RESUMO
AIM: Selective root-canal retreatment has been proposed as an alternative to full retreatment in multirooted, root-canal-filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost-effectiveness of full versus selective root-canal retreatment using data from a recent clinical pilot study, employing a modelling approach. METHODOLOGY: A Markov model was constructed to follow up a previously root-canal treated maxillary molar with apical pathology on a single root (mesio-buccal), receiving either selective or full root-canal retreatment. A private-payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50-year-old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte-Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost-effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost-effectiveness at different willingness-to-pay-thresholds was evaluated. RESULTS: In the base-case scenario, selective retreatment was less costly (2137; 2.5%-97.5% percentiles: 1944-2340 Euro) and more effective (19.6; 18.3-20.8 Years) than full retreatment (2495; 2305-2671 Euro; 16.5; 15.2-17.9 Years) in 100% of the simulations and regardless of the willingness-to-pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective. CONCLUSIONS: Selective retreatment, when clinically applicable, is likely to be more cost-effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.
RESUMO
BackgroundAt present, it remains uncertain which method to decontaminate N95 is most suitable and should be recommended to healthcare professionals worldwide. ObjectivesThe aim of this scoping review was to map and compile the available evidence about the effectiveness of decontaminating N95 masks against coronavirus. MethodsWe selected studies written in English assessing or discussing decontamination strategies of N95 masks against coronavirus. The search and study screening were performed in PubMed and SCOPUS by two independent researchers. A descriptive analysis was performed considering the study design of included studies. ResultsWe included nineteen studies. Eight articles were letter to the editors, five were in vitro studies, three were literature reviews, and three were classified as other study designs. The use of vaporized hydrogen peroxide and ultraviolet irradiation were the strategies most cited. However, there is a lack of evidence and consensus related to the best method of N95 masks decontamination. ConclusionThe evidence towards decontamination strategies of N95 masks against coronavirus remains scarce. Vaporized hydrogen peroxide and ultraviolet irradiation seem the current standard for N95 masks decontamination.
