Two-Phase Orthodontics

First Phase Treatment - Jaw Alignment and Dental Arch Development

Bite disharmonies can consist of both dental problems (crowding, spacing, tipping) and also skeletal problems (jaw relations). The goals of first phase treatment are to develop the circumference of the dental arches in order to accommodate all of the developing permanent teeth and to properly 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 can be recognized at an early age. Children in the 6-9 year old range who exhibit a deviation from normal jaw growth are candidates for early orthodontic treatment. We therefore recommend that Dr. Shimizu has an opportunity to perform an initial evaluation on children 7-8 years of age to insure that care can be delivered at the optimal time.

Because they are growing rapidly, children can benefit greatly from an early phase of orthodontic treatment utilizing appliances that direct the growth relationship of the upper and lower jaws. A good foundation can be established, providing adequate room for the eruption of the remaining permanent teeth. This early correction may prevent later removal of permanent teeth to correct overcrowding, and may eliminate the need for surgical procedures to align the upper and lower jaws. Leaving certain conditions untreated until all of the permanent teeth have erupted could result in a jaw discrepancy too severe to achieve an ideal result with braces alone.

Orthodontic records (models, radiographs, and photographs) will be necessary to determine the type of appliances to be used and the duration of treatment. Dr. Shimizu will use these materials to develop a customized treatment plan for each patient. First phase treatment will usually last between 12-18 months, depending on the severity of the malocclusion. Still, not all children are candidates for early orthodontic treatment. There are many cases that are best treated when most of the permanent teeth have erupted. Dr. Shimizu will base his decision on each individual; what is best for their health and, at the same time, what is most cost-effective for the parent. If we decide to hold off on treatment, we will continue to monitor your child's growth and development at periodic no-charge observation visits.

Interim Retention / Resting Phase - Holding Space for Permanent Teeth

Following the completion of active first phase treatment, retainer appliances are delivered and the remaining permanent teeth are allowed to erupt. A successful first phase will have created room for teeth to find an eruption path and the retainers will maintain this space. The final positions of the teeth have not yet been established and minor irregularities (tipping and rotations) may develop. A completion of the orthodontic alignment (detailing) will be accomplished in the second phase of treatment.

The duration of this resting phase depends on the rate at which the remaining primary teeth are lost and the permanent bicuspids and canines erupt. Selective removal of certain primary (baby) teeth may be necessary to enhance the eruption of the underlying permanent teeth during this resting phase. Periodic recall appointments for observation and retainer adjustments are necessary, usually on a 3 to 6 month interval.

Second Phase Treatment - Detailing the Bite

The ideal alignment of the permanent teeth will allow for maximum chewing efficiency, dental health, and attractiveness. Obtaining this arrangement is the goal of the second and final phase of orthodontic treatment.

The second phase of treatment is initiated when all of the permanent teeth have erupted. Braces are usually required on all of the teeth for a period of 9-15 months. Once the bite corrections have been completed, the braces are removed and a final set of retainers are delivered. These retainers will allow the patient to maintain the optimal alignment of his or her teeth.

An orthodontic examination will be necessary to determine if early interceptive orthodontics is appropriate for your child. We would be happy to provide this service for your family.

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