Cost-effectiveness of molar single-implant versus fixed dental prosthesis.

BACKGROUND: This study evaluates the cost-effectiveness of implants (Implant), insurance fixed dental prosthesis (IFDP) and private fixed dental prosthesis (PFDP) for a single intermediate missing tooth in the molar region to calculate the Incremental Cost Effectiveness Ratio (ICER). METHODS: The Markov model for cost-effectiveness analysis of the Implant, IFDP and PFDP was carried over maximum 30 years. The starting age for prosthetic treatment was decided to be 50 years. The General Oral Health Assessment Index (GOHAI) was used for the indicator of effectiveness as an oral health QOL value. The GOHAI value was collected from patients who visited the Department of Oral Implantology of Osaka Dental University between September 2014 and March 2016. In addition, the Tornado diagram was drawn and Monte-Carlo simulations made for sensitivity analysis. RESULTS: From the analysis of survey of QOL of each stage and treatment, the selection of an Implant led to a higher QOL value than FDP. However, the estimated 30-year cost for IFDP was lower than Implant. It also became evident that PFDP had an extended dominated condition compared with IFDP and Implants. The ICER on the Implant versus IFDP was €1423.00. CONCLUSIONS: These results suggest that a better of QOL value can be obtained from an Implant than from IFDP or PFDP. An evaluation form using an indexed scale for oral health-related aspects needs to be developed that is also consistent as an indicator of effect.

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.

EAO consensus conference: economic evaluation of implant-supported prostheses.

OBJECTIVE: There are various alternatives for the management of oral conditions that may lead to or already have lead to partial or full edentulism. Economic evaluations measure the efficiency of alternative healthcare interventions and provide useful information for decision-making and the allocation of scarce resources. MATERIAL AND METHODS: The current English literature dealing with "cost-effectiveness" of dental implant therapy versus different alternative treatment modalities, that is, complete and fixed partial dentures, root canal, and periodontal treatment, has been included in this narrative review. Due to the high heterogeneity within the literature, a meta-analysis could not be conducted. RESULTS: The available evidence from economic evaluations indicated that for the treatment of central incisors with irreversible pulpitis and coronal lesions, root canal treatments were most cost-effective initial treatment options. When initial root canal treatments failed, orthograde retreatments were most cost-effective. When root canal retreatments failed, extractions and replacement with single implant-supported crowns were more cost-effective compared to fixed or removable partial dentures. In the treatment of periodontitis in molars with Class I furcation invasion, non-surgical periodontal therapy was more effective and costed less than implant-supported single crowns. For the replacement of single missing teeth, two evaluations indicated that implant-supported single crowns provided better outcomes in terms of greater quality-adjusted tooth years or survival rates at lower costs compared to fixed partial prostheses. Another economic evaluation found that implant-supported crowns costed more, but provided greater survival rates compared to fixed partial dentures. For the restoration of edentulous mandibles, two evaluations indicated that overdentures retained by two or four implants improved oral health-related quality of life outcomes, but costed more than complete dentures. CONCLUSIONS: To better assess the efficiency of implant-supported prostheses in various clinical conditions, more economic evaluations are needed that follow well-established methodologies in health economics.

Reimbursement systems influence prosthodontic treatment of adult patients.

OBJECTIVE: To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. MATERIALS AND METHODS: Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. RESULTS: Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. CONCLUSIONS: Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Shortened dental arch concept shown to be cost effective.

