Secondary Treatment for Asymptomatic Root Canal Treated Teeth: A Cost-effectiveness Analysis

When faced with a clinically asymptomatic root canal treated tooth with certain radiographic findings (e.g., underextended or overextended root fillings or persistent periapical lesions), clinicians need to decide between endodontically retreating the tooth before restoration or not retreating it now but possibly later on. The present study compared the cost-effectiveness of both strategies.

A Markov model was constructed following a root canal treated, clinically asymptomatic molar with one of the described radiographic findings in a 50-year-old patient during his lifetime. Hazard functions were derived from systematically and non-systematically assessed literature, and costs were estimated for German health care. Monte Carlo microsimulations were performed for teeth with composite restorations, crowns, or post-core crowns, and costs per year of tooth retention were calculated.

Regardless of the radiographic findings, not performing immediate retreatment was found to be significantly less costly (589-954 Euro) and more effective (retention time, 25-29 years) than immediately performing secondary root canal treatment (1163-1359 Euro, 25-27 years). Both strategies had similar effectiveness only for teeth that received post-core crowns, whereas immediate retreatment remained more expensive. The uncertainty around the obtained strategy ranking was low.

The high costs for secondary root canal treatment do not seem to be outweighed by the increased risks associated with certain radiographic findings in asymptomatic teeth. Our results should be interpreted with caution because the quality of the underlying data is limited.