Abstract
Background
With rising life expectancy, partial edentulism has increased, particularly in developing nations where economic constraints, limited awareness, and inadequate dental care exacerbate the burden on aging populations. Patients with fewer than 20 teeth often experience a reduction in Oral Health-Related Quality of Life (OHRQoL), emphasizing the need for effective tooth replacement. Removable partial dentures (RPDs) are versatile, cost-effective solutions for partial tooth loss, including metal clasp-retained RPDs (MC-RPDs), thermoplastic resin RPDs (TR-RPDs), and cast partial dentures (CPDs).
Methods
This study evaluates the oral health-related quality of life, patient satisfaction, and cost-effectiveness of these three RPD types. A cross-sectional study was conducted with 42 participants, divided into three groups: MC-RPD, TR-RPD, and CPD, each with 14 patients. The Oral Health Impact Profile (OHIP-14) and Satisfaction Questionnaire (SAT) were administered at baseline and three months post-denture delivery. The study adhered to Consolidated Health Economic Evaluation Reporting Standards.
Results
Results showed significant differences in OHIP scores between the groups, with CPD offering the highest quality of life, followed by TR-RPD, and MC-RPD. Post-treatment, the mean OHIP scores for MC-RPD, TR-RPD, and CPD were 30.57 ± 4.09, 20.71 ± 4.03, and 22.36 ± 2.92, respectively, with CPD showing the greatest improvement. Patient satisfaction was highest for CPD, followed by TR-RPD, and least for MC-RPD. However, satisfaction differences between the groups were not statistically significant after three months.
Conclusion
This study highlights the superior performance of CPDs in enhancing OHRQoL and patient satisfaction, though their higher cost may limit accessibility. These findings provide valuable insights for dental practitioners and patients in selecting the most suitable and cost-effective RPD treatment options.
Keywords: Cost effectiveness, Removable partial dentures, Oral health related quality of life, Prosthetic rehabilitation, Case partial dentures
1. Introduction
With the rising life expectancy, the incidence of partial edentulism has also increased. This, grappled with economic constraints, limited awareness, and inadequate access to essential dental care, amplify the burden of edentulism on aging populations particularly among those in developing nations.1,2 Patients with fewer than 20 teeth are reported to experience a reduction in Oral health-related quality of life (OHRQoL). This underscores the need for replacing missing teeth, thereby enhancing both function and appearance.3 The removable partial dentures (RPD) continues to represent a versatile, economically efficient, and reversible therapeutic approach for addressing this absence of teeth in individuals with partial tooth loss.3
The effectiveness of different treatment modalities for rehabilitation varies in terms of patient satisfaction, which in turn is related to factors such as age, location of edentulous span, pain experienced, number and angulation of remaining teeth, soft tissue and periodontal health, the shape of tooth, the material and type of the prosthesis etc.4,5 The advantages of removable partial prosthesis of being minimal to non-invasive as well as its low cost makes it more acceptable. The various removable treatment options based on materials used, include metal clasp-retained RPDs (MC-RPDs), Thermoplastic resin RPDs (TR-RPDs), and cast partial dentures (CPD).
Despite their frequent fabrication, MC-RPDs pose an aesthetic challenge in the aesthetic zone due to metal clasps on abutment teeth. As voiced by the patients, these dentures can hamper speech, alter the taste sensation, reduce the tongue space, and cause reduction in temperature perception due to the increased thickness of the prosthesis.6 Thermoplastic resin RPDs (TR-RPDs) offer both functionality and aesthetic appeal by securely fastening abutment teeth in the aesthetic zone. The flexible nature of thermoplastic materials is suited for different clinical situations and are better accepted by the many patients. But there are reports of rapid staining of the prosthesis clinically.7 The Cast Partial Dentures (CPDs) have several advantages like accuracy, durability, resistance to distortion, inherent cleanliness, reduced weight and bulk, which enhances the patient's patient comfort and acceptance.8 However, the high cost of the CPDs and TR-RPDs is the important factor which limit its use.
