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healthy_back https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1529705121321354/
A short history of orthodontics....
"Functional" Orthodontics---looking at jaw development, breathing, tongue function---began in the early 20th century in France and Germany. Keeping the tongue on the palate and developing the jaws was a basic premise in Functional Orthodontics.
Then the rival school of American or what was called "Aesthetic" Orthodontics took power by the 1940s, and ended up dominating the development of orthodontics worldwide.
By the 1970s,, each country in the world had tumbled and accepted the American model based on extracting teeth to achieve better smiles in faster time, with less relapse.
Health and function forgotten.
Here is a brief AI version of this history below.
-----
Functional Orthodontics in Germany and France: History, Philosophy, and Craniofacial Development
Functional orthodontics developed in Germany and France as a response to mechanistic, extraction-focused orthodontics. Its core principle is that craniofacial growth is shaped by function—especially oral posture, tongue position, and breathing patterns. This document outlines its historical development, philosophy, and biological rationale, especially the role of tongue posture and mouth closure in facial growth.
Historical Timeline
- 1920s–1930s (Germany): Dr. Wilhelm Balters develops the Bionator. This appliance guides jaw growth and promotes oral function, laying the foundation for German functional orthodontics.
- 1950s (France): Drs. René Soulet and André Besombes introduce the Soulet-Besombes activator, focusing on neuromuscular re-education.
- 1950s (Germany): Dr. Rolf Frankel develops the Frankel appliance, emphasizing soft tissue balance.
- 1970s (France): Dr. Jean Delaire creates the Delaire facemask to treat maxillary deficiencies and integrates orthopedic principles into facial growth correction.
Philosophy of Functional Orthodontics
1. Form Follows Function: Malocclusion is a consequence of dysfunctional habits such as mouth breathing and incorrect tongue posture.
2. Growth Guidance: Appliances encourage natural skeletal development instead of restricting it.
3. Removable Functional Appliances: Devices like the Bionator, Frankel, and Soulet-Besombes activators are designed to work with muscle action and oral posture.
4. Holistic View: Emphasis on posture, airway, swallowing, and muscle balance. Treatment often includes myofunctional training.
Biological Rationale: Tongue Pressure and Oral Posture
Both German and French schools emphasized the tongue's role in shaping the maxilla. A properly positioned tongue (resting on the palate) provides upward and outward pressure that stimulates transverse and sagittal growth of the maxilla. Similarly, keeping the lips sealed promotes nasal breathing and proper mandibular positioning.
Key concepts include:
- The tongue as a natural palatal expander
- Mouth closure promoting nasal breathing, balanced muscle tone, and vertical control
- Dysfunction (e.g., open-mouth posture) leading to long-face syndrome, retruded jaws, and narrow dental arches
-===============
As for othotropics, it borrows its basic premises from Functional Orthodontics (the "Tropic Premise" for example was not John Mew's invention). It also upholds the French/German emphasis on jaw development.
However, Functional Orthodotists emphasized heath as the outcome.
The Mews' version (with some changes in recent years) emphasizes achieving "better looking faces", in a sense following the American idea that "looks" is the goal of orthodontics.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1791408905150973/
International Responses to the American Shift to Extraction-Based Orthodontics
OVERVIEW
The American turn to premlar extractions associated with Charles H. Tweed in the 1940s and with Percy Raymond Begg in Australia in the 1950s is not identical everywhere.
The broad pattern is this: early European discussion on extraction use did not uniformly trail the United States. While Swiss and Swedish authors were already formalizing extraction-guided eruption in 1947–1948, generally Europe did not follow the American trend in the 1940s. What changed in the 1950s and especially the 1960s was the scale and rationale of adoption, following the cephalometric normalization of premolar extraction in the US and the UK. Continental Europe remained more heterogeneous, with lower extraction frequencies overall and stronger persistence of functional/removable traditions.
English-language record
The English-language record shows that Europe’s earliest serialized extraction discourse was initially Swiss/Swedish and was often framed as eruption guidance rather than cephalometric denture reduction. Birger Kjellgren published Serial Extraction as a Corrective Procedure in Dental Orthopedic Therapy in 1948 in Acta Odontologica Scandinavica, and Rudolf Hotz is cited in primary records as presenting Active supervision of the eruption of teeth by extraction in the 1947–1948 Transactions of the European Orthodontic Society. By 1970, Hotz was explicitly reframing the debate in Guidance of eruption versus serial extraction, which already suggests a European retreat from any crude “extract first, explain later” Anglo-American method.
In the Anglo-American sphere, extraction became much more normalized in the 1950s–1960s. A German historical synthesis summarizes the 1960s American situation as an extraction rate of roughly 60–80%, explicitly attributing the rise to the influence of Begg and Tweed and to the wider use of multibanded fixed appliances that enabled more bodily movement and more routine premolar extraction for both crowding and intermaxillary correction.
As for the British/Irish response, the contrast is sharp. Ernest Sheldon Friel is remembered in later historical review as reporting only 8% extraction frequency in Ireland in 1931, i.e., a distinctly conservative baseline before the postwar American turn. However, in contrast, British survey literature by the late 1960s and early 1970s reflects a far more extraction-tolerant environment: Hooper’s Orthodontics as a public service: the Wessex survey is a key mid-1960s marker, and later prevalence compilations place English rates extremely high, including 83.5% for Hooper’s 1967 material and 75% for Rose’s early-1970s series.
