Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
J Dent. 2023 Sep;136:104646. doi: 10.1016/j.jdent.2023.104646. Epub 2023 Jul 30.
Retaining and restoring severely compromised teeth with subcrestal defect extensions or removing and replacing them using implant-supported crowns (ISC) remains controversial, and economic analyses comparing both strategies remain scarce. We performed a cost-time analysis, comparing the expenditures for retaining "unrestorable" teeth using forced orthodontic extrusion and restoration (FOE) versus extraction and ISC, in a clinical prospective cohort study.
Forty-two patients (n = 21 per group) were enrolled from clinical routine at a university into this study. Direct medical and indirect costs (opportunity costs) were assessed for all relevant steps (initial care, active care, restorative care, supportive care) using the private payer's perspective in German healthcare based on a micro-costing approach and/or national fee items. Statistical comparison was performed with Mann-Whitney-U test.
Patients were followed up for at least one year after initial treatment (n = 40). The drop-out rate was 5% (n = 2). Total direct medical costs were higher for ISC (median: 3439.05€) than FOE (median: 1601.46€) with p<0.001. We observed a higher number of appointments (p = 0.002) for ISC (median: 14.5) in comparison to FOE (median: 12), while cumulatively, FOE patients spent more time in treatment (median: 402.5 min) in comparison to ISC (median: 250 min) with p<0.001, resulting in comparable opportunity costs for both treatment groups (FOE: 304.50€; ISC: 328.98€).
ISC generated higher costs than FOE. More in-depth and long-term exploration of cost-effectiveness is warranted.
ISCs were associated with higher initial medical costs and required more appointments than the restoration of severely compromised teeth after FOE. Treatment time was higher for patients with FOE, resulting in similar opportunity costs for both treatment approaches. Future research needs to investigate long-term cost-effectiveness.
对于存在骨下缺损扩展的严重受损牙齿，保留和修复它们，或者通过种植体支持的牙冠（ISC）将其拔除并替换，这两种方法仍然存在争议，而且比较这两种策略的经济分析也很少。我们进行了一项成本-时间分析，比较了使用强制正畸外展和修复（FOE）与拔牙和 ISC 保留“无法修复”牙齿的支出，这是一项在大学临床常规中进行的前瞻性队列研究。
从大学临床常规中招募了 42 名患者（每组 21 名）参与这项研究。使用微观成本法和/或国家费用项目，从德国医疗保健的私人支付者角度评估了所有相关步骤（初始护理、主动护理、修复护理、支持性护理）的直接医疗和间接成本（机会成本）。采用曼-惠特尼 U 检验进行统计学比较。
所有患者在初始治疗后至少随访 1 年（n=40）。失访率为 5%（n=2）。ISC 的直接医疗总费用（中位数：3439.05 欧元）高于 FOE（中位数：1601.46 欧元），p<0.001。我们观察到 ISC 的就诊次数（p=0.002）更高（中位数：14.5），而 FOE 的就诊次数（中位数：12）则更低，同时，FOE 患者的治疗时间（中位数：402.5 分钟）也更长，而 ISC 患者的治疗时间（中位数：250 分钟）则更短，两组的机会成本相当（FOE：304.50 欧元；ISC：328.98 欧元）。
ISC 的成本高于 FOE。需要更深入和长期的成本效益探索。
ISC 比 FOE 具有更高的初始医疗成本，并且需要更多的就诊次数，而 FOE 后的严重受损牙齿修复则需要更少的就诊次数。FOE 患者的治疗时间更长，导致两种治疗方法的机会成本相似。未来的研究需要调查长期的成本效益。
