Orthodontic indication groups
What are the orthodontic indication groups?
Due to the variability of misalignments in orthodontics, it is difficult to narrow down them and classify them according to their severity. For this purpose, the orthodontic indication groups have been developed, which divide a misalignment of the teeth into a scheme and according to which the various health insurances are based. In the subdivision there are five groups, which are numbered with the numbers 1-5. The severity of the deformity increases from CIG 1 to CIG 5. The treating orthodontist arranges the Dysgnathia (= Misalignment) of the patient and draws up an expert opinion so that the health insurance company can assess precisely whether and to what extent the costs for the planned therapy will be covered and how long a therapy will probably last until the expected goal.
Orthodontic indication group 1 (KIG 1)
The orthodontic indication group 1 describes slight misalignments. The correction of this would be an aesthetic one, which is why the statutory health insurances do not subsidize a treatment. The 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 orthodontic indication group 1, as well as a deep bite of one to three millimeters in which the upper incisors overlap the lower ones too much. Furthermore, crowding, by which a contact point between two teeth is displaced by up to one millimeter, is not an indication that the statutory health insurance company would have to pay something for orthodontic therapy. The private supplementary insurance as well as the private insurance usually pay a portion of the total costs, some also the full amount. In individual cases, however, you should consult your health insurance company.
Orthodontic indication group 2 (KIG 2)
The orthodontic indication group 2 describes a degree of severity in which a correction is necessary from a medical point of view and this is not only from an aesthetic point of view. However, as in KIG 1, the statutory health insurance companies do not pay for the treatment in this subgroup. With 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 in which the upper jaw teeth protrude over the lower teeth to the gums. Orthodontic group 2 also includes a crossbite, in which the cusps of the upper jaw teeth, which actually protrude outside the lower jaw teeth, protrude inwards, making it difficult for the patient to chew. This group also includes a crowding 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 with all of these diagnoses in order to establish a neutral bite position so that no worse secondary diseases arise from the misalignment. The statutory health insurances do not pay anything, however, it is different with additional insurance or private insurance.
Orthodontic indication group 3 (KIG 3)
From orthodontic indication group 3, the misalignments of the jaws and teeth are so immense that any health insurance company, be it statutory, private or additional insurance, will cover the costs for the treatment up to the age of 17. The treatment is medically necessary to restore chewing function, aesthetics and language skills. This includes an open bite in the front between two and four millimeters and a cross bite on both sides. In addition, a crowding of the contact points of over three to five millimeters has severity 3, as well as a lack of space of over three millimeters. A deep bite over three millimeters, in which the gums are injured by the deep bite, also belongs to the third orthodontic indication group.
Orthodontic indication group 4 (KIG 4)
The orthodontic indication group 4 includes serious misalignments that must be treated from a medical point of view. This includes a one-sided crossbite, which is particularly difficult to treat. The even more extreme case that not just a crossbite, but the entire tooth in the upper jaw is too far inward and there is no longer any contact, 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 that is over 4mm wide and can be caused by habits such as excessive thumb-sucking. Furthermore, severity 4 includes a distal bite in which the upper incisors protrude six to nine millimeters above the lower ones. Also the opposite, the mesial bite, in which the lower jaw teeth protrude three millimeters in front of the upper jaw teeth.
Further indications for group 4 are the failure of teeth in which the teeth are not genetically present or in the case in which they have been lost due to tooth loss. An eruption disorder, which results in a delayed or absent penetration phase of the teeth, is also an indication for an orthodontic intervention. In the case of breakthrough disorder, which belongs to severity level 4, implants are anchored in the jaw as counter bearings in order to pull teeth out of the jaw and thus force them to break through. The KIG 4 is also achieved through a lack of space of over 4 mm or a crowding of over 5 mm.
Orthodontic indication group 5 (KIG 5)
The orthodontic indication group 5 includes the extreme cases in which orthodontics alone does not lead to the goal, but surgical therapy must be carried out in addition to orthodontic treatment in order to achieve a neutral bite. Severity 5 includes the cleft lip and palate, in which the ossification and fusing of the upper jaw and the soft tissue above did not take place and therefore a cleft is present. Patients with this misalignment are born and are treated from day one. A plastic drinking plate is made for them, with which they can drink and suckle at all. With today's medical options, it is possible to reposition the misalignment of patients with congenital cleft lip and palate in an aesthetically high quality so that hardly any scarring is present.
Indication group 5 also includes retained, displaced teeth whose misalignment was caused by eruption disorders. A distal bite in which the upper jaw teeth extend over 9mm over the lower teeth, as well as a mesial bite in which the lower jaw teeth protrude more than 3mm in front of the upper jaw teeth, also belong in KIG 5. An open bite with more than 4mm, in which the front teeth or Posterior teeth have no contact with the opposing teeth when biting down, counts as severity level 5. All these misalignments have in common that they have a long treatment path until a complete correction is achieved. This often exceeds the usual treatment time of one to three years.
What consequences do the KIGs have for the assumption of costs by the health insurance company?
With the orthodontic indication groups, the health insurance company has precisely limited which misalignments are accepted from how many millimeters of deviation and which are paid for privately. The statutory health insurances apply that orthodontic groups three to five are paid up to the age of 17, while groups one and two are not. In the case of private supplementary insurance and private insurance, it depends on the conditions of the insurance, to what extent costs are borne, but the rule is that private individuals usually subsidize and cover more than statutory health insurance. The insured person should deal with the health insurance company and the orthodontic report in advance so that the question of costs is completely settled.
What if the orthodontist misjudged the KIG?
Due to the legal regulation of the orthodontic indication groups, there are special guidelines that must be adhered to in order to produce a correct assessment. Small deviations result in errors in the orthodontic report, which can lead to incorrect allocation and the associated recourse. Only a certain probe is accepted for the measurement; the use of a different one can falsify the measured values and thus possibly achieve a severity that is too high or too low, resulting in a wrong orthodontic indication group. Careful checking of the expert opinion using the documentation models can lead to funds paid back from being reclaimed from the fund, so that the patient has to pay a larger share himself.
