Skip to main content
SpringerLink
Log in

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system.

Materials and methods

Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained.

Results

Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54).

Conclusion

Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration.

Clinical relevance

This study can provide information for decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL (2022) Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent 23:2–21. https://doi.org/10.1007/s40368-021-00668-5

    Article  Google Scholar 

  2. Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J (2018) Global burden of molar incisor hypomineralization. J Dent 68:10–18. https://doi.org/10.1016/j.jdent.2017.12.002

    Article  PubMed  Google Scholar 

  3. Zhao D, Dong B, Yu D, Ren Q, Sun Y (2018) The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent 28:170–179. https://doi.org/10.1111/ipd.12323

    Article  PubMed  Google Scholar 

  4. Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I (2010) Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an EAPD policy document. Eur Arch Paediatr Dent 11:75–81. https://doi.org/10.1007/BF03262716

    Article  CAS  PubMed  Google Scholar 

  5. Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL (2022) An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent 23:39–64. https://doi.org/10.1007/s40368-021-00635-0

    Article  CAS  PubMed  Google Scholar 

  6. Elhennawy K, Jost-Brinkmann PG, Manton DJ, Paris S, Schwendicke F (2017) Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare. J Dent 63:65–71. https://doi.org/10.1016/j.jdent.2017.05.020

    Article  PubMed  Google Scholar 

  7. Neves AB, Americano GCA, Soares DV, Soviero VM (2019) Breakdown of demarcated opacities related to molar-incisor hypomineralization: a longitudinal study. Clin Oral Investig 23:611–615. https://doi.org/10.1007/s00784-018-2479-x

    Article  PubMed  Google Scholar 

  8. Cabral RN, Nyvad B, Soviero VLVM, Freitas E, Leal SC (2020) Reliability and validity of a new classification of MIH based on severity. Clin Oral Investig 24:727–734. https://doi.org/10.1007/s00784-019-02955-4

    Article  PubMed  Google Scholar 

  9. Grossi JA, Cabral RN, Leal SC (2017) Caries Experience in Children with and without Molar-Incisor Hypomineralisation: A Case-Control Study. Caries Res 51:419–424. https://doi.org/10.1159/000477099

    Article  PubMed  Google Scholar 

  10. Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, Orlewska E, Watkins J, Trueman P (2007) Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices–budget impact analysis. Value Health 10:336–347. https://doi.org/10.1111/j.1524-4733.2007.00187.x

    Article  PubMed  Google Scholar 

  11. Silva EN, Silva MT, Pereira MG (2016) Health economic evaluation studies: definition and applicability to health systems and services. Epidemiol Serv Saude 25:205–207. https://doi.org/10.5123/S167949742016000100023

    Article  PubMed  Google Scholar 

  12. Sanghvi R, Cant A, de Almeida Neves A, Hosey MT, Banerjee A, Pennington M (2022) Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis. Community Dent Oral Epidemiol 31. https://doi.org/10.1111/cdoe.12751

  13. Brazil (2014) Ministry of health. Methodological guidelines: evaluation guideline economical. http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_diretriz_avaliacao_economica.pdf. Accessed 23 May 2023

  14. Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S (2022) CHEERS 2022 ISPOR good research practices task force. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health 25:3–9. https://doi.org/10.1016/j.jval.2021.11.1351

    Article  PubMed  Google Scholar 

  15. Lygidakis NA, Chaliasou A, Siounas G (2003) Evaluation of composite restorations in hypomineralised permanent molars: a four year clinical study. Eur J Paediatr Dent 4:143–148

    CAS  PubMed  Google Scholar 

  16. Kotsanos N, Kaklamanos EG, Arapostathis K (2005) Treatment management of first permanent molars in children with Molar-Incisor Hypomineralisation. Eur J Paediatr Dent 6:179–184

    CAS  PubMed  Google Scholar 

  17. Mejàre I, Bergman E, Grindefjord M (2005) Hypomineralized molars and incisors of unknown origin: treatment outcome at age 18 years. Int J Paediatr Dent 15:20–28. https://doi.org/10.1111/j.1365-263X.2005.00599.x

    Article  PubMed  Google Scholar 

  18. Ha N, Kim Y, Kim H, Nam S (2017) A prognostic assessment of first permanent molars showing molar-incisor hypomineralization based on restorative materials and defect class. J Korean Acad Pediatr Dent 44:263–271. https://doi.org/10.5933/JKAPD.2017.44.3.263

