Phase I Versus Phase II Orthodontic Treatment

So what exactly is Phase I orthodontic treatment?  It is early interceptive orthodontic care that precedes the placement of full-mouth braces.  Active Phase I treatment usually takes between 12 to 18 months to complete and it can range from a simple retainer or headgear to placing braces on the front teeth and expanding the arches.

When is Phase I orthodontic treatment done?  Typically it is done when the front teeth, or the four upper and the four lower incisors are in place.  This is usually between the ages of 7 and 9 depending on how rapidly these teeth erupt and the severity of the orthodontic problem.

What happens after Phase I orthodontic treatment has been completed?  In most cases, retainers are placed to provide the young patient’s teeth with a resting period while the remaining permanent teeth erupt.  Periodic recall appointments are scheduled every 3 to 6 months to supervise the eruption of the permanent teeth and to monitor the correction achieved during Phase I treatment.

What is Phase II orthodontic treatment and why is it necessary?  Even though a child may have completed a first phase of orthodontic treatment, over half of the adult or permanent teeth have yet to erupt.  The permanent teeth erupt into the mouth in two time periods.  Usually, from about age 5 to about age 8½, the front four upper incisors, the front four lower incisors and the four back 6-year molars erupt.  That accounts for 12 out of 28 teeth (not including the wisdom teeth).  The remaining permanent teeth erupt into the mouth from about age 11 to age 13.  Every tooth in the mouth has an ideal location in harmony with the lips, cheeks, tongue and other teeth.  When this equilibrium is established, the teeth have the best chance of functioning properly, remaining healthy and looking attractive.  Phase II involves placing braces on all of the teeth and this phase of orthodontic treatment takes between 18 to 24 months to complete.  Final retainers are then delivered to hold the orthodontic correction.

What are the advantages of two-phase orthodontic treatment?  The primary goal of two-phase treatment is to maximize the potential for an ideal, healthy and functional bite, and for an aesthetic and pleasing smile.  Two-phase treatment can accomplish the following:  improve jaw discrepancies, create more space for erupting teeth (thus encouraging proper alignment and reducing the need for extraction of permanent teeth in some cases), eliminate abnormal muscle habits, correct harmful crossbites, realign crooked or protrusive front teeth (thus reducing the chance for traumatic injury), and improve the young patient’s facial appearance (often resulting in enhanced self-esteem).

Are there any disadvantages of doing two phases of orthodontic treatment?  Usually a child will begin Phase I orthodontic treatment at age 7 or 8 and eventually complete Phase II at about age 14.  Obviously this a relatively long span of time (6 to 7 years) and some children feel like they have spent innumerable years going to the orthodontist and even show signs of burnout during Phase II.  The other factor is expense.  The cumulative costs of Phase I and Phase II orthodontic treatment are often as much as 50% more than waiting and just doing a single phase of treatment at age 13.  For this reason, some orthodontists may try to simplify Phase I and only place space maintainers to help alleviate crowding.  Many space maintainers can be billed under “dental” insurance instead of “orthodontic” insurance thus deferring some costs until later.  In addition, some orthodontists will delay the start of treatment until age 12 or so and treat a child in one long phase by starting with a headgear when only a few baby teeth remain and then place full braces a year or so later once the last few permanent teeth erupt.

By Gary Reichhold, DDS

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Most people think of orthodontic treatment as being expensive.  The typical costs for braces or Invisalign treatment for the average teenager is anywhere from $5000 to $7000 depending on where you live and the complexity of the treatment.  Clearly that’s nothing to laugh at!  To most people, that’s a lot of money.  However, when you consider that the average treatment time is anywhere from 18 to 24 months, it really brings the value into the proper perspective relative to other areas of dentistry.

For example, the cost for a single crown or a porcelain veneer is likely in excess of $1000.  The same is true for a root canal on just one tooth.  These procedures typically take just a few hours from start to finish to complete.  Consider that orthodontic treatment takes several appointments of anywhere from 15 to 20 minutes every 8 weeks over the course of 18 to 24 months, and it becomes clear that the costs for orthodontic treatment are actually quite reasonable.  Add in the fact that most orthodontists offer no-interest financing and it becomes even more of a bargain.

One way that people try to cut the costs of orthodontic treatment is to seek care through a non-specialist or through a clinic.  Non-specialists are usually general dentists who offer orthodontic treatment as an adjunct to their other routine dental services.  Unfortunately, most general dentists have very little advanced training in orthodontics, so they clearly lack the experience that most certified orthodontists have.  They may have taken a few weekend courses on orthodontic treatment, but they really are not truly equipped to take on most orthodontic cases.    Typically their main focus is simply to “straighten the teeth”.  All orthodontists are required to have at least two years of advanced training and many have had at least three years.  Orthodontists are highly trained specialists that not only have the ability to straighten teeth; they understand the importance of providing good function and long-term stability for every patient they treat.

