Full Coverage Crowns and Resin-bonded Bridge Combination for Missing Mandibular Anterior Teeth

Most often the anterior teeth and those that are visible when a patient speaks or smiles are chosen for esthetic restorations. The mandibular anterior fixed bridge often presents problems to the dentist due to the size of the natural teeth and their visibility. In addition, due to high cost factor, many patients are not able to afford fixed partial denture for missing anterior teeth. This article describes a cost effective technique for the restoration of missing mandibular anterior teeth by fabrication of full coverage crowns and resin-bonded fixed bridge combination.

Clinical Teaching of Prosthodontics in Undergraduate Courses in a German Dental School: Patients, Visits, Efforts, and Incentives

It is unknown what disadvantages are faced by patients deciding for a prosthodontic treatment by inexperienced students. Commonly, the related extra effort and time are compensated by cost reduction of treatment fees. Thereby, the dental schools subsidize treatments to teach clinical prosthodontics. The aim of this study was to clarify the benefits to patients as well as the efforts of the dental school. Data collected from three courses in a dental school in Germany were patient gender, age, occupation, zip code, number of visits, scope of treatment including costs, financial discount, and remaining copayment. Travel costs were calculated based on zip code. Balance of travel costs and treatment discount was defined as financial benefit. The results showed that 185 patients (95 male) aged 32 to 82 years (median=58) were treated with fixed restorations (FR, n=110), telescopic dentures (TD, n=87), complete dentures (CD, n=17), or other (RD, n=3). The mean number of visits was 11 for FR, 12 for TD, and 9 for CD. Single distance to the clinic ranged from 0.6 to 65 miles (median=12). Total costs of prosthodontics were reduced by 19% on average. The mean financial benefit was 429 USD (median=298, min=-482, max=4025). The financial benefits were found to differ widely, including additional expenditures of patients. Participation, travel burden, and copayment did not depend on age, gender, or occupation. The financial benefit was relativized because students needed at least twice the sessions of a dentist. As a result, the financial efforts of dental schools are significant and compromise a cost-covering education.

Single implant and crown versus fixed partial denture: A cost-benefit, patient-centred analysis

Single implants and their crowns have high survival rates that exceed the survival rates for fixed partial dentures on teeth and most but not all publications have determined single implants are more cost-effective than 3-unit fixed partial dentures. Both initial root canal treatment and retreatment are more cost-effective than tooth extraction and rehabilitation with a single implant and crown.

Reimbursement systems influence prosthodontic treatment of adult patients

OBJECTIVE

To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss.

MATERIALS AND METHODS

Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed.

RESULTS

Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system.

CONCLUSIONS

Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives

PURPOSE

To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated.

MATERIALS AND METHODS

The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis.

RESULTS

The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities.

CONCLUSIONS

When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

[Aftercare for durability and profitability of single-unit and multi-unit fixed dental prostheses]

An important aim ofa treatment with single-unit and multi-unit fixed dental prostheses is a durable and profitable treatment outcome. That requires aftercare, too. First, the frequency of routine oral examinations should be assessed, using an individual risk profile. The objectives of the routine oral examinations are the prevention and, when necessary, the treatment of pathological conditions and complications. With regard to prevention, attention should be paid to information and instruction, oral biofilm and calculus, non-functional activities, hard tooth tissues, periodontal and peri-implant tissues, and saliva. Subsequently, it can be determined whether the intended durability and profitability have been achieved or can still be achieved, whether or not through indicated adjustments. Special attention should be paid to endodontically treated teeth. Restorative, repair or replacement treatments may be indicated in case ofcomplications, such as loose single- or multi-unitfixed dental prosthesis, fracture of a fixed dental prosthesis unit, lost tooth pulp vitality, tooth root fracture, and implant or implant abutment problems.

[Cost-effectiveness when treating an edentulous mandible]

When treating an edentulous patient with complaints of unsatisfactory retention of his complete mandibular denture, various treatment options are available: a new conventional denture, an implant-supported overdenture, and an implant-supported fixed partial denture. Important considerations during the decision-making process are patient satisfaction, cost of denture fabrication, and cost of maintenance. The outcome of the diagnostic procedure will have financial consequences. On that basis, a satisfactory treatment plan can be established and carried out. The need exists for a protocol which takes into account cost-effectiveness and is useful in selecting the appropriate treatment option, adjusted to individual requirements.

Estimating costs for shade matching and shade corrections of fixed partial dentures for dental technicians in Germany: a pilot investigation

AIMS

To evaluate the additional operating expenses caused by shade matching by dental technicians in the dental practice and by color changes of fixed partial dentures.