An increase in discomfort combined with a decline in benefits is unacceptable in any dental treatment. In the context of prosthetic rehabilitation, evaluating cost-effectiveness is essential to ensure patient satisfaction and improved quality of life. Health economics, particularly pharmacoeconomics, plays a pivotal role in assessing such scenarios by quantifying the clinical and quality-of-life impacts on patients. This approach helps evaluate the effectiveness of prosthetic technologies and ensures that dental treatment strategies are aligned with delivering optimal outcomes in both cost and care.9
Limited financial resources often hinder access to advanced dental treatments, such as implants or fixed partial dentures, making cost-effective removable prosthetic options essential. Additionally, a lack of awareness about available treatments and their benefits contributes to the underutilization of dental services among aging populations. Inadequate access to dental facilities, particularly in rural areas, further complicates the situation for older individuals seeking essential care for partial edentulism 1,2.
In the context of a developing nation like India, the intricate interplay of socioeconomic constraints, healthcare challenges, and resource limitations makes cost-effectiveness a critical priority in healthcare planning. Particularly in oral healthcare, where aging populations increasingly require affordable and effective solutions, understanding the cost-effectiveness of different prosthetic rehabilitation options is essential. Removable partial dentures (RPDs) offer a range of treatment strategies, yet the comparative analysis of their cost-effectiveness and impact on patients' quality of life remains underexplored.10 Addressing this gap is vital for empowering healthcare providers and patients to make informed decisions that optimize resources while improving oral health outcomes.
This study aims to evaluate the cost-effectiveness of three distinct removable prosthetic treatment options—clasp-retained RPDs, thermoplastic resin RPDs, and cast partial dentures—by comparing their impact on oral health-related quality of life and patient satisfaction. By providing evidence-based insights, this research seeks to guide practitioners and policymakers in selecting the most suitable and economically viable tooth replacement strategies for partially edentulous patients in Indian context.
2. Materials and methodology
The cost-effectiveness analysis was performed by guidelines established by Consolidated Health Economic Evaluation Reporting Standards. This cross-sectional study was conducted at a tertiary care center in India. The patients reported from January 2021 to 2022 January were included in the study.
The patients receiving: metal clasp-retained RPDs (MC-RPDs), Thermoplastic resin RPDs (TR-RPDs), and cast partial dentures (CPD) were randomly selected for the study. Based on the mean and SD of treatment fees TR RPD (1467 ± 364.04 Yen), CPD (702 ± 675.83), and among MC-RPD (197 ± 23.24 Yen) observed in an earlier publication3 and with 95 % confidence and 80 % power the minimum sample size comes to 8, 2 and 14 per groups for the pair TR RPD vs CPD, TR RPD vs MC RPD and CPD vs MC RPD respectively. Thus, the minimum required sample size is 14 participants per group, resulting in a total of 42 participants.
The inclusion criteria for our study encompassed a diverse group of patients, including those with Kennedy's class I, class II, class III, and class IV situations, alongside individuals of the age group between 50 years and 65 years, who are unsuitable for implants or fixed partial dentures (FPDs), and those facing financial constraints hindering access to fixed treatment plans. The exclusion criteria were designed to maintain focus on our target population, thereby excluding completely edentulous patients and those unwilling to undergo treatment or participate in the study.
Any partially edentulous patient who reported to the Department of Prosthodontics, at Amrita School of Dentistry, a tertiary care center, was selected based on the aforementioned inclusion and exclusion criteria. The study population consisted of three groups: MC-RPD, TR-RPD, and CPD patients, with 14 participants in each group. Oral Health Impact Profile (OHIP) questionnaire consist of 14 questions and were assessed at baseline and after 3 months of denture insertion. Responses are made on a 5-point scale, coded 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often.11
The Minimal Important Difference (MID) score refers to the smallest change in a treatment outcome that a patient would perceive as important or meaningful. It represents the threshold at which a change in a clinical measure (such as a score on a health-related quality of life questionnaire or a functional assessment) is considered significant from the patient's perspective.3
The direct cost of achieving the clinically minimum important difference (MID) in OHIP- Oral Health Impact Profile 14 summary score with each RPD treatment was calculated by using the following formula:
MID cost = (direct cost/change in OHIP summary score from pre-to post-treatment evaluations) × MID score.
The satisfaction scale used in the study consists of 20 questions, which were assessed through standard questionnaires both at baseline and three months after denture delivery.12 To account for the financial aspect, the study considered the subsidized cost for patients at the educational institution. The costing process involved calculating the lab charge, which served as the base cost. Additionally, a 35 % markup was added to the lab charge to estimate the total direct cost of the dentures provided to the patients. This approach ensures that the direct cost reflects both the lab expenses and a proportion of overheads.
