Search

Objectives: Cancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients., Methods: Data from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses., Results: Between the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded., Conclusions: The expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients., Clinical Significance: Timely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding a national health insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Seokyung Hahn reports financial support was provided by National Research Foundation of Korea, Korea Health Industry Development Institute. Areum Han reports financial support was provided by National Research Foundation of Korea, Korea Health Industry Development Institute. Hee-Kyung Park reports financial support was provided by Korea Health Industry Development Institute. Eun-Gee Park reports financial support was provided by National Research Foundation of Korea, Korea Health Industry Development Institute. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

We aimed to assess the cost-effectiveness of amalgam alternatives-namely, incrementally placed composites (IComp), composites placed in bulk (BComp), and glass ionomer cements (GIC). In a sensitivity analysis, we also included composite inlays (CompI) and incrementally placed bulk-fills (IBComp). Moreover, the value of information (VOI) regarding the effectiveness of all strategies was determined. A mixed public-private-payer perspective in the context of Germany was adopted. Bayesian network meta-analyses were performed to yield effectiveness estimates (relative risk [RR] of failure). A 3-surfaced restoration on a permanent molar in initially 30-y-old patients was followed over patients' lifetime using a Markov model. Restorative and endodontic complications were modeled; our outcome parameter was the years of tooth retention. Costs were derived from insurance fee items. Monte Carlo microsimulations were used to estimate cost-effectiveness, cost-effectiveness acceptability, and VOI. Initially, BComp/GIC were less costly (110.11 euros) than IComp (146.82 euros) but also more prone to failures (RRs [95% credible intervals (CrI)] were 1.6 [0.8 to 3.4] for BComp and 1.3 [0.5 to 5.6] for GIC). When following patients over their lifetime, IComp was most effective (mean [SD], 41.9 [1] years) and least costly (2,076 [135] euros), hence dominating both BComp (40.5 [1] years; 2,284 [126] euros) and GIC (41.2 years; 2,177 [126] euros) in 90% of simulations. Eliminating the uncertainty around the effectiveness of the strategies was worth 3.99 euros per restoration, translating into annual economic savings of 87.8 million euros for payers. Including CompI and IBComp into our analyses had only a minimal impact, and our findings were robust in further sensitivity analyses. In conclusion, the initial savings by BComp/GIC compared with IComp are very likely to be compensated by the higher risk of failures and costs for retreatments. CompI and IBComp do not seem cost-effective. All alternatives are likely to be inferior to amalgam. The VOI was considerable, and future studies may yield significant economic benefits.

