(updated and expanded on November 26, 2024)

by Andrew I Spielman

How to cite this page: Spielman, AI. History of Orthodontics. In: Illustrated Encyclopedia of the History of Dentistry. 2024. https://historyofdentistryandmedicine.com/

The history of orthodontics spans thousands of years and can be divided into several distinct stages, each representing a fundamental shift in treatment. These stages demonstrate how orthodontics evolved from an observational to a sophisticated specialized discipline (Figure 1, below).

a.     The earliest recorded stage of orthodontics was observational for conditions related to the discipline. Cleft palate and crowding of teeth were observed, but no intervention was recommended due to a lack of knowledge. 

b.     The following stages of orthodontics are all interventional. The first interventional stage is best described as incidental interventions. The authors stumble onto treatments by incidental observation, trial, and error. The first such recorded intervention was in 1541 in Zene Artzney, when primary teeth were removed to make room for permanent teeth. 

c.     Pierre Fauchard, the father of dentistry, initiated the next period in 1746. This stage introduces deliberate interventionbased on individual knowledge from practitioners like Pierre Fauchard (1686-1761), a French surgeon-dentist who assembled the first comprehensive work on dentistry, Le Chirurgien Dentist. His 20-page chapter in the second edition on treating dental malposition is based on his experiences and marks the first work addressing orthodontic needs.

d.     The next stage in the development of orthodontic treatment relies on knowledge assembled from the collective experience of many practitioners. The publication of the first textbooks dedicated to orthodontics marks the beginning of the deliberate intervention phase, which is based on collective or cumulativeknowledge. Authors like Joseph Sigmond’s (1819), William Mortimer’s (1836), and Johann F.C. Kneisel’s (1836) textbooks mark the start of this period. 

e.     Moving forward to 1880, Norman Kingsley’s specialized text, A Treatise on Oral Deformities, and Angle’s 1890 work on the Treatment of Malocclusion of the Teeth and Fractures of the Maxillae, were published. These events mark a new phase of specialized intervention in orthodontics.

f.      The last phase, currently unfolding, is a hybrid phase emphasizing face-to-face and digital specialized treatments.

Figure 1. Stages of Orthodontics based on treatment options.

1. Orthodontic concerns in antiquity.

There is no evidence of orthodontic interventions in antiquity. Archeological evidence suggests they could diagnose but not treat conditions that fall under orthodontics today. After Howard Carter stumbled on King Tutankhamun’s (1334-1324 BCE) intact tomb, a thorough medical and radiological evaluation of the mummy revealed the pharaoh’s many ailments, including a cleft palate.

The earliest written evidence of dental crowding comes from the Corpus Hippocraticus, a collection of around 60 ancient Greek medical texts attributed to Hippocrates (460-368 BCE) and his followers, written between the 5th and 4th centuries BCE. Covering topics like anatomy, diagnosis, surgery, and ethics—including the famous Hippocratic Oath—the corpus marks a foundational shift toward natural explanations for disease, shaping medical practice for centuries. In it, malpositioned and crowding of teeth are highlighted. 

In the 1st Century Rome, Aulus Cornelius Celsus (25 BCE – 50 CE), a Roman medical authority active during the reigns of Augustus, Tiberius, and Claudius, suggests the removal of deciduous teeth if they interfere with the eruption of permanent teeth and applying daily finger pressure to ectopic permanent teeth to move them into position. (1)

One of the great orators of ancient Greece was Demosthenes (384–323 B.C.); the orator, legend has it, was a stutterer and practiced his speech by placing pebbles in his mouth. A more recent discovery of a bust of Demosthenes at the British Library shows the orator with what looks like a one-sided cleft lip. An intriguing hypothesis posits that Demosthenes was not a stutterer but had unilateral cleft lip and palate, and the pebbles he placed in his mouth were attempts to learn to speak with a make-shift obturator. (2) 

2.    Orthodontic concerns in the 16th and 17th Century

During the 16th Century, the first book dedicated to dentistry, Zene Artzney, appeared. Written for barber-surgeons, the book has seen 11 editions. In the 1541 (4th) edition printed by Christian Egenolff, it is suggested

…” When the teeth begin to drop out, other teeth grow by the side of those which are about to drop out; therefore, we should loosen the tooth about falling out from the gums and move  it to and fro until it can be taken out, and then push the new one every day toward the place where the first one was, until it sits there and fits in among the others, for if you neglect to attend to this, the old tooth will remain, become black, and the young one will be impeded from growing straight, and can no more be pushed to its proper place…” .(3)

The first palatal obturator for cleft palate or palatal syphilitic perforation was suggested in 1560 by Amatus Lusitanus (1511-1568) (4, 5). He describes the case of a perforated palate that he plugged with a custom-made gold lentil-shaped nail broad enough to cover the perforation. On the nasal side, the obturator was fitted with a sponge that expanded with use, holding the plug-in place. The device was removable and cleaned twice daily. Lusitanus was preceded by three years by Franz Renner, a barber-surgeon from Nurnberg, who also described an obturator made of multiple layers of leather (6). 

Contemporary to Lusitanus was the French barber-surgeon Ambroise Paré (1510-1590), the surgeon who introduced gentle tissue handling, ligature of blood vessels instead of hot-iron cauterization, and, for the first time, treatment of edentulism using ivory-carved replacement teeth. In his collective work, Oeuvres, 1561 (7), Paré describes and illustrates Lusitanus’ obturator. Paré has a sponge hanging from the nasal side to anchor it. Later models have a button-like structure that could be turned 90 degrees to hold the obturator in place. The term obturator appears only from 1575 (“obturateur du palais”).

Figure 2. Obturators depicted in Pare’s Oeuvres (1561)


The 1619 text by Hieronymus Fabricius ab Aquapendente (1537–1619) recommends the extraction of crowded and malpositioned teeth. Aquapendente was an influential anatomist at the University of Padua. He was among the first to describe the venous valves that led William Harvey, his pupil, to explain blood circulation in 1628. (8)

Figure 3. How to remove malpositioned teeth that injure the tongue and the cheek. Text from Ref. 8.

