A method to compare cost-effectiveness of dental treatments: adhesive bridges compared to conventional bridges

Terminology focused on design and retention methods used for anterior resin-bonded fixed partial dentures in English literature: A scoping review

Purpose

Novel terms describing several designs of resin-bonded fixed partial dentures (RBFPDs) continue to appear. Indeed, a variety of terms are used in the English scientific literature The use of a standard terminology is important for a fair and efficient understanding. This study aimed to investigate if the terminology used to describe designs and retention methods for anterior RBFPDs is standard.

Methods

An electronic search in the English literature was conducted in PubMed/Medline to identify all publications reporting RBFPDs in the anterior region until August 2022. This search was completed by hand searching. Terms indicating different designs of RBFPDs were listed and then classified. Percentages of their use were calculated to determine the commonly used terms. Analysis of the use of these terms was performed based on the standards determined by the latest edition of the Glossary of Prosthodontic Terms (GPT). The impacts of the MeSH Thesaurus and GPT on the nomenclature used for RBFPDs was assessed.

Results

A total of 125 articles were eligible for this review. In the retained articles, 86 terms were found. Among them, thirty-nine terms were classified into three groups. Only six terms were defined in the latest edition of GPT (GPT-9). Several classified terms that are commonly used were not identified in the GPT-9. Conversely to the GPT-9 which impact was insignificant, the MeSH Thesaurus had an important impact on the nomenclature used for RBFPDs.

Conclusion

The terminology used to describe designs and retention methods for anterior RBFPDs was non-standard. The GPT-9, constituting an important reference, defined a limited number of terms related to RBFPDs and had no significant impact on the standardization of the terminology used for RBFPDs. Efforts should therefore be continued to standardize the terminology. A specialized mini-glossary grouping and defining all the terms found in this study will helpful in clarifying the terminology used for the anterior RBFPDs.

Universal Dental Adhesives: Cost-Effectiveness and Duration of Use

The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of different brands of universal dental adhesives used for composite restorations. Four adhesive brands were included: Single-Bond Universal (SB), Tetric N-Bond Universal VivaPen (TN), OptiBond All-In-One (OB), and G-Premio Bond (GP). Adhesives were applied 5 times daily in a standardized class II cavity onto a plastic tooth. A precision-analysis scale was used to measure all of the following parameters before and after use: adhesive bottle, applicator, dosing plate, and plastic tooth. CEA was done by measuring the amount of material utilized/day, waste/day, efficacy, efficiency, average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER). Data were analyzed using Kruskal–Wallis and Dunn’s tests with Bonferroni correction at 0.05 significance level. CEA tested parameters were significantly different between groups (p < 0.001) except for ICER (p = 0.112). GP was the least effective (median = 0.062), and SB was the least efficient (median = 0.366). The highest and lowest ACER values were associated with TN (median cost ≈ USD 317) and SB (median cost ≈ USD 317), respectively. ICER analysis reported an incremental cost for extra material utilized per milliliter of ≈USD 208 for TN, USD 3.8 for GP, and USD −38 for OB, compared to SB. TN seems to be the most efficient and cost-effective dental adhesive.

Time to Survival for the Restoration of the Shortened Lower Dental Arch

Removable partial dentures may adversely affect remaining tissues and have a low prevalence of use. This randomized controlled trial was designed to compare the time to survival of cantilever resin-bonded fixed partial dentures and conventional removable partial dentures to restore shortened lower dental arches. We randomly allocated 25 male and 35 female patients (median age, 67 years) to fixed or removable partial denture groups of 30 persons, matched for age and sex. Survival of the prostheses was assessed, based on listed criteria, at each review or when problems arose. Although the removable partial denture group required rather more maintenance visits, the difference in survival rates was not statistically significant (hazard ratio = 0.59, with 95% CI 0.27, 1.29). In the absence of significant differences in five-year survival, the reported advantages of fixed partial dentures, including reduced maintenance frequency, offer positive support for the use of resin-bonded fixed partial dentures.

A review of the success and failure characteristics of resin-bonded bridges

OBJECTIVES

This literature review was designed to assess and compare the success rates and modes of failure of metal-framed, fibre-reinforced composite and all-ceramic resin-bonded bridges.

MATERIALS AND METHOD

A Medline search (Ovid), supplemented by hand searching, was conducted to identify prospective and retrospective cohort studies on different resin-bonded bridges within the last 16 years. A total of 49 studies met the pre-set inclusion criteria. Success rates of 25 studies on metal-framed, 17 studies on fibre-reinforced composite and 7 studies on all-ceramic resin-bonded bridges were analysed and characteristics of failures were identified.

