Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano
Ano de defesa: | 2019 |
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Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | , , , , |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | eng |
Instituição de defesa: |
Universidade Federal de Goiás
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Programa de Pós-Graduação: |
Programa de Pós-graduação em Odontologia (FO)
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Departamento: |
Faculdade de Odontologia - FO (RG)
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País: |
Brasil
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Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | http://repositorio.bc.ufg.br/tede/handle/tede/10168 |
Resumo: | This randomized trial compared the effectiveness and cost-effectiveness (cost x patient centered outcomes) of three treatment alternatives for mandibular edentulism rehabilitation: unit-implant-retained mandibular overdenture (Group I), two-implant-retained mandibular overdenture (Group II) and four-implant-supported mandibular fixed prosthesis (Group III). We included 50 fully edentulous patients who initially received new conventional total dentures (baseline) and were later randomly allocated to one of the treatment groups. External hexagon implants (Titamax TI Cortical, Neodent, Curitiba, Brazil) were installed following the conventional loading installation protocol. Generalized Estimating Equations (GEE) was used to calculate the primary outcome variables were the direct dental costs which were identified, measured and valued; oral health-related quality of life (OHIP-Edent) and patient satisfaction with prostheses in all groups for a follow-up period of 1 year. Masticatory performance, prosthetic complications, maintenance events and peri-implant evaluation (marginal bone loss, peri-implant tissue status, implant stability quotient - ISQ) were evaluated as secondary outcomes. Data from 37 participants: Group I (n = 11); Group II (n = 13); Group III (n = 13) were collected and were similar in relation to baseline clinical characteristics and outcomes of initial treatment with conventional full dentures. Incremental cost-effectiveness - ICER ranged for Group II (compared to Group I) from R$ 36.20 to R$ 81.46 for a 1-point increase in patient satisfaction (base value = R$ 54.30) for Group III (compared to Group I) ranged from R$ 1321.12 to R$ 2972.52 (base value = R$ 1981.68). The total cost of treatment for the surgical and prosthetic phases was R$ 2,370.70 for Group I, R$ 3,185.20 for Group II and R$ 5,739.50 for Group III. There was a significant difference between the costs in the three groups (p <0.001). The greatest impacts on total treatment cost were related to the initial laboratory, implant and component costs in Group III. The satisfaction questionnaires and OHIP-Edent satisfaction scores in the 12 months improved in all groups compared to baseline. and were similar in intergroup comparison at baseline (with new conventional full dentures) and 1 year after implant prosthesis capture. In intra- and inter-group comparisons there was no significant change regarding satisfaction with the maxillary prosthesis. Regarding masticatory performance, there was no difference between groups evaluated in the same period for the different cycles (20 and 50 cycles) with gradual improvement for all groups up to 6 months and a slight decrease in 12 months for all groups. It was concluded that the rehabilitation of edentulous patients with implants significantly improved patient-reported outcomes in all treatment groups. Regarding the economic aspects of the treatments, the direct dental cost and the clinical time spent to perform the treatment and follow-up during the 1 year period in the fixed prosthesis (Group III) was approximately three times higher than in Group I, which did not correspond to a proportional gain in effectiveness as well as the additional cost of overdenture retained by two implants did not result in significant effectiveness gain over overdenture retained per unit implant. The implant survival was 100% in all groups after the 1-year follow-up. Considering the limitations of the study, implant-retained overdentures were the most cost-effective modalities. |
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Leles, Cláudio Rodrigueshttp://lattes.cnpq.br/6740286066154410Schimmel, MartinLeles, Cláudio RodriguesGonçalves, Thais Marques Simek VegaAbreu, Mauro Henrique Nogueira Guimarães deRibeiro-Rotta, Rejane FariaNogueira, Túlio Eduardohttp://lattes.cnpq.br/5981857085438577Hartmann, Roberto2019-11-11T15:24:08Z2019-08-23HARTMANN, R. Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano. 2019. 