3.    Addressing orthodontic needs in the 18th Century

The 18th Century marks the beginning of the second stage of orthodontics, deliberate interventionbased on individual knowledgestage. Its main protagonist is Pierre Fauchard (1678-1761), the surgeon-dentist who defined dentistry as a profession and named chirurgien-dentist to posterity. Fauchard published the first comprehensive review of dentistry in 1728 after consulting with 19 of the most important physicians, surgeons, and dentists of the time. His enlarged second edition of 1746 includes a chapter on orthodontics entitled Manière de redresser les dents, et de les remettre en place, par le moyen des fils et des plaques, which extends to 20 pages. (9) He suggests a silver or gold plate (“bandelet”) extending over three or more teeth, with the ectopic tooth in the center. The pressure would push the malpositioned tooth inward by placing silver or gold wires around the end of the plate and anchoring it to the teeth at each end of the plate. The band was placed on the buccal side of the ectopic tooth. The wires were adjusted for tension daily. Fauchard even suggested first loosening the malpositioned tooth with a Pelican for a more rapid effect.

Figures 4A and 4B. The silver plate (top, original illustration) is in position over an ectopic tooth of a contemporary patient, as one would imagine the plate worked.

The band could be extended over several teeth if needed. A lead band was practical for its malleability. Placed over the six frontal teeth and held in place by wires, it could treat anterior tooth extrusion.

Figure 5. Anterior tooth extrusion treatment with a lead band in Fauchard’s time. The replica was recreated by a dental technician in Halle, Germany, in the 1950s.

A contemporary of Fauchard, Etienne Bourdet (1722-1789), Royal Dentist to Louis XV, published Recherche et observations sur toutes les parties de l’art du dentiste -1757, (10). advocated extraction of the first bicuspids to ease crowding and improve appearance. He also used a lingual bar to extend the arches and strips to straighten and rearrange teeth. 

Figure 6. Illustration of plates (strips) – Etienne Bourdet.

The first dentist indirectly tied to America was Thomas Berdmore (1740-1785), dentist to George III and tutor to Robert Woffendale, the first recorded dentist in America in 1766. In 1768, Berdmore published A Treatise on the Disorders and Deformities of the Teeth. (11) One chapter dedicated to the irregularities of the teeth and their reduction by ligatures advocates the same treatment already described in Paris. A second chapter advocates filing off teeth that are interfering with occlusion or causing injury to neighboring tissue. Berdmore’s description of the seven-page chapter is less detailed than Fauchard’s or Bourdet’s, most likely because Fauchard’s book was not translated into English until 1946.

From the turn of the 18th to the 19th Century, Joseph Fox (1775-1816), an English surgeon and educator, emerged as an important figure in the history of dentistry. In 1797, Fox was the first to provide formal lectures on dentistry to medical students at Guy’s Hospital. These lectures were compiled into successful publications, The Natural History of the Human Teeth (1803) and The History and Treatment of the Diseases of Teeth (1806). Fox is the first to advocate deliberate treatment of tooth irregularities. He was the first to classify malocclusions and cautions against premature removal of deciduous teeth. He states in his first book: 

“When a tooth requires to be extracted, and also of the particular tooth; for often more injury is occasioned by the removal of a tooth too early, than if it is left a little too long; because a new tooth, which has too much room long before it is required, will sometimes take a direction more difficult to alter, than a slight irregularity occasioned by an obstruction of short duration. If an improper tooth is extracted, irreparable mischief will ensue, as in the case where young permanent teeth have been removed, instead of the obstructing temporary ones” (12).

A focused improvement of orthodontic treatment is seen in Johann Jacob Joseph Serre’s work (1759-1830), a Belgian surgeon and court-dentist in Berlin. He takes a wax impression of the malpositioned arch and teeth and, with the help of a goldsmith, creates a plaster model and prepares an appliance (13).

Joseph Fox is also remembered for using the chin cap for TMJ dislocation (1803), a tool advocated by the French surgeon Cellier (1802) to treat prognathism. 

A critical moment in the development of orthodontics was the introduction of the first bite plane in 1808. Joseph L. Catalan (1776? -1830) illustrated the inclined bite plane for treating malocclusion. (14) Although he used it as early as 1808, he published his treatment only in 1814 in a study entitled: Mémoire sur un nouvel instrument, nome Plan Incline, destine a remédier à la difformité connue vulgairement sous le nom de “menton de galoche”.


Figure 7. The journal in which Catalan published the use of the first bite plane and illustrations in his eight-page publication.

A decade later, in 1819, Christoph-Francois Delabarre (1784-1862) was the first to try to categorize the various types of malocclusions and suggested the placement of a space-maintainer. He was against removing deciduous teeth to make room for permanent dentition. Delabarre adopted Catalan’s bite plane and was the first to introduce a metal appliance for rotating a tooth. (15) 

The 19th-century French dentist Christoph-Francois Delabarre (1777-1862), in his 1819 book Traite de la second dentition, et method naturelle de la diriger, describes several orthodontic firsts: space maintenance, the lever (spring) that delivers tooth movement and tooth rotation, and a metallic cap (crown) to anchor the springs to ensure rotation (15,16).


Figures 8A and 8B. A. Classification of malocclusion (1819). B. The spring to rotate teeth (1820).

The early 19th Century also brought the first three dedicated textbooks to orthodontics. 

A practical and domestic treatise on the irregularities of the teeth and gums with the methods of treatment (17) by Joseph Sigmond (1750-1826), a dentist from Devonshire who aimed to educate the public was the first such book. Next is Observations on the growth and irregularities of children’s teeth (18) by William H. Mortimer, a text focused on orthodontics. The same year, the first German-language text on orthodontics was also published (19) by Johann F.C. Kneisel – Der Schiefstand der Zahne (1836).


