Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth.

OBJECTIVE: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. MATERIAL AND METHODS: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. RESULTS: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. CONCLUSIONS: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.

Reasons for Apical Surgery Treatment in an Underserved New York City Population.

Endodontic retreatment often involves remaking restorations. The total cost may steer the treatment towards surgery. The aim of this study was to retrospectively record the reasons for performing apical surgery in an economically deprived patient population. The clinical reasons (59%) for apical surgery were most common, but the nonclinical (financial) reasons (41%) emerged as a major cause. The finding that 41% of the apicoectomies were performed because of nonclinical constraints is a high figure and may not reflect the situation generally. Still, economic factors potentially play a major role in the selection of surgical versus nonsurgical endodontic retreatment.

Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis.

INTRODUCTION: Excavation of deep caries often leads to pulpal exposure even in teeth with sensible, nonsymptomatic pulps. Although direct pulp capping (DPC) aims to maintain pulpal health, it frequently requires follow-up treatments like root canal treatment (RCT), which could have been performed immediately after the exposure, with possibly improved outcomes. We quantified and compared the long-term cost-effectiveness of both strategies. METHODS: A Markov model was constructed following a molar with an occlusally located exposure of a sensible, nonsymptomatic pulp in a 20-year-old male patient over his lifetime. Transition probabilities or hazard functions were estimated based on systematically and nonsystematically assessed literature. Costs were estimated based on German health care, and cost-effectiveness was analyzed using Monte Carlo microsimulations. RESULTS: Despite requiring follow-up treatments significantly earlier, teeth treated by DPC were retained for long periods of time (52 years) at significantly reduced lifetime costs (545 vs 701 Euro) compared with teeth treated by RCT. For teeth with proximal instead of occlusal exposures or teeth in patients >50 years of age, this cost-effectiveness ranking was reversed. Although sensitivity analyses found substantial uncertainty regarding the effectiveness of both strategies, DPC was usually found to be less costly than RCT. CONCLUSIONS: We found both DPC and RCT suitable to treat exposed vital, nonsymptomatic pulps. DPC was more cost-effective in younger patients and for occlusal exposure sites, whereas RCT was more effective in older patients or teeth with proximal exposures. These findings might change depending on the health care system and underlying literature-based probabilities.

Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives.

INTRODUCTION: One of the most challenging situations in dentistry is a failed root canal treatment case. Should a failed root canal-treated tooth be retreated nonsurgically or surgically, or should the tooth be extracted and replaced with an implant-supported restoration or fixed partial denture? These four treatment alternatives were compared from the perspective of cost-effectiveness on the basis of the current best available evidence. METHODS: The costs of the four major treatment modalities were calculated using the national fee averages from the 2009 American Dental Association survey of dental fees. The outcome data of all treatment modalities were retrieved from meta-analyses after electronic and manual searches were undertaken in the database from MEDLINE, Cochrane, ISI Web of Knowledge, and Scopus up to April 2010. The treatment strategy model was built and run with TreeAge decision analysis software (TreeAge Software, Inc, Williamstown, MA). RESULTS: Endodontic microsurgery was the most cost-effective approach followed by nonsurgical retreatment and crown, then extraction and fixed partial denture, and finally extraction and single implant-supported restoration. CONCLUSIONS: The cost-effectiveness analysis showed that endodontic microsurgery was the most cost-effective among all the treatment modalities for a failed endodontically treated first molar. A single implant-supported restoration, despite its high survival rate, was shown to be the least cost-effective treatment option based on current fees.

Trends in oral surgery in England and Wales 1991-2000.

OBJECTIVE: To investigate trends in oral surgery in England and Wales 1991-2000. METHODS: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics. RESULTS: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period. CONCLUSIONS: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.