    Article  Google Scholar 

  19. Oh N, Nam S, Lee J, Kim H (2020) Retrospective study on the survival rate of preformed metal crowns in permanente first molars. J Korean Acad Pediatr Dent 47:140–147. https://doi.org/10.5933/JKAPD.2020.47.2.140

    Article  Google Scholar 

  20. Grossi JA, Cabral RN, Ribeiro APD, Leal SC (2018) Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model. BMC Oral Health 18:65. https://doi.org/10.1186/s12903-018-0528-0

    Article  PubMed  PubMed Central  Google Scholar 

  21. Koleventi A, Sakellari D, Arapostathis KN, Kotsanos N (2018) Periodontal impact of preformed metal crowns on permanent molars of children and adolescents: a pilot study. Pediatr Dent 40:117–121

    PubMed  Google Scholar 

  22. Linner T, Khazaei Y, Bücher K, Pfisterer J, Hickel R, Kühnisch J (2020) Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization- related enamel breakdown-A retrospective cohort study. Int J Paediatr Dent 30:597–606. https://doi.org/10.1111/ipd.12636

    Article  PubMed  Google Scholar 

  23. Fragelli CM, Souza JF, Jeremias F, Cordeiro Rde C, Santos-Pinto L (2015) Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth. Braz Oral Res 29:S1806–S83242015000100271. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0076

    Article  PubMed  Google Scholar 

  24. Durmus B, Sezer B, Tugcu N, Caliskan C, Bekiroglu N, Kargul B (2021) Two-year survival of high-viscosity glass ionomer in children with molar incisor hypomineralization. Med Princ Pract 30:73–79. https://doi.org/10.1159/000508676

    Article  PubMed  Google Scholar 

  25. Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assunção LR, de Menezes JVBN, Feltrin-Souza J (2021) Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clin Oral Investig 25:1513–1524. https://doi.org/10.1007/s00784-020-03459-2

    Article  PubMed  Google Scholar 

  26. Sönmez H, Saat S (2017) A clinical evaluation of deproteinization and different cavity designs on Resin restoration performance in MIH-affected molars: two-year results. J Clin Pediatr Dent 41:336–342. https://doi.org/10.17796/1053-4628-41.5.336

    Article  PubMed  Google Scholar 

  27. de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cássia Loiola Cordeiro R (2017) Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig 21:1725–1733. https://doi.org/10.1007/s00784-016-1968-z

  28. Gatón-Hernandéz P, Serrano CR, da Silva LAB, de Castañeda ER, da Silva RAB, Pucinelli CM, Manton D, Ustrell-Torrent JM, Nelson-Filho P (2020) Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study. Int J Paediatr Dent 30:4–10. https://doi.org/10.1111/ipd.12581

    Article  PubMed  Google Scholar 

  29. Zagdow AM, Fayle SA, Pollard MA (2003) A prospective clinical trial comparing preformed metal crowns and cast restorations for defective first permanent molars. Eur J Paediatr Dent 4:138–142

    Google Scholar 

  30. Observatório da criança (2021) Estimated populations by age groups according to IBGE. http://observatoriocranca.org.br/cenario-infancia/temas/populacao/1048-populacao-estimada-pelo-ibge-segundo-faixas-etarias?filters=1,1622. Accessed 24 May 2023

  31. da Costa-Silva CM, Jeremias F, de Souza JF, Cordeiro Rde C, Santos-Pinto L, Zuanon AC (2010) Molar incisor hypomineralization: prevalence, severity and clinical consequences in Brazilian children. Int J Paediatr Dent 20:426–434. https://doi.org/10.1111/j.1365-263X.2010.01097.x

    Article  PubMed  Google Scholar 

  32. Jeremias F, de Souza JF, Silva CM, Cordeiro Rde C, Zuanon AC, Santos-Pinto L (2013) Dental caries experience and molar-incisor hypomineralization. Acta Odontol Scand 71:870–876. https://doi.org/10.3109/00016357.2012.734412

  33. Hanan SA, Filho AOA, Medina PO, Cordeiro RCL, Santos-Pinto L, Zuanon ACC (2015) Molar-incisor hypomineralization in school children of Manaus, Brazil. Braz Res Pediatr Dent and Integr Clin 15:309–317. https://doi.org/10.4034/PBOCI.2015.151.33

