CRITICAL APPRAISAL OF ARTICLE

1. AGENESIS OF MAX LATERAL INCISOR AND
TOOTH REPLACEMENT: COST –EFFECTIVENESS
OF DIFFERENT TREATMENT ALTERNATIVES
BY GREGORY ET AL , INT J PROSTHODONT 2014;27:257-263
CRITICAL APPRAISAL
BY DR AYESHA SADAF

2. BACKGROUND
• Prevalence of agenesis of maxillary Lateral Incisor is 0.8-
2%
• Treatment options can be 1) Orthodontic space closure
2) Replacement of missing Lateral incisors with a
prosthesis
Substitution by canine

3. RESIN BONDED BRIDGES

4. CANTILEVER FPD

5. AUTOTRANSPLANTATION

6. IMPLANT SUPPORTED CROWN

7. RESEARCH QUESTION
• What are the Costs and benefits of different
treatment options for replacement of maxillary
lateral incisors

8. AIMS & OBJECTIVES
• Was to evaluate and compare the long-term cost-
effectiveness of the different treatment alternatives in
cases of maxillary lateral in Incisor agenesis where space
maintenance and tooth replacement are indicated.

9. MATERIALS & METHODS
5 treatment Modalities were considered
• A single tooth implant supported crown
• Resin bonded FPD
• Cantilever FPD
• Full coverage FPD
• Autotransplantation

10. INCLUSION CRITERIA
• Healthy Patients with unilateral agenesis of maxillary lateral incisor
without any other dental problem
• Only patients with clear indication of replacement of missing teeth were
considered.
• All cases require an equal amount of orthodontic treatment where the
costs are equal.
• Orthodontic treatment outcomes are stable with no relapse
• Orthodontic retention cost is same for all patients.

11. COSTS
• Only direct costs were considered in the following analysis
, Both clinical and laboratory costs were considered.
• National fee schedule in Swtizerland , BY SWISS DENTAL
ASSOCIATION using a point scheme used by health
Insurance for reimbursement purposes.

12. OUTCOME
• Metanalyses or Systematic review for long term outcome for individual
treatment
• Survival Rate was used as Primary Outcome Data
• Definition: Functional retention without adverse clinical signs &
Symptoms

13. COST EFFECTIVENESS ANALYSIS
• RATIO OF THE SURVIVAL PROBABILITY OF EACH INDIVIDUAL TREATMENT
MODALITY DIVIDED BY THE FEE FOR THAT INDIVIDUAL TREATMENT IN
INTERNATIONAL DOLLARS.

15. CRITIQUE
Materials and methods fig 1 are not matching with
the text.

16. CRITIQUE
• NO DETAIL OF THE SELECTED STUDIES IS MENTYIONED IN THE
ARTICLE
• IN THE TEXT IT WAS MENTIONED THAT THEY HAVE SELECTED 4
METANALYSIS
• AND ONE REVIEW BUT FIGURE IS DEPICTING DIFFERENT RESULTS

20. CONCLUSIONS
• Most cost-effective treatment Modality is
auto-transplantation and least effective is
Fixed Partial Denture

21. CRITIQUE
• There is no statistical test applied
• Results, discussion and conclusion have contradictory
statements.
• This study can be improved if effectiveness is determined on
the same population retrospectively or doing a longitudinal
study.