Orthotown May 2018 - 9

facial muscle balance. Reports of behavior
changes are becoming more commonplace.
Of course, looking at Phase I or early treatment this way necessitates a different view
of ourselves and the logistical-or should I
say business-side of the profession. Who
knows? It may even change the profession
to something we've envisioned.
If you are like me and have been in
practice awhile, you probably agree that Phase
I treatment is a wonderful service, but many
times leads to extended treatment, runs into
Phase II or in some instances, accomplishes
things that easily could have been achieved
during a patient's adolescence. There are
many published studies that attest to these
statements and I am sure that many of you
have anecdotes of your own.
What if our whole understanding of the
transitional dentition changed, so that rather
than just correcting cross-bites, closing gaps
and making room for teeth, we were truly
treating the individual's developing airway,
facial characteristics and proportions, and
improving overall health? Would Phase I
treatment still be given second-class status in
the busy orthodontic practice? What if Phase
I care became the most important part of
the treatment equation? Imagine if what we
accomplished in Phase I treatment was the
essential objective of orthodontic practice?
In addition to a CBCT lecture, I recently
attended the joint AAO/AAPD conference,
where early treatment was encouraged to

eliminate the infrequent occurrence of
impaction of cuspids. I know that in my
practice, Phase I care was responsible for
only a small part of the revenue but many
times a larger-than-proportional amount
of chair time.
With the advent of CBCT and the
resultant knowledge from sophisticated
software analysis and treatment planning,
this service may soon become a necessary part
of orthodontic care, viewed as the "primary
reason for care" only to be followed by the
"cosmetic" or tooth alignment service. I am
sure many of you have already discovered
what took me this long to find out on my own.

Changing face
I will admit, I am part of the same
group of orthodontists who views their
job as to efficiently and cost effectively
align teeth during the various stages of
dentition. In addition, I have always worked
to eliminate unhealthy habits, encourage
healthy breathing and identify contributing
medical conditions.
What we are realizing now, thanks to
many reports and observations, is that the
face indeed does change over time, making
our value judgment about facial proportions
and tooth position to be less accurate over
time. We're also witnessing an unprecedented
number of adults subjected to airway and
breathing treatments, many times following
self-inflicted conditions (such as overeating

and lack of activity), but sometimes-possibly
by coincidence-orthodontic care.
I have questioned some message board
treatment plans that are still driven by the
magical Class I molar relationship at all
cost, and lower incisor position that, with
varying muscular habits, becomes less
relevant over time.
My realization that Phase I treatment
is now becoming of equal importance as a
later phase of care is obviously coming in
the autumn of my career, but hopefully, not
too late for others. I am not limiting my
discussion to only early treatment. With
the rapidly developing software and ever
lowering doses of radiation, it won't be long
before every patient is scanned for:
* Airway evaluation
* Growth projection
* Various appliances and indirect
bonding
* Treatment simulation
* Superimpositions to evaluate the
above results.
I am quick to admit that more research
is needed to validate some of the comments
I've made. I ask that clinicians reading this
will begin to look at their patients with a
different set of eyes and hopefully attend a
CBCT lecture soon to see what is going on
under their noses. I thank Sean Carlson, JC
Quintero and others for contributing to my
knowledge and challenging me and others
to look further. ■
orthotown.com \\ MAY 2018

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