Part 2 | Systematic Approach to Diagnosis & Treatment of Interceptive Orthodontics: Defining Successful Phase I Treatment & Growth Management

In the first installment of this article, we discussed the rationale for doing Phase I (Ph1) orthodontic treatment (tx). This is the second installment of the four-part article. Phase I success is NOT defined as a patient not eventually needing extractions. Some patients need teeth removed to produce an optimal aesthetic, stable and periodontally healthy result. Those that claim extracting teeth ruins faces must also acknowledge that many cases treated with extractions look gorgeous, yield beautiful faces, ideal profiles, and long-term results. Conversely, many non-extracted cases produce protrusive profiles, crowding relapse, and fail to correct A-P discrepancies.

An ultimately successful Ph I treatment would result in no need for Phase II (Ph II) treatment or nothing more than straightening the teeth remaining for Ph II. And while many well-managed interceptive orthodontic cases do result in non-extraction cases, it is never wise to suggest to parents that performing interceptive orthodontic treatment will assure that a case can terminally be treated non-extraction in Ph II. The reason is that, as clinicians, there are three major variables in any Phase I case we may not be able to control. These include: 1) Ph I treatment effect and results, 2) Patient cooperation, and 3) quantity and direction of growth.

If any of these variables are not in our favor, the Ph I tx outcome can be limited or the results deemed disappointing. But if Ph I is less than a mitigated success, it does not necessarily result in Ph II failure. If we are smart, honest and savvy, we can learn from the Ph I results and design a Ph II tx plan that adjusts from, corrects, and compensates for Ph I limitations (Fig. 1-2).

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