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.

A Prospective Clinical Study of Alumina-Toughened Zirconia Abutments for Implant-Supported Fixed Restorations with a Mean Follow-up Period of 6.9 Years.

PURPOSE: The goal of this study was to compute the estimated cumulative survival and success rates of alumina-toughened zirconia (ATZ) abutments used for external connection-type implant-supported fixed dental prostheses (FDPs) after a mean follow-up of 6.9 years (82.3 months). MATERIALS AND METHODS: From May 1998 to July 2016, patients who provided informed consent and received implant-supported restorations with ATZ abutments were recruited. Clinical performance of zirconia abutments was evaluated using survival analysis. Failure was defined as the removal of the restoration due to zirconia abutment fracture, and complications included both failure and abutment screw problems. Survival and success were the counterparts of failure and complications, respectively. The effects of restoration-related factors (restored area, type of prosthesis, and implant system) on the survival and success of the abutments were estimated. RESULTS: A total of 231 patients were included in this study. One hundred twenty-six implant-supported single-unit and 204 multiple-unit FDPs were evaluated. All the placed implants had the external hex connection. The estimated cumulative 5-year, 7-year, and 10-year survival rates (95% confidence interval [CI]) of zirconia abutment-supported FDPs were 97.3% (95.5% to 99.1%), 96.8% (94.8% to 98.8%), and 94.1% (90.4% to 97.8%), respectively. The estimated cumulative 5-year, 7-year, and 10-year success rates (95% CI) were 94.1% (91.4% to 96.8%), 90.8% (87.3% to 94.3%), and 80.1% (73.6% to 86.6%), respectively. The type of prosthesis (P = .001) and implant system (P < .001) were the significant factors in the success of zirconia abutment-supported FDPs. CONCLUSION: Prefabricated ATZ abutments have a high predictability of survival at 10 years when used in implant-supported FDPs that replace both anterior and posterior teeth. However, the success of zirconia abutments was significantly influenced by the type of prosthesis and implant system.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis / Custo-efetividade da prótese implanto-suportada comparada à prótese total convencional

ABSTRACT 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.

RESUMO OBJETIVO Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$ 464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.

Análisis tridimensional de la deformación ósea cortical en prótesis parcial fija implantosoportada con voladizo distal sobre implantes cortos en maxilar / Three-dimensional analyisis of cortical bone deformation in implant-supported fixed partial prosthesis with distal cantilever, on short maxillary implants

Objetivo: Analizar la distribución de tensiones que provoca una fuerza axial en el modelo tridimensional, con elmétodo de elementos finitos, en la prótesis parcial fija implantosoportada con voladizo distal (PPFIVD) sobre implantes dentales cortos en el sector posterior del maxilar parcialmente desdentado. Materiales y métodos: Se crearon modelos geométricos del maxilar. Se diseñaron dos grupos y cuatro subgrupos. En zona premolar, se ubicaron implantes cortos StandardPlus SLA® (Straumann) de diferentes longitudes. Grupo A: PPFIVD con dos implantes, GA1 de 8 mm y GA2 de 4 mm. Grupo B: PPFIVD con un implante, GB1 de 8 mm y GB2 de 4 mm. Se aplicó una fuerza axial de 100 N a 30°.Resultados: La distribución de las tensiones en los implantes fue menor en GA1 que en GA2, y en GB1 que enGB2. A nivel óseo, la distribución de las tensiones fue mayor en GA1 que en GA2, y en GB2 que en GB1. Se observaron microdeformaciones óseas periimplante y, posteriormente, desplazamiento del conjunto prótesis/implante. Conclusiones: La PPFIVD sobre dos implantes de 8 y4 mm ferulizados podría ser una alternativa viable al levantamiento del piso de seno maxilar. La PPFIVD sobre un implante de 4 mm no sería recomendable. Las tensiones elevadas provocaron menor rendimiento en geometría oseoimplantaria, evidenciando microdeformaciones en el tejido óseo tridimensional y desplazamientos de la PPFIVD.

Aluminum Oxide Sandblasting of Hexagonal Coping and Abutment: Influence on Retention and Marginal Leakage Using Temporary Cements.

