What Is Two-Phase Orthodontic Treatment?

Parents are often surprised to discover that the American Association of Orthodontists recommends that all children visit an orthodontist by the age of 7. While orthodontic treatment used to begin in the teenage years, it is becoming increasingly common for younger children.

When you see a small child wearing braces or dental appliances, she likely has a two-phase orthodontic treatment plan. This is a special treatment option that is usually available only to children in cases where early orthodontic intervention will reduce the amount of work needed during treatment in adolescence.

As the name suggests, two-phase orthodontic treatment involves two rounds of treatment with orthodontics. The initial phase helps guide the growth of the jaw and teeth while the child still has primary teeth. An observation phase follows where the orthodontist monitors the child’s dental development for approximately one to three years while waiting for all the primary teeth to fall out. The second phase of treatment with braces takes place after the child’s permanent teeth have grown in.

Children between the ages of about 6 and 9 with abnormal jaw development can be good candidates for two-phase treatment. This may be due to early to late loss of primary teeth, crowded or misplaced teeth, underbites, overbites, crossbites, and oversized or undersized upper and/or lower jaws. Your orthodontist is most likely to recommend two-phase treatment when one or more of these conditions is severe.

Only a consultation with an orthodontist can determine whether your child is a candidate for two-phase treatment. Your orthodontist is likely to recommend this approach if she believes it can prevent a problem from occurring, intercept a problem that is already developing or guide the development and positioning of the jawbones.

Signs Your Child Might Need Early Orthodontic Treatment

There are several indicators that your child might benefit from two-phase orthodontic treatment. One sign is the early loss of primary teeth. Typically your child will start losing teeth at about age 6, with the two top and bottom front teeth going first, followed by lateral incisors, first molars, canines and second molars. If your child begins losing teeth before age 5 or begins losing teeth significantly out of order (e.g. the first lost tooth is a molar), you should schedule an appointment with an orthodontist.

Sucking on the thumb, other fingers, pacifiers and toys is normal for infants and very young children. However, if your child is still engaging in this behavior at age 5 despite your efforts to break the habit, you should schedule an appointment with an orthodontist as this could be a signal that early treatment is needed. Persistent thumb sucking can cause an overbite and malformation of the roof of the mouth.

A child who is experiencing difficulty biting or chewing might also benefit from early intervention. Several factors can cause biting and chewing problems. Your child could be experiencing pain from tooth decay or a tooth infection. These problems also could indicate a misaligned bite, in which your child is unable to properly open or close his or her jaw, or is experiencing pain from a temporomandibular joint (TMJ) disorder.

An orthodontist also can address early signs of a crossbite. A crossbite occurs when the top teeth and bottom teeth do not come together correctly or they bite into an incorrect overlapping position. You will notice a crossbite if your child’s top teeth fit inside of the bottom teeth, or the top back teeth bite inside the bottom back teeth. This misalignment can happen on one or both sides of the mouth.

Prematurely crowded teeth also could indicate a problem that needs orthodontic correction. If your young child is growing in adult teeth that are coming in overlapping, rotated or up high, early treatment can help make room for them to grow in. This might involve expanding the jaw, which needs to happen during childhood while the bones are still growing.

In a normal bite, when the mouth is closed the upper front teeth should rest relatively snuggly over the bottom front teeth (about 2 millimeters apart). If your child’s upper or lower teeth are protruding, she might benefit from early correction. Protruding teeth can cause a variety of problems including difficulty biting and chewing, as well as speech problems.

How Two-Phase Treatment Works 

The primary goal of the first phase of treatment is to allow for normal development of the permanent teeth. This usually stems from issues involving jaw growth in children who are at significant risk for needing jaw surgery later in life. This early phase of treatment occurs when the jawbones are highly malleable. Once the bones become firm, it is too late to reshape them through orthodontic procedures and invasive surgery will be required.

Common methods of treatment in phase one include:

  • Traditional braces (usually on select teeth)
  • Specialized retainers
  • Headgear
  • Space maintainers
  • Functional appliances
  • Expansion appliances

Phase one treatment is designed to prepare your child for a better outcome and easier treatment path in phase two. In most cases, this early intervention will not eliminate the need for treatment with braces in early adolescence.

In between phase one and two treatments, your child’s orthodontist will use X-rays and physical examinations to monitor further jaw development and eruption of any remaining permanent teeth. Although this in-between period typically will not require any appliances–though in some cases your child may be asked to wear a retainer to maintain progress made in phase one–it is important that you keep up with regular appointments and follow all your orthodontist’s instructions. This can save a substantial amount of time and effort during phase two treatment.

Phase two orthodontic treatment is the process that most people are familiar with, where braces are applied to the top and bottom teeth. This will position all your child’s permanent teeth and set him or her up with a healthy and attractive smile. Teeth also will be aligned for function and stability with braces and specialized retainers or expansion appliances, if needed. Missing teeth may be replaced during this stage, and teeth that are out of position or fail to erupt may be brought down into the dental arch or removed. For children who have completed a two-phase treatment process, this phase will usually begin when they are about 11 or 12 and will likely last between one and two years.

How Does Two-Phase Treatment Benefit My Child?

If your child is a candidate for two-phase treatment, he is likely experiencing some uncomfortable physical symptoms, such as pain or tenderness in the face and jaw, difficulty biting and chewing, and difficulty producing certain speech sounds.

Phase one treatment can alleviate these symptoms, as well as reduce the risk of broken or cracked teeth. It also can affect your child emotionally, as early correction of significant dental abnormalities can make him more comfortable and improve self-esteem, especially in cases where speech is affected or he cannot eat normally along with his peers.

If you think your child may benefit from two-phase orthodontic treatment, schedule a complimentary consult with one of our board-certified orthodontists today.


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