THE HISTORY OF BRACES &ORTHODONTICS
There was a time that teenagers and adults alike trembled at the thought of having to get braces. The minute a dentist recommended seeing an orthodontist, the words "metal mouth", "tin teeth" and other unattractive adjectives ran through people‘s heads. Boy, have times changed. Today, with the new technologies available, people of all ages are choosing orthodontic treatment to achieve a beautiful, healthy smile.
An Overview of Modern-Day Braces
Orthodontic treatment used to be considered "cosmetic", but today, dentists and patients alike realize that orthodontic treatment may be a necessity. Correcting misaligned teeth can often prevent a lifetime of periodontal problems and severe tooth wear, and even premature tooth loss!
Generally, orthodontic evaluations are done on all children around the ages of 6-10 years old. By the time most children are 12-years-old, they have all of their permanent teeth and are able to receive orthodontic treatment. Many older patients now are seeking orthodontic treatment to correct their misaligned teeth, but don‘t want to go through traditional wires and brackets; hence the introduction of clear aligners.
Braces leverage the basic principles of engineering. Constant, mild pressure in the direction of desired movement will allow for an overall change in tooth position. As pressure is applied to the periodontal ligament, which holds the teeth in place, the body will automatically create room in the desired new location while also filling in the space where the teeth used to be located. If too much force is applied at once or in a short period of time, tooth loss is possible. This is the reason for the need for small changes to be made every 30 or so days for the duration of treatment. To be sure, teeth movement by way of orthodontic treatment must be constantly monitored and adjusted. While every patient is different, movement of 1 mm per month is usually possible with orthodontic care.
Traditional braces are generally worn for two to two-and-a-half years, depending on the extent of orthodontic treatment needed. When a lot of movement is needed, a longer duration of care may be necessary. Conversely, small amount of movement of the dentition will require a shorter period of time.
Since braces require regular adjustment (in addition to the initial application), the cost of orthodontic treatment is somewhat higher than many simple dental procedures. Traditional braces will cost anywhere between three and six thousand dollars in the United States. While insurance coverage of orthodontic coverage was a rarity years ago and is still not included in many policies, some insurance companies do pay a portion of orthodontic care.
Before Braces Were Known as Braces
Orthodontic braces weren‘t invented until the early 1800s, but people‘s preoccupation with straight teeth, and/or proper jaw alignment dates back to the time of the ancient Egyptians. The methods of teeth straightening varied from culture to culture, but the intent was clear — people wanted straight teeth for a perfect smile. Exploring the history of orthodontic braces can not only relieve some of the fear and emotions surrounding this sometimes intimidating dental device, but it can also be interesting to see just how braces have progressed and improved over the years.
Braces-Like Appliances for Egyptian Mummies
Archaeologists discovered many mummified remains in and around Egypt, with what researchers believe could have been an early attempt to close gaps in teeth. These remains have a cord made from animal intestines (known as catgut) wrapped or run along the teeth in a very similar style to how modern orthodontists run orthodontic wire along the teeth in an effort to close off gaps.
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Etruscan Dental Devices for the Afterlife
According to the American Association of Orthodontists [AAO], archaeologists discovered Greek and Etruscan dental appliances (the first known "bridge") that indicate humans began practicing orthodontics as early as 1000 B.C.
The Etruscans lived in and around Italy sometime between 770 BC and 270 BC, and were the predecessors to the ancient Romans. Etruscans had extensive burial rituals that involved preparing the body for the afterlife, before burying it in a tomb.
Archaeologists discovered that part of the burial ritual included the placement of a device that was similar to a mouth guard into the deceased's mouth. This was done to preserve the spacing and to prevent an inward collapse of the teeth, so the deceased looked good when they entered the afterlife. The bridges were made from pure gold excavated from the ancient site of Satricum in central Italy. A significant discovery is that the Etruscan bridges were worn only by women, hinting that cosmetics and vanity were important dental concerns.
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Use of Finger Pressure by an Ancient Roman Encyclopaedist
Aulus Cornelius Celsus was an ancient Roman who dedicated his life to studying and discovering new medical procedures. Celsus kept detailed accounts of his work, and holds the first recorded attempt to straighten or move teeth by use of finger pressure. Celsus documented a case that involved applying finger pressure to the teeth at regular intervals. Through detailed notes and recordings it was hypothesized by Celsus that the teeth were slowly moving and realigning themselves due to the extended exposure to the finger pressure.
Early Roman Attempts at Braces
Romans invented a dental device resembling modern orthodontic dental devices. Many Roman tombs were opened up by archaeologists only to discover that some teeth of the deceased had a small gold wire, known as a ligature wire, that was used to affix the arch wire to the bracket. The wire was bound to the teeth in an effort to force the teeth to move and close off noticeable gaps. Although there is no date documented, this process was most likely before the start of our era.