Figure 9. First three textbooks on orthodontics. Sigmond 1825, Mortimer 1836, and Kneisel 1836.

Figures 10A and 10B. A. The bite plane, and B. The “pernicious effect of premature extraction of deciduous lower incisors”. Illustrations from Mortimer’s textbook (1836).

Figure 11. A “before and after” case is shown in Frederich Kneisel’s book, 1836.

Philibert Joseph Roux (1780-1854) achieved a remarkable milestone in the history of orthodontics in 1825 with the first surgical repair of a cleft palate, described in Memoire sur la staphyloraphie (20). The surgery is all the more important because it happened before the advent of general or local anesthesia.


Figures 12. Philibert Joseph Roux. 

The Frenchman to whom we owe the name of the specialty is Joachim LeFoulon (1800-?).  

“Orthodontosie” – is defined as “the specialty that deals with congenital or accidental deformities of the mouth”. Figure 13 depicts the title of the chapter in his 1841 book entitled, Nouveau traité théorique et pratique du l’art du dentiste.

Figure 13. The chapter entitled “Orthodontosie” in Lefoulon’s work. (21)


Lefoulon is credited with simultaneously expanding the maxillary bones using both lingual and labial arches (21).

Figure 14A-C. Labial and lingual bars of Joachim Lefoulon

His second major work on orthodontics, “Des deviations des dents et de l’orthopedie dentaire, published 18 years later, describes his important discovery that orthodontics is not limited only to adolescents; Orthodontic treatment can also be applied to adults. He states, “I have learned that dental arches are inextensible in adulthood. My tests proved this completely wrong. At twenty and beyond, it is possible to obtain widening of the dental arches.” (22).  

Figure 15. Three “Before and After” cases from Lefoulon’s 1859 volume (22).


In 1839, vulcanized rubber was discovered. Within two years, in 1841, Alexis J.M. Schange, a French dentist, already used India rubber as a flexible band to correct maxillary protrusion. His book is “Precis sur le Redressement des Dents” (23). In it, he demonstrates the use of elastic bands ((“bande de caoutchouc”) and screws to regulate appliances. Alexis Change defines a new classification of malocclusions based on abnormalities in the number of teeth, in form, in position (migration and transposition), in direction (deviation anteriorly, posteriorly, laterally, and rotations), and in relation to the arches: (protrusion, retrusion, and inversion).


Figure 16 A-D   A. Lingual hook; B. Schange’s crib with labial arch; C. device to correct extreme protrusion; D. using the India rubber elastic band (1841).

Several prominent American dentists emerged in the middle of the 19th Century with contributions to orthodontics. These include Amos Westcott (1815–1873) and Solyman Brown (1790–1856). Scott was an influential educator, mainly known for his contributions to orthodontics and cross-bite correction. Wescott was a New York-based dentist and one of the founders of the New York College of Dentistry in Syracuse (1852-1875). He was among the first to use a chin cap to treat cross-bite, a revolutionary approach at the time. In addition to his dental achievements, Westcott was a civic leader, serving as the mayor of Syracuse, New York, from 1860 to 1861. Solyman Brown, similarly, was a founder of the New York College of Dentistry in New York City in 1865.He was a notable dentist, poet, and advocate for professionalization in dentistry during the mid-19th Century in New York. Trained as both a dentist and clergyman, Brown co-founded the American Society of Dental Surgeons, the first national dental organization, aiming to establish higher ethical and educational standards in the field. In 1840, the freshly established American Society of Dental Surgeons (1840) decided to sponsor a dedicated publication on orthodontics. The following year,  In 1841, Brown published a short essay on regulating children’s teeth, Essay on the importance of regulating children’s teeth. It was intended as an educational pamphlet for parents.

George Carabelli (1787–1842) was a Hungarian-born Viennese dentist and professor of dental surgery at the University of Vienna. He is best known for studying dental morphology and his simple classification of malocclusions (1842): normal, edge-to-edge, open bite, protruding, retruding, and zig-zag (cross-bite), senile, and edentulous.

In 1844, he published Systematische Handbuch der Zahnheilkunde (24), a Systematic Handbook of Dentistry that became a foundational resource for dental education in Europe.

He is also famous for identifying and describing the “Carabelli cusp,” a small additional cusp found on the upper molars, which remains a significant marker in dental anthropology and forensic science.

Thomas W. Evans (1823–1897) was another American dentist and ardent innovator who embraced new technologies. He practiced in Philadelphia and Paris, where he became the personal dentist to Napoleon III and members of European royalty, earning the nickname “dentist to the courts.” Evans used orthodontics in his daily practice. Evans created an anchorage by soldering a metal tube to the side of a plain band. Through the tube, he passed a flat wire adjustable in length with a screw. In 1854, Evans described five cases in a paper entitled On the regulation of teeth (25), Figure 17).

Figure 17 A-C. Devices used by Thomas Evans.

He is also known for his advancements in gold foil fillings and the development of new surgical techniques for oral and maxillofacial conditions. Evans played a critical role in popularizing the use of anesthesia in dental treatments in Europe. During the Franco-Prussian War, he assisted in the escape of the French Empress Eugénie, solidifying his status as a trusted figure in medical and royal circles. 

Evans’s philanthropy led to the establishment of the Thomas W. Evans Museum and Dental Institute at the University of Pennsylvania, Philadelphia. 

Another important American dentist, educator, and founder of dental school was William H. Gwinelle (1819-1896), the co-inventor of the expansion (Jack) screw (1856). The development of the jack screw allowed for precise and controlled tooth movement, marking a transformative moment in orthodontic treatment. This tool, co-invented independently by Charles Gaine of London, was integral in expanding dental arches and addressing malocclusions. Gwinelle also co-founded the New York College of Dentistry in New York City. His contributions extended beyond his technical innovations, as he significantly shaped orthodontic practices and education in the 19th Century.

