Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant


Pennington, MW; Vernazza, CR; Shackley, P; Armstrong, NT; Whitworth, JM; Steele, JG; (2009) Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant. International endodontic journal, 42 (10). pp. 874-83. ISSN 0143-2885 DOI: https://doi.org/10.1111/j.1365-2591.2009.01582.x

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Abstract

AIM: To evaluate the cost-effectiveness of root canal treatment for a maxillary incisor tooth with a pulp infection, in comparison with extraction and replacement with a bridge, denture or implant supported restoration. METHODOLOGY: A Markov model was built to simulate the lifetime path of restorations placed on the maxillary incisor following the initial treatment decision. It was assumed that the goal of treatment was the preservation of a fixed platform support for a crown without involving the adjacent teeth. Consequently, the model estimates the lifetime costs and the total longevity of tooth and implant supported crowns at the maxillary incisor site. The model considers the initial treatment decisions, and the various subsequent treatment decisions that might be taken if initial restorations fail. RESULTS: Root canal treatment extended the life of the tooth at an additional cost of pound5-8 per year of tooth life. Provision of orthograde re-treatment, if the root canal treatment fails returns further extension of the expected life of the tooth at a cost of pound12-15 per year. Surgical re-treatment is not cost-effective; it is cheaper, per year, to extend the life of the crown by replacement with a single implant restoration if orthograde endodontic treatment fails. CONCLUSION: Modelling the available clinical and cost data indicates that, root canal treatment is highly cost-effective as a first line intervention. Orthograde re-treatment is also cost-effective, if a root treatment subsequently fails, but surgical re-treatment is not. Implants may have a role as a third line intervention if re-treatment fails.

Item Type: Article
Keywords: Cost-Benefit Analysis, Crowns, economics, Decision Making, Decision Trees, Dental Implants, economics, Dental Prosthesis, Implant-Supported, economics, Dental Pulp Diseases, economics, therapy, Denture, Partial, Fixed, economics, Denture, Partial, Fixed, Resin-Bonded, economics, Denture, Partial, Removable, economics, Humans, Incisor, pathology, Markov Chains, Maxilla, Models, Economic, Post and Core Technique, economics, Retreatment, economics, Root Canal Therapy, economics, Sensitivity and Specificity, Survival Analysis, Time Factors, Tooth Extraction, economics
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 19751289
Web of Science ID: 269673700003
URI: http://researchonline.lshtm.ac.uk/id/eprint/2564

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