORMATION OR GROWTH;
DEVELOPMENT.
And an ORTHODONTIC
APPLIANCE can be defined as—
appliance by means of which mild
pressure may be applied to a tooth
or a group of teeth in a predetermined
direction.

APPLIANCES may be classified as;APPLIANCES may be classified as;
REMOVABLEREMOVABLE
FIXEDFIXED
MECHANICAL FUNCTIONALMECHANICAL FUNCTIONAL

““MEN will never barter their souls or spillMEN will never barter their souls or spill
blood for it ; yet this time-testedblood for it ; yet this time-tested
stainless steel, with the single exceptionstainless steel, with the single exception
of intrinsic value offers more desirableof intrinsic value offers more desirable
characteristics to the fine-metal workercharacteristics to the fine-metal worker
than do the precious metalsthan do the precious metals
themselves. The craftsman asks onlythemselves. The craftsman asks only
that his material be chemically INERT ,that his material be chemically INERT ,
NATURALLY BEAUTIFUL, STRONGNATURALLY BEAUTIFUL, STRONG
yet amenable to his artistry ; it is theyet amenable to his artistry ; it is the
buyer who measures precious metalsbuyer who measures precious metals
by PRICE.”by PRICE.”

the startersthe starters
 Like metallurgy, dentistry has aLike metallurgy, dentistry has a
long history of artistic creativity .long history of artistic creativity .
Over 4500 years ago when the metalOver 4500 years ago when the metal
worker was sweating copper fromworker was sweating copper from
malachitemalachite for weapons, makingweapons, making
primitive tools from “bia n pet”primitive tools from “bia n pet”
(meteoric iron), and separating(meteoric iron), and separating
GOLD from crushed quartz stoneGOLD from crushed quartz stone
literally using what became knownliterally using what became known
as the GOLDEN FLEECE, theas the GOLDEN FLEECE, the
“TOOTHER” was likely splinting the“TOOTHER” was likely splinting the
teeth of the Egyptian court.teeth of the Egyptian court.

 Time passed from the Bronze AgeTime passed from the Bronze Age
to the Iron Age and the industrialto the Iron Age and the industrial
Revolution until, in the latter halfRevolution until, in the latter half
of the 19of the 19thth
century , Henry Cliftoncentury , Henry Clifton
Sorby (1863-1887) and EdwardSorby (1863-1887) and Edward
Hartley Angle (1886-1930)Hartley Angle (1886-1930)
professionally ascended toprofessionally ascended to
become the pioneers of modernbecome the pioneers of modern
Metallography and modernMetallography and modern
orthodontics, respectively. Yet fromorthodontics, respectively. Yet from
all these artistic developments ,all these artistic developments ,
the formalized scientific underthe formalized scientific under
standing of both fields was limitedstanding of both fields was limited
to about the last 100 years .to about the last 100 years .

THE BEGINNINGSTHE BEGINNINGS
 Teeth were regarded by the ancients asTeeth were regarded by the ancients as
very precious to the extent that “ . . .very precious to the extent that “ . . .
Special penalties [ were exacted ] forSpecial penalties [ were exacted ] for
knocking out the teeth of an individual,knocking out the teeth of an individual,
either freeman or slave.” As early aseither freeman or slave.” As early as
400 B.C , Hippocrates referenced in his400 B.C , Hippocrates referenced in his
writings the correction of toothwritings the correction of tooth
irregularities . And while Greece was inirregularities . And while Greece was in
its Golden Age , the Etruscans ( theits Golden Age , the Etruscans ( the
precursors of the ROMANS) wereprecursors of the ROMANS) were
burying their dead with appliances thatburying their dead with appliances that
were used to maintain space andwere used to maintain space and
prevent collapse of the dentition duringprevent collapse of the dentition during
life. Then in a roman tomb in Egyptlife. Then in a roman tomb in Egyptwww.indiandentalacademy.comwww.indiandentalacademy.com

Breccia finds a number of teeth boundBreccia finds a number of teeth bound
with a GOLD WIRE , and at the time ofwith a GOLD WIRE , and at the time of
CHRIST , Aurelius Cornelius CelsusCHRIST , Aurelius Cornelius Celsus
first records the treatment of teeth byfirst records the treatment of teeth by
FINGER PRESSURE. Thus , inherentFINGER PRESSURE. Thus , inherent
malocclusions and the use of correctivemalocclusions and the use of corrective
force are recognized, the virtue offorce are recognized, the virtue of
maintaining space is appreciated, andmaintaining space is appreciated, and
the first orthodontic material isthe first orthodontic material is
documented –documented – a golda gold ligature wireligature wire……
IN All these early references , itIN All these early references , it
was clearly evident that the interest inwas clearly evident that the interest in
treating irregularities of the teeth wastreating irregularities of the teeth was
purelypurely esthetic.esthetic.

