by Robert N. Pickron, DDS

Robert N. Pickron, DDS

Early orthodontic treatment is defined as treatment that is started and finished before all of the permanent teeth erupt into the mouth. There is controversy within the profession over the value of early treatment. The question always seems to be, “Is early treatment necessary when the same results can be obtained with a single phase of treatment at age 12 to age 15, after the eruption of all of the permanent teeth?” Studies seem to focus on the orthodontist’s time, effort, and profitability, and ignore the true value of Phase I treatment to the patient.

If you could see the smile on the young patient and their parent’s faces when we finish a Phase I case where we have aligned the front four teeth and expanded both alveolar arches for better tooth eruption, you would agree that we are doing a service and that “medically necessary” and “efficient use of time” are not the only criteria that we should use to judge the value of an orthodontic treatment.

At Pickron Orthodontic Care, we offer a free consultation and we offer Early Phase I treatment for our patients. Phase I treatment usually lasts 18 months and includes expansion of arches and alignment of the upper and lower incisors. Although we always insist that a second phase will be needed, I have personally found that Phase I may negate the need for Phase II treatment. It will reduce the amount of time needed to finish treatment in the teen years. We make sure that the parents sign a one-page Phase I disclaimer to prevent a misunderstanding later regarding the need for a second phase of treatment. They are made aware of the costs and the limitations of any treatment before beginning treatment.

Most orthodontists agree that elimination of oral habits and orthopedic treatment of Class III and posterior crossbites deserve treatment at an early age. With Phase I treatment as we define it, the child has the added benefit of straight front teeth during the preteen years. Many shy children benefit from this treatment by having improved self-esteem during these formative years. Children will tease others at this age. This can cause a child to get into the habit of not smiling, which, in turn, can make an already shy child feel isolated or “different.” I cannot tell you how many times parents thank me for the changes that they see in their child’s confidence and “desire to smile.”

Benefits of Early Treatment

  • Straightening front teeth before teen years;
  • correcting dental and skeletal crossbites;
  • reducing procumbency of upper anteriors;
  • making room for erupting teeth (minimize impactions); and
  • a shorter second phase (if needed).

Disadvantages of Early Treatment

  • May require Phase II treatment; and
  • may cost more if a second phase is needed.

We use early treatment to improve the overjet and reduce the procumbency of anterior teeth. Severely procumbent teeth may be broken or chipped from falling or bumping into a wall or door. A simple test is to use a mouth mirror handle against the nose and chin. If the teeth touch first, the teeth are in danger of being accidentally fractured or lost. When this happens, it can be an expensive and lifelong problem.

Early orthopedic expansion can create more room for the teeth to erupt normally if treated early. Arches that are not wide enough to accommodate the erupting teeth can result in delayed eruption, ectopic eruption, and impaction. This, too, can result in expensive treatment and lifelong problems.

Posterior crossbites may affect the growth of the underlying alveolus and should be corrected in the preteen years if possible to allow normal growth of the underlying hard and soft tissues. Anterior crossbites affect the alveolar bone growth and create gingival recession.

We do not attempt A/P correction in Class II cases until the bicuspids are erupting, except in extreme cases of 10 mm overjet or more. In these cases, the parents want something done even if it requires later treatment.

Phase I treatment at age 7 combined with a shorter Phase II treatment later should not cost much more than Comprehensive treatment at age 12, if you factor in inflation. If you wait 5 years, the cost of comprehensive treatment escalates 28% when compounded at 5% per year. ($3,000 for Phase I plus $3,500 for Phase 2 equals $6,500, while $5,000 x 1.28 = $6,400.)

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It should be the parent’s choice, and we allow them to make an informed decision about what they want for their child. We will continue to educate and to offer Early Phase I treatment in cases where there is a desire by parents for positive change in the overall health or appearance of the front teeth and/or we can improve the shape of the alveolar arches. If you want to suggest that it takes more time or costs more, I might agree. But is it worth it? You only have to ask the question, “If it were my child, what would I do?” Then you should sleep well.

Robert N. Pickron, DDS, is in private practice in Atlanta. He can be reached at