(37) Retaining or replacing periodontally questionable or hopeless teeth. A long-term cost-effectiveness comparison of prediction-based decisions.

Introduction: Tooth loss prediction could improve decision-making for periodontally affected teeth. This study aimed to assess the long-term cost-effectiveness of retaining versus removing periodontally involved teeth which are predicted to be at-risk for extraction during periodontal maintenance therapy (PMT) versus replacing them via implant-supported crowns (ISCs).

Methods: A total of 281 patients with 6762 teeth followed-up for a mean period of 28.5 ± 6.34 years were evaluated. All teeth were then individually assessed to identify teeth with questionable or poor prognosis as indicated by the Miller-McEntire periodontal prognosis system. Building on cost and effectiveness data from 971 questionable and hopeless teeth (241 patients) who received long-term (mean 22.1 years) PMT in a university setting, two main prediction strategies were compared: Periodontal therapy (scaling and root planing, flap surgery, adjunctive therapy, and guided-tissue regeneration) was compared with tooth replacement using ISCs (including possible accompanying surgeries based on tooth location). Using microsimulations, the lifetime costs for our cohort were evaluated. Transition probabilities were calculated based on the best available evidence. Probabilities of success, failure, complications, and expected stability of the treatment before a breakdown or arise of other complications were extracted from the literature. Costs were analyzed for the total time of tooth or implant retention. The model adopted a university setting and private practice perspective within the US health care system. Microsimulations analyses were performed. The validity of the models and the effects of the heterogeneity was assessed.

Results: Our initial analysis shows that compared to periodontal therapy, ISCs will be more costly regardless of the degree of the tooth prognosis (questionable or poor), the smoking status of the patient (smoker/non-smoker), or the type of treatment provided. Based on the estimated life expectancy of some patients, ISC may be a more fitting treatment due to the longer time-to-event need for intervention following treatment. Prediction methods needed to be highly specific in to avoid unnecessary tooth loss and the associated high costs.

Conclusions: Our initial analysis shows indicate that, in most cases, retaining teeth with questionable and poor prognoses might be more cost-effective in the long term than replacing them with ISCs. Changes in the utilized evidence might alter these results. Removing questionable teeth prior to PMT should be prescribed cautiously.

Lead Author’s Contributions to the Research Project: The Lead Author was responsible for the study's inception, data collection, and the composition of the abstract.