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One Phase vs. Two Phase Treatment
By Stephen Yang, DMD, MS
Board Certified Orthodontist
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What is Phase 1 and Phase 2 Treatment?
Phase 1 or early treatment occurs when the child still has a mixture of primary and permanent teeth. The age that Phase 1 treatment is usually started at is between ages seven to ten, though ages can vary due to some patients with early and others with late erupting permanent teeth. Phase 1 treatment typically ranges from 6-18 months. There can be many orthodontic problems to address during Phase 1 treatment. See Common Orthodontic Problems in Children.

Phase 2 or full treatment occurs when all of the teeth from molar to molar have erupted. Patients are generally ready for full treatment starting around 11-13 years old. Because dental development happens sooner with girls, girls are generally ready for full treatment 6-12 months earlier than boys.  See Common Orthodontic Problems in Teens and Adults.

Why should I spend money on Phase 1 treatment when I can just have everything done at once when all of my child’s baby teeth have fallen out?
Though many orthodontic problems can wait to be corrected when all the baby teeth have fallen out, there are some orthodontic problems that are better corrected when the patient is younger. Delaying treatment for some orthodontic problems can lead to increased difficulty in correcting the problem, less stable results, abnormal jaw growth, abnormal tooth wear, or increased risk of chipping a tooth. Some orthodontic problems that are better corrected early are: severe crowding, eruption problems, open bite, deep bite, crossbite, large “overbite,” underbite, narrow jaws, harmful habits, and severely protruded front teeth.

If my child had early treatment (Phase 1), will he/she need additional treatment when all of his/her adult teeth erupt?
Most of the time, additional treatment will be needed to align the newly erupted teeth and finish correcting any bite problems not fully corrected in Phase 1. This additional treatment using a full set of braces is called Phase 2.

What happens in between Phase 1 and Phase 2?
Depending on your child’s orthodontist, your child may need to wear retainers or a space maintainer to hold his/her treatment progress. Your child will see the orthodontist for periodic checks to evaluate his/her jaw development and eruption progress and decide on the optimal time to start Phase 2 treatment.

Can my child have orthodontic treatment with baby teeth?
Yes. Some orthodontic problems like crossbites, underbites, and large “overbites” are better corrected earlier rather than later. Early correction often leads to easier and more predictable treatment after all of the permanent teeth have erupted. See Orthodontic Problems in Children.

My child’s friends already have braces, but my orthodontist says my child is not ready for treatment yet. Why?
Just as children mature at different ages, their teeth and jaws mature at different ages. Early developers may have all of their permanent teeth erupted (except wisdom teeth) by age 9 while late bloomers may not until age 14 or later. Your orthodontist will be able to determine what stage of development your child is in, and can determine the optimal time to begin treatment. If you have further concerns, consult your orthodontist.

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