Is Two-Phase Orthodontic Treatment Really Necessary?

Your best friend says, "One of my daughter's little friends just got braces on. She is only seven years old, and hasn't even lost all her baby teeth. Isn't she too young for orthodontic treatment?" How would you answer?

Are there benefits to two-phase treatment?
Two-phase orthodontic treatment (also known as early, preventative, or interceptive treatment) is an approach to care that remains controversial in some professional circles. While a few university studies suggest that the same bite can be achieved in a single phase of braces after all the permanent teeth are in, these studies do not take into consideration all the variables that are in play.

Most studies do not consider soft tissue nor psychology of young patients
Most of the studies quoted by those who are not in favor of two-phase treatment suggest that the same orthodontic results are attainable whether the problems are addressed in a single or in multiple phases. These studies are usually retrospective (meaning that they are conducted on plaster models after the patients are long gone) and do not consider the soft tissue and psychological aspects of the treatment provided. These are two key areas where two-phase treatment provides benefits over waiting until all the permanent teeth are in place.

Early treatment can make final results easier to achieve
Even though there is no way to prove that interceptive care makes the final orthodontic results easier to achieve, most clinicians believe that early treatment does just that. Early expansion and growth modification can often convert surgery cases into extraction cases. Early treatment can also convert some extraction cases into simple expansion cases. Early treatment can in some cases even eliminate the need for full braces altogether, although this is definitely the exception to the rule. If a child has a condition serious enough to call for treatment at age seven, it is almost certain that he or she will need to have their treatment finished in a second phase as a teenager.

Early treatment can make soft tissue results better
The appearance of the gum tissues around the teeth is affected by where the permanent teeth grow into the mouth. If a child has a lot of crowding and the canines come in very high (like fangs), the tissue over those teeth will always be higher than the surrounding teeth, even if grafting is performed. Expanding the dental arches to encourage normal eruption usually helps prevent most of these gum problems. These soft tissue problems are not taken into consideration in the studies that question the value of two-phase treatment

Early treatment can help your child's self-esteem
Perhaps the most important reason for interceptive treatment at age seven or eight is the psychological benefit that it provides for our young patients. Even if a similar result is possible at age 13, it is hard to erase the scars of four or five years of ridicule and embarrassment that many times go with "fangs" or "overbites." Our young people have enough problems with self-esteem without having to worry about their teeth. Early orthodontic correction of orthodontic problems can not only reduce the joking and name calling, it can turn a liability into an asset. Two-phase orthodontic treatment can give a child a beautiful smile that improves self-esteem and many times changes the way they approach the world.

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.