These figures indicate that the British response moved much nearer the American extraction mainstream than most continental systems did.
French-language record
The French record, as preserved in French doctoral syntheses and congress-history material, points to initial resistance followed by later selective conversion, not early wholehearted adoption. A French historical thesis states that Roger Xavier O'Meyer was “pro-conservateur jusqu'en 1950,” but that after repeated visits to the Tweed Foundation he “défendit avec vigueur les extractions” at the 1960 congress. A second French synthesis similarly states that in France O’Meyer, initially conservative under Tacail’s influence, publicly embraced Tweed after Tweed Foundation training, and that the influence of Tweed and Begg fed an increase in premolar extractions through the 1960s and 1970s.
This matters historiographically because it suggests that the French reaction was not simply derivative of U.S. clinical results; it was mediated by training circuits, foundation courses, and congress culture. The French material supports a delayed adoption of premolar extractions, with stronger extractionist alignment emerging only around 1960 and afterward. The same French synthesis also emphasizes that subsequent lowering of high extraction frequencies in France came with the rise of functionalist and bioprogressive currents in the 1970s.
If one is strict about journal evidence, the French archive is patchier here than the English-language archive. In this session, the French evidence is strongest not from contiguous full-text runs of L’Orthodontie Française or Orthod Fr but from later French scholarly syntheses that cite congress speeches, national teachers, and longer prevalence trends.
That still gives a coherent answer: France appears to have resisted longer than the U.K. and to have crossed over only once Tweedian teaching was institutionalized.
German-language record
The German-language record points much more clearly toward partial resistance and slower uptake than toward rapid alignment with the American extraction turn. A German thesis on Class II therapy states that while America reached 60–80% extraction rates in the 1960s under Begg/Tweed influence, “die Extraktionsrate in Europa lag ... mit ca. 20% wesentlich niedriger,” which it explains mainly by the more limited use of fixed appliances and the continued reliance on functional orthodontic devices for occlusal correction without premolar extraction. That is the single strongest macro-historical formulation available in the German material gathered here.
EASTERN EUROPE
Eastern Europe was also slow to pick up on the extraction trend. A French historical compilation citing earlier national surveys lists Germany 15.9% in Breeg (1963) and Germany 27.8% in Bredy and Reichel (1971), compares these figures with much lower or moderate values in Poland 17.4% (Majchrowicz, 1972) and Czechoslovakia 19.2% (Adam, 1968).
The overall picture is that German-speaking and East-Central European systems remained well below the late-1960s American and English extraction highs.
The ideological counterweight is also visible. Rolf Fränkel published The guidance of eruption without extraction in 1971, in immediate historiographic aftermath of the 1960s debate. The title alone is significant: it marks a German/East German intervention that did not merely moderate extraction, but proposed an explicitly nonextraction version of eruption guidance.
In other words, by the turn of the 1970s the German-speaking response was not passive under-adoption; it had become an articulated counter-program.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1853848405573689/
For those curious who have TMD and have been told orthodontics cannot cause it:
How on earth did the Orthodontic Industry manage to argue that orthodontics have nothing to do with TMD---given that changes to occlusion (changes in height, contact, jaw position) are proven potential causes of TMD?
AI's response reading the articles published post the Brimm Case denying any crrelation:
The way they argue it is not by literally saying orthodontics cannot move teeth, alter bite, or affect mandibular position. The argument is more slippery and medico-legal:
They concede pieces of the mechanism, then deny that the mechanism produces a statistically provable, generalizable TMD injury.
Their logic is basically this:
1. They reframe Brimm as a legal/public-relations event, not a biological warning.
Pollack’s “Tempest in a Teapot” does not primarily answer the biological question. It tells orthodontists that the Michigan jury verdict should have “no legal effect at all on orthodontic practice,” and that calling it a precedent or landmark case misleads the profession. In other words: do not change treatment protocols because of this jury verdict.
2. They isolate Brimm as a bad individual case rather than a warning about extraction mechanics.
The same account admits that Brimm had no TMJ symptoms before treatment, that symptoms began after bands were removed, and that the complaint alleged improper bite, improper occlusion, mandibular/maxillary deformity, severe pain, crepitus, and limited opening after braces. It also reports that plaintiff experts testified that orthodontic treatment led to her TMJ problems and that premolar extraction was contraindicated. But the defense frame is: her treatment was conventional, standard, and excellent; therefore the verdict should not be generalized.
3. They break the causal chain into separate links and say each link is unproven.
The Bernstein/AJODO-type argument explicitly names the chain: premolar extraction → reduced vertical dimension / over-retraction / deep bite / anterior interferences → distalized mandible → posterior condyles → TMD. Then it says the literature does not show higher TMD incidence in premolar-extraction patients, nor increased posterior mandibular or condylar displacement compared with nonextraction or untreated patients.
