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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1. Brackets
Brackets are the metal or ceramic pieces that are bonded to each tooth and hold archwires in place. They are the foundations of braces.

2. Self-ligating brackets
There are brackets that have a locking door which secures the archwire to the brace. They are more hygienic and more comfortable than a traditional bracket. They also are more efficient than a traditional bracket because there is less friction (no rubber elastic ties are necessary) and thus teeth will move faster.

3. Bands
Bands are thin stainless steel metal rings that are cemented typically to the back teeth (the molars) where biting forces are stronger. They are more durable than brackets and do not come loose as readily.

4. Archwires
The archwires are the metal wires that go through all of the bands and brackets of braces and guide the teeth into their new positions. In most cases, you will have an upper archwire and a lower archwire. Some of your orthodontist appointments might be for a new archwire, which means you will be getting a tighter wire to help continue the movement of the teeth.

5. Elastics
Elastics, or rubber bands, are attached to hooks on the teeth and can move teeth in ways that brackets and wires alone cannot do. Elastics are most commonly used to realign the jaws in patients with bite problems such as an overbite, an underbite or a crossbite.

6. Elastic ties or rubber bands
Elastic ties are the little rubber loops or O-rings that secure the archwires to the brackets. One of the fun parts of braces for children is getting to pick from a whole array of colored elastic ties.

7. C-Chain, Power Chain or Energy Chain
A c-chain in similar to elastic ties, except the elastic ties are linked together to form a continuous chain. This type of ligature is extremely effective in closing spaces between teeth and keeping those spaces closed. Power chains or energy chains are simply stronger versions of c-chains.

8. Steel ligature ties
These are similar to elastic ties, but they are made of stainless steel and they are used to secure the archwire more snugly to the bracket. There is a twisted end to these ligatures that can sometimes bend outward and cause irritation, so use a pencil eraser to simply bend it back inward if this occurs.

9. Crimpable or ball hooks
These are small rigid metal hooks that are used to attach rubber bands from the top to the bottom braces.

10. Kobiyashi or k-hooks
These are stainless steel ligatures with hook for elastics similar to crimpable or ball hooks, but they can be easily clipped to remove them when they are no longer needed.

11. Coil spring or push coil
A stainless steel or a nickel titanium spring used to open space between teeth. They work opposite of c-chains.

12. Headgear or neckgear
A common orthodontic appliance that applies extraoral traction for growth modification, tooth movement and anchorage. Headgears and neckgears typically are composed of a stainless steel wire (a facebow) that inserts into metal tubes attached to metal bands on the upper first molars within the mouth. The facebow extends out of the mouth where a thick elastic strap attaches to the facebow and applies a light force backward to help correct an overbite for example.

13. Separators or spacers
Separators, or spacers, are just that. They are very small rings that are placed between teeth to create enough space for metal bands. They typically stay in place for about one week or long enough to create adequate space between back teeth.

14. Bite Plate
A bite plate is an acrylic appliance most commonly used to open one’s bite. It is similar to a retainer, but its main purpose is to prevent the upper teeth from occluding on the lower teeth or biting off the lower braces.

15. Palatal Expander
A palatal expander is an appliance that is often used in the earliest stage of orthodontic treatment, or Phase I. Its name describes its purpose: it expands or widens the upper jaw so that the upper teeth and the lower teeth can fit together better. If the upper jaw is too narrow, the palatal expander will widen the jaw to eliminate a crossbite of the back teeth. It is usually activated over time by turning a key in the center of the expander.

16. Debanding
This is the removal of the braces following the completion of treatment.

17. Gingiva
This is the term describing the gum tissue that surrounds the teeth. It consists of a fibrous tissue that is continuous with the periodontal ligament and mucosal covering.

18. Maxillary
Pertaining to the upper jaw. May be used to describe teeth, dental restorations, orthodontic appliances or facial structures.

19. Mandibular
Pertaining to the lower jaw. May be used to describe teeth, dental restoration, orthodontic appliances or facial structures.