Figure 18 A-B. A. W.H. Dwinelle. B. The expansion screw (jack screw).

John Nutting Farrar (1839–1913) was a notable figure in the development of modern orthodontics, renowned for his work, A Treatise on the Irregularities of the Teeth and Their Correction, 1880 (26,27). This two-volume work was groundbreaking for its comprehensive exploration of the science of tooth movement, detailing the principles of applying light, intermittent forces to move teeth effectively and safely at the expense of speed. Farrar was among the first to systematically study and document the biological (histological) and mechanical aspects of orthodontics, interested in understanding the changes that occur to the bone during tooth movement. Rather than speed in treatment, Farrar suggested gradual adjustments to avoid damage to the supporting structures. His studies concluded that applying force to move 1/60 inch a day caused pain that lasted three hours. As he fine-tuned the force, he concluded that applying intermittent force to a tooth, with a movement not to exceed 0.2 mm or 1/120 inch a day, was appropriate (27).

A unique aspect of orthodontic history is the beginning of orthognathic surgery. The founding father of orthognathic surgery was James Edward Garretson in 1869, a pioneer surgeon from Philadelphia Dental College, now part of Temple University, who published “A System of Oral Surgery,” a textbook that had seen six editions in 30 years while in use. 

During the second half of the 19th century, a number of incremental advances in orthodontics were introduced by many contributors, both in the United States and Europe. A few names, however, stand out: Norman Kingsley, the “founding father”, Edward Hartley Angel, the “father of modern orthodontics”, and John Nutting Farrar, of Brooklyn, NY.


Norman W. Kingsley (1829–1913), was the founding dean of New York College of Dentistry (1865). Kingsley was a trailblazing dentist, artist, and author whose groundbreaking work laid the  foundation for modern craniofacial surgery and orthodontics. Born in New York, Kingsley initially worked as a cabinet maker before pursuing dentistry, where he was quickly recognized for his extraordinary skill and artistry. He started treating complex dental and facial deformities cases by designing unique devices and was the first practicing dentist specializing in unique facial and maxillary malformation cases. His contributions extended beyond dentistry and education, as he became one of the first practitioners to view facial deformities as a specialty. Kingsley’s most notable work, A Treatise on Oral Deformities as a Branch of Mechanical Surgery (1880) (28), focused on his experience with the treatment of facial deformities. The work included detailed descriptions of orthodontic devices and unique surgical interventions. Kingsley single-handedly defined a new specialty, establishing him as an expert in the field. 

Figure 19. Norman Kingsley.


Kingsley developed a palate obturator that was in contact with the soft palate, a feast achieved using vulcanite, a rubbery substance. For the first time, patients could speak and eat without much difficulty. His devices won gold medals at the 1853 (New York City) and 1855 (Paris) World Fairs. His work highlighted the relationship between orthodontics and craniofacial development, and he advocated for early intervention in treating facial deformities long before this became a standard practice.

Figure 20. Skullcap, chin cap, and device used by Kingsley (1892).

4. Orthodontic treatments in the 20th Century

No person has done more to advance orthodontics than Edward Hartley Angle (1855–1930), often called the “Father of Modern Orthodontics,”. He was an American dentist and innovator who revolutionized the field of orthodontics, transforming it into a distinct and formalized specialty. Born in Herrick, Pennsylvania, Angle initially studied at the Pennsylvania College of Dental Surgery and later the Philadelphia Dental College, where he received his DDS in 1878. Early in his career, he became fascinated by the irregularities of the teeth and jaws, which were overlooked in dental practice at the time. Angle’s interest in malocclusion and its correction led him to shift his focus entirely toward orthodontics, leaving general dentistry to refine theories and techniques that would become foundational to the specialty.

Figure 21 A-C. A. Signed picture of Edward Angle. B. The expansion arch. C. An orthodontic device to gradually move an impacted canine to erupt into proper occlusion.

Angle’s contributions were both theoretical and practical. He defined a new simple classification system based on the relationships of the upper and lower first molars. It was a standardized way to diagnose malocclusions. Beyond theory, Angle was an inventor. In 1893, he applied traction via intermaxillary elastic bands. He developed innovative orthodontic appliances such as the Edgewise Appliance (1916), which allowed for greater control over tooth movement and laid the groundwork for modern braces. His most significant publication, Treatment of Malocclusion of the Teeth and Fractures of the Maxillae (1890) (29-31), translated into French, German, Dutch, Spanish, and Scandinavian languages, underwent seven editions and became a cornerstone in orthodontic education. Additionally, in 1900, he founded the first school dedicated exclusively to orthodontics, the Angle School of Orthodontia in St. Louis, Missouri, which trained the first generation of orthodontic specialists.

Angle was committed to elevating orthodontics as a respected branch of dentistry. He founded the American Society of Orthodontists in 1901 (now the American Association of Orthodontists) and the first orthodontic journal, The American Orthodontist, in 1907. He emphasized function and aesthetics in orthodontics, including an understanding of facial harmony and oral health. Angle’s influence remains profound even today.

European orthodontists are probably more aware of the contribution of Pierre Robin (1867–1950) to developing a critical device called the monobloc in 1902. Robin was a French surgeon trying to address a solution to a relatively rare malformation: glossoptosis, today part of the Pierre Robin Syndrome. The monobloc was designed to address jaw alignment and respiratory problems, particularly in children with airway obstructions. The monobloc was a precursor to functional orthodontic devices. Robin’s innovative approach to combining orthodontic and functional therapy demonstrated his holistic understanding of craniofacial growth and airway health.

Figure 22. The monobloc to treat Glossoptosis Syndrome, 1902.