EARLY CONTRIBUTORSEARLY CONTRIBUTORS
The FRENCH and ENGLISH dominatedThe FRENCH and ENGLISH dominated
the earliest contributions to the field ofthe earliest contributions to the field of
orthodontics , which as yet had not beenorthodontics , which as yet had not been
formally named. Among theseformally named. Among these
contributors is PIERRE FAUCHARDcontributors is PIERRE FAUCHARD
(1723) who Invents the expansion arch(1723) who Invents the expansion arch
and gives the first comprehensiveand gives the first comprehensive
discussion of appliances . The reputeddiscussion of appliances . The reputed
father of dentistry details the use offather of dentistry details the use of
ligature wires and gold or silverligature wires and gold or silver
mechanical devices . He corrects teethmechanical devices . He corrects teeth
using finger pressure and silk threadusing finger pressure and silk thread
and intuitively recognizes that theand intuitively recognizes that the
source of a force does not matter insource of a force does not matter in
mechanotherapy .mechanotherapy .

 In 1819 Delabarre introduces theIn 1819 Delabarre introduces the
wire crib,and this marks the BIRTHwire crib,and this marks the BIRTH
of CONTEMPORARY orthodontics.of CONTEMPORARY orthodontics.
Later, Schange would show thatLater, Schange would show that
the gold wire crib affordedthe gold wire crib afforded
adequate anchorage and formed aadequate anchorage and formed a
base for attachments.base for attachments.
A century later,Lufkin would stateA century later,Lufkin would state
that “...Schange made an invaluablethat “...Schange made an invaluable
contribution” because it reallycontribution” because it really
marked the beginning of ---marked the beginning of ---

EDGEWISE. In the second halfEDGEWISE. In the second half
of 19of 19thth
century(1865), Kingsleycentury(1865), Kingsley
advocates plates as retainingadvocates plates as retaining
devices. In the early part of 20devices. In the early part of 20thth
century, Angle would tout thiscentury, Angle would tout this
device as one of the best toothdevice as one of the best tooth
maintainers. Fifteen years latermaintainers. Fifteen years later
Kingsley would write his book,Kingsley would write his book,
““ORAL DEFORMITIES”, whichORAL DEFORMITIES”, which
would become the mostwould become the most
comprehensive text on thecomprehensive text on the
subject in its day.subject in its day.

In 1877, Johnston wouldIn 1877, Johnston would
recommend placing Zinc in arecommend placing Zinc in a
predrilled hole of a steel jackscrew,predrilled hole of a steel jackscrew,
which was simultaneously inventedwhich was simultaneously invented
by Dwinelle and Gaine (1849),by Dwinelle and Gaine (1849),
to “… give it the same immunityto “… give it the same immunity
from oxidation asfrom oxidation as gold orgold or
platinumplatinum.”Modern books term this.”Modern books term this
the concept of the ‘ SACRIFICIALthe concept of the ‘ SACRIFICIAL
ANODE’.ANODE’.

thethe enlightenmentenlightenment
In 1908,Norman William KingsleyIn 1908,Norman William Kingsley
already called Angle “…one of thealready called Angle “…one of the
greatest empirics of his day”.greatest empirics of his day”.
Angle identified and lauded manyAngle identified and lauded many
people who sought the truth –people who sought the truth –
Fauchard,Fox,Harris,Kingsley,Fauchard,Fox,Harris,Kingsley,
Magill,Schange and Wescott; .HeMagill,Schange and Wescott; .He
also criticized and wrote scathingalso criticized and wrote scathing
letters to those he thought wereletters to those he thought were
poisoning the newly formed practicepoisoning the newly formed practice
of “ORTHODONTIA” as it wasof “ORTHODONTIA” as it was
called in 1917 . He particularlycalled in 1917 . He particularly
admired Kingsley who , like Farraradmired Kingsley who , like Farrar

(1926),was hailed by his(1926),was hailed by his
contemporaries as “the fathercontemporaries as “the father
of orthodontia.”Kingsley madeof orthodontia.”Kingsley made
particularly substantive contributions toparticularly substantive contributions to
our knowledge of occipital anchorage,our knowledge of occipital anchorage,
which in that period would have beenwhich in that period would have been
using elastic straps, forgedusing elastic straps, forged
Stubbs’ steel,and a swaged silverStubbs’ steel,and a swaged silver
plate.plate.

On the other hand, a material was theOn the other hand, a material was the
proximate cause of the rift betweenproximate cause of the rift between
those who used heavy and bulkythose who used heavy and bulky
NICKEL-SILVER appliances(theNICKEL-SILVER appliances(the
german school) and Angle and hisgerman school) and Angle and his
contemporaries. In 1906, Angle andcontemporaries. In 1906, Angle and
most of his graduates resigned frommost of his graduates resigned from
the society, in part because of theirthe society, in part because of their
difference towards nickel- silverdifference towards nickel- silver
alloys( ie, German silveralloys( ie, German silver
or“NEUSILBER”), which were firstor“NEUSILBER”), which were first
introduced by Angle to the U.S inintroduced by Angle to the U.S in
1887 but which were actually1887 but which were actually
Copper, Nickel, and Zinc Alloys thatCopper, Nickel, and Zinc Alloys that
contained no Silver.contained no Silver.www.indiandentalacademy.comwww.indiandentalacademy.com

