The shift in emphasis from molars to incisors

When Angle introduced his classification in the late 1920s, orthodontics focused primarily on the molar relationship as Class I, Class II, or Class III. Non-extraction treatment and expansion was generally the treatment of choice. In the 1940s Tweed1 moved the emphasis to the lower incisors, with extraction treatment becoming more prevalent. This was clearly a reaction against the shortcomings of excessive non-extraction treatment. However, it should also be noted that the emphasis on the lower incisors, with minimized emphasis on the upper incisors, was due to the fact that surgical correction was not available at the time, nor was improved facial appearance with functional appliances. The orthodontist was relegated to deciding a stable lower incisor position and then moving the upper incisors into contact with the lowers.

It should also be emphasized that in many Class I treatments the malocclusion may be corrected by tooth alignment only, accepting the position of the upper and lower incisors in the face. This is so-called 'tooth alignment' orthodontics, and it can be straightforward using the preadjusted bracket system.

However, the majority of orthodontic cases require changes in incisor position. In addition to 'tooth alignment', most cases require more challenging 'denture-positioning' procedures. For example, all malocclusions with a (Mass II or Class III incisor relationship will require treatment planning and then treatment mechanics to achieve not only pleasing tooth alignment, but also denture positioning in the facial complex for optimal facial esthetics.

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