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The Tweed Philosophy: The Tweed Years
JamesJ. Cross
Charles H. Tweed revolutionized clinical orthodontics, His inquisitive scientific mind coupled with his outstanding clinical ability and his unselfish work
ethic are legendary. He gave the orthodontic specialist diagnostic and
mechanical treatment concepts that have stood the tests of both time and
intense scrutiny, (Semin Orthod 1996;2:231-236,) Copyright © 1996 by W.B.
Saunders Company
equential Directional Force T e c h n o l o g y
which is taught at the Tweed Study Course
has been developed over the last half-century. To
understand the development of this technology,
one must go back to the father o f orthodontics,
Edward H. Angle (Fig 1). Angle gave the specialty many concepts and ideas, but two of them,
the edgewise appliance and his concept of a line
of occlusion x have had great impact on the
specialty of orthodontics.
Angle developed the edgewise appliance from
the ribbon arch mechanism and called it the
open bracket appliance. He discarded the ribbon arch appliance because of its lack of control
in both the horizontal and vertical planes o f
space. By changing the slot from vertical to
horizontal and increasing the size of the slot, he
was able to achieve a degree of control never
before possible. The new slot was .022 by .028
inches in dimension and was designed to accept
a rectangular wire .0215 by .0275 inches in size.
For the first time in history, bodily tooth movem e n t and torquing movements were possible.
Although Angle invented the appliance, he had
only 2 years of his life to perfect its design and its
use.
The original edgewise bracket was made of
gold alloy and was considerably smaller in size
than the ones in use today. Although gold had
many good qualities, its softness and malleability
caused problems when it was used as an orthodontic appliance. Placing a full-size wire in a small
S
Dr Cross is in private practice.
Address correspondence to James J. Cross, DDS, MS, 18114
Kings Rd, Ardmore, OK 73401.
Copyright© 1996by W.B. Saunders Company
1073-8746/96/0204-000255.00/0
gold bracket would often cause the bracket to
open. While the gold bracket was easy to close,
several adjustments would result in a broken
bracket. Bracket breakage was a major problem
during early days of the edgewise appliance. The
archwire was also made of gold alloy and was
somewhat softer than stainless steel. Because the
bands were gold, they were thicker than stainless
steel.
O t h e r problems included ligature wires (stainless steel had not yet been invented), broken
eyelets (tiny gold rings soldered on the labial
surfaces of the bands), and the bands pulling
away from the labial surface of the tooth, resulting in enamel decalcification. It is no surprise
that the practitioners of that era were reluctant
to use the appliance.
The line of occlusion concept led Angle to the
premise that the arches should always be exp a n d e d to accommodate a full c o m p l e m e n t of
teeth. H e believed that arch expansion stimulated b o n e growth, making extractions unnecessary. A somewhat confusing sidelight is that in
one of his texts Angle illustrated extraction
treatment. This apparent anomaly is inexplicable because Angle taught and advocated nonextraction treatment.
Tweed applied to Angle's school in Pasadena
in 1925 but was refused admittance. Angle told
him to study and to b e c o m e more serious about
orthodontics. He applied again and was accepted. Members of his class were to be: Glen
Terwilliger, Ken Terwilliger, Charles DePerteus,
and Bruce Curran.
A letter 2 from Glen Terwilliger describes the
course of study u n d e r t a k e n by Tweed and his
classmates. It also gives insight into orthodontic
training during that period in history. The letter,
Seminars in Orthodontics, Vol 2, No 4 (December), 1996: pp 231-236
231
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Tweed Years
Figure 1.