PURPOSE: To compare the tensile strength and marginal leakage of prefabricated abutments/copings, with or without surface sandblasting with aluminum oxide, luted with a calcium hydroxide-based temporary cement (CH, Dycal; Dentsply, Petrópolis, RJ, Brazil) or a noneugenol zinc oxide cement (ZO, Temp Bond NE; Kerr, Orange, CA). MATERIALS AND METHODS: A total of 48 CeraOne abutment analogs and respective copings were divided into 6 groups (n = 8) according to the component that was sandblasted: the coping only, coping + abutment or no sandblasting and the temporary cement used: CH or ZO. After cementation, the samples underwent 500 thermal cycles (5°C ± 2°C and 55°C ± 2°C) and were subsequently immersed in an aqueous solution of 0.5% basic fuchsine dye for 24 hours. Next, the tensile test was performed, and microleakage was assessed qualitatively. Data were analyzed using Mann-Whitney, Kruskal-Wallis tests, followed by the Student-Newman-Keuls test (α = 0.05). RESULTS: CH cement showed a tensile strength (245.6 N) significantly higher than that of the ZO (18.1 N). Sandblasting both abutment and coping increased tensile strength by 1.7 times. Marginal leakage was not influenced by sandblasting; however, CH presented less microleakage. CONCLUSION: Aluminum oxide sandblasting of the coping and abutment favored the tensile strength of temporary cements and the CH showed a higher tensile strength and less microleakage than did the ZO cement.

Application of Ce-TZP/Al2O3 nanocomposite to the framework of an implant-fixed complete dental prosthesis and a complete denture.

PATIENT: A 69-year-old Japanese male visited Nihon University Dental Hospital for refabrication of his mandibular implant-supported complete fixed prosthesis (ISCFPD) and maxillary complete denture, which had been fabricated 15 years previously. In this case, Ce-TZP/Al2O3 nanocomposite (Ce-TZP/A) was applied to the framework of the mandibular ISCFPD and maxillary complete denture. Three years after deliver of the framework, no particularly notable biological or prosthetic complications were observed, and a high level of patient satisfaction had been achieved. DISCUSSION: Conventional ISCFPD frameworks were fabricated by casting gold alloys; however, with the recent advancement of CAD/CAM technology, titanium (Ti) or yttria tetragonal zirconia polycrystal (Y-TZP) frameworks have become more common. In contrast, the main fabrication method for Ti or Co-Cr frameworks of removable dental prostheses has shifted from the conventional casting method to CAD/CAM fabrication. Ce-TZP/A, which was chosen as the framework material this time, shows higher strength and greater toughness than Y-TZP. However, since it has a low light-transmitting property and exhibits an opaque white color, the range of its application in fixed prostheses, particularly in the esthetic area, is limited. CONCLUSION: We described a case in which Ce-TZP/A was applied to the frameworks of a mandibular ISCFPD and a maxillary complete denture. No particularly notable biological or prosthetic complications were observed in the mandibular ISCFPD or the maxillary complete denture, and a high level of patient satisfaction was achieved. Medium- and long-term observations with a greater number of cases are essential to obtain information concerning various phenomena related to this procedure.

Patients' satisfaction with conventional dentures and mini implant anchored overdentures.

UNLABELLED: The aim of this study was to assess complete edentulous patient satisfactionwith two treatment alternatives--conventional dentures and mini implant anchored overdentures. MATERIALS AND METHODS: Study sample comprised 36 patients--18 treated with newly made conventional prosthesis and 18 with mini implants anchored overdentures, with a ball attachment system (from IMTEC Corporation). RESULTS: Patients treated with mini implant anchored overdenture presented a higher satisfaction regarding chewing ability (all of them reported satisfactory mastication, 50% accusing occasionally discontent) compared with the conventional denture group (28% reported impaired masticatory function and 39% occasionally discontent). Denture's retention was better in the mini implant overdenture sample (only 17% reported occasional problems, none of them feel the need to use denture adhesives), compared to the conventional treatment alternative (28% were dissatisfied about this issue). Both treatment alternatives were seen as being highly satisfactory regarding the aesthetic restoration of facial appearance and for performing phonation. Still, in the complete denture group 22% of patients claimed difficulties in articulating certain phonemes. The main reasons why patients refused implant treatment were its higher cost and fear of surgery. CONCLUSIONS: Patients treated with mini implant anchored overdentures were more satisfied than those treated conventionally, due to the increased retention and stability of dentures, mastication efficiency and improved comfort, these having probably a positive effect on the quality of life.

