Two-Phase Treatment
What is the advantage of two-phase orthodontic treatment?
Children with orthodontic problems that can be expected to worsen with time often benefit from early treatment. Harmful habits like thumb-sucking and mouth breathing that interfere with normal jaw growth can be addressed before too much harm has occurred. Early treatment can make room for blocked-out permanent teeth to come in and guide the erupting teeth into better positions, improve facial growth and alignment of the jaws, and reduce the risk of fracture of protruding front teeth.What if I put off treatment?
Most orthodontic problems get worse with time. You do not outgrow them. Putting off treatment until all of the permanent teeth come in may result in more crowding and impacted teeth, a more severe protrusion and deep overbite, and asymmetrical jaw growth. If the teeth are late coming in, the opportunity to treat the bite while the jaws are still growing is lost. Waiting until the teeth are as crooked as they can get means there is a lot of catching up to do. Leaving such conditions untreated until all permanent teeth erupt could result in a jaw discrepancy too severe to achieve an ideal result with braces. Permanent teeth may have to be extracted and the patient may be faced with the choice between camouflage treatment and a compromised result or jaw surgery. And treatment is prolonged into the high school years. We like our two-phase patients to finish treatment without extractions and before high school.
Phase I Treatment: A pro-active approach to get ahead of orthodontic problems.
Dr. Neely screens patients for orthodontic problems at age 7, or earlier if the problem is severe. When the six year molars and the permanent front teeth have come in, you can diagnose the bite and predict future problems.
A comprehensive early treatment protocol consists of appliances in both jaws for twelve to fifteen months. It is designed to address each item on the problem list in a significant way, so that subsequent growth is better and the teeth come in straighter that they otherwise would have.
Observation visits between phases:
In this phase, the remaining permanent teeth are allowed to erupt and growth and development is monitored. The lower molar bands and a space maintaining arch inside the lower teeth are all that remain of the Phase I appliances. Other retaining devices are not usually recommended since they may interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement while final eruption of teeth occurs. A successful first phase will have created room for teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.
In other words, at the end of the first phase of treatment, teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment. Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.
Phase II Treatment: Full braces or InvisalignTeen®
While Phase I treatment may have created enough space for all the teeth to erupt, many primary teeth remain and the permanent teeth are not in their final positions. Individual teeth have their own inherited angulations and rotations, particularly the canine teeth. If there is a growth discrepancy between the jaws, it will continue to manifest itself as the patient grows.
Phase II treatment can begin when most of the permanent teeth have erupted, usually age 10:6 in girls and 11:6 in boys. It is important to have treatment take place during the adolescent growth spurt, so that the maximum opportunity to influence growth is not lost. Phase II finishes perfecting the tooth alignment and addresses remaining jaw growth problems. The goal is to create an ideal smile in harmony with the patient's face, a healthy bite, and a stable result.
Phase II is usually competed with clear, silver, or gold braces bonded to all of the permanent teeth, but many patients also qualify for InvisalignTeen®. Whichever treatment you choose, retainers must be worn to protect the result until growth is complete and over the long term.
The jaws have the potential to grow for as long as the patient is getting taller. A few patients with severe inherited jaw growth problems may need additional treatment when jaw growth is complete at age sixteen in girls and eighteen in boys.
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