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Two-phase treatment consists of:

  • Early (phase I) treatment. Usually between the ages of 7 and 10.
  • A maintenance phase.
  • Phase II treatment. Initiated once most of the baby teeth have fallen out.

These different phases are described in detail below.


The American Association of Orthodontists recommends all children have an orthodontic screening around age 7. Usually, the first permanent molars and permanent incisors have come in by that time. Treatment is not usually started at this age unless severe problems exist which will adversely affect the way the teeth are growing. Also, an upper and lower jaw that is growing too much or not enough can be recognized at this age. If children are found to have this jaw discrepancy, it is best to treat it sooner, rather than later.

Some problems that need early treatment include:

  • An anterior crossbite (1 or more of the upper front teeth are behind the lower front teeth upon biting)
  • A posterior crossbite (1 or more of the upper back teeth are inside the lower back teeth. This can cause a shift of the jaw upon closure)
  • Severe crowding
  • Crooked teeth cause psychological stress
  • When the midlines of the upper and lower teeth don’t line up (this potentially indicates other problems)
  • When upper or lower front teeth protrude excessively
  • Habits such as thumb sucking/finger sucking
  • Unusually early loss of a baby tooth may allow the adjacent permanent teeth to shift

Early (phase I) treatment is only recommended in about 5-10% of the patients we evaluate. In most cases, growth and development are seen as normal and no intervention is required.

What is Early Treatment (Phase I) and what are the advantages?

The major advantage of a two-phase treatment is to allow the permanent teeth to erupt into their best natural position and restore the normal developmental relationships of the teeth. The eruption of each tooth is affected by those around it, so proper positioning of the teeth during early development serves as the foundation for normal growth. In such cases that possess the problems listed above, treating them early can help avoid the development of more serious dental problems over time. Many of these orthodontic problems can be treated much easier by working with the growth that takes place in younger children. Early treatment (phase I) often reduces the difficulty of comprehensive treatment (phase II) and helps make optimal treatment outcomes more achievable. Other benefits of early (Phase I) treatment are:

  • Adjust the width of the upper and lower dental arches.
  • Making space for permanent teeth (avoiding the need for extractions later).
  • Relate the upper and lower jaws to each other properly.
  • Reducing the likelihood of impacted permanent teeth.
  • Eliminating shifting of the jaw on closure.

In other words, early treatment can simplify later treatment! Early treatment provides a good foundation for a smile that will last a lifetime.

What if I don’t due early (Phase I) treatment?

The disadvantage of waiting for the complete eruption of permanent teeth and having only one phase of treatment for someone with a jaw discrepancy is facing the possibility of a compromised result that may not be stable. The longer these problems go unrecognized, the harder they are to treat. Many of these orthodontic problems can be treated much easier by working with the growth that takes place in younger children. Some developmental problems, like functional shifts of the jaw, open bite tendencies, and under-bites, actually have a strong negative impact on facial growth. Early intervention for these developmental problems can have a significant impact on your child’s facial development and appearance. Other disadvantages of waiting for the complete eruption of permanent teeth and having only one phase of treatment are:

  • Possible gum loss or visible enamel wear and notching of the teeth.
  • Asymmetric jaw growth.
  • Impaction of a permanent tooth or asymmetric eruption and tooth alignment.
  • Extractions may be necessary.
  • Only a compromised orthodontic result may be achievable.
  • Extractions and/or oral surgery may be required to obtain a proper occlusion.
  • Longer treatment time in braces.

What is the Maintenance Phase?

A successful first phase will have improved the appearance of the teeth and created an unobstructed path for all of the teeth to erupt into the mouth. A normal developmental relationship has been achieved and usually, only some of the permanent teeth have grown into the position. In other words, some baby teeth may still need to fall out, and it is necessary to wait until all of the permanent teeth have erupted into position before the bite and final alignment of the teeth can be evaluated. This is called the maintenance phase.

Retainers are sometimes recommended to preserve the relationship achieved during the first phase of treatment but are then discontinued to allow the loss of the baby teeth and eruption of the permanent teeth. It is best to allow the existing permanent teeth some freedom of movement while the final eruption of the permanent teeth occurs. In some instances, phase II may not be necessary if all the permanent teeth erupt properly. During the maintenance phase, periodic recall appointments are required to monitor the growth and the eruption of the permanent teeth.

What is the Second Phase of Treatment?

The final alignment of the teeth and bite correction are the goals of the second phase of treatment. We strive to create harmony between the lips, cheeks, tongue, and other teeth. Bite correction is important for several reasons: 1) Ideal positioning of the bite helps prevent accelerated tooth wear from functional interferences; 2) Ideal positioning of the bite helps maintain a health TMJ joint; 3) Ideal positioning of your teeth and bite means you will have a more stable result. What does this mean for you? Your teeth are more likely to remain healthy and straight throughout your life if you properly correct the way the teeth fit together and function.

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