Non-Extraction Orthodontics

By on 10-10-2011 in Special Feature

In the field of orthodontics the most dominant, dynamic and influential figure was Edward H Angle (1855-1930), who is now regarded as the father of Modern Orthodontics. Through his efforts, the study of orthodontics flourished as an important field of dentistry. Such was his dedication to the field that he was the first dentist of his time to limit his practice solely to orthodontics.

One of his influences was the French Philosopher Jean Jacques Rousseau‘s philosophy of the perfectibility of man, the best balance, the best harmony, the best proportions of the mouth in its relation to the other features require that there shall be full complement of teeth, and that each tooth shall be made to occupy its normal position – ie normal occlusion. Angle developed a classification of malocclusion based on this principle, which was first published in the Dental Cosmos in 1899, and is still use today. This also led him to the notion that every person can obtain an ideal relationship of all 32 natural teeth; hence extraction for orthodontic manipulation was never necessary.

The emerging biological concepts of that era also influenced Angle’s Theories. In the early 1900s, the German anatomist/surgeon Julius Wolff theorized that bone in a healthy person or animal will adapt to loads it is placed under. Wolff Law of Bone stated that the internal osseous architecture or bone trabeculae were arranged in response to the stress lines on the bone, hence the tenet of form follows function.

Because of these influences, Angle formulated his two key concepts. One, that skeleton growth could be influenced readily by external pressure, and two, that proper function of the dentition would be the key to maintaining in their correct position.

He believed that the etiology for Class II malocclusion must be abnormal stresses on the jaws. Thus, if one introduces different patterns of pressure during treatment, this would be effective in changing growth and overcoming the problem, For him skeletal structures were so adaptable that rubber bands could overcome improper jaw relationships, stimulating growth where it was needed. And just as Wolff’s Law dictates, if all teeth were placed in proper occlusion, forces transmitted to the teeth would cause bone to grow around, thus, stabilizing them in their new position.even when a great deal of expansion has occurred. He believed that his appliances can make the bone grow eliminating the problem of extraction.

The expanded appearance of dentofacial esthetics was solved for Angle when he consulted the famous artist Prof Edmund Henry Wuerpel about the perfect face. According to Wuerpel, a great variety exists in human face, making it impossible to specify any one facial form ideal. Angle then considered that if one changes the relationship of dentition to the face, so would the esthetics of the lower face. By applying pressure to produce the ideal dental occlusion, this change will similarly yield ideal facial esthetics. Therefore for Angle, proper orthodontic treatment for every patient involved expansion of the dental arches and the use of rubber bands as needed to bring teeth into occlusion was the basic precept when he organized and opened his new school in the specialty – The Angle School of Orthodontia

Kim E, Gianelly AA (2003): Extraction vs Nonextraction: Arch Widths and Smile Esthetics. Angle Orthod; 73: 354-8.
Asbell MB (1990): A Brief History of Orthodontics, AJODO, 98: 206-13
Dewell BF (1964): The Case-Dewey-Cryer Extraction Debate: A Commentary, AJODO, 59:862-5.
Jang IG, Kin IY (2008): Computational Study of Wolff’s Law with Trabecular Architecture in the Human Proximal Femur Using Topology Optimization, J of Biomechanics, 41 (11): 2353-2361

Written by
Josievitz U Tan Zafra DMD
Decision Making in Orthodontics
Braces Cost –

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