From the end of the 19th century fixed appliances were more commonly used in America, while removable appliances were more popular in Europe. This continued until the introduction of stainless steel and bonding.
At the end of the 19th century, Edward H. Angle developed his system of regulation and retention of the teeth which used a series of prefabricated components to form appliances.
At the same time, there was a lot of controversy regarding the use of extraction as treatment. Angle led the anti-extraction camp while two of his students, Case and Tweed were pro-extraction.
In England, John Mershon popularised the lingual arch which was demonstrated at a meeting of the BSSO in 1925.
Most appliances at this time were made of precious metals. This changed with the introduction of stainless steel in 1931, which made appliances more affordable. Harold Watkin’s orthodontic spot welder revolutionised fixed appliance therapy by enabling bands to be made for individual teeth.
Over the 20th century, there were many advances in the development of fixed appliances by orthodontists such as Begg, Tweed, Andrews, and Bennett and McLaughlin. These advances are examined in more detail over the following pages.
Construction of fixed appliances
Edward H. Angle was the first to introduce prefabricated components which could be fixed together to build an appliance. However, many orthodontists continued constructing each required component until late in the 20th century when several developments in the manufacture of components led to an increased use of prefabricated elements.
Until the early 20th century gold was the principle material used for constructing brackets. Stainless steel was introduced in the 1930s, which allowed for smaller brackets. Brackets at this time were welded to metal bands which were cemented to the teeth. Bands were often constructed out of strips of metal, although some preformed bands were available. Buonocore’s discovery of direct bonding enabled brackets to be directly bonded to teeth. Brackets are now available in a variety of materials; stainless steel, plastic and ceramic.
Gold was superseded by stainless steel post World War II. This was augmented by non ferrous alloys in the 1970s, which had the unique properties of shape memory and super elasticity. Further alloy variants with the addition of various elements have further expanded the choice of arch wire material. To improve aesthetics, wires coated in tooth coloured materials are now available.
Some landmarks in the development of fixed appliances
Edward H. Angle introduced the E. Arch. This was followed by the Pin and Tube appliance in 1911, the ribbon arch appliance in 1910 and the Edgewise bracket in 1928. Angle’s treatment systems dominated fixed appliance use in America for many years.
Joseph E. Johnson developed the Twin Wire technique which used 2 light wires instead of one heavy one to provide a gentler force.
Dr P.R. Begg, a student of Angle, introduced the Begg Technique, a light wire differential force technique.
Charles H. Tweed displayed 100 cases using the Tweed Technique, based on Angle’s Edgewise system.
Lawrence Andrews introduced the Straight Wire Appliance, a pre-adjusted appliance system.
Craven Kurz introduced the Kurz/Ormco lingual bracket system, the first fixed lingual appliance system.
Peter Kesling introduced the Tip Edge bracket, a modified Edgewise bracket which utilised light forces to move teeth.
John Bennett and Richard McLaughlin introduced their version of the Andrews SWA System and their concept of associated Biomechanics.