Economic evidence on provider-level implications of direct posterior amalgam alternatives following the EU phase-out: a scoping review.

Abstract

To map and characterise economic evaluations (EEs) and provider-level cost/resource reporting related to direct posterior restorative alternatives following the European Union (EU) dental amalgam phase-out. Scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. PubMed, Embase, Web of Science, CINAHL and LIVIVO (ZB MED search portal for life sciences (Germany)). Peer-reviewed studies (English/German; 1 January 2021-22 February 2026) reporting EEs or cost/resource-use components for direct posterior restorations in permanent teeth. Data were charted using a predefined extraction framework focusing on analytic perspective, time horizon, modelling approach and granularity of provider-level resource components. Two reviewers independently screened records and charted data; disagreements were resolved by discussion and, if needed, by consultation with a third reviewer. Six studies met the inclusion criteria (four model-based or trial-based EEs; two cross-sectional surveys). Most analyses adopted payer, societal or mixed perspectives and used decision-analytic models with medium- to long-term horizons. Outcomes included cost per complication-free month, cost per tooth-year retained and lifetime cost projections. Detailed provider-level reporting (eg, chair time, personnel allocation, overheads or warranty-related retreatment burden) was limited, and survey evidence relied on self-reported estimates. Heterogeneity in methods and metrics precluded quantitative synthesis. Economic evidence regarding direct posterior restorative alternatives after the EU amalgam phase-out is sparse and primarily based on modelled or reimbursement-derived inputs from payer, societal or mixed perspectives, rather than explicitly measured provider-level microcosting. Greater transparency in analytic perspective and microcosting components may support evidence-informed adaptation to restorative material substitution policies.