Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants.

BACKGROUND: There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. AIM: This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). METHODS: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method. RESULTS: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis. CONCLUSION: This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

Bone quality assessment in routine dental implant treatment among Brazilian and Swedish specialists.

OBJECTIVES: To investigate the interpretation and assessment of bone quality among Brazilian and Swedish specialist performing implant treatment. MATERIAL AND METHODS: A questionnaire was developed containing open and closed questions on attitudes, knowledge, and understanding of diagnostic methods for bone quality assessment. The questionnaire was sent by mail to dental implant specialists in Brazil while the Swedish version was Web-based and sent to specialists in periodontology and maxillofacial surgery. The response rate in the Brazilian group was 15.4% and in the Swedish group 36.5%. RESULTS: Most respondents in both groups considered bone quality to be an important parameter for implant treatment outcome. Among Swedish specialists, bone quality, however, was considered to be of low relevance. The most popular method for assessing bone quality among Swedish specialists was the hand-felt perception of drilling resistance followed by radiography. The Brazilian specialists more often used peak insertion torque. Most respondents classified bone quality, and both groups used the classification proposed by Lekholm & Zarb (Tissue-Integratedprosthesis: Osseointegration in Clinical Dentistry, 1985, Quintessence, Chicago) most frequently. CONCLUSION: Specialists in both countries considered bone quality to be an important parameter for implant treatment outcome, but there was no consensus neither on what bone quality means nor on how to assess bone quality.