The question comes up at every consultation: “At what age should orthodontics begin?” Many parents expect a precise figure, a single threshold beyond which braces ought to be fitted. The clinical reality is more nuanced. Orthodontics is not triggered at a precise age; it falls within therapeutic windows that follow the growth of the face and the jaw. Depending on the problem to be corrected, the useful window may open as early as 6 or 7 years of age, or conversely may only present itself in adolescence, or even later.<\/p>\n
This logic of windows explains why two children of the same age can receive very different recommendations, and why the idea of a universal “ideal age” is misleading. A crossbite corrected at 8 years of age sometimes avoids surgery at 18. Conversely, moderate crowding with no functional impact can wait for the permanent dentition. This guide sets out the reference points published by the leading learned societies, the AAO, SSO and SFODF, and describes what the team at Chantepoulet Dental Clinic, in Geneva, observes in consultation with families and adult patients.<\/p>\n
Orthodontics acts on two distinct levels: the movement of the teeth and the guidance of growth of the bony bases, that is, the jaws. The first level is possible at any age, as long as the periodontal structures are healthy. The second is only open for as long as growth has not finished. This difference is central.<\/p>\n
For as long as the upper jaw and the mandible are growing, it is possible to modulate their relative position<\/strong>, to widen a narrow palate, to bring forward a retruded mandible, or to slow excessive vertical growth. Once growth is complete, these manoeuvres are no longer accessible other than through orthognathic surgery. The useful windows therefore correspond to moments when biology offers room for manoeuvre that will no longer be available afterwards.<\/p>\n Three broad windows emerge. The interceptive window<\/strong> lies at around 6 to 10 years of age, during the mixed dentition, when the palatal sutures are still open and functional appliances can guide growth. The adolescent window<\/strong> corresponds to the pubertal growth peak, at around 11 to 15 years depending on sex, the period during which the majority of fixed-brace or aligner treatments are carried out. The adult window<\/strong> is open with no upper limit: it concerns pure tooth movement, in a stabilised periodontal environment.<\/p>\n No window is compulsory. Depending on the diagnosis, everything can be done in a single window, or two phases can be combined. It is this diagnosis, made at an initial assessment, that determines the schedule, not a theoretical age.<\/p>\n The American Association of Orthodontists, followed by most European learned societies including the SSO in Switzerland, recommends a first orthodontic assessment at around 7 years of age<\/strong>, regardless of any apparent problem. This recommendation is not arbitrary: at 7 years, the first permanent molars and the upper central incisors are in place or erupting, which makes it possible to assess the future occlusal pattern while growth is still accessible.<\/p>\n At this visit, the orthodontist is not seeking to “fit braces”. Several specific elements are assessed.<\/p>\n The relationship between the dental arches<\/strong> in the three planes of space: anteroposterior (Angle Class I, II or III), transverse (narrow palate, lateral crossbite) and vertical (open bite, deep bite). The Angle classification, which describes the relationship between the upper first molar and the lower first molar, remains the common reference language.<\/p>\n The space available<\/strong> for the future permanent teeth. At 7 years, around eight permanent teeth are present out of the twenty-eight expected, excluding the wisdom teeth. The practitioner anticipates shortages or excesses of space.<\/p>\n The presence of oral habits<\/strong>: thumb or dummy sucking beyond the expected age, atypical swallowing with tongue interposition, chronic mouth breathing. These parafunctional habits can lastingly deform the arches if they persist.<\/p>\n The symmetry and growth of the jaws<\/strong>, observed on clinical examination and, where necessary, on appropriate radiographs (orthopantomogram, lateral cephalogram).<\/p>\n In the majority of cases, this assessment does not trigger any treatment<\/strong>. It establishes a baseline and monitoring, with a review appointment every six to twelve months. In a minority of cases, it reveals an interceptive indication, and that is precisely why it takes place at this age: so as not to miss it.<\/p>\n Interceptive orthodontics, also called first phase<\/strong> or early phase<\/strong>, aims to correct, in the mixed dentition, situations that would become more complicated if one waited for adolescence. It is only indicated in certain well-defined circumstances, not systematically.