Casey Castaldi

CRD 118
Fall 2013
The Evolution of Dental Braces
Human beings have historically been characterized as being a
particularly inventive species. Throughout history, we have invented
technologies to meet out basic human needs in creative ways. However, the
inventive capacity of human beings is not limited to necessity. In his book
about the evolution of technology, George Basalla states, If technology
exists to meet basic human needs any complexity that goes beyond the
basic fulfillment of needs could be judged superfluous and would need to be
explained on ground other than necessity.(Basalla, 1988). The desire for
straight teeth did not originate from a direct human need. In fact, human
beings survived and thrived for thousands of years without any form of
intervention. However, at a certain point in human history, standards of
beauty forever changed in a way that produced a desire for straight
symmetrical teeth.
Over the years, other standards of beauty have changed significantly;
with different clothes, sizes, and looks drifting in and out of fashion.
However, despite these changes, straight teeth have remained an intrinsic
part of our idea of beauty, specifically in U.S society. So much so in fact, that
an entire field of medicine was created in its name. Dental braces and have
become a pivotal technology in the United States due to their ability to

create the beautiful straight smiles that we revere so dearly in this culture.
What this paper will attempt to do is explore the evolution of dental braces
as a technology by first examining the progression of materials and
mechanisms used in the practice and then by looking at the social forces
behind the acceptance and adoption of the technology. By examining the
evolution of this technology through both physical material and socio-cultural
lenses, I hope to illuminate the connections and relationships that exist
between braces technology and the larger cultural trends of our society.
Evolution of Materials:
While a lot of modern orthodontic development occurred in the United
States during the 20th century, the idea and practice of straightening crooked
teeth has been around for centuries. Ancient historical figures such as
Hippocrates, Aristotle, Celcus, and Pliny the Elder have all been cited
discussing the appearance and structure of teeth dating back all the way to
460 B.C. (Wahl, 2005: Chpt 1). These figures hypothesized the different
reasons and causes behind crooked teeth, and proposed manual ways to
correct them; including the application of pressure, extraction, and filing
teeth down to improve their alignment (Wahl, 2005: Chpt 1). It wasnt until
the 18th century that the first physical mechanism was invented with the sole
purpose of correcting malocclusion, otherwise known as crooked teeth. Pierre
Fauchard, referred to by many as the father of orthodontia, invented an
instrument know as the bandeau (see fig. 1). The device was made of a
band of precious metal, either gold or silver, and a series of silk ligatures

which were tied to individual teeth (Asbell, 1994). Fauchard used the
precious metals due to their malleability and the ligatures to try and pull
individual teeth towards the preformed metal band. The concept behind this
device was to pull teeth into the desired symmetrical U shape, while
avoiding the extraction of permanent teeth, as was a common practice for
many dentists at the time. (Wahl, 2005: Chpt 1).
For years, the bandeau was the norm in the practice what would
later be known as orthodontics. Other orthodontists, including Etienne
Bourdet who was the personal dentist to the King of France, would expand
and adjust his device in order to expand the arch
more efficiently to make room for more teeth
(Wahl, 2005: Chpt 1). The majority of initial
development to orthodontic devices and
methods occurred in Europe, however in the
beginning of the 19th century, the United States

Figure 1: Pierre Fauchards

bandeau

became a major player in dentistry and subsequently orthodontics. The

devices being used by American orthodontists were similar to their European
counterparts and were made primarily out of gold and silver, although some
did experiment with different types of wood (Asbell, 1994). Due to their
malleable consistencies, the gold and silver brackets and devices needed
constant adjustments that were often times very uncomfortable for patients.
In 1839 however, Charles Goodyear invented a remarkable new material
called vulcanite that drastically changed the design and nature of

orthodontic devices. The softer material allowed orthodontists to create new

bite plates that were substantially cheaper and lighter than their metal
counterparts (Wahl, 2005: Chpt 1). Professionals also used the new material
to make rubber bands, which are still used today in orthodontia to reduce
discomfort and correct malocclusion. The introduction of vulcanite into
braces technologies allowed for more experimentation and combinatory
technologies that would help advance the technology in many ways.
While the invention of vulcanite was extremely important to the
development of orthodontic technology, dentists still relied primarily on
metal wires and brackets. As mentioned before, the precious metals were not
only highly malleable, but were also extremely expensive. This issue was
addressed in the early 1900s with the introduction of a new material,
stainless steel. While this metal had been around for years, it was first
introduced into mainstream U.S production in the first two decades of the
1900s and orthodontists quickly adopted the material. Stainless steel was
cheaper and stronger than gold or silver, while still being malleable enough
to be molded and adjusted to custom fit patients needs (Stainless Steel,
2013). After its adoption into braces technology, many dentists started to
change the construction of their devices, because they could now use more
metal with every patient without paying higher costs. As a result, around the
same time that stainless steel made its first appearance in orthodontics the
individual bracket also debuted. Brackets were circular metal devices that

