Cost-effectiveness of composite resins and amalgam in the replacement of amalgam Class II restorations

Objectives: The replacement of an old amalgam Class II restoration is a com mon 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 w as to yield information on the relative cost-effectiveness of the use of co mposite resins and amalgam for the rerestoration of amalgam Class II restor ations. Methods: As part of a larger randomized clinical trial, treatment e ffectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations. The main treatment outcome was longevi ty. Secondary outcomes included need of repair and quality of the margin wh ile in situ. Costs were analyzed from the perspective of dentistry, assumin g a treatment strategy aimed at offering 'value for money'. From this persp ective, differential costs were based on personnel costs as approximated by treatment time. Results: Replacing an amalgam Class II restoration with am algam in associated with lower costs than replacing with a composite resin. A sensitivity analysis, considering type of composite, increasing proficie ncy with the material, and time needed for future removal of material, demo nstrated that these differences are fairly robust. The materials performed equally well for the first 5 years after placement with respect to longevit y. 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.