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Chen Z, Lin CY, Wang HL. Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis. Periodontol 2000 2024. [PMID: 39118280 DOI: 10.1111/prd.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.
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Affiliation(s)
- Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan city, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Ravidà A, Saleh MHA, Ghassib IH, Qazi M, Kumar PS, Wang HL, Eke PI, Borgnakke WS. Impact of smoking on cost-effectiveness of 10-48 years of periodontal care. Periodontol 2000 2024. [PMID: 39054672 DOI: 10.1111/prd.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Abstract
The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.
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Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Iya H Ghassib
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, The Virginia Commonwealth University, Richmond, Virginia, USA
| | - Musa Qazi
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Purnima S Kumar
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Kardaras G, Christodorescu R, Boariu M, Rusu D, Belova A, Chinnici S, Vela O, Radulescu V, Boia S, Stratul SI. A Low-Cost Protocol Using the Adjunctive Action of Povidone-Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III-IV Periodontitis: A Single-Blind, Randomized Controlled Trial. Dent J (Basel) 2024; 12:144. [PMID: 38786542 PMCID: PMC11119210 DOI: 10.3390/dj12050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
In severe stages of periodontitis, conventional periodontal therapy and maintenance care are usually insufficient due to the viral and bacterial etiology; thus, a mechanical approach alone may not be sufficient to eliminate a substantial portion of subgingival pathogens, especially in deep periodontal sites. Background and Objectives: This single-blind, randomized clinical trial aimed to compare the clinical and microbiological efficacy of a low-cost protocol using povidone-iodine and sodium hypochlorite formulations as adjuncts to non-surgical therapy for patients with stage IV periodontitis when compared with chlorhexidine, the most commonly employed substance to date for antimicrobial regimens in periodontal therapy. Materials and Methods: Forty-five patients were randomly divided into two groups: control (subgingival instrumentation, chlorhexidine-assisted) and test (antiviral medication, subgingival instrumentation with povidone-iodine, sodium hypochlorite rinsing solution, and antibiotics). Clinical measurements and microbiological analyses were performed at baseline and after three months. Results: After three months, notable differences were found in the bacterial detection scores for Porphyromonas gingivalis (a significant reduction in detection frequency was observed in the test compared to the control (p = 0.021)), and there were significant reductions in detection in the test group for Tannerella forsythia and Treponema denticola, showing undetectable levels (p < 0.0001 for both). In the test group, the pocket probing depth median value was reduced significantly (p = 0.0005); similarly, bleeding on probing showed a marked decrease (p < 0.0001). However, changes in clinical attachment loss and full-mouth plaque score were not statistically significant. Conclusions: Using the proposed protocol, substantial improvements in clinical and microbiological parameters were obtained when compared with the current antimicrobial recommendations.
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Affiliation(s)
- Georgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Ruxandra Christodorescu
- Department V Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Alla Belova
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Salvatore Chinnici
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Octavia Vela
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Viorelia Radulescu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Chen X, Xu C, Wu Y, Zhao L. The survival of periodontally treated molars in long-term maintenance: A systematic review and meta-analysis. J Clin Periodontol 2024; 51:631-651. [PMID: 38317331 DOI: 10.1111/jcpe.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
AIM This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance. MATERIALS AND METHODS Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs). RESULTS From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy. CONCLUSIONS The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.
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Affiliation(s)
- Xiao Chen
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Xu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yafei Wu
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lei Zhao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Mensi M, Scotti E, Sordillo A, Dalè M, Calza S. Air-polishing followed by ultrasonic calculus removal for the treatment of gingivitis: A 12-month, split-mouth randomized controlled clinical trial. Int J Dent Hyg 2024. [PMID: 38689395 DOI: 10.1111/idh.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the advantages of a novel protocol involving full-mouth erythritol-powder air-polishing followed by ultrasonic calculus removal in the maintenance of patients treated for gingivitis, with a focus on time and comfort. METHODS Systemically healthy patients with gingivitis were selected. Following a split-mouth design, quadrants 1-4 and 2-3 were randomly allocated to receive air-polishing followed by ultrasonic calculus removal following a protocol known as Guided Biofilm Therapy (GBT) or traditional full-mouth ultrasonic debridement followed by polishing with a rubber cup and prophylactic paste (US + P). Bleeding on probing (BoP) and the plaque index (PI) were collected at baseline (T0), 2 weeks (T1), 4 weeks (T2), 3 months (T3), and 6 months (T4) and 12 months (T5). Following the same randomization, prophylactic therapy was provided at 3 months (T3) and 6 months (T4). Clinical parameters, treatment time and patient comfort and satisfaction were evaluated. RESULTS A total of 41 patients were selected, 39 completed the study. The clinical parameters were clinically satisfactory for both treatments at every time. At 4 months after treatment, GBT maintained significantly lower BoP and PI. GBT protocol required a significantly lower treatment time, especially at T3 and T4, when it saved 24.5% and 25.1% of the time, respectively. Both treatments were rated positively by most patients. However, GBT was perceived as more comfortable, and a higher number of patients preferred it. CONCLUSION No significant difference was observed between GBT and conventional ultrasonic debridement and rubber cup polishing in terms of BoP and PI levels. The GBT protocol allowed less time expenditure and higher patients' perceived comfort.
