Abstract
Objectives: Children and adolescents with amelogenesis imperfecta (AI) have extensive treatment needs, but costs have not been explored previously. We calculated the costs of prosthetic rehabilitation and analyzed whether costs of treatment begun in early adolescence are lower compared with in early adulthood. Methods: Data from the dental records of 25 patients with AI and 25 age- and sex-matched controls were analyzed. Patients were followed for a mean period of 12.3 ± 1.5 years. Number of dental visits, dental treatment costs, and indirect costs were calculated during three time periods, before, during and after prosthetic therapy. Swedish national reference prices for general and specialist dental care were used. Results: The mean number of visits was significantly higher in the AI group: 43.3 ± 19.7 (controls: 17.5 ± 19.8; p < .001). Mean total costs were 8.5 times higher for patients with AI: €16,257 ± 5,595 (controls: €1,904 ± 993). Mean number of crowns made in patients with AI was 12 ± 7 (range 1 − 31). Indirect costs were significantly higher in the AI group and constituted 22% of the total costs. After crown therapy, costs between groups ceased to differ significantly. Calculations of total costs in the hypothetical scenario (discount rate at 3% annually) were €18,475 for prosthetic rehabilitation began at age 12 years compared with €20,227 if treatment began at 20 years of age. Conclusions: Prosthetic rehabilitation costs for children and adolescents with AI can be high. Early crown therapy is associated with lower costs and a lower number of dental visits. Clinical ImplicationsEarly crown therapy in children and adolescents with severe AI is a cost-reducing treatment associated with few complications and reduced need of dental care during adolescence compared with treatment begun at age 20.
Highlights
Amelogenesis imperfecta (AI) is a hereditary developmental disorder affecting the enamel of all or most teeth [1, 2]
Due to the alterations in enamel quality that occur in patients with AI, con ventional composite resin restorations have a significantly shorter longevity compared to restorations in patients with normal enamel [4]
We found no significant differences regarding start of crown therapy (p = .336) or number of crowns made (p= . 969) in relation to AI type
Summary
Amelogenesis imperfecta (AI) is a hereditary developmental disorder affecting the enamel of all or most teeth [1, 2]. Patients with severe forms of AI present with tooth hypersensitivity, enamel fractures, and tooth wear as well as alterations in color and shape (Fig. 1), all of which compromise esthetic appearance and masticatory function [3]. Due to the alterations in enamel quality that occur in patients with AI, con ventional composite resin restorations have a significantly shorter longevity compared to restorations in patients with normal enamel [4]. This lower quality of composite resin restorations engenders a recurring need for replacements and dental visits. Stress levels are higher due to experiences of pain and frequent emergency visits for fractures or failed restorations [7]
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