Early Phase (Two-Phase) Orthodontics

Early Phase Orthodontics

We know that typically when people think of orthodontic treatment, they think of teenagers with braces. Well, that is not completely correct! At Bethesda Dental Specialties, we are proud to be one of the only practices that are currently offering Early Phase orthodontics. Our orthodontist, Dr. Hickory, has given national and international meetings on the benefits of early phase treatment!

But what is Early Phase (EP) orthodontics? EP orthodontics is completed in 2 phases (and also known as two-phase treatment): Phase I and Phase II. Children ages 7-10 have a varying mix of both baby and permanent teeth, so during this age, it may be beneficial to complete early orthodontic intervention (Phase I). Some children will have more value in waiting for all of their permanent teeth to come in for orthodontic treatment, so it depends on your child’s unique case.

How Is Early Phase Completed?

Early phase can be completed with either orthodontic appliances or with braces/Invisalign.

  • Orthopedic Appliances
    If expansion or other jaw growth modification appliances are needed, this is usually completed as the first step. Read more about appliances here.
  • Braces
    Braces are typically only placed on just the permanent teeth during EP treatment. These teeth include the front 4 incisors and the back 6-year-old molars. The orthodontic arch wire spans the distance from the anchor molar teeth to the incisors. The incisors can be moved forward or back, up or down, and aligned so as to hold their space.
  • Invisalign
    Dr. Hickory was one of the first orthodontists in America to routinely use Invisalign for early phase. He was also the first orthodontist to present this innovative technique at national and international meetings. Invisalign is not limited to just teenagers or adults – it can be used during orthodontic treatment for all ages!Invisalign can be used during EP treatment in the same manner as braces, and is created with computer modeling. Children often enjoy Invisalign as it is very gentle and there is very little to no pain associated with wearing the aligners.

What Problems Can Be Fixed By Early Treatment?

  • Crowding
    If teeth are very crowded, they have often lost contact with their adjacent teeth, and therefore not able to hold their space. Since back teeth have a strong tendency to drift forward, space can be easily lost.  Early expansion of the jaw helps create much needed space for normal eruption of teeth, and helps create space for better alignment.Did you know? About 20 years ago, orthodontists would extract up to 4 permanent premolars in 60% of their patients! This is because orthodontists did not see children before the age of 12, and did not complete any early preventative treatment.
  • Spacing
    Excess space in one area may be “stealing” space from another area. This might prevent normal eruption of new teeth. Spacing may also be associated with protruding teeth, which are more prone to injury.
  • Overbite or Underbite
    The upper and lower jaws grow by two different mechanisms and different genetic information, both independent of the other. Both jaws are growing forward throughout the growing years. Often, one jaw is deficient in its growth, leading to an overbite or underbite.Part of early orthodontics is jaw orthopedics. With plastic “retainer-like” appliances, we can shape the jaw growth to achieve a better occlusion (bite), obtain better relation of the teeth to the lips, and better the appearance of the face and profile!
  • Deep Bite or Open Bite
    Over-erupted upper incisors may give a “gummy smile.” Over-erupted lower incisors may also damage the gum tissue behind the upper incisors. This is reversible. Very gentle orthodontic pressure from braces or Invisalign can move the incisors gradually back to their proper position.Sometimes the incisors are under-erupted, leading to an open bite. A thumb habit, tongue thrusting, mouth breathing, or an inherited jaw growth pattern may have caused this. This can be treated early during growth with habit appliances, braces and/or Invisalign.
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