William E. Magill (1823-1896) introduced the modern multi-band technique in orthodontics, which is widely used today. Magill was the first to cement orthodontic archwires onto bands surrounding teeth, marking a pivotal moment in developing orthodontic devices. Around the same time, George B. Crozat (1894–1966) from New Orleans and his German colleague Albert T. Wiebrecht (1893-1988) developed the oldest system of removable orthodontic devices. This system emerged when fixed arch appliances made of precious metals were commonly used, and tooth extraction was a standard practice to address overcrowding. The Crozat system replaced the fastening straps of fixed braces with retaining clips already used in fixed prosthodontics. This method, introduced in 1919, made it simple, comfortable, and more accessible for patients to maintain oral hygiene and allowed specialists to adjust the appliances more efficiently. Additionally, it reduced the risk of root resorption caused by excessive orthodontic forces and was particularly beneficial for patients with periodontally compromised teeth. 

Crozat’s contribution became a cornerstone in functional orthodontics and laid the groundwork for removable orthodontics, a bridge between traditional fixed and modern removable orthodontic devices.

Figure 23. A removable device designed by George B Crozat


Viggo Andresen and Karl Häupl are credited with pioneering the development of modern biofunctional activator appliances – arch activators, which have become a cornerstone of functional orthodontics. Viggo Andresen, a Danish orthodontist, designed an appliance, the “Activator”. In 1920, he moved to Norway, where he collaborated with Austrian Karl Häuple. Subsequently, the system became known as the Norwegian system. It was a passive appliance meant to stimulate jaw growth and tooth alignment using the natural forces associated with muscle movement. Various biological functions, including chewing, swallowing, speech, and breathing, were harnessed in molding the forces applied to teeth. Andresen believed that the gentle forces undergoing the normal functioning of the craniofacial complex could be synergized with the desired effect in tooth movement. This simple idea became known as functional jaw orthopedics, and it is the basis of the European School of Orthodontics. Unlike the rapid changes advocated in the US through fixed appliances, Andriesen and Häuple’s slower process marked a departure from the accepted convention. 

Figure 24A and 24B. A. Viggo Andresen B. Karl Häupl.


William R. Proffitt (1936-2018)  – author of “Contemporary Orthodontics”; “Surgical Correction of Dentofacial Deformity” and “Surgical-Orthodontic Treatment”.

Figure 25. William R. Proffitt

William R. Proffitt was a towing personality, educator, and promoter of orthodontics in education during the 20th Century. Established as a Professor at the University of North Carolina at Chapel Hill, he influenced orthodontic education and specialization in the US dental schools and curriculum in postgraduate programs.   He was the author of works such as Contemporary Orthodontics, Surgical Correction of Dentofacial Deformity, and Surgical-Orthodontic Treatment. Contemporary Orthodontics became standard texts worldwide for several decades over multiple editions. Proffitt was a proponent of combined surgical-orthodontic treatment for severe cases, emphasizing interdisciplinary approaches.

5. Development of diverse activator appliances.

(This section is based on a previously published review. Ref. 32)

In addition to Angle, several significant contributors to the development of orthodontics at the end of the 19th and 20th centuries were involved. 

At the close of the 19th Century, the dental polyclinic in Berlin merged with a specialized institute for operative, prosthetic, and orthopedic dentistry to create a comprehensive dental clinic headed by Alfred Körbitz. Körbitz, a German orthodontist, played a significant role in introducing the Angle orthodontics system to Europe and advocated for the principles of biological orthodontics. This approach emphasized using minimal force to move teeth, which was considered more natural and less invasive.

In 1920, Charles Hawley invented the retainer, a device used after orthodontic treatment to stabilize teeth in their new positions. That same year, Alfred Kantorowicz (1880-1962), a German Pediatric Dentist, established the Department of Orthodontics at Rheinische Friedrich-Wilhelms University in Bonn, transitioning it from a private dental institute to an academic institution. Kantorowicz’s efforts also led to integrating orthodontics into dental school curricula, making orthodontic treatment more accessible to a broader population, and increasing the number of cases treated. Meanwhile, Charles F. Nord, with his experience in prosthetics and materials, developed affordable orthodontic devices, which helped democratize orthodontics, making it accessible to more patients.

After 1930, Artur Martin Schwarz and his colleagues advanced orthodontics by developing multiple versions of orthodontic devices with adjustable screw elements. These devices allowed patients to adjust following simple instructions, further improving the convenience of treatment.

1977, Percy Raymond Begg introduced the Begg technique, which focused on light-wire differential force to move teeth with minimal force. Alongside him, Robert M. Ricketts employed the edgewise technique and emphasized aesthetics as the central goal of treatment. Ricketts believed that individualized treatment plans and facial aesthetics were more important than achieving proper occlusion. He also highlighted the significance of biology, facial orthopedics, differential diagnosis, and biomechanical knowledge in orthodontics. Ricketts introduced the visual treatment objective (VTO), a method based on cephalometric analysis, to help guide treatment planning.

In 1989, Lawrence F. Andrews published his influential book Straight-Wire: The Concept and Appliance, which laid the foundation for the modern straight-wire technique. More recently, in 2008, Wick Alexander offered new perspectives on orthodontics, pushing the field forward.

Today’s orthodontic devices can move teeth in three dimensions within the masticatory plane, both horizontally and vertically, a concept first imagined by Pierre Joachim Lefoulon and described by Fujita in 1981. The research into new orthodontic devices continues to advance, promising even more precise and effective treatments.

During the following decades, orthodontic treatments focused on improving patient comfort. Wires, retainers, and appliances focused on thinner wires, less visibility, longer-term treatments, and minimal pressure. The advent of new materials resulted in lighter appliances. In the 1960s, New appliances like the Herbst Appliance to correct overbite were introduced. Several technological innovations occurred in the latter part of the 20th Century, such as introducing Invisalign, 3D printing, digital impression taking, and self-ligating brackets like the Damon System (1990s), which aimed to reduce friction. These innovations transformed the patient experience.