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Affiliation(s)
- M Mensi
- Section of Periodontics, Department of Surgical Specialties, Radiological Science and Public Health, School of Dentistry, University of Brescia, Brescia, Italy
- U.O.C. Odontostomatologia - ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - E Scotti
- Section of Periodontics, Department of Surgical Specialties, Radiological Science and Public Health, School of Dentistry, University of Brescia, Brescia, Italy
- U.O.C. Odontostomatologia - ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - A Sordillo
- Section of Periodontics, Department of Surgical Specialties, Radiological Science and Public Health, School of Dentistry, University of Brescia, Brescia, Italy
| | - M Dalè
- Section of Periodontics, Department of Surgical Specialties, Radiological Science and Public Health, School of Dentistry, University of Brescia, Brescia, Italy
| | - S Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Saleh MHA, Decker A, Ravidà A, Wang HL, Tonetti M. Periodontitis stage and grade modifies the benefit of regular supportive periodontal care in terms of need for retreatment and mean cumulative cost. J Clin Periodontol 2024; 51:167-176. [PMID: 38084661 DOI: 10.1111/jcpe.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/03/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024]
Abstract
AIM This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost-effectiveness of periodontal therapy. MATERIALS AND METHODS Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow-up of ≥10 years. Analysis was done to identify factors associated with the incidence of additional sub-gingival instrumentation (SGI) and/or surgery (SUR) during SPC and mean cumulative cost of recurrence was calculated. All relevant data were collected. RESULTS In all, 442 patients were included. Over the follow-up period, 62% of Stage I and II patients and 72% of Stage III and IV patients required further treatment following the APT; 56.5% of SGI patients and 78.6% of SUR patients received a second intervention. SUR patients received more SUR during the follow-up period (p = .035). Stage III and IV patients received more SUR during SPC than Stage I and II patients (p = .001). Grade C patients received more SUR during the follow-up period (p < .05). During the 5-year period preceding retreatment, the mean SPC visits were lower for patients who did not require retreatment (p < .001). Risk factors such as regularity of maintenance, smoking and diabetes were related to a higher chance of receiving SUR during the follow-up period (p < .05). The mean cumulative costs indicated less recurrence cost for compliers in Stage III and IV or Grade B and C but not for those in Stage I and II or Grade A. CONCLUSIONS The risk of relapse in the maintenance population may be correlated with higher stage and grade, patient compliance, modifiable risk factors and the nature of the treatment provided during APT. The total cost of treatment of recurrences was lower for compliers in Stage III/IV and Grade B/C compared with erratic compliers with the same severity and risk.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Ann Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Andrea Ravidà
- Department of Periodontics, University of Pittsburgh School of Dentistry, Pittsburgh, Pennsylvania, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Maurizio Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- European Research Group on Periodontology, Genoa, Italy
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Sema3A Drives Alternative Macrophage Activation in the Resolution of Periodontitis via PI3K/AKT/mTOR Signaling. Inflammation 2023; 46:876-891. [PMID: 36598593 DOI: 10.1007/s10753-022-01777-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
Macrophages actively participate in immunomodulatory processes throughout periodontal inflammation. Regulation of M1/M2 polarization affects macrophage chemokine and cytokine secretion, resulting in a distinct immunological status that influences prognosis. Semaphorin 3A (Sema3A), a neurite growth factor, exerts anti-inflammatory effects. In this study, we investigated the immunomodulation of Sema3A on macrophage-related immune responses in vivo and in vitro. Topical medications of Sema3A in mice with periodontitis alleviated inflammatory cell infiltration into gingival tissue and reduced areas with positive IL-6 and TNFα expression. We observed that the positive area with the M2 macrophage marker CD206 increased and that of the M1 macrophage marker iNOS decreased in Sema3A-treated mice. It has been postulated that Sema3A alleviates periodontitis by regulating alternative macrophage activation. To understand the mechanism underlying Sema3A modulation of macrophage polarization, an in vitro macrophage research model was established with RAW264.7 cells, and we demonstrated that Sema3A promotes LPS/IFNγ-induced M1 macrophages to polarize into M2 macrophages and activates the PI3K/AKT/mTOR signaling pathways. Inhibition of the PI3K signaling pathway activation might reduce anti-inflammatory activity and boost the expression of the inflammatory cytokines, iNOS, IL-12, TNFα, and IL-6. This study indicated that Sema3A might be a feasible drug to regulate alternative macrophage activation in the inflammatory response and thus alleviate periodontitis.