RESULTS

The analysis of the studies indicated an estimation of annual failure rates per year to be 4.6% (±1.3%, 95% CI) for metal-framed, 4.1% (±2.1%, 95% CI) for fibre-reinforced and 11.7% (±1.8%, 95% CI) for all-ceramic resin-bonded bridges. The most frequent complications were: debonding for metal-framed, resin-bonded bridges (93% of all failures); delamination of the composite veneering material for the fibre-reinforced bridges (41%) and fracture of the framework for the all-ceramic bridges (57%).

CONCLUSIONS

All types of resin-bonded bridges provide an effective short- to medium-term option, with all-ceramic performing least well and having the least favourable mode of failure. The methods of failures were different for different bridges with metal frameworks performing the best over time.

Shear bond strength between different materials bonded with two resin cements

BACKGROUND

The aim of this study was to compare the shear bond strength between Ni-Cr alloy specimens bonded to air-abraded Ni-Cr, bur-abraded Ni-Cr, etched ceramic and etched enamel substrates using the resin cements RelyX ARC or Enforce.

MATERIALS AND METHODS

Ni-Cr specimens were made and sandblasted with Al(2)O(3) airborne-particles. Disc-shaped patterns were made for each of the four experimental substrates: Ni-Cr treated with Al(2)O(3) airborne-particles, Ni-Cr treated with diamond bur abrasion, etched enamel and etched ceramic.

RESULTS

Significant differences in shear bond strength were found between the different materials and luting agents evaluated. The Ni-Cr alloy cylinders bonded to Ni-Cr surfaces sandblasted with 50 μm Al(2)O(3) particles and bonded with Enforce achieved the highest bond strength when compared with other substrates (28.9 MPa, p < 0.05). Bur-abraded metal discs had lowest values, regardless the cement used (2.9 and 6.9 MPa for RelyX and Enforce, respectively). Etched enamel and etched ceramic had similar shear bond strengths within cement groups and performed better when RelyX was used.

CONCLUSIONS

Bonding Ni-Cr to Ni-Cr and ceramic may result in similar and higher bond strength when compared to Ni-Cr/enamel bonding. For metal/metal bonding, higher shear bond strength was achieved with resin cement Enforce, and for metal/ceramic and metal/enamel bonding, RelyX had higher results.

Resin-Retained Bridges as Predictable and Successful Restorations

Resin-retained bridges have been used clinically since the 1970s and offer a more conservative approach to the restoration of edentulous spaces than conventional bridgework. They are easy to place, cheap to fabricate, and have been shown to be cost-effective. Despite this, they are not frequently used in general dental practice and have an exaggerated reputation for premature failure. Since their initial introduction, they have undergone a number of changes to their method of retention and the materials used in their construction. This has resulted in a predictable, aesthetic restoration which, second only to restoration with dental implants, is often the treatment of choice when teeth adjacent to an edentulous space are minimally or not restored.

The Cost-Effectiveness of Large Amalgam and Crown Restorations Over a 10-Year Period

OBJECTIVE

To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome.

METHODS

Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated. Costs of initial treatment (large amalgam or crown), and future treatments were determined, averaged and discounted. The effectiveness measure was defined as the number of years a tooth remained in a state free of catastrophic subsequent treatment. Years free of catastrophic treatment were averaged, and discounted. The years free of catastrophic treatment accounted for individuals who dropped out or withdrew from the study.

RESULTS

Teeth with crowns had higher effectiveness values at a much higher cost than teeth restored with large amalgams. The cost of an addition year free of catastrophic treatment for crowns was 1088.41 dollars at 5 years and 500.10 dollars at 10 years. Teeth in women had more favorable cost-effectiveness ratios than those in men, and teeth in the maxillary arch had more favorable cost-effectiveness ratios than teeth in the mandibular arch.

CONCLUSIONS

Neither the large amalgam or crown restoration had both the lowest cost and the highest effectiveness. The higher incremental cost-effectiveness ratio for crowns should be considered when making treatment decisions between large amalgam and crown restorations.

Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial

CONTEXT

Removable partial dentures used to restore the shortened lower dental arch may adversely affect the remaining natural teeth and are associated with a low prevalence of use.

OBJECTIVE

To report the findings for caries incidence 2 years after restoration of lower shortened arches with bilateral cantilever resin-bonded bridges (RBBs) and conventional partial dentures (RPDs).

DESIGN

Randomised controlled trial.

SETTING

Secondary care

PATIENTS

25 male and 35 female subjects of median age 67 years. were randomly allocated to 'bridge' and 'denture' treatment groups of 30 patients each matched for age and sex. Caries incidence was recorded during dental examinations 3 months, 1 and 2 years after insertion of new lower prostheses.

