Cost-effectiveness decision analysis of obtaining periapical radiographs of traumatized maxillary incisors

A long-term decision analysis approach has been applied to the problem of whether or not periapical radiographs should be taken routinely of patients presenting with simple fractures of otherwise asymptomatic maxillary incisors. Information from the literature concerning the accuracy of cold, hot and electrical tests for pulp vitality, combined with data on the accuracy of radiographic diagnosis of periapical pathology, and therefore vitality, has been used in the analysis of the diagnostic problem structured in the form of a decision tree. By adding information concerning the direct costs of examining and treating patients over a 10-year period to the analysis and varying the likely prevalence of periapical lesions in a three-way sensitivity analysis, the following results were arrived at: (1) if the disease prevalence in teenage patients is < 5%, it is economically justifiable to make a visual inspection only and then to proceed with simple restorative treatment; (2) if there is evidence from the clinical examination or patient history that the prevalence of pulp necrosis is between 5% and 50% then, in our case, radiographs were the most appropriate single diagnostic test.