Full Coverage Crowns and Resin-bonded Bridge Combination for Missing Mandibular Anterior Teeth.

Most often the anterior teeth and those that are visible when a patient speaks or smiles are chosen for esthetic restorations. The mandibular anterior fixed bridge often presents problems to the dentist due to the size of the natural teeth and their visibility. In addition, due to high cost factor, many patients are not able to afford fixed partial denture for missing anterior teeth. This article describes a cost effective technique for the restoration of missing mandibular anterior teeth by fabrication of full coverage crowns and resin-bonded fixed bridge combination.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives.

PURPOSE: To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated. MATERIALS AND METHODS: The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis. RESULTS: The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities. CONCLUSIONS: When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

A preliminary report of the cost-effectiveness of tooth replacement strategies for partially dentate elders.

OBJECTIVE: To compare the cost-effectiveness of conventional treatment using partial dentures with functionally orientated treatment to replace missing teeth for partially dentate elders using a randomised controlled clinical trial. BACKGROUND: In many countries, including the Republic of Ireland, the only publically funded treatment option offered to partially dentate older patients is a removable partial denture. However, evidence suggests that these removable prostheses are unpopular with patients and can potentially increase the risk of further dental disease and subsequent tooth loss. MATERIALS AND METHODS: Fourty-four partially dentate patients aged 65 years and older were recruited. Patients were randomly assigned to the two treatment arms of the study. The conventional treatment group received removable partial dentures to replace all missing natural teeth. The functionally orientated group was restored to a Shortened Dental Arch (SDA) of 10 occluding contacts using resin-bonded bridgework (RBB). The costs associated with each treatment were recorded. Effectiveness was measured in terms of the impact on oral health-related quality of life (OHRQoL) using OHIP-14. RESULTS: Both groups reported improvements in OHRQoL 1 month after completion of treatment. The conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally orientated group. The mean total treatment time was 183 min 19 s for the conventional group vs. 124 min 8 s for the functionally orientated group. The average cost of treatment for the conventional group was 487.74 Euros compared to 356.20 Euros for the functional group. CONCLUSIONS: Functionally orientated treatment was more cost-effective than conventional treatment in terms of treatment effect and opportunity costs to the patients' time.

Markov models in dentistry: application to resin-bonded bridges and review of the literature.

Markov models are mathematical models that can be used to describe disease progression and evaluate the cost-effectiveness of medical interventions. Markov models allow projecting clinical and economic outcomes into the future and are therefore frequently used to estimate long-term outcomes of medical interventions. The purpose of this paper is to demonstrate its use in dentistry, using the example of resin-bonded bridges to replace missing teeth, and to review the literature. We used literature data and a four-state Markov model to project long-term outcomes of resin-bonded bridges over a time horizon of 60 years. In addition, the literature was searched in PubMed Medline for research articles on the application of Markov models in dentistry.

Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant.

AIM: To evaluate the cost-effectiveness of root canal treatment for a maxillary incisor tooth with a pulp infection, in comparison with extraction and replacement with a bridge, denture or implant supported restoration. METHODOLOGY: A Markov model was built to simulate the lifetime path of restorations placed on the maxillary incisor following the initial treatment decision. It was assumed that the goal of treatment was the preservation of a fixed platform support for a crown without involving the adjacent teeth. Consequently, the model estimates the lifetime costs and the total longevity of tooth and implant supported crowns at the maxillary incisor site. The model considers the initial treatment decisions, and the various subsequent treatment decisions that might be taken if initial restorations fail. RESULTS: Root canal treatment extended the life of the tooth at an additional cost of pound5-8 per year of tooth life. Provision of orthograde re-treatment, if the root canal treatment fails returns further extension of the expected life of the tooth at a cost of pound12-15 per year. Surgical re-treatment is not cost-effective; it is cheaper, per year, to extend the life of the crown by replacement with a single implant restoration if orthograde endodontic treatment fails. CONCLUSION: Modelling the available clinical and cost data indicates that, root canal treatment is highly cost-effective as a first line intervention. Orthograde re-treatment is also cost-effective, if a root treatment subsequently fails, but surgical re-treatment is not. Implants may have a role as a third line intervention if re-treatment fails.

Fibre reinforced composites--alternative for lost teeth replacement.

The loss of an anterior tooth can affect a patient psychologically and socially. This trauma can be minimized by the immediate replacement of the lost tooth, preferably using a fixed prosthesis. This paper describes the immediate replacement of anterior lost teeth by using fibre reinforced composite materials, although these techniques can be employed very successfully in the replacement of posterior teeth as well. The abutment teeth can be conserved, with little or no preparation, making this procedure truly minimally invasive and keeping the technique reversible. Additional advantages are that the procedure is completed at the chairside in a single visit, thereby avoiding laboratory costs and saving time while waiting for the finished prosthesis. This technique can be used as an interim measure or as a permanent prosthesis.

The Umgeni bridge, a resin bonded pontic using a preformed fibre post an aesthetic procedure of low biological and fiscal cost.

