Planning Beyond the Mixed Dentition

Jun 18, 2019

ALF therapy during the mixed dentition phase is a gentle, powerful way for arch development. To bring about the best results for our patients, we need to envision where we want to end up: with enough space for the permanent canines and bicuspids to erupt.

Here is what can easily happen: the patient starts out with anterior crowding. We develop the maxilla and now everything looks good.


The patient may wear a night-time Hawley retainer while we are waiting for the permanent teeth to erupt. Parents and dentist think we have reached our goal, BUT…

Upper Permanent Canines Erupt and Are Slightly Blocked Out 

Let’s look at a possible scenario, the one that happens most often: the upper canines don’t have quite enough space and are blocked out to the labial. While this looks good on Dracula, it does not have much cosmetic appeal for parents.



Overdeveloping Is the Key

 If we make the most of “phase 1” treatment, our patients may not need a “phase 2” (unless they want a "textbook result").

The key is to slightly overdevelop the arches, not only the transverse dimension but also the sagittal. I like to use Pont’s index as a guideline and pay attention to the measurement for the anterior triangle.

Here is a reference file about Pont's measurements and how to use them.

CAVEAT: Please understand that if you are using your fingers to pull the ALF apart, making it wider, you won't get anterior-posterior arch development, and your patient will most probably need phase 2 treatment.

At the end of arch development in the mixed dentition, I like to see spaces around the primary canines. It doesn’t matter whether mesial, distal, or mesial and distal. Those spaces are like money in the bank and reduce the likeliness that you have to go back with an ALF later to create space for the canines.

ALF-Design to Create Some Extra Space for Upper Canines

Sometimes, I did not create enough extra space during phase 1 and need about two to three more millimeters to align the upper canines. This can easily be done using a design with three anterior loops:


Please have OVERDEVELOPING in mind as you finish phase 1.


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Warm personal regards and happy ALFing,


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