{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:27:13Z","timestamp":1777951633634,"version":"3.51.4"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Implant Dent"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent apical periodontitis in mandibular second molars presents a clinical decision between tooth preservation and extraction with implant replacement. Although intentional replantation (IR), surgical endodontic treatment, and implant therapy demonstrate acceptable outcomes, their long-term economic value remains unclear. This study evaluated the cost-effectiveness of tooth-preserving strategies versus extraction with implant placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A Markov model simulated 40-year-old patients with persistent apical periodontitis in a mandibular second molar from a United States (US) private payer perspective. Three strategies were compared: IR, surgical endodontic treatment, and extraction with implant placement. The model used 6-month half cycles over 39.3 years with 3% annual discount rate. Transition probabilities were derived from systematic reviews and clinical studies. Costs were obtained from the American Dental Association (ADA) 2022 survey adjusted to 2025 USD. Effectiveness was expressed as retained tooth-years or implant-years. Deterministic and probabilistic sensitivity analyses using 10,000 Monte Carlo simulations assessed uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>IR yielded 16.09 retained tooth-years at USD 2,676. Surgical endodontic treatment provided an additional 0.32 years corresponding to 16.41 tooth-years at an Incremental Cost-Effectiveness Ratio (ICER) of USD 4,279.66. Extraction with implant placement achieved 19.08 implant-years at an ICER of USD 580.60. Probabilistic analysis showed IR was cost-effective at lower willingness-to-pay thresholds, whereas implant placement became preferred beyond approximately USD 600.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In mandibular second molars with persistent apical periodontitis, IR proved economically favorable in the short-term, while extraction with implant placement offered superior long-term effectiveness at reasonable incremental costs for patients with extended life expectancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s40729-026-00678-2","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:47:25Z","timestamp":1775465245000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of tooth preservation versus implant for persistent periapical pathosis in mandibular second molars"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6479-3518","authenticated-orcid":false,"given":"Muhammad Muthar","family":"Shaikh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4994-5841","authenticated-orcid":false,"given":"Nighat","family":"Naved","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2106-9918","authenticated-orcid":false,"given":"Asif R.","family":"Khowaja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3817-5941","authenticated-orcid":false,"given":"Fahad","family":"Umer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"678_CR1","unstructured":"Goldberger T, Rosen E, Tsesis I. The Dynamics of Periapical Lesions in Endodontically Treated Teeth: American Association of Endodontists (AAE Communiqu\u00e9); 2022 [cited 2026 4th January]. Available from: https:\/\/www.aae.org\/specialty\/the-dynamics-of-periapical-lesions-in-endodontically-treated-teeth-rationale-for-a-clinical-intervention\/."},{"issue":"11","key":"678_CR2","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1111\/iej.13822","volume":"55","author":"M Le\u00f3n-L\u00f3pez","year":"2022","unstructured":"Le\u00f3n-L\u00f3pez M, Cabanillas-Balsera D, Mart\u00edn-Gonz\u00e1lez J, Montero-Miralles P, Sa\u00faco-M\u00e1rquez JJ, Segura-Egea JJ. Prevalence of root canal treatment worldwide: a systematic review and meta-analysis. Int Endod J. 2022;55(11):1105\u201327.","journal-title":"Int Endod J"},{"key":"678_CR3","doi-asserted-by":"crossref","unstructured":"Park DM, Seok WH, Yoon JY. Factors influencing non-surgical root canal treatment outcomes in mandibular second molars: a retrospective cone-beam computed tomography analysis. J Clin Med. 2024;13(10).","DOI":"10.3390\/jcm13102931"},{"issue":"Suppl 1","key":"678_CR4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/aej.12692","volume":"49","author":"Q Guo","year":"2023","unstructured":"Guo Q, Wang Q, Yang Y, Guo D. Root and root canal morphology of mandibular second permanent molars in the Gansu province population: a CBCT study. Aust Endod J. 2023;49(Suppl 1):27\u201332.","journal-title":"Aust Endod J"},{"issue":"5","key":"678_CR5","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/0030-4220(93)90073-D","volume":"76","author":"IB Bender","year":"1993","unstructured":"Bender IB, Rossman LE. Intentional replantation of endodontically treated teeth. Oral Surg Oral Med Oral Pathol. 1993;76(5):623\u201330.","journal-title":"Oral Surg Oral Med Oral Pathol"},{"issue":"5","key":"678_CR6","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.14219\/jada.archive.1966.0125","volume":"72","author":"LI Grossman","year":"1966","unstructured":"Grossman LI. Intentional replantation of teeth. J Am Dent Assoc. 