A study from Tübingen proves: Removable appliances can’t be worn enough

Most of the removable orthodontic appliances must be worn at least 12 hours a day in order to achieve the desired tooth movement. Many orthodontists even ask their young patients to wear the removable devices for 14 to 16 hours a day.

Recently scientists from the University of Tübingen have shown that this is completely unrealistic. In a study with 281 young patients undergoing orthodontic treatment with a variety of removable appliances a microsensor was added to them for monitoring of wear-time. The collected data from the TheraMon® microelectronic system can be read off by computers. They measure the actual wear-time of the young patients. It could be shown that the 281 study participants wore their removable orthodontic appliances for a median of nine hours per day – which is far below the required level. Only eight percent of them followed their orthodontist’s prescription. Moreover the scientists found out that the young patients showed a heterogeneous wear-time behavior. Fluctuating and numerous zero wear-time periods therefore counteracted a successful tooth movement.

Regarding the results of the study the authors don’t dare to make statements against the usage of removable orthodontic appliances. But taking these bad results into account orthodontic treatment with most of the removable devices can’t be carried out honestly in modern orthodondics. This is hardly surprising because the appliances are always associated with severe speech impediments which aren’t acceptable in every day life. This is the reason why most of the young patients only wear their removable appliances at night. Bearing in mind that most of the children and teenagers don’t reach the optimal wearing time, it would be sensible from the outset not to plan any treatment using these appliances. As a matter of fact most orthodontic treatments can be performed more reliably, faster, more comfortably and economically by fixed appliances.

However, probably 50 percent of the treatment duration for young German patients is still wasted by using inefficient removable appliances. Besides of educational deficiencies of some orthodontists the reason for this is the extraordinary profit: Treatment with removables results in double income in comparison to fixed appliances. This is a serious mistake resulting from the German system of reimbursement for dentists which makes German children wear millions of inefficient removable orthodontic appliances throughout the year.
Instead of waiting for improvements by the German legislature patients and parents can do something on their own: Just ask your orthodontist for fixed appliances and only accept removable braces if he/she is able to prove their merits.

Reference: Schott TC, Ludwig B. Microelectronic wear-time documentation of removable orthodontic devices detects heterogeneous wear behavior and individualizes treatment planning. Am J Orthod Dentofacial Orthop. 2014 Aug;146(2):155-60. doi: 10.1016/j.ajodo.2014.04.020. PubMed PMID: 25085297


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