Early treatment versus main treatment
Orthodontic treatment in children and adolescents often runs in two phases: early treatment in the mixed dentition (about between six and ten years) and main treatment in the permanent dentition (typically between eleven and fourteen years).
Not every child needs early treatment. For many findings the later main treatment is sufficient. In certain constellations early treatment is medically sensible because growth structures can only be optimally influenced in this phase. This article explains when what makes sense.
What early treatment achieves
In childhood the jawbone is still in growth. With targeted appliances growth can be influenced so that bite misalignments can be corrected without jaw surgery. After completion of growth many of these corrections are either no longer possible or only achievable through surgery.
Specifically, early treatment can:
- Adjust the jaw in width or length
- Correct functional disorders that would lead to further misalignments
- Create space for the moving-in permanent teeth
- Correct functional habits (sucking, mouth breathing) before they permanently affect the dentition
What early treatment does not achieve:
- Completely replace the main treatment in the permanent dentition
- Minor crowding or aesthetic corrections that are better addressed later
Classic indications for early treatment
Frontal crossbite
When one or more upper front teeth bite behind the lower ones, this is called a crossbite. During growth the crossbite can be relatively easily corrected with active plates or small fixed appliances. If correction is omitted, the crossbite can lead to tooth abrasion, gum recession on the involved lower tooth and a dysfunctional bite shift.
Lateral crossbite with narrow jaw
When the upper tooth row is too narrow and the lower molars bite outside over the upper, a palatal expansion (PE) is effective during growth. The still unossified suture in the middle of the palate can be expanded with a fixed appliance over several weeks. After completion of growth this only works surgically.
Pronounced open bite from sucking habits
When a child sucks the thumb or uses the pacifier beyond toddler age, an open bite can develop where the front teeth do not touch when closing. Sucking stoppers and accompanying explanation are effective in this phase. The earlier the habit ends, the better the bite recovers.
Pronounced deep bite or protrusion misalignment
With clear Class II misalignment (lower jaw retro, protrusion of upper front teeth), functional orthodontic treatment with removable activators or fixed functional appliances is effective during growth. The goal is stimulation of lower jaw growth.
Class III misalignment (underbite)
With a pronounced Class III misalignment with lower jaw protrusion, early treatment with mask (Delaire mask) can stimulate the growth of the upper jaw. This treatment must begin early, ideally between six and nine years.
Space deficiency in the permanent dentition
When it is foreseeable that not enough space will be available for the moving-in permanent teeth, space can be created with a space maintainer, palatal expansion or other appliances. This avoids later extractions of permanent teeth.
Atypical functional patterns
Mouth breathing, wrong swallowing pattern, tongue pressing or other functional problems can negatively affect dental growth. An orthodontic-myofunctional therapy corrects these functional patterns before they cause permanent misalignments.
When early treatment is not needed
For most children the main treatment in the permanent dentition between eleven and fourteen years is sufficient and more efficient. Specifically not a priority to treat in the mixed dentition:
- Mild to moderate crowding that can be corrected in the permanent dentition
- Front tooth rotations, aesthetically motivated
- Gap closure of smaller diastemas when no space problems exist
- Minor Class II or Class III misalignments without growth indication
In these cases observation and recall are recommended, possibly the main treatment later.
When the first orthodontic consultation makes sense
The Swiss Society for Orthodontics recommends a first assessment at the age of seven to eight years. At this time:
- the first permanent molars (six-year molars) have erupted
- the lower jaw is still in growth
- most relevant bite misalignments can already be recognized
- compliance for early treatment appliances is sufficient
With clear findings such as pronounced underbite or open bite, earlier consultation can be sensible.
Which appliances are used
Removable appliances
Active plates, activators, bionators. Worn removably, usually at night and partly during the day. Compliance-dependent: the child must actually wear the appliance.
Fixed appliances in the mixed dentition
Palatal expanders, space maintainers, pendulum appliances. Are placed fixed in the mouth, not removable.
Functional orthopedic appliances
Activators, Twin-Block, clasp activators. Stimulate jaw growth through functional loading.
Combinations
With complex findings multiple appliances are combined over the treatment duration.
Main treatment after the early treatment
The early treatment is usually not the end. After the change of the permanent teeth the main treatment with fixed braces or aligners for fine adjustment of tooth position often follows.
For children and adolescents fixed braces are the standard in main treatment because compliance with aligner treatment is difficult. For selected findings with clearly sufficient wearing time aligners are possible. More on the comparison in the article Invisalign or fixed braces.
What insurance covers in children
Swiss basic insurance covers orthodontic treatments in children only in rare severe cases with clearly documented medical indication. Specific examples are:
- Cleft lip and palate
- Very pronounced bite misalignments with functional impairment
- Consequences of severe systemic diseases or trauma
Most children’s orthodontic treatments are self-pay services. Supplementary insurance with dental care module for children can cover part of the costs if the insurance exists before treatment begins and the waiting time has expired.
More on insurance logic in the article on health insurance at the dentist.
Families with foreseeable orthodontic need for their children ideally take out family insurance early. More in the article on supplementary insurance for teeth.
How we proceed at Resident
At the first consultation appointment for the child we perform a clinical examination, an X-ray (orthopantomogram and possibly lateral cephalogram) and an intraoral scan or impression. On this basis we prepare a treatment recommendation.
If no early treatment is necessary, we recommend observation with annual check-ups. If early treatment is indicated, we discuss the appliances and the expected course. You receive a written treatment plan with cost estimate.
Orthodontic treatment in our practice group is handled by Dr. Athanasios Toloudis, Master of Science in Orthodontics from Danube Private University Krems, at his rotating consultation days in Rapperswil-Jona, Berg, Küsnacht and Ermatingen. The initial consultation and scan take place at your location practice, the orthodontic treatment then at one of the four Toloudis locations.
More on general Invisalign and braces treatment in our service overview for braces or on children’s dentistry.
Arrange an appointment for your child for the first orthodontic assessment. With preference for Dr. Toloudis state this preference when booking; we coordinate the suitable location and appointment.