Orthodontic treatment corrects improperly positioned teeth and jaws. In younger patients, it is often a staged process designed to address issues as the face and mouth develop. The goal is to improve the appearance of the smile, the function of the bite, and the health of the teeth and gums. The initial stage, known as Phase 1 orthodontic treatment, is a focused intervention for complex problems.
Defining Early Orthodontic Intervention
Phase 1 orthodontic treatment, also called interceptive orthodontics, is the first stage of a two-part plan used while a child is still growing rapidly. This treatment occurs during the period of mixed dentition, typically between the ages of six and ten, when the child has a combination of primary and permanent teeth. The objective is to intercept a developing problem before it becomes severe, not to achieve perfect alignment of all teeth. By addressing skeletal and functional issues early, orthodontists guide the development of the jaw bones and create room for permanent teeth. This proactive intervention simplifies or shortens the comprehensive treatment required later.
Specific Issues Phase 1 Addresses
Phase 1 focuses primarily on correcting severe structural or functional problems involving the jaw or the relationship between the upper and lower arches. A common issue is a posterior crossbite, where the upper back teeth bite inside the lower back teeth, potentially leading to asymmetric jaw growth. Addressing this while the upper jaw’s bone structure is pliable can normalize the bite. Phase 1 also mitigates severe dental crowding by creating adequate space for permanent teeth to erupt, preventing impaction or the need for future extractions.
Phase 1 also addresses pronounced skeletal discrepancies, such as an underbite, where the lower jaw grows excessively forward. Correcting this jaw relationship early prevents the need for orthognathic surgery once growth is complete. Persistent detrimental oral habits, like prolonged thumb or finger sucking, can cause an open bite where the front teeth do not overlap. Phase 1 helps stop the habit and reverses the resulting dental changes. Finally, protruding front teeth, which are susceptible to trauma, can be retracted during this phase to reduce injury risk.
How Phase 1 Treatment Works
Phase 1 treatment uses specialized appliances to influence skeletal growth and tooth eruption, with active treatment typically lasting between six and eighteen months. The palatal expander is a frequently used device, cemented to the back upper teeth, which gradually widens the upper jaw to correct a crossbite or create space. The controlled widening is achieved by turning a small screw on the expander. Space maintainers are used when a baby tooth is lost prematurely, ensuring adjacent teeth do not shift into the empty space and block the path of the permanent tooth.
Limited or partial braces may be used during Phase 1, placed on select permanent teeth to correct specific alignment issues or guide the jaw relationship. Functional appliances, often removable, may also be prescribed to guide the growth of the upper and lower jaws into a harmonious alignment. This active treatment focuses on foundational corrections, such as proper jaw width or bite relationship, and is not aimed at the final detailed alignment of every tooth. Once the goals are met, the appliances are removed, and the child enters a supervised observation period.
The Rest Period and Phase Two
Following Phase 1, the patient enters a “resting period” of retention and observation before the potential start of Phase 2. During this time, the Phase 1 corrections are maintained, often with a retainer, while the remaining permanent teeth erupt into the guided spaces. The orthodontist closely monitors the patient’s dental and facial development every few months. This period can last for several years and is necessary because Phase 1 rarely results in a perfect, permanent finish.
Phase 2 treatment, or comprehensive treatment, is typically initiated in early adolescence once most permanent teeth have erupted. This stage involves using full upper and lower braces or aligners to achieve the final, detailed alignment of all teeth and establish a precise, functional bite. The benefit of the earlier Phase 1 intervention is that it addresses complex jaw and space issues, making Phase 2 shorter, more straightforward, and less invasive.