There are certain orthodontic and bone disharmonies that benefit from early treatment procedures. These are: skeletal and growth disharmonies, non-extraction correction of cases with borderline crowding, restoring lost space in the dental arches, severe esthetic problems, and functional problems such as Mandibular displacements, cross bites, or severe deep-bites. Treatment of these problems at early ages can produce benefits that would be more limited if treated at a later time. Such treatment usually requires a two phase program.
A typical two phase treatment consists of a first phase of approximately twelve to eighteen months of active orthodontics in the mixed dentition (permanent and baby teeth are present). This is followed by a year or two in retainers while the permanent teeth erupt (and possibly a headgear at night). The second and final phase of active orthodontic treatment follows the intermediate retention period and takes approximately one to one half years. It should be emphasized that the ultimate success of the early phase treatment depends to a great extent upon patient cooperation in wearing the prescribed appliances, such as a headgear or elastics.
As is the case for a single phase treatment program, the total active treatment time for two phases is approximately two to three years. However, a two phase treatment program has been split into two time periods, with each period being the best time to correct the specific problems of concern. The patient's skeletal problem, borderline crowding, and formative problems are most effectively dealt with at an early age in the first phase of treatment. The extremely important final dental and bite refinements are most effectively achieved in the later second phase of treatment. The diagram below illustrates the timing of the treatment sequence.
First Phase Active Treatment 1-1½ Years
Mixed Dentition (Permanent and Baby Teeth)
Correction of Crowding, Functional, Formative and Skeletal Problems
Intermediate Period 1-1½ Years
(Waiting for eruption)
Maintenance of tooth alignment while allowing growth to continue
Second Phase Active Treatment 1-1½ years
Full Permanent Dentition
Final Correction of Tooth Position, Functional and Skeletal Problems
Occasionally, when a patient is being treated with a two phase treatment program, the permanent teeth erupt more rapidly than anticipated. If this situation should occur, the parents will be advised at a second consultation, and the patient will continue directly into the second phase of treatment without removing the orthodontic appliance.
Although the two phase treatment program does require more complex and involved orthodontic services, we have been able to maintain the ultimate costs at little, if any, more than the costs of a single phase treatment program.
To summarize, we will use a two phase treatment program, when it is required, because of what we are able to accomplish in altering the jaw structure and oral environment. This early approach to treatment allows correction of a skeletal problem as a child is growing, which is the preferred method of treatment for the correction of the previously mentioned types of orthodontic problems.