Edward H. Angle.
d i s p l a y e d o n t h e wall at t h e C h a r l e s T w e e d
F o u n d a t i o n , states:
Dr. Glen Terwilliger
2181 Ptarmigan Drive #1
Walnut Creek, CA 94595
Dr. James J. Cross
Adrmoreite Building
Ardmore, Oklahoma 73401
Preparation for the Angle School was a serious matt~
which involved refresher work on basic subjects, such as
Embryology, Dental Histology, Osteology, Head and Neck
Anatomy, and Dr. Angle's Seventh Edition. Under the
supervision by the graduates of the Angle School, Drs. Hahn,
Setz~ Huberty, Grover and MacKenzie, preparation was
undertaken and continued from four to six months. Other
requirements were that we dispose of our general practices and
close our offices which had already been attended to, so we
were ready for Dr. Angle's school. We had then been joined by
Dr. Charles DePertens of San Francisco, and Dr. Bruce
Curran, who had prepared in Cleveland, Ohio. When it was
time for the class to begin at the Angle school, we were notified
that it would be closed--there would be no course given, and
perhaps, would remain closed indefinitely. (With all of the
fine, formal Orthodontic education available today, it is
difficult to realize that Dr. Angle was the only Orthodontist in
the country who was concerned with the needfor a comprehensive course of training.)
Drs. Hahn, Huberty, and Setzer realized the seriousness
of our positions, and offered a plan to duplicate for us a
course of training as they had taken it under Dr. Angle in
Pasadena. Our group consisted of Charles (Tweed), my
brother Ken, Bruce Curran, Deperteus and me. Adjoining
rooms were obtained in the Koerber Bldg, in Berkeley--one
was outfitted with all essentials for the technical training that
had been given in Pasadena--the exercises were identical in
number and quality--(those done by Charles (Tweed) were
mounted and displayed on the wall of his office, and perhaps
they are still there.) All exercises were designed to acquaint
students with precision appliance requirements, and to
develop freehand precision skill.
The second room was for lectures and seminars. Here, we
undertook a serious detailed study of the subjects involved in
our preliminary preparation. Dr. Atkinson furnished material for head and neck dissection, and taught for a week or
two---lh: Furby, who had taught with Dr. Angle in Pasadena, was also with us for awhile. On his way home from the
Islands, Dr. Angle was a guest of Dr Hahn, and gave us two
lectures, "The Mill" and "Facial Art."
The duration of our course was 8 months, and approximately 1800 hours. In addition to the scientific studies, Dr.
Angle's courses were always accompanied by a reading list
with book reviews, and our assignments were:
Kenilworth, by Sir Walter Scott
Yosemite, byJohn Muir
The Story of My Boyhood Youth, byJohn Muir
Two Years Before the Mast, by Richard Henry Dana, Jr
Men of the Old Stone Age, by Henry Fairchild Osborn
The Life of the Bee, by Morris Maeterlinck
A Paper on a Famous Painter
The Life on Lincoln, by Lord Charnwood
Papers on Malocclusion
Orthodontia
Orthodontic History
The Line of Occlusion, by Dr Edward Angle
The Mill, by Dr. Edward Angle
At the close of our course in Berkeley, it was time for D~.
Angle to be preparing for the presentation of The Edgewise
Arch Mechanism (The Latest and the Best). ~6 Illustrations
were needed. Charles and Bruce Curran went directly from
Berkeley to Pasadena, and under Dr. Angle's supervision
produced the proper drawings. The SS White Company was to
produce the introductory pamphlet and the drawings were
sent to them, but as so often happens, there was a hassle. The
SS White Company maintained there were too many illustrations. Dr. Angle refused to give in, and he was left without
drawings for his slides. I received a telegram asking me to
come to Pasadena and create another set of illustrations,
which I accepted, and this became one of the highlights of my
life---the need was urgent and I was afforded a rare
opportunity to observe the warm and humorous side of Dr
Angle's personality that few others have been privileged to
enjoy.
Now, after all of this you might like to have answers to
your questions.
1. There was no course from Dr. Angle or his school. Our
course was held in Berkeley, during 1927 and 1928, under
Hahn, Huberty and Setz~ Duration involved 8 months,
and approximately 1800 hours. Dr. Angle gave Charles his
diploma (Fig 2) as a reward for his successful efforts in
accomplishing the State Board r e q u i r ~ t s for the practice of
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Figure 2. Tweed's diploma from the Angle school.
Orthodontia in Arizona. I believe the law was in force only
one year. It was a tremendous undertaking and Charles and
D~. Angle were together constantly.
2. Five (number" in the class)
3. Charles, my brother Ken, of San Francisco, Bruce
Curran of Cleveland, Ohio, Charles DePerteus of San
Francisco, and me.