1966;72(5):1111\u20138.","journal-title":"J Am Dent Assoc"},{"issue":"Suppl 1","key":"678_CR7","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1111\/aej.12707","volume":"49","author":"F Javed","year":"2023","unstructured":"Javed F, Zafar K, Khan FR. Outcome of intentional replantation of endodontically treated teeth with periapical pathosis: a systematic review and meta-analysis. Aust Endod J. 2023;49(Suppl 1):494\u2013507.","journal-title":"Aust Endod J"},{"issue":"1","key":"678_CR8","first-page":"13","volume":"20","author":"L Wang","year":"2020","unstructured":"Wang L, Jiang H, Bai Y, Luo Q, Wu H, Liu H. Clinical outcomes after intentional replantation of permanent teeth: a systematic review. Bosn J Basic Med Sci. 2020;20(1):13\u201320.","journal-title":"Bosn J Basic Med Sci"},{"issue":"7","key":"678_CR9","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1016\/j.joen.2015.01.004","volume":"41","author":"M Torabinejad","year":"2015","unstructured":"Torabinejad M, Dinsbach NA, Turman M, Handysides R, Bahjri K, White SN. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review. J Endod. 2015;41(7):992\u20138.","journal-title":"J Endod"},{"issue":"7","key":"678_CR10","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1016\/j.joen.2009.04.023","volume":"35","author":"M Torabinejad","year":"2009","unstructured":"Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009;35(7):930\u20137.","journal-title":"J Endod"},{"issue":"11","key":"678_CR11","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.joen.2010.08.007","volume":"36","author":"FC Setzer","year":"2010","unstructured":"Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature--Part 1: comparison of traditional root-end surgery and endodontic microsurgery. J Endod. 2010;36(11):1757\u201365.","journal-title":"J Endod"},{"issue":"3","key":"678_CR12","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.joen.2012.11.044","volume":"39","author":"I Tsesis","year":"2013","unstructured":"Tsesis I, Rosen E, Taschieri S, Telishevsky Strauss Y, Ceresoli V, Del Fabbro M. Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. J Endod. 2013;39(3):332\u20139.","journal-title":"J Endod"},{"issue":"1","key":"678_CR13","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.joen.2019.10.008","volume":"46","author":"A Mainkar","year":"2020","unstructured":"Mainkar A, Zhu Q, Safavi K. Incidence of altered sensation after mandibular premolar and molar periapical surgery. J Endod. 2020;46(1):29\u201333.","journal-title":"J Endod"},{"issue":"6","key":"678_CR14","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.joen.2018.02.021","volume":"44","author":"MR Kohli","year":"2018","unstructured":"Kohli MR, Berenji H, Setzer FC, Lee SM, Karabucak B. Outcome of endodontic surgery: a meta-analysis of the literature-Part 3: comparison of endodontic microsurgical techniques with 2 different root-end filling materials. J Endod. 2018;44(6):923\u201331.","journal-title":"J Endod"},{"issue":"Suppl","key":"678_CR15","first-page":"96","volume":"22","author":"MK Iqbal","year":"2007","unstructured":"Iqbal MK, Kim S. For teeth requiring endodontic treatment, what are the differences in outcomes of restored endodontically treated teeth compared to implant-supported restorations? Int J Oral Maxillofac Implants. 2007;22(Suppl):96\u2013116.","journal-title":"Int J Oral Maxillofac Implants"},{"key":"678_CR16","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jdent.2019.03.008","volume":"84","author":"MS Howe","year":"2019","unstructured":"Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: a systematic review and sensitivity meta-analysis. J Dent. 2019;84:9\u201321.","journal-title":"J Dent"},{"issue":"1","key":"678_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-023-02986-0","volume":"23","author":"S \u00c7olak","year":"2023","unstructured":"\u00c7olak S, Dem\u00efrsoy MS. Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas. BMC Oral Health. 2023;23(1):304.","journal-title":"BMC Oral Health"},{"key":"678_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2022.104280","volume":"125","author":"E Sanz","year":"2022","unstructured":"Sanz E, Azabal M, Arias A. Quality of life and satisfaction of patients two years after endodontic and dental implant treatments performed by experienced practitioners. J Dent. 2022;125:104280.","journal-title":"J Dent"},{"issue":"1","key":"678_CR19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/0022034513504782","volume":"93","author":"FC Setzer","year":"2024","unstructured":"Setzer FC, Kim S. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res. 2024;93(1):19\u201326.","journal-title":"J Dent Res"},{"issue":"12","key":"678_CR20","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1016\/j.joen.2017.08.019","volume":"43","author":"A Mainkar","year":"2017","unstructured":"Mainkar A. A systematic review of the survival of teeth intentionally replanted with a modern technique and cost-effectiveness compared with single-tooth implants. J Endod. 2017;43(12):1963\u20138.","journal-title":"J Endod"},{"issue":"1","key":"678_CR21","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jval.2021.11.1351","volume":"25","author":"D Husereau","year":"2022","unstructured":"Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health. 