4. They use group averages to erase vulnerable individuals.
This is the core move. They say extraction and nonextraction groups do not differ significantly in “signs and symptoms commonly associated with CMD/TMD.” Therefore the treatment choice is “of little functional significance.” But that conclusion is based on group comparison. It does not prove that no individual patient can be injured by a particular combination of extraction, retraction, vertical change, bite collapse/interference, condylar loading, or pre-existing vulnerability.
5. They admit orthodontics can affect condylar/mandibular position — then say the changes are too small or clinically irrelevant.
This is the contradiction you can use. One passage says different orthodontic and surgical treatments “probably had markedly different mean impacts on condylar position,” but because there were no statistically significant functional differences, “a small iatrogenic change in condylar position” is “of no particular import.” That is not “orthodontics cannot affect condylar position.” It is “it may affect it, but our group data did not show functional consequences.”
6. They rely on adaptation/remodeling.
Another passage says that even where 30% of patients showed evidence of distal displacement, condylar remodeling apparently stabilized surface landmarks. So again, they do not really prove “no displacement.” They argue that displacement/remodeling does not translate into clinically meaningful TMD, at least in their sample.
7. They turn condylar position into a “red herring.”
The strongest rhetorical move is that they call condylar position a “red herring” and dismiss the older mechanism as mechanistic/parochial conjecture. But in the same discussion, they are still analyzing whether extraction or nonextraction treatment changes mandibular/condylar displacement. That means the issue was relevant enough to study; they just wanted the conclusion to be that it did not matter clinically.
So the answer to your question — “how on earth can they argue this?” — is:
They do not really prove orthodontics cannot affect the TMJ or mandibular position. They argue that, in the studies they cite, orthodontic treatment did not produce a higher average incidence of TMD signs/symptoms, and therefore extraction/retraction cannot be treated as a general cause of TMD.
That is a much narrower claim than the professional slogan that later emerged.
A precise sentence could be:
The post-Brimm literature did not show that orthodontics cannot affect mandibular position or the TMJs. On the contrary, it examined whether extraction mechanics altered mandibular and condylar position, and in places acknowledged that orthodontic and surgical treatments could have “markedly different” effects on condylar position. What it concluded was narrower, and more useful medico-legally: that such changes did not produce a statistically higher rate of TMD signs and symptoms in the treatment groups studied.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1867257990899397/
Should Orthodontist Associations Be Taking Responsibility for the Patients Damaged by Premolar Extractions?
Today it is common knowledge in the orthodontic specialty that past generations of patients were damaged by the over-use of premolar extractions with orthodontic treatment. The fact that "too many" people in the first decades of premolar extraction use (1940–1980) had had their faces "flattened" or "dished in" is recognized in articles in orthodontic journals. The flattened face with premolar extractions, along with the risk for Temporomandibular Disorder, is the reason the premolar extraction rate in the US dropped from 70% of cases in the 1970s to its current 25%.
The problem is that this "mistake" in orthodontic history is given no importance.
To quote Dr. Elvire LeNorcy, director of the orthodontic school at the Brettaneau Hospital in France:
"Yes it is true that we damaged many people in the past with premolar extractions. But one has no reason to get upset about it. But now we all know that premolar extraction shrinks the size of the oral cavity and the space for the tongue, and we do it less than now."
To quote Dr. Nicolas Goussens, former president of the French Orthodontic Association, and current director of the orthodontic school at the Pitie Salpettriere Hospital in France:
"Premolar extractions weredefinitely a problem in the past. It caused flattened faces, TMD and other issues in a lot of people. Yeah, so now we use them a lot less, oh maybe, in 15% of cases."
These perspectives of this major orthodontic "mistake" make the same mistake: they refer to premolar extraction damage as a problem in "the past".
This overlooks the inconvenient fact that many of those people damaged "in the past" are still alive. The "mistake" in their orthodontic treatment is not past for them.
Many who had premolars extracted as kids are today suffering from life-impairing chronic ailments due to their flattened faces from premolar extractions. According to thousands of testimonies, these include respiratory problems like Obstructive Sleep Apnea, snoring, and mouth-breathing; chronic neck pain and compromised cervical spines; temporomandibular joint disorder; tinnitus, and comorbid consequences such as ADHD, poor sleep, poor stamina in exercise; poor vocal resonance, speech defects, bad posture, and psychological disorders such as anxiety and depression due to the difficulty dealing with their facial disfigurement and/or chronic health issues.
What compounds the injury is that these damaged people feel they have been abandoned by the specialty, who chalk them off as an unfortunate blip in orthodontic history.
Nor is any research devoted to their issues, or how to treat them. There are no research articles on what can be termed Premolar Extraction/Retraction Syndrome. There is no information disseminated to the medical community on the common consequences of premolar extractions: recessed jaws, narrower airways, abnormally small oral cavities, a backwards positioned hyoid bone and a kypthotic or hyperlordotic cervical spine. The average doctor thinks that orthodontics just straightens teeth. There is no institiutonally recognized treatment method.
Hence the victim of premolar extractions is faced with ignorance about their condition everywhere they turn. They are left with no institutional support, and no roadmaps for solutions for their symptoms.
