Two-Phase Treatment

Dr. Tsibel’s goal is appropriate Two-Phase orthodontic treatment and NOT over-treatment!

The American Association of Orthodontists (AAO) recommends that all children be screened by an orthodontist for orthodontic problems at age 7 and Dr. Tsibel supports this recommendation being fully aware that some orthodontic problems are best treated in two phases. In fact, amazing results can be achieved with the two-phase treatment when it’s appropriate and necessary! However, most children do not need two-phase treatment and Dr. Tsibel will let you know that a lot of recent orthodontic clinical research has demonstrated that some of the early orthodontic problems, even though they appear quite severe and disturbing to parents, are best treated in a single stage of treatment later, around age 12 when all permanent teeth are in, rather than in two phases. Unfortunately, some orthodontists aggressively treat many children with an unnecessary first phase of treatment. This results in treatment that is no more effective or efficient - with far more appointments over time, with far greater cost to the family, and with no better end result for the child than what would have been achieved with an appropriate and well-timed single phase.

When you bring your child in for a consultation, Dr. Tsibel will always honestly tell you which types of orthodontic problems should be treated in two phases, and which can and should be delayed until all of the permanent teeth have come in to be treated in one stage. Statistically in our practice, we recommend two phases of treatment for our younger patients only about 30% of the time.

Phase I

Phase I, or early interceptive treatment, is limited orthodontic treatment (i.e., expanders, growth appliances, or partial/limited braces) before all of the permanent teeth have erupted. Such treatment can occur between the ages of six and ten and is usually 9 to 12 months long. This treatment is often recommended to make more space for developing teeth when early signs of severe crowding are present, and to correct crossbites (reverse bite relationships), severe overbites, underbites, premature loss of "baby" teeth, tooth eruption abnormalities, or harmful oral habits. Any problem where dental arches need to be developed, jaws need to be widened, and/or jaw growth needs to be "stimulated", or modified, would be started before all permanent teeth are in. Phase I treatment creates a good foundation for the erupting permanent teeth, and corrects growth/jaw problems that would otherwise require permanent tooth extractions, complex/extensive orthodontic treatment, and/or jaw surgery later.

At the end of the first phase of treatment, teeth are not in their final, ideal positions. This will be determined and accomplished in the second phase (Phase II) of treatment.

Resting Period

In this resting phase, the remaining permanent teeth are allowed to erupt. Retainers are initially recommended, but may be discontinued if they begin to interfere with the erupting permanent teeth. It is best to allow the erupting permanent teeth some freedom of movement as they come in to the arch.

Phase II

Phase II treatment involves full braces when all of the permanent teeth (usually including the 12-year molars) have erupted, usually between the ages of eleven and thirteen. Phase II is usually the final stage of multi-phase treatment and on average requires 24 months of treatment. During Phase II treatment, the permanent teeth are moved into ideal place to create optimal esthetics and function, and final bite alignment takes place leaving you with a beautiful, straight smile and a healthy bite. It is during the second phase (Phase II) that your new, beautiful smile comes together.

Putting off the recommended Phase I Treatment

The disadvantages of waiting for complete eruption of all permanent teeth and having only one phase of treatment for someone that can greatly benefit from multi-phase treatment are:

  • The possibility of complex, extensive and prolonged single phase treatment
  • The possibility of permanent tooth extractions and/or jaw surgery
  • The possibility of compromised (less than ideal) final result with unfavorable long-term prognosis that may not be stable.