Relationship Between the Number of Occlusal Supporting and Medical Cost: Analysis Using Large Claims Database from Employee Health Care Insurance in Japan.

BACKGROUND: There are several previous reports suggesting that the number of remaining teeth is related to increase of total medical expenditure. However, the measurements of oral healthcare conditions used in the previous studies were the number of remaining teeth, and occlusal support was not assessed. OBJECTIVES: The aim of this study was to evaluate the relationships between occlusal support and healthcare resource utilization. METHODS: This study was a retrospective cohort study using a claims database. Measurements of occlusal support were defined by the Eichner and Miyachi classification systems based on dental formula information. Medical healthcare resource usage was measured by medical visit rate and 12-month medical expenditure. RESULTS: Of the total population in the claims database, 1 288 713 patients were included in the analysis. The proportion of patients who had at least one medical visit and annual medical expenditure in the best condition classes in each classification measure (i.e. A1 for Eichner classification and Area I for Miyachi classification in both endpoints) were 58.2% and 61.1%, and JPY34 597 (US$314.52 at JPY110/US$) and JPY43 129 (US$392.08), respectively. Those in the poorest condition classes in each classification measure (i.e. B3 for Eichner classification and Area IV for Miyachi classification in the medical visit rate, and C1 for Eichner classification and Area III for Miyachi classification in medical expenditure) were 75.3% and 75.1%, and JPY149 339 (US$1357.63) and JPY120 925 (US$1099.32), respectively. We found a positive correlation with the outcomes by regression analysis adjusting for deterioration of occlusal support with age and gender. CONCLUSION: We found significant relationships between occlusal support conditions and healthcare resource utilization. The maintenance of oral health or dental treatment may positively impact overall health, and active dental intervention may reduce the total medical expenditure.

Cost-Utility Analysis of Molar Single Implant Versus Fixed Dental Prosthesis.

PURPOSE: To calculate the incremental cost-effectiveness ratio (ICER) of prosthetic treatment of a single missing intermediate molar by performing cost-utility analysis on implants, insurance fixed dental prostheses (IFDPs), and private fixed dental prostheses (PFDPs). MATERIALS AND METHODS: Transition probability (based on the results of past research) and the Markov model were used for cost-utility analysis, and Monte Carlo simulations were performed for sensitivity analysis. The utility values for various types of missing teeth were collected in September 2017, and dental prosthetic treatment was performed in general members of the Japanese population, distributed by sex and age. The time trade-off (TTO) method, which is an index scale (0-1), was used for measuring the utility values. RESULTS: The utility value was the highest when measured at the state in which implant treatment was performed and the lowest when measured in the untreated missing-tooth state. This model showed that compared to FDPs, implant treatment resulted in higher quality-adjusted life years (QALYs). However, the estimated cost over 30 years was lower for IFDPs. The results also showed that PFDPs were in a more extended, dominant state than both IFDPs and implants. The implant-to-IFDP ICER was €2,454.37. CONCLUSION: The results suggest that implants can be used to obtain higher utility values in comparison to IFDPs and PFDPs. The ICER threshold for 1 QALY in Japan is approximately €37,037 to €44,444, and the implant-to-IFDP ICER was found to be below that found in this study. Accordingly, it appears that implants offer superior cost-effectiveness.

Effectiveness of scaffolds with pre-seeded mesenchymal stem cells in bone regeneration--assessment of osteogenic ability of scaffolds implanted under the periosteum of the cranial bone of rats.

To date, there has been no study on the development of novel regimens based on the following tissue engineering principles: seeding and culturing mesenchymal stem cells (MSCs) on a scaffold before surgery or injecting cultured MSCs into a scaffold during surgery. The purpose of this study was to assess the in vivo osteogenic ability of scaffold/MSCs implanted beneath the periosteum of the cranial bone of rats in three different sample groups: one in which MSCs were pre-seeded and cultured on a scaffold to produce the 3-D woven fabric scaffold/MSC composite using osteo-lineage induction medium, one in which cultured MSCs produced by osteo-lineage induction in cell cultivation flasks were injected into a scaffold during surgery and a control group, in which only the 3-D woven fabric scaffold was implanted. The results indicate that pre-seeding MSCs on a scaffold leads to a higher osteogenic ability than injecting cultured MSCs into a scaffold during surgery.