Objectives: Dentists have a range of options for managing molars with severe molar-incisor hypomineralization (MIH), each with different long-term implications. The cost-effectiveness of managing molars with severe MIH was assessed., Methods: A mixed public-private-payer perspective within German healthcare was adopted. Individuals with one to four severely MIH-affected molars were followed over their lifetime. We compared: (1) removal of the tooth/teeth and orthodontic alignment of the second and third molars (Ex/Ortho); (2) restoration of the tooth using resin composite (Comp); (3) restoration using an indirect metal crown after temporizing it using a preformed metal crown (PMC/IR). The health outcome was tooth retention years. Transition probabilities were estimated based on the best available evidence. Cost calculations were based on German dental fee catalogues. Monte-Carlo microsimulations were performed for cost-effectiveness-analysis., Results: If extraction was performed at the optimal age (9.5/11 years for maxillary/mandibular molars), Ex/Ortho was most cost-effective (67 years, 446-938 Euro). Comp (51 years, 1911 Euro) and PMC/IR were dominated (50 years, 2033 Euro). This cost-effectiveness ratio was also determined when >1 molar was treated. If extraction was performed later, assuming no spontaneous alignment, Ex/Ortho was more costly than Comp, at least when only 1 molar was treated., Conclusions: For molars with severe MIH, extraction at the optimal age and, if needed, orthodontic alignment can be cost-effective, especially when >1 molar is affected. For single molars where the chance of spontaneous alignment is low, Comp might also be considered. These findings apply to German healthcare and within the limitations of this study only., Clinical Significance: When deciding how to manage molars with severe MIH, both tooth retention, with lower costs but higher needs for re-treatments, and tooth removal, with possible need for orthodontic alignment, can be considered. Considering cost-effectiveness, the latter may be preferable, especially if the age of extraction is chosen correctly, or several molars are affected., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: Repairing instead of replacing partially defective composite or amalgam restorations might reduce the initial treatment risks and costs, but could be less advantageous long-term due to repeated re-interventions being required. This study aimed to compare the cost-effectiveness of repairing versus replacing composite or amalgam restorations., Methods: A mixed public-private-payer perspective from the German healthcare setting was adopted. A permanent molar with a three-surfaced partially defective composite or amalgam restoration in need of repair or replacement was modelled. Risks of complications after repair or complete replacement were derived by a rapid systematic literature review. The health outcome measure was tooth retention years. Costs were estimated from the German public and private fee catalogues. Monte-Carlo microsimulations were performed and incremental-cost-effectiveness ratios (ICERs) were used to express cost differences per gain or loss of effectiveness., Results: Compared with complete composite replacement, composite repairs were marginally more costly and more effective (€326 versus €321; 24.7 versus 24.0 years; ICER: €7.14). Amalgam repairs were more costly and more effective than complete replacement (€467 versus €326; 24.3 versus 23.7 years; ICER: €235). If composite repair costs were €<67 or complete replacement costs €>166, composite repair was always cost-effective. This was not the case for amalgam repair. The size of the restoration, the reason for repair/replacement, and patients' age were found to influence the cost-effectiveness., Conclusions: Repair was found to be more effective, but not necessarily less costly than complete replacement of restorations., Clinical Significance: Repairing instead of replacing partially defective restorations is likely to retain teeth for longer compared with complete replacement. When considering cost-effectiveness, repairing composite can be recommended more strongly than repairing amalgam restorations., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Use a low shrinkage stress composite but, if not, use incremental placement and a layer of flowable at the gingival box; Ensure good bonding to dentine and enamel and avoid (over) etching the dentine; Ensure good adaptation at the gingival floor of a Class II box; Make sure that the restoration has received sufficient light; Provide good isolation; Use reliable and tested materials throughout.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

Purpose: The purpose of this study was to perform a cost-benefit analysis of the age one dental visit for privately insured patients., Methods: A major insurance company provided claims from various states submitted between 2006-2012. Data provided included numbers of procedures and respective costs from the first visit until age six years. Data was organized into five groups based on age, for which the first D0145/D0150 code was submitted [(1) age younger than one year old; (2) age one or older but younger than two years old; (3) age two or older but younger than three years old; (4) age three or older but younger than four years old; and (5) age four or older but younger than five years old]. The ratio of procedures per child and average costs per child were calculated., Results: Claims for 94,574 children were analyzed; only one percent of these children had their first dental visit by age one. The annual cost for children who had their first dental visit by age one was significantly less than for children who waited until an older age., Conclusion: There is an annual cost benefit in establishing a dental home by age one for privately insured patients.

Dental clinicians have an expanding range of biomaterial choices for restoring tooth structure. Scientific developments in cariology, advances in dental biomaterials, and patients' esthetic concerns have led to a reduction in amalgam restorations and an increase in composite restorations. The aim of this study was to compare teaching time with students' clinical procedures in amalgam and composite posterior restorations in dental schools across the United States. Academic deans in 60 schools were invited to complete a survey that asked for the amount of instructional time for amalgam and composite posterior restorations and the number of clinical restorations performed by their Classes of 2009, 2010, and 2011. Of these 60, 12 returned surveys with complete data, for a 20% response rate. Responses from these schools showed little change in lecture and preclinical laboratory instruction from 2009 to 2011. There was a slight increase in two-surface restorations for both amalgam and composites; however, the total number of reported composite and amalgam restorations remained the same. Of 204,864 restorations reported, 53% were composite, and 47% were amalgam. There were twice as many multisurface large or complex amalgam restorations as composites. One-surface composite restorations exceeded amalgams. Among the participating schools, there was little to no change between curriculum time and clinical procedures. Findings from this preliminary study reflect a modest increase in two-surface resin-based restorations placed by dental students from 2009 to 2011 and little change in curricular time devoted to teaching amalgam restorations. The total number of posterior composite restorations placed by students in these schools was slightly higher than amalgams.

