Biographical account of Dr. Angle – his life and contributions to Orthodontics
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Edward Hartley Angle (1855 – 1930)
regarded as the "Father of Modern Orthodontics.“
the most dominant, dynamic, and influential figure in the specialty of orthodontics.
separated orthodontics from the other branches of dentistry www.indiandentalacademy.com
Early life
born on June 1, 1855, in Herrick, Pennsylvania.
He did not like school; nor did he care for work around the farm.
derived his greatest pleasure from roaming the hills and woods around his home www.indiandentalacademy.com
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fascinated by the crude machines that were used in the farming community
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showing an early flair for inventiveness, he designed and built the horse-drawn hay rake that was used on American farms for many years afterward.
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In Dentistry
to avoid the distasteful work of the farmer; he apprenticed himself to a dentist.
Pennsylvania College of Dental Surgery (1876) DDS degree in 1878.
It was then that he started his first orthodontic case, on his preceptor’s son. www.indiandentalacademy.com
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1886- joined the faculty of the Dental Department of the University of Minnesota.
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1892 - Resigned from the University of Minnesota - moved to Chicago - the first professor of orthodontics at Northwestern University School of Dentistry
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1895 - moved to St. Louis, assuming the same post first at Marion Sims College of Medicine and shortly afterwards at Washington University Dental School
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1895 - MD degree from Marion Sims College www.indiandentalacademy.com
Angle’s school
experiences in various schools led him to the conviction that orthodontia could not be properly taught in a dental college.
1900 - the first school of orthodontia— The Angle School of Orthodontia at St. Louis www.indiandentalacademy.com
The course of instruction art (taught by artist Edmund Wuerpel), rhinology, embryology, histology, comparative anatomy, dental anatomy, Angle’s appliances.
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the members organized the first orthodontic society - "The Society of Orthodontists."
In 1935, the society adopted the name it bears today: The American Association of Orthodontists (AAO).
They also established the magazine, a quarterly titled The American Orthodontist, which we read today as the American Journal of Orthodontics www.indiandentalacademy.com
1903 - Dr. Anna Hopkins was elected the Society’s first secretary. She completed one of the early Angle courses, but was never to practice orthodontia. In 1906 she became Mrs. Edward Hartley Angle.
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Angle’s influence on his students was profound
his teaching methods were most unorthodox
he made men learn through a rigid system of discipline.
This covered every phase of their lives while they were under him, from the preparation of their assignments in theoretical subjects and the meticulous execution of their technical procedures to the menial housekeeping tasks of dusting and polishing their working quarters and even to sweeping the floors. www.indiandentalacademy.com
His object was “to light the fire of ambition” in order that the student would develop to his highest potential.
His lectures often lasted 3 or more hours and were gems that were never to be forgotten.
Philosophy, literature and science- became as familiar to his students as the study of biology and force control in orthodontia. www.indiandentalacademy.com
Angle felt that his students must have available the best sources of information possible.
restricted his own private practice to the treatment of malocclusion, thus becoming the first dental specialist.
He built up a faculty; among them were Milo Hellman, Raymond Osborn, Frederick Noyes and Albin Oppenheim. From them, they learned of tissue tolerance, the effect of mechanical forces on bone and tooth structure, and the physiologic and anatomic development of the dentofacial complex. www.indiandentalacademy.com
1907 - moved his school to New York City.
1908 - found the school in New London, Connecticut.
1909 - the graduates of the New York and New London schools organized the Eastern Association of Graduates of the Angle School of Orthodontia
1913 - the students of Angle practicing on the Pacific coast formed the Pacific Coast Society of Graduates of the Angle School. www.indiandentalacademy.com
ill health forced Angle to leave the East Coast
1916 - Dr. and Mrs. Angle settled in Pasadena
Angle determined to devote his time to study, invention, and experimentation and relaxation.
One room in the home was set up as a workshop, and it was here that Angle was his happiest – tinkering, improving, and creating some of the instruments for which he held 32 patents. www.indiandentalacademy.com
New school
In 1917, a young dentist James Angle who had once studied under the master appeared at the door of the Angle home.
