David Hertzberg, DDS, MS
160 Commerce Drive,
Suite 101
Grayslake, IL 60030
Tel: 847-548-4330

For Children and Adults

For Children and Adults

Interceptive Treatment (phase I)

Interceptive treatment is designed to treat children from age 6-9 who have significant orthodontic problems. Not all children need this type of treatment. According to research studies around 20% of children benefit from this type of treatment. It is very important that these problems are diagnosed properly and why the American Association of Orthodontists advises that all children see an orthodontist by age 7.


Some of the most common problems that are treated are crossbites, underbites, severe crowding, severe protrusion, very deep overbites, dental habits (such as thumb sucking, tongue thrust, etc.), space loss due to early loss of baby teeth, or dental eruption issues (such as poor angulation, impacted teeth, etc). Also, other types of problems such as missing teeth can be addressed early so appropriate treatment can be discussed and planned early on.


There are many different types of treatment that can be used to help correct these problems. Dr. Hertzberg utilizes the best possible treatment for each case depending on the exact problem. For example, some treatment only requires an expander, some can be fixed with limited braces, and others can be corrected with retainers. Also, combinations of these can be used as well.


In some cases extractions of baby teeth are used as a part of treatment as well. This is most common in cases where there is severe crowding, but there are other indications as well. Sometimes baby teeth will prevent permanent teeth from erupting, or cause teeth to erupt in the wrong place. In severe situations, this can lead to damage to permanent teeth or destruction of periodontal tissues, which is permanent damage. If this is recommended, Dr. Hertzberg will give a very thorough explanation for the reasons as well as the benefits for the extractions. The extractions can be done by either the general or pediatric dentist or in some cases an oral surgeon.


Phase I treatment is not designed to prevent the need for comprehensive orthodontic treatment. This does happen in some cases, but most children will need full treatment once the permanent teeth have fully erupted. Phase I treatment is designed to eliminate significant dental and skeletal problems early on and to allow normal dental and skeletal development to proceed while the remaining permanent teeth are erupting. Phase I treatment will reduce the complexity of comprehensive treatment and provide a more stable long-term result. The total time in orthodontic treatment is still the same overall, with some during Phase I and the remaining during Phase II. The average time for comprehensive treatment given by the American Association of Orthodontists is about 26 months. The average time in this office for comprehensive treatment ranges from 18-24 months, depending on the severity of the case. Phase I treatment times range from 3-12 months, again depending on the severity of the problem.


The costs of Phase I treatment are part of the overall treatment fee, so the overall cost of treatment is still the same. Any payments for phase I treatment are applied to future comprehensive treatment. For example, if $1800 was paid for Phase I treatment and the comprehensive fee is $5000, then the Phase II fee would be $3200. In most cases where Phase I treatment was done, comprehensive treatment tends to be less difficult to complete and shorter in duration, which is why Dr. Hertzberg has this fee plan in place. This is different from many other orthodontic offices, which make the Phase I fee totally separate from the comprehensive fee, which makes the overall fee significantly higher.


Comprehensive Treatment

This is the most common type of orthodontic treatment. It is usually done around age 12 and is designed to correct all of the orthodontic problems present. In some cases treatment can start with a few primary teeth left, but in many, treatment will start when all of the permanent teeth have erupted. Braces are usually placed on all possible teeth (sometimes there are a few that have not fully erupted and they are added later). Sometimes other appliances, such as space maintainers or expanders are needed as well, but not in most cases. During treatment it is critical to maintain the cleaning schedule with your general dentist. This should be at least every 6 months and sometimes less if hygiene is a major problem.


The most common type of braces used are the traditional metal "twin" braces. "Clear" braces can also be used on the top front teeth if desired if esthetics are a concern. Using these on the bottom is dangerous since they can cause significant wear on the edges of the teeth. The clear braces are made of ceramic (to avoid discoloration seen in plastic braces) and ceramic is much harder than enamel, which is why bottom ceramic braces will damage enamel on the upper front teeth. In certain cases, "self-ligating" braces are an option (our office uses the Damon system). Many offices are actively marketing "self-ligating" braces (such as Damon or Smart Clip), which make claims such as reducing treatment time in half, correcting problems that "regular" braces can't, and eliminating all discomfort. Dr Hertzberg has tried all of the major types of self-ligating braces and found the claims to be completely untrue in most cases. Some of the advantages of self-ligating braces are that they do slightly reduce the total number of appointments and have no "colors" that need to be retied, which does help with hygiene. They are very useful in extraction cases and for people who live further away since there will be slightly fewer overall visits to the office.


The overall time in treatment is dependent on the difficulty of the case to start. The average time in treatment is 18-24 months, but many can be either shorter or longer than this average. This will be explained before the start of treatment. Some other factors that effect the time in treatment are patient compliance (especially wearing rubber bands and keeping scheduled appointments), breakage of appliances, and eruption of permanent teeth (especially 2nd molars or teeth that were blocked to start treatment). Even after all of the movement has been completed, the braces are left on for a time to stabilize the corrections made. If hygiene is a major problem during treatment, the appliances could be removed early (before all movement is complete and stabilized) to prevent excessive damage to the teeth. In some cases (especially underbites) additional jaw growth is a concern and may need to be watched for a longer period of time.


In all cases, retainers are needed after treatment is complete. There are numerous different types of retainers that are used, depending on the problem at the start of treatment. Traditional removable wire and plastic (Hawley) retainers are the most common. Permanent (bonded) retainers are commonly used behind the lower front teeth, and in some cases can be used in the top. This is the area of the mouth that has the most instability over the long-term and this type of retainer will prevent movement of the teeth. Clear (Essix) retainers are another common type, especially for adults. Some of the Essix retainers have the ability to wear rubber bands as well to help stabilize the corrections without braces. At the very least, retainers are used until the 3rd molars (wisdom teeth) are accounted for (either in or extracted). This is usually about 4 years after treatment is complete. Ideally, if the retainers still fit, it is never a bad idea to wear them indefinitely (even if it is 1-2 times per month).


For Children and Adults

Adult Orthodontics

Orthodontic treatment can be successful at any age, and adults especially appreciate the benefits of a beautiful smile. One of every five patients in orthodontic treatment is over 21.


Treatment in adults is often based on the exact problems present and can often be handled with limited appliances or even Invisalign. Treatment can range from very simplistic movements of specific teeth to work to prepare for implants, crowns or bridges. This type of work involves close contact with the restoring dentist to ensure as ideal a final result as possible.


Jaw surgery is more often required for adult orthodontic patients because their jaws are not growing. Adults also may have experienced some breakdown or loss of their teeth and bone that supports the teeth and may require periodontal treatment before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. In all cases, careful periodontal charting from the dentist will be needed prior to the start of active treatment. In more severe problems, a referral to a periodontist will be necessary as well.


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