Two-Phase Treatment

What is the advantage of two-phase orthodontic treatment?

Two-phase orthodontic treatment is often recommended for children between the ages of 7 and 10 when there is some disruption in normal tooth eruption or jaw development. The first phase of treatment is considered “early” or “interventional” treatment and is designed to correct the disturbance and re-position the teeth for normal growth and development. This phase of treatment often corrects narrowness of the upper jaw, transitional crowding of the front teeth, functional shifting of the jaw, and habits like tongue thrusting or finger sucking. The American Association of Orthodontists recommends all children have an orthodontic screening around age 7. However, early (phase I) treatment is only recommended in about 5-10% of the patients we evaluate at this age. In most cases, growth and development is seen as normal and no intervention is required.

What if I put off treatment?

Early treatment is interventional. It allows the permanent teeth to erupt into their best natural position and restores the normal developmental relationships of the teeth. The eruption of each tooth is affected by those around it, so proper positioning of the teeth during early development serves as the foundation for normal growth. Early treatment (phase I) often reduces the difficulty of comprehensive treatment (phase II) and helps make optimal treatment outcomes more achievable. However, some developmental problems, like functional shifts of the jaw, open bite tendencies, and under-bites, actually have a strong negative impact on facial growth. Early intervention for these developmental problems can have a significant impact on your child’s facial development and appearance.

First Phase Treatment: Your foundation for a lifetime of beautiful teeth

The goal of early treatment is to develop the jaw size in order to accommodate all the permanent teeth and to relate the upper and lower jaws to each other. Ideal facial esthetics and orthodontic positioning of the teeth depend on balance between the upper and lower jaws. Children sometimes exhibit early signs of jaw problems as they grow and develop.

Planning now can save your smile later

Some (phase I) treatments are aimed at reducing the discrepancy between the jaw positions and allow improved outcomes during comprehensive treatment (phase II). An upper and lower jaw that is growing too much or not enough can be recognized at an early age. If children after age 6 are found to have a jaw size discrepancy, they are candidates for early orthodontic treatment. This early correction may prevent later removal of permanent teeth to correct overcrowding and/or surgical procedures to align the upper and lower jaws. Leaving such a condition untreated until all permanent teeth erupt could result in a jaw discrepancy too severe to achieve an ideal result with braces.

Resting Period

After the first phase of treatment, a normal developmental relationship has been achieved and the remaining permanent teeth are allowed to erupt. Retainers are sometimes recommended to preserve the space and position achieved during the first phase of treatment. It is best to allow the existing permanent teeth some freedom of movement while final eruption of teeth occurs. Natural eruption with sufficient space allows the best positioning of the teeth to take place. A successful first phase will have improved the appearance of the teeth and created an unobstructed path for all of the teeth to erupt into the mouth.

Monitoring your teeth's progress

At the end of most interventional treatments, only some of the permanent teeth have grown into place. In other words, all of the teeth are not in their final positions. It is necessary to wait until all of the permanent teeth have erupted into position before the bite and final alignment of the teeth can be evaluated. Occasionally, primary teeth (baby teeth) do not fall out on their own. When this occurs, permanent teeth may become impacted or severely displaced. Both increase the time, difficulty, and expense of orthodontic treatment. Therefore, periodic appointments to evaluate the growth and eruption of the teeth during this resting phase are in the patient’s best interest. Occasionally, selective removal of “over-retained” primary (baby) teeth is necessary to allow normal growth and eruption.

Second Phase Treatment: Stay healthy and look attractive

Final alignment of the teeth and bite correction are the goals of the second phase of treatment. We strive to create harmony between the lips, cheeks, tongue, and other teeth. Bite correction is important for several reasons: 1) Ideal positioning of the bite helps prevent accelerated tooth wear from functional interferences; 2) Ideal positioning of the bite reinforces the final positing of the teeth created during orthodontic treatment. What does this mean to you? Your teeth are more likely to remain healthy and straight throughout your life if you properly correct the way the teeth fit together and function.  

Movement & Retention

It takes a lot of work and effort on everyone’s behalf to achieve a beautiful smile. A great smile is valuable and should be enjoyed for a lifetime. Nobody wants to see their teeth move or shift after treatment. However, throughout our lives, our teeth are programmed to achieve two goals: 1) teeth continue to erupt toward the opposing dental arch until they hit something; and 2) teeth move toward a position where forces are equally distributed among the teeth. As we age and our teeth and jaw joints wear, our teeth move to adjust to those changes. As a result, teeth can move at any age. In an ideal bite, both of those goals are met by all of the teeth, and so the teeth are happy where they live and are less likely to move over time. What does this mean to you! Bite correction and retainer wear are important! The more ideal your bite correction, the less likely your teeth are to shift and move over time. Uncorrected bites may require daily use of retainers indefinitely to prevent tooth movement from occurring after treatment. People with unstable bites or a high likelihood of relapse are good candidates for fixed bonded retainers. Bonded retainers are always in place and serve as insurance against unwanted tooth movement. There are some contraindications for bonded retainers, however, with proper care and maintenance, a bonded retainer can provide many years of worry free retention.