The incremental cost-effectiveness ratio (ICER) was then calculated using the following formula:
ICER = direct cost difference/outcome score difference between TR-RPD, MCRPD, and CPDs.
ICER indicates an additional cost that needs to increase an extra one unit in each outcome measure with TR-RPD compared to MC-RPD treatment. ICER was determined using the OHIP summary score and patient satisfaction scores as outcome measures. To test the statistically significant difference between the three groups One-Way ANOVA was performed separately for two different outcomes. Post-hoc tests were conducted to identify group differences.
Tooth- and tissue-supported dentures in each group were analyzed to assess the distribution across the three treatment groups (MC-RPD, TR-RPD, and CPD). A Chi-square test was used to compare the allocation of tooth-supported and tissue-supported cases.
3. Results
The study population consisted of three groups: MC-RPD, TR-RPD and CPD patients, with 14 participants in each group. Oral Health Impact Profile (OHIP) scores consist of 14 questions (Higher total mean values lower the quality of life) and the satisfactory scale consists of 20 questions (Higher mean values higher the satisfaction) were assessed using standard questionnaires at baseline and after 3 months of denture delivery.
The distribution of tooth-supported and tissue-supported cases across the three treatment groups is as follows: in the MC-RPD group, there are 6 tooth-supported cases and 8 tissue-supported cases; in the TR-RPD group, 7 tooth-supported cases and 7 tissue-supported cases; and in the CPD group, 6 tooth-supported cases and 8 tissue-supported cases. To assess whether there is a significant difference in the distribution of these cases among the groups, a Chi-square test was conducted. The results indicate that the p-value is greater than 0.05, suggesting that there is no statistically significant difference in the distribution of tooth-supported and tissue-supported cases across the three treatment groups. This implies that the allocation of cases based on support type is similar across all groups, and differences in outcomes are unlikely to be due to the type of support.
3.3. OHIP results
At baseline, the mean OHIP scores (± standard deviation) for the MC-RPD, TR-RPD, and CPD groups were 29.93 ± 5.62, 23.21 ± 4.76, and 22.07 ± 3.08, respectively. Analysis of variance (ANOVA) test for between-group comparison yielded a statistically significant result (F (2,41) = 11.880, p = 0.001). Bonferroni post hoc analysis revealed significant differences between MC-RPD vs. TR-RPD (Mean difference = 6.74, p = 0.001) and MC-RPD vs. CPD (Mean difference = 7.857, p = 0.001).
After three months, the mean OHIP scores (± standard deviation) for the MC-RPD, TR-RPD, and CPD groups were 30.57 ± 4.09, 20.71 ± 4.03, and 22.36 ± 2.92, respectively. ANOVA test results showed a significant difference between the groups (F (2,41) = 28.225, p = 0.001). Higher quality of life was noted for CPD, followed by TR-RPD and least for MC-RPD. Bonferroni post hoc analysis indicated significant differences between MC-RPD vs. TR-RPD (Mean difference = 9.857, p = 0.001) and MC-RPD vs. Group CPD (Mean difference = 8.214, p = 0.001) at three months. These findings suggest that both flexible and cast partial dentures may offer a better quality of life compared to conventional dentures (Refer Table 1).
Table 1.
Oral health impact profile (OHIP).
| N = 14 | Baseline | F Statistic | Group Comparison | Post Hoc | At 3 months | F Statistic | Group Comparison | Post Hoc |
|---|---|---|---|---|---|---|---|---|
| MC-RPD | 29.93 ± 5.62 | 11.880 (p-value: 0.0001∗) | MC-RPD vs. CPD | 0.001∗ | 30.57 ± 4.09 | 28.225 (p-value: 0.0001∗) | MC-RPD vs. CPD | 0.001∗ |
| TR-RPD | 23.21 ± 4.76 | MC-RPD vs. TR-RPD | 0.001∗ | 20.71 ± 4.03 | MC-RPD vs. TR-RPD | 0.001∗ | ||
| CPD | 22.07 ± 3.08 | TR-RPD vs. CPD | 1.000 | 22.36 ± 2.92 | TR-RPD vs. CPD | 0.749 | ||
| One-Way ANOVA test; Level of significance: ∗P < 0.05 Bon-Ferroni Post-hoc test; Level of significance: ∗P < 0.01 | ||||||||
3.4. Satisfaction questionnaire (SAT) results
Most participants in all groups wore their current lower partial denture as their first, with 85.7 % in MC-RPD, 71.4 % in TR-RPD, and 100 % in CPD. Regarding the duration of use, 85.7 % of MC-RPD, 64.3 % of TR-RPD, and 78.6 % of CPD participants wore their dentures for less than a year. Nearly all participants wore their dentures most of the time except when sleeping, with 92.9 % in MC-RPD, and 100 % in TR-RPD and CPD. MC-RPD participants reported more gum disease (64.3 %) and the need for adjustments (57.1 %) compared to TR-RPD (21.4 % and 35.7 %) and CPD (21.4 % and 21.4 %). In terms of usage, 71.4 % of MC-RPD and 85.7 % of CPD users used their dentures for eating, while only 42.9 % of TR-RPD users did. Cleaning methods varied, with 100 % of MC-RPD and CPD groups using soap or water, whereas 57.1 % of TR-RPD participants used soap or water, and 42.9 % used toothpaste.
