An economic evaluation of different sinus lift techniques.
OBJECTIVE
To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence.


METHODS
We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation.


RESULTS
When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches.


CONCLUSIONS
On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights.
Listl
Stefan
S
Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany. stefan.listl@med.uni-heidelberg.de
Faggion
Clovis Mariano
CM
D016301:Alveolar Bone Loss / Q000473:pathology; D018786:Bone Substitutes / Q000191:economics; D016025:Bone Transplantation / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003758:Dental Implantation, Endosseous / Q000191:economics*; D015921:Dental Implants / Q000191:economics*; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D016557:Guided Tissue Regeneration, Periodontal / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D009010:Monte Carlo Method; D013516:Oral Surgical Procedures, Preprosthetic / Q000191:economics* / Q000379:methods*; D012196:Review Literature as Topic
D018786:Bone Substitutes; D015921:Dental Implants