    Article  Google Scholar 

  34. Raposo F, de Carvalho Rodrigues AC, Lia ÉN, Leal SC (2019) Prevalence of hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH). Caries Res 53:424–430. https://doi.org/10.1159/000495848

    Article  PubMed  Google Scholar 

  35. Reyes MRT, Fatturi AL, Menezes JVNB, Fraiz FC, Assunção LRDS, Souza JF (2019) Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization. Braz Oral Res 15:e048. https://doi.org/10.1590/1807-3107bor-2019.vol33.0048

    Article  Google Scholar 

  36. Dourado DG, Lima CCB, Silva RNC, Tajra FS, Moura MS, Lopes TSP, De Deus Moura LFA, de Lima MDM (2021) Molarincisor hypomineralization in quilombola children and adolescents: A study of prevalence and associated factors. J Public Health Dent 81:178–187. https://doi.org/10.1111/jphd.12429

    Article  PubMed  Google Scholar 

  37. Bonzanini LIL, Arduim ADS, Lenzi TL, Hugo FN, Hilgert JB, Casagrande L (2021) Molar-incisor hypomineralization and dental caries: A hierarchical approach in a populational-based study. Braz Dent J 32:74–82. https://doi.org/10.1590/0103-6440202104511

    Article  PubMed  Google Scholar 

  38. Farias L, Laureano ICC, Fernandes LHF, Forte FDS, Vargas-Ferreira F, Alencar CRB, HonÓrio HM, Cavalcanti AL (2021) Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren. Braz Oral Res 35:e13. https://doi.org/10.1590/1807-3107bor-2021.vol35.0013

    Article  PubMed  Google Scholar 

  39. Duarte MBS, Carvalho VR, Hilgert LA, Ribeiro APD, Leal SC, Takeshita EM (2021) Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization? J Appl Oral Sci 16:e20200890. https://doi.org/10.1590/1678-7757-2020-0890

    Article  Google Scholar 

  40. Reis PP, Jorge RC, Americano GCA, Thiago Pontes NS, Peres AM, Silva Oliveira AGE, Soviero VM (2021) Prevalence and severity of molar incisor hypomineralization in Brazilian children. Pediatr Dent 43:270–275

    PubMed  Google Scholar 

  41. Damares Lago J, Restrepo M, Girotto Bussaneli D, Patrícia Cavalheiro J, Feltrin de Souza J, Santos-Pinto L, de Cássia Loiola Cordeiro R, Jeremias F (2022) Molar-incisor hypomineralization: prevalence comparative study in 6 years of interval. Sci World J 9:4743252. https://doi.org/10.1155/2022/47432523

    Article  Google Scholar 

  42. Brazil (2022) Ministry of health. Agência Nacional de Saúde Suplementar. http://www.gov.br/ans/pt-br/acesso-ainformacao/perfil-do-setor/dados-gerais. Accessed 24 May 2023

  43. Brazil (2002) Ministry of Health. Secretary of Health Care. Department of Primary Care. Oral Health / Ministry of Health, Department of Health Care. https://bvsms.saude.gov.br/bvs/publicacoes/sistema_saude.pdf. Accessed23 May 2023

  44. Brazil (2008) Ministry of Health. Secretary of Health Care. Department of Primary Care. Oral Health / Ministry of Health, Department of Health Care(Series A. Standards and Technical Manuals) (Primary Care Notebooks; 17).https://bvsms.saude.gov.br/bvs/publicacoes/saude_bucal.pdf. Accessed 23 May 2023

  45. Brazil (2018) Ministry of Health. Secretary of Health Care. Department of Primary Care. Oral health in the Unified Health System [electronic resource]. https://bvsms.saude.gov.br/bvs/publicacoes/saude_bucal_sistema_unico_saude.pdf. Accessed 23 May 2023

  46. Batista da Silva MC, da Silva RA, Costa Ribeiro CC, Nogueira da Cruz MC (2007) Perfil da assistência odontológica pública para a infância e adolescência em São Luís (MA) [Profile of public dental care for children and adolescents in São Luís, Maranhão State]. Cien Saude Colet 12:1237–1246. https://doi.org/10.1590/s1413-81232007000500021

    Article  PubMed  Google Scholar 

  47. Valença AMG, Dantas ELA, Protasio APL, Limão NP, Ribeiro ILA, Santiago BM, de Medeiros-Serpa EB (2021) Oral health attention offered to children and adolescents in primary health care. RSD 10:e17710615669. https://doi.org/10.33448/rsdv10i6.15669

