Brochado Martins João Filipe, Hagay Shemesh, Herbst Sascha Rudolf, Falk Schwendicke
Department of Endodontology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
Int Endod J. 2023 Nov;56(11):1319-1327. doi: 10.1111/iej.13972. Epub 2023 Sep 21.
Selective root-canal retreatment has been proposed as an alternative to full retreatment in multirooted, root-canal-filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost-effectiveness of full versus selective root-canal retreatment using data from a recent clinical pilot study, employing a modelling approach.
A Markov model was constructed to follow up a previously root-canal treated maxillary molar with apical pathology on a single root (mesio-buccal), receiving either selective or full root-canal retreatment. A private-payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50-year-old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte-Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost-effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost-effectiveness at different willingness-to-pay-thresholds was evaluated.
In the base-case scenario, selective retreatment was less costly (2137; 2.5%-97.5% percentiles: 1944-2340 Euro) and more effective (19.6; 18.3-20.8 Years) than full retreatment (2495; 2305-2671 Euro; 16.5; 15.2-17.9 Years) in 100% of the simulations and regardless of the willingness-to-pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective.
Selective retreatment, when clinically applicable, is likely to be more cost-effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.
对于有多根且已进行根管充填、存在根尖病变证据的牙齿，有人提出选择性根管再治疗可作为完全再治疗的替代方法，即仅对受影响的牙根进行再治疗。虽然此方法最初可能节省成本，但失败和再次治疗可能抵消这些初始节省的费用。我们采用建模方法，利用近期一项临床试点研究的数据，评估完全根管再治疗与选择性根管再治疗的成本效益。
构建一个马尔可夫模型，随访一颗先前已进行根管治疗、单根（近中颊根）存在根尖病变的上颌磨牙，该磨牙接受选择性或完全根管再治疗。采用荷兰医疗保健中私人支付者的视角。对最初50岁患者一生中患有近中根根尖病变的恒磨牙进行模拟。牙齿可能出现牙髓并发症，并需要进行诸如再治疗或拔牙及修复等干预措施。成本根据荷兰牙科费用目录计算。进行蒙特卡洛微观模拟以评估终生成本和有效性（以牙齿保留时间衡量），以及由此产生的成本效益。进行概率联合不确定性和敏感性分析，并评估不同支付意愿阈值下的成本效益。
在基础病例情景中，在100%的模拟中且无论支付意愿阈值如何，选择性再治疗比完全再治疗成本更低（2137欧元；2.5% - 97.5%百分位数：1944 - 2340欧元）且更有效（19.6年；18.3 - 20.8年），而完全再治疗成本为2495欧元（2305 - 2671欧元），有效性为16.5年（15.2 - 17.9年）。仅在最坏情况情景下，选择性再治疗成本更高，但仍然更有效。
在临床上适用时，对于患有持续性根尖周炎的根管治疗磨牙，选择性再治疗可能比完全再治疗更具成本效益。由于基础数据质量有限，我们的结果应谨慎解读。
