The Two Phase Treatment


To describe what Dr. Cassar focuses on in Phase I portion, which is adjustment of the bone involvement of the orthodontic problem he uses the analogy of building a house. One must build a foundation to the size and model of the house we choose. Orthodontic problems are much the same thing. If the teeth don’t match the size of the jaw, they won’t be straight or if the upper jaw isn’t a matching size relative to the lower jaw, the bite won’t fit.

In “the old days” the most common approach to achieve this was to reduce the number of teeth present, “making them all fit in”. Yes, we would pull permanent teeth. And yes, treatment results were very acceptable but the missing permanent teeth forever. Today, we can treat your children typically with NO Extraction of permanent teeth and usually, in my opinion, far superior results than ever before. Best of all, what we are really doing is naturally enlarging the foundation of the house, NOT trimming down the house to fit.


Two-phase orthodontic/orthopedic treatment consists of tooth straightening (orthodontics) as well as jaw and facial changes (orthopedics). In today’s society there is an emphasis on living longer, remaining healthy and looking attractive. Optimum treatment results are needed to achieve these goals. The main benefit of two-phase treatment is to maximize the opportunity to achieve excellent, healthy, attractive, comfortable and functional long-term results. When appropriately utilized, it will provide a better treatment result.


The simple answer is yes. It typically costs about 25% to 40% more.

However, Dr. Cassar is so committed in his technique that for him it would be a shame if his patient’s, especially adolescent patients, were denied this specialized care for monetary reasons. So, to avoid his patients having to make this choice, Dr. Cassar has never placed an extra charge for Two Phase Treatment. This commitment Dr. Cassar has provided for his patients since he started using this technique at the very beginning of his practice.

The commitment of Dr. Cassar to his technique does not end there. Timing is an important factor in this technique. By beginning treatment just at the right time, we can maximize the results in a shorter treatment time period. To allow this to take place, Dr. Cassar wants you to consult by the age of 7 years old, as recommended by the American Association of Orthodontists.

Even though most seven year olds will not require orthodontic treatment, we can identify developing problems or issues and begin to formulate a plan and determine the time for future orthodontic treatment. To encourage patients to accept his philosophy, there is generally no charge for future recall visits (even if they require an X-Ray) until we are ready to begin a treatment. Once again, Dr. Cassar has been providing this service to all his patients since beginning his practice.


During this phase, we employ orthodontic appliances to slowly and steadily redistribute and redirect growth in patients. This improves the jaw position and establishes the appropriate space for permanent teeth – all prior to even considering braces. Dr. Cassar likes to refer to this phase as a ‘Deprogramming Phase’ especially when applied to the adult patient.


Once the foundation is properly set, we apply braces to guide teeth into the appropriate positions. There is a precise location in the mouth for each tooth, where it is in proportion with the cheek, tongue, jaws, jaw joints and other teeth. It is with the results of Phase I treatment that makes this possible with braces. When this balance is established, the teeth will function appropriately. When the bite, teeth, bones and gums work in harmony, the results will last a lifetime.

Although Phase I Treatment is most identified with adolescent patients, adults can also benefit from a Phase I Treatment. Most of Dr. Cassar’s adult patients will receive some form of occlusal plate to help deprogram their occlusion before putting the braces on. This ensures us that the teeth will be aligned according to a proper, more comfortable position of the lower jaw. It is important to understand that teeth dictate where the jaw closes. However, where the teeth bring together the jaws does not necessarily correspond to where the jaws should close. Enter Phase I treatment.

It is of utmost importance that we establish the proper position of the lower jaw in Phase I before putting the braces on. We use orthodontic appliances to guide the upper and lower jaw into a proper alignment in adults. A good foundation is imperative to achieve proper alignment of teeth. When used in adolescents, Phase I treatment can help prevent the need for surgical procedures by improving jaw alignment. We also reduce the need for extraction of permanent teeth to correct over-crowding.

Two Phase treatment – Illustrated

To best illustrate the Two Phase Treatment let us follow the progress using a patient I have treated. I will choose a patient with a severe problem for an orthodontist not only to treat but to maintain a long term stability.

traitement en deux phases

Roxanne is a patient who has deformed her palate due to a finger sucking habit. Because of this habit she also has developed a poor swallowing pattern. When she swallows she places the tongue between her front teeth thereby creating an open bite(the teeth in front do not touch when she closes her teeth together.

Results after 1 year of phase 1:

Although the bite is still open, one notes a significant improvement in the shapes and position of both jaws. With Phase I treatment we have allowed both jaws to grow and position themselves in a natural position favourable to the her joints. Notice how we evolved from a situation where we had crowded teeth to a situation where we now enjoy the fact that there is excess space. However, one might notice that the teeth still do not touch properly. We are ready for the Phase II treatment where we use braces to align the teeth.


fleche-down Photos after treatment


fleche-down Photos 10 years later

A smile that lasts a lifetime

When patients suffer from poor swallowing habits, it is very important that the jaws are properly developped. The more developped the jaws are, the more room for the tongue to remain within the oral cavity thereby insuring long term stabiltiy. The following pictures demonstrate the same case about 10 years following removal of her braces.