<\/p>\n A Class III<\/strong> is characterised by a mandible that is relatively forward in relation to the upper jaw, sometimes visible from childhood through a prominent chin and a crossbite on the incisors. Treated early, at around 7 to 9 years, with a device such as a facemask combined with palatal expansion, it benefits from the growth of the upper jaw to rebalance the bony bases. If left until adulthood, it may require orthognathic surgery. This is one of the most widely agreed interceptive indications in the literature.<\/p>\n When one or more upper teeth close behind<\/strong> the lower teeth instead of being in front of them, this is known as a crossbite. In the anterior region, the procedure is dental and quick. In the lateral region, it often reflects a transverse deficit of the upper jaw<\/strong>, that is, a palate that is too narrow, which is corrected by palatal expansion (widening) for as long as the mid-palatal suture is not fused, which is the case before puberty.<\/p>\n A narrow palate is identified clinically (high vault, crowding, crossbite) and radiologically. Its interceptive correction, using a fixed expander bonded to the molars, widens the bony base within a few weeks and frees up space for the future teeth. Carried out in adulthood, the same correction requires a surgical procedure to assist it.<\/p>\n Prolonged non-nutritive sucking beyond 4 to 5 years can lead to an anterior open bite<\/strong> (the incisors no longer meet in occlusion) and a protrusion of the upper incisors. A retained infantile swallowing pattern, with interposition of the tongue between the arches, sustains the deformation. Interception combines weaning off the habit, sometimes with the help of a palatal crib, and tongue re-education with a speech and language therapist. The earlier one acts, the less the deformation becomes fixed.<\/p>\n A milk tooth lost prematurely can allow its neighbours to drift into the space that has been freed, compromising the space for the underlying permanent tooth. A simple, well-indicated space maintainer<\/strong> prevents this drift and preserves later treatment options.<\/p>\n Interceptive orthodontics does not always shorten the total treatment. Often, a second phase in adolescence is still needed to complete the alignment. But it makes possible<\/strong> a correction that would otherwise be heavier, longer, or surgical. To explore the orthodontic and Invisalign treatments offered at the clinic<\/a>, the assessment remains the starting point.<\/p>\n Adolescence is, statistically, the period during which the majority of orthodontic treatments are carried out. Three clinical reasons justify this.<\/p>\n First, the pubertal growth peak<\/strong> offers a final margin to guide the bony bases, in particular the mandible in Class II cases. Next, the permanent dentition is in place<\/strong> or close to it, which makes it possible to plan a complete and stable alignment. Finally, the patient’s cooperation<\/strong> reaches a level compatible with a long treatment, whether this involves wearing aligners or maintaining fixed appliances.<\/p>\n Brackets bonded to the teeth, linked by an active archwire, remain the reference solution for complex cases: marked rotations, vertical movements, associated extractions, and millimetre finishing. Ceramic versions are less visible than traditional metal, with no loss of effectiveness. The average duration is between 18 and 30 months, followed by retention<\/strong> (a bonded wire or a night-time aligner) that must be maintained for a long time, sometimes for life in the front region, otherwise relapse may occur.<\/p>\n The Invisalign Teen system is designed for adolescents: aligners with wear indicators<\/strong> (blue dots that fade as they are worn), allowance for the eruption of permanent teeth during treatment, and compliance attachments. The principle remains identical to the adult aligner: a series of clear aligners, changed every one to two weeks, that move the teeth in stages. The condition for success is effective wear of at least 22 hours a day<\/strong>, which requires genuine cooperation from the adolescent. Without this discipline, treatment drags on or fails.<\/p>\n The choice between fixed appliances and aligners depends on the complexity of the case, the adolescent’s profile, and aesthetic preference. In suitable indications, the aligner produces the same functional results as braces. Outside its indications, it quickly reaches its limits, and an honest orthodontist says so in consultation.