Early (Phase 1) Orthodontics: Expanders and Sagittal Correction
Phase 1 orthodontics is treatment carried out between roughly seven and ten years old, while the jaws are still growing. An expander widens a narrow upper jaw across; a sagittal appliance develops it forward. The purpose is to create room and correct the relationship between the upper and lower jaws before all the adult teeth arrive — which can reduce what later treatment is needed, and can avoid removing healthy adult teeth to make space.
- Ages
- About 7–10
- Duration
- 9–18 months
- Appliance
- Fixed or removable
- Fee
- S$1,090 – 2,180
What happens
Assessment with full records: photographs, a 3D scan, an OPG and where indicated a lateral cephalogram, plus a look at how the child breathes and whether the tonsils are obstructing.
A discussion of whether treating now is genuinely better than waiting. For some children the honest answer is to review in a year.
The appliance is fitted — a fixed expander cemented to the back teeth, or a removable plate, depending on what has to move.
Activation on a schedule, usually turned at home by a parent with a key, plus reviews every four to six weeks.
A retention period once the target width is reached, so new bone fills in and holds.
Reassessment when the adult teeth are through, to decide whether Phase 2 — braces or aligners — is needed at all.
Timing is the entire argument for treating early. The two halves of the upper jaw are joined by a suture that has not yet fused at this age, so widening the arch is a matter of gentle separation and new bone forming in the gap. Once that suture fuses in the teenage years, the same change requires surgery. A crossbite, a narrow arch with crowding, or an upper jaw sitting behind the lower is therefore genuinely easier to correct at eight than at fifteen.
Sagittal correction addresses the front-to-back relationship rather than the width — developing an upper jaw that sits too far back, which is often what is really behind a “crowded” upper arch. It uses the same principle: guide growth while there is growth to guide.
What Phase 1 will not reliably do is worth stating plainly, because this area attracts a lot of overclaiming. It is not a substitute for later orthodontics in most children — expect to reassess for Phase 2. It will not straighten teeth that have not erupted yet. And while a wider upper arch does increase nasal airway volume, the evidence that expansion treats paediatric sleep apnoea is not strong enough for us to offer it on that basis. If your child snores, mouth-breathes or sleeps restlessly, that deserves a proper ENT and sleep assessment on its own merits, and we will refer.
We also do not treat every narrow arch. Mild crowding in a child who is growing well is often best watched, and we will tell you when the right decision is to do nothing yet.
Who does this at Calm Dental
Fees for this treatment are on our fees page, including GST. A written quotation follows examination.
Questions
What age should a child be assessed for early orthodontics?
About seven. By then the front adult teeth are coming through and the pattern of the bite is readable, while enough growth remains to use. Assessment at seven does not mean treatment at seven — often it means reviewing annually.
Does my child need an expander now, or can we wait?
It depends on what is being corrected. A crossbite or a genuinely narrow arch is easier to treat before the palatal suture fuses, so waiting has a real cost. Mild crowding often can wait. We will show you the records and explain which case yours is.
Will my child still need braces later?
Usually yes, in some form. Phase 1 creates space and corrects the jaw relationship; Phase 2 aligns the individual teeth once they are all through. Phase 1 often makes Phase 2 shorter and can avoid extracting adult teeth, but it rarely replaces it entirely. Anyone promising otherwise is overselling.
Does an expander hurt?
There is pressure and a feeling of tightness for a few minutes after each turn, and sometimes a dull ache on the first day or two. Children eat and speak normally within a week, though speech can sound different at first.
Will an expander help snoring or mouth breathing?
It may increase nasal airway volume, but the evidence is not strong enough for us to offer expansion as a treatment for snoring or sleep apnoea. If your child snores or mouth-breathes, we will refer you for a proper ENT assessment, which is the right investigation for it.
Who provides this at Calm Dental?
Dr JD Tan. Complex skeletal cases are referred to an orthodontic specialist.