Composition of ALLOYS used during 20th
century

During this period, Gold, Platinum,
Silver, Steel, Gum rubber, Vulcanite
and, occasionally, Wood,Ivory, Zinc
and Copper were used as was brass
in the form of loops, hooks, spurs
and ligatures. 14-18 -karat Gold was
routinely used for wire bands, clasps,
ligatures, and spurs,as were iridium-
platinum bands and archwires and
Platinized gold for brackets. The
advantage of gold was that you
could heat treat it to variable
stiffness(30%) , which was
comparable to today’s beta-titanium
alloy. This was accomplished by
heating at 450°C(842°F) for 2

REPORTED PROPORTIES of ALLOYS used during 20th
century

minutes, cooling to 250minutes, cooling to 250°°C(482C(482°°F)F)
over a period of 30 minutes, andover a period of 30 minutes, and
finally quenching to roomfinally quenching to room
temperature. Gold has excellenttemperature. Gold has excellent
corrosion resistance too.corrosion resistance too.
In 1920, Dewey presents a paper onIn 1920, Dewey presents a paper on
clock spring auxiliary as anclock spring auxiliary as an
“Application of spring forces from“Application of spring forces from
Gold and Platinum removableGold and Platinum removable
Appliances.” This presentation wasAppliances.” This presentation was
credited as being the long awaitedcredited as being the long awaited
response to the nickel-silverresponse to the nickel-silver
appliances that caused the rift 14appliances that caused the rift 14
years earlier.years earlier.www.indiandentalacademy.comwww.indiandentalacademy.com

known as the edgewise appliance whichknown as the edgewise appliance which
was never formally named by EDWARDwas never formally named by EDWARD
ANGLE in his lifetime.ANGLE in his lifetime.
Finally, in the Dental cosmos(1928)Finally, in the Dental cosmos(1928)
we see the design of what was to bewe see the design of what was to be

EDGEWISE PARAPHERNALIA OF 1928
WINGLESS BRACKET
Without an archwire engaged
With an archwire engaged

EDGEWISE PARAPHERNALIA OFEDGEWISE PARAPHERNALIA OF 1928
PROTOTYPE OF MODERN BRACKET
Without an archwire engaged
With an archwire engaged

Type of STAPLE
THREADED WASHER used as spacer
LIGATURE WIRE

On Aug 11,1930,EDWARD ANGLE passedOn Aug 11,1930,EDWARD ANGLE passed
into history. As a tribute to him, we shouldinto history. As a tribute to him, we should
recognize that in a 40 year career, herecognize that in a 40 year career, he
truly did understand patients and theirtruly did understand patients and their
tissues , had knowledge of Biology andtissues , had knowledge of Biology and
engineering, comprehend mechanicalengineering, comprehend mechanical
requirements, and contributed 4 distinctrequirements, and contributed 4 distinct
Biomechanical Appliances–Biomechanical Appliances–
the Angle E arch(1909),the Angle E arch(1909),
the pin and the tube appliance(1911),the pin and the tube appliance(1911),
the ribbon arch(1915), andthe ribbon arch(1915), and
the edgewise appliance in the year 1925 .the edgewise appliance in the year 1925 .

No one has yet eclipsed thoseNo one has yet eclipsed those
accomplishments. One couldaccomplishments. One could
readily argue that Edward Anglereadily argue that Edward Angle
was one of the first biomedicalwas one of the first biomedical
engineers. Yet with all theseengineers. Yet with all these
accomplishments, Angle wasaccomplishments, Angle was notnot thethe
greatgreat innovator of novel materials–innovator of novel materials–
others wouldothers would
fulfill that role.fulfill that role.

STAGNATION ABOUNDSSTAGNATION ABOUNDS
From the 1930s to the1960s theFrom the 1930s to the1960s the
proliferation of materials did not occur.proliferation of materials did not occur.
With the death of Angle, a time ofWith the death of Angle, a time of
stagnation eventuates .ASstagnation eventuates .AS
THUROW said, “…the ‘edge-wise men’THUROW said, “…the ‘edge-wise men’
literally rode off in all directions at once”literally rode off in all directions at once”
what became more important at that timewhat became more important at that time
because of their lack of development werebecause of their lack of development were
CEPHALOMETRICS AND BIOLOGICALCEPHALOMETRICS AND BIOLOGICAL
ASPECTS. And so for a while, thoseASPECTS. And so for a while, those
fields of knowledge were emphasized, asfields of knowledge were emphasized, as
profound changes to orthodonticsprofound changes to orthodontics
occurred at the expense of novel materialsoccurred at the expense of novel materials

andand innovative mechanics .It is duringinnovative mechanics .It is during
this period that BEGG gives thisthis period that BEGG gives this
warning to thewarning to the orthodonticorthodontic
communitycommunity: “: “Orthodontics is ill-servedOrthodontics is ill-served
by presentation of new orthodonticby presentation of new orthodontic
techniques that are claimed to be basedtechniques that are claimed to be based
on adaptations of engineering principleson adaptations of engineering principles
but that have not been proven suitablebut that have not been proven suitable
for successful treatment of patients.”for successful treatment of patients.”
During this materials stagnation, weDuring this materials stagnation, we
learn that gold alloyslearn that gold alloys have deficiencieshave deficiencies
too. At the 1931 meeting of thetoo. At the 1931 meeting of the
American Association of OrthodontistsAmerican Association of Orthodontists
(AOO), Norris Taylor and George(AOO), Norris Taylor and George
Paffenbarger discussedPaffenbarger discussedwww.indiandentalacademy.comwww.indiandentalacademy.com

