A comparison of cost and cost-effectiveness analysis of two- implant-retained overdentures versus other removable prosthodontic treatment options for edentulous mandible: A systematic review

Abstract

Aim: The aim of this study was to examine systematically the data published on the cost and cost-effectiveness of mandibular two-implant-retained overdentures compared to other removable prosthodontic treatment options for edentulous mandible. Settings and Design: It is a systematic review which analyses the available data from the prospective and retrospective studies and randomized clinical trials to find out costs and cost effectiveness of different removable treatment modalities for completely edentulous mandible. The study protocol was decided according to PRISMA guidelines. Materials and Methods: The search was limited to English literature only and included an electronic search through PubMed Central, Cochrane Central Register of Controlled Trials, and complemented by hand-searching. All clinical trials published up to August 2019 were included (without any starting limit). Two independent investigators extracted the data and assessed the studies. Statistical Analysis Used: No meta-analysis was conducted because of the high heterogeneity of data. Results: Out of the initial 509 records, only nine studies were included. The risks of bias of individual studies were assessed. Six studies presented data on cost and cost analysis only. The rest three articles provided data on cost-effectiveness. The overall costs of implant overdentures were higher than the conventional complete dentures. However, implant overdentures were more cost-effective when compared to conventional complete dentures. Single-implant overdentures are also less expensive than two-implant overdentures. Overdentures supported by two or four mini-implants were also reported as more cost-effective than conventional two-implant-supported overdentures. Conclusions: Two-implant-retained overdentures are more expensive but cost-effective than the conventional complete dentures. Two- or four-mini-implant-retained overdentures are less expensive than two-implant-retained overdentures, but there is a lack of long-term data on aftercare cost and survival rate of mini-implants. Single-implant overdentures are also less expensive than the two-implant-retained overdentures. The differences of the aftercare costs of different attachment systems for implant overdentures were not significant. There is a need of further studies on comparative cost-effectiveness of different types of implant overdentures.

A comparative evaluation of masticatory load distribution in different types of prosthesis with varying number of implants: A FEM analysis

“…This suggests that the stress around the peri-implant bone was within the range of the physiological tolerance limit and had only a slight impact on the implant survivability. 16 , 17 , 18 …”

Clinical Outcomes of Three versus Four Mini-Implants Retaining Mandibular Overdenture: A 5-Year Randomized Clinical Trial

“…Therefore, they recommended the splitting of two mini-implants for better clinical success or the insertion of four MDIs as single units. Also, a lack of data exists about the aftercare costs and survival rates of two miniimplants for mandibular OD retention [31]. The study of Misfud et al [32] described an MBL change in two MDIs, but they used category 2 narrow implants (diameter = 2.9 mm, with locator system for the retention of ODs).…”

Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible

“…However, the difference between the two OD solutions was broadly neutralised in the sensitivity analysis, showing a comparable ranking of the OD strategies, because of the similarity in their cost and effectiveness for both the time horizons. The costeffectiveness of two-implant retained OD has been already showed in several studies, 42 advocating its dominance on the other removable solutions. A result not in accord with the literature has been obtained for the OD supported by mini-implants, in the present model such solution resulted to be the less convenient, considering the associated costs (4742,00€) and utility (0,81 normalised points); meanwhile, some studies advocate its convenience compared to the standard implants OD solutions 43 and a significantly higher success rate.…”