Why is the term dentofacial orthopedics used in orthodontics?

The objective of contemporary orthodontics is a well-proportioned face as well as an esthetic and stable dentition. For that reason, the orthodontist must evaluate the dental arches and face in three dimensions of space: transverse, anterior-posterior, and vertical. It is often through facial orthopedics that the orthodontist is able to achieve a treatment result with jaws in proportion to each other and to the rest of the face.

Why are some children treated in two phases?

In most cases where early orthodontic treatment is recommended, the objective of the first phase of treatment will be one or more of the following:

• To correct jaw disproportions before aligning the teeth
• To eliminate damaging habits
• To prevent injury to protruded teeth
• To manage insufficient arch length (crowding)

With these problems, early intervention may provide advantages that are not available later. After the permanent teeth erupt, the treatment objective is to achieve optimal esthetics and stability.

Do all children with skeletal discrepancies require two phases of treatment?

No. The need for interceptive orthodontics must be determined on an individual basis. After diagnosis, the orthodontist will determine if the benefits and opportunities significantly outweigh the time and effort involved in early treatment. For some children, a delayed single-phase treatment is the best approach.

Why are serial or selective extractions recommended for some young patients?

Early removal of selected primary teeth can be necessary to guide the eruption of permanent teeth. Carefully-timed extractions may prevent a variety of problems, including:

• Palatal impaction or high eruption of permanent canines with little or no attached gingiva
• Root resorption, especially on permanent lateral incisors
• Severe crowding in the permanent dentition requiring extensive appliance therapy

When is the best time to refer a child with skeletal disproportion or oral habit?

Because some orthodontic problems respond best to early correction, the child should be referred as soon as a problem is recognized. Optimal treatment timing will be determined by an accurate differential diagnosis and growth and development of the individual patient.

What’s the problem with waiting until the permanent teeth erupt to refer?

The problem may be one of opportunity missed with respect to growth and development. It’s useful to view treatment opportunities in three phases: early, on time, or too late. While patients can be treated at any age, those with available growth may enjoy a substantial advantage. For some patients, early treatment may prevent the need for jaw surgery, extraction of permanent teeth, or fracture of protruded incisors. Early treatment may also aid in psychological development that is appearance-related. Most harmful oral habits respond best to early treatment. A patient referred in the mixed dentition may also benefit from space management and guidance of eruption.