<\/p>\n For Class II cases with mandibular retrognathia<\/strong> (a retruded mandible), functional appliances for mandibular advancement (activators, Herbst, jumping jacks) are effective if they are fitted at the time of the pubertal peak. This peak occurs on average at around 11 to 12 years in girls and 13 to 14 years in boys, with significant individual variability. An assessment of bone maturation<\/strong> (a radiograph of the hand or of the cervical vertebrae) helps to locate it so as not to miss it.<\/p>\n Adult orthodontics has progressed strongly over the past twenty years, driven by the maturing of clear aligners and by an aesthetic demand that no longer concerns adolescents alone. The majority of new orthodontic patients in Geneva today are adults. Several clinical features nevertheless set their treatment apart.<\/p>\n Growth is complete.<\/strong> All corrections involve pure tooth movement. Significant discrepancies of the bony bases (severe skeletal Class II or III, marked asymmetry, vertical excess) can no longer be corrected orthopaedically and call, where the aesthetic or functional indication justifies it, for orthognathic surgery<\/strong> combined with orthodontics.<\/p>\n The periodontium calls for particular attention.<\/strong> Many adults present with periodontal disease, even mild, or localised bone loss. Orthodontic treatment on a periodontium that has not been treated can accelerate the loss of attachment. The preliminary examination therefore systematically includes a periodontal assessment, and a thorough scaling, sometimes a complete periodontal treatment, precedes the fitting of aligners or braces.<\/p>\n Existing restorations complicate movements.<\/strong> Crowns, bridges and implants do not behave like natural teeth. An implant, in particular, is ankylosed<\/strong> in the bone: it does not move. The treatment plan must take this into account, sometimes by rethinking the order of care: completing the orthodontics before placing a definitive implant.<\/p>\n The duration can be longer.<\/strong> Without the lever of growth, and with slowed bone remodelling, movements often take more time than in adolescence. One to three years is common, depending on the complexity.<\/p>\n Retention is for life.<\/strong> As adult teeth have been in their initial position for decades, the memory of the periodontal fibres drives relapse. A bonded lingual retention wire on the incisors and a night-time aligner are the rule, and this aspect of maintenance must be accepted from the outset.<\/p>\n Invisalign has become, for many adult cases, the first-line option: invisible in social settings, removable for eating and brushing, and compatible with professional life. Its limits relate to the complexity of the case and the rigour of wear, not to age.<\/p>\n Certain situations fall outside the framework of the three windows described and call for a multidisciplinary strategy from the initial diagnosis.<\/p>\n An agenesis<\/strong> is the congenital absence of one or more permanent teeth. The most frequent involve the upper lateral incisors, the second premolars and the wisdom teeth. Identified early on an orthopantomogram, it opens two strategic choices: closing the space<\/strong> through orthodontics by bringing the posterior teeth forward, or opening the space<\/strong> to place an implant or a bridge there later. This choice depends on the Angle class, the aesthetics of the smile, and the occlusion, and is discussed as a team with the orthodontist, the restorative dentist and, where appropriate, the implant surgeon.<\/p>\n Severe skeletal dysmorphoses<\/strong> not corrected during growth fall to orthognathic surgery: osteotomies of the upper jaw, the mandible or both, carried out by a maxillofacial surgeon. Orthodontics frames the surgical procedure: a pre-surgical phase<\/strong> of 12 to 18 months aligns the arches within their bony base, the surgical procedure repositions the bases, then a post-surgical phase<\/strong> of 6 to 12 months finalises the occlusion. This type of treatment is typically planned in late adolescence or in the young adult, once growth is complete.<\/p>\n Clefts and craniofacial syndromes follow their own schedule, coordinated from birth by a multidisciplinary team (surgeon, orthodontist, speech and language therapist, ENT doctor). Orthodontics intervenes here on several occasions, in the mixed dentition and then in the permanent dentition, often in connection with alveolar bone grafts.<\/p>\n Even before an orthodontist becomes involved, the general dentist (or the paediatric dentist for children) plays a decisive role in referral<\/strong> and preparation<\/strong> for the rest of the treatment.