Treatment Timing

Our doctors provide orthodontic treatment for adults, adolescents, and children. We follow the guidelines established by the American Association of Orthodontists by recommending that an orthodontic evaluation take place at age 7 for all children. This early evaluation may help to determine the best time to address any treatment needs for your child or to help guide the erupting teeth into the mouth. Orthodontic treatment can be divided into two separate phases of treatment with a monitoring period in between (Two Phase Treatment). Treatment can also be completed in a single comprehensive period of treatment. Our doctors will thoroughly review any orthodontic problems with you and which treatment option is best suited for you or your child.

Comprehensive Orthodontic Treatment

For many children only monitoring of growth and development may be required until all of the permanent teeth have erupted. During this period of time we will focus on the child’s transition from the primary (baby teeth) to the permanent dentition, facial development, and functional occlusion. Orthodontic care may be recommended once most or all of the permanent teeth have erupted (age 11-14) to address crowding/spacing, esthetics, bite correction and precision fit and finish of the teeth. This is usually referred to as “full orthodontic treatment”.

Two Phase Orthodontic Treatment

There are certain children who can benefit from early orthodontic treatment (also called Phase I Orthodontic Treatment). These include children with moderate/severe crowding of the permanent teeth, severe esthetic concerns, jaw growth discrepancies, space loss in one or both dental arches, and functional problems such as crossbites, deepbites, underbites or severe protrusions.

Treatment of these problems at an early age will allow the orthodontist to utilize the patients’ active growth as well as produce benefits such as:

Decreasing the chance of a traumatic occlusion or injury (such as protruding or “buck” teeth)
Controlling harmful habits
Shortening the treatment for full braces during the critical “teen” years
Facilitating proper jaw growth and enhancing the facial profile (proper growth relationship of the upper and lower jaws to each other)

An average two-phase treatment plan consists of a first phase of approximately 12-18 months of active orthodontics in the mixed dentition (permanent and baby teeth are present) at an average age of 7-9 years. This is usually followed by a 1-2 year period of wearing retainers and guiding permanent teeth into favorable positions. The second phase of active orthodontic treatment follows the intermediate retention period once all of the permanent teeth have erupted, and takes approximately 1 year.

The total active treatment time for two phases of treatment is approximately 2 - 3 years, similar to the length of “comprehensive orthodontic treatment”. However, a two-phase treatment program has been split into two time periods, with each period being the best to correct the specific problems of concern. The patient’s skeletal problem, moderate/severe crowding, harmful habits, and formative problems can be effectively addressed at an early age in the first phase of treatment because they are growing rapidly. After this initial treatment retainers will be worn while the orthodontist monitors your child’s dental development and the eruption of the remaining permanent teeth. The critical dental and bite refinements of the permanent dentition are most effectively achieved in the later second phase of treatment. The goal of the second phase of treatment is to place the permanent teeth into positions for optimal comfort, function, esthetics, and long-term stability. The diagram below illustrates the timing of the treatment sequence:

FIRST PHASE ACTIVE TREATMENT	INTERMEDIATE PERIOD	SECOND PHASE ACTIVE TREATMENT
Mixed Dentition (Permanent & Baby Teeth) 1 to 1.5 years		Full Permanent Dentition 1 to 1.5 years

Correction of Crowding, Habits, Functional, Formative and Skeletal Problems	Growth observation and Tooth Eruption Guidance (patients seen approximately every 6 months)	Final Correction of Tooth Position, Function and Precision Alignment

At your child’s initial examination we will be able to best assess their orthodontic needs and give them the best opportunity for a healthy and beautiful smile. We will address the advantages and disadvantages of pursuing a two phase orthodontic program vs. a single comprehensive treatment plan for your child’s individual treatment needs.