Two-phase orthodontic treatment is a very specialized process to address specific concerns that if left untreated until all the permanent teeth are present would not provide the best long term result for the orthodontic patient. Phase 1 orthodontic treatment is initiated before all the permanent teeth are present. Some indications for this interceptive treatment are crossbites, openbites, crowding with lack of space for permanent tooth eruption, traumatic bites causing excessive wear on teeth, protrusive incisors with concern for fracture and for significant upper and lower jaw disharmony.
Not all children need a Two-Phase orthodontic treatment approach. However, when indicated, it can provide tremendous advantages in establishing a good foundation and adequate room for eruption of all permanent teeth.
Phase 1 treatment encompasses not only tooth alignment but also growth modification for jaw structure changes. Appliances are used to direct harmonious growth of the upper and lower jaws and establish space for eruption of all permanent teeth. This early correction may prevent the need for removal of permanent teeth in the future and/or surgical procedures to align the upper and lower jaws. A successful first phase will have created room for teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.
In this phase, retainers are often placed while the remaining permanent teeth are allowed to erupt. In other words, at the end of the first phase of treatment, permanent teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment. Checking the fit of retainers and selective removal of certain primary (baby) teeth to enhance eruption may be necessary during this resting phase. Therefore, patients are followed closely during this period, monitoring growth and eruption of teeth.
A second phase of orthodontic treatment will upper and lower full braces is generally recommended when all permanent teeth are present to perfect alignment and bite fit. 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.