Dental News - Study points to possible alternative to amalgam

Dental Tribune International

Fri. 23. February 2018

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BRASILIA, Brazil: When planning primary oral health care services, the cost implications of adopting new intervention practices are important. Despite the range of opinions, amalgam remains the standard of care in some developing countries; however, in a new study, researchers have compared the cost differences between amalgam and high-viscosity glass ionomer cement (HVGIC) restorations in the city of Brasilia and concluded that HVGIC could be considered a viable alternative to amalgam in primary teeth.

Speaking to Dental Tribune International, head researcher Ann Goldman, now Director of Education Programs at Milken Institute School of Public Health, Washington, U.S., said: “Amalgam is still the restorative material of choice in Brazil and other developing countries. Information about the cost-effectiveness of materials that may be used in place of amalgam is of interest to dental practitioners and oral health programs in developing countries in view of the worldwide phase-out of amalgam that went into effect in August 2017.”

Adopting the perspective of the Brazilian government, the study compared the costs between amalgam and HVGIC restorations and the consequences of failed restorations over three years. The cost data were collected prospectively, and cost estimates were developed for the study sample with a projection of 1,000 single- and 1,000 multiple-surface restorations per group.

According to the study, the results were mixed. For single-surface restorations, HVGIC cost $51 per failure prevented, while for multiple-surface restorations, HVGIC was cost-effective with a savings of $11 compared with amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost-effective 49.2 percent of the time compared with 50.6 percent of the time with HVGIC at a willingness to pay threshold of $237 per failure prevented. Staff accounted for more than half the cost burden for both methods, while instruments and supplies accounted for about a third. According to the results, the per-restoration cost to replace amalgam with HVGIC ranged from $1 to a savings of $0.84.

Goldman went on to say that, because the researchers had not seen a great difference between amalgam and HVGIC in terms of cost-effectiveness in their study, it is worth conducting more research on HVGIC as a material that can be used to replace amalgam in restorations. The researchers also noted that the overall cost burden seemed to diminish as the number of restorations increased.

The study, titled “Replacing amalgam with a high-viscosity glass-ionomer in restoring primary teeth: A cost-effectiveness study in Brasilia, Brazil,” was published online on Dec. 28, 2017, in the Journal of Dentistry.

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