METHODS

A questionnaire was handed out to visitors of the 2010 ADT dental technician congress in Germany. Thirty-one completed questionnaires were evaluated.

RESULTS

Mean costs caused by shade matching and shade correction per month were 1269$ (SD = 1278$; n = 25) and per unit of FPD 9.32$ (SD = 8.89$).

CONCLUSIONS

An improvement of shade matching, shade communication and reproduction should be made in order to minimize the considerable economic damage for dental laboratories.

Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations

Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

Clinical evaluation of fixed partial dentures made in Sweden and China

The aim of this study was to compare the quality of fixed partial dentures (FPDs) made in a Chinese dental laboratory with corresponding FPDs made in Swedish dental laboratories. Twenty-one patients were fitted with FPDs between March 2007 and December 2008. Single crowns and prostheses of up to seven units were made. All dentures, gold and CoCr alloys covered with ceramic, were produced in duplicate: one by a dental technician in China and the other by a dental technician in Sweden. The dentures were blind-tested with regard to marginal integrity, anatomic form and color, approximal and occlusal contacts, and time taken for adjustments. The composition of dentures was analyzed, and the material used, framework weight, compliance of the laboratories, and costs (material and labour) were recorded. There was no difference in the quality of marginal integrity, anatomic form, color, approximal and occlusal contacts, or in the time taken for adjustments. The bridge frameworks made in China were thinner and lighter (p<0.01) than those made in Sweden. Three FPDs from China showed elastic deformation when tested clinically and were considered too thin for clinical use. In 11 out of 14 orders from the Chinese laboratory, the gold alloy specified was not delivered and the cobalt-chromium alloy contained small amounts (0.19%) of nickel.The prostheses with gold-alloy frameworks from China cost 47% of those from Sweden (p<0.01) and those with cobalt/chromium frameworks 44% (p<0.01). In conclusion, the quality of the FPDs made in Sweden and China was comparable, with the exception of the dimension of the Chinese bridges, which in some cases was considered too weak. The gold alloy ordered from the Chinese laboratory was often not the alloy delivered and the CoCr alloy contained small amounts of nickel. FPDs from China cost less than half the price of those from Sweden.

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.

Economic aspects of single-tooth replacement

The aim of this study was to assess and compare economic parameters of two treatment options in patients requiring single-tooth replacements in private practice. Thirty-seven patients received 41 conventional three-unit fixed partial dentures (FPDs). Fifty-two patients received 59 single crowns on implants (I). Treatment assignment was not random. All except one were metal ceramic reconstructions. All except one were crowns cemented on solid abutments of the ITI((R)) Dental Implant System. Economic parameters were noted for the preparatory phase, the actual reconstruction and for treatment of biological and/or technical complication thereafter (range 1-4 years): number of visits, chair-side time, treatment costs, costs for implant components and laboratory work. Costs were based on the tariffs between the Swiss dentists association and the insurers (Sfr 3.1 per tariff point). Implant treatment required more visits than FPD (8.1+/-2/4.8+/-2.3, chi(2): P=0.02). However, the total treatment time was similar (I: 4.8 h+/-0.9 h/FGM: 5.1 h+/-1.3 h, NS). Laboratory costs were higher for FPD (1527.8+/-209 SFr) vs. 579.6+/-106.9 CHF for I. Costs for treatment of technical and biological complications were similar. Total costs amounted to 3939.4+/-766.4 SFr for FGM vs. 3218+/-512.2 SFr for I (P<0.003, Kolmogorov-Smirnov). Even when considering opportunity costs (50 SFr) for each visit the implant solution was less expensive: 3623.2+/-656.1 SFr vs. 4178.7+/-822.1 SFr (P<0.04, Kolmogorov-Smirnov). Costs for treatment of complications were similar. In conclusion, over a short observation period, the implant reconstruction demonstrated a more favorable cost/effectiveness ratio. Especially in clinical situations with either non- or minimally restored teeth and sufficient bone, the implant reconstruction is to be recommended from an economical point of view.

