Which is more expensive – a fixed or removable brace?
For each year of treatment, the costs of a fixed brace are significantly higher than those of a removable brace. But, since the length of treatment with a fixed brace is only a fraction of that with a removable brace, for most orthodontic treatment a fixed brace is actually more cost-effective. This is also true of minor orthodontic treatment where a fixed brace can produce a perfect aesthetic result in just a few months.
Treatment with a removable brace, on the other hand, often lasts several years. This puts a great strain on the patients so many of them become completely demotivated and no longer cooperate. It is just as bad for those patients who go through a number of tooth adjustments with a removable brace without cooperating at all so that the results of this kind of treatment are usually very modest indeed. For both these reasons – overly long treatment times and bad end results – removable braces, with a few exceptions, are generally not cost-effective either for the patients or for the health insurance companies who ultimately have to bear the costs.
Uneconomic for Patients but Profitable for the Doctors
It is true that because of the German reimbursement system, removable braces are not cost-effective for the patients yet are highly profitable for the orthodontists. One point is that the German system remunerates less intensive, long treatment well whereas short, intensive treatment with a fixed brace is remunerated quite badly. Another point is that most orthodontists have their own laboratories where they manufacture removable braces. So, from the point of view of the orthodontists themselves, removable braces are twice as interesting. Even if we do not want to accept that, because of this, some orthodontists consciously favour second-class treatment with removable braces, we have to assume that the fee structure itself has a much greater influence on treatment than any amount of scientific knowledge. This is an example of how the limited resources of the health service can be directed into inappropriate healthcare as a result of a badly-structured, antiquated fee structure.
A tip for parents
If your child is offered orthodontic treatment with a removable brace, always ask about fixed-brace alternatives!