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Dentistry/Phase I retainer

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Expert: - 11/13/2008


Question
Thanks in advance for your help. My 9-year-old daughter is about to finish two years of treatment with a palette expander. Now we're told she'll need a permanent retainer for her top teeth for three years until she starts Phase II. (She is now wearing a traditional retainer for her bottom teeth -- that expander was taken out a few months ago.) We're frustrated because we were originally told the expanders would be in for 9 months, and weren't told anything about retainers. Now we're learning of studies that show many kids don't need Phase I treatment and do just as well with only Phase II. My questions: If kids in between Phase I and II don't wear retainers, how much does it affect movement and extend the time of Phase II treatment? Also, what are the pros/ cons of permanent retainers versus traditional ones? We don't want to make her suffer through three more years of metal in her mouth, harder dental care, and dietary restrictions if we don't have to. Thanks.

Answer
Not all orthodontic problems can be treated by a two phase approach, but there are several types of problems (crossbites especially) that are best treated early with phase I treatment and later on with phase II braces.
Expansion is something that should be retained for a long time to prevent the relapse or return of the crossbite.  The usual removable retainer is not appropriate during the period between phase I and phase II since it would interfere with the loss of baby teeth and the proper emergence of permanent teeth.  That's why a permanent retainer like a Nance holding arch is the best type of appliance in this case.

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Dr. Randolph Myerson

Expertise

Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.

Experience

I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

Organizations
I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

Education/Credentials
I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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