Use of mandibular implant overdentures: treatment policy in prosthodontic specialist clinics in Sweden

The aim was to examine the use of mandibular implant overdentures in Swedish prosthodontic specialist clinics. Questionnaires related to treatment with mandibular implant overdentures during 2001 were sent to the heads of the 30 prosthodontic specialist clinics of the Public Dental Health Service in Sweden. Completed questionnaires were received from 28 (93%). The number of treatments with mandibular implant overdentures varied much among the clinics (0 to 22). Seven clinics had not performed any such treatment, and the median number was 2. The number of fixed implant-supported prostheses was much higher (median value 17, range 4 to 100). The correlation between the number of implant overdentures and fixed implant-supported prostheses in edentulous mandibles was weak (r = 0.33; P = 0.10). The most common anchorage system was ball attachments on two unsplinted implants. The most common reason for the choice of the overdenture treatment was the reduced cost, whereas the patient's main wish to improve denture retention came next. The question whether the demand for implant overdentures had increased during the last few years, was answered with "no" by 19, with "yes" by 5 and with "don't know" by 4 clinics. All but one responded that their attitude to implant overdentures had not changed after the introduction of free pricing in Swedish dentistry. It can be concluded that compared to the rapidly increasing international use of mandibular implant overdentures, this treatment of edentulous patients is rare in Sweden, where fixed implant-supported prostheses still are predominant.

A cost minimization analysis of implant treatment in mandibular edentulous patients

PURPOSE

This study aimed to determine if implant-supported overdentures are a long-term economically efficacious therapy for edentulous patients when compared to fixed osseointegrated prostheses.

MATERIALS AND METHODS

Clinical records of 25 patients from two long-term studies (fixed and overdenture) were included in this analysis. A cost minimization analysis from the patient perspective was employed. Direct clinical and time costs incurred over the 9-year period were deflated to 1995 Canadian dollars using the Consumer Price Index. National salary rates by occupation and gender were used to value patients' time, and a sensitivity analysis was carried out to assess the robustness of the results when an equal mean salary rate across treatment groups was assumed.

RESULTS

The mean total, clinical, and time costs were significantly higher (Ps .05) for the fixed restoration group (dollars CAD10,748, dollars CAD10,094, and dollars CAD654, respectively) when compared to the overdenture group (dollars CAD3,665, dollars CAD3,343, and dollars CAD322, respectively). The initial, maintenance, and clinical visit costs were also significantly higher (P < or = .05) in the fixed restoration group (dollars CAD7,567, dollars CAD2,527, dollars CAD542, respectively) than in the overdenture group (dollars CAD2,505, dollars CAD830, dollars CAD292, respectively). The sensitivity analysis demonstrated that the time cost for the fixed prosthodontic group (dollars CAD488 vs dollars CAD322) was still significantly higher (P = .002), even after an equal mean salary rate was assumed.

CONCLUSION

Overdenture therapy for edentulous patients is a more cost-effective treatment compared to fixed prosthodontic treatment.

[Orthodontic appliance made from silicone elastomer, evaluated clinically and from patient opinions after treatment for malocclusion]

Elastodontics is a new branch of orthodontics dealing with orthodontic appliances made with silicone elastomer. The appliances are simple in construction and function, easy to use, and safe. One of the simplest is the elasto-aligner used in some forms of malocclusion. The purpose of this work was: 1) to evaluate the results of treatment of malocclusion with this type of appliance in relation to age of patient and duration of treatment; 2) to gather the opinions of patients; 3) to assess the costs and duration of treatment. 70 patients were examined clinically and asked to fill in a questionnaire (Tab. 1, 3). The elasto-aligner was especially useful when applied in malocclusion after treatment with a fixed appliance. The silicone appliance is recommended for the youngest of patients and should be worn for at least 12 hours per day (Tab. 2). Adaptation to the silicone appliance was long and the most uncomfortable symptoms were toothache, excessive salivation, and dry lips in elderly patients (Fig. 1). The time needed to make the elasto-aligner was up to 20 hours and the cost of materials varied between an acrylic activator and a fixed appliance.

Chairside prefabricated fiber-reinforced resin composite fixed partial dentures

The introduction of pre-impregnated fiber-reinforced resin composites has provided the dental profession with the opportunity to fabricate and deliver adhesive, esthetic, and metal-free tooth replacements. Utilizing this technology, a prefabricated fiber-reinforced resin composite fixed partial denture prototype that allows rapid, cost-effective, and noninvasive fixed tooth replacement for single anterior teeth has been developed. Ideal situations for this type of service include: a fixed replacement following tooth loss from trauma; a fixed tooth replacement in medically compromised patients who cannot sit for extended periods of time or have local anesthesia; periodontally compromised abutments; a fixed space maintainer following orthodontic movement; and a fixed provisional during the post implant healing phase prior to loading. This article describes the framework construction and placement protocol for the prefabricated fiber-reinforced resin composite fixed partial denture.

Design principles for cantilevered resin-bonded fixed partial dentures

Recent clinical studies show 2-unit cantilevered resin-bonded fixed partial dentures to be as retentive or more retentive than their fixed-fixed counterparts. The fact that the 2-unit prosthesis is successful adds value to the clinical use of resin-bonded fixed partial dentures because the single-abutment prosthesis is even simpler and more cost effective than fixed-fixed designs. However, there is no evidence-based information relating to design principles for abutment preparation and framework design for the single-abutment, single-retainer prosthesis. The aim of this report is to suggest principles of design for the 2-unit cantilevered fixed partial denture, based on information gained from studies on fixed-fixed designs.