encircled each individual tooth and then connected those teeth to larger
wires (Indian Dental Academy, Feb 2013; fig 2).
The bracket changed the way that orthodontists attempted to correct
crooked teeth, and it was only possible with the introduction of a cheaper
lighter weight metal. However, despite
the major advances that stainless steel
created for orthodontic mechanisms,
there were some drawbacks. After
orthodontists realized that some of their
patients had allergies to the Nickel

Figure 2: Angle's Ribbon Arch:

individual bracket use

found in steel, they needed to find a new alternative solution and were not
willing to revert to silver or gold. Instead, they were able to offer titanium as
an alternative once it was commercially produced in the mid 1930s
(Titanium, 2013). Titanium was a lighter and equally strong metal and thus
provided consumers with a valid alternative to steel. However, due to the
nature of its production, it came at a higher cost.
Along with the production of new cheaper and lightweight metals like
titanium and steel, the 20th century also marked the evolution of various
other technologies that greatly advanced the field of orthodontics in different
ways. Firstly, the evolution and widespread use of x-ray technology
throughout the entire medical and dental field provided orthodontists with a
new view into the mouths of their patients. X-rays enabled dentists and
orthodontists to better treat and predict the natural movements of teeth like

they had never been able to before (Wahl, 2005: Chpt 6). As dentists and
orthodontists began to study the root structure of their patients, they were
able to understand the physical causes of malocclusion and could treat
patients accordingly.
Secondly, the 20th century also marked big changes in the evolution of
adhesive technologies or cements used in orthodontics. Since the end of the
19th century, dental cements had been used in order to bond the different
brackets to teeth. With the changes to bracket shape and use in the 1930s
and 1940s, existing cements were not providing orthodontists with strong
enough bonds to hold brackets to individual teeth. However in the 1960s
adhesive technologies evolved dramatically, with the creation of a dental
cement that incorporated the natural make up of tooth enamel into the
boding process (Ewoldsen & et.al. 2001). Orthodontists would have to prime
the teeth with a phosphoric acid and then would later apply a zinc
polyacrylate cement to bond the metal brackets directly to teeth. Over the
years the bonding technology has evolved even further to incorporate resins
and glass ionomers in order to improve both the strength of the bonds as
well as the negative effects of some original cements. These new adhesive
cements were stronger, clearer, and healthier for patients than previous
versions. They allowed orthodontists to use smaller amounts of adhesives to
receive the same strength of bonds, thus enabling them to use smaller
brackets with no loss in corrective power (Al-Munajed, 2000) These changes

reduced not only the overall discomfort level of many consumers, but also
drastically improved the overall aesthetic appearance of braces.
Despite the aesthetic improvements that adhesive technology
provided for braces technology, consumers were still off put by the overall
appearance of braces. In response, there has been a drastic increase within
the past twenty years in new braces technologies. New materials are now
being used primarily to lessen the harsh physical appearance of braces, and
in some cases make them completely invisible. The first move away from the
traditional use of metals in orthodontia came in the 1980s with the use of
ceramic brackets and wires. These tooth colored devices camouflaged the
braces and gave consumers the benefits of an improved smile without
having to live with large amount of metal in their mouths for years at a time
(Archwired, 2005; fig. 3). Even more recently the development of Invisalign
technology has made correcting crooked teeth even less intrusive. The
removable retainers are made out of a thermoplastic material and are
created using 3-D imaging of an individuals teeth (Invisalign, 2013). Patients
go through a series of different retainers that gradually shift the alignment of
their teeth. Lingual braces, or braces that go around the inside of teeth as
opposed to the outside, have also been around the orthodontic field for years
and have advanced dramatically in recent years. However, due to the
advanced training that orthodontists need to properly apply the devices,
many dont offer the service to their patients (Wahl, 2005: Chpt 6). While
both these new materials have allowed consumers to have braces without

dealing with the aesthetic consequences, it should be noted that they are
also more expensive options.