6. The development of Invisalign

The development of Invisalign started at Stanford University, where Zia Chishti created a plastic aligner to ensure his teeth did not relapse after orthodontic treatment. In 1997, Zia, Kelsey Wirth, Apostolos Lerios, and Brian Freyburger established Align Technology. The following year, the FDA approved Invisalign for public use, and three years later, the company was traded publicly on NASDAQ. Twenty years after the first patents were issued in 1997, several competitors appeared on the market, providing cheaper alternatives. 

7. Orthodontic treatment in the 21st Century

The development of modern orthodontics in the 21st Century has been marked by rapid advancements in technology, materials, and treatment methodologies, revolutionizing the field and transforming patient experiences. Digital technology has played a pivotal role, particularly with the widespread adoption of 3D imaging, computer-aided design (CAD), and cone-beam computed tomography (CBCT). These innovations allow orthodontists to create highly accurate virtual models of patients’ teeth and jaws, enabling precise diagnosis and individualized treatment planning. Aligners, such as Invisalign, introduced in the late 1990s but gaining dominance in the 2000s, have made orthodontic treatments more aesthetically appealing and comfortable. These aligners, powered by digital scans and software, offer a virtually invisible and highly customizable solution for correcting malocclusions. Advances in materials, such as heat-activated nickel-titanium wires, have also improved the efficiency and comfort of traditional braces.

Additionally, artificial intelligence (AI) and machine learning have begun to influence orthodontic workflows by predicting treatment outcomes and streamlining decision-making processes. The integration of teledentistry has expanded access to orthodontic care, allowing patients in remote areas to receive consultations and monitoring through digital platforms. Moreover, innovations in biomechanics, such as self-ligating brackets and mini-implants for anchorage, have enhanced the efficiency and effectiveness of treatment. Combined with a growing emphasis on interdisciplinary approaches that address craniofacial anomalies and sleep apnea, orthodontics in the 21st Century is increasingly patient-centered, offering tailored solutions to improve both function and aesthetics. The field continues to evolve, with ongoing research into regenerative techniques, bioengineered tissues, and genetic factors that could further personalize and refine treatment outcomes in the future.

8. Conclusions

The history of orthodontics from the early 18th Century to today reflects an extraordinary evolution from rudimentary techniques to cutting-edge technology. In 1728, Pierre Fauchard, known as the “Father of Modern Dentistry,” laid the groundwork for orthodontics with his book Le Chirurgien Dentiste. In it, he described methods to straighten teeth using gold and silver strips and wires, marking the first significant attempt to correct malocclusion. By the mid-18th Century, Etienne Bourdet expanded on Fauchard’s work, introducing techniques such as extracting premolars to alleviate crowding. The field advanced in the 19th Century, with practitioners like Christophe-François Delabarre devising the first orthodontic appliances, such as metallic caps and springs for tooth movement. Joseph Fox and others formalized the classification of malocclusions and developed early treatment protocols, while Joachim Lefoulon coined the term “orthodontia” in 1841, recognizing it as a distinct specialty.

The 20th Century ushered in the modern era of orthodontics with the innovations of Edward H. Angle, who standardized malocclusion classification and introduced the Edgewise Appliance, the precursor to today’s braces. Technological advancements like stainless steel wires, functional appliances, and removable devices like Crozat Appliance broadened treatment options. By the late 20th Century, aesthetics and patient comfort became paramount with clear aligners like Invisalign, introduced in 1998, and self-ligating brackets. Today, orthodontics embraces digital technology, including 3D imaging, computer-aided design, and artificial intelligence, enabling precise diagnosis and treatment planning. Orthodontics has transitioned from a purely mechanical art to a sophisticated, interdisciplinary science, continually improving patient outcomes and experiences. 

This brief review of the history of orthodontics provides an idea about the profession’s complexities and intricacies. For an in-depth review of the specialty’s history up to 1926, the reader is invited to read Bernhard Weinberger’s two-volume, 1,100-page review (33).Figure 35. Invisalign

  1. Celsus p.445
  2. Bien, p.1152
  3. Zene Artzney, p.48
  4. Lusitanus, p.42-43
  5. Leibowitz, J, p.492
  6. Renner, F. p86-87.
  7. Pare (1649) p.579, Pare (1561). p.261-2.
  8. Aquapendente (1619) p.32
  9. Fauchard (1746) vol 2, Fig. 38 p.305.
  10. Bourdet Vol. I. p. 19
  11. Berdmore
  12. Fox (1803), p.51
  13. Serre p.370 
  14. Catalan, p397-405.
  15. Delabarre (1819)
  16. Delabarre (1820) Fig 114-116.
  17. Sigmond
  18. Mortimer
  19. Kneisel
  20. Roux
  21. Lefoulon (1841)
  22. Lefoulon (1859) p.40
  23. Schange p.128, Fig 11.
  24. Carabelli p.126-127.
  25. Evans
  26. Farrar 1888
  27. Farrar 1876
  28. Kingsley
  29. Angle 1890, Angle 1887
  30. Angle 1899
  31. Angle 1928.
  32. Forrai, Spielman 2023
  33. Weinberger 1926

Timeline of Orthodontics

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References and notes on orthodontics

Align Technology Inc (2000). Systems and methods for positioning teeth. US Patent 6783360B2. https://patents.google.com/patent/US6783360B2/en; related to: U.S. Pat. No. 5,975,893 entitled “Method and system for incrementally moving teeth,” issued to Chishti et al. on Nov. 2, 1999; U.S. Pat. No. 6,406,292; and Ser. No. 09/556,022, entitled “System and Method for Determining Final Position of Teeth,” filed Apr. 20, 2000, now U.S. Pat. No. 6,457,972.

Andresen, Viggo. (1936). The Norwegian system of functional gnatho-orthopedics. Acta Gnathol., 1:5-36. (The Norwegian System of Orthodontics).

