Long-term treatment costs and cost-effectiveness of restoration repair versus replacement

Objectives. When managing partially defective restorations, dentists can choose between repair and replacement. We aimed to assess the long-term treatment costs of repairs and replacements. Methods. Partially defective anterior and posterior composite restorations in permanent teeth had been repaired or replaced in a German university hospital and were retrospectively followed until censoring or one of the following events: (1) Extraction, (2) Major complications including placement of indirect restorations, endodontic treatments and extractions, or (3) Any complications including major complications and further direct restorations. Costs were estimated from a German mixed public-private-payer perspective. Cost-effectiveness differences were described using median-based incremental-cost-effectiveness ratios (ICERMEDIAN). Statistical analysis was performed using generalized linear mixed modeling (GLM), Chi(2)-test, and Wilcoxon rank-sum test (p < 0.05). Results. A total of 616 repairs in 468 patients (follow-up: 4.9 +/- 4.1 years) and 264 replacements in 218 patients (follow-up: 4.8 +/- 4.3) were included. While replacements were associated with higher initial treatment costs, median annualized treatment costs did not significantly differ between repair (47.58 Euro [IQR: 24.41-107.04]) and replacement (50.64 Euro [IQR: 26.30-118.78]; p > 0.05), but were higher for molars (75.53 Euro [IQR: 24.41-92.18]) than incisors (45.03 Euro [IQR: 28.19-168.50]; p = 0.011). The difference in the % of extractions, major and any complications were minimal between both groups. The mean ICERMEDIAN of replacement vs. repair was -146.8 Euro/% when extractions were considered as outcomes. Regarding major and any complications, mean ICERMEDIAN amounted to 67.6 Euro/% and 23.9Euro/%, respectively. Significance. Repairs and replacements of partially defective restorations showed similar long-term costs and cost-effectiveness. (C) 2021 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

Automated summary

The study found that there was no significant difference in the median annualized treatment costs between repairs and replacements for partially defective restorations, but the treatment costs for molars were higher than for incisors.