The history of orthodontics in the 20th century begins with the American dentist Edward Angle. Angle is popularly recognized as the first dedicated orthodontist because of his pioneering innovative orthodontic practices and his public push to have orthodontics recognized as a distinct dental specialty. While Angle’s defining work began in the 1800s, his efforts came to full fruition in the 20th century when the first orthodontic organizations were founded, orthodontic procedures and technologies were further refined, the number of orthodontic practitioners grew, and the greater dental profession formally identified orthodontics as one of its specialties. In the last AlgerBlog, we looked specifically at the contributions and legacy of Angle along with a predecessor, the Frenchman Pierre Fauchard, two historic figures who helped lay the groundwork for modern orthodontics. In this issue, we continue to chart the history of orthodontics, plotting the evolution of the field through the 20th century. For a more historical look at the history of orthodontics, please read our first two installments: “The History of Orthodontics Part 2: Pierre Fauchard and Edward Angle’s Contributions to Modern Orthodontics” and “The History of Orthodontics Part 1: Orthodontics in the Ancient World.”
Recognizing Orthodontics as a Dental Specialty
First Steps Toward Formal Recognition
The first strong evidence for orthodontics being recognized as a formal dental specialty came with the formation of the American Association of Orthodontists (AAO) in 1901. This organization, founded by Angle, set strict requirements for dentists to be called orthodontists. The AAO also promoted Angle’s unique classification system for malocclusions, a system that is still in use today.
Formal Recognition by the American Dental Association
Further support for an orthodontics specialty came in the late-1940s and the 1950s. In the second half of the 1940s, the American Dental Association (ADA) took clear steps to identify and empower dental specialties by outlining the requirements necessary to anoint examining boards in dental specialties and drafting the following definition:
A specialty in dentistry is a field of practice which calls for intense study and extended clinical and laboratory experience by a dentist beyond the training offered as a preparation for general practice in the undergraduate curriculum. The following branches of dentistry are recognized at this time as suitable fields for the certification of specialists: oral surgery, orthodontics, pedodontia, periodontia, and prosthodontia.
In 1950, the ADA approved the formal recognition of the American Board of Orthodontics as the certifying body of the dental specialty of orthodontics. In 1989, eight recognized dental specialties applied to the ADA for re-recognition of their specialty statuses. The formal recognition of “Orthodontics and Dentofacial Orthopedics” was approved along with the other seven specialties: Dental Public Health, Oral and Maxillofacial Pathology, Prosthodontics, Oral and Maxillofacial Surgery, Periodontics, Endodontics, and Pediatric Dentistry.
Orthodontic Innovation in the 20th Century: The Rise of Braces
The 20th century witnessed incredible advances in orthodontic technology and treatment methods. Materials such as stainless steel, nickel-titanium alloys, and plastics were introduced, allowing for more effective and comfortable braces. The treatment process itself became less invasive and more predictable, and orthodontics became increasingly popular among people of all ages.
The Introduction of Braces
The turn of the century saw the widespread use of braces as the primary tool for correcting misaligned teeth. Modern braces are popularly traced back to 1819 when French dentist Christophe-Francois Delabarre introduced his wire crib braces. This design wove firm wire over the upper and lower teeth, which helped realign the teeth when worn for an extended period of time. As one can imagine, wire crib braces were quite uncomfortable and much bulkier than today’s designs. The 20th century brought significant advancements in braces technology that improved patient comfort and helped foster the popularity of braces during this period.
New Designs: The Edgewise Appliance
In 1928, Angle introduced the edgewise appliance, a revolutionary orthodontic tool that transformed the field. The edgewise appliance was a metal bracket bonded to the tooth surface with a wire threaded through it. The wire could be adjusted to apply precise pressure to move teeth into better alignment. Prior to this, orthodontists used crude bands and wires that lacked control and flexibility. The edgewise appliance made it easier to move teeth with more accuracy, offering greater control and predictability in treatment.
New Designs: Retainers
Once the desired realignment of teeth was successfully completed, orthodontists needed a reliable way of ensuring their good work lasted. In 1919, American orthodontist Charles A. Hawley answered that need with his invention of the retainer, a customized, removable device made of an acrylic baseplate and wire components that is specifically designed to maintain the newly formed alignment of teeth after braces are removed.
New Materials: Stainless Steel
Stainless steel was invented in 1913 by English metallurgist Harry Brearley of Sheffield, UK. This “rustless” steel found its way into dentistry in 1947 when dentists first started crafting stainless steel dental crowns. By the 1950s and 1960s, stainless steel braces became the industry standard due to their durability, strength, and resistance to corrosion. In addition to the advancement in materials, orthodontists began to focus more on passive treatment techniques that required less frequent adjustment of braces. These innovations made orthodontic treatment more efficient and comfortable for patients.