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The Dawning of Braces in Dental Research
Before dental braces could be introduced to the general public, extensive medical and dental research needed to be conducted. Dental braces and the concept of orthodontic braces started to appear in medical journals and books around 1770.
"The Surgeon Dentist"
The Surgeon Dentist is a medical book published in 1728 by Pierre Fauchard. Fauchard was a French dental surgeon notorious for his out of the box approach to dentistry. The Surgeon Dentist documented numerous general dentistry topics, but what made the book stand out in the world was a particular chapter devoted to orthodontics. The chapter explored various ways to straighten teeth, but focused mostly on a relatively new concept involving the "Bandeau." The "Bandeau" is a dental device that looks like a horseshoe. This device was inserted into a patient‘s mouth to keep the natural arch of the teeth and mouth in place.
"The Dentist‘s Art"
The Dentist‘s Art is a medical book penned in 1757 by the dentist to the King of France. Pierre Bourdet dedicated a section of the book to exploring various methods that could be used to improve tooth alignment. Two medical theories were monumental in The Dentist"s Art. The first monumental discovery was the theory that teeth in the back of the mouth (wisdom teeth) could be extracted to prevent overcrowding, which was the leading cause of tooth misalignment. The second discovery was the improvement of the "Bandeu" device. Pierre Bourdet wrote extensively on how the device could be improved from its original concept.
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The Basic Invention of Braces
The term "braces" wasn‘t coined until the early 1900s. However, dentists were working diligently to create and improve the methods and techniques used to align and straighten teeth. The world of orthodontics saw considerable advances that eventually led to the invention of modern day braces. Orthodontic advances between the early 1800s and 1890 include:
- 1819 – Christophe-Francois Delabarre invented the first wire crib. Wire cribs are an early model of the dental brace, and thought by many to be the first form of modern day orthodontics. The wire crib is a half circle device that can be placed directly on the teeth, with the hopes of having the teeth stay in alignment.
- 1843 – Dr. Edward Maynard was the first dentist to use gum elastics as a technique used to correct improper jaw alignment. An elastic material would be connected to wiring in the mouth to slowly move the jaw until it was in proper alignment.
- 1850 – E.J. Tucker elaborated Dr. Maynard‘s idea of using gum elastics to correct jaw alignment. Tucker took rubber tubing, and cut it into small bands that could comfortably fit into the mouth.
- 1864 – A New York dentist by the name of Dr. S.C. Barnum invented the rubber dental dam. Dental dams are latex sheets that keep teeth dry while orthodontists or dentists work on the teeth. The use of a dental damn is often used during the application process of the braces onto the teeth.
- 1893 – Henry A. Baker was the first to combine many of the concepts used by previous dentists into one orthodontic treatment. Baker devised the method known as the "Baker anchorage." Baker anchorage combines the rubber tubing discovered by E.J. Tucker, with the wire crib. This technique eliminated the need to completely remove numerous teeth to help correct their alignment.
- 1894 – Eugene S. Talbot was the first dentist to incorporate X-rays into orthodontic procedures. X-rays were commonly used to discover potential teeth that were out of sight due to being impacted underneath the gum. Talbot believed discovering these teeth and extracting them could eliminate overcrowding within the mouth.
Advances in Braces during the 20th Century
The first official use of the word "braces" was in the early 1900s. While the name may still be the same as the technique used in modern dentistry, the actual technique and devices used in orthodontics advanced considerably during the 20th century.
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The Very First Set of Braces in the Early 1900s
The braces of the early 1900s were dramatically different than the braces people think about today. Dentists would individually wrap bands (materials varied) around each tooth. The bands would then be connected by a wire. The wire could be adjusted to apply pressure to the teeth in hopes of slowly moving them into proper alignment.
There was no set standards in terms of what type of materials were used when the very first set of braces came into existence. Some dentists used ivory, while others used wood, copper or zinc. The materials that were used were completely dependent upon the dentist‘s personal preference, the patient‘s budget, and what was available in the geographical area at the time. However, there was one material preferred by dentists all over the world; gold.
Gold was preferred by many dentists because the material is extremely flexible when heated. The gold could be shaped and molded to wrap around the teeth. Materials such as wires, bands, clasps, and spurs were made out of 14K and 18K gold.
While gold was preferred it was not commonly used for a number of reasons; mainly the price and frequent adjustments that were required. Gold was extremely expensive even in the early 1900s, and not all patients could afford the added expense. In addition to the price of gold, patients who had gold braces required frequent adjustments from the dentist as the material would often start to grow soft due to body heat.
Patients who couldn‘t afford to purchase the gold used for the braces would often have to use the dentist‘s second choice of material; silver. Silver was significantly cheaper than gold, but not as flexible. However, it was preferred over the alternative materials such as ivory and wood, which were extremely difficult to work with at the time.
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Brace Application Techniques Improve in the 1970s
Orthodontic techniques stayed relatively the same until the 1970s when numerous breakthrough techniques were discovered. The biggest breakthrough technique was the use of a dental adhesive to hold dental brackets to the teeth.
