Cost-effectiveness analysis of full versus selective root canal retreatment

Area of Science:

• Endodontics
• Health Economics
• Dental Public Health

Background:

• Selective root-canal retreatment targets only affected roots in multirooted teeth with apical pathology.
• Full retreatment addresses all roots, potentially incurring higher initial costs.
• The cost-effectiveness of selective versus full retreatment requires thorough evaluation.

Purpose of the Study:

• To assess the cost-effectiveness of selective versus full root-canal retreatment for molars with apical pathology.
• To compare long-term outcomes, including tooth retention time and costs, from a private-payer perspective.

Main Methods:

• A Markov model simulated lifetime outcomes for 50-year-old patients undergoing selective or full retreatment of a maxillary molar with mesial root apical pathology.
• Dutch dental fees were used for cost calculations.
• Monte-Carlo microsimulations and sensitivity analyses evaluated cost-effectiveness and uncertainty.

Main Results:

• Selective retreatment was consistently less costly (€2137 vs €2495) and more effective (19.6 vs 16.5 years of tooth retention) than full retreatment in the base-case scenario.
• These findings held true across 100% of simulations and various willingness-to-pay thresholds.
• Even in worst-case scenarios, selective retreatment remained more effective, though potentially more costly.

Conclusions:

• Selective root-canal retreatment is likely more cost-effective than full retreatment for endodontically treated molars with persistent apical periodontitis, when clinically feasible.
• The study highlights the potential for improved long-term outcomes and cost savings with a targeted retreatment approach.
• Results should be interpreted cautiously due to limitations in the underlying data quality.