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Two-Phase Treatment

What is the advantage of two-phase orthodontic treatment?

The goal of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, aesthetic result that will remain stable throughout your child’s life. Orthodontists complete a 2-3 year specialty education program after completing dental school. This training gives us the insight to know when an interceptive or 2-phase orthodontic treatment would benefit our patients. Dr. Mellas completed a 3 year orthodontic specialty program at the prestigious University of Connecticut where she also received a Masters in Dental Science for research she completed in bone biology. Only where indicated, she will recommend a first phase of orthodontic treatment to improve the profile, make room for blocked out permanent teeth and intercept oral habits that can have deleterious effects on the jaws and teeth. If your child is 7 or older, schedule an appointment for a complimentary exam for your child to determine if they would benefit from an interceptive orthodontic treatment.

Phase I

You may have noticed many of your child’s classmates embarking on orthodontic treatment at what seems to be a very young age. In the past, children were typically seen by the orthodontist at a much later age. Unfortunately, beginning treatment at a later age oftentimes led to the need to extract permanent teeth and in some cases the need for jaw surgery. Research has shown that there are many benefits to early orthodontic treatment. The goal of phase one treatment is to help the jaw develop in a way that will accommodate all of the permanent teeth and to improve the way the upper and lower jaws fit together. In certain patients, jaw discrepancies exist that are better managed early. If we “intercept” a patient while they are still growing, we can redirect their jaws to grow in a more harmonious manner. Orthopedic devices only work while patients are young enough to still be growing. This is the reason the AAO recommends that the 1st orthodontic exam occurs at the age of 7. Patients with significant jaw discrepancies that miss this important window of opportunity may require permanent teeth extractions or jaw surgery to achieve the same end result that could have been managed less invasively. Several indicators for an interceptive or Phase I treatment include but are not limited to:

  • Overjet: Upper front teeth protrude excessively ahead of the lower teeth, or are bucked
  • Overbite: Upper front teeth cover the majority of the lower teeth when biting together (deep bite)
  • Underbite: Upper front teeth are behind or inside the lower front teeth
  • Crossbite: The lower jaw shifts to one side or the other when biting together
  • Open Bite: The upper and lower front teeth do not touch when biting together
  • Crowding: Permanent teeth are blocked out or significantly overlapped
  • Significant spacing: may cause a speech issue
  • Myofunctional Habits: Finger or thumb sucking habits, tongue thrusting
  • Difficulty chewing
  • Teeth wearing unevenly or excessively
  • Sleep apnea or snoring
  • Insecurity or social anxiety due to any of the above dental issues


1st Orthodontic Exam

At your child’s first orthodontic appointment, we will make your child feel comfortable by taking you and your child on a tour of the office. Your child will love the office setup as we have taken a lot of time and effort to make the office environment very friendly. We have televisions mounted above the dental chairs and a gaming area. Dr. Mellas will examine your child to determine if there is any need for an interceptive or Phase 1 treatment. If treatment is recommended, you will have the option to start orthodontic records that same day. Orthodontic records include digital pictures of your child, radiographs and impressions that will allow us to create study models of your child’s teeth. The orthodontic records will give us the information we need to be able to determine the type of appliances to be used, the duration of treatment time, and the frequency of visits.


Resting Period

After a Phase I treament is completed, a retainer will be worn to maintain the results. During this time, the remaining permanent teeth are left alone as they erupt. The teeth are not in their final positions. A successful first phase will have created room for permanent teeth to find an eruption path; otherwise, they may become impacted or severely displaced. Also, the jaws will be in a more harmonious alignment than before. Selective removal of certain primary (baby) teeth may be in the best interest of enhancing eruption during this resting phase. Periodic recall appointments for observation are necessary, usually on a six-month basis.


Phase II

The goal of the second phase of orthodontics is to align the teeth and to guide the bite into a healthy functioning occlusion. The teeth are brought into a position where they have harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. The second phase of orthodontics is typically achieved either through the use of braces or Invisalign. This phase typically lasts anywhere between 12-24 months as long as the patient is cooperative with food list instructions and maintains good oral hygiene. Retainers are recommended to be worn every night for life to ensure you retain your beautiful smile.