Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth

Brodén, Joséphine; Davidson, Thomas; Fransson, Helena

doi:10.1080/00016357.2018.1538536

Cited by 23 publications

(23 citation statements)

References 26 publications

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“…2016), and the procedure has been suggested as a cost‐effective alternative to root canal treatment in children and young adults in modelling studies (Schwendicke & Stolpe 2014, Brodén et al . 2019). To date, many studies have evaluated the outcome of DPC using various materials and for several clinical indications.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis

et al. 2020

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Background The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre‐operative pulpal diagnosis. Objectives To conduct a systematic review and meta‐analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome. Methods Sources: MEDLINE Ovid‐SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta‐analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality. Results Quality assessment highlighted four non‐randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow‐up. Calcium hydroxide success rate was 74% at 6‐months, 65% at 1‐year, 59% at 2–3 years and 56% at 4–5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6‐months, 86% at 1 year and 86% at 2–3 years. The meta‐analysis revealed MTA had better success than calcium hydroxide at 1‐year (OR 2.66, 95% CI; 1.46‐ 4.84, P = 0.001) and 2‐ to 3‐year follow‐up (OR 2.21, 95% CI; 1.42–3.44, P = 0.0004). There was no difference between MTA and Biodentine. Discussion These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI. Conclusions Low‐quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long‐term outcomes for MTA and Biodentine compared with calcium hydroxide.

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Section: Introductionmentioning

confidence: 99%

Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis

et al. 2020

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“…The clinical success criteria after a minimum 6-months follow-up period were the presence of a functional tooth without clinical signs or symptoms of pulp or periradicular disease (no spontaneous pain or hypersensitivity to cool, heat or sweets, no pain in response to palpation and/or percussion, no sinus tract, soft tissue swelling or mobility). The presence of any of these signs or symptoms was considered indicative of failure (Brodén et al, 2019).…”

Section: Key Pointsmentioning

confidence: 99%

Follow‐up of patients subjected to direct and indirect pulp capping of young permanent teeth. A retrospective study

Llena

Hernández

Melo

et al. 2020

Clinical & Exp Dental Res

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Objective: A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6-14 years-old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH).Material and methods: Data were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi-squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann-Whitney test.Results: The IPC and DPC success rate was 99.4%, and 84.6%, respectively (p = .01).Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p = .01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p = .07).Conclusions: When caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH.

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“…The chemical-mechanical preparation stage that involves instrumentation, irrigation, flooding and aspiration of the root canal is one of the most important stages of this treatment and is susceptible to accidents and complications [3]. These challenges have led to a constant search for improvement in the quality of root canal preparation and has motivated the transition from manual instrumentation to automation in contemporary clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

et al. 2022

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Background To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS). Methods This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques—manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated. Results The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, − R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, − R$ 0.73/min and − R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be − R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (− 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be − R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments. Conclusions The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.

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Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth

Cited by 23 publications

References 26 publications

Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis

Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis

Follow‐up of patients subjected to direct and indirect pulp capping of young permanent teeth. A retrospective study

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

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