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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Nonsurgical periodontal treatment in type II diabetics in a middle-income country: a cost-effectiveness analysis. Int J Technol Assess Health Care 2022; 38:e73. [PMID: 36169019 DOI: 10.1017/s0266462322000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of the nonsurgical periodontal treatment (NSPT) compared with supragingival therapy in type II diabetics with periodontitis. METHODS A decision tree analysis was used to estimate the costs and health outcomes of two periodontal therapies in a hypothetical cohort of type II diabetics with periodontitis. The analysis was developed from the perspective of a third-party payer at 1 year and 5 years. Probabilities were derived from two systematic reviews. The costs and resource use were validated by a Delphi expert panel. All costs were expressed in USD, using the 25 May 2021 Colombian pesos market exchange rate (USD 1 = COP 3,350). RESULTS NSPT was a dominant alternative compared with subsidized supragingival therapy in type II diabetics with periodontitis, generating savings of USD 87 and 400, during the first year or up to 5 years, respectively, and improving dental survival from 32 to 69 percent. CONCLUSIONS NSPT can generate savings by reducing the complications derived from uncontrolled periodontitis and tooth loss.
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Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation. BMC Oral Health 2021; 21:616. [PMID: 34861866 PMCID: PMC8642876 DOI: 10.1186/s12903-021-01932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis. Methods We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions. Results Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses. Conclusions Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01932-2.
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Tay JRH, Ng E, Nair R, Tan ZS, Tan SHX. Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review. J Clin Periodontol 2021; 48:679-694. [PMID: 33768622 DOI: 10.1111/jcpe.13456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019. MATERIAL AND METHODS A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed. RESULTS Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective. CONCLUSIONS There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.
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Affiliation(s)
- John Rong Hao Tay
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Ethan Ng
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Rahul Nair
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Zhe Sheng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
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13
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Graetz C, Woeste S, Mrowietz U, Ehrenthal JC. The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study. BMC Oral Health 2021; 21:95. [PMID: 33663457 PMCID: PMC7934537 DOI: 10.1186/s12903-021-01457-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background While there is increasing evidence for the relevance of psychosocial variables such as dental fear or psychological attachment in dentistry, much less is known about the mechanisms that determine the strength of those associations. One potential moderator is the occurrence of a comorbid chronic disease such as psoriasis, which is linked to relevant disease parameters such as periodontal inflammation. The aim of the study was to test a moderation model of the relationship between dental fear, psychological attachment and psoriasis on periodontal health. Methods A total of 201 patients (100 with psoriasis, 101 without psoriasis) were included in a questionnaire-based, cross-sectional study. Dental status was measured with the Community Periodontal Index (CPI), dental fear was measured with the Hierarchical Anxiety Questionnaire (HAQ), and psychological attachment was measured with the Relationship Questionnaire (RQ). In addition to the examination of main effects, bootstrapping-based analyses were conducted to test the moderating influence of psychological attachment on the association between CPI and dental fear, gain moderated by group (with vs. without psoriasis). Results Controlling for several covariates, higher CPI scores were associated with higher levels of dental fear only in individuals without psoriasis under conditions of higher levels of psychological attachment anxiety and lower levels of attachment avoidance. Conclusion In individuals without psoriasis, psychological attachment can moderate the association between periodontal health and dental fear. This may provide a useful framework for reducing dental fear through interventions on the level of the dentist-patient relationship.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany.