[Role of computerised programs for the evaluation, diagnosis and treatment of partially edendulous patients]. / Aportul programelor computerizate in evaluare, diagnostic si tratament la pacientul edentat partial.

UNLABELLED: In order to elaborate a correct plan of diagnosis and find the correct therapeutic solution of election in partial edentulous it would be necessary to use a Support System for Clinical Decisions (SSCD). This may bring many benefits both to the private medical assistance,and to institutions with wider therapeutic, educational and scientific objectives. MATERIALS AND METHODS: Using as starting point the ProDent platform of application existing at the Faculty of Dental Medicine from The University of Medicine and Pharmacy Gr.T. Popa Iasi we have developed an expert system for clinical case evaluation and for providing a reliable therapeutic solution. In this respect we have used the ProDent application database--a complete and complex database which records information about patients. RESULTS: At the same time the application generates a table recording a clinico-biological data hierarchy, highlighting the categories which may require intervention during the specific preparation stage. The use of bayes inference also indicates the most reliable therapeutic solution, the initial plan of treatment, the reliability score and the oral rehabilitation predictions. By adding the patient initial score and the oral rehabilitation predictions provided by the application, we obtain the patient initial therapeutic score. CONCLUSIONS: The simulation programs and the electronic format of the observation paper are efficient tools that provide an integrative holistic approach of patients with different forms of oral pathology, under the incidence of local, loco-regional and general complications.

Análisis fotoelástico comparativo de un sistema de construcción de barras articuladas para sobredentaduras mandibulares soportadas por cuatro implantes / A comparative photoelastic analysis of a system of articulated bars construction for overdentures supported by four implants

El ajuste pasivo de las barras para sobredentaduras implantosoportadas ha sido sugerido como un pre-requisito para el éxito a largo plazo de la oseointegración. Sin embargo, no hay lineamientos científicos de cómo lograrlo ni medirlo clínicamente con precisión. El propósito de este estudio fotoelástico fue determinar los patrones de estrés generados por la falta de pasividad en un diseño de construcción de barras tipo Hader para sobredentaduras, alrededor de cuatro implantes ubicados en la región intermentoniana, con una articulación horizontal ubicada en el tramo central. Se fabricó un modelo fotoelástico que simuló una mandíbula humana edéntula, en la que se incorporaron cuatro implantes roscados con hexágono externo (3.75 de diámetro x 13 mm de longitud, con base de 4 mm). Fueron construidas cuatro barras que ferulizaron los cuatro implantes y a las que se les colocó una articulación horizontal en el tramo central. Las barras fueron asentadas y torqueadas sobre el modelo fotoelástico y se registraron fotográficamente los patrones de estrés generados en cada implante. Las barras articuladas mostraron mayor pasividad en el tramo central donde se ubicó la unión articulada. Además, se determinó que el área crítica para la mayor concentración de tensiones fueron los cuellos de los implantes y no así los ápices, que mostraron valores muy inferiores. Cada ejemplar de férula mostró un comportamiento diferente a las demás, a pesar de que fueron procesadas todas sobre el mismo modelo y con idéntico procedimiento de construcción. Las uniones articuladas mostraron pasivisar más el tramo donde se ubican pero no es un recurso suficiente para otorgar un asentamiento pasivo cuando son colocados y torqueados los tornillos que fijan las barras a los implantes (AU)

Análisis fotoelástico comparativo de un sistema de construcción de barras articuladas para sobredentaduras mandibulares soportadas por cuatro implantes / A comparative photoelastic analysis of a system of articulated bars construction for overdentures supported by four implants