Objective: Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment., Methods: We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding., Results: We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr., Conclusions: Because of children's increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs., (© International & American Associations for Dental Research.)

The cost-effectiveness of glass-carbomer, conventional high-viscosity glass-ionomer cement (HVGIC) [without or with heat (light-emitting diode (LED) thermocuring) application], and composite resin sealants were compared after 2 yr in function. Estimated net costs per sealant were obtained from data on personnel time (measured with activity sampling), transportation, materials, instruments and equipment, and restoration costs for replacing failed sealants from a community trial involving 7- to 9-yr-old Chinese children. Cost data were standardized to reflect the placement of 1,000 sealants per group. Outcomes were the differences in the number of dentine caries lesions that developed between groups. The average sealant application time ranged from 5.40 min (for composite resin) to 8.09 min (for LED thermocured HVGIC), and the average cost per sealant for 1,000 performed per group (simulation sample) ranged from $US3.73 (for composite resin) to $US7.50 (for glass-carbomer). The incremental cost-effectiveness of LED thermocured HVGIC to prevent one additional caries lesion per 1,000 sealants performed was $US1,106 compared with composite resin. Sensitivity analyses showed that differences in the cost of materials across groups had minimal impact on the overall cost. Cost and effectiveness data enhance policymakers' ability to address issues of availability, access, and compliance associated with poor oral-health outcomes, particularly when large numbers of children are excluded from care, in economies where oral health services are still developing., (© 2014 Eur J Oral Sci.)

This paper presents a printed wide-slot antenna design and prototyping on available low-cost polymer resin composite material fed by a microstrip line with a rotated square slot for bandwidth enhancement and defected ground structure for gain enhancement. An I-shaped microstrip line is used to excite the square slot. The rotated square slot is embedded in the middle of the ground plane, and its diagonal points are implanted in the middle of the strip line and ground plane. To increase the gain, four L-shaped slots are etched in the ground plane. The measured results show that the proposed structure retains a wide impedance bandwidth of 88.07%, which is 20% better than the reference antenna. The average gain is also increased, which is about 4.17 dBi with a stable radiation pattern in the entire operating band. Moreover, radiation efficiency, input impedance, current distribution, axial ratio, and parametric studies of S11 for different design parameters are also investigated using the finite element method-based simulation software HFSS.

Objectives: To review two policy issues that define publicly financed dental care as a "wicked policy problem.", Methods: Historical review., Results: By demonstrating how governments have shifted their funding focus from direct delivery care, to public third-party financing arrangements in private dental offices, and by their willingness to fund composite restorations in public fee schedules, it is clear that the logic and sustainability of public programming needs reconsideration., Conclusions: The current contradictions in public dental care programs speak to the need for policy makers to reassess their goals, and ask whether decisions are based more on political necessity than on a logical evidence-informed approach to the delivery of publicly financed dental care., (© 2012 American Association of Public Health Dentistry.)

Objective: To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil made a combined visual-radiographic caries examination of 40 occlusal surfaces of extracted permanent teeth mounted on two dental mannequins and proposed treatment plans for each tooth. Histological validation then evaluated the diagnoses validity and the suitability of the treatment plans., Outcome Measures: Inter-examiner agreement was calculated by Cohen's Kappa statistics. The sensitivity and specificity of caries detection and treatment decision were calculated. The costs of dental treatment plans for public health system were calculated from a Brazilian public health service fee scale., Results: Inter-examiner agreement for caries detection was moderate (kappa = 0.42) while for treatment decisions it was fair (kappa = 0.29). The sensitivity and specificity were 0.69 and 0.65 for caries detection and 0.56 and 0.65 for treatment decision respectively. Dentists overestimated the presence and depth of carious lesions and there was a tendency to treat enamel lesions using invasive therapeutic procedures. Mean treatment cost across the two cases was 32US$ (range 9-65) while the histologically validated cost was 23US$., Conclusion: The variability in caries detection and treatment decision negatively affected the cost of the dental treatment.