DESIGN: Randomised controlled trial. INTERVENTION: All patients received treatment to render them dentally fit. Patients were randomly allocated to either the removable dental prostheses (RPD) or the shortened dental arch (SDA) group. Patients in the RDP group were restored to complete arches with RDP using cobalt-chromium frameworks according to a standardised protocol. For the SDA group, patients were restored to a shortened arch of ten occluding pairs of natural and replacement teeth using resin-bonded bridgework (RBB). OUTCOME MEASURE: Treatment effect was measured using the change in oral health-related quality of life (OHrQOL). For each patient the costs of delivering treatment were recorded by a research nurse during the intervention period. Laboratory costs were recorded as part of normal hospital policy for all patients. All of the dental materials used were recorded and given a unit price. The cost of professional time per patient was estimated using the highest point of the salary scale for the Community Dental Service in Ireland. RESULTS: One hundred and thirty-two patients were randomised; 65 to the RPD group and 67 to the SDA group. Ninety-two patients (69.7%) completed the study (46 in RPD group; 46in SDA group). There was no difference in the success rates of the two treatments over the period. Five pieces of resin-bonded bridgework (RBB) debonded and were recemented over the 12-month period giving a success rate of 95.5% for the RBB. Four patients discontinued wearing their RPDs; all four RPDS were fitted in the lower arch and included bilateral free end saddles, a success rate of 95.9%. Both RPD and SDA groups demonstrated statistically significant improvements in OHrQoL scores after 12 months.The total cost of achieving the minimally important clinical difference (MID) in OHrQOL for an average patient in the RDP group was [euro ]464.64. For the SDA group, the cost of achieving the MID for an average patient was [euro ]252.00. The cost-effectiveness ratio was therefore 1:1.84 in favour of SDA treatment. CONCLUSIONS: With an increasingly ageing population, many patients will continue to benefit from removable prostheses to replace their missing natural teeth. From a purely economic standpoint, the results from this analysis suggest that the treatment of partially dentate older adults should be focused on functionally orientated treatment because it is simply more cost-effective.

Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye.

OBJECTIVES: The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye. METHODS: Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created. RESULTS: Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06. CONCLUSIONS: These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research's findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses]. / Nazorg voor dutrzaamheid en profijtelijkheid van kronen en bruggen.

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine oral examinations are the prevention and, when necessary, the treatment of pathological conditions and complications. With regard to prevention, attention should be paid to information and instruction, oral biofilm and calculus, non-functional activities, hard tooth tissues, periodontal and peri-implant tissues, and saliva. Subsequently, it can be determined whether the intended durability and profitability have been achieved or can still be achieved, whether or not through indicated adjustments. Special attention should be paid to endodontically treated teeth. Restorative, repair or replacement treatments may be indicated in case ofcomplications, such as loose single- or multi-unitfixed dental prosthesis, fracture of a fixed dental prosthesis unit, lost tooth pulp vitality, tooth root fracture, and implant or implant abutment problems.

Implants versus short-span fixed bridges: survival, complications, patients' benefits. A systematic review on economic aspects.

AIM: To systematically evaluate the existing evidence to answer the focused question: For a patient with a single tooth to be replaced, is the implant crown, based on economic considerations, preferred to a conventional fixed partial denture? MATERIAL AND METHODS: PubMed MEDLINE, Cochrane-Central and Embase databases were searched using an extended list of search terms related to economics, which were then combined with the terms "prosthodontics" and "dental implant." RESULTS: The combined search for the "economic terms" and "prosthodontics" revealed 904 titles. The combination with "dental implants" revealed 2039 titles. Based on the abstracts, 73 full text publications were evaluated and data comparing outcomes with FDPs and implant crowns were retrieved from 26 publications. Initial costs for single implant crowns and FDPs on teeth were similar, but varied between tariff systems. The conditions of neighboring teeth and of the alveolar ridge defined the complexity (costs) of the treatment. Failure rates reported with single implant crowns and FDPs on teeth were similar. The long-term financial economic comparison showed a similar outcome for single implant crowns and FDPs. CONCLUSION: Other factors than costs and survival rates such as patient or provider reported factors may be more decisive when choosing between implant crowns and FDPs on teeth. The utility for the patient to keep healthy adjacent teeth unprepared makes the implant crown more economic.

Implant survival and complications. The Third EAO consensus conference 2012.

OBJECTIVES: The task of this working group was to analyze biological, technical and aesthetic complications of single crowns on implants and fixed dental prostheses with or without cantilevers on implants over 5 years or more. In addition, the group analyzed economic aspects on such implant treatment. MATERIALS AND METHODS: A systematic search of the relevant literature was conducted and critically reviewed. Four manuscripts were presented to cover the topics. RESULTS: The consensus statements prepared by the group and later accepted at the plenary session as well as suggestions for future research are presented in this article. The four reviews by Jung et al., Pjetursson et al., Romeo & Storelli and Scheuber et al. are printed separately and present detailed analyses of the research topics.

