This issue of when is the best time to begin orthodontic treatment
has been debated in orthodontics for nearly 100 years.
It would be foolish to attempt to consolidate all the years
of research and all the varying opinions in a webpage.
However, the goal of answering this “faq” is to briefly
outline the evidence-basis for the philosophy we use in our
practice.
Most patients lose their last deciduous (“baby”) teeth by about age
10-13. If comprehensive
orthodontic treatment is to include these permanent teeth, it cannot
be completed until all these teeth have erupted and positioned
appropriately. The
concept of “early” orthodontic treatment usually involves some
limited orthodontic treatment in the mixed dentition (when the
patient has both baby teeth and permanent teeth), followed by a
second course of comprehensive treatment later when the rest of the
permanent teeth are erupted.
In general, there are a few specific types of cases we do treat with
“early” orthodontic treatment.
Some of these cases include”
- Expanding a patient’s upper jaw when there upper back teeth
are positioned
“inside” of their lower back teeth on one or both sides.
This is situation known as a posterior crossbite.
- Aligning and retracting severely protruding upper front teeth to
address social concerns and possibly reduce the risk of trauma to
these teeth.
Our general philosophy regarding mildly or moderately “crooked” or
crowded teeth that meet together well is to consider postponing
comprehensive treatment until the patient is closer to being ready
for “full treatment”.
This philosophy is based on many factors including the efficiency
and total time and cost of treating the patient once verses treating
them twice. Ultimately,
each patient is unique and so is each treatment plan.
It should be noted that we are in no way saying that this is the
“only right answer.” As
stated previously, there may be several reasonable ways to treat a
given patient. There are
a huge number of research articles that address this issue.
Some of these articles support one-phase treatment and others
support two-phase or “early” treatment.
One article that makes a strong case for one-phase treatment
is from the Journal of the American Dental Association
(Evidence-Based Orthodontics for the 21st Century." JADA 135 (2004): 162-167. <http://jada.ada.org/cgi/content/full/135/2/162>).
One section of this article reads, “The
result was no difference in the quality of dental occlusion between
the children who underwent early treatment and those who did not, as
judged by both the Peer Assessment Rating index and the percentages
of the groups with excellent and less-than-optimal outcomes.”
