Phase One in the Permanent Dentition

by Dr. Michel Champagne, BA, DMD, MAGD, IBO, CDE

 When you treat an adolescent or an adult patient, you may need a Phase One treatment for a specific case.  But what is Phase One treatment in the permanent dentition. We are not talking about interception at this stage. We are more involved with the prevention of cranio-facial dysfunction, probably not present at the beginning of treatment or in other cases we may have for objective to do  everything we can to give proper lip support and a balanced musculature. Phase One treatment starts with basic principles to promote a good environment for nasal breathing and swallowing. If problems are depicted, we have to come back to a basic protocols as with younger patients and really address the problems by referring to the proper professional of the team i.e. ENT, allergist, speech therapist, etc. Let’s take the example of a patient with a swallowing problem, if our treatment does not include a specific therapy addressing the problem, long term stability will be compromised. The dentist is like the maestro, he has the central role in the global treatment of the patient. Phase One treatment with these patients must also address the centric occlusion to which the patient will be treated. This will be a neuro-muscular position determined by any technique that works well in your hands. This is essential for proper treatment and for the prevention of TMJ problems. The neuro-muscular centric position can give you a very different view of the malocclusion than the static occlusion of the plaster or 3D models.

Let’s take a case where the patient is Class 1 dental on one side and Class 2 dental on the other; you deprogram the patient’s occlusion in CR and you see a different picture, he is Class 2 on both sides…what happened? The patient probably has in habitual occlusion an asymmetrical condylar position with one condyle being more mesial than the other. If this is not diagnosed at the beginning of treatment and you treat to the habitual occlusal position, you and the patient will be in a situation that can lead to major complications. You might say that few clinicians take the time to evaluate these conditions but let me resume in a few words: ‘’ You cannot see what you do not know’’. In our days, the specialty may be more concerned with treatment speed than with treatment quality. In adult dentition, Phase One has to minimize temporo-mandibular dysfunction probabilities. We can add that some patients in permanent dentition between the age 11 and 16 can respond well to Phase One treatment including dento-facial orthopaedics.

We must always remember than at any age, unlocking the occlusion by removing obstacles will always have a place.

               

Open bite with occlusal cant                                   Ceph with double mandibular plane                  Panorex showing different condyles shape