Cost satisfaction analysis: a novel patient-based approach for economic analysis of the utility of fixed prosthodontics.

The aim of this study was to apply a novel economic tool (cost satisfaction analysis) to assess the utility of fixed prosthodontics, to review its applicability, and to explore the perceived value of treatment. The cost satisfaction analysis employed the validated Patient Satisfaction Questionnaire (PSQ). Patients with a known prostheses outcome over 1-20 years were mailed the PSQ. Five hundred patients (50·7%) responded. Remembered satisfaction at insertion (initial costs) and current satisfaction (costs in hindsight) were reported on VAS, and the difference calculated (costs with time). Percentage and grouped responses (low, <40%; medium, 40-70%; high, > 70%) were analysed in relation to patient gender, age and willingness to have undergone the same treatment again, and in relation to prostheses age, type, complexity and outcome. Significance was set at P = 0·05. Averages were reported as means ± standard error. Satisfaction with initial costs and costs in hindsight were unrelated to patient gender and age, and prostheses age, type and complexity. Patients with a failure and those who would elect to not undergo the same treatment again were significantly less satisfied with initial costs (P = 0·021, P < 0·001) and costs in hindsight (P = 0·021, P < 0·001) than their counterparts. Patient's cost satisfaction (entire cohort) had significantly improved from 53 ± 1% at insertion to 81 ± 0·9% in hindsight (28 ± 1% improvement, P < 0·001). Patient cost satisfaction had also significantly improved, and the magnitude of improvement was the same within every individual cohort (P = 0·004 to P < 0·001), including patients with failures, and those who in hindsight would not undergo the same treatment again. Low satisfaction was reported by 166 patients initially, but 94% of these reported improvements in hindsight. Fourteen patients (3%) remained dissatisfied in hindsight, although 71% of these would still choose to undergo the same treatment again. Cost satisfaction analysis provided an evaluation of the patient's perspective of the value of fixed prosthodontic treatment. Although fixed prosthodontic treatment was perceived by patients to be expensive, it was also perceived to impart value with time. Cost satisfaction analysis provides a clinically useful insight into patient behaviour.

[Cost-effectiveness when treating an edentulous mandible]. / Kosteneffectiviteit bij de behandeling van een edentate onderkaak.

When treating an edentulous patient with complaints of unsatisfactory retention of his complete mandibular denture, various treatment options are available: a new conventional denture, an implant-supported overdenture, and an implant-supported fixed partial denture. Important considerations during the decision-making process are patient satisfaction, cost of denture fabrication, and cost of maintenance. The outcome of the diagnostic procedure will have financial consequences. On that basis, a satisfactory treatment plan can be established and carried out. The need exists for a protocol which takes into account cost-effectiveness and is useful in selecting the appropriate treatment option, adjusted to individual requirements.

Estimating costs for shade matching and shade corrections of fixed partial dentures for dental technicians in Germany: a pilot investigation.

AIMS: To evaluate the additional operating expenses caused by shade matching by dental technicians in the dental practice and by color changes of fixed partial dentures. METHODS: A questionnaire was handed out to visitors of the 2010 ADT dental technician congress in Germany. Thirty-one completed questionnaires were evaluated. RESULTS: Mean costs caused by shade matching and shade correction per month were 1269$ (SD = 1278$; n = 25) and per unit of FPD 9.32$ (SD = 8.89$). CONCLUSIONS: An improvement of shade matching, shade communication and reproduction should be made in order to minimize the considerable economic damage for dental laboratories.

Clinical evaluation of fixed partial dentures made in Sweden and China.