A dental adhesive was placed on the surface of the teeth where the brackets would be "stuck" directly to the teeth. This technique replaced the need for dentists to wrap individual wire around each tooth to keep the brackets in place. In addition to the dental adhesive, tie wires and elastic ligatures were often used to keep the braces tight and in place.
The use of stainless steel, instead of gold or silver, was a part of the improved dental techniques used for braces in the 1970s. Stainless steel was becoming popular in the 1960s, but it wasn‘t until the mid-1970s that dentists started to embrace the material into their dental practice. Stainless steel was a relief to both patients and dentists; patients were happy because it reduced the cost of braces, while dentists liked it because it was extremely flexible and easy to manipulate.
The 1970s also saw the first attempt at ’invisible’ braces. People wanted an alternative to the unsightly wires and head gear. Dentists in Japan and the United States started to experiment with the possibility that dental braces could be applied to the insides of the teeth, instead of the outside. Placing the brackets on the inside of the teeth allowed people to get the benefits of braces without having to have people see the physical braces on the teeth.
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The Perfection of Invisible Braces in the 1990s
The concept of invisible braces was of great interest and study between the 1970s and early1990s. But it wasn‘t until 1997 that a technique, discovered by two individuals who had no dental training, came about that was widely accepted by orthodontists all across the globe.
Zia Chishti, a Stanford University graduate with no medical or dental background, discovered that his teeth started to shift when he didn‘t wear the clear plastic retainer that was a part of his orthodontic treatment. When the clear retainer was placed back in the mouth for several days, it would slowly move the teeth back into proper alignment.
Chishti took his discovery and paired up with Kelsey Wirth (another Stanford grad, and an investment banker for Robertson Stephens) to create a method that combined 3-D computer technology with plastic retainers. The 3-D technology would take several images of a patient‘s teeth, and show the slow progression needed to realign the teeth properly. The slow progression of the teeth back into proper alignment would be assigned a number or stage.
Each stage of progression would be represented by a different clear plastic retainer that the patient would wear for a specified amount of time. The different clear plastic retainers would slowly shift and move the teeth into place, which is similar to how braces work. However, instead of having the cumbersome braces attached to the teeth, the clear retainers did the work and no one would notice them.
Chishti and Wirth co-founded Align Technology, Inc. "to develop a new generation of high technology orthodontic products." The process they developed is known as Invisalign, and it became available to the public in 2000. Soon dentists and orthodontists all over the world were incorporating this orthodontic treatment into their practice.
Several companies have started to incorporate the Invisalign technique into their product. Clear Correct uses 3-D computer imaging, in addition to several clear retainers to slowly shift teeth back into proper alignment. Patients wear the retainers for the specified amount of time, and switch them out for the next clear retainer. The clear retainers are designed to slowly move or shift teeth back into proper alignment.
Image Courtesy of Invisalign
The Popularity of Braces in Today’s Society
When braces were first invented they were a dental device that was typically reserved for the wealthy, or those with extreme cases of orthodontic deformations. Today, braces are considered a routine dental procedure that many children and adults undergo to beautify their smiles and improve their oral hygiene and overall health.
The American Association of Orthodontics, which is the presiding organization over orthodontists in the United States, has come out with some dramatic statistics in regards to the popularity of braces in today‘s society.
Statistics presented by the American Association of Orthodontics include:
- Over four million individuals in the United States are undergoing some type of orthodontic treatment. Orthodontic treatment can consist of braces, invisible braces, or retainers.
- 33 percent of the world‘s population has undergone orthodontic treatment at some point in their life.
- 80 percent of the teenagers in the United States are currently undergoing orthodontic treatment.
- The number of adults who are seeking orthodontic treatment increased by 24 percent between the years of 1982 and 2008.
- 1982 to 2008 saw a 99 percent increase in the number of teenage orthodontic cases that were taken on by orthodontists all across the United States.
- The average age to seek treatment for overcrowding of the teeth in the United States is around the age of 10, which is dramatically different from the 1900s when people saw orthodontists in their mid-20s.
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Where Braces Can Go From Here
Braces have come a long way since the first use of a small catgut cord to slowly shift the teeth into proper alignment. In fact, there have been so many advancements in the techniques used that it‘s hard to imagine that after nearly 3,000 years‘ worth of advancements that there could be any room for growth in the world of orthodontics, but there is. Orthodontists predict that the popularity of seeking orthodontic treatment will only increase as both the cost and length of treatment time decreases.
Some research suggests that it is possible that the use of stainless steel for orthodontic treatments may be replaced within the coming years. A special heat-activated, nickel-titanium metal discovered by NASA might be the next big advancement in orthodontic treatment. Researchers believe that this metal, which can be molded into a small wire, can improve how teeth align in the mouth. This metal could eliminate the need for people to have to undergo multiple orthodontic visits just to realign or tighten their braces.