Regarding upper dentures, participants in all groups had a mix of full upper dentures, partial dentures replacing some upper back teeth, and their own upper teeth. Specifically, 14.3 % of MC-RPD had a full upper denture, 42.9 % had some upper back teeth replaced with an RPD, and 42.9 % had all their own upper teeth. In TR-RPD, 21.4 % had a full upper denture, 42.9 % had some upper back teeth replaced with an RPD, and 35.7 % had mostly their own upper teeth plus some bridge. CPD showed the most variety, with 28.6 % having a full upper denture, 28.6 % having some upper back teeth replaced with an RPD, 14.3 % having mostly their own upper teeth plus some bridge, and 7.1 % having all their own upper teeth. Kennedy's classifications were spread across all groups, with Class I being the most common. The presence of modification space was reported similarly in MC-RPD and TR-RPD (both 42.9 %), but higher in CPD (57.1 %). Anterior replacement teeth on RPD were more common in MC-RPD (28.6 %) and TR-RPD (42.9 %), with fewer cases in CPD (7.1 %).
At baseline, the mean Satisfaction Questionnaire (SAT) scores (± standard deviation) for the MC-RPD, TR-RPD, and CPD groups were 22.43 ± 6.02, 30.07 ± 3.69, and 34.93 ± 4.75, respectively. Analysis of variance (ANOVA) test results showed a statistically significant difference between the groups (F (2,41) = 23.034, p = 0.001). Bonferroni post hoc analysis revealed significant differences between MC-RPD vs. TR-RPD (Mean difference = 7.64, p = 0.001) and MC-RPD vs. Group CPD (Mean difference = 12.50, p = 0.001).
After three months, the mean SAT scores (± standard deviation) for the MC-RPD, TR-RPD, and CPD groups were 22.93 ± 4.89, 23.54 ± 3.93, and 26.93 ± 3.08, respectively. Higher patient satisfaction was noted for CPD, followed by Flexible dentures, and the least for CD. ANOVA test results did not indicate a statistically significant difference between the groups (F (2,41) = 3.843, p = 0.036). (Refer Table 2).
Table 2.
Satisfactory scale (SAT).
| N = 14 | Baseline | F Statistic | Group Comparison | Pos Hoc | At 3 months | F Statistic | Group Comparison | Post Hoc |
|---|---|---|---|---|---|---|---|---|
| MC-RPD | 22.43 ± 6.02 | 23.034 (p value: 0.0001∗) | MC-RPD vs. CPD | 0.001∗∗ | 22.93 ± 4.89 | 3.843 (p value: 0.030) | MC-RPD vs. CPD | 0.036 |
| TR-RPD | 30.07 ± 3.69 | MC-RPD vs. TR-RPD | 0.001∗∗ | 23.54 ± 3.93 | MC-RPD vs. TR-RPD | 1.000 | ||
| CPD | 34.93 ± 4.75 | TR-RPD vs. CPD | 0.038 | 26.93 ± 3.08 | TR-RPD vs. CPD | 0.136 | ||
| One-Way ANOVA test; Level of significance: ∗P < 0.05 Bon-Ferroni Post-hoc test; Level of significance: ∗P < 0.01 | ||||||||
These findings suggest that while there were significant differences in satisfaction levels among the denture groups at baseline, these differences diminished after three months, with no statistically significant variation observed among the groups. The SAT questionnaire also had few descriptive questions along with satisfaction questions. The results of these questions are reported below.