Fixed or removable implant-supported restorations in the edentulous maxilla: literature review

Among the prosthesis designs used to treat the edentulous maxilla are fixed or removable implant-supported restorations. Since the aesthetic requirements and preoperative situation of each patient varies, controversy exists regarding prostheses' success rates and complications. The purpose of this article is to compare the treatment options and prosthesis designs with their indications and to compare implant and prosthesis success and treatment expense. This objective was accomplished through the review of reports with regard to varying design considerations and factors that influence the decision-making process and treatment outcomes.

Tooth stabilization and splinting before and after periodontal therapy with fixed partial dentures

The design and use of fixed partial dentures as a definitive restoration to stabilize and splint teeth have been reviewed. The provisionalization of the splinted patient has been described as it is incorporated into the treatment plan of patients with a weakened periodontium. The current controversy of incorporating implants in the patient requiring splinting was discussed, and recommendations are made. Dentists are encouraged to explain all potential ramifications of splinting with fixed partial dentures, including cost, frequency of office visits, and potential alterations or remakes of the prosthesis should physiologic demands surpass the capabilities of the remaining teeth.

A prospective study on the maintenance of implant prostheses in private practice

This study examined the adjustments, repairs, time, and costs required to maintain 69 implant prostheses in private prosthodontic practice for an average of 22 months after placement. For the removable prosthesis design, the most common adjustment was contouring the prosthesis and the most common repair was retentive component replacement. Screw tightening or fracture repair were the most frequently needed modifications for fixed implant prostheses. Each removable implant prosthesis averaged four times as many postplacement adjustments and almost twice as many repairs as did each fixed implant prosthesis, and the mean length of each maintenance appointment was also longer for removable prostheses. Mean repair costs were approximately 60% higher for the removable design.

Dentists' opinions on aspects of cast titanium restorations

OBJECTIVES

The purpose of this paper was to study dentists' opinions regarding aspects of the clinical use of cast titanium restorations.

METHODS

Since 1988 more than 10,000 cast titanium units of crowns and fixed partial dentures have been produced by the only dental laboratory that produces cast titanium restorations in Norway. A questionnaire on the clinical behaviour of such restorations was mailed to all 72 dental practitioners who were recorded in the computer file of this laboratory.

RESULTS AND CONCLUSION

In the opinion of the 64 dental practitioners who completed the questionnaire, cast titanium is a useful supplement to conventional casting alloys, particularly because of its favourable cost. It has a satisfactory clinical behaviour, although there may be some problems related to technical and aesthetic aspects.

Clinical and laboratory parameters in fixed prosthodontic treatment

Prosthodontic treatment demands competence from each member of the professional team; this includes the staff of the dental office and the dental laboratory. Members of the dental team should understand their responsibility to each other and their patients to ensure optimal prosthodontic care. Knowledge of individual limitations are critical, as are two specific attributes of technical success, quality and communication. The dentist and dental technician should provide services in concert, practice mutual respect, and encourage each other to critique results. Successful prosthodontic treatment also represents a collaborative effort between the patient and attending dentist. Because specific limitations exist with various treatment options, patients need to make decisions concerning their treatment on the basis of detailed informed consent comprehensively presented by the dentist. This article illustrates examples of fixed prosthodontic treatments and demonstrates collaborative, professional responsibilities of the dentist and dental laboratory technicians.

Long-term observations of extensive fixed partial dentures on mandibular canine teeth

Twelve patients were followed for 15 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposite to a complete maxillary denture. Four constructions failed and had to be removed but four were still in function after 15 years. Four patients died during the observation period still wearing their constructions. Endodontic complications, pulpal necrosis and loss of retention of posts were the most frequent, while caries and periodontal lesions were rare. The maintenance costs over the years were fairly low even compared to maintenance costs for patients treated with implants. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties adapting to removable dentures.

