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 for good facial balance and esthetics.
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. If children after age six are found to have this jaw discrepancy, they are candidates for early orthodontic treatment. Because they are growing rapidly, children can benefit enormously from an early phase of orthodontic treatment utilizing appliances that direct the growth of the upper and lower jaws. Thus, a good foundation can be established, providing adequate room for eruption of all permanent teeth and good facial balance. This early correction may prevent later removal of permanent teeth 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 that cannot be treated with braces alone. Orthodontic records will be necessary to determine the type of appliances to be used, the duration of treatment time and the frequency of visits. Records will consist of X-rays, and photographs of the teeth and jaw structures.
Resting Period (After Phase I Treatment) – In this phase, the remaining permanent teeth are allowed to erupt. Retaining devices may or may not be used during this period. It is best to allow the existing permanent teeth some freedom of movement while final eruption of teeth occurs. A successful first phase will help create more room for teeth to find an eruption path.
In other words, at the end of the first phase of treatment, teeth are not in their final positions. This will be accomplished in the second phase of treatment. Selective removal of certain primary (baby) teeth may be in the best interest to enhance eruption during this resting phase. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.
Second Phase of Treatment – 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. They will stay healthy and look attractive. This is the goal of the second and final phase of treatment. The second phase is initiated when all permanent teeth have erupted and, usually requires braces on all teeth for an average of 18-24 months. A retainer is worn nightly after this phase to maintain the results long-term.
Advantages of Two-phase Orthodontic Treatment – Two-phase orthodontic treatment is a very specialized process that encompasses tooth straightening and physical, facial changes. The emphasis today on living longer, staying healthy and looking attractive requires optimum treatment results. The major advantage of a two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional and esthetic result.
The disadvantage of waiting for complete eruption of permanent teeth and having only one phase of treatment – for someone with a jaw discrepancy – is having to face the possibility of a compromised result that may not be completely functional and cosmetically pleasing.