Long-term cost-effectiveness of single indirect restorations in selected dental practices

Objective To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. Methods Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class 11 cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. Results The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. Conclusions When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.