Abstract
ObjectivesWe evaluated the initial and follow-up treatment costs of different post-restorations in a practice-based German healthcare setting.MethodsA total of 139 incisors, canines, or premolars received post-restorations placed by eight general dental practitioners in Germany, and were followed over a mean ± SD 7.1 ± 4.5 years. Preformed metal (MP, n = 68), glass-fiber (GF, n = 28), or cast post-and-core buildups (MC, n = 23) had been used to retain crowns or bridge anchors. Preformed metal and glass-fiber had also been used to retain directly built up post-retained composite restorations (PC, n = 20). Material and treatment costs for the initial post-restorations as well as restorative, endodontic, or surgical re-treatments were estimated from a public-payer-perspective in Germany. Associations between total and annualized total costs and covariates were assessed using generalized linear modeling. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00012938).ResultsMC showed highest initial treatment costs (557.23 Euro), but the least re-treatments (6/23, 26%), while PC showed lowest initial costs (203.52 Euro) but the most re-treatments (11/20, 55%). Costs for MP/GF post-crowns were initially similarly costly (496.47/496.87 Euro), and both also showed similar re-treatments (35%/36%). The overall annual failure rate was 5.2% (MC: 3.5%, MP: 4.6%, GF: 5.3%, PC: 10.3%). Including costs for the resulting re-treatments, mean total costs were 591.66 Euro (MC), 548.31 Euro (MP), 526.37 Euro (GF), and 361.81 Euro (PC). Annualized total costs were 171.36 Euro (MC), 141.75 Euro (MP), 146.12 Euro (GF), and 135.65 Euro (PC). Total and annualized total costs were highest for MC, with PC being the significantly less costly option (p < 0.001).ConclusionsWithin German healthcare, both initial and follow-up costs for post-restorations were considerable. Saving costs initially may, at least partially, be offset by more complications long-term.Clinical relevanceDentists need to be aware that the placement of posts is not only initially costly but also comes with significant long-term costs for treating occurring complications. This should be communicated with patients and considered during treatment planning.
Highlights
Materials and methodsFor endodontically treated teeth with extensive loss of coronal hard tissue, post placement is often performed to allow a subsequent core buildup
Different post materials may come with different risks of root fracture [2, 3] and different failure rates. [4,5,6,7] clinical studies indicate only limited differences between different posts
In a reduced model, including only the post-restoration type, the gender, age, and follow-up period, we found post-retained composites (PC) to be significantly less costly than MC again both when assessing total and total annualized costs
Summary
Materials and methodsFor endodontically treated teeth with extensive loss of coronal hard tissue, post placement is often performed to allow a subsequent core buildup. A number of previous investigations have assessed success and survival of post-restorations, showing limited annual failure rates of such restorations, at 0–2% per year. Different post materials may come with different risks of root fracture [2, 3] and different failure rates. [4,5,6,7] clinical studies indicate only limited differences between different posts. Limited differences in risks of failure may, translate in substantial long-term costs depending if such failures are mainly re-cementations, renewals of the whole restoration, or extractions and tooth replacement. The coronal restoration (crown or direct composite restoration) may heavily affect initial costs and long-term complications too, with direct post-retained composites (PC) probably being less costly, but possibly less successful. The coronal restoration (crown or direct composite restoration) may heavily affect initial costs and long-term complications too, with direct post-retained composites (PC) probably being less costly, but possibly less successful. [9]
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