RESUMEN
INTRODUCTION: The aim of this study was to investigate the survival rate of teeth intentionally replanted with a modern technique and to compare their cost-effectiveness with that of single-tooth implants. MATERIALS AND METHODS: Four databases were systematically searched for articles that met inclusion criteria published between January 1966 and February 2017. Overall survival rate of intentional replantation was determined through a meta-analysis using a random-effects model. Cost of different procedures was determined from the 2016 American Dental Association Dental Fees Survey. Cost-effectiveness analysis was performed for different treatment modalities. RESULTS: Six studies met the inclusion criteria. Meta-analysis resulted in a survival rate of 89.1% (95% confidence interval, 83.8%-94.4%). Compared with a single-tooth implant, intentional replantation was more cost-effective even when custom post/core and crown are also needed. CONCLUSION: The meta-analysis revealed a high survival rate for intentional replantation. Although the survival rate of implants is higher, intentional replantation is a more cost-effective treatment modality. Intentional replantation should be a treatment option discussed with patients, especially because an implant can still be placed if intentional replantation is unsuccessful.
Asunto(s)
Análisis Costo-Beneficio , Implantes Dentales de Diente Único/economía , Reimplante Dental/economía , Reimplante Dental/métodos , Humanos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Replantation of a permanent tooth is an intervention that carries the same responsibilities in terms of informed consent as a surgical procedure. Unlike many procedures that can be planned in advance, an avulsion requires decision-making shortly after the injury, often by a distraught patient or parent. Under these circumstances, patients or parents prefer, or may even pressure, clinicians to make the replantation decision for them.Later, the parents may seek advice of other professionals or be confronted by lay opinions or Internet information that may lead them to doubt the decision or even feel betrayed by the dentist who provided the acute care. This article uses an actual parent complaint to illustrate the medicolegal aspects of the replantation decision and describe measures to be taken by the clinician faced with this situation.
Asunto(s)
Consentimiento Informado , Procedimientos Quirúrgicos Orales/legislación & jurisprudencia , Pautas de la Práctica en Odontología/legislación & jurisprudencia , Gestión de Riesgos/legislación & jurisprudencia , Reimplante Dental , Niño , Toma de Decisiones , Humanos , Participación del Paciente , Reimplante Dental/economíaRESUMEN
This study describes the socio-economic burden and attitudes of children and their parents following replantation of avulsed incisors. Records of 80 patients with 99 avulsion injuries treated in a teaching hospital clinic from 1988 to 1999 were reviewed. Mean age at time of injury was 10.6 years (range = 6.6-17.7 years). Complete records for a minimum of 1 year were obtained for 43 patients with 60 replanted incisors. Mean treatment procedures provided during the first year included 5.5 diagnostic periapical radiographs, 1.9 occlusal radiographs, 1.3 pulpectomies, and 2.7 pulp medicament applications. The mean estimated treatment cost and direct time (dentist) for first-year post-trauma management was 1465 dollars CAD and 7.2 h, respectively. Treatment costs were significantly higher during the first year post-trauma for patients who had their incisors extracted (P = 0.04), but there was no significant difference in direct treatment time between the two groups (P = 0.19). Twenty-one patient-parent pairs were surveyed for a number of qualitative factors. Ninety per cent of patients and 86% of parents reported that school and work time was lost. Even after having gone through the painful experience of replantation, the demands of recall, and in some cases, extraction, the majority of patients (67%) and parents (81%) stated that they would have still made the same (replantation) decision. Patient and parent responses were not statistically different (P = 0.453). Almost half the parents stated they would be willing to pay over 2000 dollars CAD to save an incisor. Patients rated retention of an incisor as significantly more important than infraocclusion. This is the first study to quantify the treatment burden of replantation of avulsion injuries exclusively in the pediatric population. This study describes the socio-economic burden and responsibilities of patient/parent and dentist and their role in informed consent.
Asunto(s)
Actitud Frente a la Salud , Incisivo/lesiones , Avulsión de Diente/economía , Reimplante Dental/economía , Absentismo , Adolescente , Niño , Conducta de Elección , Costo de Enfermedad , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Masculino , Ontario , Padres/psicología , Pulpectomía/economía , Radiografía Dental/economía , Estudios Retrospectivos , Tratamiento del Conducto Radicular/economía , Factores de Tiempo , Avulsión de Diente/psicología , Extracción Dental/economía , Reimplante Dental/psicologíaRESUMEN
The authors conducted a survey of dentists reporting tooth avulsions from basketball net accidents. Although the number of people injured was small, the dental injuries were serious. In many cases, multiple teeth were avulsed as a result of the maxillary anterior teeth becoming entangled in the basketball net while the patients were attempting to slamdunk a basketball either on a lowered backboard or from a raised take-off area. The authors present recommendations for preventing tooth avulsions resulting from basketball net entanglement.