Two-phase orthodontic treatment seems to be more popular today than ever. It is not uncommon to see braces on elementary school children. Won’t waiting to get braces until all the teeth are in save us money?

AAO recommends screending all children at age 7
There are two schools of thought when it comes to the timing of orthodontic treatment. Some orthodontists do not believe in performing treatment of any kind until all the baby teeth have been lost. Most however, follow the American Association of Orthodontists’ recommendation that all children be screened at age 7. While not all orthodontic problems can be fixed at this age, the severity of many problems can be reduced and the self-esteem of the young patient improved dramatically (see my earlier article entitled “Is Two-Phase Orthodontic Treatment Really Necessary?”).

What happens in Phase 1 orthodontic treatment?
The first phase of a two-phase orthodontic treatment begins ideally after all four of the permanent first molars and all four of the permanent central incisors have come into the mouth. Most orthodontists place braces on only some of the teeth since the remaining baby teeth will fall out shortly after Phase 1. Many first phase treatments also use some type of growth modification device like an expander, habit appliance (to stop thumb or finger sucking), functional appliance (to reduce an overbite), or headgear. Following the first phase of treatment, retainers are used to maintain the results achieved.

Why do we continue to see the orthodontist between phases?
Between the two phases of treatment, patients are seen at regular intervals so that the orthodontist can check the condition of the retainers, the loss of the baby teeth, and the arrival of the remaining permanent ones. Periodic x-rays help your doctor make sure that everything is developing as desired. It is also an opportunity for the orthodontist to repair the retainers and refer you back to your general dentist if primary teeth are not being lost on schedule.

When does the second phase of orthodontic treatment begin?
The second phase of treatment begins ideally after the last primary tooth is lost, about the same time the 12-year-molars make their appearance. Treatment may begin earlier if the patient is having social problems due to their smile, the orthodontic problems are severe, or there are teeth that cannot take their place without help. Treatment will take too long if started too soon, and it will not be finished before the end of high school if started too late.

Two-phase orthodontic treatment does cost more
So does two-phase treatment cost more? The simple answer is yes. It typically costs about 25% more. There are two sets of braces and two sets of retainers. There is a 2 to 4 year observation period in between phases involving x-rays and retainer repairs. There are clearly more expenses if the braces are done twice. So why would anyone submit their children to two phases of treatment and more expense?

The benefits of two-phase treatment outweigh the additional cost
The answer is that the benefit to young patients is worth more than the extra cost. As discussed in my previous article, early treatment allows the orthodontist to achieve results he cannot get in a single treatment later. Many girls finish growing by the time their second molars are in place. Teeth that erupt into the wrong place, through the wrong tissue, may never look as good even if their position is corrected later on. Extractions and surgery that might have been avoided with early intervention may become necessary. Most important however is the improvement in self-esteem that occurs when a child is given a pretty smile to go with them through the socially awkward junior high years. How much is your child’s self-esteem worth to you?

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.