Evolution of esthetic considerations in orthodontics.

The importance of facial esthetics to the practice of orthodontics has its origins at the beginning of our specialty. In 1900, Edward H. Angle believed that an esthetic or a "harmonious" face required a full complement of teeth, but many who came after him questioned this notion. In the 1930s, the development of cephalometrics laid the foundation for studying growth and development, treatment effects, facial forms, and esthetics. By the 1950s, the importance of diagnosing and planning treatment for an esthetic result was established, but the measurement of soft tissue variables was lacking, and this became an important area of research. In the 1970s, researchers were looking at the stability of hard tissue changes over time, and they were also interested in how the soft tissues change with age. Although the early studies of esthetics in orthodontic treatment focused on how clinicians viewed their patients, changing demographics and cultural attitudes led researchers to look more seriously at consumer preferences and the public's attitudes. Their findings--that consumers preferred fuller lips--led to a swing back toward nonextraction treatment. Expansion appliances and molar distalization techniques became popular, and surgical procedures to obtain more ideal esthetic results became more common. Since the 1990s, advances in computers and technology have allowed us to study, predict, and produce esthetic results previously thought unattainable. Today, more so than at any other time in our specialty, we have the ability to provide esthetic results to our patients.

A century of influence: Part 2. The greatest generation.

The story of orthodontics during the first 100 years of Journal publication can be told through the people who lived it. As part of the American Journal of Orthodontics and Dentofacial Orthopedics' Centennial celebration, we present 100 people who most influenced the specialty during the last 100 years. Part 2 picks up with "the greatest generation" and describes those born in the first 2 decades of the 20th century. Whether born in Europe or the United States, their lives and educations were disrupted by world war. Many served during the years of conflict, and a few paid an even heavier price. After World War II, they returned home or immigrated to the United States and resumed their life's work in orthodontics.

The contributions of Edward H. Angle to dental public health.

The genius of Edward Hartley Angle, (1855-1930), the founder of the dental specialty of orthodontics, to create order from chaos in the study and treatment of positional discrepancies of the teeth, jaws and face advanced greatly the cause of dental public health. Angle's innovations that had the most public health impact were (1) his identification of dental occlusion, not simply tooth irregularity, as a prime concern, (2) his development of an uncomplicated classification system for occlusal conditions, (3) his introduction of prefabricated orthodontic appliances and (4) his framing of orthodontics as a dental specialty by organizing the world's first educational program to train orthodontists.

Orthodontics in 3 millennia. Chapter 16: Late 20th-century fixed appliances.

Ever since Edward Angle introduced his edgewise appliance in 1925, orthodontic innovators have been working to improve on not only its original design, but also the method of attachment. Our "strap-ups" have evolved from banding to bonding, from labial to lingual, and from metallic to clear. But, as Angle would be pleased to learn, we still call it edgewise.

How we got from there to here and back.

Edward H. Angle dominated orthodontic armamentarium, diagnosis and treatment planning for almost a half century until Charles Tweed successfully challenged his mentor's nonextraction mantra. The ensuing diagnostic regimen used by Tweed, however, proved to have serious limnitations and clearly resulted in the extraction of too many teeth. This caused a subsequent deterioration of soft tissue appearances of patients that neither they nor their doctors liked. This article will describe and illustrate how new expansion techniques differ qualitatively from those of Angle, and how these techniques offer patients and doctors less invasive and more comfortable therapies which do not jeopardize facial appearances.

Orthodontics in antiquity: myth or reality.

Malocclusion, although a common finding in today's world, appears to have been less frequent in antiquity. There are references to overcrowding, delayed exfoliation of deciduous teeth and basic orthodontic treatment in the writings of classical authors such as Hippocrates, Celsus and Galen. However, early authentic archaeological finds of dental appliances are extremely rare. Considerable attention has focussed on gold banded devices excavated from ancient Etruscan sites in central Italy which have been dated to around the seventh to the fourth centuries BC, with a number of authors suggesting an orthodontic function for these appliances. This paper reviews the evidence for the possible treatment of malocclusions in antiquity and concludes that the use of orthodontic appliances to facilitate tooth movement is not supported by the available evidence.

Lingual orthodontics: history, misconceptions and clarification.

Many frank misconceptions still exist surrounding the efficacy and clinical nature of lingual orthodontics, which were first introduced over 25 years ago in Japan and the United States. Despite early difficulties in the development of the technique, it has become a valid clinical option for patients in many parts of the world. Specific problems, for example concerning patient comfort and biomechanics, have been systematically solved over time. Continuing modification of clinical methods significantly increases options for clinicians and patients, especially adults who may be reluctant to accept traditional labial orthodontic appliances.

Contributions of orthodontists to organized dentistry.

The first specialty board in dentistry has been celebrating its 50th anniversary. The need for the specialty and for presenting orthodontic diagnosis and classification at the undergraduate level remains. The orthodontic specialty has contributed an active source of leadership to all of dentistry and is proud to share in the common heritage of service to the public and in responsibility to the patient.

The dawn of rapid maxillary expansion.

The first report of lateral maxillary expansion by separation of the maxilla, written by Angell and published in 1860, was discredited. Applying our present-day knowledge of the technique to the original documents indicates that the case history agrees in general with current observations. The arguments mounted against Angell, especially by McQuillen, may be dismissed as irrelevant and Angell's thesis is upheld. In addition, good reason exists to accept three further "firsts" in this unprecedented work: (1) The significance of the first permanent molars in occlusal development, (2) the use of a double-action jackscrew, and (3) the use of a retention plate.

The Tweed philosophy: the Tweed years.

Charles H. Tweed revolutionized clinical orthodontics. His inquisitive scientific mind coupled with his outstanding clinical ability and his unselfish work ethic are legendary. He gave the orthodontic specialist diagnostic and mechanical treatment concepts that have stood the tests of both time and intense scrutiny.

The Tweed-Merrifield philosophy.

Charles Tweed's concepts have been simplified, enhanced, and expanded by Levern Merrifield. Merrifield's ideas have augmented Tweed's to give orthodontics the Tweed-Merrifield philosophy. Adherence to the philosophy allows the orthodontic specialist to define objectives for the face, the skeletal pattern, and the teeth, and to diagnose and treat a malocclusion to efficiently reach these predetermined objectives.