I began to embrace clear aligner treatment specifically designed to correct developing malocclusions of young patients when I treated my own daughter who had a large overjet and deep overbite. I treated her as a young child with a twin block, which was all we had available to us at the time, because I saw the impact of a malocclusion on her self-esteem, confidence and even her ability to eat, because she was biting into her palate. This opened my whole mindset to providing early interceptive treatment.
However, things have moved on considerably since then. We now have Invisalign First which is a smart choice of treatment for addressing large overjets, deep overbites, anterior and posterior crossbites, as well as crowding in young patients.
Early orthodontics
There are so many benefits to early orthodontic treatment. Young children are especially prone to trauma and if they have an increased overjet they are more likely to damage their front teeth, which then could result in a lifetime of dental treatment. Furthermore, early arch development can create more space for the adult teeth, thus reducing the need for removal of teeth later when they are ready to start the more comprehensive phase of treatment. Creating space has the potential to reduce the likelihood of permanent teeth becoming impacted.
When I explain the benefits of early orthodontics to the patient and parents, the advice is largely welcomed. I find the majority appreciate the opportunity to do something to improve the appearance of their children’s teeth as well as their oral health. A big deciding factor is when I explain that, while I can’t guarantee teeth won’t need to be extracted later, the likelihood is reduced. This is a definitive advantage over waiting until all the adult teeth have erupted and then having to remove healthy teeth.
Case study
Poppy was a nine-year-old girl with a class II division II malocclusion and crowding. She was self-conscious about her prominent lateral incisors and had some overcrowding in her lower arch.
Timing is critical and treatment depends on a child’s dental age, rather than their chronological age. In my professional opinion, Poppy was an ideal patient for some alignment and arch development to create space for her permanent teeth.
The first step was an assessment to ensure she was suitable for treatment. Like all prospective patients in my practice, she had an intraoral digital scan performed with iTero scanner, and she was shown how her smile could look post-treatment using Invisalign Outcome Simulator Pro. When patients, and their parents, can visualise the end result, they can more easily understand the benefits of treatment. It’s important to spend time sharing the scans and X-rays and discussing the potential problems if we leave things untreated.
With patients and their carers, I also explain the limitations of what I expect to achieve in this first phase; I ensure they know that I’m not aiming for perfection at this stage. This means everyone’s expectations are met; they know the patient is going to look better and future treatment should be more straightforward. Both patients and parents understand that a second phase of treatment will be needed once they are older.
This patient’s treatment was straightforward. She was very motivated to wear her Invisalign aligners, meaning at the end of her first phase, her teeth were beautifully aligned, and her arches were developed to allow plenty of space for her permanent teeth to erupt. We will need to assess if she will need a second treatment phase. However, the fact that we achieved her arch development in phase one means it could be a very straightforward, non-extraction alignment treatment. I believe this second phase could be completed within nine to 12 months.
Poppy and her parents were happy with her orthodontic treatment and outcome. Poppy’s parent said, “I was slightly apprehensive about how Poppy would cope with aligners at such a young age. I thought the aligners would spend more time in the box then in her mouth, but I didn't need to worry. She coped really well and didn't have any issues; she remembered to change to a new set when I forgot! The treatment was relatively quick, and we were delighted with the results. Catherine and all the team were fantastic explaining everything, so Poppy understood, she felt comfortable and relaxed during appointments.”
Conclusion
In my opinion, early intervention orthodontic treatment for children can be so beneficial – not only from a clinical perspective, but also for the patient’s self-esteem and confidence. It is important to educate other orthodontists about this option. Currently, the NHS only provides early treatment when children have their permanent dentition, but there are options of having treatment earlier.
It's also important for patients, their parents and treating orthodontists to understand that the phase one treatment, with Invisalign First, does not need to be complicated; correcting the main issues, but not trying to correct everything in that first phase.
For more information visit www.invisalign.co.uk/ortho/treatment-solutions/invisalign-first