4. Drs. Hahn, Huberty and Setz~ outlined, prepared
and conducted our course. D~. Angle gave us two lectures, but
gave us no teaching.
5. The course was g~ven in Berkeley, California.
6. The only comprehensive course available was the one
we had in Berkeley. There was no Angle course.
Unlimited gratitude should be extended to those graduates from Dr. Angle's School, Drs. Hahn, Huberty, and Setze%,
who without remuneration of any sort, and purely in the eyes
of science and devotion to our profession, contributed 11/2
days, often more, each week to assist us in our training-actually, this group is really responsible for the institution,
which through Charles, has influenced the quality of Orthodontic treatment throughout the world.
Those who have passed away:
My brother Ken
1957
Charles
1970
Bruce Curran
1976
We have never heard from Dr DePer'teus since the close of
our course in Berkeley, and he has never attended our
meetings.
Of our instructors:
Dr Setzer passed away in 1942
Dr Hahn divides his time between Monticeto and Dutch
Flat, California
Dr Huberty resides near Scottsdale, Arizona
I trust this information will serve your purpose.
Sincerely,
G.H. Terwillig~ D.D.S.
Angle and Tweed worked closely together for
the last 2 years of Angle's life. Tweed b a n d e d his
patients with an edgewise appliance and Angle
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acted as the advisor. The system worked in the
following manner: Tweed m a d e progress records
o f his patients every 4 months. H e packed the
records in a suitcase and took t h e m to Pasadena
where Angle studied t h e m and outlined a treatm e n t plan for the next 4 months. This was
repeated every 4 m o n t h s for the next 2 years.
This was a very productive time for Charlie's
education and for the evolving edgewise appliance. Angle was so pleased with Tweed's work,
that he was instrumental in making it possible
for Tweed to be invited to give lectures at several
orthodontic meetings.
In 1932, Tweed published his first article in
the Angle Orthodontist. It was titled "Reports of
Cases Treated with the Edgewise Arch Mechanism. ''7 Tweed held to Angle's firm conviction
that the practitioner must adhere to the line of
occlusion c o n c e p t and never extract teeth. This
conviction lasted for 3 years after Angle's death.
After 5 years of orthodontic practice Tweed
b e c a m e disheartened with his work for two
reasons: (1) the protrusive faces that he was
creating, and (2) the unstable dentitions. He
b e c a m e so disappointed that he almost left
orthodontics. H e resolved to study his m a n y
failures a n d his few successes by devoting each
m o r n i n g he was in his office to the making of
progress records of his patients. After studying
these records, he came to realize that the patients who had pleasing facial balance and harm o n y also had m a n d i b u l a r incisors that were
upright over basal bone. H e selected some failures, extracted first premolars, a n d retreated
them. H e reached the conclusion that carefully
p l a n n e d extractions allowed him to improve
a p p e a r a n c e and stability. Tweed wrote, "foresight caught up with hindsight," and the diagnostic facial triangle was born. 8
In 1936 Tweed presented his first extraction
papers 9,1° to, of all people, the Angle Society. If
he was expecting praise, he was sadly disappointed. " M o t h e r " Angle, the editor of the
Angle J o u r n a l and an Angle Society m e m b e r ,
refused to attend the lecture. George H a h n ,
Tweed's teacher and a leader in the Angle
Society, criticized h i m severely. Almost everyone
considered Tweed to be a traitor to the greatest
m a n orthodontics had ever known. H e was absolutely crushed by the response. H e r e t u r n e d
h o m e sadder and wiser, with a steadfast resolve to
continue his clinical research.
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Figure 3. One hundred case report display at a 1940
meeting.
H e worked h a r d e r than ever and by 1940 he
had records of 100 patients, treated first without
extractions, and then retreated with extractions.
H e put these patient records on display at an
American Association of Orthodontists (AAO)
m e e t i n g (Fig 3). Although it was a t r e m e n d o u s
exhibit, he was severely criticized. His daughter,
Alice, was to say later that the criticism was so
harsh that she p r e f e r r e d to wait outside the
lecture hall rather than e n d u r e the pain.
