IADR Abstract Archives
Implant Interventions for the Edentulous Mandible: 1-year Cost-Effectiveness Clinical Trial
Objectives: There is growing evidence that simplified implant treatments for edentulous patients result in favorable outcomes and may be considered as alternatives to more complex interventions. This parallel three-group randomized clinical trial alongside a cost-effectiveness analysis compared the 1-year outcomes of treatment strategies for the edentulous mandible: single-implant (G-I; n=11) or two-implant overdentures (G-II; n=13), and fixed 4-implant denture (G-III; n=13).
Methods: Implants (Neodent TI-Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group. Outcomes were assessed up to 1-year, including implant survival, patient-reported outcomes, masticatory performance, peri-implant bone changes, longitudinal implant stability, peri-implant aspects, incidence of prosthodontics events, and costs. Data analyses included pairwise comparison tests, estimates of effect sizes and incidence rates, cost and cost-outcome estimates, and regression analysis using Generalized Estimating Equations.
Results: Implant survival was 100% with no biological or technical complications. Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and masticatory performance, compared to baseline. No significant between-group differences were found, although effect sizes were higher for G-III. No relevant detrimental effects were found regarding longitudinal implant stability and peri-implant features. Incidence of prosthodontics complications was higher for G-I and G-II, mainly due to overdenture fracture and replacement of retentive inserts. Incremental costs ranged from 252% (G-I) to 741% (G-III), and incremental cost-effectiveness ratios suggested that costs for G-III were not proportional to the respective gain in effectiveness.
Conclusions: All treatments improved the assessed outcomes after transition from the baseline condition. Although G-III was associated with slightly better patient-perceived outcomes and fewer prosthodontics complications, economic analysis suggests that mandibular overdentures, irrespective of the use of one or two implants for retention, were more cost-effective than the fixed 4-implant treatment.
Methods: Implants (Neodent TI-Cortical, Brazil) were inserted using single-stage surgery and conventional loading. The mandibular dentures were incorporated into implants using specific retention systems and procedures according to the treatment group. Outcomes were assessed up to 1-year, including implant survival, patient-reported outcomes, masticatory performance, peri-implant bone changes, longitudinal implant stability, peri-implant aspects, incidence of prosthodontics events, and costs. Data analyses included pairwise comparison tests, estimates of effect sizes and incidence rates, cost and cost-outcome estimates, and regression analysis using Generalized Estimating Equations.
Results: Implant survival was 100% with no biological or technical complications. Results showed improvement in patient-reported outcomes (lower OHIP-Edent scores and higher satisfaction) and masticatory performance, compared to baseline. No significant between-group differences were found, although effect sizes were higher for G-III. No relevant detrimental effects were found regarding longitudinal implant stability and peri-implant features. Incidence of prosthodontics complications was higher for G-I and G-II, mainly due to overdenture fracture and replacement of retentive inserts. Incremental costs ranged from 252% (G-I) to 741% (G-III), and incremental cost-effectiveness ratios suggested that costs for G-III were not proportional to the respective gain in effectiveness.
Conclusions: All treatments improved the assessed outcomes after transition from the baseline condition. Although G-III was associated with slightly better patient-perceived outcomes and fewer prosthodontics complications, economic analysis suggests that mandibular overdentures, irrespective of the use of one or two implants for retention, were more cost-effective than the fixed 4-implant treatment.