A treatment in two phases
Orthodontics in children often takes place in two separate phases. Early treatment begins in the mixed dentition at about five to eight years and treats structural problems that worsen with growth or complicate later treatment. The main treatment begins at ten to thirteen years when the permanent teeth have largely erupted and corrects tooth position in its definitive form.
Not every child needs both phases. Some need neither, some only one, some both. The decision follows the diagnosis. This article shows the criteria for when which phase makes sense.
The early treatment
Early treatment begins at five to eight years, in the mixed dentition between milk teeth and permanent dentition. It uses the natural jaw growth to correct structural problems that would later be difficult or no longer treatable without surgery.
Typical treatment devices:
- Removable braces (activators, bionators, plate appliances).
- Fixed devices like Quad-Helix or Hyrax screw for palatal expansion.
- Functional orthodontic devices to control the growth of upper and lower jaw.
- Mini brackets in rarer cases when individual permanent teeth must be treated early.
Early treatment usually lasts six to 24 months, followed by a pause period in which the remaining permanent teeth erupt.
The main treatment
The main treatment begins at ten to thirteen years when most permanent teeth have erupted. It corrects tooth position in its definitive configuration.
Treatment options:
- Fixed multiband appliance (brackets) with wires, the classic solution, usable in any constellation.
- Aligner therapy (Invisalign) transparent plastic trays, aesthetically inconspicuous, suitable with moderate corrections, requires high compliance. More in the article Invisalign vs fixed braces.
- Lingual technique brackets on the inside of the teeth, very inconspicuous, technically demanding, higher costs.
The main treatment usually lasts 18 to 36 months depending on complexity.
Comparison of the two phases by criteria
Treatment goal
Early treatment: structural correction of growth, bite position and space problems. Often fundamental prerequisite for successful later main treatment.
Main treatment: fine correction of tooth position in the permanent dentition, aesthetic and functional ideal position.
Treatment effort
Early treatment: 6 to 24 months, often with removable devices, low compliance requirement if the child wears the devices.
Main treatment: 18 to 36 months, often with fixed brackets, higher daily oral hygiene requirement.
Compliance requirement
Early treatment: with removable devices the wearing discipline is decisive. Here the parents are needed to check the wearing.
Main treatment: brackets are permanently fixed, no wearing discipline needed. With aligner therapy the wearing discipline (at least 22 hours per day) is decisive.
Costs
Early treatment: low to middle range.
Main treatment: higher range.
Insurance-covered orthodontics is in Switzerland only covered in narrowly defined cases (severe orthodontic malformations with role by IV or disease case). Usually the costs are borne privately or through dental supplementary insurance. More in the article on supplementary insurance for teeth.
Pain and comfort
Early treatment: usually well tolerable because the devices are removable and usually mildly set.
Main treatment: at the beginning and after every wire adjustment pressure feeling and mild pain for one to three days. Mucosal irritations from brackets or aligners possible.
When an early treatment makes sense
Certain findings justify an early treatment at five to eight years:
Crossbite
When upper and lower teeth stand wrongly in transverse direction to each other (lower teeth outside, upper inside), this can lead without correction to asymmetric jaw growth. Early treatment with palatal expansion or activator corrects the problem before it worsens.
Pronounced overbite or underbite
With significantly protruding upper incisors (overbite over 6 mm) the risk of front tooth injuries from falls increases. An early treatment can reduce the overbite and mitigate the risk.
With underbite (lower teeth in front of upper) the early treatment is more important because the problem often worsens with growth. Later correction then often requires orthognathic surgery.
Front tooth injury risk
When the upper incisors strongly protrude and the child is active (sports, cycling), early treatment makes sense to reduce the injury risk.
Pronounced space deficiency
When the milk teeth stand too tightly and no space for the permanent teeth is recognizable, a space holder or expansion therapy can prevent permanent teeth from erupting incorrectly or remaining displaced.
Habits (thumb sucking, lip or tongue pressing)
Persistent sucking habits lead to open bite or forward displacement of the upper incisors. Early treatment with function regulator or habit breaker can help.
Cleft lip and palate
With congenital clefts the orthodontic accompaniment begins very early, often already in the first year of life within an interdisciplinary treatment plan.
When the main treatment is sufficient
For many children the main treatment at ten to thirteen years is sufficient. Early treatment would not be sensible or even counterproductive.
Mild to moderate crowding
When the permanent teeth stand too tightly but no structural problems exist, the main treatment in the permanent dentition is sufficient. Alternatively in some cases extraction of individual premolars is considered.
Mild position anomalies
Rotated or slightly displaced individual teeth are efficiently corrected in the main treatment.
Tooth gaps
Gaps between teeth are closed in the main treatment with fixed appliance or aligner.
Symmetric growth conditions
When findings at five to eight years show no abnormalities, treatment can be postponed to the main phase without disadvantages.
When treatment is not mandatory
Some position deviations are cosmetically recognizable but not medically treatment-mandatory:
Mild misalignment of individual teeth without functional consequences
When a single tooth is slightly rotated but no bite problem exists, the correction is a matter of taste. We discuss openly what the treatment can and cannot do.
Mild crowding in adults without functional disorders
In adults treatment is possible at any time but often not mandatory. More on adult orthodontics in the article Invisalign vs fixed braces.
Diastema (gap between upper incisors)
A diastema is often cosmetically inconspicuous or even characteristic. Treatment sensible only if the gap is pronounced or the patient wants to correct it.
How Resident proceeds
We recommend the first orthodontic findings at five to six years, as part of the first dentist routine check-ups. More on first dentist visits in the article on early treatment in children.
- Initial examination with functional findings by Dr. Toloudis, our certified orthodontist.
- Diagnosis and indication: Early treatment needed, main treatment sufficient, or no treatment required?
- Treatment plan and explanation with showing the phases, devices and duration.
- Written cost estimate with all phases so the family can plan. More in the article on the cost estimate.
- Treatment start at the optimal time, in coordination with growth and the family’s preference.
- Regular check-ups every four to six weeks during the active phase, annually in pause phases.
Dr. Athanasios Toloudis, Master of Science in Orthodontics, treats children and adolescents at our Rapperswil-Jona, Berg, Küsnacht and Ermatingen locations in rotating consultation. Patients from Winterthur and Bellevue are referred for orthodontic treatment to one of the four Toloudis locations. Arrange an appointment for an orthodontic initial examination. We honestly recommend whether treatment is sensible and when.