He spread the news of Angle’s experience, and soon others applied for training
Thus did the 62-year-old Angle once again, and for the last time, take up teaching. www.indiandentalacademy.com
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No clinical facilities were available, and the little workshop served as a classroom.
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Spencer Atkinson, George Hahn and Cecil Steiner were students of this school.
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School at Pasadena, CF
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In June 1922, the members of this school founded a formal association : The Edward H. Angle Society of Orthodontia (commonly called the Angle Society).
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The meeting of this society in New London in 1928 was the last meeting that Angle ever attended. www.indiandentalacademy.com
Prior to admission, student was thoroughly grilled in the basic sciences, either by Dr. Angle or one of his staff.
The applicant was expected to know the anatomy, embryology and histology of the head and neck (exclusive of the brain), the growth, development, and functioning of the denture
He also expected the applicant to be reasonably familiar with history, general science, and English literature www.indiandentalacademy.com
Filing, soldering, and wire bending had to be mastered before the student was permitted to do any appliance manipulation. Only after surviving the rigors of discipline, theory, technique, and case analysis, the student was allowed admission to the clinic. www.indiandentalacademy.com
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They had no acrylics, no alginates, no light wires, no model trimmers and no preformed bands.
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Impressions were taken in plaster and, because undercuts prevented removing the stony mass in one piece, the operator was obliged to score the material and pry it off, piece by piece.
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The poured impression was later trimmed by hand with a plane, a saw, or a huge file. www.indiandentalacademy.com
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Angle tried to introduce licensure bill (license orthodontists separately from dentists)
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but was unsuccessful in getting his licensure bill to pass the California legislature.
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He did, however, live to see a similar bill, introduced by Charles Tweed, become law in Arizona. (The law was repealed six years later.) www.indiandentalacademy.com
The mechanical genius
Filed 32 patents
the American Society of Orthodontists, under the presidency of Rodriguez Ottolengui, passed a resolution condemning such patents.
Angle, Anna Hopkins Angle, and a number of Angle disciples resigned www.indiandentalacademy.com
Angle’s Patented Orthodontic Devices ď Ź
First patent - 1889 - Push type jackscrew for increasing width
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1895 Angle patents A lingual arch soldered to bands that are cemented on teeth; forcing teeth “outward and forward” special plier pinched the wire increasing its length
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1899 - the “E” (expansion) arch appliance
arch wire with threaded ends, extended in the tube of an anchor molar band
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nut is provided with a threadless extension that works with a friction sleeve to hold the adjustment www.indiandentalacademy.com
According to the nut’s position, the teeth could be moved either distally or mesially. the banded teeth were attached to the arch with the help of a soft wire that allowed their tipping or aligning.
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1901 patent - ribbed arch to prevent the sliding of ligatures ď Ź
A ribbed arch to prevent the sliding of ligatures which could occur in E-arch
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1899 patent, clamp band with long buccal tube
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solved the problem caused by the bulky adjustable clamp band by ď Ź
Replacing it with molar band which is streamlined and formed in such a way that the band is thick where the tube is soldered on the buccal, but the band is thin on the lingual ends
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1903 patent both arches connected by elastic traction ď Ź modified Kingsley headgear bow and extraoral force potential, if needed. ď Ź
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1911 patent ď Ź
detachable arch bar, with a vertical 90Âş bent end inserted in a vertical tube
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1912 - pin and tube appliance ď Ź
soldered vertical pins on arch wire that insert in vertical tubes soldered to individual bands
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Pins are resoldered each time as needed as the arch wire is straightened out toward the ideal arch configuration
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In 1912 ď Ź
option to add coil springs, held in place by pins, similar to those used later in the ribbon arch (and Begg) appliances.
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1915 patent ď Ź
ribbon arch bracket with retaining pin. The band wall approximates the inner surface of the ribbon arch
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advanced version with the arch wire wholly contained within the ribbon arch bracket; precursor of the Begg bracket
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1926 - edgewise bracket
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the rectangular wire was inserted in a horizontal slot in the edgewise position and kept there with the help of ligature wires tied around the tie wings. allows tooth movement in all 3 planes with the help of a single wire Dr. Begg cut the first bracket on lathe.
