While attempts to straighten teeth have been tried since ancient times, early dental devices would not be recognizable when compared to modern dental braces. Modern braces have evolved quickly over the past two centuries both in terms of the theoretical basis and approaches.
From cosmetic to scientific
Hippocrates wrote of the aesthetic benefit of straight teeth 400 years before the birth of Christ. Beauty seems to be the primary motivation behind the development of orthodontics up until the mid 1800s. It was during the 1800s that the initial theories about gums, teeth and jaws were investigated and bitterly contested. Could the teeth be moved within the skull? Would forcibly moving teeth lead to disease? Were crooked teeth and misshapen jaws hallmarks of “degenerates or lunatics” as some people claimed?
During the last 150 years the science of orthodontics was described. The medical benefits of straight teeth and proper jaw closure were discovered during this time. Only recently has the general appreciation that patients come to orthodontists for cosmetic reasons reemerged.
Major pioneers and developments in braces
The 19th century a number of pioneers in dentistry distinguished themselves. While straight teeth were always the goal of most patients, dentists saw other objectives and approaches. Norman W. Kingsley extracted specific teeth and used dental devices to pull teeth into the now vacant space. Later he would use various techniques to correct cleft palate. Kingsley advocated the use of accurate diagnoses and detailed treatment plans. Other pioneers of dentistry worked out ways to improve crossbite/underbite by widening the maxillary arch (roof of the mouth, essentially). These dental devices included piano wire bent into a spring, platinum bands, and surgically opening the gums.
The invention of headgear
Amos Westcott used a chincup that was anchored to the back of the head which applied constant retraction forces to the bottom jaw. It was meant to correct crossbite. This concept of “occipital anchorage” was adapted by John Nutting Farrar except that instead of cupping the chin, the dental device was anchored to the row of teeth that were too far forward either the top row or the bottom row. Similar dental devices are still used today.
Moving the teeth a little at a time
Farrar also determined the amount that teeth could be moved in a single day. He published Treatise on Irregularities of the Teeth and Their Correction in 1888 stating that teeth could be moved through outside dental devices “about one two-hundred-fortieth of an inch every morning, and the same in the evening.” The very notion that teeth could be moved safely by external pressure was a debatable concept at the time. Farrar clearly showed that this approach was both safe and effective.
The “Father of Modern Orthodontics”
No discussion of modern braces would be complete without the mention of Edward H. Angle. Angle is generally regarded as the “Father of Modern Orthodontics.” While he was a very outspoken and controversial person, Angle’s contribution to modern orthodontics and braces are many. He strongly advocated orthodontics as a separate specialty of dentistry. His classification of malocclusions is still used today. Perhaps most impressive was the development of prefabricated parts of braces that could be applied to various patients depending on their specific needs. Prior to 1887 each person required unique construction of braces; however the “Angle System” streamlined the process and ultimately reduced costs and time.
References
Wahl N. Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th century. Am J Orthod Dentofacial Orthop 2005;127: 510-5.