SPECIAL ARTICLE

Orthodontics in 3 millennia. Chapter 1:

Antiquity to the mid-19th century
Norman Wahl
Sequim, Wash

Orthodontics had its beginnings in the time of the ancient Egyptians, who used crude metal bands and
catgut, but it was not until the late 18th century that the first practical appliances came into use. These were
fine-tuned during the early 1900s; today’s mechanisms are merely refinements. Major changes occurred
when practitioners— originally physicians— began turning their attention from cosmetic “regulating” to
occlusion and stability, while empiricism gave way to objectivity and the scientific method. The purpose of
this article is to review the history of orthodontics from antiquity to the modern era. The article is divided into
chapters that will be presented serially in every other issue of the Journal. (Am J Orthod Dentofacial Orthop
2005;127:255-9)

E
ver since Eve flashed Adam her first grin, we to be shed is to be drawn out and the new one daily
have been concerned about our smiles. How- pushed toward its place by means of the finger until it
ever, it would be another 100 millennia1 before arrives at its just proportion.” That might still be good
we could do anything about it. Although the smile was advice, but kids today do not need ancient history to tell
the first goal for early “regulators,” it was occlusion them how to goad a high canine into place.
that gave orthodontics its scientific foundation. Now it Probably the first mechanical treatment was advo-
appears that facial esthetics is again in the forefront as cated by Pliny the Elder (ad 23-79), who suggested
we realize why patients come to us in the first place. filing elongated teeth to bring them into proper align-
From evidence found in human skulls, crooked ment. This method remained in practice until the 1800s.5
teeth have been around since the time of Neanderthal
man (about 50,000 bc), but it was not until about 3000 MIDDLE AGES (5TH TO 15TH CENTURIES) TO THE
years ago that we had the first written record of 18TH CENTURY
attempts to correct crowded or protruding teeth.2 Long Progress during the Middle Ages was nil. Dentistry
before braces, long before the word “orthodontics” was entered a period of marked decline, as did all sciences.
coined, it was known that teeth moved in response to After the 16th century, considerable progress was
pressure. Primitive (and surprisingly well-designed) made, although little was written of orthodontics during
orthodontic appliances have been found with Greek and this period. In France, students of dentistry were
Etruscan artifacts.3 Archaeologists have discovered admitted to a university as early as 1580. The first
Egyptian mummies with crude metal bands wrapped mention of practicing dentistry exclusively was made
around individual teeth. It is speculated that catgut was by Pierre Dionis (1658-1718). He called dentists “op-
used to close the gaps.4 erators for the teeth” and stated that they could also
“open or widen the teeth when they are set too close
ORTHODONTICS IN GREECE AND ROME
together.”
The earliest description of irregularities of the teeth Matthaeus Gottfried Purmann (1692) was the first
was given about 400 bc by Hippocrates (ca 460-377 to report taking wax impressions. In 1756, Phillip Pfaff
bc). The first treatment of an irregular tooth was used plaster of Paris impressions.6
recorded by Celsus (25 bc-ad 50), a Roman writer, who Malocclusions were called “irregularities” of the
said, “If a second tooth should happen to grow in teeth, and their correction was termed “regulating.” It
children before the first has fallen out, that which ought remained for the Enlightenment to reawaken the spirit
of scientific thought necessary to advance dentistry and
Private practice, Glendale, Calif.
Reprint requests to: Dr Norman Wahl, 202 Williamson Rd, Sequim, WA other disciplines.
98382-3096; e-mail, [email protected]. Beginning in the 18th century, the leading country
Submitted, October 2004; revised and accepted, November 2004. in the field of dentistry was France. This was due, in
0889-5406/$30.00
Copyright © 2005 by the American Association of Orthodontists. large measure, to the efforts of 1 man: Pierre Fauchard
doi:10.1016/j.ajodo.2004.11.013 (1678-1761; Fig 1) has been called the “Father of
255
256 Wahl American Journal of Orthodontics and Dentofacial Orthopedics
February 2005

Fig 1. Pierre Fauchard.

Fig 3. Fauchard’s bandeau refined.

