orthodontics orthodontics orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. it may also address the modification of facial growth, known as dentofacial orthopedics. orthodonticsoccupationnamesorthodontistoccupation typespecialtyactivity sectorsdentistrydescriptioneducation requireddental degree, specialty trainingfields ofemploymentprivate practices, hospitals abnormal alignment of the teeth and jaws is very common. nearly 50% of the developed world's population, according to the american association of orthodontics, has malocclusions severe enough to benefit from orthodontic treatment: although this figure decreases to less than 10% according to the same aao statement when referring to medically necessary orthodontics. however, conclusive scientific evidence for the health benefits of orthodontic treatment is lacking, although patients with completed treatment have reported a higher quality of life than that of untreated patients undergoing orthodontic treatment. treatment may require several months to a few years and entails using dental braces and other appliances to gradually adjust tooth position and jaw alignment. in cases where the malocclusion is severe, jaw surgery may be incorporated into the treatment plan. treatment usually begins before a person reaches adulthood, insofar as pre-adult bones may be adjusted more easily before adulthood. history since the dawn of humankind, individuals have been grappling with the issue of overcrowded, irregular, and protruding teeth. evidence from greek and etruscan materials suggests that attempts to treat this disorder go back to 1000 bc - showcasing primitive yet impressively well-crafted orthodontic appliances. in the 18th and 19th centuries, a range of devices for the "regulation" of teeth were described by various dentistry authors who occasionally put them into practice.as a modern science, orthodontics dates to the mid 1800s. the field's influential contributors include norman william kingsley (1829–1913) and edward angle (1855–1930). angle created the first basic system for classifying malocclusions, a system which remains in use today. beginning in the mid-1800s, norman kingsley published oral deformities, which is now credited as one of the first works to begin systematically documenting orthodontics. being a major presence in american dentistry during the latter half of the 19th century, not only was kingsley one of the early users of extraoral force to correct protruding teeth, he was also one of the pioneers for treating cleft palates and associated issues. during the era of orthodontics under kingsley and his colleagues, the treatment was focused on straightening teeth and creating facial harmony. ignoring occlusal relationships, it was typical to remove teeth for a variety of dental issues such as malalignment or overcrowding. the concept of an intact dentition was not widely appreciated in those days, making bite correlations seem irrelevant. in the late 1800s, a concept of occlusion was essential for creating reliable prosthetic replacement teeth. this idea was further refined and ultimately applied in various ways when dealing with healthy dental structures as well. as these concepts of prosthetic occlusion progressed, it became an invaluable tool for dentistry. it was in 1890 that the work and impact of dr. edwards h. angle began to be felt, with his contribution to modern orthodontics particularly noteworthy. initially focused on prosthodontics, he taught in pennsylvania and minnesota before directing his attention towards dental occlusion and the treatments needed to maintain it as a normal condition - thus becoming known as the “father of modern othrodontics”. by the beginning of the 20th century, orthodontics had become more than just the straightening of crooked teeth. the concept of ideal occlusion, as postulated by angle and incorporated into a classification system, enabled a shift towards treating malocclusion, which is any deviation from normal occlusion. having a full set of teeth on both arches was highly sought after in orthodontic treatment due to the need for exact relationships between them. extraction as an orthodontic procedure was heavily opposed by angle and those who followed him. as occlusion became the key priority, facial proportions and esthetics were neglected. to achieve ideal occlusals without using external forces, angle postulated that having perfect occlusion was the best way to gain optimum facial aesthetics. with the passing of time, it became quite evident that even an exceptional occlusion was not suitable when considered from an aesthetic point of view. not only were there issues related to esthetics, it usually proved impossible to keep a precise occlusal relationship achieved by forcing teeth together over extended durations with the use of robust elastics, something angle and his students had previously suggested. charles tweed in america and raymond begg in australia (who both studied under angle) re-introduced dentistry extraction into orthodontics during the 1940s and 1950s so they could improve facial esthetics while also ensuring better stability concerning occlusal relationships. in the postwar period, cephalometric radiography started to be utilised by orthodontists for measuring changes in tooth and jaw position caused by growth and treatment. the x-rays showed that many class ii and iii malocclusions were due to improper jaw relations as opposed to misaligned teeth. it became evident that orthodontic therapy could adjust mandibular development, leading to the formation of functional jaw orthopedics in europe and extraoral force measures in the us. these days, both functional appliances and extraoral devices are applied around the globe with an aim of amending growth patterns and forms. consequently, pursuing true or at least improved jaw relationships had become a main objective of treatment by mid-20th century. at the beginning of the twentieth century, orthodontics was in need of an upgrade. the american journal of orthodontics was created for this purpose in 1915; before it, there were no scientific objectives to follow, nor any precise classification system and brackets that lacked features. until the mid-1970s, braces were made by wrapping metal around each tooth. with advancements in adhesives it became possible to instead bond metal brackets to the teeth. in the year 1972, lawrence f. andrews gave an insightful definition of the ideal occlusion in permanent teeth. this has had meaningful effects on orthodontic treatments that are administered regularly, and these are 1. correct interarch relationships 2. correct crown angulation (tip) 3. correct crown inclination (torque) 4. no rotations 5. tight contact points 6. flat curve of spee (0.0 - 2.5 mm), and based on these principles, he discovered a treatment system called straight-wire appliance system or the pre-adjusted edgewise system. introduced in 1976, larry andrews' pre-adjusted edgewise appliance, more commonly known as the straight wire appliance, has since revolutionised fixed orthodontic treatment. the advantage of the design lies in its bracket and archwire combination which requires only minimal wire bending from the orthodontist or clinicisn. it's aptly named after this feature - the angle of the slot and thickness of the bracket base ultimately determine where each tooth is situated with little need for extra manipulation. prior to invention of a straight wire appliance, orthodontists were utilizing a non-programmed standard edgewise fixed appliance system or begg's pin and tube system. both these systems employed identical brackets for each tooth and necessitated bending of an archwire in three planes for locating teeth in their desired positions - with these bends dictating ultimate placements. evolution of the current orthodontic appliances when it comes to orthodontic appliances, they are divided into two types - removable and fixed. take the removable type for instance, these can be taken on and off by the patient as required. on the other hand, fixed appliances cannot be taken off as they remain bonded to the teeth during treatment. fixed appliances fixed orthodontic appliances are predominantly derived from the edgewise appliance approach, which typically begins with round wires before transitioning to rectangular archwires for improving tooth alignment. these rectangluar wires promote precision in the positioning of teeth following initial treatment.in contrast to the begg appliance, which was based solely around round wires and auxiliary springs, the tip-edge system emerged in the early 21st century. this innovative technology allowed for the utilization of rectangular archwires to precisely control tooth movement during finishing stages after initial treatment with round wires. thus, almost all modern fixed appliances can be considered variations on this edgewise appliance system. early 20th century orthodontist edward angle made a major contribution to the world of dentistry. he created four distinct appliance systems that have been used as the basis for many orthodontic treatments today, barring a few exceptions. they are e-arch, pin and tube, ribbon arch and edgewise systems. e-arch edward h. angle made a significant contribution to the dental field when he released the 7th edition of his book back 1907, which outlined his theories and detailed his technique. this approach was founded upon the iconic "e- arch" or 'the-arch' shape as well as inter-maxillary elastics. this device was different from any other appliance of its period as it featured a rigid framework to which teeth could be tied effectively in order to recreate an arch form that followed pre-defined dimensions. molars were fitted with braces and a powerful labial archwire was positioned around the arch. the wire ended in a thread and to move it forward an adjustable nut was used, which allowed for an increase in circumference. by ligation, each individual tooth was attached to this expansive archwire. pin and tube appliance due to its limited range of motion, angle was unable to achieve precise tooth positioning with an e-arch. in order to bypass this issue, he started using bands on other teeth combined with a vertical tube for each individual tooth. these tubes held a soldered pin which could be repositioned at each appointment in order to move them in place. dubbed the "bone growing appliance", this contraption was theorized to encourage healthier bone growth, due to its potential for transferring force directly to the roots. however, implementing it proved troublesome in reality. ribbon arch realizing that the pin and tube appliance was not easy to control, angle developed a better option, the ribbon arch, which was much simpler to use. most of its components were already prepared by the manufacturer, so it was significantly easier to manage than before. in order to attach the ribbon arch, the occlusal area of the bracket was opened. brackets were only added to eight incisors and mandibular canines, as it would be impossible to insert the arch into both horizontal molar tubes and the vertical brackets of adjacent premolars. this lack of understanding posed a considerable challenge to dental professionals; they were unable to make corrections to an excessive spee curve in bicuspid teeth. despite the complexity of the situation, it was necessary for practitioners to find a resolution. unparalleled to its counterparts, what made the ribbon arch instantly popular was that its archwire had remarkable spring qualities and could be utilized to accurately align teeth that were misaligned. however, a major drawback of this device was its inability to effectively control root position since it did not have enough resilience to generate the torque movements required for setting roots in their new place. edgewise appliance in an effort rectify the issues with the ribbon arch, angle shifted the orientation of its slot from vertical, instead making it horizontal. in addition, he swapped out the wire and replaced it with a precious metal wire that was rotated by 90 degrees in relation - henceforth known as edgewise. following extensive trials, it was concluded that dimensions of 22 × 28 mils were optimal for obtaining excellent control over crown and root positioning across all three planes of space. after debuting in 1928, this appliance quickly become one of the mainstays for multibanded fixed therapy; although ribbon arches continued being utilized for another decade or so beyond this point too. labiolingual prior to angle, the idea of fitting attachments on individual teeth had not been thought of; and in his lifetime, his concern for precisely positioning each tooth was not highly appraised. in addition to using fingersprings for repositioning teeth with a range of removable devices, two main appliance systems were very popular in the initial part of the 20th century. labiolingual appliances used bands on first molars joined with heavy lingual and labial archwires affixed with soldered fingersprings to shift single teeth. twin wire utilizing bands around both incisors and molars, a twin-wire appliance was designed to provide alignment of these teeth. constructed with two 10-mil steel archwires, its delicate features were safeguarded by lengthy tubes stretching from molars towards canines. despite its efforts, it had