Detecting Proximal Secondary Caries Lesions: A Cost-effectiveness Analysis

Area of Science:

• Dental diagnostics
• Health economics

Background:

• Choosing secondary caries detection methods involves balancing sensitivity for early treatment against specificity to prevent overtreatment.
• Accurate diagnosis is crucial to avoid unnecessary invasive procedures and costs.

Purpose of the Study:

• To assess the cost-effectiveness of different detection methods for proximal secondary caries.
• To compare the lifetime cost and effectiveness (tooth retention) of tactile, radiographic, and laser fluorescence detection methods.

Main Methods:

• Monte Carlo microsimulations modeled a vital permanent molar with a restoration over a lifetime.
• Evaluated methods individually and in pairwise combinations at sensitive and specific thresholds.
• Applied a mixed public-private payer perspective within the German healthcare system.

Main Results:

• Radiographic detection verified by tactile assessment (specific thresholds) was least costly (€1,060) with 50 years of tooth retention.
• Laser fluorescence verified by radiography (specific thresholds) was most effective (53 years retention) but more costly (€1,157).
• Combining methods at specific thresholds was generally more effective and less costly than using single methods or sensitive thresholds.

Conclusions:

• Combined detection methods, particularly at specific thresholds, are recommended for secondary caries to minimize false positives and overtreatment.
• Future longitudinal studies should assess the predictive value of different diagnostic methods.