Two Phase Orthodontics
Myths and Truths about Orthodontics: Why Braces Twice?
Many of you may have noticed there has been a shift in orthodontics over the last 20 years. Away from having braces placed at 13-14 years old for around two years, to having braces in place two different times, once around 8 or 9 years old and then again at 13 years of age.
“Why twice?” is the obvious question “Don’t the Baby Teeth fall out anyway? That seems dumb to straighten Baby Teeth!” As a parent, I would agree with you. This topic is arguably the advancement in modern orthodontics that affects the largest segment of our young patents over the last quarter of a century. Without exception, every pre-teen patient evaluated at our office is considered for Two Phase Orthodontic care but only about 50% actually will need it.
The Myth: Two Phase Orthodontics involves treating the same “crooked teeth” twice.
The Truth: The Two Phases of treatment involves treating two distinctly different factors of your children’s orthodontic problem at the age best suited to alter them.
Two Phase orthodontic treatment was virtually not done twenty-seven years ago, when I first started my practice in the Denver area. In that era, I simply did not typically even see kids until they were 13 or 14 years old. At that time, orthodontic correction was done after the teeth would get as “crooked” as they were going to get, then we attempted to “retro-fix them” as best we could. So what has changed today?
Orthodontic problems are a result of perfectly healthy, completely normally formed “parts”, making up the mouth, having to all work together but mismatched to each other. Phase I treatment involves putting nature on a “better path”. It involves an enhancement of the sizes or shapes by using generally painless, slow passive, “braces-looking” appliances for usually 6-12 months. The primary emphasis in this phase is the bones. They are softer and growing more rapidly, consequently easier to change. This is then followed up a year or two later with Phase II treatment that “finishes the job”, by typically just straightening the teeth. One of the things many people are not aware of is that at our office, the total combined active treatment time of Two Phase treatment is typically that magic 2-2 ½ years in “braces” that everyone seems to be aware of. Overall, THE SAME TREATMENT TIME BUT BETTER RESULTS, in most cases. Additionally, the Second Phase of treatment to usually significantly shorter in time during those “wonderful” early teenage years; it’s a sanity factor for you.
To describe what I focus on in Phase I portion, which is adjustment of the bone involvement of the orthodontic problem. I use the analogy of a door and a doorframe. Individually, a door and a doorframe can be superbly crafted but if they are not made to match each other in size, they will never work together to latch. Orthodontic problems are much the same thing. If the teeth don’t match the size of the jaw, they won’t be straight or if the upper jaw isn’t a matching size relative to the lower jaw, the bite won’t fit. Just like trying to latch that door which does not match the frame.
In “the old days” the most common approach to achieve this was to reduce the number of teeth present, “making them all fit in”. Yes, we would pull permanent teeth. And yes, treatment results were very acceptable but the missing permanent teeth forever. Today, we can treat your children typically with NO Extraction of permanent teeth and usually, in my opinion, far superior results than ever before. Best of all, what we are really doing is naturally Enlarging the Door Frame, NOT Trimming Down the Door to Fit.
Not every child has an orthodontic problem severe enough to require Two Phase Orthodontic care, but as a Specialist in Orthodontic Dentistry, we are the most qualified and have had advance education beyond your family dentist to recognize these genetically determined mal-alignments of the mouth. We can do that best at 8 or 9 years old. If the overall correction will not be improved or involve a similar overall time and expense than can be achieved by simply waiting for all the permanent teeth, then it would be “dumb to do it twice”. The majority of kids we see at our Complimentary Initial Evaluation, we will wait. For your peace of mind, you owe it to your children to at least find out if Two Phase Treatment could benefit them.