20. Retainer
Any orthodontic appliance, fixed or removable, used to maintain the position of the teeth following orthodontic treatment. Retainers can be made of acrylic and wires (Hawley), clear plastic (Essix or truax) or sometimes wires that are bonded to the backs of teeth permanently.

21. Retention
The passive treatment period following active orthodontic correction during which retainers are typically used.

Whether you are new to braces for kids or adults, or already in full treatment, it never hurts to have a better understanding of some of the terms you might hear at your visits to the orthodontist.

By Dr. Gary Reichhold

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TAD’s are sometimes necessary in cases where a patient’s teeth need to be moved in a certain way to get the results that we want. For example, when a tooth is extracted prior to orthodontic treatment due to crowding in that area of the mouth, the teeth on either side of the extracted tooth move toward each other to close the space. This movement between teeth is based on one of the laws of physics that states that “for every action there is an equal and opposite reaction”. However, if a patient has a severe overbite and an upper tooth is extracted on each side of the mouth to make room to move the upper front teeth back, we need to maximize that backward movement to correct the severe overbite. In order to accomplish this, we need to anchor the upper back teeth so that all of the movement comes from the upper front teeth. That’s where TAD’s come into play!

The placement of a TAD is very simple and painless. We typically place a topical anesthetic on the gum tissue overlying where the TAD will be placed. The gum tissue is the only part of the mouth that can feel anything because there is no innervation within bone itself. As long as the gum tissue is numb, the procedure will be completely painless. A driver that is similar to a screwdriver is used to drive the TAD through the gum and into the bone. Insertion takes less than a minute in most cases. TAD’s are usually placed between the roots of two adjacent teeth. In the rare case of root damage, roots will typically repair themselves without issue. When it is time for the TAD to be removed, anesthesia is rarely even needed. It’s that easy!

After a TAD is in place, it provides an immovable object that can be used to pull, push, intrude or extrude teeth that are being straightened. The only requirement is that patients keep the gum tissue around the TAD clean and healthy. In addition to routine brushing, a mouth rinse such as chlorhexidine should be used on a regular basis until the TAD is removed. As long as the gums are kept healthy, there are very few complications that can arise from a TAD.

There are many advantages to utilizing TAD’s during orthodontic treatment. Since TAD’s don’t move, orthodontists can use them to move teeth in directions and amounts that previously were not possible. TAD’s are comfortable, they can reduce treatment time, they can help to improve esthetics, they reduce reliance on patient cooperation such as wearing a headgear, they sometimes can eliminate the need for jaw surgery, they enable us to move and place teeth into healthy positions that otherwise would not be possible and they can help close spaces more efficiently. Orthodontics has a come a very long way in the last 10 to 20 years. Temporary anchorage devices are one of many new and exciting innovations that make orthodontic treatment more desirable and efficient to both children and adults!

By Dr. Gary Reichhold

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Invisalign treatment is utilized to gradually straighten teeth as an alternative to traditional metal or ceramic braces.  Invisalign aligners are switched out in the series about every two weeks.  The number of aligners in treatment varies depending on your individual needs.  Each aligner is custom-made with exact calculations to gradually shift your teeth into place.  Since the Invisalign aligners are custom-made for your teeth and your teeth only, with a plan devised specifically by your orthodontist, you will end up with a smile that truly fits you.

Invisalign is the brand name of a revolutionary and innovative way to straighten teeth.  A sequential series of clear plastic aligners similar to bleaching trays are

If you’re ready for a smile that transforms your appearance, Invisalign treatment may be your answer.  Although there are many choices out there, no system other than Invisalign works as effortlessly.  We believe Invisalign is the best way to transform your smile without interfering with your day-to-day life!  If you have had orthodontic treatment in the past and have had some relapse, but do not want braces again, you likely are a great candidate for Invisalign treatment.  To learn more about Invisalign, click on the link below.

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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