Multiphasic Orthodontics: The Modern Orthodontic Paradigm
Ernest A. Rider, DDS

Orthodontics, like other medical and dental specialties, is ever evolving. Yesterday orthodontic treatment was most often limited to teenage children who had all their permanent teeth. But today, orthopedic treatment often works best at an early age (4-7) when significant jaw growth remains and skeletal changes still can be made.

In the past, treatment was delayed because:
1) Orthodontists believed they could move only teeth and not change jaw structures.
2) Orthodontists thought treatment could be completed in a shorter period of time since only straightening of the teeth was possible.
3) A cookbook process of treatment could be provided for all patients
4) Diagnosis was limited to that which was possible with only tooth movement
5) It was still thought that skeletal problems could be treated only surgically.

Today, it is widely accepted that a multiphasic form of treatment beginning very early in childhood produces the best esthetic, functional and stable results.

Multiphasic orthodontics is a very specialized form of orthodontic treatment that consists of these phases:
1)Skeletal Phase
A) Early skeletal management (orthopedic phase) of the abnormally developing jaws
B) Alignment of the front permanent teeth as necessary during the orthopedic phase to maintain good dental esthetics
2) Resting Phase
That period of time between the orthopedic phase and the orthodontic phase (supervised or unsupervised) that allows the natural forces of growth and eruption of permanent teeth to occur in the corrected skeletal environment
3) Orthodontic Phase
Braces to align all the permanent teeth after they erupt
4) Retention Phase
Retainers to maintain the corrected result

In the modern orthodontic paradigm, definitive orthodontic treatment usually begins when the permanent front teeth erupt at age 6 or 7 in order to minimize self-image problems due to tooth malalignment and to manage any skeletal problems not dealt with at a younger age.

Traditional orthodontic treatment left until the full set of adult teeth has erupted (ages 12-15) is still an accepted form of treatment for some problems and for
adults. The results are not nearly as ideal as with multiphasic treatment since, at this point, treatment is mainly limited to tooth movement alone unless combined with jaw surgery to correct a previously untreated skeletal discrepancy.

Multiphasic orthodontic treatment encompasses both the orthopedic phase (early
treatment) and the orthodontic phase (mid or late treatment to fine tune the result).
The orthopedic phase consists of...
1) eliminating thumb and finger habits
2) maximizing the child's ability to breathe through the nose, rather than mouth breathing
3) correction of skeletal deformities and malrelationships of the jaws
4) tooth movement to allow for maximum skeletal change and esthetics

Today, due to new diagnostic and treatment technology, the modern orthodontist often is able to improve jaw development in young children and thus harmonize all the elements of good facial form and function early in life, to the great benefit of these children.

First Phase of Treatment
The goal of the First Phase of treatment is to develop proper skeletal form to...
1) accommodate all the permanent teeth
2) provide an adequate upper airway for good nasal breathing function
3) relate the upper and lower jaws correctly to each other, in harmony with the face
4) provide adequate functional space for the tongue
5) help maximize self-esteem

Many young children have jaw development problems that go undetected because parents are not aware of these problems. The upper or lower jaw may be growing too little, too much or asymmetrically; these are problems that can be easily detected and helped by a trained orthodontic specialist long before they become serious.

Because young children grow rapidly and their developing bones are easily molded, they benefit enormously from orthopedic orthodontics, usually with devices that direct the growth of the upper and lower jaws and face. The orthodontist can create positive developmental changes that are lifelong a broader, healthier smile; improved upper airway and healthy jaw joints. A good foundation also is provided for the permanent teeth. This early correction most often can prevent later removal of permanent teeth because of overcrowding and/or jaw surgery to align the upper and lower jaws.

Leaving such a condition untreated until all permanent teeth erupt can result in jaw discrepancy too severe to treat fully with braces only and often leaves the child1s self image damaged. Also, this phase often involves intervention by an otolaryngologist (ear, nose and throat specialist) to correct any obstructions of the upper air passages that have caused mouth breathing.

Rest Period
At the end of the First Phase, all the teeth are not in their final positions. Proper tooth position will be determined and accomplished in the Second Phase of treatment. Periodic recall appointments are necessary during the Rest Period to make sure all the permanent teeth are erupting properly. In this Phase, the remaining permanent teeth are allowed to erupt. Retaining devices are usually used to maintain the alignment of the upper and lower front teeth. A successful First Phase will have properly related the upper and lower front teeth to one another and will have created sufficient room to prevent the unerupted teeth from becoming impacted or severely displaced.

Second Phase Treatment
The First Phase of treatment is about skeletal development while the Second Phase is directed at optimizing jaw position and aligning (with braces) the full adult dentition.

Each tooth has an exact location in the mouth where it is in harmony with lips, cheeks, tongue and other teeth. When balance is established, the teeth will function together properly and be in harmony with the jaw joints and the muscles that move the jaws and surround the teeth. The goal of orthodontic treatment is good facial balance, a broad, attractive smile, a good bite and healthy teeth, periodontium and jaw joints. This is best achieved in most case with multiphasic orthodontic treatment.

Because young children grow rapidly and their developing bones are easily molded, they benefit enormously from orthopedic orthodontics, usually with devices that direct the growth of the upper and lower jaws and face. The orthodontist can create positive developmental changes that are lifelong -- a broader, healthier smile; improved upper airway and healthy jaw joints. A good foundation also is provided for the permanent teeth. This early correction most often can prevent later removal of permanent teeth because of overcrowding and/or jaw surgery to align the upper and lower jaws.

Leaving such a condition untreated until all permanent teeth erupt can result in ~ jaw discrepancy too severe to treat fully with braces only and often leaves the child1s self image damaged. Also, this phase often involves intervention by an otolaryngologist (ear, nose and throat specialist) to correct any obstructions of the upper air passages that have caused mouth breathing.

Retention Phase
The jaws and teeth live in a dynamic environment that is constantly undergoing change and the Retention Phase is designed to maintain the skeletal and dental changes achieved during orthodontic treatment. Retainers are provided to "maintain" tooth alignment. If retainers are not worn as directed, the teeth may slip out of ideal alignment and require additional orthodontic treatment to correct, followed by "retainers".

Advantage of Phased Treatment
Multiphasic orthodontic treatment is a very specialized process that involves both teeth straightening and structural changes to the bones of the face and jaws. The emphasis for today on living longer, staying healthy and looking attractive makes us want optimum treatment. The major advantage of multiphasic treatment is maximizing the possibility of obtaining an ideal, healthy and esthetic result that will remain stable; multiphasic treatment also will minimize or eliminate the adverse psychological impact of poor facial form and crooked teeth during the critical early years of life.

For someone with a jaw discrepancy, waiting for all the permanent teeth to come in and having only one phase of treatment means having to face these results:
1) the possibility of a compromised result that may not be completely functionally healthy and may not stay stable
2) needing jaw surgery to correct a jaw discrepancy
3) going through the critical early years of life with crooked teeth and abnormally shaped jaws and face.