Early Intervention Orthodontics: A Case Study

In my clinical opinion, the value of early intervention in cases of orthodontic crowding cannot be overstated. By taking advantage of a child’s natural oral growth and development between the ages of 7 and 12, functional appliances can course-correct, as it were, what would otherwise become a complicated case of crowded secondary dentition, improper bite development, and airway constriction.

Waiting for obviously crowded secondary dentition to fully erupt creates a common misconception that the child’s teeth are too big for the mouth, often leading to unnecessary extractions and distalizations in order to align whatever teeth that will fit. Crowding is never that simple, however. In most cases, it isn’t that the teeth are too big or that the mouth is too small; it’s that the natural growth and development of the arches is inhibited in some way. Childhood allergies and other airway constraints that trigger mouth-breathing habits are often the primary cause of improper arch development. Early intervention with functional appliances can not only restore the proper arch development, but also improve airway constrictions by making more room for the tongue.

Let’s take a look at a classic case of a successful first phase of early intervention orthodontics.

Initial Presentation

Before Sequence
In this case, our patient is a 8 year-old boy who presents with very crowded primary dentition with little room for proper secondary eruption.

  • Both arches are small and narrow, and the palate is vaulted.
  • His occlusion is Class II on both sides, with the mandible resting in a very distalized position.
  • Airway issues are already a problem for our young patient and he is understandably already extremely anxious about impressions and bite registrations for appliances.
  • The impression appointment is challenging, with the patient spitting out the materials before they are completely set. However, with the support of his mother in making another attempt, we are able to help him through the discomfort and capture a usable set of impressions.

A treatment plan of functional appliances to move the teeth, expand the arches, bring his mandible forward, and create more room for guided secondary eruption is commenced.

Case Progress After Phase One Treatment

After Sequence
After 18 months of active treatment, our patient now has enough room for the incoming secondary dentition.

  • He is now in a holding pattern while the second molars erupt and lock cusps.
  • The arches are now properly shaped and wide enough to receive all the teeth.
  • The palate is no longer vaulted and allows adequate space for the tongue.
  • The mandible is in a class I position.
  • His mother reports that he is sleeping better and the night snoring had stopped.
  • Braces will only be necessary if final eruption of the secondary teeth reveals rotational issues that need to be addressed.
  • Treatment in braces would likely be for less than a year, if at all.

Without early orthodontic intervention, this patient most certainly would have required many more months in braces to correct the crowding and rotational issues that would have developed if the secondary dentition had been allowed to erupt on their own. Headgear and/or extractions may even have been prescribed. Without palatal expansion, oral breathing habits would likely have worsened and the arches may have narrowed even further, causing even more airway constriction. By intervening early in what was obviously improper development of the oral cavity, we were able to help this child avoid much longer and more complicated treatment later on.

My hope is that someday all children will have access to this kind of orthodontic correction and that unnecessary extractions and distalization procedures will become a thing of the past. If you are interested in learning more about early intervention orthodontics and how you might be able to integrate some of these treatments into your own practice, I hope that you will join me for my upcoming course Early Orthodontic Intervention with Functional Appliances offered in partnership with the OAGD.