DOI: 10.1051/odfen/20084210113 J Dentofacial Anom Orthod 2008;11:68-74 © RODF / EDP Sciences How, why, and when was the edgewise appliance born? Julien PHILIPPE ABSTRACT Angle corrected anterior crowding by advancing the crowns of the incisors. For a long time he hoped the apices would follow along spontaneously. Then because of the uncer- tainty of this reaction, he started his quest for an appliance that would be able to accom- plish root movement. The first one was difficult for orthodontists to manipulate, the second did not incorporate vertical control, but the third had all the qualities Angle was looking for. He died satisfied. KEYWORDS Bracket Movement of the apex Edgewise Orthodontic mechanics Ribbon-Arch. Address for correspondence: J. PHILIPPE 1 bis, rue des Vieux Rapporteurs, 28000 Chartres. julien.philippe28@ wanadoo.fr 68 Article available at http://www.jdao-journal.org or http://dx.doi.org/10.1051/odfen/20084210113 JULIEN PHILIPPE 1 - INTRODUCTION Angle created the edgewise appli- Nature* and believed that the ance 80 years ago. It wasn’t the fruit Creator* shared his notion of an ideal of a sudden inspi ration. For years he treatment result. But, little by little, he had been searching for an appliance realized he would have to correct the that would offer all the qualities he deficiencies of natural evolution with thought were needed in orthodontics. mechanics that were more and more Many times he thought he had found sophisticated. it and he proposed systems that In order to understand how the demonstrated improvement over their edgewise appliance was born we predecessors but finally turned out to must begin with the problems that be imperfect. Angle encountered when he utilized At the beginning of the twentieth his expansion arch, the “E Arch.” century, Angle, an extremely idealistic These problems illuminated the path man, counted on the aid of Mother that he followed until he reached the edgewise goal. 2 - THE TREATMENT OF DENTAL CROWDING In 1907, Edward H. Angle pub- teeth in pushed forward. Angle rec- lished his most important work, ognized this defect but he thought the7th edition of his book1 that that, during the retention period, the described his theory, his methods, anterior segments of the maxillae and his technique, which was based that had been compressed by the on the “E- Arch” (fig. 1) and the use cause of the deformation, usually of inter-maxillary elastics. muscular pressure, would assume To treat Class I cases that were their normal shape, the one Nature frequently complicated by crowding had planned for them, thanks to a without ordering extractions, which, compensatory growth, which, in a by then, he had decided were inad- few words, expresses Angle’s funda- missible, the expanded the dental mental belief. This new growth would arches with the “E-Arch.” The goal permit the teeth that had been tipped was to place all the teeth on the ideal forward by treatment to return to curve of the arch that Angle called their normal inclination, as he put it, “the line of occlusion.” Most of the “The very apices of the roots, then so time in order to arrive at this state, convergent, would ultimately be treatment had to include moderate moved by Nature to their full normal transverse expansion and sometimes upright positions” (Angle1: p. 344). a considerable amount of labial move- Modern practitioners will freely ment of the incisors. Angle’s book confess that that type of sponta- shows many treated Class I cases neous movement of root apices is far treated in this way with the incisor from the outcome they most fre- quently observe. Angle came to real- ize this, and without in any way (*) Angle always wrote “Nature” and changing his funda mental philosophy, “Creator” with an initial capital letter. 69 Philippe J. How, why, and when was the edgewise appliance born? HOW, WHY, AND WHEN WAS THE EDGEWISE APPLIANCE BORN? Figure 1 After Angle2. The “E- Arch”. The arch can be advanced, and, therefore activated, in mouth by tightening screws with a key, without which it would be necessary to change the ligatures. a new idea took posses sion of his but this requires a great deal of time soul, the dream of finding an “appli- and demands a long and tedious ance to move the apices of roots.” retention period and, furthermore, Numerous solutions popped into his success depends on growth of the fertile mind, but it is always a delicate bones, which is related to the age and matter for the head of a School to the health of the patient.” (Angle2). He change his mind and aban don the sys- continued, “Our treatment plan would tem whose merits he had been be greatly improved if, instead of leav- preaching until then. Angle extricated ing the roots in an abnormal inclina- himself from this trap skillfully, writing tion to be uprighted by Nature during in 1912, “We know that working the retention period, those roots were through the masticatory function, moved bodily by a force so gentle and Nature will stimulate development so well distributed that it would stim- and upright the roots of teeth until ulate cellular activity and the growth they return to their normal inclination, of bone” (Angle2, p. 855). 