3.5. Cost Effectiveness of MC-RPD, TR-RPD, and CPD for OHIP
For one-tooth, two-teeth, and three-teeth scenarios, the negative ICER values indicate that FL is associated with a lower cost and lower OHIP (improved quality of life) compared to MC-RPD for all three scenarios. This suggests that TR-RPD is more cost-effective than MC-RPD in terms of improving oral health-related quality of life. For four to five teeth, the ICER between MC-RPD and TR-RPD is undefined as there is no difference in effectiveness. However, CPD is more cost-effective compared to TR-RPD, as indicated by its lower ICER. For six teeth, MC-RPD is more cost-effective compared to TR-RPD, as indicated by its lower ICER. Additionally, CPD is still more cost-effective compared to TR-RPD, with a significantly lower ICER (Refer Table 3).
Table 3.
Cost effectiveness of MC-RPD, TR-RPD, and CPD for OHIP.
| CD |
FL |
CPD |
ICER CD Vs FL |
ICER CD VS CPD |
ICER FL VS CPD |
||||
|---|---|---|---|---|---|---|---|---|---|
| Cost | OHIP (Pre-post) | Cost | OHIP (Pre-post) | Cost | OHIP (Pre-post) | ||||
| 1 teeth | 400 | 3 | 3527 | 6 | 5667 | - | −1042.33 | - | - |
| 2 teeth | 400 | 3 | 5299 | 4.5 | 8335 | - | −3266 | - | - |
| 3 teeth | 400 | 2.8 | 5299 | 3 | 8335 | - | −24,495 | - | - |
| 4,5 teeth | 400 | 2 | 7070 | 2 | 11,219 | 5.5 | 0 | 3091.14 | 1185.43 |
| 6 teeth | 600 | 6 | 7070 | 4.5 | 11,219 | 0 | 4313.33 | 1769.83 | 922 |
3.6. Cost Effectiveness of MC-RPD, TR-RPD, and CPD for SAT
For each scenario, the ICER represents the additional cost incurred for each additional unit of effectiveness (improvement in SAT score). Lower ICER values indicate better cost-effectiveness. In this case, for one-tooth and two-teeth scenarios, the ICER values for TR-RPD compared to MC-RPD are Rs. 284.27 and Rs. 840.20 per unit of effectiveness, respectively. However, for the three-teeth scenario, the ICER value is higher at Rs. 14845.45 per unit of effectiveness, indicating that TR-RPD may not be cost-effective compared to MC-RPD for this particular scenario. For the four or five teeth scenario, MC-RPD is the most cost-effective option compared to TR-RPD and CPD, as it has the lowest ICER value when compared with each alternative. In the six teeth scenario, MC-RPD is the most cost-effective option compared to TR-RPD and CPD, as it has the lowest ICER value when compared with each alternative (Refer Table 4).
Table 4.
Cost-effectiveness comparison between three groups with respect to SAT.
| CD |
FL |
CPD |
ICER CD Vs FL |
ICER CD VS CPD |
ICER FL VS CPD |
||||
|---|---|---|---|---|---|---|---|---|---|
| Cost | SAT | Cost | SAT | Cost | SAT | ||||
| 1 teeth | 400 | 2 | 3527 | 13 | 5667 | - | 284.27 | - | - |
| 2 teeth | 400 | 4.5 | 5299 | 10.33 | 8335 | - | 840.31 | - | - |
| 3 teeth | 400 | 2 | 5299 | 2.33 | 8335 | - | 14845.45 | - | - |
| 4,5 teeth | 400 | 2.4 | 7070 | 6.4 | 11,219 | 6.4 | 1667.5 | 2704.75 | 0 |
| 6 teeth | 600 | 0 | 7070 | 8.5 | 11,219 | 4.5 | 761.18 | 2359.78 | 1037.25 |
4. Discussion
The loss of tooth can result in physical as well as mental disability because of the difficulty in performing normal activities like eating, speaking and socialising.13 The rehabilitation of teeth and there by enhancing the function of oral cavity has great influence on improving the normal life of individuals. Despite advancements in technologies offering numerous options to restore missing teeth like dental implants, the removable partial dentures continue to have a higher acceptance in cases of inadequate oral tissues, systemic issues and economic reasons which limits the fixed treatment options.14
Removable prostheses are known to improve quality of life, but their long-term effects and cost-benefit outcomes remain inconclusive.15 Various studies have reported the need for periodic review for a removable prosthesis.16 This study selected a period of three months17 for the assessment of the prognosis, as this time period provides enough time for the settling and acceptance of the denture by the patient, as well as the initiation of ridge resorption.18,19
When replacing missing teeth with Removable Partial Dentures (RPD), it is crucial to consider a comprehensive range of factors, including clinical oral health indicators, costs, and patient-reported outcomes such as quality of life, oral function, and aesthetics.20. In this study the Oral health-related quality of life and cost effectiveness analysis of Removable Partial Dentures was done based on patient-reported outcomes and treatment costs.