Andrews, L. F. (1979). The Straight-Wire Appliance. British Journal of Orthodontics. https://doi.org/10.1179/bjo.6.3.125 

Angle, Edward H. (1887). Notes on orthodontia with a new system of regulation and retention. The Ohio Journal of Dental Science, VII(10):457-464. (https://archive.org/details/ohiojournalofden7188unse/page/456/mode/2up?q=Orthodontia)

Angle, Edward H. (1890). Treatment of malocclusion of the teeth and fractures of the maxilla. Angle’s System. Philadelphia. https://archive.org/details/treatmentofmaloc00angliala/page/n5/mode/2up or https://www.google.com/books/edition/Treatment_of_Malocclusion_of_the_Teeth/BvkzAQAAMAAJ?hl=en&gbpv=1&bsq=arch%20E

Angle, Edward H. (1899). Classification of Malocclusion. Dental Cosmos 41(3):248-264,  350-357).

Angle, Edward H. (1928). The latest and best in orthodontic mechanism. Dental Cosmos, 70(12):1143-1158. (edgewise arch introduction).

Aquapendente, Hieronymus Fabricius ab (1619). Operationes chirurgicae in duas partes divisa, quibus adjectum est pentateuchon antea editum et alia. Italy: Paulus Megliettus. (p.32, suggests extraction of malpositioned teeth).https://www.google.com/books/edition/Oeuvres_chirurgicales_de_Hierosme_Fabric/qwmTwJeK3CIC?hl=en&gbpv=1&bsq=des%20dents

Bell, Thomas (1829). The anatomy, physiology and diseases of the teeth. S. Highley, London, p. 93-103. (Improved arch bar and a gold crown on permanent molars to move vestibular malpositioned teeth.

Berdmore, Thomas (1766). Of irregularities of the teeth, and the reduction of them by ligature. IN: A treatise on the disorders of the teeth and gums. p. 212.

Bien SM (1967). Why Demosthenes Mouthed Pebbles? Lancet, 2(7526):1152. DOI: 10.1016/s0140-6736(67)90664-2

Bourdet, Etienne (1757). Recherche et observations sur toutes les parties de l’art du dentiste Vol II, p. 19. (First suggestion is to remove bicuspids to make room for crowded teeth and use a full arch metal strip to pull individual malpositioned teeth. It is an extension of Fauchard’s idea.)

Broadbent, B.Holly. (1931). A new X-ray technique and its application to orthodontia. Angle Orthodontist, 1, 45-66.

Brown, Solyman (1841). Essay on the importance of regulating the teeth of children. New York. p.11

Carabelli, Georg Edlen von  Lunkaszprie (1842). Systematisches Handbuch der Zahnheilkunde. Vol II. Anatomie des Mundes,  p.126-127. Wien. (First systematic classification of occlusions).

Catalan, LJ. (1814). Mémoire sur un nouvel instrument, nome Plan Incline, destine a remédier a la difformité connue vulgairement sous le nom de “menton de galoche”. Journal Général de Médicine, de Chirurgie et de Pharmacie; ou Recueil Périodique de la Société de Médecine de Paris, 1814. pp. 397-405.

Celsus, Cornelius A. (1687). De Medicina Libri Octo. Apud Joannem Wolters, Amstelædami, Cap. XII, p.445. (Removal of deciduous teeth is necessary, and pushing day-by-day the permanent tooth into position). (https://books.googleusercontent.com/books/content?req=AKW5QaeEvhp1S0fawl6eZY7tIDsDyTu6YX3BtYjbyInW65tNeX92vkiQ-hw245OgU1x3I47jxz6chPeQpeL32rJRhXha3vFTJ4ZMKkoIdSCctaACHFXJ94mRSDlXiy1x7cd8xIX4qf5QrZotUIrGXzyfUHs78UGYyJruuGmvfZwxF1wCdzvlJ8dJT3OLs9XIioxJo8X9-1s00WJDZoTzqpiFpYCuydKx9Kvbe-Su1dbpw4BEjsfbr8SwimKIfgeH7f1BtKyb9ttWo5J4kHQZK43LzXIh3EYmwgeorJBmba_g5MovMy9aiOU). The Latin text on page 445, chapter 12, Book VII, line 3: Si quando etiam in pueris ante dens nascitur, quam prior excidat, is, cadere debuit, circumradendus et evellendus ets; is qui natus est in locum prioris, quotidie digito adurgendus, donec ad justam magnitudinem perveniat. Translated based on Guerini, 1921: When a permanent tooth appears before the fall of the milk tooth, it is necessary to dissect the gum all around the latter and extract it; the other tooth must then be pushed with the finger, day by day, toward the place that was occupied by the one extracted; and this is to be done until it has firmly reached its right position”. (https://www.gutenberg.org/files/51991/51991-h/51991-h.htm)

Delabarre, Christophe-Francois (1819). Traite, de la seconde dentition, et method naturelle de la diriger. Paris. (Contraindicates early removal of deciduous teeth and suggests space maintainer). https://www.google.com/books/edition/Trait%C3%A9_de_la_seconde_dentition_et_m%C3%A9th/f_-OR0rD2u8C?hl=en&gbpv=1&dq=inauthor:Christophe+F.+Delabarre&pg=PT50&printsec=frontcover

Delabarre, F.C. (1820). Traite de la partie mécanique de l’art de chirurgien dentiste. Paris. (Fig. 114-116). https://numerabilis.u-paris.fr/medica/bibliotheque-numerique/resultats/index.php?do=page&cote=31410×02&p=140

Dubois-Foucou, & Deschamps (1814). Un nouvel instrument presente par M. Catalan fils, pour remedier a la difformite connue sous le nom Menton de Galoche. Journal General de Medecine, de Chirurgie et du Pharmacie, Vol 49;402-405.

