title: Direct pulp capping after a carious exposure versus root canal treatment: a cost-effectiveness analysis.
abstract: BACKGROUND
  Excavation of deep caries often leads to pulpal exposure even in teeth with sensible, nonsymptomatic pulps. Although direct pulp capping (DPC) aims to maintain pulpal health, it frequently requires follow-up treatments like root canal treatment (RCT), which could have been performed immediately after the exposure, with possibly improved outcomes. We quantified and compared the long-term cost-effectiveness of both strategies.
  
  
  METHODS
  A Markov model was constructed following a molar with an occlusally located exposure of a sensible, nonsymptomatic pulp in a 20-year-old male patient over his lifetime. Transition probabilities or hazard functions were estimated based on systematically and nonsystematically assessed literature. Costs were estimated based on German health care, and cost-effectiveness was analyzed using Monte Carlo microsimulations.
  
  
  RESULTS
  Despite requiring follow-up treatments significantly earlier, teeth treated by DPC were retained for long periods of time (52 years) at significantly reduced lifetime costs (545 vs 701 Euro) compared with teeth treated by RCT. For teeth with proximal instead of occlusal exposures or teeth in patients >50 years of age, this cost-effectiveness ranking was reversed. Although sensitivity analyses found substantial uncertainty regarding the effectiveness of both strategies, DPC was usually found to be less costly than RCT.
  
  
  CONCLUSIONS
  We found both DPC and RCT suitable to treat exposed vital, nonsymptomatic pulps. DPC was more cost-effective in younger patients and for occlusal exposure sites, whereas RCT was more effective in older patients or teeth with proximal exposures. These findings might change depending on the health care system and underlying literature-based probabilities.
authors.affiliation: Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany. Electronic address: falk.schwendicke@charite.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Schwendicke
authors.affiliation: Kiel Institute for the World Economy, Kiel, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stolpe
mesh_terms: D000367:Age Factors; D001047:Apicoectomy / Q000191:economics; D003362:Cost-Benefit Analysis; D003442:Crowns / Q000191:economics; D003731:Dental Caries / Q000191:economics* / Q000628:therapy; D015921:Dental Implants / Q000191:economics; D019094:Dental Prosthesis, Implant-Supported / Q000191:economics; D003785:Dental Pulp Capping / Q000191:economics*; D003789:Dental Pulp Exposure / Q000191:economics* / Q000628:therapy; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008390:Markov Chains; D008963:Molar / Q000473:pathology; D009010:Monte Carlo Method; D019233:Retreatment / Q000191:economics; D012390:Root Canal Therapy / Q000191:economics*; D014081:Tooth Extraction / Q000191:economics; D019553:Tooth, Nonvital / Q000191:economics / Q000628:therapy; D016896:Treatment Outcome; D035501:Uncertainty; D055815:Young Adult
chemical_list: D015921:Dental Implants
keywords: Caries; dental; endodontics; health economics; public health; pulpal vitality