INTERVENTIONS

Cantilever RBBs and conventional RPDs with cast metal frameworks.

RESULTS

There was a highly significant difference in the frequency of new caries lesions, 11 and 51 in the bridge and denture groups respectively (P < 0.01). 20 out of 27 bridge patients and 9 of 23 denture patients had no caries experience. Multivariate modeling identified treatment group as the only significant predictor of caries occurrence.

CONCLUSIONS

Two years after restoration of lower shortened arches for an elderly sample of patients, there was a significantly greater incidence of new and recurrent caries lesions in subjects restored with RPDs compared with cantilever RBBs.

Meta-analysis of anterior veneer restorations in clinical studies

OBJECTIVES

To make an inventory of clinical studies on veneer restorations (VRs) using a meta-analysis review procedure and to aggregate an overall survival result for four types of VRs.

METHODS

From the dental literature published from 1983 to November 1996, papers were selected using an in- and exclusion protocol in a two-step procedure. Additionally, the papers selected were subjected to a quality assessment. Although not all studies used an identical definition of 'failure of a restoration', this item was chosen to be the common study outcome. After a homogeneity test, cumulative survival curves were constructed by pooling the data from the studies.

RESULTS

On a 0-1 scale, the weighted overall mean quality score of the studies was 0.57 (s.e. 0.09). There was adequate agreement between the independent assessors. The results of the quality assessment could not be used as weights for the survivals, but the quality outcome supports the description of the sample of studies. From the nine studies on porcelain VRs, the pooled cumulative proportion of survival after 3 years was 0.92 (s.e. 0.01) and from three studies on preformed acrylic VRs this figure was 0.74 (s.e. 0.03). From both direct and indirect resin composite VRs, data from only one study were available after 2.5 and 2 years, respectively.

CONCLUSION

The evaluative and statistical basis of clinical VR studies may be improved to obtain an effective inference of the results. Furthermore, porcelain VRs show acceptable longevity after 3 years, which appears to be better than that of preformed acrylic VRs.

A conceptual framework for understanding outcomes of oral implant therapy

The use of implants has expanded so rapidly that its effectiveness for many clinical situations has not been firmly established. Dentists are responsible for making appropriate therapeutic recommendations for the management of partial and complete edentulism. These decisions require an understanding of the consequences or outcome of treatment approaches. Outcome measures to evaluate the benefits of alternative therapies include longevity as well as physiologic, psychologic, and economic impacts. Future research should include outcome measures beyond implant prosthesis survival to more fully assess the practical impact of dental implants on the patient's oral health and to determine the most cost-effective approaches for managing completely and partially edentulous patients.

Sensitivity analysis in economic evaluation: a review of published studies

A structured methodological review of journal articles published in 1992 was undertaken to determine whether recently published economic evaluation studies deal systematically and comprehensively with uncertainty. Ninety three journal articles were identified from a range of searches including a computerised search of the MEDLINE CD-Rom database. Articles were reviewed to determine how they had handled uncertainty in: a) data sources; b) generalisability; c) extrapolation; and d) analytic method. Articles were subsequently assessed to determine how they had represented this uncertainty in terms of the overall results of their analysis. Finally, studies were rated on the basis of their overall performance with respect to dealing systematically and comprehensively with uncertainty. Despite the numerous books and articles devoted to the appropriate methods to be employed by analysts conducting economic evaluation, 22 (24%) studies failed to consider uncertainty at all and 35 (38%) studies employed sensitivity analysis in a manner judged as inadequate. In all, 36 (39%) studies were judged to have given at least an adequate account of uncertainty with 13 (14%) of those judged to have provided a good account of uncertainty. Such disappointing results may reflect a general lack of detail in much of the methods literature concerning how sensitivity analysis should be applied and how results should be presented. Journal editors and readers of economic evaluation articles should acquaint themselves with the methods for handling uncertainty in order that they can critically evaluate the extent to which authors have allowed for uncertainties inherent in their analysis.

Resin-retained bridges in the treatment of traumatized dentition

Resin-retained bridges can be used as the definitive treatment, as well as for interim treatment. Compared with conventional fixed prostheses, there are some advantages which make this treatment especially useful in traumatized dentition. The ultra conservative approach makes the adhesive bridge a standard treatment option in cases of uncertain prognostic factors. However, in such specific situations as traumatized dentition some complicating factors may be present. These complicating factors must be recognized and eliminated to create situations in which this kind of restoration can be successful. Therapeutic and patient-related factors are discussed using data from longitudinal clinical studies. Available clinical information indicates the anterior adhesive bridge to a 'permanent restoration'. However, a benefit-cost analysis is necessary to weigh the value of this restorations.