HistoryBook
Fig.1: Pierre Fauchard
Editors Note: Dr. Phoebe Good, UCSF 07 Resident, provides us
with a literature review of historic orthodontic appliances.
History of Orthodontic Appliances
From Ancient Times to Today
By Dr. Phoebe Good
E
ven the Ancient
Egyptians
(~3000 BC)
were con-
cerned with
straightening teeth, as
mummies have been found
to have crude metal bands
wrapped around individual
teeth with catgut to close
spaces.1-3 But regulation of
teeth, as orthodontic align-
ment was formerly referred
to, did not gain signicant
attention until Pierre Fau-
chard (1678-1793, French;
Fig 1), who is considered
the Father of Modern
Dentistry and Orthodon-
tia, developed the bandeau
or bandolet in 1723 (Fig
2).2,4-6 This was the rst
expansion appliance,
consisting of a heavy maxil-
lary labial arch of precious
metal to which teeth were
ligated, and was the basis
for Angles E(expansion)-
arch.2,6 Western Europe
continued to be the
center of orthodontic
developments during the
18th and early 19th centu-
ries.2,5,6
20
Fig.2: Fauchards Bandeau Fig.3: Norman W. Kingsley
European-trained op- 1903) was likely the rst
erators of teeth soon to expand the midpalatal
brought their skills to suture with a split plate.6,7 Fig.4: Amos Wescotts
Colonial America, and by C.R. Con designed a chincup
the fourth decade of the new expansion appliance
19th century the United embedded with a W
States held the dominant shaped midline spring
position in dentistry, (Fig 5). John Nutting
and specically ortho- Farrar (1839-1913; Fig 6)
dontics.2,6 The late 19th is known as the Father
century was marked by of American Orthodon-
signicant developments tics for his 1888 Treatise
by American pioneers in on Irregularities of the
orthodontics. Norman W. Teeth and Their Correc-
Kingsley (1825-1913; Fig tion and beginning the
3) introduced occipital era of biologic tooth
traction to move anterior movement. Additionally, Fig.5: C.R. Cofns
teeth back into extraction he was among the rst expansion appliance
spaces in 1879, used a to retract anterior teeth
vulcanite (sulfur cross- using occipital anchor-
linked rubber) inclined age (Fig 7).6-8 Henry A.
plane to jump the bite, Baker introduced the use
and also perfected a gold of interarch elastics (Baker
obturator and articial anchorage) in 1893, to
vellum of soft rubber for correct dental protrusion.6
cleft palate treatment in
1859.6,7 Amos Westcott Moving into the end
reported using a telescopic of the 19th and begin-
bar to correct a maxillary ning of the 20th century,
crossbite in 1859 and he orthodontics in America
used chincups to treat advanced considerably
as the Age of Systems Fig.6: John Nutting Farrar
Class III patients (Fig 4)
in the 1840s.7 In 1860, began. Calvin S. Case
Emerson C. Angell (1823- (1847-1923, Fig 8) not
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 HistoryBook
Fig.7: Farrars occipital Fig.8: Calvin S. Case
anchorage for anterior
teeth retraction
only contributed greatly to
the orthodontic literature,
but was the rst to try
bodily tooth movement
with the contouring appa-
ratus (Fig 9), to use light
wires (.016 and .018
gold), and to use (~1893),
along with Henry Baker,
Class II elastics. Case
favored extraction when
Fig.10: Victor H. Jackson facial esthetics demanded
it and wanted to change
the specialtys name to
facial orthopedia.
Although Case only
extracted in 10% of his
patients, the Dewey-
Case Great Extraction
Debate ensued in 1911.
Case is also known for
his prosthetic correction
of cleft palate.7,9 In 1887,
Victor H. Jackson (Fig 10)
developed the Jackson
System, consisting of a
Fig.11: Crozat appliance wire crib with soldered
nger springs for tooth
movement. William E.
Walker used the Jackson
appliance with precious
metals, and then George
B. Crozat modied the
Walker appliance (Fig 11)
in 1919, and he originally
called the Crozat appli-
ance the invisible brace
with its most important
advantage being that it
was removable.4,10
Fig.12: Edward H. Angle
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Fig.9: Cases Contouring
Appliance
