Orthotown August 2015 - (Page 18)

clinical orthodontics // feature THE TRUTH About Phase I Orthodontics Fig. 1 O ne of the most controversial issues today in orthodontics is whether early orthodontic treatment, also known as phase I treatment, is ultimately beneficial for patients who are still growing and in the deciduous early mixed-dentition stage of development. This controversy stems from two main concerns, voiced by orthodontists and parents. The extra expense of a twophase orthodontic treatment and the extra time the patient will be in some sort of orthodontic appliance are major concerns for both parties. As a result, doctors often are reluctant to provide phase I treatment, and parents are hesitant as well. However, some doctors feel it is absolutely necessary to handle certain types of problems in the early mixed dentition, especially as they relate to growth and jaw development. Many doctors feel that if they do not have the opportunity to handle a specific type of growth problem while the child is still growing, the window of opportunity will be lost as growth is completed. As a result, the only way to handle the problem is through more advanced, complicated and potentially even more expensive procedures, such as surgery and extractions. So what is the bottom line when it comes to phase I treatment and its indications and benefits? While I do not promise to solve the issue, my goal is to present information from both sides of the aisle from respected leaders in the field and let you decide for yourself. Like most things in orthodontics, there are two sides to this story! Fig. 2 Fig. 3 Fig. 4 Fig. 5 The two sides In the November 1995 issue of the American Journal of Orthodontics and 18 JULY / AUGUST 2015 // orthotown.com by Donna Galante, DMD Dentofacial Orthopedics, Dr. Anthony Gianelly concluded that about 90 percent of all orthodontic problems could be treated in a single phase of treatment and phase I intervention was not necessary. Further, he states that 5 percent to 10 percent of patients who show up with crossbites leading to a shift in the lower jaw and certain types of Class III malocclusions "could benefit from immediate resolution of the problem."1 Another prominent researcher and respected orthodontist, Dr. William Proffit, has compiled research showing early treatment of Class II malocclusions with either headgear or a functional appliance. This study looked at children at least one year away from peak pubertal growth spurts with overjet greater than 7mm. While initially it looked as though there had been some success in resolving the Class II malocclusion, he ultimately found that "the differences created between the treated children and untreated control group by phase I treatment before adolescence disappeared when both groups received comprehensive fixed-appliance treatment during adolescence." His team concluded that two-phase treatment of Class II malocclusions "might be no more clinically effective than one-phase treatment started during adolescence in the early permanent dentition."2 On the other side of the table, Dr. James McNamara-who has contributed to more than 68 books on orthodontics and craniofacial development, and participated in many studies on the benefits of early intervention-is very much a proponent for treating crowding, crossbites and even Class III malocclusions in young, growing patients. In an article he coauthored in 2006 and published in the AJO-DO on the http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown August 2015

Orthotown.com Highlights
Embrace Progress: AAO Reflections
Poll
Managing Missing Upper Canines
Adult Class II Patient Possibility for Pre-Prosthetic Treatment
The Truth About Phase I Orthodontics
Ten Steps to Hire Slow— And Achieve Success Fast
Townie Choice Awards
A Review of “Uncomplicate Business”
Separating Your Practice from the Rest
10 Best Practices for Patient- Referral and Retention Programs
The Mini-Screw for Skeletal Anchorage in Pre-Prosthetic Orthodontics
The Use of Laser Technology in the Modern Orthodontic Practice
Ad Index

Orthotown August 2015