Objectives: This clinical study was designed to compare the patient's opinion of the cosmetic improvement after the placement of direct composite and indirect porcelain veneers., Methods: This retrospective study involved a survey of 145 patients (96 responses) each treated with 10 direct composite (Vitalescence) or 10 porcelain (Fortress) veneers. Patients subjectively evaluated multiple aspects of their smile using visual analogue scales before and after treatment for colour, shape, size, smile line and overall facial appearance., Results: There were no statistical differences between the cosmetic improvement achieved for porcelain and composite (p > or = 0.05). Cost factors were not significant. Significant factors were: tooth conservation (p < or = 0.021), time (p < or = 0.012), repair costs (p < or = 0.009) and replacement costs (p < or = 0.024) and favoured the direct composite veneers over the porcelain veneers. Correlation findings relating to what patients feel as the key components of the smile for overall cosmetic improvement showed medium to high correlations (0.301 < or = r < or = 0.718) with tooth shape, colour and level of tooth display, gingival level, gingival symmetry and tooth whiteness., Conclusion: The choice of material (direct composite resin vs porcelain) when constructing maxillary anterior veneers does not significantly affect the patient's perception of cosmetic improvement. However, there was a preference towards accepting the composite veneer option. Overall aesthetic satisfaction is multifactorial. The results support the opinion that the more conservative composite veneers are justified and that, given the choice and information, patients may prefer this option.

Purpose: The purpose of this study was to determine pediatric dentists' current practices and the perceptions about parents' opinions and how those parental preferences regarding dental materials influence dentists' practices., Methods: A questionnaire was sent to 500 randomly selected active members of the American Academy of Pediatric Dentistry. Twenty-five items queried demographics, use of restorative materials, perceptions of parents' attitudes towards materials, and dentists' reactions to parents' concerns., Results: The survey response rate was 61%. Parental concerns about materials in decreasing order were: (1) esthetics; (2) cost; (3) toxicity; and (4) durability. Parents' greatest concerns about stainless steel crowns were: (1) esthetics; and (2) cost. Among respondents, 43% followed parental preferences when challenged, and 28% currently never use amalgam. Amalgam use and the dentists' perception of parental challenge were each related to the socioeconomic status of the practice population, with lower socioeconomic practices feeling less parental challenge than higher socioeconomic practices and being more likely to use amalgam than "white" filling materials (P = .001)., Conclusions: Mercury concerns occur more frequently with higher than lower socioeconomic status parents (P = .002). Stainless steel crowns are challenged based on esthetics and cost. When confronted, many pediatric dentists (43%) follow parental preferences, even when that action is contrary to their initial clinical judgment.

Dental fillings represent an established procedure to treat tooth decay. The present paper provides a cost comparison of dental filling procedures across nine European countries. More specifically, the paper aims to estimate the costs and prices (i.e. reimbursement fees) of a single dental filling procedure in an approximately 12-year-old child with a toothache in a lower molar who presents at a dental practice, as described in a case vignette. Both amalgam and composite fillings were examined. Total costs were determined by identifying resource use and unit costs for the following cost components: diagnostic procedures, labour, materials, drugs, and overheads. Altogether, 49 practices provided data for the cost calculations. Mean total costs per country varied considerably, ranging from 8 euros to 156 euros. Labour costs were the most important cost driver in all practices, comprising 58% of total costs. Overhead costs were the second-most important cost component in the majority of countries. Actual cost differences across practices within countries were relatively small. Cost variations between countries were primarily due to differences in unit costs, especially for labour and overheads, and only to a lesser extent to differences in resource use. Finally, cost estimates for a single dental filling procedure based on reimbursement fees led to an underestimation of the total costs by approximately 50%., (Copyright 2008 John Wiley & Sons, Ltd.)

The aim was to evaluate the cost of direct composite and glass ionomer class II molar restorations, and the theoretical cost per year of function, at Public Dental Services (PDS) in Sweden, years 2000 and 2005. Costs for patients, Social Insurance Offices (SI; Försäkringskassan), and total cost, were calculated based on fee schedules from all PDS in Sweden. Theoretical cost per year calculations were based on the median survival times (MST) of failed direct composite and glass ionomer class II molar restorations, derived from a set of clinical studies conducted in Nordic general practices. Due to lack of national statistics from SI, the number of direct restorations including more than one surface, made in adults, in general dentistry at PDS in the county of Halland were studied. From the year 2000 to year 2005, the total cost of composite class II molar restorations increased by 25%, whereas the total cost of glass ionomer restorations more than doubled. Theoretical calculations implied a higher cost per year of function for composite restorations in year 2000, whereas in year 2005, glass ionomer restorations had a higher cost per year of function. The cost of direct composite and glass ionomer class II molar restorations increased from year 2000 to 2005, at PDS in Sweden. In the context of planning public health care funding, theoretical models for cost prediction may prove useful.

Economic, esthetic, and concerns of tooth preservation are important when considering bonded composite resin for the partially edentulous patient's prosthetic rehabilitation. This article has described the clinical success of the use of bonded composite resin in removable prosthodontics. Composite resin may be used in daily clinical practice for the restoration of abutment teeth in contour, vertical support, and re-establishment of a patient's vertical dimension.

Certainly, we could spend more time matching shades, applying characterizations, placing secondary anatomy, and even finishing. However, if posterior composite restorations are to be a viable alternative to amalgam in appropriate cases, we must accomplish efficient and predictable placement so that fees for the two types of restorations are somewhat in line. Contact must be solid, sensitivity must be kept to a minimum, and placement and finishing must be fairly simple and organized. If the problems with posterior composites aren't kept to a minimum, all of dentistry will suffer. Our contacts are excellent most of the time, but occasionally we need to redo a "light" one. Our best estimate is that about one in 100 fillings that had no preoperative symptoms needed some postoperative care after restoring. Usually these complaints are corrected by occlusal adjustment, and very rarely by replacing the restoration. We have not yet made a perfect restoration in our practice--we are still trying.

Background: The changing oral health needs in South Africa require that both the teaching and clinical techniques of atraumatic restorative treatment (ART) form a part of the restorative undergraduate curriculum., Objective: This study was undertaken to establish and compare the estimated costing of an amalgam, composite resin and ART restoration within the Board of Health Funders (BHF) recommended scale of benefits at the School of Oral Health Sciences Oral and Dental Hospital, University of the Witwatersrand (SOHS)., Methods: Fixed and variable costs were calculated by pricing items and equipment used in each procedure. The output values were established according to the recommended scale of benefits (BHF, 1999). This enabled the calculation of contribution margins and net income for each of the three restorations., Results: The annual capital cost for the ART approach is approximately 50% of the other two options (e.g. per multiple surface restoration ART = R1.58; amalgam and composite resin restorative procedures: R3.12 and R3.10 respectively), despite the fact that ART restorations are rendered in a modern dental setting., Conclusions: Our study shows that implementation of the ART approach within the clinic setting of the SOHS can be accomplished without additional cost. Furthermore ART can be performed as an economically viable alternative to conventional treatment procedures within the clinic setting. The study represents a first step towards determining the cost efficiency of implementing ART as a pragmatic and cost-effective restorative option within the SOHS, University of the Witwatersrand.

The aim was to evaluate the theoretical long-term treatment costs of direct class II molar restorations (amalgam, composite, glass ionomer) using the Median Survival Times (MSTs) derived from longevity studies conducted in the Nordic countries as time for replacement. Theoretical long-term cost calculations were based on fee schedules from all Public Dental Services (PDS) in Sweden, for patients, Social Insurance Offices (SI), and total cost. Costs over 10 years were calculated and sensitivity calculations were conducted in order to demonstrate the effect of different MSTs on the long-term cost development. Glass ionomer molar class II restorations had the lowest and composite restorations had the highest initial total cost. The highest total cost over 10 years was seen for composite restorations. Amalgam restorations had the lowest long-term total cost, except when the costs were based on the shortest MSTs for each material. As there were considerable differences in the long-term costs for class II molar restorations with different materials, the importance of cost-analyses over time cannot be enough emphasised when decisions about resource allocation in the dental health insurance system are considered.

The aim was to evaluate the median survival time (MST) of direct molar class II restorations (glass ionomer, composite, amalgam) in the Nordic countries and the initial cost, as well as, the theoretical cost per year of function of treatment for patients, Social Insurance Office (SI), and total cost, at Public Dental Services (PDS) in Sweden. Restoration longevity studies conducted in general practice settings in the Nordic countries were used to calculate the MSTs of class II restorations. The initial costs were based on fee schedules from all PDS in Sweden. The MSTs of class II molar restorations in Nordic general practices were shortest for glass ionomer and longest for amalgam. Glass ionomer molar class II restorations had the lowest and composite restorations had the highest initial total cost at PDS in Sweden. The highest theoretical cost per year of function was seen for composite restorations. Amalgam restorations seem to have the longest functional lifetime in Nordic general practices and the lowest theoretical cost per year of function for the patients at PDS in Sweden.

Adhesive techniques play an important role in almost every discipline of dentistry. Compared to conventional direct and indirect techniques, the direct adhesively bonded composite restoration offers many advantages. This article summarizes and illustrates some of them.

The breakage of prosthesis constructed in polymethacrylate resin is a reality in daily practice. Several solutions have been proposed to overcome this problem. Thus, the reinforcement of resin with carbon fibre improved greatly the mechanical properties, notably the fatigue strength. The technique of elaboration of such prosthesis proposed in this study has little impact on aesthetic as well as on the final cost. This proposition could be a relevant solution for third world countries opposite to economical and technological problems generated by cast metallic framework.

Objective: This paper examines the cost to the Iowa Medicaid program of hospitalizing young children for restorative dental care under general anesthesia, and describes the dental services received in this setting., Methods: Medicaid dental claims for young children receiving restorative dental care under general anesthesia during fiscal year 1994 were matched with corresponding hospital and anesthesia claims., Results: The total cost to the Medicaid program of treating a child in the hospital under general anesthesia was $2,009 per case. Less than 2 percent of Medicaid-enrolled children under 6 years of age who received any dental service accounted for 25 percent of all dollars spent on dental services for this age group, including hospital and anesthesia care. The most frequent type of procedure was stainless steel crowns (SSCs), with an average of almost six per case., Conclusions: Early identification, prevention, and intervention are critically important to prevent the costly treatment of children with ECC in hospital operating rooms.

Objective: The purpose of this study was to evaluate the teaching program of Class I and Class II resin-based composite (RBC) restorations in Brazilian dental schools and to observe if any differences were found from similar surveys conducted in North American, European, and Japanese dental schools., Method and Materials: A questionnaire containing 15 questions was distributed to 92 Brazilian dental schools, and 64 (70%) schools returned the questionnaire. The questions inquired the amount of time the curriculum dedicated to teaching of posterior RBC restorations, future expectation regarding the teaching time, limitation in extension of the occlusal width and the proximal box in Class II, contraindications for placing posterior RBC restorations, protocol for using bases and liners, brand of bonding agents and RBC used, instruments and techniques employed for finishing, cost relative to amalgam restorations, and biologic reactions related to the use of posterior RBC. The responses were calculated as percentages based on the number of schools that responded to the questionnaire. Where appropriate, the Chi-squared test and the Fisher exact test were used for statistical analysis., Results: Of the dental schools that responded, 88% dedicated 10% to 50% of the teaching time in operative dentistry to posterior RBC restorations. A significant correlation (P = 0.041) was found between the percentage of time dedicated to the teaching of posterior RBC restorations and the higher cost of posterior RBC compared to amalgam restorations. Resin-based composite restorations cost 30% to 70% more than amalgam restorations in the 40% of dental schools that charged a fee. Posterior composites for large restorations in molars were used by 14% of the dental schools. Base and liner were not placed by 10% of dental schools in deep Class I or Class II RBC restorations. One school did not recommend acid etching of the dentin., Conclusion: No major differences were found in the teaching philosophy of posterior RBC restorations by comparing the Brazilian data to the data from similar surveys done in North America, Japan, and Europe.

Objectives: The replacement of an old amalgam Class II restoration is a common treatment and will remain so for decades. In addition to effectiveness, possible adverse health effects and esthetics, the costs of the treatment options will play a role in the choice of material. The aim of this study was to yield information on the relative cost-effectiveness of the use of composite resins and amalgam for the rerestoration of amalgam Class II restorations., Methods: As part of a larger randomized clinical trial, treatment effectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations. The main treatment outcome was longevity. Secondary outcomes included need of repair and quality of the margin while in situ. Costs were analyzed from the perspective of dentistry, assuming a treatment strategy aimed at offering 'value for money'. From this perspective, differential costs were based on personnel costs as approximated by treatment time., Results: Replacing an amalgam Class II restoration with amalgam is associated with lower costs than replacing with a composite resin. A sensitivity analysis, considering type of composite, increasing proficiency with the material, and time needed for future removal of material, demonstrated that these differences are fairly robust. The materials performed equally well for the first 5 years after placement with respect to longevity. Differences in secondary outcomes were minor and not all in favor of the same material., Conclusions: It is tentatively concluded that amalgams are more cost-effective than composites for replacing existing Class II amalgam restorations.

This retrospective study examined the survival and cost-effectiveness of five different types of dental materials used to restore various classes of cavity preparations in permanent teeth. Information on the restorations was obtained from the casenote records of 100 long-term adult patients treated at various times by 20 dentists in three city practices. Patients attended for checkups and restorative treatments on a regular basis for around 25 years on average, ranging from 10 to 46 years. All of the restorative materials lasted well, despite the frequent patient checkups and changes of dentists. Cusp-covered amalgams were approximately 3.8 times more cost-effective than were either cast gold or ceramometal crowns, and resin composites were approximately 3.7 times more cost-effective than were cast gold inlays for restoring Class IV preparations. However, there were no significant differences found in the cost-effectiveness of using either resin composites or glass-ionomer cements to restore Class III preparations, or between using either of these two materials, or amalgams, to restore Class V preparations.

Objectives: This study sought to determine the effects of variation in both dentists' decisions to treat and choice of treatment on the costs of care., Methods: Each of 37 patients was examined individually by several practicing dentists (between 3-22, mean = 6.2). For each dentist's recommended treatment for each patient, the total cost of restorative treatment was calculated first using the least expensive treatment possible for each tooth indicated as needing treatment, and second using the costs of specific treatment selected by each dentist, Results: Considerable variation was found among dentists in each patients cost of treatment using both methods. The mean of the median cost per patient of the specific treatment selected was three times larger than the cost per patient of basic treatment. Few dentists were found to consistently recommend higher or lower cost treatment plans., Conclusions: These findings suggest that inconsistencies in both dentists' decisions to intervene and dentists' selection of treatment can have a profound effect on cost. Further, focusing utilization review on "outlier dentists" is likely to be much less productive in containing costs and improving quality than comprehensive attempts to improve consistency across the profession.

Porcelain and laboratory-processed composite inlays and onlays are enjoying increasing popularity as a result of heightened patient concern over the esthetics and biocompatibility of restorative materials. This paper reviews current clinical concerns about porcelain and indirect composite restorations, focusing on indirect procedures, microleakage, technique sensitivity, long-term serviceability, finish and polish, abrasion, and wear resistance. The available data indicate that there are still significant limitations to the routine use of these esthetic alternatives for posterior restorations.

The paper reviews data on biological side-effects of dental materials on patients and also on personnel who routinely handle the materials. The incidence of adverse effects is low--in one study indicated to be 1:700 for all types of treatments. For individual types of materials, it will be significantly lower, and for restorative materials, probably in the 1:10,000 to 1:20,000 range. Allergic reactions are the most common type of adverse effect of dental materials. Lichenoid reactions on the oral mucous membrane adjacent to amalgam restorations are the most frequently encountered side-effects for a specific group of restorative materials. Cost analyses were based on reports of longevity of different restorations and the cost of restorations at the time of placement. Amalgam restorative therapy was more cost-effective than composite restorations and gold castings.