Phase One and Phase Two Orthodontic Treatment

Phase One and Phase Two Orthodontic Treatment

Many parents will ask at their child’s exam, “When is the best time to start orthodontic treatment?”  The answer is that it varies from person to person, depending on what the orthodontic problems are.  The American Association of Orthodontists recommends that kids be seen for their first orthodontic check up at age 7.  This is the age when most kids have their permanent front teeth, incisors, and their first set of adult molars fully grown into place.  In most cases, kids don’t need treatment at that age, but Dr Kyger can identify any potential problems that are developing and give you an idea of when the appropriate time to start will be.  In general, it is easier on everyone (the patient, orthodontist, and the parents) if treatment starts after all the adult teeth have grown in (usually around the age of 12-13).  However, their are some instances where it is advisable to start treatment earlier than that.

Sometimes Dr Kyger will recommend treatment while some of the baby teeth are still present.  This is often called interceptive, or Phase One, orthodontic treatment.  Some of the indications for this early treatment are significant crowding or bite problems (overbites, underbites, open bites, extreme deep bites where the lower front teeth are digging into the roof of the mouth, and crossbites of the front or back teeth).  Some of these bite problems are associated with a current thumb or finger sucking habit that needs to be addressed as well.

 

Orthodontic Problems to Watch for in 7 Year Olds

Orthodontic Problems to Watch for in 7 Year Olds

 

One of the goals of Phase One treatment are to harmonize the growth of the upper and lower jaws as much as possible.  Another goal is to make enough room through expansion of the dental arches to make enough room for all the adult teeth to fit into place.  Our goal is to treat our patients without having to have any teeth pulled whenever possible.  By timing an appropriate Phase One treatment we are usually able to straighten all the teeth in Phase Two without any extractions.

You can think of Phase One as treating significant bite problems or correcting a developing skeletal growth problem.  Phase Two is the definitive straightening of the teeth.  Most people are ready for Phase Two by the time they are 12 to 13 years old.  This is usually the age when most people have lost all their baby teeth and the adult second molars all the way in the back have grown into place.  Phase Two is usually a shorter treatment time than it would have been without the Phase One treatment (12-18 months vs 18-24 months).  On rare occasions we get such a nice result out of Phase One that we don’t need to do a Phase Two treatment.  This is the exception to the rule, however.  If your child is getting Phase One treatment, plan on needing a Phase Two treatment in a few years.

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Orthodontic Retainers, Why They Are Needed

 

Orthodontic Retainers

Orthodontic Retainers

Orthodontic Retainers, why they are needed.  Everyone needs some kind of retainer after they finish up with their braces or Invisalign treatment.  Your teeth have memory, and for most people, their teeth want to move back in the direction they came from.  The amount of movement varies from person to person.  Some people are lucky and their teeth don’t move very much.  Others see a more significant amount of movement.

When asked by my adult patients why retainers are needed, I pose them this question.  ”Can you name one part of your body that hasn’t changed over the last 30 or 40 years?”  Our bodies change as we age, and that includes your teeth.  They are not set in stone.  You can generate a lot of force when you bite down.  These forces are transmitted to the teeth and they can move the teeth around.  This is especially true for people that grind their teeth (brux) in their sleep.

The most common reason I see people in their 30′s or 40′s to get their teeth straightened for a second time is because they stopped wearing their retainers and their lower teeth crowded up.  It is for this reason I typically use a bonded (fixed) retainer on the inside of the lower front 6 teeth after we are done with treatment.  It is not visible to others and after a day or two people really don’t notice them that much.  Those bite forces I mentioned earlier have a tendency to make the lower canine teeth collapse inward toward the tongue over time.  As the canine teeth drop back, the lower front teeth (incisors) tend to crowd up.  With the lower bonded retainer in place this can’t happen.  Of course, if someone doesn’t want this type of retainer, I will make them a removable retainer.

For most of our patients, we make a removable upper retainer.  This is either a traditional retainer that has the wire that goes across the front teeth, or a clear plastic retainer that is form fitted to the teeth.  Both types have their advantages.  The nice aspect of a traditional retainer is that the orthodontist can move teeth with it (we can with the clear retainer as well, but on a much more limited basis).  If a tooth moves, I can put a bend in the wire and move it back.  Having said that, whenever possible, I do like to use the clear retainer.  It’s clear!  People can’t really see it, and patient compliance is higher with this type of retainer.

When we have a patient that started out with a very large gap between their upper front teeth, in addition to the removable upper retainer, we may also bond the upper two front teeth together to prevent the gap from opening again.

People will often ask, “How long do I have to wear my retainer?”.  The answer is “How long do you want your teeth to stay straight?”  It is a long term proposition.  Now that certainly doesn’t mean you have to wear it all the time forever.  We start people off with full time wear (take it out to eat, brush, and for sports).  As soon as we can we start to cut back on the number of hours a day it needs to be worn.  For most of our patients, we have them wearing it just at night within about six months.  Eventually, we like to get to the point where people are just putting it in a night or two a week to keep things straight.

Check out our retainer video on youtube to see images of different kinds of retainers.

