What Is Two Phased Orthodontic Treatment?

An Ounce Of Prevention Is Worth A Pound Of Cure.

Some significant orthodontic conditions such as severe dental crowding, impacting teeth (especially upper canines), and significant dentofacial skeletal discrepancies (such as underbites) are better treated early, around age 7, than waiting until age 12 or later. Intercepting these orthodontic problems early is akin to “an ounce of prevention is worth a pound of cure.”

Figure 1. Patient At 8 Years Of Age Before Early Interceptive Treatment With A Severe Underbite And Crossbite. Actual Patient Of Dr. Edgren

Children who need early treatment generally need “regular braces” in a second phase, but many times the extraction of baby and permanent teeth, and possible jaw surgery, are significantly reduced if not eliminated, when treated early.
Therefore, additional treatment later is not “re-treatment” but following the initial treatment plan. Remember, in medicine for example, there may be a “series” of surgeries/procedures to correct a problem. It is no different in orthodontics.

By the age of 7, 75% of a child’s total skeletal facial growth has been achieved; by age 12, 90% of facial development is complete. The large majority of females are finished with growth before the age of 15. Why is this important? Because, if you want to orthopedically, or naturally, correct significant facial skeletal discrepancies or severe crowding, the more potential growth available to the orthodontist, the better the chance that remaining growth can be modified and improved. Waiting until after the age of 12, when next to 90% or more of a dentofacial deformity has already been established, before instituting appropriate early orthodontic treatment, is not consistent with preventative philosophy. Both vertical and horizontal facial discrepancies are linked to growth; that said, early interceptive (Phase I) treatment should be initiated closer to age 7 than waiting until the problem becomes more severe, and therefore more difficult to correct.

Figure 2. Same Patient After Final Treatment. Actual Patient Of Dr. Edgren

After eruption of the 6 year molars, the width of the upper jaw changes little with future growth. As I stated in the March issue of BOG, over 66% of young patients experiencing significant dental crowding have a narrow upper jaw. Expansion is much easier the younger the patient. After expansion, there is more bone for the permanent teeth to erupt into; reducing alveolar bone level problems in adulthood.
Crossbites of the molars and the incisors should be corrected as soon as they start to develop. Patients exhibiting crossbites do not grow out of them, they only worsen with time.
Consequently, children with underbites should be addressed when first noticed to reduce the possibility of corrective jaw surgery in the future. Why? Because the lower jaw continues to grow forward more over time than the upper jaw, particularly in patients with strong lower jaws.

Two phased orthodontic treatment is a valuable tool in treating severe dental and facial skeletal problems providing patients with a lifetime of beautiful smiles.

Bradford N. Edgren DDS, MS, FACD, Diplomate, American Board of Orthodontics, 3400 W. 16th St. Bldg 4-V, Greeley.