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1926 - streamlined edgewise bracket soldered eyelets on mesial and distal to control rotations, paving the way to the twin brackets (Siamese brackets) of today
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Angle’s last patent
belatedly filed almost 3 years after his death by his wife
The highly popular Broussard bracket of the 60s and 70s was based on this patent. www.indiandentalacademy.com
Other contributions ď Ź
concern about the biological response to foreign bodies used in oral environment.
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reflected in many of his patents in which he has constantly tried to cover all possibilities for adverse use or unfavorable reaction.
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Angle made an inventory of the available materials - gold, silver, platinum, platinous silver, iridio-platinum, platinoid, aluminum, brass, copper, aluminum bronze, steel, iron and vulcanized rubber.
he found that “the material most fitting was nickel silver,” a brass (copper-zinc alloy) that did not have any silver in it at all! www.indiandentalacademy.com
He was largely self-taught, and yet he mastered complex metallurgy.
in one of his publications, he explains that pinching the arch “not only spreads the particles of metal, so as to increase the length of the rod, but tempers the part subjected to the pinching action, thereby largely compensating for the reduction in the area of the rod section at that point, and consequently maintaining the strength and rigidity of the rod under the longitudinal strain thereon.” www.indiandentalacademy.com
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His knowledge of noble metals is witnessed also by his use of gold and of platinum-iridium arches in orthodontics.
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He was the first to use coil springs. But he connected them only to nobler metal arches www.indiandentalacademy.com
1887 - introduction in orthodontics of both soldering and a “baser” alloy which contained 60% to 70% copper 10% to 20% zinc 10% to 15% nickel
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Publications & Presentations
First scientific paper- "Irregularities of the Teeth" -at the ninth International Medical Congress.
Considered as the first edition of his textbook which was to go through seven editions
The seven editions of Angle’s book were published under the following titles
Irregularities of the Teeth, 1887 A System of Appliances for Correcting Irregularities of the Teeth, 1890
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The Angle system of Regulating and Retention of the Teeth, 1892
The Angle system of Regulation and Retention of the Teeth- With an Addition of Treatment of Fractures of the Maxillae, 1895
Angle system of Regulation and Retention of the Teeth and Treatment of Fractures of the Maxillae, 1899
Malocclusion of the Teeth and Fractures of the Maxillae, 1900
Treatment of Malocclusion of the Teeth, 1907 www.indiandentalacademy.com
1899 - “The Classification of Malocclusion” in the Dental Cosmos
His classification provided an intelligent and easily understood means of communication among members of the dental profession.
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Angle believed the maxillary first molars were the key to occlusion
The anterior-posterior position of the maxillary permanent first molars is relatively immutable
considered the upper first molar as the most reliable point of reference from which to compare other teeth
the eruption pattern of the maxillary permanent first molars causes them to assume a normal position. www.indiandentalacademy.com
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Subsequent investigations have shown that the A-P position of the permanent first molar is not constant in relation to the base of the skull.
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Though Angle postulated tooth movements in three planes, the main focus of his classification was in one plane (sagittal) krogman www.indiandentalacademy.com
Angle - the environmentalist
Individual variation from structurofunctional harmony was due to faulty environment
A Class II Div. 1 malocclusion – can be viewed as basically due to an underdeveloped mandible - in turn due to an environmental failure
So treatment must also be environmental, aiming at restoring normal function, to make up for an unachieved normal mandibular growth. www.indiandentalacademy.com
Angle was aware of the fact that the orthodontic tooth movement involved a feedback situation in which tooth and bone reacted reciprocally.
Angle influenced by Julius Wolff “Wolff’s law of bone” – bone trabeculae arranged in response to stress lines on the bone. www.indiandentalacademy.com
Angle had an uncompromising position against extraction.
It was his credo that "the best balance, the best harmony, the best proportions of the mouth in its relation to the other features require that there shall be a full complement of teeth, and that each tooth shall be made to occupy its normal position— i.e., normal occlusion." www.indiandentalacademy.com
CASE/ANGLE CONTROVERSY
Originally, Case was a genuine admirer of Angle.
