Early Orthodontic Treatment/Two-Phase Orthodontic Treatment

Phase One: A Foundation for a Lifetime of Beneficial Smiles

Early orthodontics, which is also called Phase One or Interceptive Orthodontics, is the orthodontic treatment of a child who has baby (primary) and permanent teeth present. During this time, usually between the ages of 6 and 10 years old, there is a window of opportunity to make skeletal changes which can have a significant benefit in the patients' facial growth, position (straightness) of the teeth and health of the gums. This window, if missed, may result in less than optimal orthodontic results when treated later as a teen. The reason is, the bones of the upper and lower jaws are very malleable (soft) during this 6 to 10 y.o. interval. When manipulated properly, they can be shaped for the best esthetics and health of the smile. Since the changes made are skeletal the stability of the results are enhanced. 

One example is crowded teeth. We used to think that the child would "grow out of it." We now know this won't happen. A child has all the room for teeth they will ever have by the time the first permanent molars come in (around 7 y.o.). So if we see the child's teeth are crowded at 7 y.o. we know they will be crowded as they get older. If we want straight teeth and they are crowded then we have 2 options:

  1. Take out (extract) baby teeth now. This will accommodate the teeth coming in now at the expense of teeth coming in later, "Robbing Peter to Pay Paul". Later, permanent teeth are taken out (usually 4) and braces are used to straighten the remaining teeth.
  2. Expand the jaw(s) (upper and or lower) in the 6 to 10 y.o. range to make room for all the teeth so pulling teeth is not necessary. Because the jaws are malleable the expansion that occurs is skeletal which has the benefits noted above. When expansion is done after 10 y.o. the result is dental expansion. With skeletal expansion the jaws are widened, with dental expansion the jaws are not widened, the teeth are pushed out which is not esthetic, healthy or stable.

As a result of doing this Phase One treatment, then when braces are needed after all the permanent teeth are in, the treatment is much shorter and the results better!

The course of treatment is usually 6 to 12 months of Phase One treatment followed by a resting period while the remaining permanent teeth come in. The child is seen every 6-8 weeks during treatment and every 6-12 months during the resting period to check growth.

Phase Two Treatment

When all the permanent teeth are close to being in or are in (12-13 y.o.), then an evaluation for a Phase Two treatment occurs. This treatment involves complete braces for 12-20 months to finalize tooth alignment and fit. The results achieved by a two stage treatment when indicated, cannot be duplicated with one long treatment as a teenager. 

If your child is 7 y.o. then an evaluation by an Orthodontist is recommended by the American Association of Orthodontists. They might not need any treatment but better safe than sorry.  If you have any questions, please do not hesitate to contact us.  At Elite Smiles Chastain we aim to "Build a Better Smile!"


How to tell if your child may need early orthodontic treatment:

  • Early or late loss of baby teeth (your child should typically start losing teeth around age five, and will have all permanent teeth around age 13)
  • Difficulty chewing and/or biting
  • Mouth breathing
  • Your child continues sucking his or her thumb after age five
  • Speech impediments
  • Protruding teeth (the top teeth and the bottom teeth extend away from each other)
  • Teeth that don't come together in a normal manner or even at all
  • Shifting of the jaw when your child opens or closes his or her mouth (crossbites)
  • Crowded front teeth around age seven or eight

Advantages of Early Treatment at Elite Smiles Chastain:

  • All appliances are custom fit for comfort.
  • Precise diagnosis using the latest 3D technology combined with the experience of more than 15,000 smiling faces treated.
  • Your child will be seen by Dr. Sebastian at each appointment.
  • Elite Smiles Chastain uses only fixed appliances, so there is nothing removable to lose.
  • Dr. Sebastian will make all adjustments at the office, nothing for you to turn or adjust at home.
  • Most early treatments are 6 to 10 months in length with no braces necessary
  • Early treatment is designed to make skeletal changes which are the cause of most issues we treat (For example, crowded teeth are caused by small jaws not too many teeth)
  • Airway enhancement-If proper appliances are used, the upper airway can be enlarged for better breathing. Reference Sleep Disorder Breathing on our home page.

Two-Phase Treatment

What is the advantage of two-phase orthodontic treatment?

Two-phase orthodontic treatment is a specialized process that combines tooth straightening and physical, facial changes. The purpose of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, and aesthetic result that will remain stable throughout your child's life.

What if treatment is put off?

Putting off treatment can result in a need for more invasive treatment later in life that may not completely fix your child's smile. Early treatment is most effective for achieving lasting results.

Phase One

A Foundation for a Lifetime of Beautiful Smiles

The goal of Phase One treatment is to help the jaw develop in a way that will accommodate all of the permanent teeth and improve the way the upper and lower jaws fit together. Children often exhibit early signs of jaw problems as they grow and develop. An upper jaw that is growing too much or is too narrow can be recognized at an early age. If children over the age of six are found to have this jaw discrepancy, they are candidates for early orthodontic treatment. Also, if children around the age of eight have crowded front teeth, early treatment can prevent the need to extract permanent teeth later.

  • Planning now can save your child's smile later

    Children benefit tremendously from early-phase treatment. Receiving early treatment may prevent the removal of permanent teeth later in life, or the need for surgical procedures to realign the jaws.

  • Making records to determine your child's unique treatment

    Orthodontic records will be necessary to determine the type of appliances to be used, the duration of treatment time, and the frequency of visits. Records consist of a CBCT scan and precisely calibrated photographs. During your child's initial consultation, Dr. Sebastian will reveiw the records with you to determine if early treatment is necessary.

Resting Period

In this phase, the remaining permanent teeth are left alone as they erupt. Retaining devices may not be recommended if they would interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement. A successful first phase will have created room for permanent teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.

  • Monitoring the teeth's progress

    At the end of the first phase of treatment, teeth are not in their final positions. This will be determined and accomplished in the second phase of treatment. Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.

Phase Two

Stay healthy and look attractive

The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. Phase Two usually involves full upper and lower braces.

At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan was established. Certain types of appliances were used in the first phase to correct and realign the teeth and jaw. The second phase begins when all permanent teeth have erupted, and usually requires braces on all the teeth for an average of 18 months. Retainers are worn after this phase to ensure your child retains his or her beautiful smile.