Longterm costs for reconstructive care in patients with birth defects

Objectives: to assess the cumulative costs for the longterm 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 ?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 cleft lip and palate, 5 had malformations of the tooth substance and 22 were cases with partial anodontia. 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). Multivariate linear regression analyses for the initial treatment costs per unit revealed the formula 731 CHF + (811 CHF * # units) on teeth and 3369 CHF + (1183 CHF* # units) for reconstructions on implants (p < .001). 58% of the patients with tooth-supported reconstructions remained free from all failures/complications (mean observation 15.7 years) (47%, mean observation 8.0 years for implant cases respectively). Implant reconstructions demonstrated their first complication earlier (Kaplan-Meier p=0.01). At 1, 4, and 8 years, there were no statistically significant differences in the rates of technical and biological complications (Pearson Chi2 test). 27% of the initial treatment costs were needed to cover supportive periodontal therapy as well as the treatment of any technical/biological complications and failures.

In conclusion: Patients with malformation of the tooth substance required the highest treatment costs. Initial treatment costs per unit were higher for implant cases. The longterm treatment costs, however, did not differ statistically significantly compared to patients reconstructed with tooth-borne reconstructions.

Supported by the Clinical Research Foundation (CRF) for the Promotion of Oral Health, University of Berne, Switzerland.