The vast majority report that most orthodontists, beginning with their own, do not acknowledge their complaints. They report that orthodontists instead seem hostile at them for bringing up their issues. They tend to be treated like lepers, a symbol of a blemish in the history of orthodontics and its secret shame. One young woman said her orthodontist responded to her concern with respiratory issues caused by her orthodontic treatment by forbidding her to ever step foot in her office.
To add injury to injury, the patients damaged by premolar extractions must also pay for their own treatments, which are lengthy and costly. Costs for what are colloquially termed "reversal treatments" range from$15,000 for an adult palate expander to $40,000 for orthodontic re-opening of the extraction spaces and implants to $70,000 for jaw surgery, to $250,000 if Total Jaw Replacement is necessary. One retired nurse had to sell the mortgage of her home to afford the treatments. So have others.
The majority of people damaged by premolar extractions do not have the financial means to get the help they need.
This is unjust.
Why should people damaged from an industry mistake have to mortgage their homes to heal the consequences of this mistake? Why should people without resources be stuck with iatrogenic health/aesthetic consequences without support or solution?
Car companies take responsibility for a faulty product: recall them, and make redress to injured parties. Should not orthodontist associations take responsibility for the orthodontic patients of the past who have been adversely affected by their standard of care ?
There was supposedly talk at a recent orthodontic conference that the American Association of Orthodontists (AAO) was about to launch a program to offer recompense to the people damaged by premolar extractions.
What happened to this initiative ?
Financial support is just the first step, however.
Ideally, the industry would be conducting research into the best medical methods to repair the retractive damage to the skull caused by extraction orthodontic treatment. A premolar extracted patient who developed problems is very difficult to fix. Research has shown that the dimensons of their oral cavity are likely to have shrunk in the lateral, vertical and anterior-posterior dimensions, and if done in childhood, the growth of their jaws may have been stunted. Their tongue may have insufficient space to functon. The upper airway may have narrowed, as may have their palate and nasal passages.
It is not easy to get these multiple dimensions returned to norm, and it is not even clear what the norm for each person should be, as their original face is gone, and if done in childhood, the face that should have grown is left as a hypothesis.
It is also impossible to repair the less forward and narrower cheekbones and sunken eyes that patients frequently report. Normally surgeons treating premolar extraction patients operate only on the jaws. They are already challenged to know how to restore the width of both jaws, given that widening the lower jaw is not in most surgeons' tool box.
Patients report being given wildly different treatment plans, and not knowing which is right. It is impossible to know what is right until there has been study on methodology.
The orthodontist industry should also -as soon as possible, given the high demand - establish free interdisciplinary clinics for extraction/retraction damaged people, where specialized teams of professionals - maxillofacial surgeons, orthodontists, ENTs, myofunctional therapists, dental restoration dentists and osteopath - could diagnose and treat them.
The current solution -which seems to be to wait for these past generations to die off, and for this «mistake» in orthodontic history to be buried in silence with them- is not viable.
First, because these mistakes are still alive.
Second, the « mistakes » keep coming. The majority of people reporting problems today are between 14 and 28 years old. Premolar extractions continue to be done in anywhere from 5% to 85% of all patients in orthodontic treatment.
These « mistakes » are not the fault of any one orthodontist.
The responsibility lies with the leaders in the industry who dictate education programs and protocol. Orthodontists mistakenly using premolar extractions are only following what their trusted professors have taught them and what they have been trained to do in good faith as a safe and beneficial treatment.
Indeed individual orthodontists shrug with helplessness when speaking or hearing about damaged people with flattened faces- whom almost all know exist. The most common response is "Well what can I do about it?" Of the 350 orthodontists I have interviewed - some of whom have admitted flattening the faces and narrowing the airways of their own patients, and two of ther own children - none have thought there was anything they could do about it, except lower the extraction rate in their own practice.
There is something any orthodontist committed the orthodontic profession can do - and as soon as possible:
They can organize a task force to set up strict protocol guidelines on when premolar extractions are safe and beneficial, and when they are clearly not, and lobby orthodontic associations for enforcement of this protocol.
There have never been any standard protocol guidelines for the standard of care of premolar extraction use. There is still no diagnostic protocol today. Some orthodontists screen for palate size and airway patency, and assess the patient's facial structure; others continue in the old school approach of just looking at teeth.
Some extract in 60–85% of their cases. Some in less than 5%.
Some disclose the risk of face flattening and airway narrowing to their patients; others remain in the clouds and say there are no risks. Orthodontists are not bound legally to disclose any risks to patients. Protocol should include required risk disclosure.
The lack of protocol and risk disclosure may be the number reason so many worldwide are reporting adverse outcomes with premolar extractions.
Implementation of standard protocol is within reach and would be win win for patients and orthodontists alike.
It would save countless patients from impaired health and aesthetics. It would save the standard of care of premolar extraction from going into disrepute if it led only to 100% safe and beneficial outcomes.
As for the existence of clinics to help people damaged from extraction orthodontics recover, this will likely not damage the specialty's reputation, as might be feared. On the contrary, it will help the specialty gain credibility as a health-conscious institution, which aims the patients' better good, and feels remorse for the patients suffering from its mistakes.
Again this is specialty responsibility, not the individual orthodontist's.
But every orthodontist who cares about this issue can make a big difference.