The mean satisfactory scores (± standard deviation) for the MC-RPDs, T-RPDs and CPDs were higher for CPDs followed by TR-RPDs and least for MC-RPDs at baseline. Analysis of variance (ANOVA) test results showed a statistically significant difference between the groups. The CPD design offers a better patient comfort as the occlusal force is transmitted to the tooth and the tissue as well. More over offer higher strength and stability with minimal bulk, thereby allowing the conduction of heat and cold, which in turn providing a near natural experience.18,21
After three months the CPD offered a higher quality of life when compared to MC-RPDs. The difference among the group was statistically significant as indicated by ANOVA test. The CPD remained consistent in providing the quality of life by providing a superior quality of life was delivered by these prosthesis form the beginning itself, and continued to provide the same during the follow up. After three months the higher satisfactory score was noted for CPDs, provided a higher quality of life compared to MC-RPDs.
This result suggests that as time progressed, the patients tend to get used to the prosthesis, thus increasing the satisfaction score of MC-RPDs when compared to TR-RPDs. But the ANOVA test results did not show any statistically significant difference on oral health impact comparison between TR-RPDs and CPDs.
CPDs are more cost effective while compared to TR-RPDs an MC-RPDs. TR-RPDs are cost effective when compared to MC-RPDs. But when we consider cost effectiveness for one tooth, two teeth, and three teeth scenarios, the negative ICER values indicate that TR-RPDs is associated with a lower cost and lower OHIP (improved quality of life) compared to MC-RPDs for all three scenarios. This suggests that TR-RPDs is more cost-effective than MC-RPDs in terms of improving oral health-related quality of life. This may be due to the avoidance of the mouth preparations in case of CPDs and the offer of better aesthetics of TR-RPDs on anteriors due to the avoidance of visible retentive elements. Previous studies suggest a better satisfaction for TR-RPDs in terms of aesthetics, speech, and comfort.20
For four to five teeth, the ICER between MC-RPDs and TR-RPDs is undefined as there is no difference in effectiveness. However, CPDs is more cost-effective compared to TR-RPDs, as indicated by its lower ICER. This may be attributed to the higher number of posterior tooth replacement as the CPDs transmit the occlusal force to the tooth and the tissue as well.
For six teeth, MC-RPDs is more cost-effective compared to TR-RPDs, as indicated by its lower ICER. This indicated that the patients got used to the prosthesis better when larger number of tooth are to be replaced. MC-RPDs more suitable for this population considering their decreased masticatory force and softer diets compared to younger populations.
The metal clasp retained resin RPD (MC -RPD) were the most commonly used option for treating partially edentulous patients. The main advantages of this prosthesis are its ease of fabrication, less cost and can be used in many clinical situations. But many literatures reported that there is an increased incidence of caries, periodontal breakdown in relation to the prosthesis.22 MC-RPDs more suitable for this population considering their decreased masticatory force and softer diets compared to younger populations.
Additionally, CPDs is still more cost-effective compared to TR-RPDs, with a significantly lower ICER.
TR-RPDs offer a superior oral appearance in terms of aesthetics when compared to the other two partial denture types. Rather than employing metal clasps, it features slender, finger-like extensions that reach into undercuts, serving as clasps. This type of denture is also a viable choice for enhancing the cosmetic appearance of teeth affected by gum recession, causing elongation, and for individuals allergic to acrylic.23 TR-RPDs do not seem to be the treatment of first choice given its lower cost effectiveness and the absence of essential elements present in CPDs, such as Occlusal rests and a rigid framework, results in a less efficient transmission of functional loads.24 Similarly, while CPDs have advantages in oral function over MC-RPDs and TR-RPDS and it offers not only enhanced aesthetics according to the patients' preferences but also improvements in retention, function, speech, taste sensation, and heat perception.14 However, owing to its higher cost and the visibility of metal, it doesn't appear to be the preferred initial treatment choice from the patient's perspective.
