Long Comprehensive vs. Phase 1 Treatment
I. Introduction
Dr. Amanda provides an informative overview of “long comprehensive” orthodontic treatment. She explains that long comprehensive treatment involves starting comprehensive treatment when a patient is in late mixed dentition, often spanning 2.5-3 years with breaks. Dr. Amanda outlines critical considerations when evaluating if long comprehensive treatment is appropriate for a patient, including compliance, dental age, ability to finish the case properly, and risks of surprises. She notes the pros and cons of this marathon treatment versus the shorter phase one treatment. Dr. Amanda provides orthodontists and dentists critical guidance on managing expectations and decisions around extended comprehensive orthodontic treatment.
II. Factors to Consider
A. Cost considerations
1. Two-phase vs. long comprehensive treatment cost implications.
2. Front-loading costs with initial records, treatment, and retainers.
3. Potential cost differences for providers in different networks.

B. Duration of Treatment
1. Two and a half to three-year commitment.
2. Evaluation periods and breaks during treatment.
3. Monthly or periodic visits and potential scheduling conflicts.

C. Patient Commitment
1. Importance of patient and parent commitment.
2. Risks of moving during treatment.
3. Non-refundable nature of long comprehensive treatment.

D. Compliance Issues
1. Importance of patient compliance.
2. Challenges of dealing with non-compliant patients over an extended period.
3. Considerations for both patient and parent compliance.
III. Case Selection
A. Existing Relationship with General or Pediatric Dentist
1. Advantages of having a pre-existing relationship with the family.
2. Increased comfort level for orthodontists in taking on long comprehensive cases.

B. Hygiene Considerations
1. The necessity of impeccable hygiene for a three-year commitment.
2. Avoiding long comprehensive treatment for patients with hygiene issues.

C. Dental Age vs. Chronological Age
1. Understanding that dental age and chronological age may not align.
2. Considering eruption patterns and development in treatment planning.
IV. Treatment Planning
A. Finish Considerations
1. Ensuring comfort with the anticipated finish of the case.
2. Addressing potential challenges with unerupted or impacted teeth.
3. Communicating the potential need for impaction surgery and additional fees.

B. Unknowns and Surprises
1. Acknowledging the possibility of unexpected challenges.
2. The importance of transparency in treatment planning.
3. Managing parental expectations regarding potential surprises.

C. Finishing with Braces or Invisalign
1. Considering the implications of finishing with braces.
2. Challenges with offering phase two treatment after phase one.
3. Communicating effectively with parents about treatment choices.
V. Conclusion
Ultimately, the decision to pursue long comprehensive orthodontic treatment is complex, involving considerations of cost, compliance, unknown factors, and long-term commitment. While it can provide continuity of care in one treatment plan, risks include patients moving or losing motivation. Thorough informed consent regarding potential complications and fees is essential. Assess dental age, eruption status, hygiene compliance, and family plans first. Weigh the pros and cons of phased treatment as well. With careful case selection and setting appropriate patient expectations, long comprehensive treatment can benefit certain patients when factors align favorably. Still, unpredictability remains, demanding flexibility from doctors and patients alike.