| | - Sirka Woeste
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus B, 24105, Kiel, Germany
| | - Ullrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus, Kiel, Germany
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14
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Shi S, Meng Y, Li W, Jiao J, Meng H, Feng X. A nomogram prediction for mandibular molar survival in Chinese patients with periodontitis: A 10-year retrospective cohort study. J Clin Periodontol 2020; 47:1121-1131. [PMID: 32645225 DOI: 10.1111/jcpe.13343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
AIMS To develop a nomogram prediction model of mandibular molar survival by comprehensively analysing clinical and radiographic risk factors of mandibular molar loss. MATERIALS AND METHODS Four hundred and seventy-eight mandibular molars of 139 subjects who underwent non-surgical periodontal treatment were examined retrospectively within a mean follow-up period of 11.1 years. The association of risk factors including clinical and radiographic parameters with mandibular molar loss was assessed using univariate and multivariate Cox regression analyses. A nomogram prediction model was developed, and the validation and discriminatory ability of it were analysed. RESULTS Hundred and four molars were lost in this study. Probing depth (PD), attachment loss (AL), furcation involvement (FI), bleeding on probing (BOP), tooth mobility and radiographic bone loss were significantly associated with tooth loss (p < .01). A gradient effect of degree of FI on mandibular molar loss existed increasing from degree Ⅱ (HR = 2.37, 95% CI: 1.48, 3.79) to Ⅲ (HR = 5.61, 95% CI: 3.01, 10.45) versus none & degree Ⅰ. The area under the curve (AUC) of the model was 0.891. The calibration curve and decision curve analysis demonstrated good performance and high net benefit of nomogram, respectively. CONCLUSIONS A specific nomogram could be adopted to predict the mandibular molar survival and formulate tailored treatment plans in Chinese.
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Affiliation(s)
- Shuwen Shi
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Meng
- Department of Periodontology, Qingdao Municipal Hospital of Stomatology, Qingdao, China
| | - Wenjing Li
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian Jiao
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huanxin Meng
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xianghui Feng
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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15
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Angst PDM, Finger Stadler A, Mendez M, Oppermann RV, van der Velden U, Gomes SC. Supportive periodontal therapy in moderate‐to‐severe periodontitis patients: A two‐year randomized clinical trial. J Clin Periodontol 2019; 46:1083-1093. [DOI: 10.1111/jcpe.13178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amanda Finger Stadler
- Division of Comprehensive Oral Health ‐ Periodontology Adams School of Dentistry The University of North Carolina at Chapel Hill Chapel Hill NC USA
| | | | - Rui Vicente Oppermann
- Conservative Dentistry Department School of Dentistry Federal University of Rio Grande do Sul Porto Alegre Brazil
| | - Ubele van der Velden
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam VU University Amsterdam Amsterdam The Netherlands
| | - Sabrina Carvalho Gomes
- Conservative Dentistry Department School of Dentistry Federal University of Rio Grande do Sul Porto Alegre Brazil
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16
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Tolentino PHMP, Rodrigues LG, Miranda de Torres É, Franco A, Silva RF. Extractions in Patients with Periodontal Diseases and Clinical Decision-Making Process. Acta Stomatol Croat 2019; 53:141-149. [PMID: 31341322 PMCID: PMC6604564 DOI: 10.15644/asc53/2/6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the professional aspects and clinical and radiographic evidence that influences the decision for the extraction of teeth among periodontologists and general dentists. Material and methods The sample consisted of 150 (n=106 females and 44 males) dentists (n=103 general dentists and 47 periodontologists) that responded to a questionnaire designed to retrieve cross-sectional information related mainly to their level of training and time of experience in practice, as well as their personal decision for managing four patients with periodontal disease. Bivariate analyses were performed to test the association between the clinical decisions and the professional information collected from the dentists. Results In specific cases, periodontologists decided to maintain more teeth than general dentists (p<0.05). In other cases, dentists with more years of experience in practice decided to opt for more extractions (p<0.05). The level of periodontal disease (50-92%), poor oral hygiene (42.6-67.3%) and lack of alveolar bone structure (43.2-79.3%) were the most prevalent reasons behind the decision for extractions. Conclusions An advanced level of training in Dentistry, especially Periodontology, and more years of experience in practice may lead to more well-founded decisions on whether extracting teeth or not in case-specific scenarios.
