Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis

Abstract

ObjectiveTo evaluate the cost‐effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years.MethodsA Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long‐term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth‐Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years.ResultsRegardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost‐effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost‐effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis.ConclusionPreserving a cFPM was more cost‐effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost‐effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.

Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars

“…We considered that the accuracy of our study would be optimal if focussed on the immature first maxillary permanent molars. It is important to note that preservation of the immature first permanent molars is more cost-effective than the early loss of these teeth and that this procedure prevents the occurrence of severe orthodontic consequences [19,20]. Furthermore, despite their anatomical variations, most maxillary third molars exhibit root anatomy and morphology that are similar to the first molar with three separated roots, and are often extracted for orthodontic reasons [21,22].…”