Análise de custos e de desfechos clínicos e funcionais de overdentures mandibulares ao longo de 5 anos

Abstract

This study evaluated the impact of mandibular overdentures retained by 2 reduced-diameter implants (OM2) in a prospective cohort (n=42), in addition to investigating OM2 with immediate versus conventional loading through an RCT (n=20) and the costs of treatment over 5 years within the scope of the SUS. For this, the evaluated outcomes were: i) clinical: related to peri-implant health; ii) radiographic: marginal bone loss and posterior area index; iii) oral health-related quality of life through the OHIP-Edent and impact on daily life - DIDL questionnaires; iv) the influence of the change of the OM retention system - Equator attachment on quality of life; v) the influence of patient characteristics on marginal bone loss: gender, time of mandibular edentulism, atrophy, combination syndrome, anteroposterior classification, facial profile, presence of chronic diseases (diabetes, hypertension, arthritis), in addition to psychological disorders; and vi) prosthetic complications. Simple regression, mixed-effects multilevel regression, multivariate regression and chi-square test at a significance level of 5% were used for data analysis. As a result, it was observed that, in 5 years, there was maintenance of peri-implant health and peri-implant bone levels, the replacement of the Equator attachment influenced quality of life only in the 4th year and POM was also influenced by patient characteristics, such as advanced age, diabetes, prolonged mandibular edentulism, class III profile and arthritis. OM2 with CI presented clinical, radiographic and functional behavior similar to CC, however, after the 3rd year there was a tendency for decreased satisfaction with treatment. Treatment costs with OM2 were higher in the first year, with a tendency to decrease in the following years. The budget impact projection identified that, in 5 years, OM2 treatment for the elderly Brazilian population would require R$2 billion more than usual treatment; however, this investment would be justified by the improvements that OM2 rehabilitation provides to its users.