The other avenue that people may choose to reduce orthodontic costs is to go to a dental clinic.  There is one prominent dental clinic in California that provides dental services and some specialty services such as orthodontic treatment.  Their fee for orthodontic treatment is often less than $5000, so it’s much more affordable to many people.  Unfortunately, what people don’t realize is that there may be an orthodontist on staff in the office only one day a week (and often only one or two days a month) and this orthodontist is frequently fresh out of school.  These young orthodontists often use these dental clinics as a stepping stone to their next orthodontic practice, so there tends to be a high turnover of specialists in these clinics.  That leads to discontinuity in patient care which in turn leads to extended treatment times and poor results.  How do I know this?  I see it regularly in my own practice.  The influx of people who start their orthodontic treatment in these clinics and transfer to my practice (and I’m sure to other well-qualified orthodontists) is astounding!

What we see is people who are very dissatisfied with their orthodontic treatment and they want to see that it’s done right.  Their complaints range from ridiculously long waits in the reception room to continuous modifications in the treatment plan due to changes in the orthodontists (one leaves and a new one takes over).

Orthodontic treatment is something that should not be taken lightly.  It is a very long process that should be entrusted to an expert who can complete the treatment in a timely fashion to the highest level of competency.  Also, since it is a long process, it is essential that the patient feels comfortable throughout the entire experience with the individuals providing the treatment.  There is really nothing worse than entrusting your child to the care of someone who really doesn’t have the qualifications necessary to complete your child’s treatment to the highest standards.  No one wants to find out after two years that the treatment results are compromised and you truly “got what you paid for”.

By Gary Reichhold, DDS

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So why are patients still being told that they can’t use Invisalign and must instead wear full braces for their entire treatment?  The most likely reason is that many orthodontists simply lack experience with Invisalign.  Invisalign was developed in the late 1990’s and was not readily available and in use until the early 2000’s.  Thus there are thousands of orthodontists out there with many years of experience using braces, but Invisalign is still relatively new to many of them.  Due to this lack of experience with Invisalign, many orthodontists believe full braces are easier to use and better for the patient in the long run.

The reality is that this simply is not true.  Teeth can be moved effectively with either braces or Invisalign aligners.  The main difference is that braces can both “push” and “pull” teeth by means of the archwires that run through them.  This is because the braces are firmly attached to the teeth.  Invisalign aligners on the other hand can “push” teeth quite effectively, but since they are removable appliances, there isn’t the ability to “pull” teeth into their desired positions.  This can create some limitations with Invisalign when there are more complex tooth movements involved.

However, orthodontists have the ability to mix and match when it comes to the more difficult cases.  Braces can certainly be placed on some teeth for a relatively short period of time to achieve the more difficult movements, and then the patient can be switched over to Invisalign to complete their treatment.  We do this routinely in our practice and we have found that our patients are happier to wear braces on a few teeth for a few months and Invisalign aligners the rest of the time, as opposed to wearing braces for the full period of treatment.

Finally, it’s important to note that Invisalign may not be for everyone.  It is an orthodontic treatment modality that is compliance driven and obviously the aligners must be worn consistently as instructed by the orthodontist to achieve the desired results.  Therefore, the only patients that should not be treated with Invisalign are those who question their ability to wear the aligners 20 to 22 hours every day.

Remember, if you are interested in orthodontic treatment and you’re motivated to get that great smile that you’ve always wanted, Invisalign may very well be an option for you.  Simply click on the link below to find a well-qualified orthodontist with experience using Invisalign near you!

By Gary Reichhold, DDS

http://www.invisalign.com/

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Our Movie Day was a blast!  Hope you all had a great time!

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Win an iPad mini!!!

We are looking to expand our

Facebook Family and

we need your help!

*Our goal is to have 1000+ fans by May 31^st

We have 230 raving fans and we can’t wait to have you join our Facebook Family too. Best of all, one lucky Facebook fan wins an iPad mini!

Entering the contest is simple. Go to our Facebook page by scanning the QR code below. You also can use one of our office iPads at your next visit and go to our Facebook page to “like us”. Please let us know in person or via e-mail that you are a fan and we will enter your name in the drawing.

We will be selecting the winner

on June 1^st!

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