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Two-Phase Treatment

Two-phase orthodontic treatment is a specialized process that combines tooth straightening and physical, facial changes. The purpose of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, functional, and aesthetic result that will remain stable throughout your child’s life.

Putting off treatment can result in a need for more invasive treatment later in life that may not completely fix your child’s smile. Early treatment is most effective for achieving lasting results.

Phase One

The goal of Phase One treatment is to help the jaw develop in a way that will accommodate all of the permanent teeth and improve the way the upper and lower jaws fit together. Children often exhibit early signs of jaw problems as they grow and develop. An upper jaw that is growing too much or is too narrow can be recognized at an early age. If children over the age of six are found to have this jaw discrepancy, they are candidates for early orthodontic treatment. Also, if children around the age of eight have crowded front teeth, early treatment can prevent the need to extract permanent teeth later.

Children benefit tremendously from early-phase treatment. Receiving early treatment may prevent the removal of permanent teeth later in life, or the need for surgical procedures to realign the jaws.

Orthodontic records will be necessary to determine the type of appliances to be used, the duration of treatment time, and the frequency of visits. Records consist of models of the teeth, X-rays, and photographs. During your child’s initial consultation, the doctor will take records to determine if early treatment is necessary.

Resting Period

In this phase, the remaining permanent teeth are left alone as they erupt. Retaining devices may not be recommended if they would interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement. A successful first phase will have created room for permanent 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 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 six-month basis.

Phase Two

The goal of the second phase is to make sure each 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. Phase Two usually involves full upper and lower braces.

At the beginning of the first phase, orthodontic records were made and a diagnosis and treatment plan was established. Certain types of appliances were used in the first phase to correct and realign the teeth and jaw. The second phase begins when all permanent teeth have erupted, and usually requires braces on all the teeth for an average of 24 months. Retainers are worn after this phase to ensure your child retains his or her beautiful smile.

Palatal Expanders

The palatal expander “expands” (or widens) your upper jaw by putting gentle pressure on your upper molars each time an adjustment is made. The animation below will instruct you about when and how to adjust your expander. When you achieve the desired expansion, you will wear the appliance for several months to solidify the expansion and to prevent regression.

To adjust the expander:

  1. Place the key in the hole until it is firmly in place.
  2. Push the key toward the back of the mouth. You will notice the fender will rotate and the new hole will appear. The rotation stops when the key meets the back of the expander.
  3. Press back and down toward the tongue to remove the key. The next hole for insertion of the key should now be visible.

Surgical Orthodontics

Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws, and the hard and soft tissues of the oral and maxillofacial region. It is a recognized international surgical specialty, and it is one of the nine specialties of dentistry recognized by the American Dental Association.

Oral and maxillofacial surgeons are the only recognized dental specialists who, after completing dental school, are surgically trained in an American Dental Association-accredited hospital-based residency program for a minimum of four years. They train alongside medical residents in internal medicine, general surgery and anesthesiology, and also spend time in otolaryngology (ear, nose, and throat), plastic surgery, emergency medicine, and other specialty areas. Their training focuses almost exclusively on the hard and soft tissue of the face, mouth, and jaws, and their knowledge and surgical expertise uniquely qualify them to diagnose and treat the functional and aesthetic conditions in this part of the body.

Common Conditions & Treatments

Corrective jaw or orthognathic surgery is performed in which the upper jaw, lower jaw, and chin may be repositioned to correct minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth which can improve chewing, speaking, and breathing. Difficulty chewing or biting food, excessive wear of teeth, a receding chin, a protruding jaw, or sleep apnea may indicate the need for corrective jaw surgery.

Wisdom teeth are the last set of teeth to develop. Sometimes they emerge from the gum line, and the jaw is large enough to allow room for them, but more often than not, they fail to emerge and become impacted. When a wisdom tooth is impacted, it may need to be removed. Impacted wisdom teeth that are partially or fully erupted tend to be quite difficult to clean and are susceptible to tooth decay, recurring infections, and even gum disease. The American Association of Oral and Maxillofacial Surgeons strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.

Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip or a split in the opening in the roof of the mouth. Until it is treated with surgery, a cleft palate can cause problems with feeding, speech, and hearing. Oral and maxillofacial surgeons work as part of a team of health care specialists to correct these problems through a series of treatments and surgical procedures over many years.

Maxillofacial injuries or facial trauma encompass any injury to the mouth, face, and jaw. One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets, or combinations of these bones. These injuries can affect sight and the ability to breathe, speak, and swallow. Because of this, the expertise of the oral and maxillofacial surgeon is indispensable. Avoiding injury is always best, so it is extremely important to use seat belts, protective mouthguards, and appropriate masks and helmets for everyone who participates in athletic pursuits at any level.

The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet and allows the lower jaw to move and function. If you experience jaw pain, earaches, headaches, a limited ability to open or close your mouth, clicking, or grating sounds, you may have Temporomandibular Disorder (TMD). TMJ treatment may range from conservative dental and medical care to complex surgery. If non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated which can involve either arthroscopy or repair of damaged tissue by a direct surgical approach.

Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. If you notice white or red patches, an abnormal lump, chronic sore throat or hoarseness, or difficulty chewing or swallowing, you should contact your oral and maxillofacial surgeon. They will remove a section of tissue to perform a biopsy and accurately diagnose the problem.

Dental implants are long-term replacements for missing teeth that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that fuses with the jawbone through a process called osseointegration, dental implants never slip and never decay. Because dental implants fuse with the jawbone, bone loss is generally not a problem.

Oral and maxillofacial surgeons have the ability to provide patients with safe, effective outpatient anesthesia including local anesthesia, nitrous oxide, IV sedation, and general anesthesia. During their surgical residency, residents must complete a rotation on the medical anesthesiology service where they become competent in evaluating patients for anesthesia, delivering the anesthetic, and monitoring post-anesthetic patients.