Several studies have investigated the cost-effectiveness of prosthetic interventions, with a particular focus on implants over dentures tailored for individuals experiencing edentulism.14 Within the realm of cost-effectiveness analysis for RPD treatments, the scope is constrained, primarily encompassing a limited number of studies examining implant assisted RPDs and dental arch shortening.15,25
The patient satisfaction was the highest for the CPDs followed by the TR-RPDs and MC-RPDs. The CPDs and the TR-RPDs continued to have a higher satisfaction after three months. No statistical significance were noted among the two. It is reported that the type of the denture will affect the satisfaction.26,27
The study offers a comprehensive analysis of cost-effectiveness and patient satisfaction across various removable prosthetic options, providing valuable insights for dental practitioners and patients. By focusing on patient-reported outcomes—such as quality of life, oral function, and aesthetics—it underscores the significance of patient satisfaction in treatment decision-making. Additionally, it evaluates metal clasp-retained RPDs, thermoplastic resin RPDs, and cast partial dentures, presenting a thorough comparison of treatment modalities for partial edentulism.
A major strength of this research lies in its detailed comparative analysis, which equips dental practitioners with practical knowledge about the relative advantages and limitations of the three treatment modalities. This enables clinicians to make more informed treatment recommendations tailored to the economic constraints and individual preferences of their patients. Additionally, the study's focus on cost-effectiveness is particularly valuable in resource-limited settings, making it highly relevant for healthcare providers in developing nations.
There are some limitations in this study. The cost-effectiveness analysis relied on tariffs from a university-based dental hospital for MC-RPDs with metal frameworks, TR-RPDs, and CPDs. Since RPD treatment fees vary across dental hospitals and private clinics in India, the generalizability of the current cost-effectiveness analysis results may be limited and other limitations are these findings underscore the importance of considering both cost and effectiveness when making decisions regarding dental interventions, as the optimal choice may vary depending on the specific clinical scenario and patient needs. However, further analysis considering factors such as budget constraints, willingness-to-pay thresholds, and other contextual factors would be necessary to make a definitive decision regarding the cost-effectiveness of the flexible denture compared to the conventional denture.
Additionally, ICER values provide insights into relative cost-effectiveness but do not necessarily determine the overall best intervention option. For one to three teeth missing CPD data was not available. TR-RPD resin clasps are susceptible to fractures, discoloration, and surface roughening due to inherent limitations in thermoplastic resin properties.28, 29, 30 The study's short 3-month follow-up period may not capture long-term outcomes and maintenance costs associated with different prosthetic options, limiting the comprehensive evaluation of treatment effectiveness over time. The study's reliance on tariffs from a specific dental hospital may limit the generalizability of cost-effectiveness results to other healthcare settings or private clinics, warranting caution in extrapolating the findings to broader populations.
Another limitation of this study is the reliance on treatment cost as a parameter for sample size calculation, which may not fully capture the clinical or patient-reported outcomes that are central to assessing the effectiveness of prosthetic treatments. While cost is an important factor in resource-limited settings, future studies should prioritize clinically significant differences in OHIP scores or patient satisfaction as the primary basis for sample size calculation.
Looking ahead, future studies could incorporate additional contextual factors such as budget constraints, willingness-to-pay thresholds, and cultural preferences, which often influence treatment choices in diverse populations. These considerations would further enhance the applicability of the findings, particularly in resource-constrained settings.
5. Conclusion
The study evaluated the cost-effectiveness of three prosthetic rehabilitation options—Clasp-Retained Removable Partial Dentures (MC-RPD), Thermoplastic Resin Removable Partial Dentures (TR-RPD), and Cast Partial Dentures (CPD)—for partially edentulous patients in India, focusing on Oral Health Impact Profile (OHIP) and patient satisfaction (SAT). In summary, the cost-effectiveness of prosthetic rehabilitation options varies depending on the number of teeth being replaced. TR-RPDs are generally more cost-effective for fewer teeth scenarios, whereas MC-RPDs and CPDs tend to be more cost-effective for scenarios involving more teeth. These findings provide valuable insights for dental practitioners and policymakers in making informed decisions regarding prosthetic rehabilitation for partially edentulous patients in India.
Declaration of competing interest
Authors have no conflict of interest for this study.
Acknowledgments
No acknowledgements to declare.
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