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2-PHASE
ORTHODONTIC
TREATMENT
by David M. Muench, DDS
This is a companion article to
another titled “The Benefits of Early
Orthodontic Treatment,” which
explains why your child should
have their fir st orthodontic
examination at age 7.
The goal of this report is to
help you understand how children
with serious orthodontic problems
can benefit from early intervention.
Hopefully, this information will
assist you in making the best choice
for your child. This report will
explain what early orthodontic
treatment is all about, how it can
help your child, and what you need
to know about their future
treatment needs, like when they
reach their teens.
recommends an initial orthodontic
evaluation by age 7. From an
orthodontic standpoint, this is the
best time to diagnose problems with
the alignment of the jaws and teeth
which could potentially result in
harmful bite problems later.
In our office, only 1 in 10
children need early treatment. The
other 90% can safely wait until all of
their permanent teeth have erupted
prior to initiating orthodontic
treatment. But, for the 10% with the
type of severe problems listed below,
a period of early orthodontic
intervention is followed by full
braces treatment during their teens.
That means your child’s problem
will involve two separate phases of
treatment with braces or appliances.
Each phase is usually separated by a
“ re s t p e r i o d , ” d u r i n g wh i ch
additional growth and development
are monitored. If you are reading
this report, your child may benefit
from 2-Phase Orthodontic
Treatment. Allow me to explain this
in greater detail.
P ROBLEMS T HAT B ENEFIT
F ROM
2-PHASE
ORTHODONTIC TREATMENT
wding
#1 Severe Cro
F i r s t a n d f o r e m o s t ,
congratulations for bringing your
child for their first orthodontic
evaluation. You have taken an
important first step in helping your
child achieve a health bite and
beautiful smile.
Age seven is when your child’s
upper and lower permanent front
teeth are developing. These teeth set
the stage for future jaw position and
serious problems can develop if they
come into the wrong position.
T hat’s why the American
Association of Orthodontists
1.Large overbites - deep bite
2.Underbites
3.Protruding front teeth
4.Crossbites
5.T humb/finger sucking
habits
6.Severe crowding
7.Severe spacing
PHASE I - EARLY TREATMENT
Phase I, or early treatment,
typically happens between ages 8
and 9. The goal of Phase I is to
lessen the severity of the types of
problems listed. Note the emphasis
on lessen. Phase I treatment does
not completely cure all conditions
your child may have, but it will
definitely lessen the severity of
certain problems, which in turn will
m a k e f u t u re t re at m e n t l e s s
complicated, less painful, faster,
and less expensive.
#2 Protrusion
A common example would be a
child with severe crowding. Photo
#1 shows a teenaged girl with
severe crowding. Sadly, she will
need to have several permanent teeth
removed to enable proper
alignment and correction of her
bite. Early treatment could have
prevented this.
C h i l d r e n w i t h fl a r e d o r
protruding upper front teeth (photo
#2) often suffer low self-esteem as
they are mercilessly teased at
school. They are also at high risk
for tooth trauma since the teeth
stick out too far. Early intervention
can dramatically improve their
social development and selfconfidence, not to mention,
protecting their protruding teeth
from irreversible damage.
Children sometimes exhibit
early signs of jaw growth problems,
like large overbites or underbites
(#3). Overbite problems are
usually due to underdevelopment
of the lower jaw, while underbites
are usually due to overgrowth of
the lower jaw. Orthodontic
appliances can be used to correct
problems with jaw shape and size
and direct growth toward a
healthier bite.
#3 Underbite
permanent
teeth.
A
successful first
phase will
h a v e
eliminated
any serious
threat to a
healthy smile
and proper
bite and will
have set the
stage for
m o r e
normal
development.
Thumb suckers usually develop an
open bite where the front teeth
can’t touch. Not only is chewing
difficult, but tongue thrusting and
speech problems typically
accompany this problem.
A crossbite is when the top
teeth fit inside the bottom teeth.
Since the teeth don’t fit together
properly, the child shifts their jaw to
the side, as seen in Photo #4. The
resulting jaw asymmetry can
become permanent if not corrected
when the child is still growing.
Phase I Treatment can:
1. prevent the need to remove
healthy permanent teeth to correct
crowding.
2. reduce protruding upper front
teeth and avoid possible damage.
3. prevent jaw surgery to align
the upper and lower jaws.
Leaving a serious problem untreated
until all of the permanent teeth erupt is
risky and could result in far more painful
and costly treatment later.
BETWEEN PHASES REST PERIOD
Once all treatment objectives
have been accomplished in Phase I,
braces or appliances are removed,
and the child is given retainers. This
marks the beginning of the Between
Phases rest period, during which the
remaining baby teeth shed, and the
adult teeth erupt. Retainers are
designed to allow eruption of the
It is important to understand that at the
end of the first phase of treatment, the
permanent teeth are not in their final
positions, and the final adult bite has not
been established. This will be accomplished
in the second phase of treatment.
A DVANTAGES OF T WO -P HASE
ORTHODONTIC TREATMENT
Two-phase 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 major
advantage of two-phase treatment
is to maximize the opportunity to
accomplish the ideal healthy,
functional, aesthetic, and
comfortable result that will remain
stable for life.
The disadvantage of avoiding
early treatment is the possibility of
a compromised result that may not
be functionally healthy or stable
and may require preventable adult
tooth extraction or jaw surgery
later.
Periodic observation
appointments will continue to be
necessary throughout the Between
Phases Period, usually about once
every four to six months.
PHASE II - TEEN TREATMENT
Since each tooth has an exact
location in the mouth where it is in
harmony with the cheeks, tongue,
jaw joints and other teeth, Phase II
is not initiated until after all the
permanent teeth have erupted.
Stated another way, the goal in
Phase II is to finish what was
started in Phase I, and to establish
your child’s final adult bite and
beautiful smile that will last a
lifetime. This is the only way to
ensure a stable lifelong result. Once
the teeth are perfectly aligned, and
the bite has been completely
corrected, retainers are worn to
hold the teeth in their final
corrected positions. With good
home care and faithful retainer
wear, an attractive smile can be
preserved for many years. This is
the goal of the second and final
phase of treatment.
#4 Crossbite
I hope this report has helped
you better understand the benefits
of early orthodontic treatment for
your child. There may be other
things you are wondering about. If
so, don’t hesitate to ask me.
ABOUT THE AUTHOR
Dr.
Muench
is
SecretaryTreasurer of the New York State
Society of Orthodontists, and
Treasurer of the Broome County
Dental Society. He is a former
Assistant Professor in the
Departments of Orthodontics
and Pediatric Dentistry at the
University of Rochester Eastman
Institute of Oral Health. A
published author and lecturer,
Dr. Muench maintains a private
practice in Vestal, NY.