The impact of Cone Beam CT on financial costs and orthodontists' treatment decisions in the management of maxillary canines with eruption disturbance.

Background: Examination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear. Objectives: To measure: 1. the proportion of orthodontists' treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2); and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance. Subjects and methods: Orthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case. Results: One hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2. Limitations: Benefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution. Conclusions: For the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.

Reliability and agreement of root length measurements during orthodontic treatment in images from different CBCT machines using multiplanar reconstruction.

Objectives: To assess inter- and intrarater reliability and agreement for measurements of root lengths using multiplanar reconstruction (MPR) in cone beam computed tomography (CBCT) examinations.Furthermore, to determine whether using MPR from different CBCT machines was a reliable and reproducible method for assessment of root length during orthodontic treatment of adolescents. Materials and methods: A total of 40 CBCT examinations obtained before, during and after orthodontic treatment of 14 adolescents, with fixed appliances from a multicentre randomised controlled trial, were used. All roots from the incisors to the first molars were measured by two independent raters and in accordance with a protocol preceded by a multi-step calibration. Reliability was assessed by intra class correlation (ICC). Agreement was assessed by measurement error according to the Dahlberg formula and Bland-Altman plot. Results: The number of repeated measurements varied from 436 to 474 for the different timepoints. Good to excellent inter- and intrarater reliability for different tooth groups and timepoints were shown. Measurement error for inter- and intrarater agreement varied between 0.41 mm and 0.77 mm. The Bland-Altman plot with 95% limits of agreement varied between +1.43 mm and -2.01 mm for different tooth groups and timepoints. Conclusions: The results of this study indicate that CBCT using MPR from different machines is a reproducible method for measuring root length during different phases of orthodontic treatment. When interpreting root shortening measurements in CBCT using MPR for clinical or research purposes, values below 2 mm should be approached with caution, as they may contain measurement errors.

There is a paucity of economic evaluations of prediction methods of caries and periodontitis-A systematic review.

OBJECTIVES: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). MATERIAL AND METHODS: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. RESULTS: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. CONCLUSIONS: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.

Willingness to pay for osteoporosis risk assessment in primary dental care.

BACKGROUND: Fragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal women's preferences for an osteoporosis risk assessment in primary dental care. RESULTS: Most respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 € (CI 95% 38.46-50.74 €) (median 34.75 €). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment. CONCLUSIONS: Postmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit women's health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.

Economic evaluation of diagnostic methods used in dentistry. A systematic review.

OBJECTIVES: To review the literature of economic evaluations regarding diagnostic methods used in dentistry. DATA SOURCES: Four databases (MEDLINE, Web of Science, The Cochrane library, the NHS Economic Evaluation Database) were searched for studies, complemented by hand search, until February 2013. STUDY SELECTION: Two authors independently screened all titles or abstracts and then applied inclusion and exclusion criteria to select full-text publications published in English, which reported an economic evaluation comparing at least two alternative methods. Studies of diagnostic methods were assessed by four reviewers using a protocol based on the QUADAS tool regarding diagnostic methods and a check-list for economic evaluations. The results of the data extraction were summarized in a structured table and as a narrative description. RESULTS: From 476 identified full-text publications, 160 were considered to be economic evaluations. Only 12 studies (7%) were on diagnostic methods, whilst 78 studies (49%) were on prevention and 70 (40%) on treatment. Among studies on diagnostic methods, there was between-study heterogeneity methodologically, regarding the diagnostic method analysed and type of economic evaluation addressed. Generally, the choice of economic evaluation method was not justified and the perspective of the study not stated. Costing of diagnostic methods varied. CONCLUSIONS: A small body of literature addresses economic evaluation of diagnostic methods in dentistry. Thus, there is a need for studies from various perspectives with well defined research questions and measures of the cost and effectiveness. CLINICAL SIGNIFICANCE: Economic resources in healthcare are finite. For diagnostic methods, an understanding of efficacy provides only part of the information needed for evidence-based practice. This study highlighted a paucity of economic evaluations of diagnostic methods used in dentistry, indicating that much of what we practise lacks sufficient evidence.

A framework for costing diagnostic methods in oral health care: an application comparing a new imaging technology with the conventional approach for maxillary canines with eruption disturbances.

OBJECTIVES: The aims were (i) to propose a framework for costing diagnostic methods in oral health care and (ii) to illustrate the application of the framework to the radiographic examination of maxillary canines with eruption disturbances. METHODS: The framework for costing, following Drummond et al. (2005), includes three elements: (i) identification of different resources used in producing and delivering the service, (ii) measurement of the amount of each resource required and (iii) valuation of the resources in monetary terms. Four data collection instruments were designed - a protocol for apportioning the cost of capital equipment to each diagnostic procedure, separate forms for recording consumable items, for the time of different health care providers used for a diagnostic examination and a patient survey for calculation of the total cost to the patient associated with the examination. The framework was applied to the radiographic examination of maxillary canines with eruption disturbances comparing two imaging methods: (i) a new method with cone beam computed tomography and panoramic radiography and (ii) a conventional method using intraoral and panoramic radiography. The primary analysis was performed from the perspective of the health care system. A separate analysis included patient costs with health care system costs to provide a societal perspective. Comparison of the two perspectives allows consideration of whether any costs savings to the health care system are generated at the expense of greater costs for patients and their families. Data for the cost-analysis were retrieved from 47 patients (mean age 14 years) referred to a department of radiology for examination of maxillary canines. RESULTS: Application of the framework for costing allowed us to compare the resources used to perform examinations of the two methods. The mean total cost per examination for the new method was 128.38€ and 81.80€ for the conventional method, resulting in an incremental cost per examination of the new method of 46.58€. CONCLUSIONS: The application of the framework demonstrates the feasibility of measuring and comparing the total costs as well as the distribution of total costs between providers and patients for different approaches to this common examination.