<\/p>\n Referral, first. It is often the family dentist who notices, during a check-up or a scaling, a crossbite, an asymmetry, crowding, or a persistent oral habit, and who refers to the orthodontist. At Chantepoulet Dental Clinic, this communication is made easier by the fact that paediatric dentistry and orthodontics are provided within the same practice<\/a>, with a shared record between practitioners.<\/p>\n Preparation, next. Orthodontic treatment takes place on teeth that must be healthy and clean<\/strong>. Untreated cavities, gingivitis, calculus, failing restorations: everything must be treated before braces are fitted or the first aligner is worn. During treatment, the role of the hygienist takes on a new dimension, because fixed appliances make brushing more difficult and increase the risk of plaque and decay. More frequent hygiene sessions, every three to four months, become the norm for the duration of the treatment.<\/p>\n Finally, certain additional treatments (composite repairs, veneers, whitening) find their place after<\/strong> the orthodontics, when the teeth are in their final position. Thinking through the whole pathway from the start avoids having to redo a treatment three times.<\/p>\n Chantepoulet Dental Clinic, located at 21 Rue de Chantepoulet in Geneva, 300 metres from Cornavin station, offers orthodontic care for children, adolescents and adults, integrated within a multidisciplinary team.<\/p>\n Orthodontics is provided by Dr Gaia Toson<\/strong>, a dental practitioner specialising in orthodontics, trained to diagnose and treat disorders of tooth alignment and of the relationships between the jaws. She assesses each situation at a full initial assessment, proposes the appropriate schedule (monitoring, interceptive phase, main phase, adult treatment) and supervises the course of the treatment through to retention.<\/p>\n The clinic’s co-founders, Dr Jose Bernardino<\/strong> and Dr Wafa Soltana<\/strong>, lead a team of dental practitioners, an oral surgeon (Dr Alice Jurt<\/strong>) and dental hygienists. This configuration makes it possible to coordinate on a single site<\/strong> the preparatory care (cavities, periodontium, hygiene), the orthodontic treatments (Invisalign, ceramic or metal braces), any extractions, and the post-orthodontic follow-up. Children benefit from a practice designed for them, with ceiling screens and a play area, which helps them accept their first consultations. The whole team is presented on the Team page<\/a> of the clinic’s website.<\/p>\n The clinic offers Invisalign<\/strong> for suitable indications, in adolescents as well as adults. The initial phase relies on a 3D optical impression<\/strong>, without paste, which models the dental arches and makes it possible to visualise, before treatment begins, the planned trajectory of each tooth. The aligners are then produced to measure and changed every one to two weeks according to the defined plan.<\/p>\n Address<\/strong>: Rue de Chantepoulet 21, 1201 Geneva, 3rd floor.<\/p>\n Telephone<\/strong>: +41 22 547 44 44.<\/p>\n Opening hours<\/strong>: Monday to Friday from 8am to 7pm, Saturday from 8am to 5pm, closed on Sunday.<\/p>\n Booking an appointment<\/strong>: by telephone, online on the clinic’s website, or via the OneDoc platform.<\/p>\n An orthodontic assessment is recommended from the age of 7 for children, without waiting for a visible problem to appear. For adolescents and adults, a consultation is useful as soon as a functional or aesthetic concern is identified.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The question comes up at every consultation: “At what age should orthodontics begin?” Many parents expect a precise figure, a single threshold beyond which braces ought to be fitted. The clinical reality is more nuanced. Orthodontics is not triggered at a precise age; it falls within therapeutic windows that follow the growth of the face <\/p>\n2. The first consultation at age 7: what we are looking for<\/h2>\n
3. Interceptive orthodontics (6 to 10 years): what is treated early<\/h2>\n
Early skeletal Class III<\/h3>\n
Anterior or lateral crossbite<\/h3>\n
Transverse deficit of the upper jaw<\/h3>\n
Thumb sucking and atypical swallowing<\/h3>\n
Severe crowding and early loss of milk teeth<\/h3>\n
4. Adolescence (11 to 15 years): the main window<\/h2>\n
Fixed-brace treatments (fixed orthodontics)<\/h3>\n
Clear aligners (Invisalign Teen and equivalents)<\/h3>\n
The role of the growth peak<\/h3>\n
5. Adults: what changes<\/h2>\n
6. Special cases: agenesis, combined orthognathic surgery<\/h2>\n
Dental agenesis<\/h3>\n
Orthognathic surgery<\/h3>\n
Cleft lip and palate, craniofacial syndromes<\/h3>\n
7. The role of the general dentist before the orthodontist<\/h2>\n
8. At Chantepoulet Dental Clinic<\/h2>\n
Dr Gaia Toson, orthodontist<\/h3>\n
A multidisciplinary team under one roof<\/h3>\n
Invisalign and optical impressions<\/h3>\n
Practical information<\/h3>\n