Hey guys, it's Dr. Webster and I'm here to answer a question I frequently get, probably daily. It's a great question and the question is, “Why do orthodontists these days treat patients in two phases as opposed to before when it was usually just one phase?” It's a great question! Let me just talk about the history - this is about the paradigm shift that we as orthodontists in the orthodontic field have experienced over the decades.

Decades ago, when your parents had braces, orthodontists would most likely just take out four teeth and do everything in one phase of treatment. That was very customary and because they were always taking teeth out to make space to alleviate the crowding and get the teeth aligned and correct the bite, the treatment strategy was totally different back then. Because they were taking teeth out of most people, they were just doing it one phase, because that's all they needed to do. Right now, we're trying to save as many permanent teeth as we can. The smile aesthetic is such that we want a lot of breadth. We want a lot of width in our smile, kind of like the Angelina Jolie and Julia Roberts look.

The full smile is what's desirable. Because of that, we want to try and save as many teeth as possible. It really does enhance our chances of doing that if we have two phases of treatment - one phase is when patients come in and they're around eight to eleven years old and they still have some baby teeth and we find some crowding and that the teeth aren’t coming in well. It's kind of like a crazy Tetris game…I can show you some x-rays sometime, but we're just trying to get all the spacing in the mouth correct so that everything can fit. A lot of times the jaws are small and so we have to use expanders. We have to do some expansion of the teeth within the bones, and we have to move teeth around so that we can make space for erupting teeth that don't have any room or are impacted and are having a bad eruption pathway.

Sometimes we need to take out teeth and make some space so that they can erupt into place and kind of guide them in with some appliances or braces or Invisalign. That's kind of the mode and purpose of a phase one treatment. It's not to idealize the aesthetics or the bites. We're not focused on that, just because most of the teeth are still baby teeth. We kind of have our cake and eat it too in terms of getting everything set up so that we can get these teeth comfortably into people's mouths. Every time we're able to straighten the teeth in the front, which usually are permanent teeth - they're able to get all that crowding done so they don’t have to wait until all their baby teeth are out to have a really good smile and their bite is a lot more comfortable.

This is especially true for people with crossbites who have these small upper mouths - they can have these things called crossbites where the teeth are actually traumatizing each other and kind of wearing each other away. We're able to put them in a safe place and so that they aren't harmed over the years while the baby teeth are coming out of the mouth and the permanent teeth are replacing them. That's why phase one treatments are more prevalent than before, because they're very useful and it sets us up for success. It’s so that we have the best smile and the best bite we can. We’re not just resorting to taking teeth out. It was called “four on the floor”. Orthodontists would always say, “We're going to do four on the floor,” which means we're taking four teeth out essentially, and not trying to save space for them.

I hope that answers your question. Please leave any of your comments or questions. I really like your comments and responding to them and have a great day!