wrought alloys and intimated thatwrought alloys and intimated that
more springiness and fewer cracksmore springiness and fewer cracks
at tension points were possible. Andat tension points were possible. And
at nominally $30 per ounce,Kelseyat nominally $30 per ounce,Kelsey
said that they were costly. Little didsaid that they were costly. Little did
they know that the cost of gold wouldthey know that the cost of gold would
spike to $900 in early 1980.!spike to $900 in early 1980.!
By the early 1930s, stainlessBy the early 1930s, stainless
steels were generally available.steels were generally available.
Although Dumas, Guillet, andAlthough Dumas, Guillet, and
Portevin first made stainless steel inPortevin first made stainless steel in
France, its “stainless” qualities wereFrance, its “stainless” qualities were
first reported inGermany by Monartzfirst reported inGermany by Monartz

also around 1900-1910. Stainless steelalso around 1900-1910. Stainless steel
languished until World War 1 spurredlanguished until World War 1 spurred
the development of 3 different kinds ofthe development of 3 different kinds of
stainless steels, and ironically thosestainless steels, and ironically those
developers received the credit for thedevelopers received the credit for the
discovery. During that war, thediscovery. During that war, the
Germans, British, and AmericansGermans, British, and Americans
developed an austenitic, a martensiticdeveloped an austenitic, a martensitic
and a ferritic stainless steel,and a ferritic stainless steel,
respectively.respectively.
On the other world, in the early 1940’s,On the other world, in the early 1940’s,
Begg would partner with Wilcox toBegg would partner with Wilcox to
make what they envisioned to be themake what they envisioned to be the
ultimate in resilient orthodontic wires–ultimate in resilient orthodontic wires–
Australian stainless steels.Australian stainless steels.

Yet it was not until about 1960 thatYet it was not until about 1960 that
stainless steel was generally accepted.stainless steel was generally accepted.
Nonetheless, in 1933 we find thatNonetheless, in 1933 we find that
stainless steel and a chromium alloystainless steel and a chromium alloy
are being used, as Archie Brusse (theare being used, as Archie Brusse (the
founder of rocky mountain metalfounder of rocky mountain metal
product) -- and so theproduct) -- and so the strugglestruggle betweenbetween
gold and stainless steel formally begins.gold and stainless steel formally begins.

PRODUCTS made from ALLOYS that orthodontics adoptedPRODUCTS made from ALLOYS that orthodontics adopted
1936 FORD SEDAN made from stainless steel

MAINSPRING of WATCH fabricated from COBALT
CHROMIUM alloywww.indiandentalacademy.comwww.indiandentalacademy.com

HYDRAULIC shape-MEMORY COUPLING
manufactured from NICKEL-TITANIUM
intermetallic composition

SR-71 BLACKBIRD constructed from
TITANIUM-MOLYBDENUM alloywww.indiandentalacademy.comwww.indiandentalacademy.com

Regarding Acrylics, unaestheticRegarding Acrylics, unaesthetic
Vulcanite plates with 1.02mm(0.040-Vulcanite plates with 1.02mm(0.040-
inch) resilient gold wires were replacedinch) resilient gold wires were replaced
by translucent acrylic plates soon afterby translucent acrylic plates soon after
acrylic’s discovery in 1937.acrylic’s discovery in 1937.
Although Cellulose, PhenolAlthough Cellulose, Phenol
formaldehyde vinyl polymers andformaldehyde vinyl polymers and
copolymers, styrene, and alkyd resinscopolymers, styrene, and alkyd resins
were explored, by the 1940s, acrylicwere explored, by the 1940s, acrylic
materials were being poly-merized intomaterials were being poly-merized into
plates by reacting, under heat andplates by reacting, under heat and
pressure, doughs made from Methylpressure, doughs made from Methyl
methacrylate monomer and acrylicmethacrylate monomer and acrylic
powder the latter of which reducedpowder the latter of which reduced
shrinkage.shrinkage.

Ultimately, acrylic was so successfulUltimately, acrylic was so successful
that in 1946, 98 % of all denture basesthat in 1946, 98 % of all denture bases
were constructed of this polymer or ofwere constructed of this polymer or of
its copolymers. Today acrylic is the mostits copolymers. Today acrylic is the most
frequently used material for retainers –frequently used material for retainers –
they be a Hawley or a lingual-wirethey be a Hawley or a lingual-wire
retaining device.retaining device.

