Removable appliances aren’t cost-effective

For a long time it was claimed that orthodontic treatment with removables is cheaper than using fixed braces. Swedish scientists checked this statement in a cost evaluation study, published in 2015. For their study they chose a quite common task of treatment for which removable appliances can also be used: early correction of posterior crossbite by maxillary expansion. Thirty young patients were treated either with removables such as expansion plates (EPs) or with fixed appliances such as Quad Helix (QH) in a randomized controlled trial. Many treatments with removables failed and required re-treatment, whereas the outcome using fixed braces was absolutely positive.

The cost-minimization analysis of successful cases showed that the mean costs were €981 for the QH group and €1124 for the EP group. Analyzing all treatment methods, including those which failed with EPs, shows an increase of cost disadvantages using removable appliances. For both successful and unsuccessful outcomes, the mean costs increased to €1533 for the EP group in comparison to €981 in the QH group with constant successful outcomes. Direct costs like material and laboratory costs and medical fees were calculated, likewise indirect costs (loss of income due to parent’s assumed absence from work and travel costs) were considered, too.

Even regarding this simple task of treatment for correction of posterior crossbite by maxillary expansion treatment with removables (EPs) costs fifty percent more than that with fixed appliances (QH). The authors therefore concluded: “The cost-minimization analysis clearly showed that for correction of posterior crossbite, QH offers significant economic benefits over EP treatment. The QH had lower direct and indirect costs and fewer failures needing re-treatment. Even with full co-operation, i.e. when only successful treatments were considered, EP treatment was more expensive than the QH treatment.“

That’s the reason why the treatment with fixed appliances is the method of choice, whereas using removables is less successful and more expensive. This is even more important for complex treatments for which removable appliances aren’t useful. In this light it’s scandalous that at least fifty percent of treatment duration for young patients is wasted with outdated and uneconomic removables. The reasons can be easily found: On one hand the poor training of the German orthodontists and on the other hand the higher profit: German orthodontists can earn twice as much with removable appliances as with fixed ones.

A tip for patients and parents: Just insist on being treated with fixed appliances. Only accept removable braces in exceptional cases if your orthodontist is able to prove their merits.

Reference: Petrén S, Bjerklin K, Marké LÅ, Bondemark L. Early correction of posterior crossbite – a cost-minimization analysis. Eur J Orthod. 2013 Feb;35(1):14-21. doi: 10.1093/ejo/cjr047. PubMed PMID: 21447782


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