It was a b o u t this time that Tweed developed
one of his favorite phrases. It was fairly typical at
one of Tweed's lectures for a listener to stand up
and say that Charlie had mistreated a patient or
had unnecessarily extracted teeth. Tweed's standard response was "just put your plaster on the
table." In o t h e r words, let the t r e a t m e n t speak
for itself. Thus was b o r n one of the traditions of
the Tweed Foundation. To this day, at every
Foundation meeting each m e m b e r brings h i s / h e r
plaster and puts it on the table. Even in his
seventies, Charlie never attended a m e e t i n g
without his plaster.
Charles Tweed had detractors, but his results
were so outstanding that he attracted admirers as
well. An e x a m p l e was Dr R o b e r t Strang, who
Angle called the "Master of the Ribbon Arch,"
and who h a d the reputation o f being an excellent wire bender. H e was so impressed that he
converted his practice f r o m ribbon arch to the
new edgewise appliance.
Because of rejections by organized o r t h o d o n tics, Tweed concluded that his efforts would be
m o r e productive with a smaller group. H e decided to f o r m a study club. His first " c o u r s e " was
held as a study club meeting in 1941 (Fig 4).
Thirty-six orthodontists m e t for instruction at
the first session. T h e g r o u p elected Sam Lewis as
president. Copeland Sheldon was elected as
secretary-treasurer. In attendance at the first
m e e t i n g were R o b e r t Strang, Cecil Steiner, Bill
Downs, H e r b Margolis, Paul Lewis, and Hays
Nance. T h e same g r o u p m e t in 1942. Because of
World War II, no meetings were held in 1943,
1944, or 1945. In 1946, the g r o u p gathered
again. T h e first week of their session was devoted
to instruction for newly interested orthodontists,
and the second week to a seminar for the
original group. Hays Nance, the president, organized an exceptional meeting in 1947. Wendell
Wylie read two papers which were ably discussed
by H e r b Margolis. At this time, Hays Nance
proved himself to be a m a j o r essayist with his
p a p e r entitled, " T h e Limitations o f O r t h o d o n t i c
Treatment. ''u,a2 Tweed read two papers which
were analyzed by Robert Strang, H e r b e r t Margolis, and Wendell Wylie. It was at this meeting in
1947 that the organization p r o p o s e d the founding o f the Charles H. Tweed Foundation for
O r t h o d o n t i c Research. T h e Tweed Foundation's
yearly meetings were attended by the giants of
orthodontics in the 1950s and 1960s. Tweed's
course in Tucson flourished (Figs 5 and 6).
Students in Tweed's course b r o u g h t their
typodont and p r e p a r e d at least 12 sets of archwires for each malocclusion correction simulation. T h e technique can be basically described as
follows: (1) a maxillary .022 x .028 stabilizing
wire was b e n t to the malocclusion; (2) a mandibular working wire was b e n t and the m a n d i b u l a r
canines and anterior teeth were retracted into
the m a n d i b u l a r first p r e m o l a r extraction sites (if
the patient n e e d e d extractions, Tweed rarely
extracted any teeth o t h e r than the first p r e m o -
Figure 4. The first Tweed Study Course in 1941.
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James J. Cross
Figure 5. Early Tweed Course photo.
lars); (3) mandibular anchorage was prepared
with Class III elastics; (4) the maxillary premolars were removed, and the prepared mandibular arch was used as an anchorage unit so that
Class II elastics could be used to retract the
maxillary canines and the anterior teeth. Many
archwires were fabricated because the technique
was, at best, complicated. Still, it was the best
thing that orthodontics had ever seen. Tweed
was a master technician and was able to precisely
position the teeth to achieve his desired results
of esthetics, health, function, and stability.
Tweed, the prolific, indefatigable clinician,
teacher, lecturer, and writer 13-15lived a n o t h e r 40
years after the death of Edward Angle. T h o u g h
Tweed departed from Angle's line of occlusion
concept, he remained convinced that the efficient use of the edgewise appliance was synonymous with consistently good orthodontic treatment. Tweed's last great work, the two volume
Clinical Orthodontics, 16 is inscribed "To Dr. Edward Hartley Angle, a dynamic psychologist with
the power to mold the character of men; to his
devoted wife, Anna Hopkins (Mother) Angle,
who guided his career and bathed the wounds of
those undergoing his molding procedures; to Dr.
