Orthodontics for children in Cologne – braces for children and teens

Early detection of jaw misalignments helps avoid more complex interventions later. We consider a first orthodontic check-up between the ages of 6 and 9 the right time to identify developmental issues such as crossbites or12 early. A pronounced3 can often be guided particularly gently during the growth phase. Not every irregularity requires immediate treatment — sometimes it is enough to monitor the growth pattern for the time being.

What the professional societies say – and what they don’t. The German Society of Orthodontics (DGKFO) and the German Society of Dentistry, Oral and Maxillofacial Medicine (DGZMK) have published guidelines on ideal treatment timing4 and orthodontic diagnostics5 . Neither names a fixed age for the first checkup. Our range of 6 to 9 years is therefore a recommendation from practice: early enough to recognize a misalignment, late enough not to treat without cause.

You don’t have to wait for your dentist to bring it up: a check-up with us is possible without a referral, and it costs nothing if there are no findings.

Early treatment is the exception, not the rule. It makes sense when a finding interferes with growth or gets worse over time. Typical reasons:

• a crossbite — the lower jaw is forced to one side when closing
• protruding front teeth with a higher risk of injury during play and sports – for club sports, a custom sports mouthguard then provides protection
• a pronounced open bite, where the front teeth do not meet when closing
• reverse bite, in which the lower teeth sit in front of the upper ones
• loss of space after a baby tooth has been lost too early
• thumb sucking, pacifier habits or mouth breathing that shape the jaw

And just as important: when we wait and watch. Mild crowding in the mixed dentition, crooked permanent front teeth or gaps that close on their own as the teeth change do not need an early appliance. We tell you that openly – even if it means you will come back again in a year.

What we use and for how long. At this stage, we work with growth. A palatal expansion , for example, makes use of the still-open midpalatal suture and achieves results that would be more complex to obtain later. Early treatment is usually planned for 6 to 12 months ; this is typically followed by a pause until the tooth replacement has progressed sufficiently.

How the guideline classifies early treatment. The S3 guideline “Ideal Treatment Timing for Orthodontic Anomalies” by DGKFO and DGZMK4 assigns early treatment to the period before age 10 ; the diagnostic guideline from 2025 follows the same classification.5 For a pronounced transverse anomaly – crossbite – it recommends beginning early in the upper jaw, because the growing upper jaw adapts well in younger years. For a Class III anomaly, underbite, it advises treatment in the early mixed dentition phase: According to the evidence reviewed there, early treatment can reduce the likelihood of later surgical intervention.4

Working together with pediatricians, ENT specialists and speech therapists

Some conditions have their cause not in the jaw itself. With persistent mouth breathing , nasal breathing needs to be evaluated; with tongue thrusting or an atypical swallowing pattern, speech therapy helps; and with thumb sucking, we work with a vestibular screen rather than prohibitions.6910 Where appropriate, we coordinate with your child’s pediatrician, ENT specialist, or speech therapist.

The typical period for actual treatment is in the late mixed dentition. The reason is simple: As long as the jaw is growing, it can be guided. For girls, this window is usually open until about age 12, for boys until about age 14.4 The S3 guideline names exactly this period for a moderate Class II anomaly – the common overbite: preferably before or during the pubertal growth spurt in the late mixed dentition.4 Treatment remains possible afterward – but much becomes more complex.

The method chosen is based on the condition, not on age: a removable appliance guides growth78, fixed braces precisely position teeth, and for adolescents, aligners are often an alternative. At the end, there is always retention – without it, teeth shift back.

How long it takes. Depending on the findings and cooperation, the main treatment typically lasts between 18 and 36 months. A reliable figure for your child can only be given after diagnostics — before that, it would be guesswork.

For adolescents, esthetics moves to the forefront – and with it, the desire for the most discreet solution possible. Tooth-colored ceramic brackets are possible for many conditions; clear aligners are an option when the condition and compliance align13. We have compiled a separate overview of all clear aligner options ; whether aligners are suitable for younger children is addressed in our article Can my child already use clear aligners?

Whether a discreet solution is viable in a specific case depends on the findings. We will tell you openly if it is not sufficient.

Retention is part of the treatment. At the end, stabilization with a retaineris essential. Without it, teeth will shift back over the years12 – this is the most common reason adults return to us later for retreatment.

Important for planning: For statutory health insurance coverage under KIG, treatment must have started before the child’s 18th birthday . An ongoing treatment continues beyond that age.

KIG classification: When does statutory health insurance pay for braces?

Statutory health insurance funds do not pay on request, but according to the findings. For this there are the orthodontic indication groups – KIG for short – with five levels:

• KIG 1 and 2 – minor deviations. Treatment is possible, but entirely a private-pay service.
• KIG 3 – pronounced misalignment. From this level on, statutory health insurance covers the standard treatment.
• KIG 4 and 5 – very pronounced or severe misalignments, such as a crossbite, an open bite or a markedly protruding upper jaw.

We make this classification at the initial examination and record it in the treatment plan, which the health insurer approves before treatment begins. So you know where you stand in advance.

You get the co-payment back

In a treatment covered by statutory health insurance, you initially pay 20 percent of the costs yourself. Your insurance will fully refund this amountonce the treatment is completed as planned and we issue the completion certificate.

Important for your timing: coverage by statutory health insurance applies only if treatment begins before the 18th birthday . If you would like to take out supplementary dental insurance, you should do so before any findings have been recorded – afterwards it is usually too late.

Privately insured families submit the treatment plan to their insurer before treatment begins; we put together the documents needed for this.

What you pay privately

Tooth-colored brackets, certain wire systems, or aligners go beyond standard coverage. We list such items separately in the treatment plan so you can see what is covered by insurance and what is not – you decide whether you want them. What the term means is explained under non-covered services.

Nothing is done at the first visit. We look, we explain, and your child may touch anything they want to see.

1. Arriving and getting acquainted. We talk with your child, not just about them.
2. Taking a look. Teeth, bite and temporomandibular joint – no drill, no needle.
3. A digital 3D scan instead of an impression, if records are needed. No impression material, no gagging.
4. Talking it through. What we see, whether anything needs to be done and when – calmly and without time pressure.

If a removable appliance is needed later on, your child chooses the color. That may sound like a detail, but it is often the difference between an appliance that gets worn and one that stays in a drawer.

What to bring to the first appointment

• Your child’s health insurance card
• Dental bonus booklet, if you have one
• A referral from your dental practice, if you have one – it is not required
• Any existing X-rays or records from previous treatment

Follow-up appointments during active treatment are scheduled approximately every six to eight weeks and usually last 15 to 30 minutes. For school-age children, we schedule appointments as much as possible outside of school hours.

Oral hygiene. With fixed braces, brushing teeth becomes more involved. We show your child the correct technique in our practice; you can also read about it under brushing teeth with braces.

Sports. For contact sports, we recommend a custom-fitted sports mouthguard. And if something breaks or causes discomfort: Under first aid for braces problems you will find immediate measures.

Teeth grinding. If your child grinds their teeth at night, this is not unusual at certain developmental stages. When it is no longer normal is explained in the article on teeth grinding in children.

Our experienced team takes its time, explains every step in clear language and builds trust – for a relaxed atmosphere in which your child feels well looked after. Working closely with you and your family dentist, we guide your child step by step toward a healthy, stable bite.

Practice owner Dr. Julia Steinmaier is a specialist in orthodontics and actively publishes scientific work. Who treats your child is listed under our team – in addition to Dr. Steinmaier, Dr. Zanders-Grote and Dr. Pölzl provide treatment.