ParentClick Santa Barbara

Why Does My Child Need Braces Twice?


“I just finished taking my 8 year old to the orthodontist and I was told that they should start a two-phase treatment before all of the baby teeth are lost. It just seems so aggressive to start so young.”

Over the last several years, the approach to orthodontic treatment has changed remarkably. In past years, it was not unusual for the orthodontist to recommend that treatment not start until all the permanent teeth were in and growth was complete. The thinking was that the child could grow out of the correction if done early and that by waiting, there was less risk. The consequence is that once growth is complete, the ability to positively influence growth is also lost.

Studies have shown that kids with crowded teeth do not have additional useful jaw growth after the age of 6. However, in many children it is possible to gain additional jaw growth using orthopedic arch expansion to create space for the crowded teeth. This is as an alternative to extraction of permanent teeth. This is not to say that extraction is wrong, as it may still be the treatment of choice in some cases. For example, where there is a combination of crowded teeth and forward protrusion of the front teeth. It can also be useful in other cases.

This change in thinking has resulted in a change in the name of the Orthodontic specialty from “Orthodontics” to “Orthodontics and Facial Orthopedics”. It is now common for Orthodontic residency training programs to devote much of the curriculum to treatment planning for younger patients. In these selected cases, the Orthodontic treatment is purposely divided into two phases. The first to gain control of the amount of space available for permanent teeth along with preliminary bite correction and a second stage of treatment after full dental development to finish. In these cases, the second stage should not be viewed as a failure of treatment but rather a planned event to finish with the best result.

It is important to note that not all children need interceptive, two phase treatment. If early treatment is recommended, the plan is based on each child as an individual with precise measurements that assure control of the treatment so as not to over treat the child.

The treatment is also unique in that it addresses both the upper and lower dental arches where some providers propose treatment plans that treat the upper arch only. The typical Phase 1 treatment is about 13 months in length followed by observation and retention with the completing stage lasting about 12 to 15 months.

The combined treatment time is similar in time to a single stage of treatment but the results can be far superior. Early treatment can also provide an early boost for the child’s self esteem and allow them to be complete with orthodontic treatment before High School begins.


[AUTHORS: Dr. Raymond Kubisch and Dr. Drew Ferris] Kubisch and Ferris have spent the last 30 plus years developing a protocol for this type of treatment that is unique in the Santa Barbara area.

January 10, 2018

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One comment

  1. Lily de Grey says:

    Thanks for posting this informative article, Doctors Kubisch & Ferris. I think it’s important to release and acknowledge that everyone’s teeth are different; sometimes extraordinary orthodontic procedures must correlate to extraordinary teeth. It’s also important to note that not all people have unique cases. I’ve had many people who have only had braces once, and their teeth are still straight and beautiful!

    Lily de Grey | Orthodontics