Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Germany.
Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.
J Dent. 2017 Aug;63:65-71. doi: 10.1016/j.jdent.2017.05.020. Epub 2017 Jun 1.
Dentists have a range of options for managing molars with severe molar-incisor hypomineralization (MIH), each with different long-term implications. The cost-effectiveness of managing molars with severe MIH was assessed.
A mixed public-private-payer perspective within German healthcare was adopted. Individuals with one to four severely MIH-affected molars were followed over their lifetime. We compared: (1) removal of the tooth/teeth and orthodontic alignment of the second and third molars (Ex/Ortho); (2) restoration of the tooth using resin composite (Comp); (3) restoration using an indirect metal crown after temporizing it using a preformed metal crown (PMC/IR). The health outcome was tooth retention years. Transition probabilities were estimated based on the best available evidence. Cost calculations were based on German dental fee catalogues. Monte-Carlo microsimulations were performed for cost-effectiveness-analysis.
If extraction was performed at the optimal age (9.5/11 years for maxillary/mandibular molars), Ex/Ortho was most cost-effective (67 years, 446-938 Euro). Comp (51 years, 1911 Euro) and PMC/IR were dominated (50 years, 2033 Euro). This cost-effectiveness ratio was also determined when >1 molar was treated. If extraction was performed later, assuming no spontaneous alignment, Ex/Ortho was more costly than Comp, at least when only 1 molar was treated.
For molars with severe MIH, extraction at the optimal age and, if needed, orthodontic alignment can be cost-effective, especially when >1 molar is affected. For single molars where the chance of spontaneous alignment is low, Comp might also be considered. These findings apply to German healthcare and within the limitations of this study only.
When deciding how to manage molars with severe MIH, both tooth retention, with lower costs but higher needs for re-treatments, and tooth removal, with possible need for orthodontic alignment, can be considered. Considering cost-effectiveness, the latter may be preferable, especially if the age of extraction is chosen correctly, or several molars are affected.
牙医在处理严重磨牙-切牙釉质发育不全（MIH）的牙齿时有多种选择，每种选择都有不同的长期影响。本研究评估了严重 MIH 磨牙的处理的成本效益。
采用德国混合公共-私人-支付者的观点。将患有一颗至四颗严重 MIH 受累磨牙的个体终生纳入研究。我们比较了以下三种治疗方案：（1）拔牙/拔牙并矫正第二和第三磨牙（Ex/Ortho）；（2）使用树脂复合材料修复牙齿（Comp）；（3）使用预成型金属冠临时修复后，用间接金属冠修复（PMC/IR）。健康结果为牙齿保留年限。根据最佳可用证据估算转移概率。成本计算基于德国牙科费用目录。采用蒙特卡罗微模拟进行成本效益分析。
如果在最佳年龄（上颌磨牙为 9.5 岁，下颌磨牙为 11 岁）进行拔牙，Ex/Ortho 最具成本效益（67 年，446-938 欧元）。Comp（51 年，1911 欧元）和 PMC/IR 则处于劣势（50 年，2033 欧元）。当治疗的磨牙数大于 1 颗时，也可以得到这种成本效益比。如果拔牙时间延迟，且假设没有自发矫正，那么即使只有 1 颗磨牙接受治疗，Ex/Ortho 的成本也会高于 Comp。
对于严重 MIH 的磨牙，在最佳年龄拔牙，如果需要，进行正畸矫正可以具有成本效益，尤其是当有超过 1 颗磨牙受到影响时。对于自发矫正机会较低的单个磨牙，也可以考虑 Comp。这些发现适用于德国医疗保健系统，且仅在本研究的限制范围内适用。
在决定如何处理严重 MIH 的磨牙时，可以考虑保留牙齿，虽然成本较低，但需要多次治疗，也可以考虑拔牙，虽然可能需要正畸矫正。考虑到成本效益，后者可能更可取，尤其是如果拔牙年龄选择正确，或者有几颗磨牙受到影响。
