Two Phases of Orthodontics
A Special Kind of Treatment
FIRST PHASE TREATMENT:
Arch development for crowding
Jaw and bite alignment
The goal of first phase treatment is to develop the jaw size
to accommodate all the permanent teeth and to align the upper
and lower jaws to each other. Crowding and imbalances in jaw
growth, which can result in bite problems, can be recognized
at a very young age. The reason for early treatment is to
try and utilize and redirect the growth of the bone that supports
the teeth and to guide a wider eruption of the primary teeth.
By starting treatment in a very young child, there is more
available growth to do this kind of treatment, a greater adaptation
and change to achieve better treatment results and to improve
the long-term stability of the tooth alignment.
In a patient who has a bite problem, it is frequently a result
of an imbalance of how the upper and lower jaws are growing
to each other. For this reason, to achieve a balanced alignment
of the jaw bones, we attempt to redirect the growth of either
one or both jaws. Once again, the earlier we treat, the greater
amount of changes we can affect. By starting early, we can
achieve a better facial balance by utilizing the growth that
is available. This improved facial balance is not always achievable
by waiting to treat in the pre-teen or early teen years. The
vast majority of facial form has already been set and established
by this age. It is also true that misaligned bites usually
get worse with growth. This makes the treatment more difficult,
as well as longer if we wait to treat in the teenage years.
In the first phase of treatment, we do arch development,
which increases the space available for the permanent teeth.
This is accomplished by redirecting the eruption of the baby
as well as the permanent teeth that are present. The permanent
teeth follow the primary teeth into the mouth in a wider position.
This establishes more width to the supporting bone and provides
more space for the larger permanent teeth.
It is our clinical experience that most patients look better
with all of their permanent teeth in their mouth. So, if we
are able to take a crowded situation and do this expansion
and treat a youngster without removing permanent teeth, not
only are we saving some good healthy teeth, but also providing
a greater amount of lip support. This lip support will improve
the facial balance with the other areas of the face (i.e.
the nose and chin point) that continue to develop and change
in the teenage years (as well as throughout our lives).
GROWTH OBSERVATION PERIOD:
Following the early interceptive treatment that we propose
for your youngster, there will be a period that we call the
“Growth Observation Period.” During this time,
we will monitor the continued facial growth, as well as the
eruption of the teeth. Usually, this period is done without
orthodontic appliances because retention tends to restrict
the eruption and natural adjustments necessary for the bite
to settle to a proper fit.
SECOND PHASE TREATMENT:
Full braces
Two-phase orthodontic treatment is a very specialized process
that encompasses tooth straightening, physical changes and
facial changes. The emphasis of the second phase of treatment
is to try and achieve the most ideal occlusion possible both
from a cosmetic, as well as a functional, standpoint. We are
trying to place each tooth in its most ideal location in the
mouth where it is in harmony with the lips, tongue and adjacent
teeth. We must also consider at this time the gum and bone
support. Although the second phase of treatment is dictated
by the problem that is present when the adult teeth erupt,
we find most youngsters who cooperated during the first phase
of treatment are treated in full braces for 12-14 months.
Because of the improvements that were accomplished in the
first phase of treatment, this treatment time represents a
drastic decrease from the usual 2-3 years in full braces.
The changes made during the first phase also decrease or eliminate
the need for appliances that require cooperation, like headgear,
during the second phase of treatment. This obviously means
the full braces phase of treatment is easier on the “patient”
and “parents.” Because we have a relatively simple
problem requiring less patient cooperation in the second phase
of treatment, we are not having to deal with extended treatments
well beyond the normal treatment time due to a lack of cooperation.
We feel very strongly that two-phase treatment maximizes the
opportunity to achieve an ideal functional and aesthetic orthodontic
result.
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