Orthodontics

Orthodontics is a specialized branch of dentistry. It focuses on the diagnosis, prevention, and management of malocclusion. Malocclusion is the medical term for teeth or jaws that are not positioned correctly. It also includes fixing misaligned bite patterns. This field may also involve dentofacial orthopedics. This process modifies how a person's face grows. Misaligned teeth and jaws are very common worldwide. Research suggests the prevalence of malocclusion can be as high as 56%.

One major cause of malocclusion relates to childhood diet. Diets containing less fresh fruit and vegetables are often softer. These soft foods may cause jaws to grow smaller during development. Smaller jaws provide less room for teeth to erupt properly. To fix these issues, orthodontists use various appliances. These tools gradually adjust the position of teeth and the alignment of the jaw. Treatment can last from several months to a few years. In severe cases, a patient may require jaw surgery. Most treatment begins before adulthood. This is because pre-adult bones are easier to adjust.

Orthodontic history stretches back thousands of years. Evidence from Greek and Etruscan materials shows primitive appliances existed around 1000 BC. However, modern orthodontics began in the mid-1800s. Norman William Kingsley was a major influential figure. He published Oral Deformities to systematically document the field. Kingsley also pioneered treatments for cleft palates. He often used extraoral force to correct protruding teeth. During his era, the goal was often facial harmony and straightening teeth. Many teeth were removed to solve overcrowding. At that time, doctors did not fully appreciate the importance of an intact dentition.

Dr. Edward Angle is known as the "father of modern orthodontics." His work in 1890 changed the focus of the field. He moved the priority toward dental occlusion. Occlusion refers to how the upper and lower teeth meet. Angle created a classification system for malocclusions that is still used today. He believed that maintaining a full set of teeth was vital. He strongly opposed the practice of extracting teeth. Angle believed that perfect occlusion would naturally lead to better facial aesthetics. However, later practitioners found that focusing only on occlusion sometimes neglected facial proportions.

In the 1940s and 1950s, the field evolved again. Charles Tweed and Raymond Begg reintroduced tooth extraction. They did this to improve facial aesthetics and stability. During the postwar period, doctors began using cephalometric radiography. These are special X-rays used to measure changes in tooth and jaw positions. The X-rays revealed that many malocclusions were caused by improper jaw relations. This discovery shifted the focus toward functional jaw orthopedics. Today, clinicians use functional appliances and extraoral devices globally. These tools aim to amend growth patterns and jaw forms.

Dr. Edward Angle also developed four specific appliance systems. The first was the E-arch system. This used a rigid framework to recreate a specific arch shape. The second was the pin and tube appliance. This used vertical tubes to move teeth, but it was difficult to control. The third was the ribbon arch system. This was simpler and used wires with good spring qualities. The fourth was the edgewise appliance. Modern fixed appliances are mostly variations of the edgewise approach. Most fixed appliances use round wires first, then transition to rectangular archwires. These rectangular wires allow for much more precision during the final stages of treatment.

Recent technological advancements have revolutionized the process. Until the mid-1970s, braces were often wrapped around teeth with metal. New adhesives allowed doctors to bond metal brackets directly to the teeth. In 1972, Lawrence F. Andrews defined the characteristics of ideal occlusion. His definition included factors like correct crown angulation and tight contact points. In 1976, he introduced the straight-wire appliance system. This is also called the pre-adjusted edgewise system. This system uses a specific combination of brackets and archwires. It requires very little manual wire bending by the orthodontist. This makes the treatment much more efficient and predictable.