Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant.

BACKGROUND: Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China. METHODS: 211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective. RESULTS: 170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY. CONCLUSIONS: Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

Microtensile bond strength to sealer-contaminated dentin after using different cleaning protocols.

BACKGROUND/PURPOSE: Sealer residues on dentin may affect bonding to restorative materials. This study aimed to evaluate the bond strength to sealer-contaminated dentin after using different cleaning protocols. MATERIALS AND METHODS: Freshly extracted bovine incisors were prepared and exposed the buccal pulp chamber dentin, obtaining segments measuring 5 mm × 5 mm with a height of 3 mm. The segments were randomly distributed into 4 groups (n = 7) according to different protocols. Control group: no contamination was performed. In the three experimental groups, the segments were contaminated with epoxy resin-based sealer for 5 min, and different cleaning protocols were performed. Acetone group: acetone-saturated cotton pellets were used to wipe the sealer. Ultrasound group: ultrasonic ET-20D tip cleaning. Acetone combined with ultrasound group: cleaning with acetone-saturated cotton pellets and ultrasonic tip. All segments were bonded using a self-etch adhesive. Two samples in each group were scanned by swept-source optical coherence tomography (SS-OCT) to evaluate sealer residues. A microtensile test was performed on the remaining 5 samples, which were built up with composite resin. RESULTS: Sealer residues were observed in 3 of 14 (21.4%) sections of acetone group by SS-OCT. Compared to the control, ultrasound alone or in combination with acetone preserved the bond strength (P > .05). The ultrasound group exhibited the highest bond strength (39.38 MPa), which differed from that of the acetone group, which provided the lowest bond strength (32.88 MPa) (P < .05). CONCLUSION: Cleaning epoxy resin-based sealer-contaminated dentin surfaces using ultrasound or combined with acetone could preserve the bond strength.