Using Two Phases of Treatment for Better Smiles

Using 2 phase orthodontic treatment is a popular and effective method of aligning the teeth to achieve a more attractive smile. This procedure involves two separate phases which can help straighten teeth, close gaps, and improve the bite. Learn more about 2 phase orthodontic treatment here, including what to expect and potential risks.

What Is 2 Phase Orthodontic Treatment?

The 2 phase orthodontic treatment (more professionally known as "two phase orthodontic treatment") is a dental procedure that uses two approaches to straighten teeth and give a more attractive smile. This procedure involves the use of braces or aligners for each phase and typically takes about 18 months by an orthodontist. The result of 2 phase orthodontic treatment includes straighter teeth that look better and an improvement to your biting function. Additionally, it can help increase self-confidence and improve oral hygiene.

We identify at an early age certain skeletal and dental discrepancies and utilize specialized appliances to modify these conditions so the dentition and facial relationships can continue to develop more normally, maximizing the opportunity for the teeth and jaw relationships to relate in the most healthy, functional, and stable ways. When the appropriate interceptive treatment has been accomplished, the second phase of treatment, if needed, will result in far fewer compromises, reduced dental compensations for jaws not being properly related, shorter treatment times, a healthier, more functional and stable result, AND, in our office, a reduction in the second phase treatment cost that would be no more than if you were to wait until all the permanent teeth were in for treatment to start at the second phase. Dr. Skarin does not want to penalize families for choosing the plan with the best outcome only to find out it will frequently cost up to twice the fee with the use of 2 phase treatment. Learn more about how we assess treatment costs. Also, learn why early orthodontic treatment is important to consider for your child.

What Is Involved in the First Phase?

The first phase of 2 phase orthodontic treatment involves a combination of techniques such as braces, partial braces, aligners, retainers, or orthodontic appliances to help a child’s dental development into adulthood. Depending on the individual's needs, the orthodontist may also use other tools such as expanders or bite turbulators to widen the upper and lower jaw bone, creating more space for teeth alignment.

The goal of Phase One treatment is to help the jaw develop in a way that will accommodate all the permanent teeth and improve the way the upper and lower jaws fit together. Children often exhibit early signs of jaw problems as they grow and develop. A narrow upper jaw may require one of many forms of expansion, both removable or fixed, and depending on whether it is a skeletal or dental crossbite. Space gaining or space maintaining appliances are also frequently used to create needed room for all the permanent teeth to come in without crowding. Vertical problems such as impinging overbites or open bites due to tongue posturing or improper swallowing patterns are managed with appropriate appliances. Front to back skeletal problems where one jaw is too far forward or back can also be addressed early and can utilize orthopedic functional appliances, both removable or fixed, represented by different forms of headgear or Herbst fixed appliances.

Children benefit tremendously from early-phase treatment. Receiving early treatment may prevent the removal of permanent teeth later in life, or the need for surgical procedures to realign the jaws.

Orthodontic records appropriate to the problem will be recommended to determine the type of appliances to be used, the duration of treatment time, and the frequency of visits. Records may consist of radiographs that might have already been taken recently by the family dentist or specialized ones Dr. Skarin will suggest. If an appliance is suggested, models will be needed for the construction of the appliance; in Dr. Skarin’s office, those appliances are created by Dr. Skarin on site.

Observation Period prior to Second Phase

In this phase, the remaining permanent teeth are left alone as they erupt (grow/develop into place). Retaining devices that do not interfere with the eruption of the rest of the permanent teeth are usually the ones used to manage the first phase and are used to transition into the permanent dentition. In short, this period is where the development of the permanent dentition is monitored and can be tweaked as the eruption of the cuspids and bicuspids occur. A successful first phase will have created room for permanent teeth to find an eruption path, although the teeth can still come in rotated or in crossbite. However, the conditions for leading into a possible second phase have been made more ideal.

At the end of the first phase of treatment, teeth are most often not in their final positions. This will be determined and accomplished in the second phase of treatment. Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Therefore, periodic recall appointments for observation are necessary, usually on a six-month basis.

When Do You Move On to the Next Phase?

After the desired result has been achieved in the first phase of 2 phase orthodontic treatment, it's time for the second phase. During this stage, you will work with your orthodontist to fine-tune and stabilize your new smile. Your orthodontist may use braces, aligners, or our patented Skarin System technology in this phase, or they may utilize retainers, wires and other tools to spot correct any remaining problems. Once your teeth have been straightened out and all progress has been reviewed, you should have a beautiful new smile that will last for years!

What Is Involved in the Second Phase?

The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. Phase two usually involves full upper and lower braces, but if the first phases have done what they were designed to do, will not require the length of time or compromises and compensations that would be needed if we waited for treatment to begin once the permanent teeth were all erupted. As is always the case following the second phase, the retention and maintenance phases will begin in order to allow the patient to retain their beautiful, functional, and stable bite and smile!

What Are Some of the Benefits of 2 phase Orthodontic Treatment?

2 phase orthodontic treatment offers a variety of benefits, including:

It can also reduce plaque buildup, prevent tooth decay and gum disease, correct misalignment issues, properly align your jaw and teeth, reduce speech impediments caused by poor alignment, and even improve digestion.

How Long Does 2 Phase Orthodontic Treatment Take?

One of the questions that frequently comes up is how long will a multiple phase treatment take. Unfortunately, it will depend on when the first phase starts, which can be as early as seven or eight, and will not be completed and into retention until the permanent dentition is completely erupted, which for some patients that might have a delayed dental development could be as late as sixteen or seventeen, but more typically, earlier, in the thirteen to fourteen range. While this information is somewhat nebulous, it is important to realize that there can be an interval of three to four years of observation where little or nothing is done besides an occasional visit to check the eruption of the remaining permanent teeth. But this reality needs to be taken into consideration when making future decisions.