Long-term treatment costs for aggressive periodontitis in a German population.

AIM: This study assessed the long-term annual costs for treating aggressive periodontitis (AgP) patients. METHODS: A cohort of compliant AgP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planing, open flap debridement, root resections, but not pocket elimination or regenerative surgery) and supportive periodontal therapy (SPT, including also costs for restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer perspective in Germany. The impact of tooth- and patient-level factors on annual costs was assessed using mixed modelling. RESULTS: A total of 52 patients (mean [SD] age: 35.2/6.8 years), with 26.5 (4.0) teeth (38% with bone loss >50%) were treated. Mean follow-up (retention) time was 16.9 (5.4) years. Total treatment costs per patient and per tooth were 6,998 (3,807) and 267 (148) Euro, respectively. Approximately 87% of the costs were generated during SPT, 13% during APT. Annual patient- and tooth-level costs were 536 (209) and 20.1 (65.0) Euro, respectively. Annual tooth-level costs were significantly increased in patients aged 34 years or older, male patients, former or current smokers, teeth with furcation involvement degree II/III, and bone loss 50%-70%. CONCLUSIONS: Annual treatment costs for treating AgP patients were similar to those found for chronic periodontitis patients. Certain parameters might predict costs.

Incorporating severity and risk as factors to the Fardal cost-effectiveness model to create a cost-benefit model for periodontal treatment.

BACKGROUND: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation. METHODS: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk. RESULTS: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787. CONCLUSION: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.

A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects.

PURPOSE: To identify the most cost-effective approach to treatment of infrabony lesions with enamel matrix derivatives (EMD). METHODS: We incorporated costs and clinical outcomes of 12 different treatment techniques (including flap operation, EMD alone, and EMD in association with other reconstructive devices) within a decision tree model in which costs were based on insurance regulations in Germany and health outcomes followed a recent meta-analysis. The most cost-effective treatment option was identified on the basis of the maximum net benefit criterion. RESULTS: Treatment techniques using EMD were cost-efficient if the decision maker's willingness-to-pay (WTP) was at least €150-175 per incremental mm of pocket probing depth reduction and clinical attachment level gain, respectively (1-year perspective). When EMD was affordable, the maximum net benefit was achieved by treatment with EMD in conjunction with bioactive glass or bovine bone substitutes. Additional application of platelet-rich plasma (PRP) or a resorbable membrane came at relatively high costs. CONCLUSIONS: If EMD use is indicated, EMD in conjunction with either bioactive glass or bovine bone substitutes is more cost-effective than EMD alone. The additional use of PRP or a resorbable membrane may only be justifiable when monetary resources for treatment are very generous.

Effort and costs of tooth preservation in supportive periodontal treatment in a German population.

OBJECTIVES: Assessment of effort (number of visits) and costs of tooth preservation 10 years after initiation of anti-infective therapy. MATERIAL AND METHODS: Data of 98 patients who had received active periodontal treatment 10 years ago by the same examiner were analysed to gather information on effort and costs of supportive periodontal therapy (SPT). Clinical examination, interleukin-1 (IL-1) polymorphism test, smoking, search of patients' files (i.e. initial diagnosis), as well as a questionnaire on medical history and socioeconomic data were performed. Statistical analysis was performed using multivariate linear regression analysis. RESULTS: During 10 years of SPT patients had 14.8+/-7.4 visits. Number of visits was statistically significantly higher for individuals with a mean plaque control record >or=24 %. The number of subgingival scalings per tooth ranged from 0 to 14 (mean: 1.17). On tooth level several confounders could be identified: tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery (p

[Usefulness of hydroxyapatite implants for the management of alveolar bone lesions at tooth hemisection sites]. / Badanie skutecznosci wszczepów hydroksyapatytowych w leczeniu zniszczen wyrostka zebodolowego w obrebie zebów leczonych metoda hemisekcji.

INTRODUCTION: Hemisection is a surgical method for treating lesions of two- and multi-rooted teeth. This procedure includes amputation of one or two lesioned roots together with the attached dental crown, leaving an endodontically treated root and the remaining dental crown prepared for future prosthetic restoration. The results of this study demonstrate that HA Biocer implants create optimal conditions for new bone growth. MATERIAL AND METHODS: The study was done in 51 patients after hemisection treated with HA Biocer in the form of granules implanted into the alveolus. The control group consisted of 45 patients without an alloplastic implant. The following indices were assessed: radiological index of alveolar bone atrophy in the maxilla and mandible according to Engelberger, Marthaler and Rateischak [EMR]; gingival pocket depth with WHO 621 probe; tooth mobility index according to Entin; root denudation index according to Cieszyfiski; bacterial plaque index (P1.1.) according to Silness and Löe. Measurements were done before hemisection and were repeated after 1.5, 6, 12, 24, 36, 48, and 60 months thereafter. It was found that hydroxyapatite implants improved the condition of the hemisected tooth and arrested the destruction process in the alveolar bone. RESULTS: (1) In the study group (HA Biocer), no bone atrophy was noted in the root region after hemisection, whereas bone loss in the control group reached 11%. (2) The depth of gingival pockets in the study group was half of the depth in the control group. (3) Significant tooth stabilization was achieved in the study group, mainly during the first two years after implantation. Improved tooth stability was noted three times less often in the control group during the same period. (4) Root denudation diminished in patients treated with HA Biocer and increased or remained unchanged in controls. (5) A steady decrease in mean P1.1. index values was observed in both groups over the five-year follow-up period. However, the mean P1.1. value in the study group was one-third of the value in the control group.