Evans, Thomas W. (1854). On the regulation of teeth. – Dental News Letter. Vol 7(2), 65-75. https:// https://babel.hathitrust.org/cgi/pt?id=mdp.39015055652641&seq=79

Farrar, John Nutting (1888). A Treatise on the Irregularities of the Teeth and Their Correction. https://www.google.com/books/edition/A_Treatise_on_the_Irregularities_of_the/kbnRAAAAMAAJ?hl=en&gbpv=1

Farrar, John Nutting (1876). An inquiry into physiological and pathological changes in animal tissues in regulating teeth. Dental Cosmos, 18 (1):13-24.

Fauchard, Pierre (1746). Le Chirurgien Dentiste. Vol II, p.79-80, Planche 15, Fig. 38, p.305. 2d Ed. Paris. Chez Pierre-Jean Mariette, https://gallica.bnf.fr/ark:/12148/bpt6k6557462f.r=Le%20chirurgien%20dentiste%2C%20of%20traits%20des%20dents%20T.%202?rk=21459;2

Forrai J, Spielman AI. (2023). The history of orthodontic braces. In: The Encyclopedia of the History of Dentistry – online, J Hist Cult Sci Med. Budapest. DOI: 10.17107/KH.2023.26.31

Fox, Joseph (1803). The natural history of the human teeth. London, p.68, Plate XII, Fig7.  (Orthodontic device uses two ivory gag-blocks at the end of a metal straightening strip attached to upper incisors. The gag block keeps teeth from occlusion, permitting incisors in an inverted bite to expand and move vestibular.). https://www.google.com/books/edition/The_Natural_History_of_the_Human_Teeth_I/mM9i_D0n0c8C?hl=en&gbpv=0 

Kingsley, Norman (1880). A Treatise on Oral Deformities as a Branch of mechanical Surgery. New York.

Kneisel, Johann Friedrich Christoph (1841). Der Schiefstend der Zahne; Position irreguliere des dents (The oblique position of the teeth). Berlin, Posnan and Bromberg. . (First dedicated orthodontic study written in German and French). 

Kneisel, Johann F.C. (1836). Die Schiefstand der Zahne. Berlin: Druck und Verlag von Ernst Siegfried Mittler https://archive.org/details/derschiefstandde00knei/page/8/mode/2up

Lefoulon, Joachim (1841). Nouveau traite theorique et pratique de l’art du dentiste. Paris. (First to suggest that the maxilla and mandible can be expanded through gentle force. He was the first to suggest the lingual arch.) https://archive.org/details/b2194488x 

Lefoulon, Joachim (1859). Des déviations des dents et de l’orthopédie dentaire. p.40. https://numerabilis.u-paris.fr/medica/bibliotheque-numerique/resultats/index.php?do=page&cote=201520&p=3

Lundstrom, Axel Frederik (1925). Malocclusion of the teeth regarded as a problem in connection with the apical base. International Journal of Orthodontia, Oral Surgery and Radiography,  Elsevier, 11(7):591-602; 11(8):724-731; 11(9):793-812; 11(10):933-941; 11(11):1022-1042; and 11(12):1109-1133. (refuting Angle’s insistence on not extracting teeth for orthodontic purposes).

Leibowitz, Joshua O. (1958). Amatus Lusitanus and the Obturator in Cleft Palates. Journal of the History of Medicine and Allied Sciences, 13(4):492–503. http://www.jstor.org/stable/24619272. This is how Lusitanus describes the case (original and translated text from reference 5.)

Lusitanus, Amatus (1560). Curationum Medicinalium, p.42-43. Venice. (First palatal obturator). Lusitanus calls cleft palate: “ulcus palato innatum” or innate palatal ulceration. https://archive.org/details/bub_gb_jlGMtjnZ6t0C

Mortimer, William H. (1836). Observations on the growth and irregularities of children’s teeth. 166p. https://wellcomecollection.org/works/mvr5vh3b/items?canvas=5

Paré, Ambroise, Baker, George. (1649). The Workes of that Famous Chirurgion Ambrose Parey. United Kingdom: Richard Cotes, and Willi: Dugard. English translation of Oeuvres. p.579. https://www.google.com/books/edition/The_Workes_of_that_Famous_Chirurgion_Amb/TzVbqmHLfGMC?hl=en&gbpv=1&bsq=teeth; 

Paré, Ambroise (1561). La méthode curative des playes et fractures de la teste humaine, or “Treatment method for wounds and fractures of the human head.” p. 261-2. The original French version.

Renner, Franz (1557). Ein Newwohlgegruendet nützliches und haylsames Handtbüch lein, etc. Nürnberg, Gabriel Heyn, p. 86-87. 

Roux, Philibert Joseph (1825) Mémoire sur la staphyloraphie, Paris: Bechet, Migneret

Schange, Alexis  J.M. (1841). Precis sur le redressement des dents. p.128, Fig 11. Paris. (First use a flat elastic band for maxillary protrusion).

Serre, Johann Jacob Joseph (1803). Praktische darschtellung aller Operationen der Zahnheilkunst, Berlin. p.370 (wax impression, plaster mold and orthodontic appliance preparation with a goldsmith).

Sigmond, Joseph (1825). A practical and domestic treatise on the irregularities of the teeth and gums; with the methods of treatment. 160p. https://babel.hathitrust.org/cgi/pt?id=osu.32435081593410&seq=11

Weinberger, Bernhard W. (1926). Orthodontics. A historical review of its origin and evolution. Mosby Co, St. Louis. Two Vol. pp.510 and 540, respectively.    .https://babel.hathitrust.org/cgi/pt?id=mdp.39015023417820&seq=9    https://babel.hathitrust.org/cgi/pt?id=mdp.39015011082891&seq=5 

Zene Artzney (1541). 4th ed. Christoff Egenolff, Frankfurt am Main, p.48. https://archive.org/details/artzneybuchfastw00daub/page/135/mode/1up 

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