The Social Construction of Braces:

Figure 3: Ceramic Brackets

As mentioned in the introduction of this

paper, braces did not become a part of our

society and culture our of an inherent human need. Although some young
adults might argue that having crooked teeth is the equivalent of committing
social suicide, that way of thinking is a derivative of the social construction of
beauty rather than an innate biological need. According to Basalla, We
cultivate technology to meet our perceived needs, not a set of universal ones
legislated by nature(Basalla, 1988). Like many technologies, braces were
created and developed due to a socially constructed belief that a straight
smile and nice teeth were defining characteristics of beauty. Throughout its
evolution the physical technology of braces was directly influenced by the
feedback of the consumers themselves. In the article The social
construction of facts and artifacts: Or how the sociology of technology and
sociology of science might benefit each other written by Trevor Pinch and
Wiebe Bijker, the relationship between society and technology is explored in
detail. Some of the key methods they identify as useful when examining
technology through this lens are the identification of relevant social groups
involved, as well as using a multidirectional model to track the
chronological evolution of a technology (Pinch & Bijker, 1987).

The Evolution of Mechanisms and SCOT:

When the idea of correcting crooked teeth first started to manifest
itself through physical technologies, there was very little background
information or study that had been put into the biological and physical
causes of malocclusion. As a result, the methods used to straighten teeth
were highly variable. Braces technology remained subjective to each
respective orthodontics up until the mid 20th century when the technology
began to steady with the introduction of new metals and bonding cement
(Ewoldsen & et.al. 2001). It is difficult to determine exactly which
technologies taken from different mechanisms in orthodontic history have
gone into the contemporary version of dental braces that we are familiar
with today. However by using the SCOT method of multidirectional modeling,
we see how many different technologies that might not appear in a linear
model of the evolution played a part in developing contemporary braces.
What braces technology shows us is that after the introduction of the
bandeau in the 1700s there were very few new technologies until nearly 100
years later. Orthodontists around Europe made small adjustments to the
existing technology, however it wasnt until the invention of vulcanite in the
mid 1800s that braces technology did more than target the movement of
individual teeth with the use of ligatures (Wahl, 2005: Chpt 1). After its
invention, different dentists and orthodontists explored different types of
arch expanders and bite plates made out of vulcanite that both improved the

understanding of arch expansion and created the foundation for many

orthodontic technologies still in use today (Whal, 2005: Chpt 2). Many of
these vulcanite-based technologies worked to improve the knowledge base
surrounding orthodontics, but are not directly linked to the technology used
in contemporary braces. In fact, they most closely resemble retainers that
are used as post-braces treatments by many orthodontists (Whal, 2005: Chpt
2).
While the vulcanite devices were not directly involved in bracket
technology that dominates the field today, the ideas they presented were
instrumental in the development of current braces technology. When
orthodontists started experimenting with vulcanite, they realized the
importance of expanding the arch in order to more easily move teeth. Dr.
Edward Angle took this knowledge and made a series of metal mechanisms
known collectively as the E-arch. This technology was based off of the
mechanisms found in previous V-arch designs, as well as the arch expansion
concepts of the vulcanite plates (Civen, 2004). The E-arch, created in 1907,
was improved upon in 1910 with the Pin an Tube arch. Both of these were
meant to perform the same function as the vulcanite mechanisms by
expanding the palate, however they were not removable. Many orthodontists
in the field had decided that removable devices were not optimal for
producing long-term straightening effects (Indian Dental Academy, Feb
2013). Eventually, the Pin and Tube arch would lead to Edgewise brackets
that were the dominant braces technology until 1956. At that point in time,

the Begg bracket was introduced and would

prove to be the basis for most proceeding braces
models; fitting into the more linear model of
technological evolution we are accustomed to
exploring. (Indian Dental Academy, Feb 2013; fig. 4).
What the SCOT model encourages us to do is examine the evolution of
technology through a more critical lens. It acknowledges that there is a much
richer history behind the evolution of a technology than we usually see by
only looking retrospectively at the successful versions. While the vulcanite
bite plates resemble modern day retainers much more so than they resemble
metal braces, they still contributed to the evolution of the technology. By
including them in the evolution of braces, we gain a new insight into not only
the development of the technology, but also the development of the entire
orthodontic practice.