    Article  Google Scholar 

  48. Serna-Muñoz C, Martínez-Beneyto Y, Pérez-Silva A, Poza-Pascual A, Ibáñez-López FJ, Ortiz-Ruiz AJ (2020) Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study. BMC Oral Health 20:260. https://doi.org/10.1186/s12903-020-01249-6

    Article  PubMed  PubMed Central  Google Scholar 

  49. Skaare AB, Houlihan C, Nybø CJ, Brusevold IJ (2021) Knowledge, experience and perception regarding molar incisor hypomineralisation (MIH) among dentists and dental hygienists in Oslo, Norway. Eur Arch Paediatr Dent 22:851–860. https://doi.org/10.1007/s40368-021-00649-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Lagarde M, Vennat E, Attal JP, Dursun E (2020) Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review. Int J Paediatr Dent 30:405–420. https://doi.org/10.1111/ipd.12621

    Article  PubMed  Google Scholar 

  51. Jälevik B, Klingberg GA (2002) Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Den 12:24–32

    Article  Google Scholar 

  52. Menoncin BLV, Portella PD, Ramos BLM, Assunção LRDS, de Souza JF, Menezes JVNB (2019) Dental anxiety in schoolchildren with molar incisor hypomineralization-A population-based cross-sectional study. Int J Paediatr Dent 29:615–623. https://doi.org/10.1111/ipd.12503

    Article  PubMed  Google Scholar 

  53. Alkhalaf R, Rosa TC, Vieira FGF, Neves AA, Hosey MT, Banerjee A (2022) Managing compromised first permanent molars in children: minimally invasive treatment protocols for practitioners. Dental Update 49:651–662

    Article  Google Scholar 

  54. De Soárez PC, Soares MO, Novares HM (2014) Decision modelling for economic evaluation of health technologies. Cien Saude Colet 19:4209–4222. https://doi.org/10.1590/1413-812320141910.02402013

    Article  PubMed  Google Scholar 

  55. Frencken JE, Leal SC, Navarro MF (2012) Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview. Clin Oral Investig 16:1337–1346. https://doi.org/10.1007/s00784-012-0783-4

    Article  PubMed  PubMed Central  Google Scholar 

  56. Gurgan S, Kutuk ZB, Ergin E, Oztas SS, Cakir FY (2017) Clinical performance of a glass ionomer restorative system: a 6-year evaluation. Clin Oral Investig 21:2335–2343. https://doi.org/10.1007/s00784-016-2028-4

    Article  PubMed  Google Scholar 

  57. da Costa RT, Pintor AVB, Magno MB, Marañón-Vásquez GA, Maia LC, Neves AA (2021) Worldwide trends on molar incisor and deciduous molar hypomineralisation research: a bibliometric analysis over a 19-year period. Eur Arch Paediatr Dent 23:133–146. https://doi.org/10.1007/s40368-021-00676-5

    Article  Google Scholar 

Download references

Funding

Thamirys da Costa Rosa was financed in part by the Rio de Janeiro State Agency for Research Support—FAPERJ with a PhD-scholarship (Rio de Janeiro, Brazil; grant number: E-26/204.126/2022).

Author information

Authors and Affiliations

  1. Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325, Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil

    Thamirys da Costa Rosa, Marcelo de Castro Costa & Aline de Almeida Neves

  2. Department of Clinical and Social Dentistry, School of Dentistry, Universidade Federal da Paraíba, João Pessoa, PB, Brazil

    Yuri Wanderley Cavalcanti

Authors
  1. Thamirys da Costa Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuri Wanderley Cavalcanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcelo de Castro Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aline de Almeida Neves
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Thamirys da Costa Rosa: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing - Original Draft and Writing - Review and Editing. Yuri Wanderley Cavalcanti: Conceptualization, Methodology, Formal Analysis, Investigation, Data curation, Writing - Review and Editing and Supervision. Marcelo de Castro Costa: Data Curation and Writing - Review and Editing. Aline de Almeida Neves: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing - Review and Editing and Supervision.

Corresponding author

Correspondence to Aline de Almeida Neves.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 46 KB)

Supplementary file2 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

da Costa Rosa, T., Cavalcanti, Y.W., de Castro Costa, M. et al. Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system. Clin Oral Invest 28, 301 (2024). https://doi.org/10.1007/s00784-024-05652-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00784-024-05652-z

Keywords

Search

Navigation