How long does treatment take?
Orthodontic treatment takes between six and twenty-four months provided that it is carried out using the latest treatment methods. Unfortunately, treatment in Germany usually takes considerably longer. On average, it takes around 4 years to treat children and adolescents in this country – i.e. at least twice as long as it should take.
There are two reasons why the length of treatment in Germany is absurdly long: weaknesses in the German fee-charging system and the bad training which German orthodontists receive.
How is Orthodontic Treatment in Germany Paid For?
Orthodontic treatment in Germany works in such a way that every single action and procedure is charged for separately. So, for the orthodontists, it makes good business sense to provide the patients with as many services and procedures as possible. In order to make as much money as possible from each individual case, it is of course necessary to extend the length of the treatment; each additional year of treatment brings with it the possibility of carrying out and charging for extra services. Against this background, the most inefficient orthodontist makes the most money. I do not wish to imply that individual orthodontists are exploiting the system to their own advantage and to the disadvantage of the patients. But we cannot escape the fact that our ridiculous reimbursement system has a much greater effect on orthodontic treatment than training or academic opinion could ever have.
Why are German Orthodontists not Trained to International Standards?
The tendency of our reimbursement system to favour unreasonably long treatment times is still fostered by the German educational system. Since the 1930’s, Germany has been the Promised Land as far as removable braces are concerned. This was the time when the so-called functional orthodontics was developed in Germany and with it came the belief that having a bulky thing in the mouth was part and parcel of being a child or an adolescent. For decades at German universities people were simply not taught to work with fixed braces which are, in every respect, superior and more effective. Even when this situation changed in the 1970’s, a large part of the older generation of professors still clung to the old way of thinking. We can well imagine how antiquated the training of young orthodontists was at many German universities. The more advanced evidence-based medicine of the Anglo-Saxon countries – the idea that patients should be treated with those techniques that are scientifically-proven to work is having a hard time in Germany.
It is Quicker in Other Countries
The result is that children and adolescents in particular have to endure unnecessarily long and ineffective orthodontic treatment. It becomes obvious how the charging system and the training process affects treatment in Germany when we compare this situation with British orthodontics: in the UK a relatively low flat rate is charged for orthodontic treatment and the treatment itself normally lasts for a little over a year. We can assume that the success of treatment in the UK does not bear comparison with the long-lasting treatment that is common in Germany. If you were to tell an English orthodontist that treating children in Germany normally takes four years, he would be quite astonished and would ask what you could possibly be doing for such a long period of time.