Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis

Area of Science:

• Dental research
• Health economics
• Clinical decision-making

Background:

• Deep caries excavation can lead to pulp exposure in asymptomatic teeth.
• Direct pulp capping (DPC) aims to preserve pulp vitality but may necessitate subsequent root canal treatment (RCT).
• Comparing the long-term cost-effectiveness of DPC versus immediate RCT is crucial for treatment planning.

Purpose of the Study:

• To quantify and compare the long-term cost-effectiveness of direct pulp capping (DPC) versus immediate root canal treatment (RCT) for exposed, vital, nonsymptomatic pulps.
• To evaluate how patient age and exposure site influence the cost-effectiveness of these dental treatments.

Main Methods:

• A Markov model simulated treatment outcomes over a lifetime for a 20-year-old male with an occlusal pulp exposure.
• Transition probabilities were derived from a systematic literature review.
• Costs were based on German healthcare data, and Monte Carlo microsimulations were used for cost-effectiveness analysis.

Main Results:

• Direct pulp capping (DPC) resulted in longer tooth retention (52 years) and lower lifetime costs (545 Euro) compared to root canal treatment (RCT) (701 Euro).
• The cost-effectiveness advantage of DPC was reversed for proximal exposures or in patients over 50 years old.
• Sensitivity analyses indicated DPC was generally less costly, despite uncertainties in treatment effectiveness.

Conclusions:

• Both DPC and RCT are viable for treating exposed vital, nonsymptomatic pulps.
• DPC demonstrates superior cost-effectiveness in younger patients and for occlusal exposures.
• RCT may be more effective for older patients or teeth with proximal exposures, with findings potentially varying by healthcare system.