Fauchard’s bandeau was refined (Fig 3) by Etienne

Bourdet (1722-1789), dentist to the king of France. His
was the first record of recommending serial extraction
(1757) and of extracting premolars to relieve crowding.
He was also the first to practice “lingual orthodontics,”
expanding the arch from the lingual. There followed a
long line of lingual appliances, including the jack-
screw, the expansion plate, and, closer to our time, the
lingual arch.
Although he was not a dentist, John Hunter (1728-
Fig 2. Fauchard’s bandeau. 1793; Fig 4) made the greatest advances in dentistry of
his time. An English anatomist and surgeon, Hunter
took a particular interest in the anatomy of the teeth and
Orthodontia.” He was the first to remove dentistry from jaws. His text, The Natural History of the Human Teeth
the bonds of empiricism and put it on a scientific (1771), presented the first clear statement of orthopedic
foundation. In 1728, he published the first general work principles. He was the first to describe normal occlu-
on dentistry, a 2-volume opus entitled The Surgeon sion to attempt to classify the teeth. He established the
Dentist: A Treatise on the Teeth. difference between teeth and bone and gave the teeth
Fauchard described, but probably was not the first names like cuspidati and bicuspidati.8 He was the first
to use, the bandeau, an expansion arch consisting of a to describe the growth of the jaws, not as a hypothesis,
horseshoe-shaped strip of precious metal to which the but as a sound, scientific investigation. His findings
teeth were ligated (Fig 2). This became the basis for have never been successfully challenged.9
Angle’s E-arch, and even today its principles are used
in unraveling a crowded dentition. He also “reposi- EUROPEAN PIONEERS OF THE EARLY 19TH
tioned” teeth with a forceps, called a “pelican” because CENTURY
of its resemblance to the beak of that bird, and ligated Joseph Fox (1776-1816), a student of Hunter, was
the tooth to its neighbors until healing took place. At another Englishman who made notable contributions to
that time, little attention was paid to anything other than the budding science of orthodontics. He devoted 4
the alignment of teeth and then almost exclusively to chapters of his book, The Natural History and Diseases
the maxilla.7 of the Human Teeth (1814), to that topic. The first to
American Journal of Orthodontics and Dentofacial Orthopedics Wahl 257
Volume 127, Number 2

Fig 4. John Hunter. Fig 5. Removable “plate” used by Friedrich Christoph

Kneisel and John Tomes.

classify malocclusion (1803), he was also one of the (1836). That same year, when he fitted his prognathic
first to observe that the mandible grows mainly by patient with a chin strap, he became the first to use a
distal extension beyond the molars, with little or no removable appliance. Kneisel wrote the first French and
increase in the anterior region. According to Wein- German treatises devoted exclusively to orthodontics.
berger,2 Fox “was the first to give explicit directions for He and John Tomes (1812-1895, English) used various
correcting the irregularities” of teeth. He was particu- removables (Fig 5). Tomes was also first to demon-
larly interested in the judicious removal of deciduous strate bone resorption and apposition.2
teeth, treatment timing, and the use of bite blocks to
open the bite. His other appliances included an expan- AMERICAN PIONEERS OF THE EARLY 19TH
sion arch and a chincup (about 1802). CENTURY
Joachim Lefoulon, a Frenchman, is probably best Before the time of Edward Angle and Calvin Case,
known for having given the science a name: orthodon- the treatment of malocclusions was chaotic, with little
tosie (1841), which roughly translates into orthodontia. understanding of normal occlusion and even less un-
He was also the first to combine a labial arch with a derstanding of the development of the dentition. Appli-
lingual arch. In the area of etiology, he arrived at ances were primitive, not only in design but also in the
factors of an entirely different character from those of metals and materials used. There was no rational basis
most authorities. These were based on biologic phe- for diagnosis and case analysis.10
nomena controlling the growth, form, and dimension of In the United States before the 1830s, there was no
organs and tissues.2 dental degree. All work in the mouth was done by
Christophe-François Delabarre (1787-1862; French) physicians, barbers, or charlatans, and there were no
introduced the crib and the principle of the lever and the such terms as orthodontics and malocclusion. There
screw (1815). He separated crowded teeth by means of were no contributions of value to the specialty by
swelling threads or wooden wedges placed between them. American authors—in fact, orthodontics had little lit-
J. M. Alexis Schange (1807-?, French) in 1841 erature until 1880.
published the first work confined to orthodontics. He However, during approximately the fourth decade of
introduced a modification of the screw, the clamp band, that century, most of these voids began to be filled, as this
and, in 1842, 3 years after the vulcanization process had country gained the commanding position in dentistry. In
been developed, rubber bands (actually, sections of 1834, the first American dental association, the Society of
rubber tubing). He also coined the term anchorage. Surgeon Dentists of the City and State of New York, was
Friedrich Christoph Kneisel (1797-1847, German), founded. In later decades, Americans invented vulcanite
was the dentist to Prince Charles of Prussia. He was the and other dental materials, pioneered the electric drill, and
first to use plaster models to record malocclusion discovered anesthesia.
258 Wahl American Journal of Orthodontics and Dentofacial Orthopedics
February 2005

