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Two-Phase or Multi- Phase Orthodontic Treatment

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Though many orthodontic problems can wait to be corrected after all the baby teeth have fallen out, there are some orthodontic problems that are better corrected when the patient is younger, that is why The American Association of Orthodontists’ recommends that all children be screened at age 7.

 

Phase 1 treatment, is when the patient has both primary (“baby”) teeth as well as some permanent (“adult”) teeth present. Problems that can be resolved at this stage are: severe crowding, open bite, deep bite, crossbite, underbite,  narrow jaws, harmful habits, severely protruded front teeth, Missing teeth, teeth not emerging in the right sequence, and Ankylosed teeth, a condition where the tooth stops erupting and stays in the same place, causing the permanent tooth to be displaced upon emergence.

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Problems that can be solved with Phase 1 Orthodontics

Fortunately, less than 10% of children need Phase 1 and Phase 2 treatment.

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The Goal of Phase 1 Treatment:

  • Influence jaw growth in a positive manner to accommodate emerging teeth.

  • Improve the width of the dental arches, giving a better prognosis for how the permanent teeth will develop and guiding them into more favorable position.

  • Reduce the need to extract permanent teeth in the future.

  • Reduce or eliminate the need for jaw surgery due to severe underbite, overbite and crossbite.

  • Lowering the risk of damage to any protruding teeth.

  • Reduce likelihood of impacted permanent teeth.

  • Improve speech development

  • The ability to improve your child’s appearance by creating a more pleasing and functional arrangement of teeth, lips and face.

  • Increase self-esteem and confidence in your child.

 

Phase 1 treatment usually starts between the ages of 7 to 10 and ranges from 9 -15 months in duration. After this, patients wear a retainer or a holding wire to maintain teeth and jaw positioning. Your child will see the orthodontist for periodic checks to evaluate his/her jaw development and eruption progress, (typically between ages of 11 and 13), and to decide on the best time to start Phase 2 treatment.

 

The Goal of Phase 2 Treatment:

  • Move permanent teeth into their final positions

  • Continue improving teeth function and facial appearance

  • Continue to increase child’s self-esteem

 

Due to improvements made in Phase 1 treatment, Phase 2 treatment requires less patient participation (no headgear, and less rubber bands), often eliminates the extraction of permanent teeth and is typically 12-18 months long.  This is important for patients as they enter their teenage years!

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FAQ.

What is Multi-Phase or two-phase Orthodontic Treatment?

Two-Phase orthodontic treatment is a very specialized process that encompasses tooth straightening and physical facial changes by encouraging natural positive growth changes in the jaw positions.  It is limited to growing children ages 7-10 before the age when all their permanent teeth have fully erupted in their mouth.

Phase 1 Orthodontic Treatment: What is it and How can it help?

The goal of Phase-One treatment is to help the jaw develop in a way that will accommodate all of the permanent teeth and improve the way the upper and lower jaws fit together. Children often exhibit early signs of jaw problems as they grow and develop. An upper jaw that is growing too much or is too narrow can be recognized by an orthodontist at an early age. For this reason, we recommend that children be seen by an orthodontist at age 7. If children age seven or older are found to have this jaw discrepancy, they are candidates for early orthodontic treatment. Also, if children around the age of eight have crowded front teeth, early treatment can prevent the need to extract permanent teeth later.

Who is the typical candidate for Phase 1 orthodontic treatment?

Young patients whose jaws are still growing and developing, and whose permanent teeth have not yet fully come in are typical candidates for Phase 1 orthodontic treatment, if the orthodontist detects issues with tooth and jaw development that could get worse if left untreated. This is why the American Association of Orthodontics recommends, that children should be seen by an orthodontist at age 7. When teeth and jaws are still in growth stage, orthodontic treatment is much more easily accomplished and can often be less invasive than if left until all permanent teeth have erupted.

What is the advantage of two-phase orthodontic treatment?

Two-phase orthodontic treatment is a specialized process combining tooth straightening and physical, facial changes. The purpose of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional and aesthetic result that will remain stable throughout your life. Historically, oral surgery was much more common, and often orthodontic treatment lasted longer and was more aggressive. By approaching treatment in multiple phases and by starting younger, we can typically avoid surgery and be more effective achieving the ideal orthodontic result.

Does every child need two-phase orthodontic treatment?

No, Two-phase orthodontic treatment is only beneficial in children when their natural jaw structures are contributing to the overall orthodontic problem. This is why an evaluation by an orthodontist is recommended at age 7.  Typically only 10% of children need two-phase orthodontics.

What if I put off orthodontic treatment?

Putting off orthodontic treatment can result in a need for more invasive orthodontic treatment later in life that may not completely fix your smile. Early orthodontic treatment is most effective for achieving predictable, lasting results.

Why should I spend money on Phase 1 treatment when I can just have everything done at once when all of my child’s baby teeth have fallen out? 

Though many orthodontic problems can wait to be corrected when all the baby teeth have fallen out, there are some orthodontic problems that are better corrected when the patient is younger. Delaying treatment for some orthodontic problems can lead to increased difficulty in correcting the problem, less stable results, abnormal jaw growth, abnormal tooth wear, or increased risk of chipping a tooth. Some orthodontic problems that are better corrected early are: severe crowding, eruption problems, open bite, deep bite,crossbite, large, underbite, narrow jaws, harmful habits, and severely protruded front teeth.

If my child had Phase 1 treatment will additional treatment be necessary when all adult teeth erupt? 

Most of the time, additional treatment will be needed to align the newly erupted teeth and finish correcting any bite problems not fully corrected in Phase 1. This additional treatment using a full set of braces is called Phase 2.

Phase 2 Orthodontic Treatment: What is it and How it can help

The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. Phase two usually begins when all permanent teeth have erupted and it involves full upper and lower braces. Phase 2 usually requires braces on all the teeth for an average of 18 months. Retainers are worn after this phase to ensure you maintain your beautiful smile.

What happens in between Phase 1 and Phase 2? 

Depending on your child’s orthodontist, your child may need to wear retainers or a space maintainer to hold his/her treatment progress. Your child will see the orthodontist for periodic checks to evaluate his/her jaw development and eruption progress and decide on the optimal time to start Phase 2 treatment.

My child’s friends already have braces, but my orthodontist says my child is not ready for treatment yet. Why?

Just as children mature at different ages, their teeth and jaws mature at different ages. Early developers may have all of their permanent teeth erupted (except wisdom teeth) by age 9 while late bloomers may not until age 14 or later. Your orthodontist will be able to determine what stage of development your child is in, and can determine the optimal time to begin treatment.

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