Interceptive Orthodontic Treatment with Fixed or Removable Appliances

Often younger patients are seen in our office with jaw (skeletal) discrepancies. These discrepancies in the size or position of the jaw result in facial imbalances. These imbalances may involve an overbite or underbite, as well as crooked teeth.

Many types of appliances are available; some are removable retainer-like devices and others are fixed to the teeth. No matter which device is used, the important factor to consider is that these appliances are to intercept and correct existing orthodontic problems. The end result is more stable orthodontic treatment, attractive, balanced profiles and less frequent removal of permanent teeth.

Two Phase Approach

Advantages of Two-Phase Orthodontic Treatment

Interceptive two-phase orthodontic treatment is a very specialized process that encompasses physical and facial changes as well as tooth straightening. The major advantages of a two-phase treatment are to:

• Reduce the risk of traumatic injury
• Improve facial and dental esthetics as well as self esteem during an important developmental period
• Simplify the second phase of treatment to enhance the chances to achieve an ideal healthy, functional, and esthetic result that will remain as stable as possible over time

A possible disadvantage of waiting for complete eruption of permanent teeth and having only one phase of treatment, for someone with a jaw discrepancy, is having to face the possibility of permanent tooth extraction or having a compromised result that may not be functionally as healthy and may not be as stable.

First Phase Treatment

The goal of the first phase is to save space where necessary in the dental arches and to relate the upper and lower jaws to each other in every plane of space. Children sometimes exhibit abnormal skeletal relationships of the jaw. An upper or lower jaw that is growing too much or not enough can be recognized at an early age. Some of these children may be candidates for early orthodontic treatment.

Because they are growing rapidly, children can benefit enormously from an early interceptive phase of orthodontic treatment utilizing appliances that direct the growth relationship of the upper and lower jaws and control the eruption of permanent teeth. Thus, early correction may prevent later removal of permanent teeth to correct overcrowding and/or decrease the probability of needing a surgical procedure 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 just braces alone.

Other problems often intercepted early in this two-phase approach are:

• Thumb and finger habits
• Tongue thrusting
• Early loss of primary teeth
• Crowding of teeth
• Functional shifting of the lower jaw
• Upper jaw constriction problems due to allergies and/or airway obstruction
• Orthodontic records will be necessary to determine the treatment protocol needed, the type of appliances to be used and the duration of treatment time. Records consist of models of the teeth, various x-rays, and photographs.

Resting Period

In this phase, the remaining permanent teeth are allowed to erupt. Retaining devices are not usually recommended, since they may interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement while final eruption occurs. A successful first phase usually 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, teeth are not always in their final ideal positions. This will be completed in the second phase of treatment.

Periodic recall appointments for observation are necessary, usually on a 3-6 month basis during this resting phase of treatment.

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