A short history of orthodontics....
"Functional" Orthodontics---looking at jaw development, breathing, tongue function---began in the early 20th century in France and Germany. Keeping the tongue on the palate and developing the jaws was a basic premise in Functional Orthodontics.
Then the rival school of American or what was called "Aesthetic" Orthodontics took power by the 1940s, and ended up dominating the development of orthodontics worldwide.
By the 1970s,, each country in the world had tumbled and accepted the American model based on extracting teeth to achieve better smiles in faster time, with less relapse.
Health and function forgotten.
Here is a brief AI version of this history below.
-----
Functional Orthodontics in Germany and France: History, Philosophy, and Craniofacial Development
Functional orthodontics developed in Germany and France as a response to mechanistic, extraction-focused orthodontics. Its core principle is that craniofacial growth is shaped by function—especially oral posture, tongue position, and breathing patterns. This document outlines its historical development, philosophy, and biological rationale, especially the role of tongue posture and mouth closure in facial growth.
Historical Timeline
- 1920s–1930s (Germany): Dr. Wilhelm Balters develops the Bionator. This appliance guides jaw growth and promotes oral function, laying the foundation for German functional orthodontics.
- 1950s (France): Drs. René Soulet and André Besombes introduce the Soulet-Besombes activator, focusing on neuromuscular re-education.
- 1950s (Germany): Dr. Rolf Frankel develops the Frankel appliance, emphasizing soft tissue balance.
- 1970s (France): Dr. Jean Delaire creates the Delaire facemask to treat maxillary deficiencies and integrates orthopedic principles into facial growth correction.
Philosophy of Functional Orthodontics
1. Form Follows Function: Malocclusion is a consequence of dysfunctional habits such as mouth breathing and incorrect tongue posture.
2. Growth Guidance: Appliances encourage natural skeletal development instead of restricting it.
3. Removable Functional Appliances: Devices like the Bionator, Frankel, and Soulet-Besombes activators are designed to work with muscle action and oral posture.
4. Holistic View: Emphasis on posture, airway, swallowing, and muscle balance. Treatment often includes myofunctional training.
Biological Rationale: Tongue Pressure and Oral Posture
Both German and French schools emphasized the tongue's role in shaping the maxilla. A properly positioned tongue (resting on the palate) provides upward and outward pressure that stimulates transverse and sagittal growth of the maxilla. Similarly, keeping the lips sealed promotes nasal breathing and proper mandibular positioning.
Key concepts include:
- The tongue as a natural palatal expander
- Mouth closure promoting nasal breathing, balanced muscle tone, and vertical control
- Dysfunction (e.g., open-mouth posture) leading to long-face syndrome, retruded jaws, and narrow dental arches
-===============
As for othotropics, it borrows its basic premises from Functional Orthodontics (the "Tropic Premise" for example was not John Mew's invention). It also upholds the French/German emphasis on jaw development.
However, Functional Orthodotists emphasized heath as the outcome.
The Mews' version (with some changes in recent years) emphasizes achieving "better looking faces", in a sense following the American idea that "looks" is the goal of orthodontics.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1791408905150973/
International Responses to the American Shift to Extraction-Based Orthodontics
OVERVIEW
The American turn to premlar extractions associated with Charles H. Tweed in the 1940s and with Percy Raymond Begg in Australia in the 1950s is not identical everywhere.
The broad pattern is this: early European discussion on extraction use did not uniformly trail the United States. While Swiss and Swedish authors were already formalizing extraction-guided eruption in 1947–1948, generally Europe did not follow the American trend in the 1940s. What changed in the 1950s and especially the 1960s was the scale and rationale of adoption, following the cephalometric normalization of premolar extraction in the US and the UK. Continental Europe remained more heterogeneous, with lower extraction frequencies overall and stronger persistence of functional/removable traditions.
English-language record
The English-language record shows that Europe’s earliest serialized extraction discourse was initially Swiss/Swedish and was often framed as eruption guidance rather than cephalometric denture reduction. Birger Kjellgren published Serial Extraction as a Corrective Procedure in Dental Orthopedic Therapy in 1948 in Acta Odontologica Scandinavica, and Rudolf Hotz is cited in primary records as presenting Active supervision of the eruption of teeth by extraction in the 1947–1948 Transactions of the European Orthodontic Society. By 1970, Hotz was explicitly reframing the debate in Guidance of eruption versus serial extraction, which already suggests a European retreat from any crude “extract first, explain later” Anglo-American method.
In the Anglo-American sphere, extraction became much more normalized in the 1950s–1960s. A German historical synthesis summarizes the 1960s American situation as an extraction rate of roughly 60–80%, explicitly attributing the rise to the influence of Begg and Tweed and to the wider use of multibanded fixed appliances that enabled more bodily movement and more routine premolar extraction for both crowding and intermaxillary correction.
As for the British/Irish response, the contrast is sharp. Ernest Sheldon Friel is remembered in later historical review as reporting only 8% extraction frequency in Ireland in 1931, i.e., a distinctly conservative baseline before the postwar American turn. However, in contrast, British survey literature by the late 1960s and early 1970s reflects a far more extraction-tolerant environment: Hooper’s Orthodontics as a public service: the Wessex survey is a key mid-1960s marker, and later prevalence compilations place English rates extremely high, including 83.5% for Hooper’s 1967 material and 75% for Rose’s early-1970s series.
