Two-Phase Orthodontic Treatment at Smithtown Orthodontics in Smithtown, NY
Two-Phase Orthodontic Treatment at Smithtown Orthodontics in Smithtown, NY

Two-Phase Orthodontic Treatment

Medically Reviewed by Dr. Duane S. Shank, DDS, Board-Certified Orthodontist

Two-phase treatment is a plan that splits orthodontic care into two phases at two different ages: a short first phase during childhood, while the jaws are still growing, followed by a resting period, then a full second phase once all the permanent teeth are in. Most children never need it. For the ones who do, it prevents problems that are much harder to fix later.

When splitting treatment makes sense

A single course of braces, started once all the permanent teeth have arrived, is the normal path and works for the large majority of patients.

Two phases become the better plan when a child has a problem with the jaws rather than just the teeth. An upper jaw growing too narrow. A lower jaw growing too far forward or lagging behind. A crossbite that will pull the developing bite off-center. Severe crowding with no room for permanent teeth at all.

These are growth problems, and growth has an expiry date. Waiting until fourteen to address a narrow upper jaw means the correction is no longer available; what is available instead is extraction of permanent teeth, or in severe cases jaw surgery in adulthood. That is the only argument that justifies splitting treatment.

Phase One: making room and guiding growth

Phase One usually begins between ages seven and ten, while a mixture of baby and permanent teeth is present.

The goal is narrow and specific: develop the jaws so there is room for all the permanent teeth, and get the upper and lower jaws into a workable relationship. That is usually done with a palatal expander, sometimes partial braces, sometimes an appliance guiding jaw growth.

Phase One typically runs 10 to 18 months. It is not a full set of braces, it does not straighten everything, and the teeth will not look finished at the end of it. They are not supposed to.

Records first

Before anything starts we take records: a digital scan or models, panoramic and cephalometric X-rays, and photographs. Those determine which appliances are needed, how long treatment should take, and how often your child is seen. They also set the baseline, which is how we show you what changed.

The resting period

Once Phase One is finished, appliances come out and nothing happens for a while. This surprises parents and it is the most important part of the plan.

During the rest, the remaining permanent teeth erupt. A successful Phase One created the room for them to find their own way in, and letting them do that unimpeded is the point. Teeth constrained during eruption become impacted or badly displaced, the very outcome the first phase was meant to prevent.

The rest usually lasts 12 to 24 months, with a check-up every six months. Occasionally a baby tooth is removed to clear an eruption path. Retainers are sometimes worn and sometimes deliberately not, because a retainer that holds teeth in place can also hold them out of the way of teeth trying to arrive.

Phase Two: finishing the job

Phase Two starts once all the permanent teeth are in, usually around ages eleven to fourteen and timed to the growth spurt, which arrives roughly at 11 to 13 in girls and 12 to 14 in boys.

This is the full course: braces on all the teeth, typically about 24 months, positioning every tooth so it works properly with the lips, cheeks, tongue, and the teeth it bites against. Retainers follow, permanently.

Not every child needs two phases

Worth stating plainly, because it is over-recommended in general.

Only a minority of children have a problem that genuinely calls for a two-phase plan. Everyone else is better served by watching through the mixed-dentition years and then doing one course of braces at the right moment. Dr. Shank is conservative about this and will tell you when the answer is to wait.

If your child has not yet had a first evaluation, start with early orthodontic treatment.

Ask at a free consultation

Bring your child in and get a straight answer about whether one phase or two is the right plan. There is no charge for the visit. Call (631) 265-3666 or request an appointment online.

Smithtown Orthodontics 200 E Main St. Smithtown, NY 11787 (631) 265-3666

Frequently Asked Questions

Families in Smithtown, NY often have questions about whether two-phase orthodontic treatment is the right choice for their child. Below are some common questions to help you better understand this approach and what to expect.

Because some problems are skeletal rather than dental, and skeletal problems can only be corrected while a child is still growing. A first phase uses that growth to widen a narrow jaw, correct a crossbite, or create room. A second phase aligns the permanent teeth once they have arrived. It is about timing, not about doing more treatment.

Usually around 24 months, and the range across cases runs roughly 12 to 24. Phase Two is the full course of braces on all the permanent teeth, so it takes about as long as single-phase treatment would have. Retainers follow it.

No. Only some children have a problem that genuinely requires it. Most are better served by monitoring through the mixed-dentition years and then one course of braces at the right time. If a practice recommends a first phase, ask what skeletal or space problem it solves and what happens if you wait.

The appliances come out and the remaining permanent teeth erupt on their own. Your child is seen about every six months, and sometimes a baby tooth is removed to clear a path. The rest usually lasts 12 to 24 months. It looks like nothing is happening, and it is what makes Phase Two shorter.

The two are usually quoted separately, and Phase Two is generally the larger of the two fees because it is a full course of braces on every tooth. Phase One is shorter and narrower in scope. At this practice you get the fee for the phase being recommended in writing at the consultation, with the payment plan set out, before anything begins.