title: Retaining or replacing molars with furcation involvement: a cost-effectiveness comparison of different strategies.
abstract: OBJECTIVE
  The comparative cost-effectiveness of retaining or replacing molars with furcation involvement (FI) remains unclear. We assessed the cost-effectiveness of retaining FI molars via periodontal treatments versus replacing them via implant-supported crowns (ISCs).
  
  
  METHODS
  Using tooth-level Markov models, we followed a molar with FI degree I or II/III in a 50-year-old patient over his lifetime. Tooth-retaining periodontal treatments (scaling and root planing, flap debridement, root resection, guided-tissue regeneration, tunnelling) were compared with tooth replacement using ISCs. We analysed costs, time until first re-treatment and total time of tooth or implant retention. The model adopted a private payer perspective within German health care. Transition probabilities were calculated based on current evidence. Monte-Carlo microsimulations were performed, and robustness of the model and effects of heterogeneity assessed using sensitivity analyses.
  
  
  RESULTS
  Despite requiring re-treatment later than other strategies, ISCs were the most costly therapy. Compared with most periodontal treatments, ISCs were retained for shorter time than natural teeth regardless of the degree of FI, the patients' age or risk profile (smoker/non-smoker).
  
  
  CONCLUSIONS
  Based on available data and within its limitations, our study indicates that retaining FI molars via periodontal treatments might be more cost-effective than replacing them via ISCs. Changes in the underlying evidence or the setting might alter these results.
authors.affiliation: Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin, Berlin, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Schwendicke
authors.forename: Christian
authors.initials: C
authors.lastname: Graetz
authors.forename: Michael
authors.initials: M
authors.lastname: Stolpe
authors.forename: Christof Edmund
authors.initials: CE
authors.lastname: Dörfer
mesh_terms: D000367:Age Factors; D003362:Cost-Benefit Analysis; D003442:Crowns / Q000191:economics; D003752:Dental Health Services / Q000191:economics; D015921:Dental Implants / Q000191:economics; D019094:Dental Prosthesis, Implant-Supported / Q000191:economics; D019232:Dental Restoration Failure / Q000191:economics; D017823:Furcation Defects / Q000191:economics* / Q000628:therapy; D016557:Guided Tissue Regeneration, Periodontal / Q000191:economics; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D008963:Molar / Q000473:pathology*; D057747:Periodontal Debridement / Q000191:economics; D011336:Probability; D019233:Retreatment; D012907:Smoking; D013524:Surgical Flaps / Q000191:economics; D016019:Survival Analysis; D016388:Tooth Loss / Q000191:economics; D019553:Tooth, Nonvital / Q000191:economics
chemical_list: D015921:Dental Implants
keywords: dental; furcation; health economics; implant; modelling; periodontal