title: Changes in university orthodontic care over a period of 20 years : Patient characteristics, treatment quality, and treatment costs.
abstract: OBJECTIVE
  The aim of the present study was to analyze whether there were changes in the severity of malocclusions of patients treated at the Department of Orthodontics, University of Giessen, Germany over a period of 20 years (1992-2012) and if the implementation of the KIG system (German index of treatment need) in 2001 had any effect on the patient cohort. Furthermore, the study aimed to analyze the influence of the severity of malocclusion on treatment quality and economic efficiency (relation payment per case/treatment effort).
  
  
  METHODS
  The files of all 5385 patients admitted to the orthodontic department between 1992 and 2012 were screened and the following information was recorded: patient characteristics, treatment duration, KIG, treatment outcome, and costs.
  
  
  RESULTS
  In the KIG period, patients were older, pretreatment malocclusions were more severe, treatment took longer, required more appointments, and did not achieve the same degree of perfection as in the pre-KIG period. Patients with a higher pretreatment KIG category had longer treatments and did not achieve the same degree of perfection as patients with lower KIG categories. Although total payment was slightly higher for the more severe cases, their cost-per-appointment ratio was significantly lower.
  
  
  CONCLUSIONS
  In the present university department, a shift of the orthodontic care task towards more complex cases has occurred over the last 20 years. Generally the quality of orthodontic treatment was good, but it has been demonstrated that the higher KIG cases did not end up at the same level of excellence as the lower KIG cases. Furthermore, KIG 5 patients had a longer treatment duration, and required more appointments than lower KIG cases.
authors.affiliation: Department of Orthodontics, Justus-Liebig-University, Giessen, Germany. julia.v.bremen@dentist.med.uni-giessen.de.
authors.forename: Julia
authors.initials: J
authors.lastname: von Bremen
authors.affiliation: Private Practice, Limburg, Germany.
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Streckbein
authors.affiliation: Department of Orthodontics, Justus-Liebig-University, Giessen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ruf
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics / Q000639:trends; D003740:Dental Clinics / Q000191:economics / Q000639:trends; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D061326:Index of Orthodontic Treatment Need / Q000191:economics / Q000639:trends*; D008297:Male; D008310:Malocclusion / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D009971:Orthodontics, Corrective / Q000191:economics / Q000639:trends*; D011787:Quality of Health Care / Q000191:economics / Q000639:trends*; D014495:Universities; D055815:Young Adult
keywords: KIG system; Reimbursement; Treatment costs; Treatment quality; University orthodontic care