Early treatment or first and second phase orthodontics (multiphase) so frequently is the issue that seems to separate orthodontists today and confuses so many parents trying to do what’s best for their child. The art and science of orthodontic treatment have come along way in the last 25 years. Today, more than ever, we are working to validate our practice with the best information available.
Early treatment involves putting braces, or removable devices of some form, on a child’s teeth when there are still 10 or 12 baby teeth. Whenever this is done, it is effectively inevitable that a second round of braces will be necessary when all the permanent teeth grow in. Even when the process is fully explained in advance, all too often parents are surprised to learn that a second phase is necessary !
There is good research into the area of multiphase orthodontic therapy. Research shows that routine early expansion for alignment is effective, but it does not accomplish more than what could be done more efficiently in one comprehensive treatment. Early expansion for a crossbite that is extreme, causes the jaw to shift out of place, or damages the gum support around a tooth is worthwhile. In a handful of extreme situations a child may benefit from reducing the magnitude of the problem, such as extreme crowding, overbite, or underbite.
Early treatment for overbites is conclusively not beneficial over one comprehensive treatment. Three studies comprise the gold standard for what we know about early treatment for over bite. All the studies concluded the same thing – nothing is gained. (Study 1, Study 2, Study 3)
Treatment for underbite can be effective, but not always sufficient and the treatment time is routinely protracted. There is accumulating evidence that shows early treatment (age 11) for under bite using bone anchors can dramatically improvment facial, skeletal and bite problems in children with significant developing underbites.
Using the best research and clinical experience we thoughtfully integrate multiphase orthodontics into our treatment protocol. Let me explain what the issues are so it is clearer for you. Every orthodontist tends to fall somewhere on this philosophical spectrum, so every parent needs to grasp the issue to help them understand what’s best.
Old school orthodontics (pre-1980) frequently required the removal of as many as eight permanent teeth to remedy a crowded mouth or to solve bite discrepancies following standards for tooth position that rarely considered facial and smile aesthetics or the changes that occur with maturation. Treatment took place when the permanent teeth were all erupted.
The paradigm of the 1980’s, still used frequently today, more often than not utilizes two distinct phases of treatment. The first phase is used to expand the dental arches and align the front teeth, followed by a long interval with removable retainers. A second phase of full braces is obligatory when all the teeth are present. The second phase frequently takes as long as if no previous treatment had occurred, despite what many advocates of this approach profess. With this approach you spend lots of time in braces, have more expense, more time at the orthodontist, lost and broken retainers, and a result that can be achieved with a lot less hassle for everyone.
In the new millennium we much more clearly understand that there is a limited place for multiphase treatment (see Timing brochure). Most problems, by far, are corrected more effectively and efficiently in one comprehensive round of braces. Nevertheless, a handful of problems really can be improved or eliminated with early treatment. There are few problematic situations that merit early intervention. Also, some parents may still choose early treatment for their child even when less intervention will still yield the same result. We feel a parent should understand the costs and benefits of early treatment to be fully informed before accepting the greater commitment.
The goal of First Phase Treatment is to develop the child’s jaw size to make room for the future eruption of permanent teeth and to improve the relationship of the upper and lower jaws. 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 may benefit from early orthodontic treatment. Leaving some conditions untreated until all permanent teeth erupt could result in an imbalance too severe to achieve an ideal result with braces.
When we utilize a First Phase Treatment we retain the correction with retainers that are bonded to the teeth and don’t interfere with the developing new permanent teeth. Rarely, do these retainers need repair and they are never lost – a benefit you won’t even be aware of. Starting at age ten, children lose twelve primary (baby) teeth and, for most kids, by age twelve or thirteen they gain sixteen permanent teeth. During this period of observation only an annual check up is necessary to check the retainers and, more importantly, to monitor the loss of baby teeth and the development of the permanent teeth.
The goal of Second Phase Treatment is to position all the permanent teeth to maximize their appearance and function. This is best accomplished by placing braces on all the upper and lower teeth. The rationale for using two phases of treatment is to:
- influence jaw growth in a positive manner
- resolve problematic cross bites
- reduce or eliminate the need for jaw surgery
- lower the risk of trauma to protruded front teeth
- improve aesthetics and self-esteem
- reduce likelihood of impacted permanent teeth
- guide permanent teeth into more favorable positions
- improve lip closure
- preserve or gain space for erupting teeth