These figures indicate that the British response moved much nearer the American extraction mainstream than most continental systems did.
French-language record
The French record, as preserved in French doctoral syntheses and congress-history material, points to initial resistance followed by later selective conversion, not early wholehearted adoption. A French historical thesis states that Roger Xavier O'Meyer was “pro-conservateur jusqu'en 1950,” but that after repeated visits to the Tweed Foundation he “défendit avec vigueur les extractions” at the 1960 congress. A second French synthesis similarly states that in France O’Meyer, initially conservative under Tacail’s influence, publicly embraced Tweed after Tweed Foundation training, and that the influence of Tweed and Begg fed an increase in premolar extractions through the 1960s and 1970s.
This matters historiographically because it suggests that the French reaction was not simply derivative of U.S. clinical results; it was mediated by training circuits, foundation courses, and congress culture. The French material supports a delayed adoption of premolar extractions, with stronger extractionist alignment emerging only around 1960 and afterward. The same French synthesis also emphasizes that subsequent lowering of high extraction frequencies in France came with the rise of functionalist and bioprogressive currents in the 1970s.
If one is strict about journal evidence, the French archive is patchier here than the English-language archive. In this session, the French evidence is strongest not from contiguous full-text runs of L’Orthodontie Française or Orthod Fr but from later French scholarly syntheses that cite congress speeches, national teachers, and longer prevalence trends.
That still gives a coherent answer: France appears to have resisted longer than the U.K. and to have crossed over only once Tweedian teaching was institutionalized.
German-language record
The German-language record points much more clearly toward partial resistance and slower uptake than toward rapid alignment with the American extraction turn. A German thesis on Class II therapy states that while America reached 60–80% extraction rates in the 1960s under Begg/Tweed influence, “die Extraktionsrate in Europa lag ... mit ca. 20% wesentlich niedriger,” which it explains mainly by the more limited use of fixed appliances and the continued reliance on functional orthodontic devices for occlusal correction without premolar extraction. That is the single strongest macro-historical formulation available in the German material gathered here.
EASTERN EUROPE
Eastern Europe was also slow to pick up on the extraction trend. A French historical compilation citing earlier national surveys lists Germany 15.9% in Breeg (1963) and Germany 27.8% in Bredy and Reichel (1971), compares these figures with much lower or moderate values in Poland 17.4% (Majchrowicz, 1972) and Czechoslovakia 19.2% (Adam, 1968).
The overall picture is that German-speaking and East-Central European systems remained well below the late-1960s American and English extraction highs.
The ideological counterweight is also visible. Rolf Fränkel published The guidance of eruption without extraction in 1971, in immediate historiographic aftermath of the 1960s debate. The title alone is significant: it marks a German/East German intervention that did not merely moderate extraction, but proposed an explicitly nonextraction version of eruption guidance.
In other words, by the turn of the 1970s the German-speaking response was not passive under-adoption; it had become an articulated counter-program.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1853848405573689/
For those curious who have TMD and have been told orthodontics cannot cause it:
How on earth did the Orthodontic Industry manage to argue that orthodontics have nothing to do with TMD---given that changes to occlusion (changes in height, contact, jaw position) are proven potential causes of TMD?
AI's response reading the articles published post the Brimm Case denying any crrelation:
The way they argue it is not by literally saying orthodontics cannot move teeth, alter bite, or affect mandibular position. The argument is more slippery and medico-legal:
They concede pieces of the mechanism, then deny that the mechanism produces a statistically provable, generalizable TMD injury.
Their logic is basically this:
1. They reframe Brimm as a legal/public-relations event, not a biological warning.
Pollack’s “Tempest in a Teapot” does not primarily answer the biological question. It tells orthodontists that the Michigan jury verdict should have “no legal effect at all on orthodontic practice,” and that calling it a precedent or landmark case misleads the profession. In other words: do not change treatment protocols because of this jury verdict.
2. They isolate Brimm as a bad individual case rather than a warning about extraction mechanics.
The same account admits that Brimm had no TMJ symptoms before treatment, that symptoms began after bands were removed, and that the complaint alleged improper bite, improper occlusion, mandibular/maxillary deformity, severe pain, crepitus, and limited opening after braces. It also reports that plaintiff experts testified that orthodontic treatment led to her TMJ problems and that premolar extraction was contraindicated. But the defense frame is: her treatment was conventional, standard, and excellent; therefore the verdict should not be generalized.
3. They break the causal chain into separate links and say each link is unproven.
The Bernstein/AJODO-type argument explicitly names the chain: premolar extraction → reduced vertical dimension / over-retraction / deep bite / anterior interferences → distalized mandible → posterior condyles → TMD. Then it says the literature does not show higher TMD incidence in premolar-extraction patients, nor increased posterior mandibular or condylar displacement compared with nonextraction or untreated patients.
