A Special Kind of Dentofacial Orthodontic/Orthopedic Treatment
FIRST-PHASE TREATMENT (INTERCEPTIVE)
The goals of the first phase of treatment are:
- To develop both the upper and the lower jaws sufficiently to accommodate all of the permanent teeth.
- To correctly relate the upper and lower jaws to each other.
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, or is too wide, too narrow, or crooked can be recognized at an early age. If children over four years of age have these jaw discrepancies, they are usually candidates for early orthodontic/orthopedic evaluation and treatment.
Because children are growing rapidly, they can benefit enormously for an early (interceptive) phase of orthodontic/orthopedic treatment. Orthodontic appliances can be used to correct the jaw shape and direct the growth toward an ideal relationship between the upper and lower jaws. A good foundation can be established, thereby providing adequate room for eruption of all permanent teeth.
Early interceptive treatment can prevent:
- The later removal of permanent teeth to correct overcrowding
- Surgical procedures to align the upper and lower jaws
Interceptive treatment can also decrease the time necessary for the second phase of treatment. Leaving a maloclussion untreated until all of the permanent teeth erupt could result in a jaw discrepancy too severe to allow achievement of an ideal result with braces alone.
Orthodontic/orthopedic records will be necessary to determine the diagnosis, treatment plan, type of appliance needed, duration of the treatment, and frequency of visits. Records consist of models of the teeth, radiographs, photographs, and clinical evaluation.
INTERMEDIATE RETENTION PERIOD
During this period the remaining permanent teeth are allowed to erupt. Retention and/or tooth guidance appliances may be recommended at the end of the first phase.
Oftentimes retainers may be used, however, usually for only a short period, as they may interfere with the eruption of the adult teeth. In this case, it is best to allow existing permanent teeth some freedom of movement while final eruption of teeth takes place. A successful first phase will have created enough room for the teeth to find an adequate eruption path and prevent possible problems.
It is important to understand that at the end of the first phase of treatment, teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment (corrective).
Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Should this be necessary, you will be consulted and a letter of recommendation will be sent to your dentist. Periodic recall appointments for observation will continue to be necessary throughout this intermediate phase on a four to six month basis.
Occasionally, when a patient is treated with two-phase treatment, the permanent teeth erupt more rapidly than anticipated. Should this occur, the parents will be advised and the patient will continue directly into the second phase of treatment without removal of the orthodontic appliances.
SECOND PHASE TREATMENT (CORRECTIVE)
Each tooth has an exact location in the mouth where it is in harmony with the cheeks, tongue, jaws, jaw joints, and other teeth. When this equilibrium is established, the teeth will function together properly. With good home care and retainer wear, your teeth should stay healthy, stable, comfortable, and look attractive. This is the goal of the second and corrective phase of treatment.
At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan were established. Certain types of appliances were used in the first phase, as dictated by the problem. The second phase is indicated when most of the permanent teeth have erupted, and usually requires braces on all of the teeth for approximately 12-24 months. Retainers are worn after this phase to hold the teeth in their new, corrected position.
The two-phase orthodontic/orthopedic treatment is a very specialized process that encompasses jaw and facial changes (orthopedics) and tooth straightening (orthodontics). The emphasis today on living longer, staying healthy, and looking attractive requires optimum treatment results. The advantage of two-phase treatment is to maximize the opportunity to accomplish the ideal, healthy, functional, aesthetic, and comfortable result that will remain stable.
The disadvantage of waiting for complete eruption of the permanent teeth and having only one phase of treatment is the possibility of a compromised result that may not be functionally healthy or stable, and may require preventable adult tooth extractions or jaw surgery.
We certainly hope this synopsis has helped you to understand our "two-phase" philosophy. Please do not hesitate to ask us any questions that may assist you in understanding our treatment concepts.
As a side note, Dr. Feldman and his assistant, Ellen, produced the "Two-Phase" brochure, which outlines this treatment modality in 1993, and it is currently the only brochure available. It is widely used by orthodontists and pediatric dental colleagues around the world. Almost one million have been produced.