Early orthodontic treatment: great promises, modest results

Almost all over the world it’s of common use to start orthodontic treatment when the patients’ permanent dentition is present. This has its logic because it’s generally questionable to start treatment in the primary dentition in order to go on with the permanent dentition after their eruption. This actually results in two courses of therapy.

In contrast especially in Germany there is the historical concept of early orthodontics. Its followers proclaim that thanks to the merits of early intervention it is possible to enhance the growth of the facial skeleton, reduce treatment duration and achieve better and more stable results. As early orthodontics was also supported in Finland there is a wide range of data which can be taken into account. In this context Finnish scientists have analysed the orthodontic treatment of 93 young patients. They found out that the most early started treatment (patients at the age between 7 and 9 years of age) took about twice as long as those started with patients at the age of 12 to 13 years of age. Furthermore it could be proved that patients who started treatment at primary school age almost needed twice as much of appliances as the adolescent patients. However, the most serious reason was that 50 percent of the early treated needed additional diagnosis and a new treatment plan.

After having analysed the treatment costs the Finnish authors noticed that not only the treatment duration but also the treatment costs were the highest in early orthodontics. Contrary to this a late start of treatment with only one fixed appliance – the gold standard in orthodontics – proved to be the most economical concept, while starting early and using various removable appliances proved to be the most uneconomic treatment. In this light it is interesting to observe that in Germany the most uneconomic concept has been propagated until now. One of the main mottos cited by German orthodontists is “the earlier the better“. Contrary to this and regarding the data from Finland one has to admit that early orthodontics is a burden to the patient as well as to the health insurance. The immortality of early treatment can be explained by stubborn conservatism on the one hand and economic interests of the orthodontists on the other hand because in Germany orthodontists can earn twice as much with removable appliances as with fixed ones. This is an extremely inappropriate treatment approach based on the faulty design of the German reimbursement system for denal care. Instead of waiting for substantial changes by German legislature patients and parents can do something on their own: Do not let start orthodontic treatment before age 11 and ask for treatment with fixed appliances.

Järvinen S, Widström E, Raitio M. Factors affecting the duration of orthodontic treatment in children. A retrospective study. Swed Dent J. 2004;28(2):93-100. PubMed PMID: 15272514
Järvinen S, Widström E. Determinants of costs of orthodontic treatment in the Finnish public health service. Swed Dent J. 2002;26(1):41-9. PubMed PMID: 12090159


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