What is Two-Phase Orthodontics?

Two-phase orthodontics adds an additional, earlier stage of orthodontic treatment (for kids) prior to the typical teen-in-braces stage. It can involve a wide variety of treatments, but some common scenarios include:

• Partial braces for six months at age 8 to correct a crossbite, followed by full braces for a year starting at age 13 to close gaps between teeth
• A space maintainer at age 5 in place of a prematurely lost tooth, then braces to address crowding once all permanent teeth have erupted
• Invisalign^® First to correct an underbite at age 6, followed by Invisalign for Teens to straighten teeth, starting at age 11
• A palatal expander in Phase 1, followed by braces or Invisalign in Phase 2

These are just examples of how two-phase orthodontics may look, but each individual case is unique. We will create a treatment plan totally personalized to your child, taking into account not only their teeth and jaw structure, but their lifestyle, activities, and personality too.

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What is Phase 1 Orthodontics?

Also known as early-interceptive treatment, Phase 1 orthodontics can address a bite or jaw development issue before it has the chance to affect permanent dentition. Phase 1, if needed, usually begins between ages 6 and 10. Examples of Phase 1 treatments include:

• Partial braces
• Invisalign First
• RPE (palatal expansion)
• Space maintainer

Phase 1 orthodontics can occasionally stand alone, depending upon what we’re treating. Most patients who get Phase 1, however, will go on to also get Phase 2.

What is Phase 2 Orthodontics?

Phase 2 orthodontics begin around the typical “braces age” of 11 or older. Phase 2 treatment may be a follow-up to a Phase 1 treatment, or it may be a patient’s only orthodontic treatment. Examples of Phase 2 treatments include:

• Full braces, with or without elastics or TADs
• Invisalign for Teens
• Surgical orthodontics

What Are the Benefits of Two-Phase Orthodontics?

Why would your child need braces twice? We don’t recommend it very often, but when it is truly indicated, two-phase orthodontics can offer your child several benefits, including:

• Easier or shorter Phase 2: The most common reason patients receive Phase 1 orthodontics is because we believe it can make their Phase 2 treatment significantly easier or shorter in duration. 
• Growth intervention: Connected to the previous reason, certain bite issues are easier to fix when a child is young and their bones are still pliable. For those specific issues, waiting until the child is in their teens could cause the correction to take longer and be more uncomfortable.
• Improved social experience: If your child has a dental difference that is causing them social distress, we want to help them. Phase 1 treatment can resolve an issue that a child is very self-conscious of or is causing them to be bullied, for example. Primary school is hard enough under even the best circumstances!
• Reduced injury risk: Certain dental issues, such as a protruding tooth or teeth, can make a child more prone to dental trauma. Bringing everything in line can reduce their chances of displacing or knocking out the tooth/teeth in question.

At Level Orthodontics, we generally prefer a watch-and-let-grow approach. But there are times when it’s clear that something is going to give us trouble later on if we don’t address it now.

Phase 1 Treatments

Phase 1 orthodontics is meant to prevent speedbumps, to guide growth early rather than correct dysfunctional growth later. At Level Orthodontics, we recommend Phase 1 sparingly. Current research around its effectiveness points to a judicious, case-by-case approach. For children who stand to benefit from early-interceptive orthodontics, the following are some of the Phase 1 treatments we offer:

Partial Braces

Phase 1 braces are different from conventional, full braces. Meant for the mixed dentition stage of development between ages 6 and 10, partial braces “work around” the business of shedding baby teeth and erupting permanent teeth. Their goal is [typically] not to align teeth, but rather to correct a bite issue. Partial braces may be on molars only, or only on the bottom arch, for example. They are also generally worn for a shorter duration than full braces.

Invisalign First

Similar to partial braces, Invisalign First is designed to correct bite or development problems during children’s mixed-dentition stage. The clear aligner trays may be more comfortable than braces, and they’re less conspicuous. Not every child who needs Phase 1 treatment will be a good candidate for Invisalign First. Dr. Zhou will be able to let you know if it’s a good choice for your child’s treatment.

Rapid Palatal Expansion (RPE)

Rapid palatal expansion, or RPE, can be a Phase 1 or Phase 2 treatment, as it is effective at least until age 14, often longer. RPE employs a small appliance that sits on the roof of the patient’s mouth, attached by bands to one molar on either side and braced against several more.

Patients or their caregivers turn a key each day to slowly expand the appliance. This places gentle pressure on the maxillary arch to expand in kind. Children tolerate RPE treatment very well because their palatal suture is not yet fused. Should a patient require palatal expansion after the teen years, then they may be a candidate for MARPE instead.

RPE is indicated for patients whose maxilla is narrow, or underdeveloped. It may be used alone or together with partial braces. Untreated, an underdeveloped maxilla can cause: 

• Underbite
• Teeth crowding
• Nasal airway obstruction
• Sleep disordered breathing (apnea)
• TMJ disorders
• Facial asymmetry
• Speech problems

Beyond age 15 or 16, patients often require MARPE instead of RPE. The two work on identical principles and functions, but older patients typically don’t respond to simple RPE. The “MA” in MARPE stands for “miniscrew assisted,” meaning that the hardware needs to be affixed to the palate, as attachment to the molars alone is insufficient to separate the palatal suture.

Space Maintainer

For children with congenitally missing teeth, or who’ve lost a tooth prematurely, a space maintainer can prevent other teeth from crowding into its space. Primary teeth are placeholders for permanent teeth, so that the latter can grow into their respective places. When a primary tooth is missing for too long before the permanent tooth erupts, other neighboring teeth may drift into its space, which can lead to impaction when the permanent tooth is finally ready to emerge. 

A space maintainer is a temporary prosthesis that holds the tooth’s space while we wait for the permanent tooth. (Or in the case of hypodontia, if the corresponding permanent tooth is also missing, until a permanent prosthesis can be placed.) The space maintainer may be bonded to neighboring teeth, or it may be removable. Dr. Zhou can let you know which type is appropriate for the specific situation.

Why Might My Child Need Phase 1 Orthodontics?

Our approach is fairly conservative. We prefer to have your child in orthodontia as little as possible, so Dr. Zhou will make his recommendations accordingly. A few specific concerns that may lead us to recommend an early-interceptive treatment may include:

• Anterior crossbite/underbite: When the patient bites down and their lower front teeth overlap their top front teeth, this is an anterior crossbite. If your child has an anterior crossbite, Phase 1 orthodontics can guide their growth and potentially help them avoid more invasive orthodontic treatment or even surgical intervention later.
• Posterior crossbite/underbite: When the patient bites down and their lower back teeth overlap their upper back teeth, this is a posterior crossbite. Phase 1 treatment of this malocclusion can also help prevent more invasive treatment later.
• Underdeveloped maxilla: If a child’s palate is too narrow, this is an underdeveloped maxilla. Rapid palatal expansion can address immediate issues like crowding, and prevent many pathologies that may emerge later in life.
• Severe crowding: If teeth are so crowded that they can’t be kept clean or your child is experiencing social problems around it, they may be a good candidate for early-interceptive treatment.
• Protrusion: A protrusion, similar to severe crowding, may cause a child social or self-esteem issues. It may also make them more prone to dental trauma injuries. 

Phase 1 and Phase 2 Orthodontics in Williamsburg, Brooklyn

Each new stage of childhood seems to call on parents to learn entire volumes of new information. Level Orthodontics and Dr. Zhou are here to help you understand your kiddo’s orthodontic options and make an informed choice for them. Book consultation today to start the conversation!