title: Cost-effectiveness of composite resins and amalgam in the replacement of amalgam Class II restorations.
abstract: OBJECTIVE
  The replacement of an old amalgam Class II restoration is a common treatment and will remain so for decades. In addition to effectiveness, possible adverse health effects and esthetics, the costs of the treatment options will play a role in the choice of material. The aim of this study was to yield information on the relative cost-effectiveness of the use of composite resins and amalgam for the rerestoration of amalgam Class II restorations.
  
  
  METHODS
  As part of a larger randomized clinical trial, treatment effectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations. The main treatment outcome was longevity. Secondary outcomes included need of repair and quality of the margin while in situ. Costs were analyzed from the perspective of dentistry, assuming a treatment strategy aimed at offering 'value for money'. From this perspective, differential costs were based on personnel costs as approximated by treatment time.
  
  
  RESULTS
  Replacing an amalgam Class II restoration with amalgam is associated with lower costs than replacing with a composite resin. A sensitivity analysis, considering type of composite, increasing proficiency with the material, and time needed for future removal of material, demonstrated that these differences are fairly robust. The materials performed equally well for the first 5 years after placement with respect to longevity. Differences in secondary outcomes were minor and not all in favor of the same material.
  
  
  CONCLUSIONS
  It is tentatively concluded that amalgams are more cost-effective than composites for replacing existing Class II amalgam restorations.
authors.affiliation: Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam, The Netherlands. h.tobi@acta.nl
authors.forename: H
authors.initials: H
authors.lastname: Tobi
authors.forename: C M
authors.initials: CM
authors.lastname: Kreulen
authors.forename: H
authors.initials: H
authors.lastname: Vondeling
authors.forename: W E
authors.initials: WE
authors.lastname: van Amerongen
mesh_terms: D000293:Adolescent; D000328:Adult; D001641:Bicuspid; D003188:Composite Resins / Q000191:economics*; D003362:Cost-Benefit Analysis; D003722:Dental Alloys; D003723:Dental Amalgam / Q000191:economics*; D018772:Dental Marginal Adaptation; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000191:economics* / Q000379:methods*; D006801:Humans; D008963:Molar; D015588:Observer Variation; D011791:Quartz; D015203:Reproducibility of Results; D019279:Resin Cements; D019233:Retreatment / Q000191:economics; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D003188:Composite Resins; D003722:Dental Alloys; D019279:Resin Cements; C065770:Herculite XR; C067786:Visio-Molar; D011791:Quartz; C084849:Clearfil Ray Posterior; C036886:tytin; D003723:Dental Amalgam