Two-Phase Orthodontics: A Special Kind of Treatment
From a historical perspective, orthodontic philosophies and concepts evolved around treating the permanent dentition.
Therefore, orthodontists were taught to wait until all the permanent teeth had erupted before initiating orthodontic treatment. Many of the studies in orthodontics also evolved around these philosophies, concepts and principles. Consequently, any contributing factors to poor dental-facial growth and development were ignored, as were the ways to treat such factors.
Simply put, orthodontists became mechanics responsible for moving teeth.
As individual orthodontists, and as a profession as a whole, we need to be more proactive, interceptive and preventive. We must treat patients in such a way that they head down a good path of dental-facial growth and development. Dr. Hietanen and I feel very strongly about this and feel it will lead to more stable and nicer-looking results for our patients.
In order to reach a better understanding of what we are talking about, you need to understand some of the philosophies and concepts of early orthodontic treatment.
~Dominic A. Colarusso, Jr., DDS
Early orthodontics utilizes growth in its favor. By age four, 60% of facial growth is accomplished. By age six, 80% of this growth is complete. By age 11 (or when the second molars have erupted), 90% of facial growth is complete.
First Phase Treatment (Interceptive)
Children sometimes exhibit early signs of jaw problems as they grow and develop. An upper or lower jaw that is growing too much or not enough, or is too wide, too narrow, or crooked can be recognized at an early age. If children over four years of age have these jaw discrepancies, they are usually candidates for early orthodontic/orthopedic evaluation and treatment.
The goals of the first phase of treatment are:
- To alleviate crowding by development of both the upper and lower jaws sufficiently to
accommodate all the permanent teeth
- To correctly relate the upper and lower jaws to each other
Orthodontic appliances can be used to correct the jaw shape and direct the growth toward the ideal relationship between the upper and lower jaws. A good foundation can be established thereby providing adequate room for eruption of all the permanent teeth.
Because children are growing rapidly, they can benefit enormously from an early (interceptive) phase of orthodontic/orthopedic treatment.
Early interceptive treatment can prevent:
- Later removal of permanent teeth to correct overcrowding
- Surgical procedures to align the upper and lower jaws
Interceptive treatment can also decrease the time necessary for the second phase of treatment. Leaving malocclusions untreated until all the permanent teeth erupt could result in a jaw discrepancy too severe to allow achievement of an ideal result with braces alone.
Orthodontic/orthopedic records will be necessary to determine the diagnosis, treatment plan, type of appliances needed, duration of treatment and frequency of visits. Records consist of models of the teeth, radiographs, photographs and a clinical evaluation.
Intermediate Retention Period (Rest Phase)
During this period the remaining teeth are allowed to erupt. Retention and or tooth guidance appliances may be recommended at the end of the first phase.
Often times retainers may be used, however, only for a short period as they may interfere with the eruption of the adult teeth. In this case, it is best to allow the existing permanent teeth some freedom of movement while final eruption of the teeth takes place. A successful first phase will have created enough room for the teeth to find an adequate eruption path and prevent possible impaction and displacement problems.
It is important to understand that 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 (corrective).
Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Should this become necessary you will be consulted and a letter of recommendation will be sent to your dentist. Periodic recall appointments for observation will continue to be necessary throughout this intermediate phase.
Occasionally when a patient is treated with a two phase treatment program, the permanent teeth erupt more rapidly than anticipated. Should this occur, the parents will be advised and the patient will continue into the second phase of treatment without the removal of the orthodontic appliances.
Intermediate Retention Period (Rest Phase)
Each tooth has an exact location where it is in harmony with the cheeks, tongue, jaws, jaw joints and other teeth. When this equilibrium is established, the teeth will function together properly. With good home care and retainer wear your teeth should stay healthy, stable, comfortable, and look attractive. This is the goal of the second and corrective phase of treatment.
At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan were established. Certain types of appliances were used in the first phase, as dictated by the problem. The second phase is initiated when most of the permanent teeth have erupted, and usually requires braces on all the teeth. The duration of treatment will be dependent upon the success in phase one. Retainers will be worn following this phase to maintain the teeth in their new positions.