Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Sep;49(9):817-826.
doi: 10.1111/iej.12537. Epub 2015 Sep 19.

Conventional treatment, Hall Technique or immediate pulpotomy for carious primary molars: a cost-effectiveness analysis

F Schwendicke  1 , M Stolpe  2 , N Innes  3
Affiliations

Conventional treatment, Hall Technique or immediate pulpotomy for carious primary molars: a cost-effectiveness analysis

F Schwendicke et al. Int Endod J. 2016 Sep.

Abstract

Aim: To compare the cost-effectiveness of three strategies for treating primary molars with cavitated carious lesions and sensible (vital), asymptomatic pulps.

Methodology: Conventional excavation and restoration, Hall Technique (caries sealing using a preformed crown), and pulpotomy were compared. As the latter would not be applied to all teeth in clinical reality, decision-making under perfect information was modelled, with teeth at-risk for pulpal complications receiving immediate pulpotomy, whilst all others were treated conventionally. A Markov model was constructed and transition probabilities derived from randomized trials and systematic reviews. A carious molar in a 5-year-old child was followed until exfoliation. Cost-effectiveness was assessed within the German healthcare system using a public-payer perspective. Monte Carlo microsimulations were performed to evaluate the primary outcome, costs (in Euros) per year of tooth retention.

Results: Conventional treatment was least effective and more expensive than the Hall Technique. Risk-based pulpotomy was more costly, but also more effective than alternatives. Overall, the Hall Technique was most cost-effective (9.77 Euros year-1 ), followed by pulpotomy (11.75 Euros year-1 ) and conventional treatment (13.31 Euros year-1 ). For payers willing to invest >59 Euros per additional year of tooth retention, risk-based pulpotomy was most cost-effective. Providing pulpotomy to all teeth was not cost-effective.

Conclusions: The Hall Technique was most cost-effective, whilst conventional treatment was least effective and more costly. Performing pulpotomy for molars at-risk of pulpal complications might be effective, but was more expensive than alternatives. Moreover, accurately predicting such pulpal complications is currently not possible. Risk-based decision-making does not necessarily reduce costs.

Keywords: caries; dental; endodontics; health economics; success; survival.

PubMed Disclaimer

LinkOut - more resources