4. They use group averages to erase vulnerable individuals.
This is the core move. They say extraction and nonextraction groups do not differ significantly in “signs and symptoms commonly associated with CMD/TMD.” Therefore the treatment choice is “of little functional significance.” But that conclusion is based on group comparison. It does not prove that no individual patient can be injured by a particular combination of extraction, retraction, vertical change, bite collapse/interference, condylar loading, or pre-existing vulnerability.
5. They admit orthodontics can affect condylar/mandibular position — then say the changes are too small or clinically irrelevant.
This is the contradiction you can use. One passage says different orthodontic and surgical treatments “probably had markedly different mean impacts on condylar position,” but because there were no statistically significant functional differences, “a small iatrogenic change in condylar position” is “of no particular import.” That is not “orthodontics cannot affect condylar position.” It is “it may affect it, but our group data did not show functional consequences.”
6. They rely on adaptation/remodeling.
Another passage says that even where 30% of patients showed evidence of distal displacement, condylar remodeling apparently stabilized surface landmarks. So again, they do not really prove “no displacement.” They argue that displacement/remodeling does not translate into clinically meaningful TMD, at least in their sample.
7. They turn condylar position into a “red herring.”
The strongest rhetorical move is that they call condylar position a “red herring” and dismiss the older mechanism as mechanistic/parochial conjecture. But in the same discussion, they are still analyzing whether extraction or nonextraction treatment changes mandibular/condylar displacement. That means the issue was relevant enough to study; they just wanted the conclusion to be that it did not matter clinically.
So the answer to your question — “how on earth can they argue this?” — is:
They do not really prove orthodontics cannot affect the TMJ or mandibular position. They argue that, in the studies they cite, orthodontic treatment did not produce a higher average incidence of TMD signs/symptoms, and therefore extraction/retraction cannot be treated as a general cause of TMD.
That is a much narrower claim than the professional slogan that later emerged.
A precise sentence could be:
The post-Brimm literature did not show that orthodontics cannot affect mandibular position or the TMJs. On the contrary, it examined whether extraction mechanics altered mandibular and condylar position, and in places acknowledged that orthodontic and surgical treatments could have “markedly different” effects on condylar position. What it concluded was narrower, and more useful medico-legally: that such changes did not produce a statistically higher rate of TMD signs and symptoms in the treatment groups studied.
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1867257990899397/
Should Orthodontist Associations Be Taking Responsibility for the Patients Damaged by Premolar Extractions?
Today it is common knowledge in the orthodontic specialty that past generations of patients were damaged by the over-use of premolar extractions with orthodontic treatment. The fact that "too many" people in the first decades of premolar extraction use (1940–1980) had had their faces "flattened" or "dished in" is recognized in articles in orthodontic journals. The flattened face with premolar extractions, along with the risk for Temporomandibular Disorder, is the reason the premolar extraction rate in the US dropped from 70% of cases in the 1970s to its current 25%.
The problem is that this "mistake" in orthodontic history is given no importance.
To quote Dr. Elvire LeNorcy, director of the orthodontic school at the Brettaneau Hospital in France:
"Yes it is true that we damaged many people in the past with premolar extractions. But one has no reason to get upset about it. But now we all know that premolar extraction shrinks the size of the oral cavity and the space for the tongue, and we do it less than now."
To quote Dr. Nicolas Goussens, former president of the French Orthodontic Association, and current director of the orthodontic school at the Pitie Salpettriere Hospital in France:
"Premolar extractions weredefinitely a problem in the past. It caused flattened faces, TMD and other issues in a lot of people. Yeah, so now we use them a lot less, oh maybe, in 15% of cases."
These perspectives of this major orthodontic "mistake" make the same mistake: they refer to premolar extraction damage as a problem in "the past".
This overlooks the inconvenient fact that many of those people damaged "in the past" are still alive. The "mistake" in their orthodontic treatment is not past for them.
Many who had premolars extracted as kids are today suffering from life-impairing chronic ailments due to their flattened faces from premolar extractions. According to thousands of testimonies, these include respiratory problems like Obstructive Sleep Apnea, snoring, and mouth-breathing; chronic neck pain and compromised cervical spines; temporomandibular joint disorder; tinnitus, and comorbid consequences such as ADHD, poor sleep, poor stamina in exercise; poor vocal resonance, speech defects, bad posture, and psychological disorders such as anxiety and depression due to the difficulty dealing with their facial disfigurement and/or chronic health issues.
What compounds the injury is that these damaged people feel they have been abandoned by the specialty, who chalk them off as an unfortunate blip in orthodontic history.
Nor is any research devoted to their issues, or how to treat them. There are no research articles on what can be termed Premolar Extraction/Retraction Syndrome. There is no information disseminated to the medical community on the common consequences of premolar extractions: recessed jaws, narrower airways, abnormally small oral cavities, a backwards positioned hyoid bone and a kypthotic or hyperlordotic cervical spine. The average doctor thinks that orthodontics just straightens teeth. There is no institiutonally recognized treatment method.
Hence the victim of premolar extractions is faced with ignorance about their condition everywhere they turn. They are left with no institutional support, and no roadmaps for solutions for their symptoms.
