A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice.

AIM: To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden. METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA. RESULTS: Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs. CONCLUSIONS: Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.

Microstructure, elemental composition, hardness and crystal structure study of the interface between a noble implant component and cast noble alloys.

STATEMENT OF PROBLEM: Casting a high-gold alloy to a wrought prefabricated noble implant-component increases the cost of an implant. Selecting a less expensive noble alloy would decrease implant treatment costs. PURPOSE: The purpose of this study was to investigate the interfacial regions of a representative noble implant component and cast noble dental alloys and to evaluate the effects of porcelain firing cycles on the interface. MATERIAL AND METHODS: Six representative alloys (n=3) were cast to gold implant abutments (ComOcta). Scanning electron microscopy (SEM) was used to characterize microstructures. Compositions of interfacial regions and bulk alloys were obtained by energy-dispersive spectroscopy. Vickers hardness was also measured across the interface. By using Micro-X-ray diffraction, the phases were evaluated at 7 points perpendicular to the interface. The effects of porcelain firing cycles on microstructures, diffusion, hardness, and phases were also evaluated. For statistical evaluation of diffusion length and hardness, a 3-way repeated measures ANOVA was used. Pairwise comparisons of interest were conducted with Tukey pairwise comparisons or, when a significant interaction was found, Bonferroni-adjusted t-tests (overall α=.05). RESULTS: Microstructures of bulk alloys were predominantly maintained to a well-defined boundary for both as-cast and heat-treated conditions. An interaction band, 5-6 µm wide, was observed. The alloy grain size at the interface and the interaction band width increased after simulated porcelain firing. The extent of elemental diffusion from the interface was about 30 µm and not affected by simulated porcelain firing. Differences in Vickers hardness for the alloys were consistent with their compositions. Micro-XRD patterns indicated that substantial amounts of new phases had not formed at the interfacial regions. CONCLUSIONS: Less expensive noble alternatives to high-gold alloys provided comparable metallurgical compatibility with the noble implant component.

Cost-Benefit Analysis of the Age One Dental Visit for the Privately Insured.

PURPOSE: The purpose of this study was to perform a cost-benefit analysis of the age one dental visit for privately insured patients. METHODS: A major insurance company provided claims from various states submitted between 2006-2012. Data provided included numbers of procedures and respective costs from the first visit until age six years. Data was organized into five groups based on age, for which the first D0145/D0150 code was submitted [(1) age younger than one year old; (2) age one or older but younger than two years old; (3) age two or older but younger than three years old; (4) age three or older but younger than four years old; and (5) age four or older but younger than five years old]. The ratio of procedures per child and average costs per child were calculated. RESULTS: Claims for 94,574 children were analyzed; only one percent of these children had their first dental visit by age one. The annual cost for children who had their first dental visit by age one was significantly less than for children who waited until an older age. CONCLUSION: There is an annual cost benefit in establishing a dental home by age one for privately insured patients.

Dentists' opinions on aspects of cast titanium restorations.

OBJECTIVES: The purpose of this paper was to study dentists' opinions regarding aspects of the clinical use of cast titanium restorations. METHODS: Since 1988 more than 10,000 cast titanium units of crowns and fixed partial dentures have been produced by the only dental laboratory that produces cast titanium restorations in Norway. A questionnaire on the clinical behaviour of such restorations was mailed to all 72 dental practitioners who were recorded in the computer file of this laboratory. RESULTS AND CONCLUSION: In the opinion of the 64 dental practitioners who completed the questionnaire, cast titanium is a useful supplement to conventional casting alloys, particularly because of its favourable cost. It has a satisfactory clinical behaviour, although there may be some problems related to technical and aesthetic aspects.

An evaluation of casting alloys used for restorative procedures.

Dental casting alloys have played a major role in the restorative process for three-quarters of a century. Gold-based compositions were used almost exclusively for most of that time-but because of their relatively high cost, they began to be replaced by a number of base metal alloys. This article discusses some of the most recent findings about the composition of alloy systems and the possible tissue responses to those systems.

Metal-ceramic bridges from commercial dental laboratories: alloy composition, cost and quality of fit.

The quality of construction of fixed bridge prostheses directly affects their long-term survival. The cost, alloy composition and marginal fit of bridges made by 30 commercial dental laboratories is assessed. Duplicate models of a three unit bridge preparation were sent to 30 different laboratories, as if required for a patient receiving treatment under the General Dental Service. Material was sent via general dental practitioners, requesting metal-ceramic bridges made from 45% Au alloy, precious metal or non-precious metal. Proximal contacts were overbuilt at 65% of sites and pontic tissue contacts were excessive in all but one bridge. Eight laboratories did not use alloys corresponding to the request made. The mean marginal gaps of non-precious metal bridges (145 microns) were significantly greater than those for 45% gold alloy (106 microns). Marginal fit was poor and a number of factors have been observed, with other postulated, which may have contributed to this problem.

Alternatives to gold.

Despite, or perhaps because of, its antiquity the lost wax casting process which we use in dentistry still produces the most accurate and durable restorations in our armamentarium. Although high-gold content alloys still act as the benchmark of quality, fit, and durability in the aggressive conditions of the mouth, their inherent cost, high density and low modulus have stimulated a search for alternatives. This has ranged widely through the metallurgical world and across the periodic table of the elements. As a result dental alloys for casting into inlays, crowns and bridges (with or without facings of dental porcelain) have become incredibly complex. This article will explain some of the reasons behind the developments.

Alloys for prosthodontic restorations.

The numbers and types of alloys for prosthodontic restorations have increased dramatically over the past 25 years, making selection of an alloy for a given clinical situation difficult. Factors such as cost, the need for better strength, and worries about alloy corrosion have pressured the alloy market to change significantly. A number of properties--including yield strength, hardness, elastic modulus, microstructural phases, grain size, corrosion performance, coefficient of thermal expansion, oxide color, and melting range--are relevant to the proper selection of an alloy for a given clinical problem. In this article, a brief historical look at prosthodontic alloys and the nomenclature for alloys is followed by a discussion of the most important physical properties of alloys for clinical practice. A summary of the types of alloys available today and their classification is then presented. Finally, speculations about future trends for alloys are made, and simple guidelines are suggested to help dentists choose appropriate alloys for their practices. This review excludes implant alloys, dental amalgam, and alloys for orthodontic and endodontic applications.