What Kingsley(1908) said almost 100What Kingsley(1908) said almost 100
years ago still rings true today – that “…years ago still rings true today – that “…
the success of orthodontia as a sciencethe success of orthodontia as a science
and an art now lies in the retainer”.and an art now lies in the retainer”.
But again stainless steel which isBut again stainless steel which is
gaining prominence as the soft ligaturegaining prominence as the soft ligature
wire, which was credited to Angle, is nowwire, which was credited to Angle, is now
displaced by an 0.254mm(0.010-inch)displaced by an 0.254mm(0.010-inch)
soft stainless steel wire. Only 3 yearssoft stainless steel wire. Only 3 years
later ,Steiner introduces thelater ,Steiner introduces the
0.457mm0.457mm×0.711mm (0.018-inch ×0.028×0.711mm (0.018-inch ×0.028
inch) slot for stainless steel wires in lieuinch) slot for stainless steel wires in lieu
of the 0.599mm ×0.711mm(0.022-inch×of the 0.599mm ×0.711mm(0.022-inch×

0.028-inch) slot for gold alloys. And0.028-inch) slot for gold alloys. And
even Jackson proposes to eliminateeven Jackson proposes to eliminate
the Crozat appliance by fabricating itthe Crozat appliance by fabricating it
in stainless steel and a nickel-in stainless steel and a nickel-
chromium alloy (TOPHET metal) butchromium alloy (TOPHET metal) but
still gold crozat appliance survives tostill gold crozat appliance survives to
today.today.

SOME PREMIER BRACKETSSOME PREMIER BRACKETS
OF THE 20OF THE 20THTH
CENTURYCENTURY
The GOLD OR CHROMIUM alloy JOHNSON
FRICTION CAPwww.indiandentalacademy.comwww.indiandentalacademy.com

a SPEED self-ligating STAINLESS STEEL bracket

The STARFIRE single-crystal SAPPHIRE bracket

An ALLURE polycrystalline alumina bracket

To close out this age, a glimmer ofTo close out this age, a glimmer of
things to come is seen asthings to come is seen as
Buonocore proposes the use ofBuonocore proposes the use of
30- second,85% phosphoric acid30- second,85% phosphoric acid
etch to enhance bonding ofetch to enhance bonding of
acrylic materials to enamelacrylic materials to enamel
surfaces.surfaces.
It is now 1958, and DEWELIt is now 1958, and DEWEL
unifies the practice and scienceunifies the practice and science
under one aegis -----under one aegis -----

ORTHOORTHO
DONTICSDONTICS

PROLIFERATION ABOUDSPROLIFERATION ABOUDS
By the 1960s, gold was universallyBy the 1960s, gold was universally
abandoned in favor of stainless steel.abandoned in favor of stainless steel.
This is how stainless steel wasThis is how stainless steel was
marketed in lieu of goldmarketed in lieu of gold1) the force1) the force
per unit activation of stainless steel wasper unit activation of stainless steel was
greater than that of gold (ie, highgreater than that of gold (ie, high
stiffness was an advantage)stiffness was an advantage)
(2) by being smaller in size, stainless(2) by being smaller in size, stainless
steel appliances were regarded assteel appliances were regarded as
being more esthetic than goldbeing more esthetic than gold
appliances (ie, the smaller theappliances (ie, the smaller the
appliance is, the more it appears toappliance is, the more it appears to
disappear). Stainless steel alsodisappear). Stainless steel also
had excellent corrosion resistance,had excellent corrosion resistance,

work hardening capabilities, and awork hardening capabilities, and a
frictional magnitude that was sofrictional magnitude that was so
low that it became the standard oflow that it became the standard of
the profession.the profession.
A FULLY BANDED PATIENT WITH EXTENSIVE
STAINLESS STEEL (SS) LOOP MECHANICS IN
THE YEAR 1965

In the 1960s, bracket bands areIn the 1960s, bracket bands are
disappearing as the bondeddisappearing as the bonded
miniature bracket appears – therebyminiature bracket appears – thereby
punctuating the beginning ofpunctuating the beginning of
esthetic orthodontics.esthetic orthodontics.
Polycarbonate Brackets with
Teflon coated Stainless Steel wirewww.indiandentalacademy.comwww.indiandentalacademy.com

Again in the 1960s cobalt-chromiumAgain in the 1960s cobalt-chromium
alloys are introduced. This alloys notalloys are introduced. This alloys not
only contain cobalt, chromium, andonly contain cobalt, chromium, and
molybdenum but also substantialmolybdenum but also substantial
amounts of nickel and iron. This alloyamounts of nickel and iron. This alloy
have high stiffness, and available inhave high stiffness, and available in
4 different tempers and are4 different tempers and are

heat treatable and thus it permitsheat treatable and thus it permits
variable amounts of Formabilityvariable amounts of Formability
which is required to place loops, V-which is required to place loops, V-
bends and various offsets into thebends and various offsets into the
archwire. Once deformation isarchwire. Once deformation is
complete, however, heat treatmentcomplete, however, heat treatment
increases the resilience of the wireincreases the resilience of the wire
by a recommended precipitation- orby a recommended precipitation- or
age-hardening process atage-hardening process at
482482°C(900°F) for 7-12 minutes.°C(900°F) for 7-12 minutes.

