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When Is Two-phase Orthodontics Beneficial – Part 1

Two phase orthodontics

Two-phase Orthodontic Treatment: Here’s one of our patient, H.C. at age 5.8 and at age 8.0, who still visits us from out-of-state.  She was first diagnosed with a posterior cross-bite along with facial asymmetry. She underwent early phase orthodontics with us to correct her cross-bite and establish symmetrical facial growth.  Upper and lower left pictures are BEFORE treatment, upper and lower right pictures are AFTER treatment.

Unilateral Lingual Crossbite with Mandibular Shift

Early orthodontic treatment, commonly referred to as Phase I treatment, is sometimes indicated on growing children when certain problems exist at a young age. One of the most common malocclusions that warrant Phase I treatment is the posterior cross-bite with mandibular shift.  This kind of cross-bite is the most frequent (about 50% of all cross-bites).  It will show a midline shift between the upper and lower incisors, a bilateral constriction of the upper arch, does not self-correct, and most importantly demonstrates moderate degrees of facial asymmetry.  Left untreated, not only does the cross-bite affect the amount of space available to the developing teeth, but also a worsening of the facial asymmetry ensues.

On my patient above, she already shows this facial asymmetry at age 5.  You can see on the facial picture that her chin is deviated to the right when her teeth are in their biting position.  When her teeth come together, the cross-bite is guiding her lower jaw to the right, and hence, promoting asymmetrical growth of her mandible.  Left untreated, these patients usually require surgery of the jaws to correct their dental and facial appearance as an adult.  When diagnosed and treated early, orthodontist can eliminate the shift of the mandible by widening the palate.  This is accomplished with the help of a palatal expander along with limited braces.  The bony plates that form the palate and upper jaw structures are not fused yet, and therefore, very moldable at a young age. This allows us to widen the palatal transverse dimension.

Phase I usually takes about 18 months in length and we typically start at the earliest age that our child-patients can tolerate.  Most children do very well between the ages of 5 and 7.  As you can see from the above pictures, our lovely patient treated out very nicely.   We were able to expand her palate, eliminate the cross-bite and establish facial symmetry and growth.  At completion of this phase, most of the difficult problems have been solved, and now we are just waiting on the remaining permanent teeth to erupt within the next few years.  These new teeth will erupt in the new upper jaw width that we have established.  At one point in the future, she will need a second detailing phase to complete her harmonious occlusion and alignment.  This 2nd phase is 12-18 months in duration and is usually needed to ensure the proper inter-digitation of their teeth.  Overall, an early orthodontic phase allows for the most important problems to be corrected at an age where it responds the best.  When done successfully, surgical intervention may be avoided.

Dr. Surillo
Diplomate, American Board of Orthodontics
Children’s Braces & Dentistry