ArticleCommunity dentistry and oral epidemiology2026
Model-Based Cost-Effectiveness of Direct Restorations: Amalgam Dominates.
Article in Community dentistry and oral epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Amalgam versus composite restorations: a cost-consequence analysis.British dental journal · 2026Article
- Economic evidence on provider-level implications of direct posterior amalgam alternatives following the EU phase-out: a scoping review.BMJ open · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesA phase-down of dental amalgam use has been mandated and the feasibility of its phase-out in England by 2030 is being explored. Amalgam use in English National Health Service (NHS) care still predominates for posterior restorations, though access to this care is increasingly limited. The objective of this study was to quantify the relative long-term costs and consequences of amalgam versus composite direct posterior restorations in adult permanent teeth in the English NHS setting.
methodsA microsimulation model of restoration failure and reintervention was constructed and parameterised in TreeAge Pro, based on a review of the literature. It extrapolated costs and outcomes of directly restoring cariously-cavitated lower premolar teeth in 10 000 18-year-old English NHS patients with amalgam and composite restorations over a lifetime-horizon. Discounting of 3.5% was applied to costs and outcomes. An extended medical-sector perspective with societal considerations was taken. Deterministic and probabilistic sensitivity analyses were performed.
resultsAmalgam robustly dominated conventional and bulk-fill composite restorations, being less costly over a lifetime from patient (£70) and funder perspectives (£34), with the restoration and tooth surviving significantly longer (4-years; 12-years non-discounted). Amalgam also incurred reduced numbers of visits (1), treatment time (43-min), and laboratory costs (£8) for fixed and removable prosthodontics over a lifetime. Time until a direct restoration was no longer possible was significantly higher for amalgam than composite (6-years; 17-years non-discounted).
conclusionsThe model showed good internal and external validity, accurately predicting tooth survival following restoration in relation to long-term NHS claims data. Without considerable educational change to upskill clinicians and health service change, an amalgam phase-out in England will likely have significant lifelong impacts on restoration and tooth survival and costs for all stakeholders, whilst reducing societal productivity and exacerbating already existing issues of limited access to care and socio-economic inequalities.
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Registered trials
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