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.

Quality of prosthetic care: patients' level of expectation, attitude and satisfaction

The aim of this study was to compare pre-treatment level of expectation and attitude and post treatment level of satisfaction with different types of prosthetic treatment according to socio-economic and demographic factors. 162 patients attending for a prosthetic rehabilitation completed an initial questionnaire to assess their level of expectation and attitude; after completion of their treatment, a second questionnaire was mailed to evaluate the level of satisfaction. 94 answers were returned (response rate: 62%). Results showed a high level of satisfaction after all prosthetic treatment, but a significant decrease after treatment when compared to level of expectation and attitude before treatment. Statistical analysis failed to show significant differences between prosthetic treatment, but demonstrated that the place of residence or level of income variable had some influence on the level of expectations and satisfaction. In this population, it was concluded that the pre-treatment data studied had limited value in predicting the outcome of the different prosthetic treatments performed.

Socio-economic characteristics and personal attitudes of patients attending a French prosthodontic teaching clinic

The aims of the study were to define the socio-economic characteristics of patients attending a Teaching Hospital Prosthetics Department and to determine the attitudes and aspirations of such patients. The study was performed on 162 patients who requested prosthetic treatment in a French university dental hospital department. They were asked to complete a questionnaire at the beginning of their treatment. The questionnaire was composed of 2 parts, covering respectively: firstly, social, economic, and demographic data concerning the patients, the source of referral and the primary motivation for their decision to request treatment, and secondly comments concerning their prosthetic treatment. The results show the socio-professional and socio-economic diversity of this population. In most cases, the patients were recommended to the university hospital service by their relatives or friends. Among the criteria proposed, they indicate that cost and quality of treatment were their major motivation. Analysis of the patients' comments identifies some factors responsible for the lack of efficiency associated with care and dental education.

To conserve or implant: which choice of therapy?

The longevity of teeth depends directly on the state of the periodontal tissues. Many etiologic factors can lead to the loss of a tooth. Tooth loss is frequently associated with bone resorption. The diagnosis of a condition and knowledge of its etiology are essential to assess the prognosis of the remaining teeth and to formulate the correct treatment plan. Many parameters must be investigated to ascertain an accurate diagnosis. An understanding of the patient's needs and the length and likely success of treatment guides the decision of whether to preserve teeth or extract them and place implants. Advanced periodontitis poses a major therapeutic dilemma. Judicious, strategic extractions may permit the placement of long implants in ideal positions.

In vitro study of the retention and mechanical fatigue behavior of four implant overdenture stud-type attachments

This study sought to determine the influence of mechanical fatigue on four varieties of implant overdenture studtype attachments (Supra-Snap, O'Ring, TSIB, ZAAG). Measurements of the initial vertical retentive force and the weight of the implant abutment were recorded. The same procedure was performed after the equivalent of 2 months, 6 months, and 12 months of clinical wear. For the four attachments, weight variation of the abutment between 0 and 1,080 cycles demonstrated no significant difference. Results indicated the TSIB to be significantly most retentive; next most retentive was the O'Ring, followed respectively by Supra-Snap and ZAAG.