According to the American Association of Orthodontists (AAO), a child should be seen by an orthodontist by age 7. However, there are three major approaches to "timing of orthodontic treatment", which I will codified. One belief is (1) early phase 1, sometimes referred to as growth modification, followed by a more comprehensive phase 2 treatment usually for difficult cases with skeletal, facial discrepancies, or intervention that may reduce the extent of future treatment. This is started at possibly 7, 8, or 9 years of age while the child is still growing. If there is a Class III facial, or dental pattern (prominent chin, or midface deficiency, or anterior/posterior crossbite), treatment at younger than age 7 may be indicated. With this approach, two fees are charged, one for phase 1 and another for phase 2. The opinion is that the parameters of treatment and the results are better since growth enhances the orthodontic treatment. Recent prospective, randomized clinical trials at three major centers, the University of Florida, the University of Pennsylvania, and the University of North Carolina however have failed to demonstrate this.

The second protocol (2), advocated by Anthony Gianelly, DMD, MD, PhD, chairman of orthodontics at Boston University, is preservation of arch length, Leeway space, E-space, in the late mixed dentition at approximately 10 ½ years of age. This age, however, is variable, and the patient needs to be evaluated before age 10½ probably around age 7. At this time the orthodontist can decide on non extraction, or extraction treatment with no harm to the patient, and the treatment can be completed in one phase, within a reasonable time frame. Currently, this protocol probably has the most evidence to support its use. Only one fee is charged for this type of treatment.

Completely contrary to the first approach described, involving two phase treatment, a (3) third belief is to wait even later than Gianelly proposed until all the primary teeth are lost, and do one treatment, with one fee. There is some evidence that patients who had two phase treatments were indistinguishable from those who had only one treatment except that it cost more for two phase treatments and it took longer for two treatments.

Since all three treatment protocols have some advantages and disadvantages, we employ all three in our practice at Rinchuse and Rinchuse. The inclusion and exclusion criteria for the three treatments are based on the scientific literature and matched to each individual patient. Therefore, each orthodontic patient at our office receives a customized treatment plan for his/her particular needs.