The vast majority report that most orthodontists, beginning with their own, do not acknowledge their complaints. They report that orthodontists instead seem hostile at them for bringing up their issues. They tend to be treated like lepers, a symbol of a blemish in the history of orthodontics and its secret shame. One young woman said her orthodontist responded to her concern with respiratory issues caused by her orthodontic treatment by forbidding her to ever step foot in her office.
To add injury to injury, the patients damaged by premolar extractions must also pay for their own treatments, which are lengthy and costly. Costs for what are colloquially termed "reversal treatments" range from$15,000 for an adult palate expander to $40,000 for orthodontic re-opening of the extraction spaces and implants to $70,000 for jaw surgery, to $250,000 if Total Jaw Replacement is necessary. One retired nurse had to sell the mortgage of her home to afford the treatments. So have others.
The majority of people damaged by premolar extractions do not have the financial means to get the help they need.
This is unjust.
Why should people damaged from an industry mistake have to mortgage their homes to heal the consequences of this mistake? Why should people without resources be stuck with iatrogenic health/aesthetic consequences without support or solution?
Car companies take responsibility for a faulty product: recall them, and make redress to injured parties. Should not orthodontist associations take responsibility for the orthodontic patients of the past who have been adversely affected by their standard of care ?
There was supposedly talk at a recent orthodontic conference that the American Association of Orthodontists (AAO) was about to launch a program to offer recompense to the people damaged by premolar extractions.
What happened to this initiative ?
Financial support is just the first step, however.
Ideally, the industry would be conducting research into the best medical methods to repair the retractive damage to the skull caused by extraction orthodontic treatment. A premolar extracted patient who developed problems is very difficult to fix. Research has shown that the dimensons of their oral cavity are likely to have shrunk in the lateral, vertical and anterior-posterior dimensions, and if done in childhood, the growth of their jaws may have been stunted. Their tongue may have insufficient space to functon. The upper airway may have narrowed, as may have their palate and nasal passages.
It is not easy to get these multiple dimensions returned to norm, and it is not even clear what the norm for each person should be, as their original face is gone, and if done in childhood, the face that should have grown is left as a hypothesis.
It is also impossible to repair the less forward and narrower cheekbones and sunken eyes that patients frequently report. Normally surgeons treating premolar extraction patients operate only on the jaws. They are already challenged to know how to restore the width of both jaws, given that widening the lower jaw is not in most surgeons' tool box.
Patients report being given wildly different treatment plans, and not knowing which is right. It is impossible to know what is right until there has been study on methodology.
The orthodontist industry should also -as soon as possible, given the high demand - establish free interdisciplinary clinics for extraction/retraction damaged people, where specialized teams of professionals - maxillofacial surgeons, orthodontists, ENTs, myofunctional therapists, dental restoration dentists and osteopath - could diagnose and treat them.
The current solution -which seems to be to wait for these past generations to die off, and for this «mistake» in orthodontic history to be buried in silence with them- is not viable.
First, because these mistakes are still alive.
Second, the « mistakes » keep coming. The majority of people reporting problems today are between 14 and 28 years old. Premolar extractions continue to be done in anywhere from 5% to 85% of all patients in orthodontic treatment.
These « mistakes » are not the fault of any one orthodontist.
The responsibility lies with the leaders in the industry who dictate education programs and protocol. Orthodontists mistakenly using premolar extractions are only following what their trusted professors have taught them and what they have been trained to do in good faith as a safe and beneficial treatment.
Indeed individual orthodontists shrug with helplessness when speaking or hearing about damaged people with flattened faces- whom almost all know exist. The most common response is "Well what can I do about it?" Of the 350 orthodontists I have interviewed - some of whom have admitted flattening the faces and narrowing the airways of their own patients, and two of ther own children - none have thought there was anything they could do about it, except lower the extraction rate in their own practice.
There is something any orthodontist committed the orthodontic profession can do - and as soon as possible:
They can organize a task force to set up strict protocol guidelines on when premolar extractions are safe and beneficial, and when they are clearly not, and lobby orthodontic associations for enforcement of this protocol.
There have never been any standard protocol guidelines for the standard of care of premolar extraction use. There is still no diagnostic protocol today. Some orthodontists screen for palate size and airway patency, and assess the patient's facial structure; others continue in the old school approach of just looking at teeth.
Some extract in 60–85% of their cases. Some in less than 5%.
Some disclose the risk of face flattening and airway narrowing to their patients; others remain in the clouds and say there are no risks. Orthodontists are not bound legally to disclose any risks to patients. Protocol should include required risk disclosure.
The lack of protocol and risk disclosure may be the number reason so many worldwide are reporting adverse outcomes with premolar extractions.
Implementation of standard protocol is within reach and would be win win for patients and orthodontists alike.
It would save countless patients from impaired health and aesthetics. It would save the standard of care of premolar extraction from going into disrepute if it led only to 100% safe and beneficial outcomes.
As for the existence of clinics to help people damaged from extraction orthodontics recover, this will likely not damage the specialty's reputation, as might be feared. On the contrary, it will help the specialty gain credibility as a health-conscious institution, which aims the patients' better good, and feels remorse for the patients suffering from its mistakes.
Again this is specialty responsibility, not the individual orthodontist's.
But every orthodontist who cares about this issue can make a big difference.