The invention of vulcanite by Charles Goodyear in

1839 greatly reduced the cost and weight of dental plates
and other appliances. Made by adding sulfur to rubber,
vulcanite could be used to make dentures by heating the
mixture in a mold. The first attempts to commercialize the
new material were not practical because it softened when
heated and was partially soluble in water. When Goodyear
accidentally discovered “sulfur cross-linking,” rubber be-
came a workable material.12
E. G. Tucker, one of the first to use this new material
in his appliances, was the first American to use rubber
bands (1846). In 1852, the first national dental association
in this country (the American Society of Dental Surgeons,
1840), formed a committee on dental irregularities. In the
first report given by Tucker, he condemned the practice of
early extraction of deciduous teeth.5
Fig 6. Chapin A. Harris.

EARLY CONCEPTS OF ETIOLOGY

Along with attempts to regulate crooked or protruding
As early as 1797, Josiah Flagg (1763-1816) of Boston teeth came efforts to determine how they got that way.
advertised that he “regulates teeth from their first teeth, to Although some fanciful causes were put forth to explain
prevent pain and fevers in children, assist nature in the malocclusion, they were surprisingly well grounded. By
extension of the jaw, for a beautiful arrangement of a the middle of the 19th century, almost all of the pressure
second set of teeth.” Philadelphia dentist Leonard habits, including those of the tongue and lips, had been
Koecker (1728-1850) offered to supply ligatures “to teeth advanced, and some practitioners were talking about
of an irregular position” and was an advocate of early congenital and hereditary factors, dietary deficiencies,
treatment, stating that “if placed under proper care at an diseases (both physical and mental), and supernumerary
early age, the greater portion of the teeth of the permanent teeth. A few even mentioned growth.13
set may invariably be preserved to perfect health and Overbite was believed to be due to mouth breathing,
regularity,” and that if first molars “be extracted at any and underbite was thought to stem from persistent thrust-
period before the age of twelve years, all the anterior teeth ing of the jaw, imitation, breathing difficulties, and finger
will grow more or less backwards and the second and habits. Only a few considered it hereditary. Lefoulon, one
third molars . . . fill up the vacant space.”2 of the keenest observers of his time, offered (1841) these
J. S. Gunnell invented occipital anchorage in 1822, factors: (1) constitutional differences brought about by
beginning orthodontists’ 180-year struggle to get their social, economic, and geographic conditions; (2) prenatal
patients to wear headgears. conditions; (3) a disease process, such as scrofula; and (4)
In 1839, the first dental journal, the American abnormal pressures during speech.2
Journal of Dental Science, was established through the During the next century, other authors offered their
efforts of Solyman Brown (1790-1876), who wrote the pet theories for malocclusion:
first patient-education material (“Importance of Regu-
lating the Teeth of Children”); Levi S. Parmly (1790- ● Kingsley considered it a result of interracial
1859), founder of a dental dynasty; and Chapin A. mixture.
Harris (1806-1860; Fig 6), who edited the journal from ● Case’s theory was that a child inherited the
1839 to 1858. Harris was also instrumental, with maxilla from 1 parent and the mandible from the
Horace H. Hayden (1769-1844), in founding the first other.
school of dentistry that year at the University of ● Talbot thought that endocrine glands were a
Maryland, where he gave the first lectures on “irregu- possible cause.
larities of the teeth.”11 In 1840, he published the first ● Angle recognized the importance of rhinology by
modern classic book on dentistry, The Dental Art. His 1904.
innovations included the use of gold caps on molars to ● Rogers suggested myofunctional causes (perni-
open the bite and knobs soldered to a band for tooth cious tongue and lip habits) (1918).
rotations. ● Brash supported the theory of inheritance (1929).
American Journal of Orthodontics and Dentofacial Orthopedics Wahl 259
Volume 127, Number 2

● Case showed remarkable foresight in differenti- 6. Salzmann JA, editor. Practice of orthodontics. Philadelphia:
ating between “dental malposition” and “dento- Lippincott; 1966. p. 2.
7. Casto FM. A historical sketch of orthodontia. Dent Cosmos
facial imperfections,” comparable to today’s
1934;76:111-35.
terms, dentoalveolar and skeletal.10 8. Asbell MB. Bicentenary of a dental classic: John Hunter’s
“Natural History of the Human Teeth.” J Am Dent Assoc
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