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

Lookup NU author(s): Dr Mark Pennington, Professor Chris VernazzaORCiD, Dr Philip Shackley, Nigel Armstrong, Professor John Whitworth, Emeritus Professor Jimmy Steele CBE

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Abstract

P>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 5-8 pound 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 12-15 pound 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.

Publication metadata

Author(s): Pennington MW, Vernazza CR, Shackley P, Armstrong NT, Whitworth JM, Steele JG

Publication type: Article

Publication status: Published

Journal: International Endodontic Journal

Year: 2009

Volume: 42

Issue: 10

Pages: 874-883

Date deposited: 16/12/2009

ISSN (print): 0143-2885

ISSN (electronic): 1365-2591

Publisher: Wiley-Blackwell Publishing

URL: http://dx.doi.org/10.1111/j.1365-2591.2009.01582.x

DOI: 10.1111/j.1365-2591.2009.01582.x

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