Edwards M J, Brickley M R, Goodey R D, Shepherd J P
Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine Dental School, Heath Park, Cardiff.
Br Dent J. 1999 Oct 9;187(7):380-4. doi: 10.1038/sj.bdj.4800285.
The study was undertaken to identify the least costly, most effective and most cost-effective management strategy for asymptomatic, disease free mandibular third molars.
A decision tree model of the outcomes of mandibular third molar retention and removal was constructed. Probability data for possible outcomes were obtained from a comprehensive literature review and entered into the decision tree. The cost to the NHS in treating each outcome was calculated. 100 patients attending the oral surgery clinics, University of Wales Dental Hospital rated the effect of each outcome on their own life. The cost and effectiveness data for each outcome were entered into the decision tree and the analyses were conducted by 'folding back' the decision tree based on the probabilities.
Mandibular third molar retention was less costly (170 Pounds), more effective (69.5 effectiveness units on a 100 point scale) and more cost-effective (2.43 Pounds per unit of effectiveness) than removal (226 Pounds, 63.3 and 3.57 Pounds respectively). These findings were sensitive to changes in the probability of pericoronitis, periodontal disease and caries.
Mandibular third molar retention is less costly to the NHS, more effective for the patient and more cost-effective to both parties than removal. However, should the likelihood of developing pericoronitis, periodontal disease and caries increase substantially then removal becomes the more cost-effective strategy.
本研究旨在确定针对无症状、无疾病的下颌第三磨牙，成本最低、效果最佳且性价比最高的管理策略。
构建了一个关于下颌第三磨牙保留与拔除结果的决策树模型。从全面的文献综述中获取可能结果的概率数据，并输入到决策树中。计算了英国国家医疗服务体系（NHS）治疗每种结果的成本。100名就诊于威尔士大学牙科医院口腔外科诊所的患者对每种结果对其自身生活的影响进行了评分。将每种结果的成本和效果数据输入到决策树中，并根据概率通过“回溯”决策树进行分析。
下颌第三磨牙保留的成本更低（170英镑）、效果更佳（在100分制中为69.5个效果单位）且性价比更高（每单位效果2.43英镑），而拔除的成本为226英镑、效果为63.3、每单位效果为3.57英镑。这些发现对冠周炎、牙周病和龋齿概率的变化较为敏感。
对于NHS而言，下颌第三磨牙保留的成本更低，对患者更有效，对双方而言性价比更高。然而，如果发生冠周炎、牙周病和龋齿的可能性大幅增加，那么拔除则成为性价比更高的策略。