In 1962 Buehler discoversIn 1962 Buehler discovers nitinolnitinol at theat the
Naval Ordinance Laboratory, so-calledNaval Ordinance Laboratory, so-called
because it was acronym for Nickel-because it was acronym for Nickel-
Titanium Naval Ordinance Laboratory.Titanium Naval Ordinance Laboratory.
Nitinol has the lowest modulus for anyNitinol has the lowest modulus for any
cross section and has the most extensivecross section and has the most extensive
deactivation (range) capabilities. Nowdeactivation (range) capabilities. Now
light forces can be offered over alight forces can be offered over a
protracted range as any of fourprotracted range as any of four
combinations of passive or activecombinations of passive or active
behaviour and of martensitic orbehaviour and of martensitic or
austenitic phase are possible. In someaustenitic phase are possible. In some
cases the thermoelastic or thecases the thermoelastic or the
pseudoplastic effects(or) both are alsopseudoplastic effects(or) both are also
exploited, the latter of which is alsoexploited, the latter of which is also
termedtermed Superelastic, inSuperelastic, in part because thepart because the

material has so much springback aftermaterial has so much springback after
displaying what appears to be puredisplaying what appears to be pure
plasticity.plasticity.
By 1970 Andreason brings theBy 1970 Andreason brings the
intermetallic composition of 50% nickelintermetallic composition of 50% nickel
and 50% titanium to orthodontics throughand 50% titanium to orthodontics through
the university of Iowa.the university of Iowa.
By 1986, two “superelastic” alloys areBy 1986, two “superelastic” alloys are
offered– a japanese NiTi and a chineseoffered– a japanese NiTi and a chinese
NiTi. These are active austenitic alloysNiTi. These are active austenitic alloys
that form stress-induced martensite.that form stress-induced martensite.
Most recently, nickel-free, titanium-Most recently, nickel-free, titanium-
niobium wires have been introduced asniobium wires have been introduced as
a finishing wire.a finishing wire.

Returning to other materials of theReturning to other materials of the
1970s elastics of all sorts find their1970s elastics of all sorts find their
niches in the orthodontic profession.niches in the orthodontic profession.
Gum elastics were first employed byGum elastics were first employed by
Maynard(1843); Tucker (1850) was theMaynard(1843); Tucker (1850) was the
first to cut rubber bands from rubberfirst to cut rubber bands from rubber
tubing. Plastic coatings on archwiretubing. Plastic coatings on archwire
occur too. One such coating,occur too. One such coating,
poly(tetrafluoroethylene) or teflon haspoly(tetrafluoroethylene) or teflon has
the lowest friction. When this quite softthe lowest friction. When this quite soft
material is placed in the hostilematerial is placed in the hostile
mechanicochemicalmechanicochemical

environment of the oral cavity, theenvironment of the oral cavity, the
coating skins off or disappears in ascoating skins off or disappears in as
little as 3 weeks.little as 3 weeks.
Self-ligating or ligatureless bracketsSelf-ligating or ligatureless brackets
reappeared in the mid 1970s asreappeared in the mid 1970s as
strite,Ltd, marketed them; thesestrite,Ltd, marketed them; these
brackets had a stainless steel body andbrackets had a stainless steel body and
a positive-locking ,spring-clipa positive-locking ,spring-clip
mechanism. Their advantage was thatmechanism. Their advantage was that
unlike conventional ligation, friction isunlike conventional ligation, friction is
purportedly reduced– but mostpurportedly reduced– but most
importantly, friction becomes moreimportantly, friction becomes more
reproducible.reproducible.

In 1977 the beta phase of titanium
was stabilized at room temperature,
and the aerospace titanium-
molybdenum alloy (β-ΙΙΙ) was
produced. This beta-titanium
alloy has a modulus closet to that of
traditional gold along with good
springback, formability , and
weldability.
By the end of 1970s, four major
groups of wire materials came into
existence, 3 of developed different
amounts of range for a given
constant force or if you kept the
same range

for a given constant deactivation. Asfor a given constant deactivation. As
a consequence, the armamentariuma consequence, the armamentarium
has expanded from just gold orhas expanded from just gold or
stainless steel and two slots havestainless steel and two slots have
been popularized – the 0.559mmbeen popularized – the 0.559mm
(0.022-inch) slot , which was(0.022-inch) slot , which was
originally used for gold, and theoriginally used for gold, and the
0.457mm (0.018-inch)slot, which was0.457mm (0.018-inch)slot, which was
advocated for stainless steel. Withinadvocated for stainless steel. Within
the capabilities of the presentthe capabilities of the present
armamentarium, both slotsarmamentarium, both slots
become viable alternatives.become viable alternatives.

