Two-Phase Treatment

Many children are ambivalent about getting braces.  On the one hand, they like the idea of perfect teeth, but on the other hand they are nervous about whether the braces will cause pain and discomfort.  The good news is that the placement of orthodontic braces is not at all painful, and the end result will be a beautiful straight smile.

Although patients of any age can benefit from orthodontic braces, timely treatment ensures maximum dental health and they tend to work much quicker on pre-teens and teenagers since they are still experiencing jaw growth.  The American Association of Orthodontists (AAO) recommends that children should get an orthodontic evaluation no later than age 7.  An orthodontic examination may be beneficial before age seven if facial or oral irregularities are noted.

Phase I treatment is early interceptive orthodontic care that precedes "full" braces and usually takes 14 to 18 months.  It is usually initiated between age 7 and 9, depending on how rapidly the permanent front teeth erupt and the severity of the orthodontic problem.

The goals of first phase treatment are to develop the jaw(s) sufficiently to accommodate the permanent teeth and to correctly relate the upper and lower jaws to each other.  Early interceptive treatment can prevent the removal of permanent teeth to correct overcrowding and surgical procedures to align the upper and lower jaws. Interceptive treatment can also decrease the time necessary for the second phase of treatment and in some cases eliminate the need for a second phase.

Here is a brief overview of some of the main types of orthodontic appliances used for children:

  • Partial Fixed Braces - Braces are placed on permanent first molars and incisors and an archwire connects    the brackets.  After braces have been applied, the child will have regular appointments to have the braces    adjusted by the orthodontist.  

    Headgear - This type of appliance is most useful to treat overbites.  A headgear is a custom-made appliance attached to wire that is worn to aid in tooth movement.  Depending on the severity of the overbite, a headgear is intended to be worn from 8-16 hours each day and must be worn as recommended to achieve good results.

    Quad Helix - This is an appliance for the upper teeth that is cemented in the mouth.  It is attached to the molars by two bands and has four active helix springs that gently widen the arch of the mouth to make room for crowded teeth, or correct a posterior crossbite, where lower teeth are buccal (outer) to the upper teeth. 

    Lingual Arch - This is an orthodontic appliance which connects two molars in the lower arch and is adapted to the lingual side of the lower teeth.  The wire is inserted into lingual sheaths welded to the molar bands. It is used as a space maintainer by maintaining the molar position and the "Leeway space", which is the extra space available in the arch when the second deciduous molar is exfoliated and the second premolar erupts. Incisors can be aligned and crowding can be alleviated by removal of deciduous teeth and allowing the incisors to unravel along the lingual arch without loss of arch length.

    Facemask - Also known as reverse-pull headgear, this appliance is typically used to correct underbites by pulling forward and assisting the growth of the upper jaw, allowing it to catch up to the size of the lower jaw.  Depending on the severity of the underbite, facemasks need to be worn approximately 14 to 16 hours each day to be truly effective.

  • Retainers – Retainers are typically utilized at the end of Phase I treatment in the supervision phase (between Phase I and Phase II).  When the original malocclusion has been treated with braces, it is essential that the teeth do not regress back to the original misalignment.  Wearing a retainer ensures the teeth maintain their proper alignment, maintains arch length that is created, and gives the jawbone around the teeth a chance to stabilize.  The retainer will be periodically adjusted to allow for new permanent teeth to erupt favorably.