Cost-effectiveness of anterior implants versus fixed dental prostheses.

For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient's perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.

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.

Socioeconomic indicators and prosthetic replacement of missing teeth in a working-age population--results of the Study of Health in Pomerania (SHIP).

OBJECTIVES: To analyse the possible effects of the socioeconomic status (SES) on the prosthetic replacement of missing teeth in working-age people and to explore the role of potential confounders. METHODS: Cross-sectional data were collected from 2310 German adults aged 30-59 years. The relationship between each of the three SES indicators (education, income, and occupational status) and dental prostheses were examined by multinomial logistic regression analyses. For that, partially dentate participants with suboptimal and no replacement of missing teeth were compared with partially dentate participants having optimal replacement. Potential confounders (age, sex, dental status, social network and social support) were entered if their inclusion in the model led to >or= 10% change in the coefficient of interest. RESULTS: Social network and social support did not meet the criterion for confounding. In the maxilla, having no replacement was positively associated with lower categories for each of the three SES indicators [Odds ratios (OR) between 1.6 and 2.1; 95% confidence intervals (CI) between 1.1 and 3.4]. Low occupational status was the single predictor for suboptimal dental prostheses (OR=3.2; 95% CI: 1.6-6.2). In the mandible, occupational status showed no association with the prosthetic status, whereas low educational level and low household income were determinants for having no replacement (OR=1.9 and 1.9, 95% CI: 1.0-3.5 and 1.1-3.0, respectively). Low household income was the single determinant for suboptimal replacement of missing teeth (OR=2.4, 95% CI=1.1-5.2). CONCLUSION: The findings may indicate the relevance of the financing of prosthodontic treatment. The strong association between various forms of upper dentures and occupational prestige can be seen as key contributing concept to how individuals' characteristics affect the outcome in prosthodontic care.

[Clinical aspects of therapeutic options in oral rehabilitation of partially edentulous patients]. / Aspecte clinice ale terapiei edentatiei partial intinse la cazurile sociale.

UNLABELLED: This study aims at identifying practical ways of approaching social cases, and creating a hierarchy of the final functions of restauration. MATERIAL AND METHOD: In 2008 the Clinical Base for Learning from the School of Dental Medicine, Iasi, recorded for the Partially Stretched Edentation Clinic and Therapy course a prevalence of biterminal partial edentation (Class I Kennedy)-66.39 per cent from the total number of patients, followed by uniterminal edentation (Class II Kennedy), having 40.24 per cent of the clinical cases, whereas INTERCALATE edentation (Class III Kennedy), frontal edentation (Class IV Kennedy), and subtotal edentation have about 20.12.1 per cent each. RESULTS: The clinical form of edentation contributes to the election of a proper therapeutic solution as well as the odonto-parodontal and muco-osseous status of each clinical case, the patient's general condition or the socio economic and technical factors leading to a modern, classical or social prothesing. An important aspect to take into account is the large percentage of social cases diagnosed with partially edentation, pleading for provisional protheses with an established role in therapy, which sometimes may become social prothesing--an outstanding clinical reality. Social cases should be solved with a view to restoring functionality such as lower level redimensioning and cranio-mandibulary repositioning, whereas aesthetic requirements fall into therapies based on metallo-ceramic and hybrid prothesing or implanto-prothetic therapy.

Does psychological stress mediate social deprivation in tooth loss?

It is unclear which theoretical dimension of psychological stress affects health status. We hypothesized that both distress and coping mediate the relationship between socio-economic position and tooth loss. Cross-sectional data from 2915 middle-aged adults evaluated retention of < 20 teeth, behaviors, psychological stress, and sociodemographic characteristics. Principal components analysis of the Perceived Stress Scale (PSS) extracted 'distress' (a = 0.85) and 'coping' (a =0.83) factors, consistent with theory. Hierarchical entry of explanatory variables into age- and sex-adjusted logistic regression models estimated odds ratios (OR) and 95% confidence intervals [95% CI] for retention of < 20 teeth. Analysis of the separate contributions of distress and coping revealed a significant main effect of coping (OR = 0.7 [95% CI = 0.7-0.8]), but no effect for distress (OR = 1.0 [95% CI = 0.9-1.1]) or for the interaction of coping and distress. Behavior and psychological stress only modestly attenuated socio-economic inequality in retention of < 20 teeth, providing evidence to support a mediating role of coping.

Determinants of dentists' decisions to initiate dental implant treatment: a judgment analysis.

STATEMENT OF PROBLEM: Do psychosocial patient characteristics influence the decision of a dentist in recommending implant treatment? PURPOSE: This study assessed the importance that dental general practitioners attach to psychosocial patient characteristics when judging the suitability of these patients for dental implant treatment. METHOD AND MATERIAL: The judgment strategy of 30 Dutch dental practitioners was studied by using 2 tasks. Dentists first judged a series of written scenarios representing fictitious patients, each patient being characterized by 4 psychosocial aspects to determine the patients' suitability for implant treatment. The second task involved rank ordering 14 patient characteristics according to their importance in implant treatment decisions. RESULTS: Dentists judged the personal appearance of the patient and, to a lesser degree, the patient's socioeconomic status to influence decisions to treat. However, these characteristics are ranked as quite unimportant in decision making, whereas motivation, oral hygiene, and level of neuroticism were the most important patient characteristics. CONCLUSIONS: The results on the 2 tasks were clearly not in agreement. There was a substantial disagreement between what dentists say to be important characteristics (rank order task) and the characteristics they actually use to judge the suitability for implant treatment (scenario task). Moreover, it appeared that agreement among the dentists is quite low, especially for the scenario task.