Evident Quality Criteria

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Quality in Orthodontics

As it is quite difficult for patients to judge the quality of orthodontic service, in the following we give some tips in order to make clear essentials of quality treatment.

Quality of Consultation

First of all, it is important that orthodontists explain the essential orthodontic findings to their patients. Furthermore, you should be offered alternatives in consultation because in most cases there are various treatment options. Something is wrong if you are only presented with a single option since this restricts the patient’s freedom of choice. Orthodontic treatments are always chosen (elective) treatments – i.e. they are not mandatory – and therefore the option of not having a treatment should be discussed as well. After all, no one has ever died of not receiving an orthodontic treatment. If an orthodontist pushes you to get treatment that is not a good sign. It is even worse, if orthodontists threaten their patients or parents with health risks that might occur if a treatment is not executed: in most cases that is inappropriate and unfair. The duration and quality of a consultation are often good indicators of how orthodontists treat their patients. This allows patients to see whether they are asked for their needs, they are taken seriously and whether a friendly and kind atmosphere prevails. In that respect it is alright to be guided by one’s emotions.

Treatment Duration

An experienced orthodontist can usually specify the duration of the treatment with an accuracy of three months before start of treatment. But this enforces disciplined working and keeping to the schedule, so many orthodontists prefer to work open-ended and without any time settings. Be careful in such cases. The treatment times in Germany are way too long on average and a lot longer than in most of the neighboring countries with developed orthodontics.
This is due to our system of fees which makes longer treatment times more profitable than shorter ones. So the colleague with the longest treatment times is the best businessman but unfortunately the worst choice for the patients. Modern orthodontic treatments take between 6 and 24 months while the latter value must be exceeded rarely. The average treatment time in our office in Mannheim is about 18 months whereas the average treatment time in Germany might rather be about 40 months, which is more than twice as much. Besides the quality of treatment results treatment duration is therefore an important indicator with which patients can discern if an orthodontist does a good job or not.

Burdens and Efforts of Treatment

Some orthodontists tend to artificially complicate the treatment: they claim that supposedly extensive functional examination before and after treatment is mandatory for treatment, jaw models would need to be mounted with the help of an articulator. Furthermore, highly technical treatment options and aggressive methods utilizing lots of surgery and implants are offered forcefully by some colleagues. All of this can be reasonable in rare cases, but a solid skepticism is advisable. We strongly advise against unnecessary magnetic resonance tomography of the jaw joints which is expensive and time consuming, but does not add any value to treatment planning or prognosis. Likewise, three-dimensional X-rays are superfluous in most cases, but associated with higher radiation exposure. So just make sure that orthodontists don’t go too far in treatment.

Quality of Treatment Results

After all, the quality of treatment results is essential: of course, your teeth should be straight and symmetrical and the bite should be relaxed and in the right position. As many patients are not aware of, in many cases only the visible front teeth are treated while other deviating findings are ignored. That is acceptable for well-informed adults but should not happen when treating children and teenagers. We do not only aspire the highest result quality, but we have also been measuring our quality with the internationally known PAR-index since 2011.

Our results from 2011 to 2015 were evaluated by an independent scientist from Cardiff University (Wales, UK). Heavy cases have up to 50 PAR points in the beginning, slight cases around 10 points. Good quality of treatment is assessed when the PAR value at the end is 5 points and the percentage improvement is at least 70%. We distinguish comprehensive treatments that correct everything, aesthetic treatments for the anterior teeth only, and small early treatments for primary school children. 90% of our patients receive comprehensive treatments.

  • Comprehensive treatments: PAR at the beginning: 25.1 points, at the end: 6.2 points, 18.9 points absolute, 75.3% percent improvement
  • Short aesthetic treatments: PAR at the beginning: 19.4 points, at the end: 8.8 points, 54.6% percent improvement
  • Early treatment for elementary school children: PAR at the beginning 19.18 points, at the end 7.45 points, 56.4% percent improvement

Efficiency of Treatment

In comprehensive treatments, our quality of results is comparable to the best results published in the scientific literature. Noteworthy, here is the efficiency: since our treatment times are particularly short, there is an extremely good improvement per month or per year. For the comprehensive treatments, that is, for most of our patients, we had an average treatment time of 18.9 months from 2011-2015. We have achieved an average improvement of 1.0 points per month or 12.0 points per year. These are good values ​​that are otherwise rarely found in German literature. For our patients the extraordinary efficiency of the treatment means that they receive good results in an unusually short time!

For Comparison: PAR Studies from Germany

In the most extensive PAR study from Germany with 11 participating orthodontists in our near Tübingen the following values ​​were obtained: PAR at the beginning: 23 points, at the end: 7.9 points, thus 15.1 points absolute, 65.7% percent improvement. An average treatment time of 4 years results in an annual PAR improvement of just 3.8 points. (Dissertation, Sondra Aull). Even if we are assuming that one year of four years of treatment did not involve active treatment but only retention, the annual improvement only increases to 5 PAR points per year. That’s not even half of what we achieve in our practices!

Results from the University Hospital of Düsseldorf were even worse: PAR at the beginning: 22.3 points, at the end: 8.4 points, 13.9 points absolute, 62.3% percent improvement. With an average treatment time of 4.6 years, there is an annual PAR improvement of a very modest 3.0 points. (Dissertation, Kim Hetz)

It is also typical that the PAR levels are lower at the beginning of treatment than in our practices. Evidently, in Germany, young patients are treated with minimal orthodontic findings, to which we would in many cases not recommend orthodontic treatment. German orthodontics means: many relatively easy cases, yet mediocre results, modest improvement and long treatment duration, poor treatment efficiency.


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