Orthotown May 2022 - 11

anterior crowding or spacing, no crossbite
and no parafunctional habit present?
Hopefully, we can also agree that there are
patients for whom Phase I treatment is not
indicated.
Common ground
Those are of course the extremes, but
they illustrate the vast majority of us agree
with Phase I treatment as sometimes indicated
and sometimes not. So now, outside
of the extremes, where is the correct middle
ground? Irrespective of the appliances we
use, we can develop a set of three rules or
conditions that can guide us. Patients with
these conditions should have Phase I treatment
and patients without them should
not. If I am correct, this will have significant
implications for certain companies
and key opinion leaders (KOLs) who push
products and treatments seemingly only
because they're profi table, not because they
are actually of help to our patients. I will
present these three conditions in descending
order, starting with the conditions that
I expect we will most agree upon.
First condition
The fi rst condition where Phase I treatment
would be indicated is when a patient's
teeth or malocclusion is causing psychosocial
issues. If a patient is being teased,
this is more than adequate reason to provide
Phase I treatment to help them. We
all went into the health professions because
we wanted to help people. Who wouldn't
want to help a child in this situation?
There are obvious caveats. The correction
desired has to be something that we can
do. It has to be something that will not cause
any immediate or long-term harm. Also, the
parents and patient must be fully aware that
this treatment is elective and is being done
now only for this reason, and that Phase II
treatment will still be needed later.
For
this fi rst
condition,
treatment
could be provided with braces, any number
of appliances or clear aligner treatment.
Second condition
The second condition would be one in
which not doing something for the patient
early would allow something to become
irreversibly worse or cause a secondary ill
effect to develop.
Examples in this category abound.
One example would be that of a primary
tooth being prematurely lost in a location
where the mesial drift of the distal molars is
anticipated. For this patient, the crowding
is minimal, and the patient may be treated
non-extraction later on if only the space
is maintained. For this example, I would
consider a holding arch Phase I.
A second example might be a patient
with a maxillary central incisor in crossbite.
Untreated, this could ultimately cause the
loss of a lower incisor, among other problems.
There may be some debate whether
certain situations qualify under this category.
However, I suspect that most of us fall
into the middle of a fairly steep bell curve
in opinion on this. Treatments in this category
would seem to be mostly done with
fi xed or removable appliances; occasionally
braces or clear aligners could be indicated.
Third condition
As promised, the third condition will
likely be the most controversial. This condition
is where doing something in Phase I
will improve the quality or duration of the
fi nal result at the end of Phase II. An additional
consideration is that this correction
cannot be achieved with Phase II treatment
alone.
Examples of patients in this category
would be the previous 7-year-old patient
who needed palatal expansion, or a 7-yearold
patient growing Class III and treated
with a protraction headgear. The younger
a patient is, the greater the percentage of
their correction will be orthopedic when
protraction headgear is used. The Phase I
goal with Class III patients we're trying to
treat nonsurgically is to maximize the orthopedic
correction and to minimize the
Determining the
best treatment
for patients is
something that
should leave
us constantly
questioning.
dental compensations that result. Early
Phase I treatment accomplishes this. Dental
compensations are then reserved for
Phase II and only applied as needed. This
is because these compensations are limited
in scope and are almost always in the category
of being compromises.
Whether or not you agree with the
above treatments is beside the point. The
real point is that almost all justifi ed treatments
in this third category are orthopedic.
Treatments that are not orthopedic
are rarely indicated under this third condition.
That is because most nonorthopedic
movements can be done more effi ciently in
Phase II alone.
This is the bombshell thought that
many companies and KOLs don't want
us thinking about. This is because this
philosophy eliminates a broad swath of
treatments that are being done under the
misleading claim that they somehow are of
benefi t to the patient long term.
Unmaking the unproven
At this point, I must deal with the all
too prevalent and unproven claim that
braces themselves, special types of archwires,
special arch forms, removable appliances
or clear aligner treatment in any
way increase the bony base, or bone facial
to the tooth roots in the alveolar ridge.
Despite decades of claims to the contrary,
orthotown.com \\ MAY 2022 11
http://www.orthotown.com
Orthotown May 2022

Table of Contents for the Digital Edition of Orthotown May 2022
