Orthotown May 2022 - 10
second opinion
The Fine Line of Phase I
Three conditions to determine the early-treatment decision
by Dr. Robert Kazmierski
M
uch of the controversy over
Phase I treatment stems from a
fact we all seem to agree upon:
Phase I treatment rarely avoids the need for
Phase II treatment. As a result, we need a
good justifi cation for doing Phase I.
While Phase I treatment isn't the most
controversial or oldest topic in orthodontic,
it has shown staying power. Newer
forms of Phase I even seem to be gaining
some traction! Unfortunately, this resurgence
is sometimes promoted for reasons
that are not with the best intentions for
patients.
Let's put others' intentions aside for
a moment and ask a question: For those
of us in the majority just trying to do the
right thing by our patients, how do we determine
when Phase I treatment should be
provided and when it should not?
I do think there is an answer, and we
fi rst have to consider the philosophy of
what we are trying to do; consideration as
to how we do something and what appliance
is appropriate is then secondary. To
start, it will be helpful to defi ne and agree
on the boundaries. Hopefully, we can then
agree upon some rules and indications
within those boundaries that will guide us
safely and ethically down the middle.
Eliminating the extremes
Right off, I believe we should eliminate
the extremes on either side. Some appear
to advocate for nearly never doing Phase I
treatment; others seem inclined toward the
opposite side. To those who say never, I'd
ask what they'd recommend for a 7-year-old
patient with a constricted palate, bilateral
crossbite and a functional shift into unilateral
crossbite. Is there any advantage to
not treating this patient now? Not treating
this patient with an appliance (e.g., fi xed
expander) capable of orthopedic palatal expansion
would only let the suture fuse more
and allow the unwanted side effects of the
functional shift to increase. Palatal expansion
is Phase I treatment. If we can agree
that this patient should receive orthopedic
palatal expansion, then we also agree that
sometimes Phase I treatment is indicated.
Likewise, even for the most ardent interceptive
practitioner, can anyone come
up with a valid reason to treat a 7-year-old
patient with Class I occlusion, very mild
10 MAY 2022 // orthotown.com
http://www.orthotown.com
Orthotown May 2022
Table of Contents for the Digital Edition of Orthotown May 2022
Orthotown May 2022 - Intro
Orthotown May 2022 - Cover1
Orthotown May 2022 - Cover2
Orthotown May 2022 - 1
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Orthotown May 2022 - Cover3
Orthotown May 2022 - Cover4
Orthotown May 2022 - Medidenta
Orthotown May 2022 - Orthopreneurs
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