The history of orthodontics across the turn of the 21st century is defined by notable technological advancements, changing patient expectations, and increased interdisciplinary collaboration. The surrounding decades of the 1990s and 2000s saw developments in efficiency, aesthetics, and patient-friendly approaches. Innovations in materials science, digital imaging, and biomechanics redefined the way orthodontists approached diagnosis and treatment planning. Moreover, public awareness of orthodontic care and aesthetics continued to grow, building on the rising popularity of cosmetic orthodontics that started earlier in the 20th century.
Orthodontics in the 1990s:
Laying the Groundwork for a New Millennium
The 1990s were characterized by a wave of innovation that laid the foundation for a digital revolution in orthodontics. Although traditional braces with metal brackets and wires remained the standard, significant advancements in appliance design, treatment philosophy, and diagnostic tools began to shape a new era in orthodontics.
Improvements in Brackets and Wires
During the 1990s, brackets evolved from large, cumbersome designs to smaller, more efficient, and less visible forms. Stainless steel remained the dominant material, but there was a growing interest in “clear braces,” which used ceramic brackets for their aesthetic advantages. Though more fragile and prone to friction, ceramic braces appealed to adult patients seeking less noticeable orthodontic treatment.
Meanwhile, the development of nickel-titanium (NiTi) archwires revolutionized tooth movement. First introduced in the 1970s, NiTi wires gained widespread popularity in the 1990s due to their shape memory and superelastic properties. These wires could deliver light, continuous forces over time, reducing the need for frequent adjustments and enhancing patient comfort.
The Rise of Early Interceptive Treatment
The 1990s also saw a shift toward early interceptive orthodontic treatment for children. Today, the American Association of Orthodontists (AAO) recommends that a child receive their first orthodontic checkup when an orthodontic problem is first recognized, and no later than age 7. Even into the 1990s, however, most children did not receive orthodontic evaluations before age 12, and early interceptive orthodontics wasn’t as widespread. The rise of interceptive treatment marked a cultural shift within the field of orthodontics, promoting a proactive approach aimed at addressing skeletal and dental issues during a child’s growth phase, potentially reducing the complexity or need for treatment during adolescence. Orthodontists began collaborating more closely with pediatric dentists, speech therapists, and oral surgeons to create comprehensive treatment plans.
Diagnostics and Imaging
Another major development in the 1990s was the refinement of diagnostic imaging tools. While traditional 2D cephalometric radiographs and panoramic X-rays remained in use, there was an increased interest in 3D imaging and computer-assisted diagnostics. Imaging software programs like Dolphin Imaging and other early digital cephalometric analysis tools began appearing in orthodontic offices, allowing for more precise treatment planning.
Orthodontics in the 21st Century:
A New Age of Innovation
As the 20th century waned, new technologies emerged and established technologies refined, setting the stage for a new age for orthodontics. Novel approaches to established concepts emerged as Invisalign, one of the defining brands of the 21st century; digital orthodontics; and a facelift for the beloved AlgerLight dental instrument.
The Advent of Invisalign
Perhaps the most defining moment in the history of orthodontics at the turn of the millennium came with the introduction of Invisalign. Introduced by Align Technology in 1997, Invisalign was instantly successful as the first clear aligner system to offer an alternative to traditional braces; it quickly gained popularity for its aesthetic and removable design.
How did Invisalign change orthodontics?
Invisalign leveraged 3D computer imaging technology to map out a patient's entire treatment plan from start to finish. Patients were given a series of custom-made, clear plastic aligners that gradually moved their teeth into alignment. The ability to remove the aligners for eating and oral hygiene made them especially attractive to adult patients who wanted to avoid these common shortcomings of traditional braces.
While initially limited to treating mild to moderate cases, Invisalign’s capabilities were eventually expanded through advancements in attachments, materials, and software. By the mid-2000s, Invisalign had become a serious contender for a wide range of malocclusions. The system’s popularity also prompted the development of competing clear aligner systems by other companies, broadening access to this form of treatment.
Orthodontics Embraces the Digital Age
The 2000s built on the momentum of the previous decade, bringing digital dentistry to the forefront and redefining how orthodontists planned, delivered, and managed treatments. Key technological advancements included the integration of 3D imaging, digital impressions, and CAD/CAM (computer-aided design and manufacturing) systems.
Digital Imaging and Cone Beam CT (CBCT)
Cone Beam Computed Tomography (CBCT) is a radiographic technique that debuted in the American orthodontics market in 2001. It instantly revolutionized orthodontic imaging by providing detailed 3D images of craniofacial structures, allowing for more accurate diagnosis, treatment planning, and surgical assessment. Unlike traditional CT scans, CBCT used lower doses of radiation and was well-suited for dental applications.
This technology enabled orthodontists to visualize impacted teeth, root positions, jaw asymmetries, and airway volumes in unprecedented detail. It also facilitated interdisciplinary collaboration, particularly in cases requiring orthognathic surgery, implant placement, or temporomandibular joint (TMJ) analysis.
Digital Impressions and CAD/CAM
The Digital Age revolutionized the process of dental impressions. Digital intraoral scanners were first introduced in the 1980s, and computer-aided design/computer-aided manufacturing (CAD/CAM) systems were first used for dental applications in 1973 by Dr. Francois Duret of France. However, by the 1990s and 2000s, these technologies experienced significant expansion within dentistry and orthodontics. By the mid-2000s, intraoral scanners like the iTero and 3Shape TRIOS began replacing traditional alginate impressions. Digital impressions were faster, more comfortable for patients, and offered higher accuracy for appliance fabrication. The digital models could be instantly transmitted to labs, streamlining the production of aligners, retainers, and other orthodontic devices.
CAD/CAM technology allowed for the fabrication of customized brackets and indirect bonding trays, improving the precision of bracket placement. Some systems, like the Insignia orthodontic system by Ormco, even allowed for fully customized orthodontic appliances based on the patient's unique dental anatomy.
The AlgerLight Gets an Overhaul
Like the explosively innovative redesigns of braces that traversed the turn of the millennium, the AlgerLight received a similar overhaul. Alger Inc.’s prized ceiling-mounted dental light, which has been found in dentists’ and orthodontists’ offices since the 1960s, received a major makeover in the early 2000s to address the needs of 21st-century practitioners.
AlgerLight inventor/Alger Inc. CEO Dr. David Alger sought the assistance of aircraft lighting engineers for the AlgerLight’s redesign. The instrument’s overhaul included the addition of two motors to better control the light’s mobility vertically and horizontally. The light’s movement was manipulated by an RF controller that was paired with each specific AlgerLight unit. The model also offered a footswitch and handheld controller options, as well as a sleeker molded plastic enclosure. Lastly, the lighting mechanism was updated to replace the traditional light source with modern LEDs, anointing the current model the AlgerLight with LED.
Conclusion
The turn of the millennium was a transformative period in the history of orthodontics. This time saw the refinement of traditional braces, the dawn of clear aligners, the evolution of digital dentistry, and a significant overhaul of established dental tools like the AlgerLight with LED. The field of orthodontics evolved rapidly in this era to meet the changing demands of patients, offering new technologies as an answer to old problems. These decades not only modernized orthodontic practice but also broadened access and improved outcomes for millions of patients worldwide. The innovations introduced during this period continue to influence orthodontic care today and helped lay the groundwork for even more personalized, precise, and efficient treatments in the decades to follow. These future developments will be addressed in the AlgerBlog’s ongoing series, “The History of Orthodontics.”
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: AlgerLight with LED.