Orthodontic Correction Lower Crowding Time Lapse Video

Orthodontic Correction Lower Crowding Time Lapse Video

This video shows the treatment results on a patient that had significant crowding of the lower teeth, with a blocked out lower canine.  The orthodontic treatment was done with braces on the upper and lower teeth.  The results were achieved without the removal (extraction) of any teeth.

In most cases these days, we are able to treat patients without having any teeth extracted.  That can be a challenge in cases like this where the person has significant crowding and there is one tooth that is completely blocked out of the dental arch.  There are several techniques we use to make enough room for blocked out teeth like this.  We expanded both the upper and lower dental arches.  Basically, this means we uprighted the side teeth and widened them a little bite.  This widening makes more room for the teeth.  The lower front teeth were also very upright.  Looking down at the lower front teeth from above you can see more of the front surface of the teeth than the back side of the teeth.  For teeth to fit normally, the front teeth should actually be angled forward.  We angled the front teeth forward for this patient, and that also made more room.

The final technique we used is called interproximal reduction of some of the lower teeth.  This is a fancy way of saying we went in between some of the lower teeth and made them a little bit skinnier.  Usually we use a sanding disk in between the teeth to do this.  This technique is very effective in allowing us to straighten the teeth without having to resort to dental extractions to make enough room.  This interproximal reduction is pretty quick, the patient does not need to be numbed up to have it done, and it stays well within the enamel of the teeth so there isn’t any sensitivity afterwards.  The use of these three techniques allowed us to make enough room for all the teeth to fit.

For more patient education videos, check out our YouTube Page.

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Orthodontic Correction of Lower Crowding Time Lapse Video

Orthodontic Correction of Lower Crowding Time Lapse Video

 

Underbite Correction Time Lapse Video

Underbite Correction Time Lapse Video

 

This video is an example of a patient that had a severe underbite. It shows a frontal view of the teeth and how their positions changed with treatment. An underbite results from either a small upper jaw, a large lower jaw, or a combination of the two.  In an underbite, the lower front teeth are in front of the upper front teeth.  The correction of the underbite was achieved without a jaw surgery by using a facemask (reverse pull headgear) and having two lower bicuspids removed.  The upper dental arch was narrow, so a palate expander was also used.

It should be noted that this kind of treatment can only be performed on a growing child.  The facemask (reverse pull headgear) actually makes the upper jaw grow forward more.  Once a girl reaches the age of 13-14 years of age or a boy reaches the age of 15 years old this type of treatment is not effective.  Often, it is easier to do this type of treatment on kids when they are 8-9 years old.  They are much more compliant with wearing the facemask at  that age than teenagers are.

Check out our other patient education videos on our YouTube channel.

Underbite Correction, Orthodontics, Facemask

Underbite Correction

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Impacted Maxillary Canine Diagram

Impacted Maxillary Canine Diagram.  This is a patient educational hand-out from the American Association of Orthodontists.  It shows from start to finish how an impacted canine in the palate is moved down into it’s proper position.  The way this technique works is we send the patient over to the oral surgeon.  The surgeon numbs up the area and then exposes the tooth.  An attachment is bonded on to the tooth and this attachment has a tiny chain coming off of it.  We see you in our office about once a month tie tie a fresh rubber band onto this chain.  Over time, this slowly moves the impacted canine down into it’s proper position.  The time it takes to bring the canine down into place varies from person to person  and it is also dependent on where the canine is initially positioned.  The farther away it is from it’s ideal spot, the longer it will take to bring into place.  We have more patient information at our website.  Check it out!

Impacted Upper Canine Image

Impacted Upper Canine Image

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Upper Crooked Teeth Time Lapse Video: Kyger Orthodontics

Upper Crooked Teeth Time Lapse Video: Kyger Orthodontics

This video shows the correction of some very out out place teeth in the upper jaw.  This treatment was done with traditional braces and no teeth needed to be removed to accomplish this result.  At the end of the video we show a facial morph as well, so you can see how the patient looks at the end.  Check it out!

Upper Crooked Teeth Time Lapse Video: Kyger Orthodontics

Upper Crooked Teeth

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Dental Trauma, What to do with a Broken or Loosened Tooth

Dental Trauma- Broken or Loosened Tooth.

This is a patient education brochure from the American Association of Orthodontists on what to do if you or your child has an dental trauma and what to do with a broken or loosened tooth.

Dental Trauma-Broken or Loosened Tooth

Dental Trauma-Broken or Loosened Tooth

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Dental Trauma- Knocked Out Permanent Tooth

Dental Trauma- Knocked Out Permanent Tooth Education Flier.  This is a publication by the American Association of Orthodontists to help educate you on what to do in case a permanent tooth is knocked out.

Dental Trauma- Knocked out Permanent Tooth

Dental Trauma- Knocked out Permanent Tooth

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Orthodontic Problems to Watch for in Adults

Orthodontic Problems to Watch for in Adults.

Here is a publication by the American Association of Orthodontists showing some examples of bite problems you should be looking for.  These photos show examples of the following:

  • Crowding
  • Spacing
  • Anterior Crossbite
  • Tooth Wear/Bruxism
  • Periodontal Problems
  • Impacted/Tipped/Missing Teeth
  • Protrusion
  • Open Bite
  • Deep Bite

If you feel you need an exam please contact our office:

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Orthodontic Problems to Watch for in Adults

Orthodontic Problems to Watch for in Adults