Two Phase Orthodontics

Orthodontic treatment is highly predictable and immensely successful.  Depending on the severity of the malocclusion (bad bite) or irregularity, orthodontic treatments may occur in either one or two distinct phases.

The benefits of correcting misaligned teeth are many.  Straight teeth are pleasing to look at and greatly boost confidence and self esteem.  More importantly, properly aligned teeth enhance the biting, chewing and speaking functions of the jaw.  There are several types of irregularities, including:

  • Overbite – The upper teeth protrude further than or completely cover the lower teeth.

  • Underbite – The lower teeth protrude further than the upper teeth causing the chin to look prominent.

  • Crossbite – Some of the upper teeth may close inside the lower teeth rather than on the outside.

  • Overcrowding – Insufficient room on the arch causes some adult teeth to erupt incorrectly and become rotated.

The Phases of Orthodontic Treatment

Generally, orthodontic treatment takes between six and thirty months to complete.  The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient.

What is the advantage of two-phase orthodontic treatment?

Two-phase orthodontic treatment is a very specialized process that encompasses tooth straightening and physical, facial changes. The major advantage of a two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, aesthetic result that will remain stable throughout your life. Dr. Robert B. Nay will recommend early treatment if he deems it beneficial for future growth and development of the jaws and/or eruption of permanent teeth. Early treatment decreases the risk of having impacted teeth, decreases the chances of permanent teeth needing to be extracted and helps improve the eruption of permanent teeth.  Improvement in esthetics is not usually a criteria for recommending early treatment; however, if parents would prefer, Dr. Nay will review the pros and cons of this elective treatment.

 What if I put off treatment?

The disadvantage of waiting for complete eruption of permanent teeth and having only one phase of treatment for someone with a jaw discrepancy is facing the possibility of a compromised result that may not be stable. Also, there may be more limitations to achieving an ideal result in a shorter period of time.

Planning now can save your smile later

Because they are growing rapidly, children can benefit enormously from an early phase of orthodontic treatment utilizing appliances that direct the growth relationship of the upper and lower jaws. Thus, a good foundation can be established, providing adequate room for eruption of all permanent teeth. This early correction may prevent later removal of permanent teeth to correct overcrowding and/or surgical procedures to align the upper and lower jaws. Leaving such a condition untreated until all permanent teeth erupt could result in a jaw discrepancy too severe to achieve an ideal result with braces.

First Phase Treatment: Your foundation for a lifetime of beautiful teeth

The goal of first phase treatment (Phase I) is to develop the jaw size in order to accommodate all the permanent teeth and to relate the upper and lower jaws to each other. Children sometimes exhibit early signs of jaw problems as they grow and develop. An upper and lower jaw that is growing too much or not enough can be recognized at an early age. If children after age 6 are found to have this jaw discrepancy, they are candidates for early orthodontic treatment.  Children are ideally between the age of 7 - 10 during this phase which is when the bones are softer and more "moldable" than a child reaching puberty.  Phase I may involve braces, removable appliances, expanders, headgear or other types of orthodontic appliances.     

What if Phase One is not needed?

The AAO recommends that all children be seen by an orthodontist at the age of 7. If early treatment is not beneficial to the child, Dr. Robert B. Nay will put the child on a recall. During the recall stage, the child will be seen every 6 - 9 months for a growth and development appointment in order for the orthodontist to monitor the eruption of teeth and follow the growth of the child.

After completing Phase One:

In this phase, the remaining permanent teeth will erupt. Retaining devices are sometimes recommended to maintain skeletal improvements. If retainers are used, Dr. Nay will design it to best allow the existing permanent teeth some freedom of movement while final eruption of teeth occurs. A successful first phase will have created room for teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.  At the end of the first phase of treatment, all teeth are 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 6-12 month basis.

Second Phase Treatment: Stay healthy and look attractive

The second phase (Phase II) is initiated when all permanent teeth have erupted, or close to erupting. Orthodontic records are made and a diagnosis and treatment plan is established. The goal of the second phase is to make sure each adult 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. An advantage for two-phase orthodontic treatment may be that the second (comprehensive) phase may be shorter as compared to one phase (no early treatment).

Orthodontic Retention:

When the teeth have been correctly aligned, fixed braces and removable devices will be removed and discontinued.  The most cumbersome part of the orthodontic treatment is now over. The orthodontist will next create a custom retainer.  The goal of the retainer is to ensure that the teeth do not begin to shift back to their original positions.  Retainers need to be worn for a specified amount of time per day for a specified time period.  During the retention phase, the jawbone will reform around the realigned teeth to fully stabilize them in the correct alignment although retainers are still needed to assure that teeth do not shift over time.

If you have any questions about orthodontic treatments, please contact our office.


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  • Morrisville
  • 6406 McCrimmon Pkwy #240
  • Morrisville, North Carolina
  • 27560
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