Single-implant Mandibular Overdenture- a Cost-effectiveness Analysis PDF Download

Author: Leles Clu00e1udio
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Languages : en
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Book Description
Background: In recent years, the single-implant mandibular overdenture has been proposed as an alternative to more complex overdenture designs for the treatment of mandibular edentulism. This approach is assumed to be simpler and less costly than both the fixed treatment and the overdenture retained by two implants. Aim/Hypothesis: The aim was to perform a randomized clinical trial designed to compare the cost-effectiveness of two treatment strategies for the edentulous mandible of elders. Materials and Methods: This study is a cost-effectiveness analysis alongside a randomized clinical trial. Participants were randomized into two groups according to the two competing strategies: conventional complete dentures (control) and the single-implant mandibular overdenture (1-OVD). External hexagon implants (Titamax TI cortical u2013 Neodent, Brazil) and o'ring attachments were used for the overdenture goup. Direct costs related to therapies were identified and valuated for one year after treatment. OHIP-Edent and satisfaction scores were the primary outcomes. Incremental cost-effectiveness ratios were estimated. The time frame for primary data collection was 1-year starting from group assignment of each participant of the clinical trial. For modeling-based data, a maximum time horizon of 10-years was assumed as a relevant time frame for clinical trials, both to accommodate the needs of decision makers and to provide a u201ctrajectoryu201d of summary measures over time. In this case, both costs and outcomes were discounted at an annual rate of 5%, as recommended by Brazilian guidelines. Results: A sample 84 patients were included and randomized for the two study groups: complete denture group (CD-group) and single-implant mandibular overdenture group (SIMO-group). Forty-two patients were assigned for each group. In the CD-group, 41 patients completed the 6-month follow-up. In the SIMO-group, from the initial group (n=42), 9 (21.4%) refused to receive the implant. The single implant was inserted in 33 patients, 32 (97%) immediately loaded implants. Two patients were excluded due to early implant failure and one patient withdrawal. Therefore, the SIMO-group had 31 patients who completed the 6-month follow-up. Data from patients who were allocated to the SIMO-group and refused to receive the implant were collected the same way as the CD-group for further intention-to-treat analysis. The average dentist fee related to the planning of the surgery and for the implant placementsurgery was R$ 185.78. The total cost related to consumables summed R$ 1709.28. Radiographs and laboratory tests accounted for R$ 1236.51 (37.47 per patient). The total cost for implants and prosthetic components was R$ 11410.00. The overall cost of postoperative items was R$ 484.04. There was an incremental cost of R$ 146.80 for each unit of reduction in the Ohip-Edent score and R$ 15.54 for each unit of increase in satisfaction with the mandibular denture, in the comparison between the conventional treatment and the single-implant mandibular overdenture. Conclusions and Clinical implications: The results of this experimental study may provide evidences about the effectiveness of simplified and low-cost interventions for edentulous subjects, especially for older people, who may be affected by the functional and psychological implications related to the use of unstable and uncomfortable mandibular dentures, and are less likely to adhere to complex and invasive implant interventions.