New Designs: Dr. Lawrence F. Andrews and the Straight-wire Appliance
In the early 1970s, American orthodontist Lawrence F. Andrews, DDS, published a groundbreaking study based on a collection of 120 naturally (untreated) optimal occlusions. He titled this work The Six Keys to Normal Occlusion, and it became a defining text of modern orthodontics as well as a blueprint for Andrew’s next major contribution, an advancement of braces design known as the Straight-wire Appliance. The Straight-wire Appliance is founded on the concept that tooth anatomy, morphology, and ideal positions are sufficiently similar across individuals, regardless of age, sex, or race to support the use of prefabricated brackets with standard prescription values. Each tooth gets its own prefabricated bracket based on its identified value, and those brackets are bound together by a flexible metal “memory wire” that applies the pressure necessary to adjust the teeth accordingly. This approach opened the door to a prefabricated approach to braces that has become the gold standard for prefabricated “stock” orthodontic appliances.
20th Century Orthodontics: An Era of Beauty Culture
Throughout the 1930s and 1940s, orthodontic treatment continued to evolve, as the profession gradually gained recognition as a specialized field within dentistry and dentistry on the whole became an increasing focus of public health. The popularizing demand for orthodontic care, particularly among adolescents, was driven by the growing popularity of aesthetic considerations alongside functional needs. During this period, many orthodontic practices began to focus not only on correcting bite issues but also on enhancing the appearance of the smile, a trend that would only continue to grow throughout the 20th century as mass media and celebrity culture fostered an increasingly conscious beauty culture to which cosmetic dentistry and orthodontics responded.
Invisible Orthodontics: Clear Braces
Andrew’s straight-wire appliance was a notable step toward less conspicuous braces. However, a much bigger leap forward in orthodontic aesthetics came in the 1980s with the introduction of clear braces. Clear braces are identical in construction to traditional metal braces, but they utilize ceramic brackets and frosted wires to blend in with the natural color of the teeth. While the materials of clear braces are not as strong as metal, they offer a more aesthetic solution for patients who are concerned about the visibility of metal appliances. Clear braces were not nearly as widely used as traditional metal braces in this era, yet they signified the growing importance of cosmetic considerations in orthodontics.
Invisible Orthodontics: Clear Aligners
The 1990s marked a pivotal decade in the history of orthodontics with the introduction of clear aligners, a revolutionary treatment option that offered a virtually invisible alternative to traditional metal braces or even the camouflage approach of clear braces. The clear aligner system, known as Invisalign, was launched in 1997 by co-creators Zia Chishti and Kelsey Wirth with their business partners Apostolos Lerios and Brian Freyburger. Since the growth of Invisalign is more of a 21st-century narrative, this subject will be explored further in a future AlgerBlog.
Orthodontic Innovation in the 20th Century: The AlgerLight
The AlgerLight was conceived by David Alger, D.D.S., M.S.D., during his dental residency in the 1960s. He observed that many of the dentists and, more particularly, orthodontists were at the time starting to retire their outdated lighting “units,” which positioned the light atop a “pole” next to the dental chair. Recognizing the need for more operatory space and enhanced mobility, Alger created a prototype of a ceiling-mounted medical light, which utilized converging light beams to provide focused illumination for dental and orthodontic procedures, all while preserving valuable floor space. By the 1970s, a refined version of the officially named AlgerLight was gaining popularity, and over the years, it incorporated new features, including a footswitch and a wireless RF controller. By the 1990s, the AlgerLight had become the instrument of choice for dentists and orthodontists seeking a ceiling-mounted operating light.
A Century of Transformation
The 20th century was a time of tremendous growth and innovation in the field of orthodontics. From the groundbreaking work of Edward Angle in the early 20th century that helped distinguish orthodontics as a dental specialty to technological innovations like modern braces, clear aligners, and the AlgerLight, orthodontics evolved from an emerging focus with sometimes rudimentary practices into a sophisticated, patient-oriented field of dentistry with its own specialty tools. With the rapid pace of technological advancements and growing demand for aesthetic and functional dental treatments, orthodontics continued to build on its rich history, promising even more exciting developments in the years to come. We will cover this subsequent history of orthodontics in our next AlgerBlog.
Visit algerinc.com to continue your education of dental and orthodontic history, learn about other interesting topics, and--if you’re a practicing dentist or orthodontist--read about Alger Inc.’s prized piece of dental technology: the AlgerLight with LED.