Figure 4: Edgewise Brackets

Relevant Social Groups:

In their article, Pinch and Bijker also stress the importance of
identifying the relevant social groups within the evolution of any technology.
They argue that in order to understand how and why a technology developed
in the way it did, it is important to look at who exactly had a vested interest
in its advancement (Pinch & Bijker, 1987). As discussed earlier, one of the
strongest driving forces behind the evolution of dental braces were the
standards of beauty that have existed historically, and have continued to
develop within our society. Therefore, when examining the technological

evolution of braces, it is important to look at who exactly was most active in

the perpetuation and creation of the standards that emphasized having
straight, symmetrical teeth. Through my research, I have determined that
the two main actors involved in the evolution of braces in the broadest
sense, were patients and orthodontists. However, within the patient group,
there are various different subcategories that have effected and supported
the evolution of braces in different ways. Specifically, the relevant groups
within patients are women, individuals with high socio-economic standing,
and most recently adults.
Beginning by examining the group of women, it is clear by examining
historical trends braces use that women have always been more interested
in using braces to straighten their teeth. Even before the technology began
to stabilize in the 1970s and became more aesthetically pleasing, women
were willing to undergo many different kinds of orthodontic treatments to
straighten their teeth. Due to the increased pressure by society to conform to
standards of beauty, women have gone to great lengths throughout history
to change their natural appearance even if that meant undergoing painful
procedures or wearing heavy metal appliances in their mouths (Jensen,
2013). Even in ancient Etruscan cultures, only female remains were found
with the remnants of some sort of corrective dental device (Wahl, 2005: Chpt
1). A more recent study done in 2009 amongst a group of children showed
that girls were generally more critical of their own smiles and thought they
needed to get braces, even if they did not have a definite treatment need

(Christopherson & et.al, 2009). What this case demonstrates is the

constructed need to have straight teeth and consequential social pressure to
conform to those social constructions being felt by young women today.
While men have also expressed an interest in braces, women have
historically and currently do experience a larger pressure to have straight
teeth and have therefore always been important actors in the evolution of
braces technology.
In more recent history, the incorporation of new materials into braces
technology has turned adults into a new relevant social group. Before the
introduction of ceramic brackets and Invisalign technology, braces did not
attract many adults due to the association of braces with adolescence
(Rosvall & et.al, 2009). Forty-year old executives with metal braces were not
likely to be taken very seriously. Therefore, when ceramic brackets and
Invisalign type technologies began to develop, adults were quick to involve
themselves in the process. Merely by typing Invisalgn or ceramic braces into
a search engine, one can see that the many of the companies and
organizations that are found advertise to adult consumer groups. As the
materials have changed and the technology has evolved, adults now have a
way to get straight teeth without having to go through the humiliating
process of metal braces.
While the social groups vary based on gender and age, there is one
characteristic that has remained relatively constant throughout the entire
evolution of braces and that is socioeconomic status. Since their inception

when they were made out of pure gold and silver, braces have always been
an expensive technology. It does not come as a surprise then, that the
majority of patients come from relatively affluent backgrounds. Original
patients who were the test subjects of the worlds first orthodontists, included
kings and princes in France who could afford to pay their dentists to create
devices out of precious metals (Wahl, 2005: Chpt 1). Today, the class divide
still exists in orthodontics, although now you dont have to be a King or
Queen to receive treatment. This being said, braces still remain a technology
only available to those with comprehensive dental plans and large savings
accounts. Traditional metal braces run between $3,500 and $6,000 dollars,
which, for families and individuals belonging to lower socio-economic
groupings are far too expensive (Proctor and Gamble, 2013). While some
dental plans do cover braces at least partially and some orthodontists offer
payment plans for patients, the price of braces generally limits the patient
base to relatively wealthy sectors of society. In fact, one of the reasons that
the new aesthetically pleasing braces technologies (which cost between
$5,000 and $8,000 dollars) have been allowed to develop and succeed is
because the social group most directly involved in their production typically
have the financial means to afford them. In effect, braces have always been
a technology paid for and influenced by the most elite groups of society.
Lastly, as I will expand upon in the near future, orthodontists
themselves are another relevant social group in the evolution of braces.
When the first orthodontists began to distinguish themselves in the dental

