What are the orthodontic indication groups?
Due to the variability of malocclusions in orthodontics, it is difficult to narrow them down and classify their severity. For this purpose, orthodontic indication groups have been developed, which classify malocclusions into a scheme and according to which the different health insurance companies are guided. There are five groups in the subdivision, which are numbered 1-5.
The severity of the malocclusion increases from KIG 1 to KIG 5. The treating orthodontist classifies the patient’s dysgnathia (= malposition) and prepares an expert opinion so that the health insurance company can accurately assess whether and to what extent the costs of the planned therapy will be covered and how long a therapy is likely to last until the expected goal is reached. Orthodontic indication group 1 describes slight malocclusions.
The correction of these would be an aesthetic one, which is why statutory health insurance companies do not subsidize treatment. KIG 1 includes, for example, a distal bite in which the upper incisors protrude up to three millimeters in front of the lower incisors. An open bite of up to one millimeter also belongs to the orthodontic indication group 1, as well as a deep bite of one to three millimeters, where the upper incisors overlap the lower ones too much.
In addition, a crowding, which shifts a contact point between two teeth by up to one millimeter, is not an indication that the statutory health insurance company would have to pay extra for orthodontic therapy. The private additional insurance as well as the private insurance usually pays a share of the total costs, some also the complete sum. In individual cases, however, the health insurance company should be consulted.
The orthodontic indication group 2 describes a degree of severity where a correction is necessary from a medical point of view and not only for aesthetic reasons. However, as in KIG 1, the statutory health insurance companies do not pay for treatment in this subgroup. In KIG 2 the patient has a distal bite of 3- 6 millimeters, an open bite of 1-2 millimeters or a deep bite over three millimeters, where the upper teeth protrude over the lower teeth up to the gum.
The orthodontic group 2 also includes a cross bite, in which the cusps of the upper teeth, which actually protrude outside the lower teeth, are positioned inwards, which makes chewing more difficult for the patient. Furthermore, this group includes a narrowing of the contact points of one to three millimeters and a lack of space of up to three millimeters. Dentists and orthodontists see a need for treatment for all these diagnoses in order to establish a neutral bite position, so that no more serious secondary diseases are caused by the malocclusions.
However, the statutory health insurance companies do not pay anything in addition, but this is different with supplementary insurance or private insurance. Starting with orthodontic indication group 3, the malpositioning of jaws and teeth is so immense that any health insurance company, be it statutory, private or supplementary insurance, will cover the costs of treatment until the patient reaches the age of 17. The treatment is medically necessary to restore chewing function, aesthetics and speech formation.
This includes an open bite in the front between two and four millimeters and a bilateral cross bite. In addition, a narrow contact point of more than three to five millimeters has a severity level of 3, and a lack of space of more than three millimeters. A deep bite over three millimeters, where the gums are injured by the deep bite, also belongs to the third orthodontic indication group.
The orthodontic indication group 4 includes serious malocclusions that require treatment from a medical point of view. These include a unilateral cross bite, which is particularly difficult to treat. The even more extreme case, where not only a cross bite but the entire tooth in the upper jaw is too far inwards and there is no contact anymore, is also in need of treatment in KIG 4.
Then the specialist speaks of lingual or buccal occlusion. Another example is a front open bite, which is over 4mm wide and can be caused by habit, such as excessive thumb sucking. Severity 4 also includes a distal bite in which the upper incisors protrude six to nine millimeters above the lower ones.Also the opposite, the mesial bite, where the lower teeth protrude three millimeters in front of the upper teeth.
Other indications for group 4 is the lack of attachment of teeth in which the teeth are genetically absent or in the case where they have been lost due to tooth loss. A breakthrough disorder resulting in a delayed or missing emergence of teeth is also an indication for orthodontic treatment. In the case of the eruption disorder, which belongs to severity level 4, implants are anchored in the jaw as counter bearings to pull teeth out of the jaw and thus force them to erupt.
The KIG 4 is also achieved by a lack of space of more than 4 mm or a crowding of more than 5 mm. The orthodontic indication group 5 contains the extreme cases where orthodontics alone does not lead to the goal, but where a surgical therapy has to be performed in addition to the orthodontic treatment in order to achieve a neutral bite. Severity 5 includes cleft lip and palate where ossification and fusion of the upper jaw and the soft tissues above it has not occurred and therefore a cleft is present.
Patients with this malocclusion are thus already born and are treated from day one of life. A drinking plate made of plastic is made for them, with which they can drink and suck at all. With today’s medical possibilities, it is possible to reposition the malposition of patients with congenital cleft lip and palate in an aesthetically pleasing way, so that there is hardly any scarring.
Indication group 5 also includes impacted, displaced teeth whose malocclusion is caused by eruption disorders. A distal bite, in which the upper teeth extend more than 9mm over the lower teeth, as well as a mesial bite, in which the lower teeth extend more than 3mm over the upper teeth, also belongs in KIG 5. An open bite of more than 4mm, in which the anterior or posterior teeth have no contact at all with the opposing teeth when biting, belongs to indication group 5. All these malocclusions have in common that they have a long therapy path until a complete correction is achieved. This often exceeds the usual treatment time of one to three years.
All articles in this series:
