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Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare

Elhennawy, Karim ; Jost-Brinkmann, Paul-Georg ; Manton, David John ; Paris, Sebastian ; Schwendicke, Falk

Journal of dentistry, 2017-08, Vol.63, p.65-71 [Periódico revisado por pares]

England: Elsevier Ltd

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Título:
Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare
Autor: Elhennawy, Karim ; Jost-Brinkmann, Paul-Georg ; Manton, David John ; Paris, Sebastian ; Schwendicke, Falk
Assuntos: Age ; Alignment ; Child ; Composite materials ; Composite Resins - economics ; Computer modelling ; Computer Simulation ; Cost analysis ; Cost-Benefit Analysis ; Crowns ; Defects ; Dental crowns ; Dental enamel ; Dental Enamel Hypoplasia - economics ; Dental Enamel Hypoplasia - therapy ; Dental Health Services - economics ; Dental implants ; Dental Restoration Failure ; Dental Restoration, Permanent ; Dental restorative materials ; Dentistry ; Dentists ; Enamel ; Extraction ; Germany ; Health care ; Humans ; Male ; Mandible ; Markov model ; Maxilla ; Medical prognosis ; Mineralization ; Molar ; Monte Carlo simulation ; Orthodontics ; Orthodontics, Corrective ; Orthondontics ; Paediatric dentistry ; Pediatric Dentistry ; Restoration ; Restorative dentistry ; Retreatment ; Teeth ; Tooth Extraction ; Transition probabilities ; Transplants & implants
É parte de: Journal of dentistry, 2017-08, Vol.63, p.65-71
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Abstract 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.
Editor: England: Elsevier Ltd
Idioma: Inglês

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Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare

Elhennawy, Karim ; Jost-Brinkmann, Paul-Georg ; Manton, David John ; Paris, Sebastian ; Schwendicke, Falk

England: Elsevier Ltd

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