CONSOLIDATION OCCURSCONSOLIDATION OCCURS
In the 1980s we haveIn the 1980s we have estheticesthetic
bracketsbrackets made from single-crystalmade from single-crystal
sapphire and from polycrystal-linesapphire and from polycrystal-line
alumina– both having the same inertalumina– both having the same inert
chemical composition, Alchemical composition, Al22OO3.3.
We also have brackets made from poly-We also have brackets made from poly-
crystalline zirconia material,ZrOcrystalline zirconia material,ZrO22 , which, which
reportedly has the greatest toughnessreportedly has the greatest toughness
among all ceramics. Unfortunately, bothamong all ceramics. Unfortunately, both
these materials inhibit slidingthese materials inhibit sliding
mechanics and they have debondingmechanics and they have debonding
problems. The single-crystal bracketsproblems. The single-crystal brackets
also exhibit specularalso exhibit specular

highlights, where as somehighlights, where as some
polycrystalline ZrOpolycrystalline ZrO22 have intrinsicallyhave intrinsically
odd colours. In the early 1990s theodd colours. In the early 1990s the
first pseudocomposite wire fromfirst pseudocomposite wire from
optical fibers is marketed, which finan-optical fibers is marketed, which finan-
cially is a failure.cially is a failure.
from these examples, we canfrom these examples, we can
see that this was clearly a period ofsee that this was clearly a period of
consolidation, as practitioners wereconsolidation, as practitioners were
balking from products that just did notbalking from products that just did not
work very well (as was the case inwork very well (as was the case in
the1970s for the early Nitinol wires).the1970s for the early Nitinol wires).

and manufactures were beingand manufactures were being
compelled either to improve them orcompelled either to improve them or
remove them from their inventories.remove them from their inventories.
Such was the case for early single-Such was the case for early single-
crystal sapphire brackets becausecrystal sapphire brackets because
during torquing, the tie-wingsduring torquing, the tie-wings
tended to break off or, worse yet,tended to break off or, worse yet,
removed facial enamel from the teeth.removed facial enamel from the teeth.
Moreover, when placed on mandibularMoreover, when placed on mandibular
incisors or canines, for ex; ceramicincisors or canines, for ex; ceramic
brackets abraded or chipped thebrackets abraded or chipped the
opposing maxillary teeth.opposing maxillary teeth.
As if this was not enough, ceramicAs if this was not enough, ceramic
brackets in combination with anybrackets in combination with any
archwire, except nickel-titanium, alwaysarchwire, except nickel-titanium, always
produced the highest frictional forces,produced the highest frictional forces,
whether in the drywhether in the drywww.indiandentalacademy.comwww.indiandentalacademy.com

or in the wet state. Furthermore,or in the wet state. Furthermore,
optical fibers, whether coated withoptical fibers, whether coated with
nylon or hot-melt adhesives, had suchnylon or hot-melt adhesives, had such
low stiffness properties that theylow stiffness properties that they
qualified as a “placebo” wire thatqualified as a “placebo” wire that
would only acclimate a patient to thewould only acclimate a patient to the
general architecture of his or hergeneral architecture of his or her
appliances. Such a poor performerappliances. Such a poor performer
would later handicap fiber-reinforcedwould later handicap fiber-reinforced
composites in the corporate mind ofcomposites in the corporate mind of
orthodontic manufacturers.orthodontic manufacturers.

EXTRA-ORAL APPLIANCESEXTRA-ORAL APPLIANCES
Extra oral forces in the form ofExtra oral forces in the form of
hedagears and chincups, very similarhedagears and chincups, very similar
of those of today was used byof those of today was used by
orthodontists of the late 1800s. Bothorthodontists of the late 1800s. Both
Kingsley and Angle described and usedKingsley and Angle described and used
astonishingly modern appearingastonishingly modern appearing
appliances of this sort with reasonableappliances of this sort with reasonable
success. As orthodontic progressedsuccess. As orthodontic progressed
in the early 20in the early 20thth
century, extra oralcentury, extra oral
appliances and mixed dentitionappliances and mixed dentition
treatment were abandoned becausetreatment were abandoned because
they were considered an unnecessarythey were considered an unnecessarywww.indiandentalacademy.comwww.indiandentalacademy.com

complication.complication.
A paper in 1936 by OPPENHEIMA paper in 1936 by OPPENHEIM
revived the idea that headgear wouldrevived the idea that headgear would
serve as a valuable adjunct toserve as a valuable adjunct to
treatment.treatment.
Rapid development in headgearRapid development in headgear
treatment followed in 1950s and 1960s.treatment followed in 1950s and 1960s.
with the demonstration in the 1960s ofwith the demonstration in the 1960s of
skeletal changes from headgear forceskeletal changes from headgear force
to the maxilla, interest in chin cupsto the maxilla, interest in chin cups
revive.revive.

Until the 1970s, face mask to bring theUntil the 1970s, face mask to bring the
maxilla forward were dismissed asmaxilla forward were dismissed as
ineffectual . The French surgeonineffectual . The French surgeon
DELAIRE, working on cleft palateDELAIRE, working on cleft palate
children, demonstrated that the maxillachildren, demonstrated that the maxilla
can be moved forward if the protractingcan be moved forward if the protracting
forces on the maxilla are used at earlyforces on the maxilla are used at early
ages.ages.
Facemask therapy is an area ofFacemask therapy is an area of
continuing innovations in treatment incontinuing innovations in treatment in
present and it may yet offer a morepresent and it may yet offer a more
satisfactory way of treating maxillarysatisfactory way of treating maxillary
deficiency problems than in the PAST.deficiency problems than in the PAST.

FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES
The MONOBLOC developed byThe MONOBLOC developed by
ROBIN in the early 1900s is generallyROBIN in the early 1900s is generally
considered as the forerunner of allconsidered as the forerunner of all
functional appliances, but thefunctional appliances, but the
ACTIVATOR developed in norway inACTIVATOR developed in norway in
1920 by VIGGO ANDERSON was the1920 by VIGGO ANDERSON was the
first functional appliance to be widelyfirst functional appliance to be widely
accepted. Andersons activator becameaccepted. Andersons activator became
the basis of “norwegian system” ofthe basis of “norwegian system” of
treatment .Both the appliances systemtreatment .Both the appliances system
and its theoritic underpinnings wereand its theoritic underpinnings were
improved and extended elsewhere inimproved and extended elsewhere inwww.indiandentalacademy.comwww.indiandentalacademy.com

Europe, particularly by the GermanEurope, particularly by the German
school led by HAUPL.school led by HAUPL.
HERBST APLIANCEHERBST APLIANCE
This appliance was first developedThis appliance was first developed
in the 1920s and re-introducedin the 1920s and re-introduced
recently by PANCHERZ and thisrecently by PANCHERZ and this
is theis the only FIXED FUNCTIONALonly FIXED FUNCTIONAL
APPLIANCE.APPLIANCE. The appliance requiresThe appliance requires
little patient compliance and produceslittle patient compliance and produces
a highly variable mixture of skeletala highly variable mixture of skeletal
and dental changes.and dental changes.www.indiandentalacademy.comwww.indiandentalacademy.com

FIXED APPLIANCEFIXED APPLIANCE
According to angle, the firstAccording to angle, the first
importance in the evolution of fixedimportance in the evolution of fixed
orthodontic appliance was the “BOWorthodontic appliance was the “BOW
OF FAUCHARD” of france. This bowOF FAUCHARD” of france. This bow
,affixed to the external surface of the,affixed to the external surface of the
teeth, was the forerunner of the modernteeth, was the forerunner of the modern
archwire.archwire.
MAGILL was the first to use a plainMAGILL was the first to use a plain
band cemented to the tooth by oxy-band cemented to the tooth by oxy-
chloride of zinc cement.chloride of zinc cement.
It was on the foundation of theIt was on the foundation of the
circumferential archwire and the plaincircumferential archwire and the plain
cemented tooth band that moderncemented tooth band that modernwww.indiandentalacademy.comwww.indiandentalacademy.com

THE COMING OF A NEWTHE COMING OF A NEW
AGEAGE
AS we enter the1990s we look backAS we enter the1990s we look back
on that century in terms of various typeon that century in terms of various type
of overallof overall innovations.innovations. We had the auto,We had the auto,
aviation, polymer, nuclear, space, andaviation, polymer, nuclear, space, and
computer ages. Indeed, it has beencomputer ages. Indeed, it has been
said that more knowledge wassaid that more knowledge was
amassed in the 20amassed in the 20thth
century than in allcentury than in all
previous centuries ofprevious centuries of mankind.mankind. AndAnd
what we learn about orthodonticwhat we learn about orthodontic
materials comes from many of thosematerials comes from many of those
burgeoning fields. From the viewpointburgeoning fields. From the viewpoint
of true esthetics– in other wordsof true esthetics– in other wordswww.indiandentalacademy.comwww.indiandentalacademy.com

from the viewpoint of not making thingsfrom the viewpoint of not making things
smaller but of making them TOOTH-smaller but of making them TOOTH-
coloured. Practitioners assert thatcoloured. Practitioners assert that
estheticsesthetics are desirable but thatare desirable but that
functionfunction isis paramount.paramount. And so weAnd so we
close this century we begin to seeclose this century we begin to see
attempts to market a continuous fiberattempts to market a continuous fiber
composite, success to manufacturecomposite, success to manufacture
CP-titanium and its products andCP-titanium and its products and
modifications to improve slidingmodifications to improve sliding
mechanics through ceramic-bracketmechanics through ceramic-bracket
inserts and self-ligating brackets.inserts and self-ligating brackets.

CONCLUSIONCONCLUSION
ORTHODONTICS has achieved theORTHODONTICS has achieved the
status of a recognized specialty ofstatus of a recognized specialty of
dentistry because of a long period ofdentistry because of a long period of
craftsmanship and professionalcraftsmanship and professional
expertise.expertise.
While it appears that a certainWhile it appears that a certain
stagnation has set in the otherstagnation has set in the other
specialties of dentistry at this time ,specialties of dentistry at this time ,
that is not to be perceived inthat is not to be perceived in
orthodontics, where a great deal oforthodontics, where a great deal of
development is still going on.development is still going on.www.indiandentalacademy.comwww.indiandentalacademy.com

Orthodontics, and indeed all of dentistryOrthodontics, and indeed all of dentistry
if it is to survive as a profession mustif it is to survive as a profession must
continually re-examine its history andcontinually re-examine its history and
find relevant and significant ideals tofind relevant and significant ideals to
meet the crisis of today.meet the crisis of today.

Thank youThank you
For more details please visitFor more details please visit

Evolution of orthodontic appliances /certified fixed orthodontic courses by Indian dental academy

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