Single phase orthodontics means we wait until nearly all of the permanent teeth are in place prior to starting treatment. Phased orthodontic treatment means a first phase of treatment is started earlier — commonly at age 7 to 9, when all permanent incisors (front teeth) and permanent first molars are in place but permanent canines and premolars have not yet erupted. There are indications for both approaches and the option selected should be individually based.
If you select the phased treatment option, it is important to realize that there is a greater than 50-50 chance that you will need to do both phases – i.e. even if you start early you will not finish early, and there may be additional cost and time involved.
In our practice, we have a comprehensive approach to the first phase, a rigid retention program, and, in fact, 1 out of 3 patients will not need to go on to a second phase. Furthermore, for the 2 out of 3 patients that still require phase II treatment, the second phase of treatment is often simpler and faster than if we had done single phase treatment. That being said, we do not do phased treatment on everyone, preferring to wait when problems are mild to moderate.
On the other hand, the benefit of a phased approach to young patients may be worth much more than the extra time or cost. For example, many female patients finish most or all of their jaw growth prior to the time their full permanent dentition is in place. Teeth that erupt into the wrong place or are impacted (‘stuck’ or blocked out of place) often require extractions or surgical intervention and this is often circumvented with earlier treatment.
The literature lists the following as benefits of phased treatment:
1. Takes advantage of growth
2. Requires fewer extractions of permanent teeth
3. Involves less orthognathic (jaw) surgery
4. Addresses harmful habits
5. Causes less tooth trauma and enamel wear
6. Improves self-esteem and social comfort
7. Assures greater compliance with the course of treatment than in the challenging teenage years
Most important is the improvement in self-esteem and confidence that occurs when a child is given a beautiful smile during the socially challenging middle school years. With a list of clear long-term medical benefits, the ultimate decision is still based most often on the consideration of that more intangible factor:
How much is your child’s self-esteem worth?