A History of Modern Orthodontics Written By : Dr Petra Van Der Merwe
The first variation of modern braces was created by Christophe-Francois Delabarre in 1819.
This system required wrapping wire around each individual tooth because bonding techniques weren’t strong enough to fasten wire to the front of teeth temporarily. Braces continued to change fundamentally over the years that followed.
The Straight-wire System
A breakthrough came in the 1970’s, when Dr Lawrence Andrews developed what is now known as the “straight-wire” system. Prior to Andrews’ contribution, a small bend had to be made on three planes for each tooth. This was to ensure they ended up in the right place – that’s 84 tediously tiny bends, each time a patient’s wire needed replacing.
Andrew’s system largely eliminated the need for wire-bending since each tooth had a specific position defined on 3 axes. His engineering of this system became one of the most significant contributions in the history of orthodontics and created a baseline reference for all future pre-adjusted appliances in the speciality.
That said, fixed braces still require wire bending, as a set of brackets is generically developed but must still be tailored to work with the patient’s mouth.
One of the biggest challenges in orthodontics is controlling forces. Every force has a counterforce, and moving the concerned tooth into the desired position creates forces on the neighbouring teeth, which can be either beneficial or counterproductive. This is referred to as biomechanics.
To move teeth in a controlled manner, we need to consider the soft tissue and the longevity of the teeth. In addition, a sound understanding of biology and physics is needed to protect the teeth against unwanted forces which cause damage.
The system was further developed over the years, incorporating numerous complementary systems, each with its own set of guidelines tailored to different protocols. It was an innovative and useful development in its time, but it had notable limitations. This was especially in terms of its inability to adopt a plan tailored to the specific needs of the patient, rather than forcing a patient’s teeth into a generic prescription.
Teeth move unless they make equal contact in all directions. This happens when a patient loses a tooth and there is no opposing one to bite on. This is also the reason for teeth moving after orthodontic treatment. If treatment is thoroughly concluded, with equal forces and contacts on all teeth, the stability post-orthodontics is impressive. But achieving this requires attention to detail and an understanding of occlusion.
The Introduction of the Aligner System; the third industrial revolution.
A young MBA student from Stanford University named Zia Chishti experienced his teeth moving after his braces were removed. Not being able to rectify and “re-straighten” his teeth using his retainer led him to develop a computer-aided system which designed a series of clear appliances to incrementally move teeth.
From this concept, Chishti and Kelsey Wirth, another Stanford MBA student, along with two orthodontists, founded Align Technology in 1997. And so was the birth of the first commercially available aligners designed to straighten teeth.
Many ascribe the advent of aligners to Chishti, but Kesling in 1945 had already said:
“Major tooth movements could be accomplished with a series of positioners by changing the teeth on the setup slightly as treatment progresses. At present this type of treatment does not seem to be practical. It remains a possibility, however, and the technique for its practical application might be developed in the future.” – H.D. Kesling, 1945
There were initially many misconceptions attached to aligner therapy. Due to the lack of control on teeth, the results during the first years were not significant enough to inspire orthodontists to begin using it, resulting in many patients undergoing aligner treatment by dentists with no experience or knowledge of biomechanics.
Aggressive marketing strategies encouraged more widespread use, although complex cases still could not be completed successfully, leaving fixed braces as the preferred treatment for specialists. With time, extensive R&D allowed a number of aligner systems to be introduced to the market, all capable of treating any malocclusion previously treated with braces.
It’s important to understand that aligners, like braces, are a system to move the teeth. Regardless of which system is used, if the case is complex, additional elements (or auxiliaries) need to be introduced. The results are not determined only by the aligners but also by the providers’ ability to understand the delicate play between correct diagnoses, treatment planning and how to optimally use the biomechanical forces to place teeth in a stable position.