Failure rates of restorations for single-tooth replacement

Failure rates of traditional fixed partial dentures, resin-bonded prostheses, and implant restorations for the replacement of a single missing tooth are compared in this literature review. A lack of documented longevity studies involving conventional fixed partial dentures makes failure rates difficult to determine. Reported failures ranged from only 3% over 23 years to 20% over 3 years. The major causes of loss were caries and endodontically and periodontally related complications. Research concerning resin-bonded fixed partial dentures was more prevalent, but indicated that overall retention of these prostheses may be unpredictable. Failure rates were quite divergent, ranging from 10% over 11 years to 54% over 11 months. Debonding was the usual cause of failure. Clinical reports of single-tooth implant replacements have followed stricter protocols than the other two alternatives. Short-term studies indicated favorable success rates for these restorations, but these must be confirmed by long-term evaluations. Failures ranged from 9% over 3 years to 0% over 6.6 years. These comparisons should be considered in treatment planning a restoration for the replacement of a single missing tooth.

A new computer-assisted method for fabrication of crowns and fixed partial dentures

The availability of high-technology systems that use computer-aided design and computer-aided machining is on the increase. One such system is the Procera system, which is currently providing cost-effective, high-quality dental restorative services to dental laboratories and to dentists. A reduction in cost to the dentist, and ultimately to the patient, is a major advantage of the Procera system. Cost benefits combined with its continued success in producing crowns and fixed partial dentures that meet professional standards of care should enhance the acceptance of this new technology.

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease

Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7-10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550, for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.

A method to compare cost-effectiveness of dental treatments: adhesive bridges compared to conventional bridges

The cost-effectiveness of a dental restoration depends primarily on the durability and the cost of the restoration. In this report a method is described to compare the cost-effectiveness using the durability data of adhesive bridges and conventional bridges. The study shows that, for the situation in the Netherlands, the breakeven point for equal cost-effectiveness compared to conventional bridges is achieved when the 50% survival for adhesive bridges is approximately 6.5 yr. Clinical data indicate a higher cost-effectiveness for anterior adhesive bridges. The method described in this report is considered to be useful for comparing cost-effectiveness of dental restorations in different situations.

Metal-ceramic bridges from commercial dental laboratories: alloy composition, cost and quality of fit

The quality of construction of fixed bridge prostheses directly affects their long-term survival. The cost, alloy composition and marginal fit of bridges made by 30 commercial dental laboratories is assessed. Duplicate models of a three unit bridge preparation were sent to 30 different laboratories, as if required for a patient receiving treatment under the General Dental Service. Material was sent via general dental practitioners, requesting metal-ceramic bridges made from 45% Au alloy, precious metal or non-precious metal. Proximal contacts were overbuilt at 65% of sites and pontic tissue contacts were excessive in all but one bridge. Eight laboratories did not use alloys corresponding to the request made. The mean marginal gaps of non-precious metal bridges (145 microns) were significantly greater than those for 45% gold alloy (106 microns). Marginal fit was poor and a number of factors have been observed, with other postulated, which may have contributed to this problem.

[Research in the dental laboratories in Thessaloniki referring to the categories and the elaboration of the dental alloys for the fixed prosthetic constructions]

The research that is presented in this article is a statistical evaluation with goal to scrutinize which classes of the dental alloys are being used by the dental laboratories in Thessaloniki for porcelain and acrylic bridge work constructions. On the other hand many elements concerning to the elaboration of the new dental alloy have been checked and evaluated. The result of this research that covers the 90% of the total number of the dental laboratories of Thessaloniki lead to the following conclusions: 1. The dental laboratories in Thessaloniki use in high percentage alloys with low cost for the fixed prosthetic constructions. 2. The Ag-Pd dental alloys for the metal-acrylic and the Ni-Cr alloys for the metal-ceramic constructions occupy the first position in frequency. 3. The dental Technicians must improve even more the elaboration of the new dental alloys.

Veterans Administration Cooperative Studies Project No. 147. Part I: A multidisciplinary, multicenter experimental design for the evaluation of alternative metal-ceramic alloys

The factors necessary for a comprehensive multidisciplinary, multicenter clinical study have been incorporated into CSP No. 147. The experimental design provides the potential for multiple laboratory and clinical data comparisons of alternative alloys. The study incorporates clinical performance observations with dental and medical histories that permit many unique correlations. This potential demonstrates the comprehensiveness of the CSP No. 147 study design and its contributions to clinical dental research in the evaluation of restorative materials.

Status report on low-gold-content alloys for fixed prostheses. Council on Dental Materials, Instruments, and Equipment

Because of their savings in cost and comparable mechanical and handling properties, low-gold-content dental casting alloys will remain an attractive alternative to high-gold-content alloys. Certain compositions perform well in the corrosive oral environment; others do not. Accurate information on such performance is currently unavailable. Accurate prediction of tarnish and ocrrosion behavior awaits development and acceptance of reliable and valid performance tests. There is adequate evidence that not only the Ag, Cu, and Pd ratios are important for resistance to corrosion but also the addition of minor amounts of other elements may be important for adequate clinical performance.