A missing anterior tooth or open embrasures destroys the aesthetics of a smile. The replacement of a missing anterior tooth is one of the most rewarding and challenging aspects of restorative dentistry. There are a number of techniques to do this, however, most involve the use of a technician, which means additional cost to the patient and multiple visits. In today's financial climate with practice expenses climbing and medical aid remuneration dwindling, one must seek methods to reduce costs and provide patients with more affordable dentistry. In addition, in crisis situations such as the traumatic loss of a tooth an immediate replacement technique albeit temporary is necessary. To replace a missing anterior tooth directly and immediately presents a rewarding challenge to the clinician. The Umgeni bridge named after the river that flows on the north side of Durban, is particularly useful in replacing congenitally missing laterals after completion of orthodontic treatment in the case of congenitally missing laterals and cleft palates.

Resin-retained bridges re-visited. Part 1. History and indications.

Resin-retained bridges have been used clinically since the 1970s, and offer a more conservative approach to the restoration of edentulous spaces than conventional bridgework. They are easy to place, cheap to fabricate and have been shown to be cost effective. Despite this, they are not frequently used in general dental practice and they have an undeserved reputation for failure. Since their initial introduction, they have undergone a number of changes to their method of retention, and the materials used in their construction. This has resulted in a predictable, aesthetic restoration which, barring the use of implants, is often the treatment of choice where teeth adjacent to an edentulous space are minimally or not restored. This first article details the history, advantages, indications, and designs of resin-retained bridges.

A modified technique for minimal-preparation, resin-retained bridges: four case reports.

The minimal-preparation, resin-retained adhesive bridge may be considered to be an ideal choice of fixed prosthesis to replace a single missing tooth, especially in the anterior maxillary region. The technique is well documented, enjoys a high success rate, and with suitable case selection generally employs a conservative preparation. Other advantages include reduced cost compared with conventional bridges and simplified laboratory and clinical procedures. Its limitations are principally due to occlusal factors, or the presence of unsuitable abutment teeth--for example, those that are extensively restored. Another traditional contraindication is the presence of diastemas, which may limit the potential aesthetic gains. This paper presents a series of case reports which describe an altered technique in order to maintain anterior spacing.

Design principles for cantilevered resin-bonded fixed partial dentures.

Recent clinical studies show 2-unit cantilevered resin-bonded fixed partial dentures to be as retentive or more retentive than their fixed-fixed counterparts. The fact that the 2-unit prosthesis is successful adds value to the clinical use of resin-bonded fixed partial dentures because the single-abutment prosthesis is even simpler and more cost effective than fixed-fixed designs. However, there is no evidence-based information relating to design principles for abutment preparation and framework design for the single-abutment, single-retainer prosthesis. The aim of this report is to suggest principles of design for the 2-unit cantilevered fixed partial denture, based on information gained from studies on fixed-fixed designs.

The provision of resin-bonded bridgework within the General Dental Services 1987-1997.

The purpose of this study was to investigate the performance of resin-bonded bridgework provided within the General Dental Services of the National Health Service. The basic procedure involved analysis of data collected from the administering authorities in England, Wales and Scotland between 1987 and 1997. These figures included the cost of the provision of such bridgework and the incidence and cost of refitting bridges which had become debonded in service. The investigation found that while the number of resin-bonded bridges provided had peaked in the early 1990s the number of claims for rebonding was still increasing at a high rate. In the most recent year of the study (1996/97) the number of claims for rebonding bridges was 50% more than the number of bridges actually fitted during that year. It was concluded that resin-bonded bridgework provided under the General Dental Services of the National Health Service was experiencing a high failure rate and that this problem was worthy of further investigation.

Direct resin-bonded, fibre-reinforced anterior bridges: a clinical report.

Direct resin composite cantilever bridges were placed in patients to replace 26 single upper anterior teeth and one upper premolar. Twenty-four bridges were simple cantilevers, and three were fixed-fixed bridges. The bridges were constructed with hybrid resin composite placed around a resin-impregnated plasma-etched polyalkane fibre bundle bonded to the abutment tooth enamel by the acid-etch technique. Twenty-five bridges were assessed at 10 +/- 1 months. Two had fractured due to trauma, however, in both cases the pontic remained attached to the abutment tooth by the fibre bundle. This method of tooth replacement is viewed as a rapid, simple, cost-effective means of replacing anterior teeth in selected patients.

Resin-retained bridges in the treatment of traumatized dentition.

Resin-retained bridges can be used as the definitive treatment, as well as for interim treatment. Compared with conventional fixed prostheses, there are some advantages which make this treatment especially useful in traumatized dentition. The ultra conservative approach makes the adhesive bridge a standard treatment option in cases of uncertain prognostic factors. However, in such specific situations as traumatized dentition some complicating factors may be present. These complicating factors must be recognized and eliminated to create situations in which this kind of restoration can be successful. Therapeutic and patient-related factors are discussed using data from longitudinal clinical studies. Available clinical information indicates the anterior adhesive bridge to a 'permanent restoration'. However, a benefit-cost analysis is necessary to weigh the value of this restorations.

A method to compare cost-effectiveness of dental treatments: adhesive bridges compared to conventional bridges.

The cost-effectiveness of a dental restoration depends primarily on the durability and the cost of the restoration. In this report a method is described to compare the cost-effectiveness using the durability data of adhesive bridges and conventional bridges. The study shows that, for the situation in the Netherlands, the breakeven point for equal cost-effectiveness compared to conventional bridges is achieved when the 50% survival for adhesive bridges is approximately 6.5 yr. Clinical data indicate a higher cost-effectiveness for anterior adhesive bridges. The method described in this report is considered to be useful for comparing cost-effectiveness of dental restorations in different situations.