Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-29T05:24:21.066Z Has data issue: false hasContentIssue false

Technology assessment in dentistry: A comparison of the longevity and cost-effectiveness of inlays

Published online by Cambridge University Press:  04 August 2005

Afschin Gandjour
Affiliation:
University of Cologne
Thomas Kerschbaum
Affiliation:
University of Cologne
Andreas Reis
Affiliation:
World Health Organization
Karl Wilhelm Lauterbach
Affiliation:
University of Cologne

Abstract

Objectives: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges.

Results: Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40–8.85), 8.65 (8.58–8.73), and 8.76 (8.72–8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive.

Conclusions: While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.

Type
GENERAL ESSAYS
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antczak-Bouckoms AA, Weinstein MC. 1987 Cost-effectiveness analysis of periodontal disease control. J Dent Res. 66: 16301635.Google Scholar
Axelsson S, Dahlgren H, Svensson Å, et al. 2000. Need to assess dental care. White Report. Stockholm: The Swedish Council on Technology Assessment in Health Care;
Bergman MA. 1999 The clinical performance of ceramic inlays: A review. Aust Dent J. 44: 157168.Google Scholar
Birch S. 1986 Measuring dental health: Improvements on the DMF index. Community Dent Health. 3: 303311.Google Scholar
Chadwick BL, Dummer PM, Dunstan F, et al. 2001. The longevity of dental restorations: A systematic review. NHS CRD Report 19. York: University of York;
Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC. 1990 Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation. 82: 11061116.Google Scholar
Erpenstein H, Kerschbaum T, Halfin T. 2001 Long-term survival of cast-gold inlays in a specialized dental practice. Clin Oral Investig. 5: 162166.Google Scholar
Fieller EC. 1954 Some problems in interval estimation. J R Stat Soc (B). 16: 175183.Google Scholar
Fradeani M, Aquilano A, Bassein L. 1997 Longitudinal study of pressed glass-ceramic inlays for four and a half years. J Prosthet Dent. 78: 346353.Google Scholar
Fuzzi M, Rappelli G. 1999 Ceramic inlays: Clinical assessment and survival rate. J Adhes Dent. 1: 7179.Google Scholar
Gold MR, Siegel JE, Russell LB, Weinstein MC. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press;
Greenwood M. 1926 The natural duration of cancer. Rep Pub Health Med Sub. 33: 126.Google Scholar
Haberkorn T. 2003. Verweildaueranalyse von Goldgussinlays und Teilkronen [dissertation]. Cologne: University of Cologne;
Harris EK, Albert A. 1991 Survivorship analysis for clinical studies. New York: Marcel Dekker; 2949.
Hickel R, Manhart J. 2001 Longevity of restorations in posterior teeth and reasons for failure. J Adhes Dent. 3: 4564.Google Scholar
Isidor F, Brondum K. 1995 A clinical evaluation of porcelain inlays. J Prosthet Dent. 74: 140144.Google Scholar
Leake JL, Birch S, Lewis DW. 1994 Technology assessment in dentistry. J Can Dent Assoc. 60: 10661070.Google Scholar
Lenzen JR. 1994. Bewährung von computer-gestützt hergestellten Keramik-Inlays nach der CEREC-Methode in einer zahnärztlichen Praxis [dissertation]. Cologne: University of Cologne;
Mjor IA. 1992 Long term cost of restorative therapy using different materials. Scand J Dent Res. 100: 6065.Google Scholar
Molin MK, Karlsson SL. 2000 A randomized 5-year clinical evaluation of 3 ceramic inlay systems. Int J Prosthodont. 13: 194200.Google Scholar
Otto T, De Nisco S. 2002 Computer-aided direct ceramic restorations: A 10-year prospective clinical study of Cerec CAD/CAM inlays and onlays. Int J Prosthodont. 15: 122128.Google Scholar
Perleth M, Luhmann D, Gibis B, Droste S. 2001 ‘Rapid Assessments’—schnelle Bewertung medizinischer Technologien. Gesundheitswesen. 63 (Suppl 1): S79S84.Google Scholar
Pocock SJ, Clayton TC, Altman DG. 2002 Survival plots of time-to-event outcomes in clinical trials: Good practice and pitfalls. Lancet. 359: 16861689.Google Scholar
Posselt A. 2003 Kerschbaum T. Longivity of 2328 chairside CEREC inlays and onlays. Int J Computerized Dent. 6: 231238.Google Scholar
Reiß B. 2001 Long-term clinical performance of CEREC restorations and the variables affecting treatment success. Compend Contin Educ Dent. 22 (Suppl): 1418.Google Scholar
Schauermann M. 1998. Verweildauer von “at chairside”-hergestellten CEREC-Restaurationen in einer Kölner Zahnarztpraxis [dissertation]. Cologne: University of Cologne;
Shekelle PG, Ortiz E, Rhodes S, et al. 2001 Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: How quickly do guidelines become outdated? JAMA. 286: 14611467.Google Scholar
Studer SP, Wettstein F, Lehner C, Zullo TG, Scharer P. 2000 Long-term survival estimates of cast gold inlays with their analysis of failures. J Oral Rehabil. 27: 461472.Google Scholar
Wilson EB. 1927 Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 22: 209212.Google Scholar