Appliance economics: From the cradle to the grave, Part 1

June 1, 2009
Let's talk about interim partials. The interim partial is a treatment tool that has a valuable application at every age, every level, and for every problem …

Rob Veis, DDS

For more on this topic, go to and search using the following key words: intraoral appliance, interim partials, appliance therapy, orthotic therapy, Dr. Rob Veis.

Let's talk about interim partials. The interim partial is a treatment tool that has a valuable application at every age, every level, and for every problem … and it is absolutely key to the guiding driving concept of appliance therapy — that of controlling and directing a patient's treatment plan to obtain optimum results.

From childhood to adulthood, a wide range of partials are available for everything from pediatric space management to adult dentofacial reconstruction.

The big picture

This article, the first of two, will focus on children. Loss of primary anterior teeth in childhood — usually the result of excessive caries or trauma — can impact esthetics, phonetics, and function – often disastrously if not properly addressed. At the very least, early tooth loss can bring about a reduction of space that directly affects the later eruption of adult teeth.

The solution? Replace the damaged teeth with a beautiful fixed interim primary bridge. If permanent teeth are not expected to erupt for at least six months, appliance therapy (to maintain the space) is indicated. Keep in mind that if space loss has already occurred, a space-regaining appliance should be used prior to placing any kind of space maintainer.

Bottom line: Pediatric space management is often the key to preventing a serious malocclusion in the permanent dentition.

Example: Every time a child swallows, the tongue moves forward, touching just behind the front teeth at the roof of the mouth. As swallowing continues, the tongue pushes against the posterior teeth, developing the maxilla laterally.

Without this applied force, a narrow upper arch can result, effectively blocking the nasal airway and/or causing the mandible to be underdeveloped. What's more, either of these conditions can lead not only to skeletal problems, but can also contribute significantly to the onset of obstructive sleep apnea.

Enter the Composite Groper

Most popular because of its esthetics, its strength, and its ability to last throughout a child's often tumultuous growth period, the Composite Groper Appliance is ideal for replacing missing or broken down and infected primary anteriors.

The anterior bridge is made extra strong by attaching each tooth separately to a specially designed stainless steel pad. Each unit is then welded and soldered to the arch wire. Within a week, the tissue is healed and the patient is able to maintain normal speech, function, and esthetics.

Constructed of composite resin, the replacement teeth are easily adjusted, shaded, added to, and repaired — no need to replace the appliance if a patient chips or breaks a tooth.

The economics of early treatment

To reiterate, early treatment — and early appliance therapy — is critical to the prevention of esthetic problems, phonetic problems, and functional problems. And, of course, from a cost-outlay perspective, early application of the Groper or similar appliances makes profound economic sense:

Cost as a child:
Appliance: $140
Early treatment: $600-$2,000

Left unaddressed, primary anterior tooth loss can eventually lead to adult skeletal crossbites or an underdeveloped maxilla due to the early loss of teeth without replacement — correctible only with extensive orthodontic care and/or surgical intervention. In addition, the underdeveloped maxilla (skeletal class II) and abnormal tongue function can often lead to onset of adult sleep apnea.

Cost as an adult:
Full orthodontic therapy: $4,000-$6,000
Surgical intervention: significantly more than $8,000

The interim partial can prove to be a valuable, cost-effective treatment tool for children, and aids in the prevention of a host of abnormal conditions persisting into adulthood. My next article (scheduled for the August issue of Dental Economics®) will focus on the esthetic and economic aspects and implications of interim partial therapy for adults.

For more information on interim partials, the Groper Appliance, or appropriate treatment and shading procedures, visit or call (800) 423-3270.

Dr. Rob Veis is chief executive officer of The Appliance Therapy Group® (ATG), comprised of Space Maintainers, Inc.®, Success Essentials®, Second Opinion® The Smile Foundation®, and The Appliance Therapy Practioners Association®. For more information, visit or call (800) 423-3270.

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