El ajuste pasivo de las barras para sobredentaduras implantosoportadas ha sido sugerido como un pre-requisito para el éxito a largo plazo de la oseointegración. Sin embargo, no hay lineamientos científicos de cómo lograrlo ni medirlo clínicamente con precisión. El propósito de este estudio fotoelástico fue determinar los patrones de estrés generados por la falta de pasividad en un diseño de construcción de barras tipo Hader para sobredentaduras, alrededor de cuatro implantes ubicados en la región intermentoniana, con una articulación horizontal ubicada en el tramo central. Se fabricó un modelo fotoelástico que simuló una mandíbula humana edéntula, en la que se incorporaron cuatro implantes roscados con hexágono externo (3.75 de diámetro x 13 mm de longitud, con base de 4 mm). Fueron construidas cuatro barras que ferulizaron los cuatro implantes y a las que se les colocó una articulación horizontal en el tramo central. Las barras fueron asentadas y torqueadas sobre el modelo fotoelástico y se registraron fotográficamente los patrones de estrés generados en cada implante. Las barras articuladas mostraron mayor pasividad en el tramo central donde se ubicó la unión articulada. Además, se determinó que el área crítica para la mayor concentración de tensiones fueron los cuellos de los implantes y no así los ápices, que mostraron valores muy inferiores. Cada ejemplar de férula mostró un comportamiento diferente a las demás, a pesar de que fueron procesadas todas sobre el mismo modelo y con idéntico procedimiento de construcción. Las uniones articuladas mostraron pasivisar más el tramo donde se ubican pero no es un recurso suficiente para otorgar un asentamiento pasivo cuando son colocados y torqueados los tornillos que fijan las barras a los implantes (AU)

Análisis fotoelástico comparativo de un sistema de construcción de barras articuladas para sobredentaduras mandibulares soportadas por cuatro implantes / A comparative photoelastic analysis of a system of articulated bars construction for overdentures supported by four implants

El ajuste pasivo de las barras para sobredentaduras implantosoportadas ha sido sugerido como un pre-requisito para el éxito a largo plazo de la oseointegración. Sin embargo, no hay lineamientos científicos de cómo lograrlo ni medirlo clínicamente con precisión. El propósito de este estudio fotoelástico fue determinar los patrones de estrés generados por la falta de pasividad en un diseño de construcción de barras tipo Hader para sobredentaduras, alrededor de cuatro implantes ubicados en la región intermentoniana, con una articulación horizontal ubicada en el tramo central. Se fabricó un modelo fotoelástico que simuló una mandíbula humana edéntula, en la que se incorporaron cuatro implantes roscados con hexágono externo (3.75 de diámetro x 13 mm de longitud, con base de 4 mm). Fueron construidas cuatro barras que ferulizaron los cuatro implantes y a las que se les colocó una articulación horizontal en el tramo central. Las barras fueron asentadas y torqueadas sobre el modelo fotoelástico y se registraron fotográficamente los patrones de estrés generados en cada implante. Las barras articuladas mostraron mayor pasividad en el tramo central donde se ubicó la unión articulada. Además, se determinó que el área crítica para la mayor concentración de tensiones fueron los cuellos de los implantes y no así los ápices, que mostraron valores muy inferiores. Cada ejemplar de férula mostró un comportamiento diferente a las demás, a pesar de que fueron procesadas todas sobre el mismo modelo y con idéntico procedimiento de construcción. Las uniones articuladas mostraron pasivisar más el tramo donde se ubican pero no es un recurso suficiente para otorgar un asentamiento pasivo cuando son colocados y torqueados los tornillos que fijan las barras a los implantes (AU)

Sobredentaduras sobre implantes oseointegrados. Sistemas de barras / Osseointegrated implant-supported overdentures. Bar systems

Los sistemas de barras proporcionan mejores resultados en la confección de sobredentaduras. Los diseños de barras Hader o Dolder son los más utilizados. Podemos confeccionar barras sobre pilares transepiteliales o barras directamente sobre los implantes, utilizando elementos mecanizados o calcinables. Sobre las barras se prefiere colocar la mínima retención posible para la sobredentadura. Para el éxito del tratamiento es fundamental la pasividad de la barra (AU)