The aim of this study was to compare the quality of fixed partial dentures (FPDs) made in a Chinese dental laboratory with corresponding FPDs made in Swedish dental laboratories. Twenty-one patients were fitted with FPDs between March 2007 and December 2008. Single crowns and prostheses of up to seven units were made. All dentures, gold and CoCr alloys covered with ceramic, were produced in duplicate: one by a dental technician in China and the other by a dental technician in Sweden. The dentures were blind-tested with regard to marginal integrity, anatomic form and color, approximal and occlusal contacts, and time taken for adjustments. The composition of dentures was analyzed, and the material used, framework weight, compliance of the laboratories, and costs (material and labour) were recorded. There was no difference in the quality of marginal integrity, anatomic form, color, approximal and occlusal contacts, or in the time taken for adjustments. The bridge frameworks made in China were thinner and lighter (p<0.01) than those made in Sweden. Three FPDs from China showed elastic deformation when tested clinically and were considered too thin for clinical use. In 11 out of 14 orders from the Chinese laboratory, the gold alloy specified was not delivered and the cobalt-chromium alloy contained small amounts (0.19%) of nickel.The prostheses with gold-alloy frameworks from China cost 47% of those from Sweden (p<0.01) and those with cobalt/chromium frameworks 44% (p<0.01). In conclusion, the quality of the FPDs made in Sweden and China was comparable, with the exception of the dimension of the Chinese bridges, which in some cases was considered too weak. The gold alloy ordered from the Chinese laboratory was often not the alloy delivered and the CoCr alloy contained small amounts of nickel. FPDs from China cost less than half the price of those from Sweden.

Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations.

Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

Cost-effectiveness modeling of dental implant vs. bridge.

AIMS: We assess the cost-effectiveness of dental implant first-line strategy vs. fixed partial denture strategy in patients suffering from one single missing tooth. MATERIALS AND METHODS: The model used a simulation decision framework over a 20-year period. Potential treatment switches can occur every 5 years. Transition probabilities come from literature, epidemiological reports or expert opinions. They have been programmed using specific distribution ranges to simulate the patients' and practice variability, and to take into account parameter uncertainty. Direct medical costs have been assessed according to a cost survey. Probabilistic sensitivity analyses were conducted using 5000 Monte-Carlo simulations, generating confidence intervals of model outcomes. RESULTS: We found that mean cost-effectiveness of the bridge strategy is higher than the implant strategy. CONCLUSION: Implant as the first-line strategy appears to be the 'dominant' strategy, considering the lower overall costs and the higher success rate.

Cumulative costs for the prosthetic reconstructions and maintenance in young adult patients with birth defects affecting the formation of teeth.

OBJECTIVES: To assess retrospectively the cumulative costs for the long-term oral rehabilitation of patients with birth defects affecting the development of teeth. METHODS: Patients with birth defects who had received fixed reconstructions on teeth and/or implants > or =5 years ago were asked to participate in a comprehensive clinical, radiographic and economic evaluation. RESULTS: From the 45 patients included, 18 were cases with a cleft lip and palate, five had amelogenesis/dentinogenesis imperfecta and 22 were cases with hypodontia/oligodontia. The initial costs for the first oral rehabilitation (before the age of 20) had been covered by the Swiss Insurance for Disability. The costs for the initial rehabilitation of the 45 cases amounted to 407,584 CHF (39% for laboratory fees). Linear regression analyses for the initial treatment costs per replaced tooth revealed the formula 731 CHF+(811 CHF x units) on teeth and 3369 CHF+(1183 CHF x units) for reconstructions on implants (P<.001). Fifty-eight percent of the patients with tooth-supported reconstructions remained free from failures/complications (median observation 15.7 years). Forty-seven percent of the patients with implant-supported reconstructions remained free from failures/complications (median observation 8 years). The long-term cumulative treatment costs for implant cases, however, were not statistically significantly different compared with cases reconstructed with tooth-supported fixed reconstructions. Twenty-seven percent of the initial treatment costs were needed to cover supportive periodontal therapy as well as the treatment of technical/biological complications and failures. CONCLUSION: Insurance companies should accept to cover implant-supported reconstructions because there is no need to prepare healthy teeth, fewer tooth units need to be replaced and the cumulative long-term costs seem to be similar compared with cases restored on teeth.

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.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis.

OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000.

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.