Cumulative costs for the prosthetic reconstructions and maintenance in young adult patients with birth defects affecting the formation of teeth.

OBJECTIVES: To assess retrospectively the cumulative costs for the long-term oral rehabilitation of patients with birth defects affecting the development of teeth. METHODS: Patients with birth defects who had received fixed reconstructions on teeth and/or implants > or =5 years ago were asked to participate in a comprehensive clinical, radiographic and economic evaluation. RESULTS: From the 45 patients included, 18 were cases with a cleft lip and palate, five had amelogenesis/dentinogenesis imperfecta and 22 were cases with hypodontia/oligodontia. The initial costs for the first oral rehabilitation (before the age of 20) had been covered by the Swiss Insurance for Disability. The costs for the initial rehabilitation of the 45 cases amounted to 407,584 CHF (39% for laboratory fees). Linear regression analyses for the initial treatment costs per replaced tooth revealed the formula 731 CHF+(811 CHF x units) on teeth and 3369 CHF+(1183 CHF x units) for reconstructions on implants (P<.001). Fifty-eight percent of the patients with tooth-supported reconstructions remained free from failures/complications (median observation 15.7 years). Forty-seven percent of the patients with implant-supported reconstructions remained free from failures/complications (median observation 8 years). The long-term cumulative treatment costs for implant cases, however, were not statistically significantly different compared with cases reconstructed with tooth-supported fixed reconstructions. Twenty-seven percent of the initial treatment costs were needed to cover supportive periodontal therapy as well as the treatment of technical/biological complications and failures. CONCLUSION: Insurance companies should accept to cover implant-supported reconstructions because there is no need to prepare healthy teeth, fewer tooth units need to be replaced and the cumulative long-term costs seem to be similar compared with cases restored on teeth.

Medical necessity of orthognathic surgery for the treatment of dentofacial deformities associated with temporomandibular disorders.

This retrospective study assessed the medical necessity of orthognathic surgery for the treatment of dentofacial deformities associated with temporomandibular joint disorders from a perspective of cost effectiveness, myofascial and masticatory function, and quality of life. Questionnaires were mailed to 385 orthognathic surgical patients from one oral and maxillofacial surgery practice. Each questionnaire consisted of three sections: medical costs associated with the patient's orofacial symptoms, symptoms associated with the patient's condition, and the patient's quality of life. One hundred fifty patients responded to the questionnaire. On average, patients spent less money per month on costs associated with their orofacial problem after surgery, and there were fewer visits to the doctor postoperatively. All temporomandibular symptoms were significantly reduced postoperatively, with the exception of facial pain. Quality of life also showed improvement postoperatively. Although orthognathic surgery may be of slightly greater benefit to specific groups of patients based on occlusal relationship and age, all patients in this study showed significant postoperative improvement.