Restoration or implant placement: a growing treatment planning quandary

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant

BACKGROUND

Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China.

METHODS

211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective.

RESULTS

170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY.

CONCLUSIONS

Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

Cone Beam Computed Tomography (CBCT) Evaluation of Alveolar Bone Thickness and Root Angulation in Anterior Maxilla for Planning Immediate Implant Placement

OBJECTIVE

 This retrospective study aimed to measure the labial, palatal, mesial, and distal bone thickness around maxillary central and lateral incisors and canines and height from crest to apex, using cone beam computed tomography (CBCT) images and compare the results based on gender. The second objective of the study was to measure root angulation on CBCT images and its relation with the labial cortical thicknesses.  Material and Methods: After the Institutional Review Board (IRB) approval, a total of 140 CBCT volumes were included in this study according to the set criteria. On each scan, right-side maxillary central, lateral incisors, and canine were selected for the measurements. All the measurements were done at three levels at the alveolar crest (L1), mid-root (L2), and apical region (L3) for each tooth.  Results: The Student's t-test was performed to compare the result of buccal, palatal, mesial, and distal bone thickness, angulation, and height of all subjects. Buccal alveolar bone thickness was minimum at the mid-root region, and the palatal bone thickness was minimum at the crestal region. The mesial bone thickness was minimum at the mid-root level, and distal bone thickness was minimum at the crest level. The available bone height was maximum at the lateral incisor and equal for the central incisor and canine. The canine was the most angulated tooth.

CONCLUSION

 Cone beam computed tomography is a reliable imaging modality to evaluate pre-surgical immediate implant sites and measure alveolar bone thickness. The canine was the most angulated tooth with more buccal alveolar bone thickness.

Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth

Prosthodontists face the difficult task of judging the influence and significance of multiple risk factors of periodontal, endodontic, or prosthetic origin that can affect the prognosis of an abutment tooth. The purpose of this review is to summarize the critical factors involved in deciding whether a questionable tooth should be treated and maintained, or extracted and possibly replaced by dental implants. A MEDLINE (PubMed) search of the English, peer-reviewed literature published from 1966 to August 2009 was conducted using different keyword combinations including treatment planning, in addition to decision making, periodontics, endodontics, dental implants, or prosthodontics. Further, bibliographies of all relevant papers and previous review articles were hand searched. Tooth maintenance and the acceptance of risks are suitable when: the tooth is not extensively diseased; the tooth has a high strategic value, particularly in patients with implant contraindications; the tooth is located in an intact arch; and the preservation of gingival structures is paramount. When complete-mouth restorations are planned, the strategic use of dental implants and smaller units (short-span fixed dental prostheses), either tooth- or implant-supported, as well as natural tooth abutments with good prognoses for long-span FDPs, is recommended to minimize the risk of failure of the entire restoration.

Diagnosis and treatment planning are essential prior to commencing endodontic treatment: discuss this statement as it relates to clinical endodontic management

Diagnosis and treatment planning are essential to the practice of endodontics. Diagnosis aims to determine whether pathological involvement of the dental pulp has or is occurring. Treatment planning meanwhile, involves appropriately selecting cases, determining how difficult the treatment may be to perform on a specific individual and sequencing treatment procedures to achieve a healthy and functional dentition. In endodontic management, this may involve establishing whether the tooth is restorable and periodontally sound, the patient is able to tolerate the treatments and the clinician has the skills to perform the required treatment procedures. Careful consideration of these issues must be given prior to commencing treatment.