Early / 2 Phase Treatment

Some patients may require early intervention (age 7-9) to correct potential future tooth and jaw discrepancies. This is usually followed by a 2nd stage (full braces) when the patient has all or most permanent teeth.

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

Examples of jaw discrepancies requiring early treatment (Phase I) include:

A crossbite: (upper back teeth located “inside” of lower back teeth)


An “Underbite”: (Upper front teeth located behind Lower front teeth)


Moderate/severe crowding that may require tooth removal if left untreated:
If treated early enough, while the child is still actively growing & bones are very “soft,” we can use a palatal expander to widen the jaws, creating more room for permanent teeth.


Thumb/finger sucking habit: This is a normal phenomenon in early ages, from birth to 2-3 years old. We recommend removing pacifiers and stopping all thumb/finger sucking habits by age 4. Since a thumb/finger habit is not easily stopped, we occasionally need to use an appliance to aid in stopping the habit. It is called a thumb crib. Here is an example of a 7 year old who sucked her thumb before & after 8 months of stopping!

Thumb crib

Thumb crib



***All of these discrepancies corrected in phase I MAY or MAY NOT require the 2nd stage (full braces). It all depends on growth & position of all permanent teeth. The goal in Phase I is to CREATE SPACE for permanent teeth & eliminate jaw discrepancies (like a crossbite or underbite) or to STOP thumb or tongue habits. Phase II is for correcting the position of the teeth & creating a nice, stable bite for optimal function.

What is the process of early/2 stage treatment?

PHASE I: Your foundation for a lifetime of beautiful smiles
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. 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 8 have crowded front teeth, early treatment can avoid the need to extract permanent teeth later.

Planning now can save your smile 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. NOT ALL PATIENTS REQUIRE PHASE ONE TREATMENT; it is up to the doctor to determine what is best for each child!!!

Resting Period
In this phase, the remaining permanent teeth are left alone as they erupt. Retainers 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.

Monitoring your teeth’s progress
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

Stay healthy and look attractive
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 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 18-24 months. Retainers are worn after this phase to ensure you retain your beautiful smile.