Micro-costing of dental prosthetics in jaw reconstruction.

INTRODUCTION: Dental rehabilitation has a significant impact on health-related quality of life (HRQOL) for patients undergoing microvascular reconstruction of the jaw. Virtual surgical planning (VSP) and computer-aided design and computer-aided manufacturing (CAD/CAM) technology allows for precise and timely delivery of an implant-retained dental prosthesis. This study characterizes the cost to produce a point of care (in-house) 3D-printed resin dental prostheses for patients undergoing osseous free flap reconstruction. METHODOLOGY: Implant-retained dental prostheses for patients undergoing osseous free flap reconstruction of the maxilla or mandible produced by the Integrated Prosthetics and Reconstruction (IPR) laboratory at Chris O'Brien Lifehouse Hospital between July 2023 and June 2024 were analysed. The costs of producing the prostheses were calculated using a "bottom up" approach where all activities associated with start-up, planning and fabrication were accounted for and unit costs for each activity quantified. Prostheses with incomplete data were excluded. All costs are reported in 2024 as USD. RESULTS: Twenty-one patients met the study inclusion criteria of which the majority (n = 19) underwent mandibular reconstruction. Twelve patients underwent reconstruction for benign disease and 17 patients had the prosthesis placed at the primary reconstruction. The mean cost of producing the dental prosthesis was $861.72 (range: $702.78 - $1032.34). Start-up costs were the highest contributor (mean cost $333.71) per prosthesis, followed by the design/planning phase (mean cost $260.37), and fabrication phase (mean cost $267.64). The overall cost increased with increasing number of implant fixtures and the number of prosthetic units placed. CONCLUSION: VSP and CAD/CAM technology allows for rapid and accessible dental rehabilitation following osseous free flap reconstruction. However, the significant startup costs of these technologies are likely to be a barrier to institutions wanting to introduce point-of-care manufacturing of dental prosthetics.