2022;25(1):3\u20139.","journal-title":"Value Health"},{"issue":"1","key":"678_CR22","first-page":"1","volume":"71","author":"E Arias","year":"2022","unstructured":"Arias E, Xu J. United States life tables, 2020. Natl Vital Stat Rep. 2022;71(1):1\u201364.","journal-title":"Natl Vital Stat Rep"},{"issue":"4","key":"678_CR23","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1016\/j.prosdent.2024.02.013","volume":"134","author":"N Naved","year":"2025","unstructured":"Naved N, Khowaja AR, Umer F. Restoration of endodontically treated teeth: a cost-effectiveness analysis of a one-piece endodontic crown versus a complete crown. J Prosthet Dent. 2025;134(4):1172\u20138.","journal-title":"J Prosthet Dent"},{"issue":"3","key":"678_CR24","first-page":"231","volume":"9","author":"N Naved","year":"2024","unstructured":"Naved N, Umer F, Khowaja AR. Cost-effectiveness analysis of regenerative endodontics versus MTA apexification. JDR Clin Trans Res. 2024;9(3):231\u20138.","journal-title":"JDR Clin Trans Res"},{"issue":"1","key":"678_CR25","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12903-024-04052-9","volume":"24","author":"N Naved","year":"2024","unstructured":"Naved N, Umer F, Khowaja AR. Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment. BMC Oral Health. 2024;24(1):285.","journal-title":"BMC Oral Health"},{"key":"678_CR26","unstructured":"ADA dental fees survery 2022 [cited 2026 4th january ]. Available from: https:\/\/www.scribd.com\/document\/774116156\/Dental-fees-survey."},{"key":"678_CR27","unstructured":"CPI September 2025 [cited 2026 4th January]. Available from: https:\/\/www.economy.com\/united-states\/cpi-urban-consumer-dental-services."},{"issue":"1","key":"678_CR28","first-page":"53","volume":"44","author":"M Kreisler","year":"2013","unstructured":"Kreisler M, Gockel R, Aubell-Falkenberg S, Kreisler T, Weihe C, Filippi A, et al. Clinical outcome in periradicular surgery: effect of patient- and tooth-related factors\u2013a multicenter study. Quintessence Int. 2013;44(1):53\u201360.","journal-title":"Quintessence Int"},{"issue":"4","key":"678_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jebdp.2022.101722","volume":"22","author":"TK Ong","year":"2022","unstructured":"Ong TK, Lim D, Singh M, Fial AV. Factors influencing the treatment outcome of intentional replantation on teeth with periapical periodontitis: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022;22(4):101722.","journal-title":"J Evid Based Dent Pract"},{"issue":"0","key":"678_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11607\/jomi.11345","volume":"0","author":"L Lang","year":"2025","unstructured":"Lang L, Saponaro PC, Hammoudeh H, Barnett SD, Nassani LM, Hsieh YL, et al. Evaluation endosseous dental implants success rate, adverse events, and associated risk factors: a retrospective study. Int J Oral Maxillofac Implants. 2025;0(0):1\u201330.","journal-title":"Int J Oral Maxillofac Implants"},{"issue":"1","key":"678_CR31","first-page":"107","volume":"35","author":"M Haacker","year":"2020","unstructured":"Haacker M, Hallett TB, Atun R. On discount rates for economic evaluations in global health. Health Policy Plan. 2020;35(1):107\u201314.","journal-title":"Health Policy Plan"},{"issue":"6","key":"678_CR32","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jval.2012.04.014","volume":"15","author":"AH Briggs","year":"2012","unstructured":"Briggs AH, Weinstein MC, Fenwick EA, Karnon J, Sculpher MJ, Paltiel AD. Model parameter estimation and uncertainty: a report of the ISPOR-SMDM modeling good research practices task force--6. Value Health. 2012;15(6):835\u201342.","journal-title":"Value Health"},{"key":"678_CR33","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.884769","volume":"13","author":"S Bae","year":"2022","unstructured":"Bae S, Lee J, Bae EY. How sensitive is sensitivity analysis?: evaluation of pharmacoeconomic submissions in Korea. Front Pharmacol. 2022;13:884769.","journal-title":"Front Pharmacol"},{"issue":"Suppl 3","key":"678_CR34","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/iej.13727","volume":"56","author":"G Plotino","year":"2023","unstructured":"Plotino G, Abella Sans F, Bastos JV, Nagendrababu V. Effectiveness of intentional replantation in managing teeth with apical periodontitis: a systematic review. Int Endod J. 2023;56(Suppl 3):499\u2013509.","journal-title":"Int Endod J"},{"key":"678_CR35","volume-title":"Methods for the economic evaluation of health care programmes","author":"MF D","year":"2015","unstructured":"D MF, S MJ, C K, S GL, T GW. Methods for the economic evaluation of health care programmes. 4 ed. Oxford: Oxford University Press; 2015.","edition":"4 ed"},{"issue":"1","key":"678_CR36","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s12903-025-05520-6","volume":"25","author":"AN Shahkoohi","year":"2025","unstructured":"Shahkoohi AN, Alipour V, Arabloo J, Meshkani Z. Patient preferences and willingness to pay for dental services: a systematic review. BMC Oral Health. 2025;25(1):227.","journal-title":"BMC Oral Health"}],"container-title":["International Journal of Implant Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40729-026-00678-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40729-026-00678-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40729-026-00678-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:03:01Z","timestamp":1777888981000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40729-026-00678-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["678"],"URL":"https:\/\/doi.org\/10.1186\/s40729-026-00678-2","relation":{},"ISSN":["2198-4034"],"issn-type":[{"value":"2198-4034","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]},"assertion":[{"value":"8 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval not required as the study is based on modelling approach and does not directly involve patient data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"19"}}