Screw- vs. Cement-retained Implant-supported Prosthesis in Partially Edentulous Patients

Abstract

Understanding the morbidity events, incidence, and cost associated with each type of retention system used for implant supported prosthesis will help the clinician in better decision making. This study assessed the clinical and cost-effectiveness of the screw- and cement-retained implant-supported single crown and fixed partial denture for the replacement of teeth in partially edentulous jaws, from a health services perspective. A systematic literature search conducted in 10 databases, complemented by 4 journal databases and International Association for Dental Research abstracts, identified 92 studies on the single crown and 40 studies on the fixed partial denture. Minor and major technical complication events, as well as failure events, were extracted from strong- and medium-quality studies. Studies based on similar designs were pooled with a random-effects Poisson regression model. A decision tree was developed to estimate the cost-effectiveness over a 15-y period posttreatment. The initial and maintenance costs to treat technical complication events were based on an American Dental Association survey of 2011 to 2012. Probabilistic sensitivity analysis was used to examine the uncertainty in the data input parameters. Clinical evidence generated from the meta-analysis suggested no statistical difference between the 2 retention systems. The cost-effectiveness is presented as an incremental cost-effectiveness ratio. The evidence from this report suggests that cement retention is the more cost-effective strategy as compared with screw retention prosthesis. Knowledge Transfer Statement: Evidence generated by this study will help clinicians make an appropriate cost-effective treatment decision in choosing the retention system for partially edentulous patients.