Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
J Dent Res. 2013 Oct;92(10):880-7. doi: 10.1177/0022034513500792. Epub 2013 Aug 14.
The treatment of deep caries lesions carries significant risks for the integrity of the pulp and often initiates a cascade of re-interventions. Incomplete caries removal may reduce these risks and avoid or delay re-treatment. The present study analyzed the cost-effectiveness of one- and two-step incomplete as well as complete excavations. We used Markov models to simulate treatment of a molar tooth with a deep caries lesion in a 15-year-old patient. Retention of the tooth and its vitality as effectiveness measures as well as accruing costs were analyzed over the patient's lifetime. The model adopted a public-private-payer perspective within German health care. Transition probabilities were calculated based on literature reviews. Monte-Carlo microsimulations were performed with 6-month cycles. One-step incomplete excavation resulted in lower long-term costs and in longer-retained teeth and their vitality (means: 53.5 and 41.0 yrs) compared with two-step incomplete (52.5 and 37.5 yrs) and complete excavations (49.5 and 31.0 yrs), and dominated the other strategies in 70% to 100% of simulations. Regardless of the assumed willingness-to-pay ceiling value, one-step incomplete excavation had the highest probability of being cost-effective. Despite limited evidence levels of input data, we expect one-step incomplete excavation to reduce costs while retaining deeply carious teeth and their vitality for longer.
深龋病变的治疗会对牙髓的完整性带来重大风险，往往会引发一系列的再介入。不完全去龋可以降低这些风险，并避免或延迟再治疗。本研究分析了一步和两步不完全以及完全挖除的成本效益。我们使用马尔可夫模型来模拟对 15 岁患者深龋磨牙的治疗。保留牙齿及其活力作为有效性指标，以及累积成本，在患者的一生中进行分析。该模型采用了德国医疗保健的公私共付者视角。转移概率是根据文献综述计算的。蒙特卡罗微模拟以 6 个月为周期进行。与两步不完全（52.5 和 37.5 年）和完全挖掘（49.5 和 31.0 年）相比，一步不完全挖掘导致长期成本更低，保留的牙齿及其活力更长（平均值：53.5 和 41.0 年），在 70%至 100%的模拟中，一步不完全挖掘占据主导地位。无论假设的支付意愿上限值如何，一步不完全挖掘都具有最高的成本效益概率。尽管输入数据的证据水平有限，但我们预计一步不完全挖掘可以降低成本，同时保持深龋牙齿及其活力更长时间。
