Is this Patient happy or what?

What a Beautiful Smile! Made possible with Braces.

Phase I and Phase II Treatment - When and Why ?

There are times when early problems are so severe that Interceptive Orthodontics is warranted, In situations like this Phase I Treatment lasting  12-14 months may be started.  After Phase I is completed, orthodontics is then halted, and braces removed while the remaining adult teeth erupt. After most if not all the baby teeth have been lost a follow up Phase II Treatment using Braces or Invisalign Appliances is then initiated.

The benefits of such  Early Phase I Interceptive Treatment is that if such early severe crowding conditions were to be left untreated, the likelihood of  extractions of adult permanent teeth would likely be very much increased.

Phase I Interceptive Treatments often involve the use of  Palatal Expanders such as a Hyrax Appliance combined with Braces.

This very young lady has small spaces about her primary teeth, but this is normal for her age. This patient would be seen for an initial orthodontic examination, but not treated. She would be again seen in about 6 - 12 months for observation.

Normally, the upper teeth overlap and cover the lower teeth much like shingles on a roof. In this example, the upper teeth do not cover the lower teeth, and the reverse in effect defines what is called a "Crossbite".

This model shows the "mid palatal suture".  This growth suture in young adults is where the left & right halves of the upper jaw meet. Along this junction line, growth occurs allowing the jaw to become wider and thus larger in order to allow  more room for the adult teeth.

The same model below shows an Orthodontic Palatal Expander Appliance in place. This type of  Orthodontic Appliance allows skeletal broadening to occur.  A Palatal Expander or " Hyrax Appliance " is in place on the model.  Slowly activating an expansion screw on this appliance once a day for 20 - 40 days allows the needed  expansion to take place. The will correct a Crossbite.

The Palatal Expansion will often help resolve the Crossbite by widening he palate and creating more room for the adult teeth.

Photo shows the Expander in Place.  After about 30 days the left & right halves are much further apart. Notice the gap on the model. In an actual Orthodontic patient, the body automatically fills in with bone so no real gap like this is seen.

Actual Hyrax Expander and Braces in Place. The crowded  and narrow upper jaw will be gently changed by this palatal expander to make more room for the adult teeth.

 
For Teenage patients who are considering Braces, the Orthodontist will need to determine if all of the adult teeth are in, or if the patient still has a mixture of baby and permanent adult teeth ( transitional dentition ).  If all of the adult teeth are in then various options are available for treatment, including Invisalign and Invisible Braces or iBraces  which are hidden on the back tongue side  of the teeth.  Teenagers may also decide on Clear Ceramic Braces or traditional metal Braces with a variety of color options for the elastics.  Choosing colors is one of the fun parts of the orthodontic appointment !  Teenage patients may want to choose school colors for football games, or orange and black for Halloween.  

Another consideration with Teenage patients is the status of the wisdom teeth, also known as the third molars.  The Orthodontist can take a special X-ray called a Panorex which will show the wisdom teeth and whether these third molars in fact are impacted or poorly oriented in the jaw.  The Orthodontist may recommend that the wisdom teeth be extracted if there is a concern that the these teeth may push the other neighboring teeth out of alignment. If extractions are recommended, the Orthodontist does not personally extract the wisdom teeth, but will generally refer the patient back to the family dentist or an oral surgeon.

The American Association of Orthodontists ( AAO ) recommends that children have their first orthodontic screening by age 7.  It is not necessary to lose most baby teeth first.  In fact, early intervention can be helpful in decreasing the need for complex future treatment. Such potentially complex treatment  may often require extraction of adult teeth because the crowding by that point has often become overwhelming.

Sometimes the Orthodontist may recommend Phase I Treatment.  The Phase I Treatment is offered when children are young and actively growing and certain profound early problems are present. Such "problems" include, but are not limited to, cross-bites, extreme crowding, canine impactions, blocked adult tooth eruption, and more.

During this time of growth, more room can be created in the mouth with orthopedic devices such as Palatal Expanders. One of the most  popularly used Expanders is called a  Hyrax Appliance.   The Hyrax Appliance can be helpful where there is crowding of the teeth in the mouth. The Hyrax comes with a key which is turned at home by the parent and this gradually helps the bone of the mouth spread to create more room for the teeth. The Hyrax Appliance is often removed after 60 - 90 days for the sake of Dental Hygiene and enhanced Patient Comfort.    Once Phase I Treatment  is completed, the child wears retainers and after a sufficient level of development, the child will enter Phase II Orthodontic Treatment.

The Timing of Phase II Treatment  is determined by the Orthodontist evaluating the growth and orthodontic status of the child.   Certain options such as Invisalign and Invisible Braces (metal Braces hidden behind the teeth) called " iBraces " are generally Not used in children with a mixed dentition, that is, if they still have both baby teeth and adult teeth. With Invisalign and " iBraces " there are no colored elastics. Because many children enjoy choosing the colors, they often transition into Phase II Treatment using the traditional metal braces.  These colors can be changed through out treatment.  Some will choose school colors for football games or holiday colors like red and blue for Independence Day.  

Large space or " diastema" between the upper left &right adult central incisors. Braces will close the gap. The wedge of soft tissue called a "labial frenum" can sometimes affect space development.

The same patient with small Braces in place.