community, they were more like specialized dentists than anything else. Due
to the fact that no official discipline of orthodontics had yet been established,
the original orthodontists had no foundation to base their work upon
therefore they had a vested interest in creating completely new technology
that could serve as an example for generations to come. Once the specialty
and technology had been established, orthodontists had much more
economically fueled interest in the evolution of the technology. When
orthodontists decided that they were not interested in going through extra
training to use lingual braces, the technology faded to the background of
new braces technologies. Orthodontists created an entirely new field of
medicine for themselves and were driven by both professional and financial
goals.
The Professionalization of Orthodontics:
Another very important factor in the evolution of dental braces was the
professionalization of orthodontics and the emergence of accredited
university and professional programs. In 1910, Dr. Edward Angle created the
first university program for orthodontics in the United States known as the
Angle School. The program was the first of its kind to focus specifically on the
practice of orthodontics, rather than dentistry. Dr. Angle himself was one of
the most influential orthodontists in the United States, and the creation of his
university program enabled many of the discoveries and mechanisms of the
20th century. After the Angle school opened, other post-graduate programs
began to emerge around the country. Student and graduates of these

programs went on to develop their own methods and devices and even went
on to publish some of the first national journals devoted to orthodontics
(Wahl, 2005: Chapt 3). Before this point, orthodontics had merely been a
subset of dentistry that a few dedicated individuals had devoted their lives
to. The progression of orthodontic technology was slow and messy because
there was no uniform curriculum or knowledge base for individuals to base
their methods off of. With the introduction of schools of orthodontics,
industrial knowledge and methods were able to flow freely and as a result
the industry experienced a growth in industry specific knowledge and an
increase in new mechanisms. (Wahl, 2005: Chpt 3; Lapsley, 2012).
Along with the introduction of new university programs, the early
1900s also marked the first instances of nation wide orthodontic
associations (Wahl, 2005: Chpt 3). These associations allowed recent
graduates of orthodontic programs, as well as already established figures in
the orthodontic field to organize and form networks amongst each other. One
result of these new networks was a newfound sense of competition between
individual orthodontists and schools of though. The majority of conflicts and
debates existed between Dr. Angle and his students, and those who attended
other institutions that didnt belong to the same school of thought. Like most
competition within industries, the competition between Angle and others in
the field did spark some controversy, but it also inspired new technologies
and methods, which would go on to advance the fields as a whole (Wahl,
2005: Chpt 6; Kenney, 2013). Without the creation of university programs

and orthodontic associates, the discussions and innovations formed in the

wake of newly created relationships and competition would have gone
unexplored.
As a profession, many individuals saw a lot

Figure 5: One current Ortho

Association

of potential in orthodontics for a variety of

reasons. Firstly, as discussed above, the demand
for straight teeth has always been, and promises
to remain, relatively high especially in U.S
society. Orthodontists rarely have to worry that their client base will suddenly
stop desiring straight teeth; therefore their jobs are almost inherently secure.
Another appeal of the profession is that orthodontists tend to make decent
livings due to the relative cost of their product. It should come as no surprise
that with a product literally made of gold; orthodontists were not operating
within a small budget when it came to developing their technology. Even
today, orthodontists are one of the top earning careers in the entire United
States. In 2012, the BLS published findings that placed orthodontists at
number six on the list of top earning positions, with those in the field earning
an average of $186,000 a year (Locsin, 2012). With high job security and
high salaries, it is not surprising that orthodontia is a competitive and highly
sought after profession.
Conclusion:
To the dismay of millions of young adults who have lived through the
experience, braces have become an important technology in U.S society. The

century old desire for straight teeth has resulted in countless mechanisms
and technologies made out of various different materials. As those materials
and mechanisms evolved, so too did the general understanding of the
underlying structure of teeth. Even in the past century, we have seen the
effectiveness of braces increase exponentially. For a price, individuals are
able to enter an orthodontists office one day with crooked teeth, and leave a
few months or a couple years later with perfectly straight teeth. Previously,
this same transformation was only possible with multiple years of therapy
and gave no guarantee of success. Braces technology has found new ways to
incorporate fresh materials and to address the needs of patients in
successful and important ways. As a result, braces have become an
important part of U.S culture and have expanded their influence into new
social groups and institutions. Unless standards of beauty in this country
change drastically in the near future, braces will remain to be an important
technology and will continue to evolve and expand as new technologies
become available. Currently, work is being done with 3-D modeling and
genetic testing in order to find new ways to map and more effectively treat
malocclusions. The incorporation of these new technologies, as well as the
further development of existing methods will undoubtedly lead to more
discrete and effective treatments for crooked teeth. Not to mention a
significant decrease in the number of embarrassing school photos that entire
generations of young children will have to hide from their friends.

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