All over the world orthodontics with fixed appliances is considered to be the gold standard. Only in Germany about fifty percent of treatment duration concerning adolescents is performed with removable appliances. However, “removables” aren’t a full-value alternative to fixed ones: Many tooth movements like the rotation of lateral teeth and lengthening or shortening of teeth aren’t possible with removable appliances. Generally, one can only tilt teeth with these primitive appliances; as physical movements and control of the tooth axis are required, removables are only suitable for simple and limited treatment. Furthermore most of the removables are associated with severe speech impediments. Studies concerning the analysis of wear-time have shown that this is the reason why young patients wear their removable appliances for a median of ten hours a day, whereas 12 – 16 hours are recommended. – Under these circumstances orthodontic treatments with removables can’t possibly succeed.
In this context it’s no wonder that improvement of dental position with fixed appliances is much more effective than with removables. Comparative studies have shown that fixed appliances are highly efficient. As British scientists have recovered the probability of worsening the malocclusion rises when using removable appliances. Moreover, thirty to sixty percent of orthodontic treatments with removables are cancelled unsuccessfully, because young patients don’t accept to wear these plastic blocks. They resist in their own ways by not wearing these troublemakers. Finally, other studies have proven that treatment with removables isn’t only less promising, but even more expensive. Removables are simply uneconomic, as it has been proven, whereas fixed appliances offer a real value for your investment.
The mystery why removable appliances, despite their disadvantages, are favoured by German orthodontists can be easily revealed. Actually there’s no dental procedure right up to dental implants which proves so highly profitable with least efforts like working with removables. They’re made by dental technicians and can be distributed to patients with little know-how, skills and effort. With 6 to 8 short checkups per year a considerable profit can be generated, without any special know-how and without lifting a finger at all. In the German system of reimbursement for dentists orthondontics with removables is too close to one of the oldest dreams of mankind of earning an income without having to work. Therefore it’s hardly surprising that it is favoured by an entire group of healthcare professionals. It is only fitting that young orthodontists who establish their practice set up a dental laboratory immediately and engage a dental technician who produces removable appliances. Whereas this is considered normal in Germany foreign orthodontists are rubbing their eyes in amazement: they don’t need a considerable amount of removables. Moreover, dental laboratories belonging to the practice are almost unknown in other countries.
It can be summarised that in Germany removable appliances are still used against better knowledge, despite their proven unsuitability, their high failure rate and inefficiency, because a small professional group makes a profit at the expense of patients. Parents can only be advised to reject any orthodontic treatment with removables and ask for fixed appliances. There’s one exception: The treatment of a mandibular retrognathism with a single double appliance – using these appliances in a sequence seems absurd and must be rejected.