Cost minimization analysis of a long-term randomized clinical trial of patients treated with immediately loaded implant-supported fixed prosthesis.

PURPOSE: To document the long-term costs from a randomized controlled clinical trial (RCT) on edentulous patients treated with mandibular 4-implant-supported fixed prosthesis and two loading protocols. METHODS: Taking the perspective of the individual patient, costs associated with treatment, complications, and patients' time from 18 patients who received an immediate-loading protocol and 21 patients treated with a conventional loading protocol were compared over 10 years of observation. All costs are in Canadian dollars and discounted to the RCT base year of 2006 at a rate of 1.5%. RESULTS: The complication rate in both arms was similar and relatively low. No statistically significant difference was observed in the total cost and discounted total cost, along with its five comprising parameters between the two arms. CONCLUSIONS: Over the 10-year time frame, the immediate loading of dental implants with mandibular fixed prosthesis proved to cost similar to the conventional loading protocol, underscoring the feasibility and reliability of this protocol from the patient's perspective. (REB protocol reference # 33395).

A cost analysis of a long-term prospective study of patients treated with immediately loaded implant-supported mandibular overdentures.

BACKGROUND: The economic burden for patients seeking treatment with implant-supported prostheses has not been given adequate attention. PURPOSE: To document long-term costs from a prospective trial on edentulous patients treated with mandibular implant-supported overdentures and 2 loading protocols. MATERIALS AND METHODS: The direct clinical and time costs for 35 patients receiving an immediate-loading protocol (ILP) and 40 patients with a conventional-loading protocol, over 14 years of observation, were analyzed in 2016 Canadian dollars as a base year. Quality of life (QoL) for the ILP was measured using the OHIP-20 questionnaire. RESULTS: The ILP was associated with higher complication costs ($870.77 ± 692.24 vs $85.73 ± 133.14) with resultant higher maintenance costs ($1746.37 ± 892.68 vs $853.04 ± 276.21) (P < .05). OHIP results showed a sustained improvement in QoL through the first 5 year of follow-up. A worsening of QoL, specifically the functional-related OHIP scores, was noted at 14 years. Incremental cost-effectiveness ratios indicated that the accrued maintenance costs for the ILP made the treatment less cost-effective over time. CONCLUSIONS: This long-term study confirmed that ILP is associated with higher maintenance costs and varying subjective QoL measurements. Clinical treatment protocols should be evaluated over a long period and address different perspectives.

Why guided when freehand is easier, quicker, and less costly?

Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.