Figure 6. Early Tweed Course photo.
235
George W. H a h n of Berkeley, California, who
directed the Angle School during Dr. Angle's
absence in Hawaii and who more than anyone
else developed in me whatever digital skill and
love of profession I possess; and to all those
members of the Foundation that bears my name,
particularly the teaching staff, who during the
past 25 years have j o i n e d in the effort to elevate
the standards of clinical orthodontics, this book
is dedicated."
Tweed (Fig 7) popularized precision appliance adjustment. He perfected first, second, and
third o r d e r bends. H e developed the concept of
en masse anchorage preparation. T h e desire to
give the patient a balanced face and stability of
the dentition led Tweed to develop his own
unique philosophy of treatment. In summary,
Tweed's basic concepts were: (1) a deep and
abiding interest in facial esthetics; (2) carefully
planned extractions to achieve a p r e d e t e r m i n e d
objective. To arrive at the p r e d e t e r m i n e d objective, Tweed had to define the anterior limits of
the dentition. H e developed the diagnostic facial
triangle for this purpose; (3) precision appliance
adjustment; and (4) en masse anchorage preparation. Angle gave orthodontics the edgewise
bracket, but Tweed gave orthodontists a way to
Figure 7. Charles Tweed.
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Tweed Years
use it. The orthodontic world beat a path to his
d o o r in Tucson. Tweed, the innovative and
perceptive diagnostician and master clinician,
kept his promise to his mentor, Edward Angle.
He devoted all 42 years of his professional life to
the use and refinement of Angle's invention, the
edgewise appliance.
References
1. Angle EH. The malocclusion of the teeth. Philadelphia,
PA: SS White Co, 1907:21-24.
2. Personal letter from Glen Terwilliger to Jack Cross, June
30, 1977.
3. Angle EH. The Latest and Best in Orthodontic Mechanism. The Dental Cosmos, vol LXX. 1928:1143-1158.
4. Angle EH. The Latest and Best in Orthodontic Mechanism. The Dental Cosmos, vol LXXi. 1929:164-174.
5. Angle EH. The Latest and Best in Orthodontic Mechanism. The Dental Cosmos, vol LXXi. 1929:260-270.
6. Angle EH. The Latest and Best in Orthodontic Mechanism. The Dental Cosmos, vol LXXi. 1929:409-421.
7. Tweed CH. Reports of cases treated with the edgewise
arch mechanism. Angle Orthod 1932;2:236-243.
8. Tweed CH. The Frankfort-Mandibular plane angle in
orthodontic diagnosis, classification, treatment planning, and prognosis. A m J Orthod Oral Surg 1946;32:175230.
9. Tweed CH. The application of the principles of the
edgewise arch in the treatment of class II, division 1
malocclusion: Part 1. Angle Orthod 1936;6:198-206.
10. Tweed CH. The application of the principles of the
edgewise arch in the treatment of class II, division 1: Part
II. Angle Orthod 1936;8:255-257.
11. Nance HN. The limitations of orthodontic treatment. I.
Mixed dentition diagnosis and treatment. ArnJ Orthod
Oral Surg 1947;33:177-223.
12. Nance HN. The limitations of orthodontic treatment. II.
Diagnosis and treatment in the p e r m a n e n t dentition.
A m J Orthod Oral Surg 1947;33:253-301.
13. Tweed CH. Indications for the extraction of teeth in
orthodontic procedures. A m J Orthod Oral Surg 1944;30:
405-428.
14. Tweed CH. A philosophy o f orthodontic treatment. A m J
O r t h o d Oral Surg 1945;31:74-103.
15. Tweed CH. The Frankfort-Mandibular incisor angle
(FMIA) in orthodontic diagnosis, treatment planning
and prognosis. A m J O r t h o d Oral Surg 1954;24:126-169.
16. Tweed CH. Clinical Orthodontics. vols I and II. St. Louis,
MO: Mosby, 1966.