Removable or fixed appliances?

Removable or fixed braces are not a real alternative because the appliances have very different performance. With conventional removable appliances, many essential tooth movements cannot be performed at all. These include rotation of teeth other than incisors and vertical movements of teeth. Due to their limited effectiveness, only tilting tooth movements are also possible with removable orthodontic braces, while very often physical movement of teeth with straightening of the roots is necessary.

Overly long treatment times

In addition, treatments with conventional removable braces usually take much longer than the usual treatment time, which places a heavy burden on the young patients. However, even with good cooperation over many years, removable braces can often only achieve unsatisfactory results that are unacceptable to the young patients and their parents. For this reason, they are usually supplemented by a subsequently inserted fixed brace. However, this sequence – which is common in Germany – is nonsensical in most cases because fixed braces are universal devices with which all treatments can be carried out on their own without any removable pretreatment at all.

Additional burden on patients, high failure rate

A major disadvantage of removable braces is the severe speech impediment. For this reason alone, removable braces usually cannot be worn sufficiently. Scientific studies have shown that conventional removable braces are not worn by young patients for more than 10 hours, whereas 16 hours would usually be necessary.

Therefore, it is not surprising that between 30-50% of treatments with removable braces end in discontinuation or failure, and often after years of frustrating treatment. Against this background, removable braces are of course also expensive and uneconomical!

Numerous studies have shown that treatments with fixed braces take less time, have better results and cost less. Actually, no one can want that: higher stress, longer treatment time, worse results, higher costs – against this background, it is almost a mystery why removable braces are still used on a large scale at all!

After all, you could do the treatments right away with a single fixed brace… but German orthodontists don’t seem to appreciate that very much!

Poor training of orthodontists and their thirst for profits

The solution to the riddle is, on the one hand, the sometimes poor training of orthodontists in Germany, which is often still based on old ideas from the 1930s to 1960s. At that time, it was believed that removable braces were particularly suitable for controlling the growth of the jaws.

Both the development of the width of the jaws and the correction of the bite were supposed to be particular strengths of removable appliances – but these old views have long since been scientifically disproved.

While this problem is slowly being solved with the retirement of older university professors, on the other hand, the nonsensical German fee schedule remains, which makes extended treatments with removable braces much more profitable than the short, intensive treatments with fixed braces.

As early as 2001, the German Advisory Council on Health Care (SVR) complained that German orthodontists would rely heavily on removable braces, although fixed braces would be more efficient. The SVR saw the reason as being that the profit margin with removable braces was higher, and recommended that orthodontists’ fees be shifted in favor of fixed appliances.

Unfortunately, nothing has happened in this direction to date! It is clear that the limited resources of the health system are being misdirected here – to the detriment of contributors and young patients. German children are treated for twice as long as children in other European countries because of the outdated removable appliances, which is associated with additional costs, but by no means with better results.

For German orthodontists, on the other hand, removable braces, which can be inserted without much effort or knowledge, are the golden goose. Nothing else in dentistry can make as much money in a short time as the use of removable orthodontic appliances.
The insertion of removable braces simply comes too close to the age-old human dream of a work-free income, so most German orthodontists succumb to this seduction.

Since one of the most common removable braces is the active plate, German orthodontists internationally like to be ridiculed as “plate setters”

Fixed braces are the gold standard

For the reasons mentioned above, treatment with fixed braces is now standard worldwide. In our orthodontic practice in Mannheim, we therefore work predominantly with fixed appliances. Fixed braces lead to less stress, shorter treatment time and consistently good results.

The treatments are much more comfortable for the patients because the fixed braces do not interfere with speaking and normal eating is possible with them. And ultimately, the fixed appliances are also more economical because they provide regular results in a short time.
Against this background, it is not surprising that removable braces are hardly used in most developed countries. Only in Germany, interestingly enough, every orthodontist operates his own laboratory with a dental technician for the production of removable appliances, while this is completely unknown in other countries.

In our orthodontic practice in Mannheim, there is no laboratory where removable braces are made – we have the few removable braces made in an external specialized laboratory in Mannheim. This allows us to choose the best therapy for our patients regardless of financial interests!

Two exceptions

There are two exceptions to these principles: The first is that in adolescents with recession of the lower jaw and large overbite of the incisors, a single – but really only one – removable double brace, a so-called functional orthodontic brace, may be justified.
Nonsensical, even in these cases, is a prolonged sequence of multiple removable braces – this is the stupidest and most inefficient treatment strategy of all.

The second exception is aligners: for older teenagers and adults, our orthodontic practice in Mannheim often uses the Invisalign system. Invisalign is a procedure for straightening teeth with removable, transparent aligners that are worn around the clock except for eating, drinking and brushing teeth.

Invisalign aligners have limited use in children for minor orthodontic procedures. Adolescents, on the other hand, can have full treatments with the Invisalign system, just like adults.

However, Invisalign treatment cannot be covered by statutory health insurance, so it is only available to privately insured and self-pay patients. Our orthodontists will be happy to advise you about this modern treatment option.



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