Edward H. Angle (1855-
1930, Fig 12) was hard at
work by this time, and by
1900 he had developed the
E(expansion)-arch. The
E-arch (Fig 13) was com-
prised of ligatures from a
heavy (0.036 0.060 of tooth movement when
gold) labial arch that
brought misaligned teeth
to the line of occlusion.
Bands were placed on mo-
lar teeth only, and the ends
of the labial arch were
threaded with small nuts
to expand or advance the
arch perimeter. However,
since the E-arch delivered
heavy interrupted forces
and was only capable
of tipping teeth, Angle
developed the pin-and-
tube appliance in 1910
(Fig 14). In this appliance
Angle banded more teeth
than just molars, a vertical
tube was soldered to each
band, and pins soldered to
the arch wire were inserted
into each tube. These pins
were repositioned at each
appointment through the
process of resoldering to
eect gradual straighten-
ing of the arch to ideal.
This appliance was clini-
cally impractical for several
reasons: it required a high
degree of craftsmanship,
its heavy base arch had
poor spring qualities
that required many small
adjustments, and its round
arch wires were not able
to control root posi-
tion. Angle attempted to
achieve three-axis control
he introduced the Ribbon
Arch in 1916 (Fig 15),
a rectangular 0.036 x
0.022 gold arch wire
held rmly with pins
into vertically positioned
rectangular slots. The
ends of the ribbon arch
were threaded, and the
malocclusion was ironed
out through expansion.
The ribbon arch wire was
smaller in the horizon-
tal direction, therefore
possessing better spring
qualities, and this was the
rst appliance with full
three-axis control of tooth
movement (especially
the incisors and canines).
However, the ribbon arch
still had relatively poor
control of root positions,
especially in the premolar
regions.4,10-13
The Edgewise appliance
overcame the weak-
nesses of the ribbon arch
in 1925, when Angle
reoriented the slot from
vertical to horizontal and
21
 HistoryBook
Fig.13: Angles E-arch
inserted the rectangular sidered the rst invisible
ribbon arch wire rotated appliance. Between 1920
90 degrees (0.022 x and 1940, Mershon de-
0.028), on its edge (Fig veloped the Labio-Lingual
16). Rectangular brackets appliance (Fig 18) made of
with gingival and occlusal labial and lingual 0.040
wings were soldered to gold wires with banded
bands at the center of incisors and premolars.
the labial surface, and The attachments, limited
rings (doughnuts) only by the practitioners
were soldered o-center creativity, were only able
to correct rotations. This to tip teeth, yet teeth had
appliance soon became the functional freedom.4,10
most popular appliance in In 1922, James McCoy
the U.S., as it was the rst developed the open-tube
to move teeth in all three appliance (Fig 19), in
planes of space simultane- which an 0.030 or 0.036
ously, and it controlled gold round arch wire was
premolars because the inserted into a horizontal
wider dimension of the bracket (a tube with 40%
arch wire was in the hori- cutout), so there was no
zontal dimension.4,9-12,14,15 torque control and this
Modern appliances are self-ligation was brutal.10
based on Angles edgewise Spencer R. Atkinson
concept, only with several (1886-1970, Fig 20)
modications and varia- invented the Universal ap-
tions. pliance (Fig 21) in 1929,
which was introduced in
Also during the Age 1937 as a combination
of Systems, still more of the ribbon-arch and
practitioners developed edgewise appliances, and
orthodontic appliances. followed Oppenheims
John V. Mershon intro- theory of using light
duced his lingual arch in forces. All permanent
1908 (Fig 17), made of teeth were banded and the
0.036 or 0.040 gold operator could use a round
arch with auxiliary springs wire and/or a ribbon arch
that were used during wire; where the round
growth with intermittent gingival wire could achieve
rest periods, and was con-
mesio-distal and extru-
22
Fig.14: Angles Pin-and- Fig.15: Angles
tube appliance Ribbon arch
sion-intrusion movements,
and the ribbon occlusal
wire would accomplish
rotations and bucco-
lingual movements. The
