Accepting that an implant-retained overdenture is treatment of choice, it is of interest which modality of implant overdenture treatment is most cost-efficient. Economic considerations may influence or even dictate that choice, but this is only reasonable if they are based on long term data.

Objectives: To determine the total direct costs for the total treatment of placing the implants and insertion of the overdenture with retentive system and, over a period of 8 years, aftercare and maintenance.

Methods: In a randomized controlled clinical trial, 1/3 of the patients received an implant-retained overdenture on two implants with ball attachments, 1/3 on two implants with a single bar and 1/3 on four implants with a triple bar. We measured direct treatment costs and costs of aftercare and maintenance.

Results: After 8,3 yrs 103 patients (94%) out of 110 patients, who were included at the start of the trial, participated in the evaluation. The initial costs are 71-79% of the total costs. The results show that there is no significant difference in time and costs in the prosthetic aftercare for the three treatment groups. There is a significant difference between the three groups for the number of checkups with a simple treatment. There is an increased demand for aftercare in the group with the ball attachments for simple readjustments like activating the matrices. Conclusion: This study shows that the total direct costs of aftercare and maintenance do not differ for the 3 treatment strategies over an evaluation period of 8,3 yrs. The initial costs make the differences and make up ¾ of the total costs. The group with the ball attachments needs the highest number of prosthodontist-patient aftercare contacts. This doesn't make a significant difference in the total time consumed by providing aftercare, but surely more patient contact moments are more demanding.

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