Orthotown November 2020 - 10

embrace progress

I set out to create a system that
could manage the needs and
expectations of efficient Phase 1
treatment, followed by a reasonable
period of waiting and culminating in
Phase 2 treatment. The goal is to treat
Phase 1 in 9-15 months and Phase 2
in less than 18 months.
growing trend that is underappreciated by
pediatric dentists and orthodontists from a
quality-of-care standpoint and the obvious
and legitimate profitability arguments. So
when in Rome, do as the Romans do and
create a systematic method to treat these
patients in a moral, ethical and time-efficient
manner.
I set out to create a system that could
manage the needs and expectations of
efficient Phase 1 treatment, followed by a
reasonable period of waiting and culminating
in Phase 2 treatment. The goal is to treat
Phase 1 in 9-15 months and Phase 2 in
less than 18 months. We all know that the
techniques and technology are available,
but we need to adapt and practice them.
Over the years, my absolute favorite and
common-sense researchers, clinicians and
educators have been:
*	 Dr. Adrian Becker, for his work
on impacted cuspids and proactive
avoidance of this situation.
*	 Dr. Anthony Gianelly, for his
endorsement and statistical evaluation
of the bilateral lingual arch and its
benefit for non-extraction treatment
in the lower arch.
*	 Dr. James McNamara, for his
method to evaluate the transverse
dimension of the maxilla, the size of

10

the dentition and his slick way
to treat the transitional dentition.
*	 Drs. Sean Carlson and Juan-Carlos
Quintero, for their commitment
to educating orthodontists about
treating volumes and not just the
Angle malocclusion with their work
and citations on crossbites, overt and
covert, as well as arch length.
Be on the lookout for upcoming articles
with photos and tracings to support these
statements.
My system involves the following steps:
*	 Patients are referred from the
pediatric dentist after age 7, or when
a couple of incisors have erupted, and
the first permanent molars are visible.
*	 Not all 7-year-olds are referred.
My pediatric dentist and I have
come to an understanding regarding
the need for evaluation.
*	 When possible, the records are
gathered at the same appointment
for an upcoming conference and
start. (We are beginning to move
to a virtual model.)
*	 The exam is conducted in a
conference room with comfortable
chairs, allowing for the family to
be seated across from me with the
patient to the side.

We explain:
*	 Why they are there and what we are
looking for regarding jaws, dentition,
habits and medical conditions.
*	 Why Phase 1 and what happens
if we delay.
If it is determined to proceed with
either interceptive or Phase 1 treatment,
the child is taken to be scanned and have
spacers placed or, in some instances, have
impressions made. Treatment is directed in
almost all situations at expanding, developing
or harnessing the maxilla and or mandible.
Primary teeth are rarely removed, unless they
are exfoliating asymmetrically, permanent
teeth are erupting ectopically or there is
difficulty placing appliances. The mandibular
incisors are rarely bonded and most likely
primary canines, self-alignment and lingual
arches are placed. Severe Class 2 issues are
addressed; however, as per McNamara, the
final molar and skeletal positioning may be
delayed until final treatment.
The goals are:
1.	 A well-expanded maxilla with
erupted incisors with room and
a pathway for cuspids to erupt.
2.	 Straight, attractive front teeth!
3.	 Good molar position with midlines
as close as possible at this stage.
(Can't stress too much or treatment
gets needlessly extended.)
4.	 Close-to-ideal overbite and overjet.
5.	 Deband and retention with Essex
and/or bonded lingual (space
permitting).
6.	 Recall.

My final thoughts
It can't be stated enough that a systematic
approach to Phase 1 treatment is essential
with proper communication. Expectations
need to be managed and questions addressed.
Be on the lookout for a mixture of cases
on the message boards and in publication
spaces. I am enthusiastic about these patients
and feel that a true benefit is achieved with
properly timed, executed and managed early
treatment. n

NOVEMBER 2020 // orthotown.com

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10/27/20 9:29 AM
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Orthotown November 2020

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