3 - THE “PIN AND TUBE APPLIANCE” (1912) Angle invented and introduced an It was useful for an elite of technically appliance capable of fulfilling those group of especially dexterous practi- objectives, the Pin and Tube appliance tioners; the others were unable to (fig. 2) in 1912. He called it a “bone adjust it correctly and had many fail- growing appliance” because, he ures with its use. thought, in normal function its action Angle was, nevertheless, happy to of transmitting force to the roots have conceived of a new appliance would stimulate the growth of bone. rich with promise and to have caught In practice, the device turned out to up with the advances that his be extremely difficult to manipulate. J Dentofacial Anom Orthod 2008;11:68-74. 70 JULIEN PHILIPPE Figure 2 a and b After Angle2. Activation of the screws is not enough. The stops must constantly be soldered in new positions or orientations. Figure 3 After C. Case. Calvin Case introduced a new system in 1893 that made it possible to move the apices of teeth by adjusting two “contouring” arches. arch-rival Calvin Case had made 192714, showed a case of “upper when, in 1893, he proposed the “con- retrusion” in which he had advance touring” appliance (fig. 3), that was the crowns of the maxillary incisors capable of moving the incisor roots. 13 mm and their apices 10 mm (!). Today it is hard to imagine the fre- Even if these measurements are only quency and the extent of movement approximate, they show what heroic that was ascribed to that appliance at objectives were aimed at. the time. C. P Tacail, for example, in 4. THE “RIBBON-ARCH” In 1916, Angle3 realizing how hard bracket in an earlier article (Philippe13). it was to regulate the Pin and Tube This bracket was open occlusally and appliance, introduced a new appli- the ribbon arch was inserted lying ance, the Ribbon Arch (fig. 4), with flat. Only the eight incisors and the more of its components prepared by mandibular canines carried brackets. the manufacturer and far easier to The bicuspids were not bracketed handle than its predecessor. We because it would have been impossi- describe its principle innovation, the ble to insert the arch simultaneously 71 Philippe J. How, why, and when was the edgewise appliance born? HOW, WHY, AND WHEN WAS THE EDGEWISE APPLIANCE BORN? Figure 5 After Angle3. Proposition, rejected by Angle, of a Pin-and-Tube system with a vertical Figure 4 molar tube. The arch would have been After Angle2. The Ribbon-Arch used in a treat- adjusted in an anteroposterior direction by ment of a Class III case. bends made in the vertical loop and not by screws. into the horizontal molar tube and into the vertical bracket of the adjacent molars that was vertical like the brack- pre- molar (Brodie9). Owing to this ets. But Angle6 had already thought conceptual deficiency, with no bear- about and rejected this solution in the ing on the bicuspid teeth practitioners Pin and Tube appliance (fig. 5). He was found it very difficult to correct an afraid that the vertical end of the arch, excessive curve of Spee (Brodie8, bent into the indis pensable vertical Dewell10). But in other respects, its loop and affected by the expansion supple character making it effective in incorporated in the arch, would be rotating incisors and for moving the unable to retain the same orientation roots of anterior teeth, it proved high- throughout treatment. This would pro- ly satisfactory to the practitioners voke round trip, or back forth, move- who used it. ments that would be harmful to “the Accordingly, Angle sought a way to cells of the periodontal liga ment and remedy this deficiency. He realized to the alveolar bone” causing a grave that he would be able to place the risk to the integrity of the molar arch in brackets fixed to the bicuspids anchorage. if they had another conformation, if, Finally his experiments with pre- for example, their slots were horizon- molar bracket design were crowned tal as was the molar tube. Angle with success. And the new bracket experimented with many models of seemed to be so eminently suitable premolar brackets and one of his stu- that Angle thought about extending dents, Raymond Begg, complained of its use to all the teeth (evidently the having to make them by hand! mixture of horizontal and vertical It’s possible that Angle might have brackets would not make the conside- red that instead of trying to orthodontist’s task an easier!) So at design a horizon tal premolar bracket first, according to Dewel10.