Clinical and Radiographic Evaluation of One- and Two-visit Endodontic Treatment of Asymptomatic Necrotic Teeth with Apical Periodontitis: A Randomized Clinical Trial

By Molander A, Warfvinge J, Reit C, Kvist T.

Date: 05/2008
Journal: JOE


•Purpose: to record the 2-year clinical and radiographic outcome of one- and two visit endodontic treatment and study the significance of the bacteriologic sampling results on the outcome.

•n: 94 patients with asymptomatic teeth with necrotic pulps and apical periodontitis


  • Patients were randomly assigned to one- or two-visit treatment. Two randomization factors were considered: tooth group and size of periapical lesion (Table 1).
  • Canals were enlarged (GT/ Profile) and/or hand (Nitiflex), to #20 at WL. Initial microbiological samples.  Canals were then enlarged to #40 &#60 under 0.5% NaOCl irrigation. Post-instrumentation microbiological samples.
  • For the one-visit group: smear layer removed with Tubulicid Plus. Then, 5% IPI for 10 minutes. Postmedication microbiological sample.
  • For the two-visit group: CH placed for aa week, CH was removed. A postmedication microbiological sample.
  • Both groups were obturated using cold lateral condensation including rosin chloroform as sealer. 
  • Two examiners blindly and independently evaluated all radiographs 2 years postoperatively. Size of PA – RL was assessed by measuring with a ruler. Outcome was classified by using a modification of the Strindberg criteria.

Most highlighted Results: 

1.(65%) in the one-visit group and (75%) in the two-visit group were classified as healed. No significant difference between the groups. 

2.(80%) of the 61 teeth that were obturated after  –ve sample were classified as healed. Teeth sealed after positive samples healed in (44%). However, No significant difference in outcome in the presence or absence of detectable microbes just before obturation.

Clinical significance: 

Similar outcome results between single and two visits Tx in cases with asymptomatic teeth with necrotic pulps and apical periodontitis. A tendency toward a more favorable outcome in teeth yielding a –ve culture immediately before root filling.