Wests rst orthodontic
supply house, Unitek Cor-
poration, made the rst
brackets for the UNIversal
TEChnique.16-19 Fig.16: Angles
Edgewise appliance
Stainless steel was widely
adopted by American
orthodontists in the
1930s, and soon became
the most common mate-
rial used in construction
of appliances.10 Joseph
E. Johnson (1888-1969,
Fig 22) introduced the
Twin-wire appliance in
1932 (Fig 23), in which
incisors and molars were
banded, twin 0.010 steel
arch wires were used that Fig.17: Mershons
Lingual arch
were more physiologic
than one heavy arch wire,
and long tubes extended
from molars to canines
to protect the ne wires.
The twin-wire appliance
successfully aligned incisor
teeth, eectively leveled
and derotated, and was
more comfortable because
of lighter forces. How-
ever, this appliance could
only tip teeth, lacked
anterior torque control, Fig.18: Mershons
did not control canines Labio-Lingual appliance
PCSO BULLETIN SUMMER 2006
 HistoryBook
Fig.19: McCoys Fig. 20: Spencer Atkinson
Open-tube appliance
or premolars, and was
not suitable for extraction
cases.4,12,19,20 In 1933, P.
Raymond Begg (1889-
1983, Fig 24) developed
his own bracket because he
found it dicult to close
extraction spaces and cor-
rect deep overbites using
the edgewise appliance.
The Begg appliance (Fig
25) consists of a nar-
Fig. 22: Joseph E. Johnson row ribbon-arch bracket
turned upside down,
single stainless steel round
archwires (0.016 or
less), greater interbracket
distance, and interbracket
loops to control the degree
and duration of force. The
Begg technique was useful
for extraction treatment,
and Begg introduced
auxiliary springs to control
root positions in the
1960s and the multiloop
Fig. 23: Johnsons Twin- light-wire Begg technique
wire appliance in 1965. However, treat-
ment with this appliance
was challenging dur-
ing the nishing stage
due to poor root torque
control.4,9,12,19,21 To ad-
dress the diculties with
nal root positions, some
practitioners began using
the combination twin-
edgewise and light-wire
technique (Fig 26): rst
stage using 0.016 stain-
Fig. 24: P. Raymond Begg
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Fig. 21: Atkinsons
Universal appliance
less steel single strand for
tipping, second stage of
multistrand (6 x 0.008
or 4 x 0.009) wires for
controlled general align-
ment, and a third stage of
engaging a nal edgewise
wire.4
Peter C. Kesling developed
the Tip-Edge bracket
(trademarked by TP
Orthodontics, Fig 27)
in 1986, by removing
opposite corners of the
edgewise bracket, to allow
mesial and distal crown
tipping during initial
stages and engagement
of rectangular wires for
torque control during n-
ishing stages. The eective
Tip-Edge slot increases
with tipping, while the
conventional edgewise slot
size decreases (Fig 28). The
bracket also features lateral
wings for rotational con-
trol, and tie wing notches
and a vertical slot for use
with auxiliaries
(Fig 29).9,22,23
The most revolution-
ary advancement in
orthodontics within the
past 50 years has been
Lawrence F. Andrews (Fig
30) development of the
Straight-Wire Appliance
(SWA) in 1970. This
preadjusted appliance soon
became the standard of the
specialty.24 The SWA was
based on measurements
of 120 non-orthodontic
normal cases, from which
Andrews described the
Six Keys to Normal
Occlusion. He designed
individual brackets for
each tooth type to work
without wire bend-
ing, because he found
that when in optimal
occlusion, there exists
extensive similarities in
morphology and position
of normal tooth types.12,25-
28
From his extensive
measurements, Andrews
determined the average
tip and torque angles and
in/out dimensions of the
labial surface of each tooth
relative to a at labial
arch wire plane, coined
the Andrews Plane
(Fig 31). When each
preadjusted bracket was
precisely positioned at the
midpoint of each tooths
facial axis, the brackets
formed the Straight-Wire
Appliance.27,29 He also
developed a series of
extraction brackets which
include anti-tip and anti-
rotation components not
found in the Standard
23
 HistoryBook