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Affiliation(s)
| | | | | | - Ademir Franco
- - Department of Therapeutic Stomatology, Institute of Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Rhonan Ferreira Silva
- - Department of Dentistry, Federal University of Goias, Goiania, Brazil.,- Department of Legal Dentistry and Forensic Anthropology, Scientific Police of Goias, Goiania, Brazil
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17
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Pini Prato GP, Di Gianfilippo R, Wang H. Success in periodontology: An evolutive concept. J Clin Periodontol 2019; 46:840-845. [DOI: 10.1111/jcpe.13150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine The University of Michigan ‐ School of Dentistry Ann Arbor Michigan
| | - Hom‐Lay Wang
- Department of Periodontics and Oral Medicine The University of Michigan ‐ School of Dentistry Ann Arbor Michigan
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18
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Helal O, Göstemeyer G, Krois J, Fawzy El Sayed K, Graetz C, Schwendicke F. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis. J Clin Periodontol 2019; 46:699-712. [PMID: 31025366 DOI: 10.1111/jcpe.13118] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 02/06/2023]
Abstract
AIM A range of predictors for tooth loss in periodontitis patients have been reported. We performed a systematic review and meta-analysis to assess the consistency and magnitude of any association between a total of 12 predictors and tooth loss. MATERIALS AND METHODS Medline/Embase/Central were searched for longitudinal studies investigating the association between predictors and tooth loss in periodontitis patients. Random-effects meta-analysis was performed, and study quality assessed. RESULTS Twenty studies (15,422 patients, mean follow-up: 12 years) were included. The mean annual tooth loss/patient was 0.12 (min./max: 0.01/0.36). Older patients (n = 8 studies; OR: 1.05, 95% CI: 1.03-1.08/year), non-compliant ones (n = 11; 1.51, 1.06-2.16), diabetics (n = 7; 1.80, 1.26-2.57), those with IL-1-polymorphism (n = 3; 1.80; 1.29-2.52) and smokers (n = 15; 1.98, 1.58-2.48) had a significantly higher risk of tooth loss. Teeth with bone loss (n = 3; 1.04, 1.03-1.05/%), high probing pocket depth (n = 6; 3.19, 1.70-5.98), mobility (n = 4; 3.71, 1.65-8.38) and molars (n = 4; 4.22, 2.12-8.39), especially with furcation involvement (n = 5; 2.68, 1.75-4.08) also showed higher risks. Gender (n = 16; 0.95, 0.86-1.05) and endodontic affection (n = 3; 3.62, 0.99-13.2) were not significantly associated with tooth loss. CONCLUSIONS Older, non-compliant, smoking or diabetic patients, and teeth with bone loss, high probing pocket depth, mobility, or molars, especially with furcation involvement showed higher risks of tooth loss.
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Affiliation(s)
- Omar Helal
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
| | - Karim Fawzy El Sayed
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany.,Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo, Egypt
| | - Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité University of Berlin, Berlin, Germany
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19
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Moreno Rodríguez JA, Ortiz Ruiz AJ, Caffesse RG. Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non-incised papillae surgical approach (NIPSA): A retrospective cohort study. J Periodontol 2018; 90:454-464. [PMID: 30421495 DOI: 10.1002/jper.18-0405] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/06/2018] [Accepted: 10/13/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to compare a minimally-invasive surgical technique (MIST) and a non-incised papilla surgical approach (NIPSA) in periodontal reconstructive surgery of deep intraosseous defects. METHODS Data on 30 patients with a deep intraosseous defect treated with MIST (n = 15) or NIPSA (n = 15) were analyzed retrospectively. All patients met the same inclusion criteria and were treated following the same protocol, except for the surgical management of soft tissue (MIST versus NIPSA). Clinical parameters at baseline and at 1-year post-surgery, early healing at 1 week, and postoperative pain were assessed. RESULTS NIPSA and MIST resulted in significant clinical attachment gain (CAG) (P < 0.001) and probing depth reduction (PDr) (P < 0.001) at 1-year post-surgery. However, NIPSA resulted in significantly lower recession of the tip of the interdental papilla compared with MIST (P < 0.001). Smoking negatively influenced early healing in both techniques (P < 0.05). CONCLUSIONS NIPSA and MIST both resulted in significant improvements in clinical parameters. NIPSA showed significant soft tissue preservation. NIPSA may represent a promising papillae preservation technique in the treatment of intraosseous periodontal defects.