102 f. Tese (Doutorado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2019.http://repositorio.bc.ufg.br/tede/handle/tede/10168This randomized trial compared the effectiveness and cost-effectiveness (cost x patient centered outcomes) of three treatment alternatives for mandibular edentulism rehabilitation: unit-implant-retained mandibular overdenture (Group I), two-implant-retained mandibular overdenture (Group II) and four-implant-supported mandibular fixed prosthesis (Group III). We included 50 fully edentulous patients who initially received new conventional total dentures (baseline) and were later randomly allocated to one of the treatment groups. External hexagon implants (Titamax TI Cortical, Neodent, Curitiba, Brazil) were installed following the conventional loading installation protocol. Generalized Estimating Equations (GEE) was used to calculate the primary outcome variables were the direct dental costs which were identified, measured and valued; oral health-related quality of life (OHIP-Edent) and patient satisfaction with prostheses in all groups for a follow-up period of 1 year. Masticatory performance, prosthetic complications, maintenance events and peri-implant evaluation (marginal bone loss, peri-implant tissue status, implant stability quotient - ISQ) were evaluated as secondary outcomes. Data from 37 participants: Group I (n = 11); Group II (n = 13); Group III (n = 13) were collected and were similar in relation to baseline clinical characteristics and outcomes of initial treatment with conventional full dentures. Incremental cost-effectiveness - ICER ranged for Group II (compared to Group I) from R$ 36.20 to R$ 81.46 for a 1-point increase in patient satisfaction (base value = R$ 54.30) for Group III (compared to Group I) ranged from R$ 1321.12 to R$ 2972.52 (base value = R$ 1981.68). The total cost of treatment for the surgical and prosthetic phases was R$ 2,370.70 for Group I, R$ 3,185.20 for Group II and R$ 5,739.50 for Group III. There was a significant difference between the costs in the three groups (p <0.001). The greatest impacts on total treatment cost were related to the initial laboratory, implant and component costs in Group III. The satisfaction questionnaires and OHIP-Edent satisfaction scores in the 12 months improved in all groups compared to baseline. and were similar in intergroup comparison at baseline (with new conventional full dentures) and 1 year after implant prosthesis capture. In intra- and inter-group comparisons there was no significant change regarding satisfaction with the maxillary prosthesis. Regarding masticatory performance, there was no difference between groups evaluated in the same period for the different cycles (20 and 50 cycles) with gradual improvement for all groups up to 6 months and a slight decrease in 12 months for all groups. It was concluded that the rehabilitation of edentulous patients with implants significantly improved patient-reported outcomes in all treatment groups. Regarding the economic aspects of the treatments, the direct dental cost and the clinical time spent to perform the treatment and follow-up during the 1 year period in the fixed prosthesis (Group III) was approximately three times higher than in Group I, which did not correspond to a proportional gain in effectiveness as well as the additional cost of overdenture retained by two implants did not result in significant effectiveness gain over overdenture retained per unit implant. The implant survival was 100% in all groups after the 1-year follow-up. Considering the limitations of the study, implant-retained overdentures were the most cost-effective modalities.Este ensaio clínico randomizado comparou a efetividade e o custo-efetividade (custo x desfecho centrado no paciente) de três alternativas de tratamento para a reabilitação do edentulismo mandibular: overdenture mandibular retida por implante unitário (Grupo I), overdenture mandibular retida por dois implantes (Grupo II) e prótese fixa mandibular suportada por quatro implantes (Grupo III). Foram incluídos 50 desdentados totais os quais receberam inicialmente novas próteses totais convencionais (baseline) sendo posteriormente,alocados aleatoriamente para um dos grupos de tratamento. Implantes do tipo hexágono externo (Titamax TI Cortical, Neodent, Curitiba, Brasil) foram instalados seguindo o protocolo de instalação para carga convencional. Equações de Estimações Generalizadas (GEE) foram utilizadas para variáveis de desfecho primário como os custos odontológicos diretos os quais foram identificados, mensurados e valorados; a qualidade de vida relacionada à saúde oral (OHIP-Edent) e a satisfação do paciente com as próteses, em todos os grupos por um período de acompanhamento de 1 ano. A performance mastigatória, complicações protéticas, eventos de manutenção e avaliação peri-implantar (perda óssea marginal, estabilidade dos tecidos peri-implantares, quociente de estabilidade implantar – ISQ) foram avaliadas como desfechos secundários. Dados de 37 participantes: Grupo I (n=11); Grupo II (n=13); Grupo III (n=13) foram coletados sendo semelhantes em relação às características clínicas basais e desfechos do tratamento inicial com prótese total convencional. O custo-efetividade incremental - ICER variou para o Grupo II (comparado ao Grupo I) de R$ 36,20 a R$ 81,46 para um incremento de 1 ponto na satisfação do paciente (valor base = R $ 54,30), para o Grupo III (comparado ao Grupo I) variou de R$ 