Angle attributed the origin of the use of intermaxillary elastics to Baker, while Case thought that he should have received that credit.
This led to charges and countercharges between them in 1903. www.indiandentalacademy.com
The second point of contention—the question of the extraction of certain teeth as a means of treatment.
Case defended the discreet use of extraction as a practical procedure, while Angle believed in nonextraction. www.indiandentalacademy.com
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The climax of this conflict was a debate in 1911 at the annual meeting of the National Dental Association
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the problem became a matter of calm and objective evaluation and respectful appreciation of various points of view, each of which has made its contribution to orthodontics. www.indiandentalacademy.com
On August 11, 1930 Angle died at his summer home in Santa Monica
On November 17, 1930, 22 members of Angle Society of Orthodontia met in Chicago, with the purpose of carrying forward Dr. Angle’s ideals of orthodontia.
They decided to reorganize the society, and decided to begin the publication of the Angle Orthodontist. www.indiandentalacademy.com
Criticisms by Bernstein
Angle favored / did extraction treatment before 1900.
In Angle's sixth edition textbook, extraction treatments are shown and discussed
Angle changed his position to non-extraction due to the controversy with Calvin Case who did advocate extractions www.indiandentalacademy.com
Theodore Adler ď Ź
Angle changed to non- extraction after 1900 because of : - introduction of intermaxillary elastics - and his invention of e-arch appliance
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criticisms ď Ź
Dr. Angle did great harm to many persons, and to orthodontics, at the same time he was making his many contributions. Bernstein
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By all accounts Angle was a difficult man. He is reputed to have harbored much of the bigotry and some of the xenophobia of his time. Theodore Adler www.indiandentalacademy.com
"He did not like the Germans. He was broadminded but he had prejudices.”
"He lost many friends, or at least he alienated them.“
"If people had heard the terms he used in regard to them he would have had still more enemies." Wuerpel www.indiandentalacademy.com
Angle "could never take criticism or argument".
When his ideas were verbally attacked, he would call his attackers "fools.“ Frederick Noyes www.indiandentalacademy.com
"E.H.A. was obviously a disturbed man, and his image has been built up, far beyond what he deserved"
"approach became a classic example of cultism and dogma."
"Case was more successful as a contemporary leader than Angle. Case was on the inside leading while Angle was the maverick. He resented Calvin Case.” Tom Graber www.indiandentalacademy.com
"So I turned to the first special course then being offered. Unfortunately, being a resident of St. Louis, where the course was then given, I was asked to sign a contract to locate elsewhere on completion of the instruction. Angle added: 'You know, Lischer, I can pick the flowers in my garden myself.‘
Lischer www.indiandentalacademy.com
“Angle possessed many of the personality qualities seen in geniuses. They can be difficult, demanding, and unforgiving. They tend to be so devoted to their field that they fail to develop other aspects of their lives. Angle seems to fit that category.� Robert Rubin www.indiandentalacademy.com
Angle's dedication to orthodontics
“it (orthodontics) was his religion and his god. He would sacrifice everything for its sake. He could only see his life and his work and his devotion in terms of orthodontia.” Wuerpel www.indiandentalacademy.com
Conclusion
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Though Angle died 1930, his influence is still felt strongly in orthodontics.
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Even his enemies recognized the many contributions made by Edward Hartley Angle. www.indiandentalacademy.com
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His pioneer efforts in orthodontic education, his contribution to orthodontic literature, and his developments of innumerable instruments and appliances are not the accomplishments for which he will be remembered.
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Long after these have faded into history, Angle’s name will be associated with the onward march of biologic science and it will be realized how perceptive was the mind that could penetrate the empiricism of his day and proclaim the significance of normal occlusion. www.indiandentalacademy.com
This established orthodontia as a science and it will remain Angle’s greatest monument.
Characteristic of the man was a remark made shortly before he died: “I have finished my work. It is as perfect as I can make it.” www.indiandentalacademy.com
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