Two Phase Treatment
What is two-phase orthodontic treatment?
Two-phase orthodontic treatment is a very specialized process that encompasses tooth straightening and physical, facial changes by encouraging natural positive growth changes in the jaw positions. Its use is limited to growing children prior to the age when all their permanent teeth have fully erupted into their mouth.
Why two phases?
Two phases or two step treatment is a pre-planned treatment approach in the overall comprehensive correction of a child’s orthodontic therapy. Given the fact that most orthodontic problems are a result of a genetic mismatch of sizes and shapes of perfectly normal and health natural structures of the mouth, the jaws themselves are just as much of a contributing factor as the teeth. Two-phase treatment is designed to specifically break the overall treatment into two age-dependent steps geared to correct the “contributing factors” at ages when they are each more effectively corrected. Depending on jaw sizes and shapes, two phase treatment can assist with a more favorable grow pattern at a younger age, when growth is much more active (Phase one - ages 7 to 11), than later when the actual complete straightening of all the permanent teeth complete their eruption (Phase two - ages 12-14).
What is the advantage of two-phase orthodontic treatment?
The major advantage of a two-phase treatment is to maximize the opportunity to correct the two general factors contributing to an orthodontic problem at ages when they are best and more easily corrected. This usually results in more comfort for the child during the treatment process as well as shorter treatment times and generally a more naturally stable end result throughout your life.
What if I put off treatment?
The disadvantage of waiting for complete eruption of permanent teeth is that the orthodontist may have limitation on the degree of jaw corrections that can be made, if needed, due simply to the reduced growth potential remaining at the beginning to the comprehensive treatment, as oppose to an earlier age.
Does every child need two-phase orthodontic treatment?
No, two-phase orthodontic treatment is only beneficial in children when their natural jaw structures are contributing to the overall orthodontic problem. This is why an initial evaluation by an orthodontist is recommended at 7 years old. The specialized training of an orthodontist can determine this and advise you on your treatment options. Many times the recommendation is to simply wait for the permanent teeth because two-phase orthodontic treatment is not necessary or of limited benefits.
First Phase Treatment: Your foundation for a lifetime of beautiful teeth
The goal of first phase treatment is to develop the jaw size in order to accommodate all the permanent teeth and to relate the upper and lower jaws to each other. Children sometimes exhibit early signs of jaw problems as they grow and develop. An upper and lower jaw that is growing too much or not enough can be recognized at an early age. If children after age 6 are found to have this jaw discrepancy, they are candidates for early orthodontic treatment.
Planning now can save your smile later
Because they are growing rapidly, children can benefit enormously from an early phase of orthodontic treatment utilizing appliances that direct the growth relationship of the upper and lower jaws. Thus, a good foundation can be established, providing adequate room for eruption of all permanent teeth. This early correction may prevent later removal of permanent teeth to correct overcrowding and/or surgical procedures to align the upper and lower jaws. Leaving such a condition untreated until all permanent teeth erupt could result in a jaw discrepancy too severe to achieve an ideal result with braces.
Your unique treatment
Dr. Hamersky, with the aid of the diagnostic records taken, will determine the type of appliances to be used, the duration of treatment time, and the frequency of your visits. Particular attention is paid to ultimate final result. Not all facets of the orthodontic problem can be corrected in this phase of treatment, but the goal is “putting Nature on a Better Path” while the remaining dental development occurs.
This is the time between the two phases of active treatment; the remaining permanent teeth are allowed to erupt. Retaining devices are not usually recommended since they may interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement while final eruption of teeth occurs. A successful first phase will have created room for teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.
Monitoring your teeth’s progress
During this Rest Period, all the permanent teeth are not fully erupted or in their final positions. This will be accomplished in the second phase of treatment. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.
Second Phase Treatment: Stay healthy and look attractive
The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly.
Movement & Retention
At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan established. Certain types of appliances were used in the first phase, as dictated by the problem. The second phase is initiated when all permanent teeth have erupted, and usually requires braces on all the teeth. Retainers are worn after this phase, just like they are in comprehensive full treatment which is started at later ages or in adults. Retainers are a integral part of all post-orthodontic treatment of any kind to maintain and ensure you retain your beautiful smile.
Dr Hamersky has written a more extensive article on Two Phase Treatment — Why Braces Twice?.