1321,12 a R$ 2972,52 (valor base = R $ 1981,68). O custo total do tratamento referente as fases cirúrgica e protética foi de R$ 2.370,70 para o Grupo I, R$ 3.185,20 para o Grupo II e R$ 5.739,50 para o Grupo III. Houve diferença significativa entre os custos nos três grupos (p<0,001). Os maiores impactos no custo total do tratamento foram relacionados aos custos iniciais laboratoriais, de implantes e componentes no Grupo III. Os escores dos questionários de satisfação com as próteses mandibulares e de OHIP-Edent no periodo de 12 meses apresentaram melhora em todos grupos em relação ao baseline. e foram semelhantes na comparação inter-grupos no tempo inicial (com as próteses totais convencionais novas) e 1 ano após a captura das próteses sobre implantes. Nas comparações intra e inter grupos não houve alteração significativa em relação à satisfação com a prótese maxilar. Em relação à performance mastigatória não houve diferença inter-grupos avaliados no mesmo período para os diferentes ciclos (20 e 50 ciclos) com melhora gradativa para todos os grupos até o período de 6 meses e leve queda no período de 12 meses para todos os grupos. Concluiu-se que reabilitação de pacientes desdentados totais com implantes melhorou significativamente os desfechos reportados pelo paciente em todos os grupos de tratamento. Com relação aos aspectos econômicos dos tratamentos, o custo direto odontológico e o tempo clínico dispendido para a realização do tratamento e acompanhamento durante o período de 1 ano na prótese fixa (Grupo III) foi aproximadamente três vezes maior em relação ao Grupo I o que não correspondeu a um ganho proporcional de efetividade assim como o custo adicional da overdenture retida por dois implantes não resultou em ganho de efetividade significativo em relação à overdenture retida por implante unitário. A taxa de sobrevida do implante, após um ano de acompanhamento, foi de 100% para todos os grupos. Levando em consideração as limitações do estudo, as overdenture retidas por implantes se apresentaram como modalidades mais custo-efetiva.Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2019-11-11T14:37:44Z No. of bitstreams: 2 Tese - Roberto Hartmann - 2019.pdf: 2709031 bytes, checksum: 83c7ab208554e65363d06cc23e86fc89 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2019-11-11T15:24:08Z (GMT) No. of bitstreams: 2 Tese - Roberto Hartmann - 2019.pdf: 2709031 bytes, checksum: 83c7ab208554e65363d06cc23e86fc89 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2019-11-11T15:24:08Z (GMT). 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dc.title.eng.fl_str_mv |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
dc.title.alternative.eng.fl_str_mv |
Effectiveness and cost-effectiveness of three treatment alternatives for rehabilitation of the edentulous mandible: one- year randomized clinical trial |
title |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
spellingShingle |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano Hartmann, Roberto Implante dentário Prótese dentária Ensaio clínico randomizado Análise de custo-efetividade Desfechos de tratamento dental Prosthodontics Randomized clinical trial Cost-effectiveness analysis Treatment outcomes Implant CIENCIAS DA SAUDE::ODONTOLOGIA |
title_short |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
title_full |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
title_fullStr |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
title_full_unstemmed |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
title_sort |
Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano |
author |
Hartmann, Roberto |
author_facet |
Hartmann, Roberto |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Leles, Cláudio Rodrigues |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/6740286066154410 |
dc.contributor.advisor-co1.fl_str_mv |
Schimmel, Martin |
dc.contributor.referee1.fl_str_mv |
Leles, Cláudio Rodrigues |
dc.contributor.referee2.fl_str_mv |
Gonçalves, Thais Marques Simek Vega |
dc.contributor.referee3.fl_str_mv |
Abreu, Mauro Henrique Nogueira Guimarães de |
dc.contributor.referee4.fl_str_mv |
Ribeiro-Rotta, Rejane Faria |
dc.contributor.referee5.fl_str_mv |
Nogueira, Túlio Eduardo |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/5981857085438577 |
dc.contributor.author.fl_str_mv |
Hartmann, Roberto |
contributor_str_mv |
Leles, Cláudio Rodrigues Schimmel, Martin Leles, Cláudio Rodrigues Gonçalves, Thais Marques Simek Vega Abreu, Mauro Henrique Nogueira Guimarães de Ribeiro-Rotta, Rejane Faria Nogueira, Túlio Eduardo |
dc.subject.por.fl_str_mv |
Implante dentário Prótese dentária Ensaio clínico randomizado Análise de custo-efetividade Desfechos de tratamento dental |
topic |
Implante dentário Prótese dentária Ensaio clínico randomizado Análise de custo-efetividade Desfechos de tratamento dental Prosthodontics Randomized clinical trial Cost-effectiveness analysis Treatment outcomes Implant CIENCIAS DA SAUDE::ODONTOLOGIA |
dc.subject.eng.fl_str_mv |
Prosthodontics Randomized clinical trial Cost-effectiveness analysis Treatment outcomes Implant |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::ODONTOLOGIA |
