Phase I and Phase II Treatment for Young Children
Phase I orthodontic treatment is an interceptive and proactive treatment. It uses fixed or removable appliances for generally about 6-15 month period to correct poor jaw growth, create space for unerupted permanent teeth, break habits, and/or provide normal facial muscle and development before it is too late. The American Association of Orthodontists (AAO) recommends that a child’s first visit to an orthodontist should occur by no later than age 7. By that age, enough permanent teeth have emerged to evaluate relationships developing between the teeth, the jaw, and bite patterns for evaluation to make sure everything in the mouth will continue to develop as it should. Early treatment may achieve results that are unattainable once the face and jaws have finished growing.
After Phase I treatment is completed, all appliances are removed. Then your child will be observed about every 3-6 months until adolescent. Retainers may be recommended during this observation period.
Although approximately 10% of patients undergoing Phase I treatment will end up not needing Phase II treatment, 90% of Phase I patients will still eventually benefit from Phase II treatment utilizing full upper and lower braces to finalize the bite correction. Usually we are waiting for 12-16 more permanent teeth to erupt before Phase II begins. This most commonly occurs at the age of 12 or 13. By 12, most if not all of the permanent teeth have erupted and are in place, and crooked teeth, gaps and bad bites can easily be detected. Orthodontic problems don't improve with age — they simply become harder to treat. It's easier to treat many orthodontic problems during adolescence because the body is still growing rapidly at this time.
The goal of Phase II Treatment is to position all the permanent teeth to maximize their appearance and function. This is best accomplished with full braces or Invisalign and is usually between 12-18 months long. Due to the improvements made in Phase I Treatment, Phase II Treatment requires less patient participation (no headgear and less rubber bands), often eliminates extraction of permanent teeth and reduces the time spent in full braces. Patients who have undergone both Phase I and Phase II treatments are more likely to have more stable results.
Limited Orthodontic Treatment
Especially for adults, not everyone needs a full set of braces. Sometimes just one, two or a few teeth are misaligned. Or sometimes one, two, or a few teeth need to be moved to prepare for other dental work, like dental implants, restorations, or periodontics. It’s in these types of situations that limited braces may be used. Limited orthodontic treatment usually requires less treatment time, and because it’s correcting a more isolated area of the mouth, also requires less appliances.
Comprehensive Treatment
This is another name for orthodontic treatment in the permanent dentition at any age. It is more commonly used when a Phase I treatment was not performed. Compared to limited treatment, comprehensive orthodontic treatment is undertaken to achieve the goal of ideal alignment of ALL the teeth and jaws in good form and function. This treatment can be undertaken in adolescents or in adult. As the name implies, comprehensive treatment may involve coordinated care from an oral surgeon, a periodontal or gum specialist, or your general dentist to establish an ideal bite and smile. Typical duration of comprehensive treatment is 1-3 years, depending on the complexity of the bite and goals desired.
Orthognathic Surgery/Surgical Orthodontics
It is used to treat severe cases that include bad bites, jaw bone abnormalities, and malocclusion. It may be needed to treat adults with improper bites or other aesthetic concerns. The necessity for surgical orthodontics occurs when the jaws do not line up correctly, and a proper bite cannot be achieved with orthodontic treatment alone. Typically, jaw growth stops by age 16 in females and 18 in males. In order to receive orthognathic surgery, the jaw must be done growing. Orthognathic surgery will help properly align the jaw, and orthodontic braces will be used to move the teeth into their proper position. With this type of treatment, it is a collaborated effort with your general dentist, orthodontist and oral surgeon.