Fig. 25: Begg appliance Fig. 26: Combination Fig. 27: Development of
twin-edgewise & light-wire Tip-edge bracket from
technique edgewise bracket

SWA prescription.30 Use chairside at each appoint- to develop. Self-ligating

of Andrews prescription
throughout the specialty
has shown that ideal tooth
positions are sometimes
not achieved with straight
wires alone, and therefore
numerous additional
prescriptions have been
developed by others,
including Roth, Rick-
etts, Alexander, Hilgers,
Burstone, Root/Tweed,
Cetlin, Bench, Creek-
more, Hasund, Orthos,
and McLaughlin/Ben-
nett/Trevisi.12,28,29 While
the SWA has certainly
shortened treatment
duration and time spent
ment, bending wires
is still required. These
reasons for wire bending
include: inaccurate bracket
placement, variations in
tooth structure, variations
in antero-posterior and
vertical jaw relationships,
overcorrecting rotations,
and the SWAs mechani-
cal deciencies of force
application being away
from the center of resis-
tance, slot play, and force
diminution as the wire
straightens.29
Orthodontic appliance
technology continues
brackets, computerized
bracket placement, com-
puter designed removable
aligners, bite-jumping
appliances, distalizing
appliances, and implant
anchorage are currently
making history. However,
without a good diagnosis
and treatment plan, and
careful management of Fig. 28: Effective Tip-edge
the treatment process, slot vertical dimension
improved appliances can increases with tipping;
not bring us closer to ideal conventional edgewise slot
treatment goals. decreases
Phoebe Good, DMD, is a
third year resident at UCSF
Orthodontics.

1. Paladin, P. Orthodontic History: braced for a century.

In: Paladin, P., editor. St Louis, MO: American Association
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127:255-259; 2005.
3. ArchWired. A Brief History of Braces. p. Review of Orth- Fig. 29: Auxiliary spring for
odontic History; 2005. Tip-edge bracket
4. Salzmann, JA. Practice of orthodontics. Philadelphia:
Lippincott; 1966.
5. Weinberger, B.W. Orthodontics: an historical review of its
origin and evolution, including an extensive bibliography
of orthodontic literature up to the time of specialization. St.
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6. Asbell, M.B. A brief history of orthodontics. Am J Orthod
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the modern era.) Am J Orthod Dentofacial Orthop;127:510-
515; 2005.
continued

24 PCSO BULLETIN SUMMER 2006

 HistoryBook

8. Asbell, M.B., John Nutting Farrar 1839-1913.

Am J Orthod Dentofacial Orthop;114:602; 1998.
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Albatross. World Journal of Orthodontics;1:142-151; 2000.
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The American Board of Orthodontics, Albert Ketcham, and
early 20th-century appliances.) Am J Orthod Dentofacial
Orthop;128:535-540; 2005.
11. Matasa, C.G., Graber, T.M. Angle, the innovator,
mechanical genius, and clinician. Am J Orthod Dentofacial
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Angle Orthod ; 44:101-112; 1974.
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Fig 30: Lawrence Andrews Am J Orthod;77:580-582; 1980.
and Will Andrews
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ciples and techniques. St. Louis: Mosby; 2000.

Fig 31: Andrews Straight 24. Roth, R.H. The straight-wire appliance 17 years later.
Wire Appliance J Clin Orthod;21:632-642; 1987.
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360-379; 1976.

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