Topic Overview

Growth modification (early treatment) is part of the first phase of two-stage orthodontic treatment of children with malocclusion (poor bite). Growth modification is only possible when bones are still growing. It is most effective during children’s growth spurts.

Orthodontists use growth modification devices (appliances) to change the position, shape, length, or width of the jawbone(s). Some common devices are:

• Headgear, an appliance that uses pressure to guide teeth and jaw growth.
• Herbst, an appliance attached to the upper and lower molars that corrects overbite caused by a small lower jaw.
• Bionator, a removable appliance that guides teeth and jaw growth.
• Palatal expander, an appliance that corrects cross bite by widening the upper jaw.

What to think about

Ideal timing of treatment varies depending on what the condition is, when adult teeth come in, and how much growth is needed to correct the malocclusion. Many children who begin growth modification in second or third grade are finished with orthodontic treatment before they begin high school.

Children are often more cooperative than teenagers when it comes to wearing their appliances for a certain number of hours a day. And children don’t seem to mind closer parental supervision as much as teens do. But the parent and the health professional must also beware of “burning out” the child on treatment before the second stage of treatment—braces—begins.

Because the jaw continues to grow during childhood and adolescence, growth modification doesn’t always last. Some teens and adults keep their new jaw structure and size, while others have short-lived improvement. Relapse can also occur after treatment with braces alone.