description |
This randomized trial compared the effectiveness and cost-effectiveness (cost x patient centered outcomes) of three treatment alternatives for mandibular edentulism rehabilitation: unit-implant-retained mandibular overdenture (Group I), two-implant-retained mandibular overdenture (Group II) and four-implant-supported mandibular fixed prosthesis (Group III). We included 50 fully edentulous patients who initially received new conventional total dentures (baseline) and were later randomly allocated to one of the treatment groups. External hexagon implants (Titamax TI Cortical, Neodent, Curitiba, Brazil) were installed following the conventional loading installation protocol. Generalized Estimating Equations (GEE) was used to calculate the primary outcome variables were the direct dental costs which were identified, measured and valued; oral health-related quality of life (OHIP-Edent) and patient satisfaction with prostheses in all groups for a follow-up period of 1 year. Masticatory performance, prosthetic complications, maintenance events and peri-implant evaluation (marginal bone loss, peri-implant tissue status, implant stability quotient - ISQ) were evaluated as secondary outcomes. Data from 37 participants: Group I (n = 11); Group II (n = 13); Group III (n = 13) were collected and were similar in relation to baseline clinical characteristics and outcomes of initial treatment with conventional full dentures. Incremental cost-effectiveness - ICER ranged for Group II (compared to Group I) from R$ 36.20 to R$ 81.46 for a 1-point increase in patient satisfaction (base value = R$ 54.30) for Group III (compared to Group I) ranged from R$ 1321.12 to R$ 2972.52 (base value = R$ 1981.68). The total cost of treatment for the surgical and prosthetic phases was R$ 2,370.70 for Group I, R$ 3,185.20 for Group II and R$ 5,739.50 for Group III. There was a significant difference between the costs in the three groups (p <0.001). The greatest impacts on total treatment cost were related to the initial laboratory, implant and component costs in Group III. The satisfaction questionnaires and OHIP-Edent satisfaction scores in the 12 months improved in all groups compared to baseline. and were similar in intergroup comparison at baseline (with new conventional full dentures) and 1 year after implant prosthesis capture. In intra- and inter-group comparisons there was no significant change regarding satisfaction with the maxillary prosthesis. Regarding masticatory performance, there was no difference between groups evaluated in the same period for the different cycles (20 and 50 cycles) with gradual improvement for all groups up to 6 months and a slight decrease in 12 months for all groups. It was concluded that the rehabilitation of edentulous patients with implants significantly improved patient-reported outcomes in all treatment groups. Regarding the economic aspects of the treatments, the direct dental cost and the clinical time spent to perform the treatment and follow-up during the 1 year period in the fixed prosthesis (Group III) was approximately three times higher than in Group I, which did not correspond to a proportional gain in effectiveness as well as the additional cost of overdenture retained by two implants did not result in significant effectiveness gain over overdenture retained per unit implant. The implant survival was 100% in all groups after the 1-year follow-up. Considering the limitations of the study, implant-retained overdentures were the most cost-effective modalities. |
publishDate |
2019 |
dc.date.accessioned.fl_str_mv |
2019-11-11T15:24:08Z |
dc.date.issued.fl_str_mv |
2019-08-23 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
HARTMANN, R. Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano. 2019. 102 f. Tese (Doutorado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2019. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/10168 |
identifier_str_mv |
HARTMANN, R. Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano. 2019. 102 f. Tese (Doutorado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2019. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/10168 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.program.fl_str_mv |
-2325576619034292269 |
dc.relation.confidence.fl_str_mv |
600 600 600 600 |
dc.relation.department.fl_str_mv |
-5569154581575113691 |
dc.relation.cnpq.fl_str_mv |
-2070498469879244349 |
dc.relation.sponsorship.fl_str_mv |
2075167498588264571 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Odontologia (FO) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Odontologia - FO (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFG instname:Universidade Federal de Goiás (UFG) instacron:UFG |
instname_str |
Universidade Federal de Goiás (UFG) |
instacron_str |
UFG |
institution |
UFG |
reponame_str |
Repositório Institucional da UFG |
collection |
Repositório Institucional da UFG |
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tasesdissertacoes.bc@ufg.br |
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