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Affiliation(s)
| | | | - Raúl G Caffesse
- Visiting Professor, Postgraduate Periodontics, Complutense University of Madrid, Spain
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20
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Schwendicke F, Engel AS, Graetz C. Long-term treatment costs of chronic periodontitis patients in Germany. J Clin Periodontol 2018; 45:1069-1077. [PMID: 29981185 DOI: 10.1111/jcpe.12984] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 12/20/2022]
Abstract
AIM We assessed the long-term costs for treating chronic periodontitis (CP) patients. METHODS A cohort of compliant CP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections) and supportive periodontal therapy (SPT including periodontal, restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed-modelling. RESULTS Two hundred and seventy-three patients (mean ± SD age: 49.6 ± 8.8 years), with 24.3 ± 4.5 teeth, were included. Mean follow-up was 18.7 ± 5.7 years. Total treatment costs per patient and per tooth were 6,146 ± 2,236 and 222 ± 98 Euro, respectively. Costs were generated mainly by periodontal therapy and during SPT. Annualized patient- and tooth-level costs were 348 ± 159 and 12.4 ± 5.7 Euro, respectively. Annual costs increased significantly in older patients, regular attenders, those with fewer teeth (<24) at baseline and teeth with higher probing pocket depths or mobility 3 at baseline. CONCLUSIONS Annual costs for treating CP patients were lower than those found for aggressive periodontitis patients. Regular attendance and having more severe periodontitis came with higher costs per year.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany
| | - Anne Sophie Engel
- Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany
| | - Christian Graetz
- Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany
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21
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Schwendicke F, Schmietendorf E, Plaumann A, Sälzer S, Dörfer CE, Graetz C. Validation of multivariable models for predicting tooth loss in periodontitis patients. J Clin Periodontol 2018; 45:701-710. [DOI: 10.1111/jcpe.12900] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité University of Berlin; Berlin Germany
| | - Elisa Schmietendorf
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Anna Plaumann
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christof E. Dörfer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christian Graetz
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
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22
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Schwendicke F, Biffar AS, Graetz C. Long-term treatment costs for aggressive periodontitis in a German population. J Clin Periodontol 2017; 44:1245-1252. [DOI: 10.1111/jcpe.12814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Anne Sophie Biffar
- Clinic for Conservative Dentistry and Periodontology; Christian-Albrechts-University; Kiel Germany
| | - Christian Graetz
- Clinic for Conservative Dentistry and Periodontology; Christian-Albrechts-University; Kiel Germany
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23
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Schwendicke F, Stolpe M, Graetz C. Cost comparison of prediction-based decision-making for periodontally affected molars. J Clin Periodontol 2017; 44:1145-1152. [DOI: 10.1111/jcpe.12796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - Christian Graetz
- Clinic for Conservative Dentistry and Periodontology; Christian-Albrechts-University; Kiel Germany
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24
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De Wet LM, Slot DE, Van der Weijden GA. Supportive periodontal treatment: Pocket depth changes and tooth loss. Int J Dent Hyg 2017; 16:210-218. [DOI: 10.1111/idh.12290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 12/26/2022]
Affiliation(s)
- LM De Wet
- Department of Periodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - DE Slot
- Department of Periodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - GA Van der Weijden
- Department of Periodontology; Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and Vrije Universiteit Amsterdam; Amsterdam The Netherlands
- Clinic for Periodontology Utrecht; Utrecht The Netherlands
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25
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Graetz C, Sälzer S, Plaumann A, Schlattmann P, Kahl M, Springer C, Dörfer C, Schwendicke F. Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment. J Clin Periodontol 2017; 44:612-619. [DOI: 10.1111/jcpe.12725] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Anna Plaumann
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Peter Schlattmann
- Institute of Medical Statistics; Computer Sciences and Documentation; Jena University Hospital; Jena Germany
| | - Maren Kahl
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Claudia Springer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Christof Dörfer
- Clinic of Conservative Dentistry and Periodontology; University of Kiel; Kiel Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité University of Berlin; Berlin Germany
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26
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Effect of periodontitis history on implant success: a long-term evaluation during supportive periodontal therapy in a university setting. Clin Oral Investig 2017; 22:235-244. [DOI: 10.1007/s00784-017-2104-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/13/2017] [Indexed: 12/14/2022]
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27
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Cost-effectiveness of regular versus irregular supportive periodontal therapy or tooth removal. Br Dent J 2017; 222:438. [DOI: 10.1038/sj.bdj.2017.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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